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  • 1.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Lundeberg, Stefan
    Pain Treatment Service, Astrid Lindgren Children's Hospital, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 101, p. 123-131Article in journal (Refereed)
    Abstract [en]

    Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.

    Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.

    Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.

    Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.

    Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.

  • 2.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Lundeberg, Stefan
    Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Hemlin, Claes
    Sollentuna Specialist Clinic, Stockholm, Sweden.
    Hessén-Söderman, Anne-Charlotte
    Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Nerfeldt, Pia
    Karolinska University Hospital, Huddinge, Sweden.
    Odhagen, Erik
    Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sunnergren, Ola
    Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden; Futurum-The Academy for health and care, County Council, Jönköping, Sweden.
    Stalfors, Joacim
    Sahlgrenska Universitety Hospital, Göteborg, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients2016Conference paper (Refereed)
    Abstract [en]

    Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 years

    Method: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.

    Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.

    Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.

    Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet

  • 3.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The development of a smartphone app for self-reporting postoperative recovery after day surgery2015In: 3rd International Conference for PeriAnaesthesia Nurses ICPAN 2015, 2015Conference paper (Other academic)
  • 4.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Utveckling av en smartphoneapp för patientrapporterad postoperativ återhämtning efter dagkirurgi2015Conference paper (Other academic)
    Abstract [sv]

    Introduktion: Dagkirurgi har expanderat avsevärt under de senaste årtiondena, i Sverige genomförs nästan 2 miljoner dagkirurgiska operationer per år. Dagkirurgiska operationer är en säker och beprövad metod, men upp till 30 % av patienterna upplever postoperativa komplikationer så som smärta, illamående och kräkningar, huvudvärk, ryggsmärta, ont i halsen, heshet, urinretention, frusenhet, och läpp-, mun- eller nervskador. En del patienter känner sig utelämnade, ensamma och osäkra på vilka symtom som är att vänta då det inte finns någon systematisk uppföljning av patientens postoperativa återhämtning.

    Syfte: Att utveckla och testa en webbaserad mobilapplikation där vuxna patienten som genomgått dagkirurgi själva rapporterar symtom relaterade till den postoperativa återhämtningen.

    Metod: Ett tvärvetenskapligt team bildades med forskare från omvårdnadsvetenskap och informatik. Tillsammans arbetade forskarna med patienter som genomgått dagkirurgisk operation och ett It-företag, för att anpassa frågorna i den svenska versionen av formuläret Quality of Recovery (QoR) till en webbaserad mobilapplikation för olika typer av smartphones, gällande frågornas formulering, svarsalternativ, layout och navigering.

    Resultat: Den svenska webbaserade versionen av QoR (SwQoR) innehåller 31 frågor som besvaras på en horisontel visuell analog skala. Passande layout för smartphone så som optimala färger och textstorlek fastställdes. Tekniska frågor kring navigation och appens funktion på olika smartphones löstes.

    Diskussion: Slutsats: SwQoR i en app för smartphone är användarvänlig då den är lätt att förstå och lätt att navigera.

  • 5.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Evaluation of the Swedish Web-Version of Quality of Recovery (SwQoR): Secondary Step in the Development of a Mobile Phone App to Measure Postoperative Recovery2016In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 5, no 3, article id e192Article in journal (Refereed)
    Abstract [en]

    Background: The majority of all surgeries are performed on an outpatient basis (day surgery). The Recovery Assessment by Phone Points (RAPP) app is an app for the Swedish Web-version of Quality of Recovery (SwQoR), developed to assess and follow-up on postoperative recovery after day surgery.

    Objectives: The objectives of this study are (1) to estimate the extent to which the paper and app versions of the SwQoR provide equivalent values; (2) to contribute evidence as to the feasibility and acceptability of a mobile phone Web-based app for measuring postoperative recovery after day surgery and enabling contact with a nurse; and (3) to contribute evidence as to the content validity of the SwQoR.

    Methods: Equivalence between the paper and app versions of the SwQoR was measured using a randomized crossover design, in which participants used both the paper and app version. Feasibility and acceptability was evaluated by a questionnaire containing 16 questions regarding the value of the app for follow-up care after day surgery. Content validity evaluation was based on responses by day surgery patients and the staff of the day surgery department.

    Results: A total of 69 participants completed the evaluation of equivalence between the paper and app versions of the SwQoR. The intraclass correlation coefficient (ICC) for the SwQoR was .89 (95% CI 0.83-0.93) and .13 to .90 for the items. Of the participants, 63 continued testing the app after discharge and completed the follow-up questionnaire. The median score was 69 (inter-quartile range, IQR 66-73), indicating a positive attitude toward using an app for follow-up after day surgery. A total of 18 patients and 12 staff members participated in the content validity evaluation. The item-level content validity index (I-CVI) for the staff group was in the 0.64 to 1.0 range, with a scale-level content validity index (S-CVI) of 0.88. For the patient group, I-CVI was in the range 0.30 to 0.92 and S-CVI was 0.67. The content validity evaluation of the SwQoR, together with three new items, led to a reduction from 34 to 24 items.

    Conclusions: Day surgery patients had positive attitudes toward using the app for follow-up after surgery, and stated a preference for using the app again if they were admitted for a future day surgery procedure. Equivalence between the app and paper version of the SwQoR was found, but at the item level, the ICC was less than .7 for 9 items. In the content validity evaluation of the SwQoR, staff found more items relevant than the patients, and no items found relevant by either staff or patients were excluded when revising the SwQoR.

  • 6.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    RAPP, en IT-lösning för uppföljning efter dagkirurgi2017Conference paper (Other academic)
  • 7.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    RAPP, en IT-lösning för uppföljning efter dagkirurgi2016Conference paper (Refereed)
  • 8.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    The process of development and testing of an IT-solution for measuring postoperative recovery2017Conference paper (Refereed)
  • 9.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden.
    “Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial2019In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, p. 33-37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.

    MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.

    RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.

    CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.

  • 10.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Odencrants, Sigrid
    Örebro University, School of Health Sciences.
    Holding It Together - Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up: Qualitative Study2018In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 20, no 5, article id e10387Article in journal (Refereed)
    Abstract [en]

    Background: There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery.

    Objective: The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery.

    Methods: This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis.

    Results: A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin.

    Conclusions: It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.

  • 11.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Odencrants, Sigrid
    Örebro University, School of Health Sciences.
    Holding it together: patients’ perspectives on postoperative recovery when using an e-assessed follow-upManuscript (preprint) (Other academic)
  • 12.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipson, Anna
    Örebro University, School of Health Sciences.
    Hagberg, Lars
    Örebro University Hospital. Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg-Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow up of postoperative recovery after day surgery: a multicentre randomized controlled trial2017Conference paper (Refereed)
  • 13.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed)
    Abstract [en]

    Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

    Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

    Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

    Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

    Clinical trial registration:NCT02492191

  • 14.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Bridgid, Gillespie
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Sweden.
    Swedish operating room nurses and nurse anesthetists' perceptions of competence and self-efficacyIn: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed)
  • 15.
    Frost, Elisabeth
    et al.
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden; Karolinska University Hospital, Solna, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Experience of physician and nurse specialists in Sweden undertaking long distance aeromedical transportation of critically ill patients: A qualitative study2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013XArticle in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Transportation of critically ill patients, intra- or inter-hospital, always involves risks when resources are limited. With aeromedical transports, additional risk factors are incurred. The physiological effects of altitude, when both pressure and density decline, can lead to hypobaric hypoxia and gases trapped in body cavities will expand and cause stress on biological tissue.

    AIM: The aim of this study was to explore the experiences of nurse and physician specialists in Sweden undertaking long distance aeromedical transport of critically ill patients, with a flight time of more than two hours.

    METHOD: A qualitative approach with a descriptive design. Thirteen recorded semi-structured interviews with physician and nurse specialists were analyzed using inductive qualitative content analysis.

    RESULTS: One overall theme emerged, To be one step ahead to ensure patient safety in the air; with three categories 1) With the patient in focus, 2) To be part of a team and concerned about patient safety and 3) To be in need of recovery.

    CONCLUSION: This study demonstrates the challenges with long distance aeromedical transport of critically ill patients. The healthcare personnel make decisions and actions to be one step ahead to ensure patient safety. This isolated work is improved with experience, education, training and good communication skills.

  • 16.
    Gillespie, Brigid M.
    et al.
    School of Nursing & Midwifery, Griffith University, Gold Coast QLD, Australia; Gold Coast Hospital and Health Service, Gold Coast QLD, Australia; National Centre of Research Excellence in Nursing, Griffith University, Gold Coast QLD, Australia.
    Harbeck, Emma B.
    National Centre of Research Excellence in Nursing, Griffith University, Gold Coast QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast QLD, Australia.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Perceptions of perioperative nursing competence: a cross-country comparison2018In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 17, article id 12Article in journal (Refereed)
    Abstract [en]

    Background: Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room.

    Methods: We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence.

    Results: Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with >10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland.

    Conclusion: Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

  • 17.
    Hedenskog, Christina
    et al.
    Department of Anesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Swedish-Registered Nurse Anesthetists’ Evaluation of Their Professional Self2017In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 32, no 2, p. 106-111Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aimed to explore how the nurse anesthetist values their professional self, compared with their peers, and also to explore whether professional self is affected by age, work experience, and/or gender.

    Design: An explorative and prospective cross-sectional design.

    Methods: During April 2011, a total of 108 registered nurse anesthetists from three different hospitals were surveyed using the Professional Self- Description Form with questions covering 21 items.

    Findings: A total of 87 (80%) responded: 21 men and 66 women with a mean age of 45 years (range, 28 to 64 years) and mean professional experience of 12 years (range, 1 to 41 years). Four factors were found: professionalism, trait of character, scientific knowledge, and empathy, with Cronbach alpha of 0.96 overall. Analysis showed that perceived professional self depends on age and amount of work experience, but not on gender.

    Conclusions: The Professional Self-Description Form exhibits satisfactory internal consistency. Work experience and age influenced the development of professional self of nurse anesthetists

  • 18.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial2018In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 153, no 8, p. 738-745Article in journal (Refereed)
    Abstract [en]

    Importance: Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes.

    Objective: To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life.

    Design, Setting, and Participants: This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients.

    Main Outcomes and Measures: The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups.

    Results: Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts.

    Conclusions and Relevance: Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery.

    The full text will be freely available from 2019-04-25 16:03
  • 19.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Att möta UKÄ:s krav för en specialistutbildning2017Conference paper (Other (popular science, discussion, etc.))
  • 20.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälsa för halsen: Forskning om ont i halsen och heshet efter generell anestesi2014Conference paper (Other academic)
  • 21.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ont i halsen och heshet efter generell anestesi2014In: Ventilen, ISSN 0348-6257Article in journal (Other (popular science, discussion, etc.))
  • 22.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Postoperative sore throat and hoarseness: clinical studies in patients undergoing general anasthesia2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A common problem following general anesthesia is postoperative sore throat (POST) and postoperative hoarseness (PH). Symptoms directly correlated with less satisfaction according to the patients. The overall aim of this thesis was to describe patients' postoperative sore throat and hoarseness after general anesthesia with endotracheal intubation or laryngeal mask airway. As well as to investigate the risk factors that are associated with the symptoms, and to test methods that may prevent sore throat and hoarseness after a general anaesthetics. A total of 889 patients are included in the four studies. Incidence of POST varied from 21% up to 52 % depending on endotracheal tube (ETT) size in women (I-IV) and in men was the incidence 32-38% (III-IV). There were no gender difference in POST in study III and IV. The overall incidence of PH varied from 42- 59% (I-IV) in all patients, with no gender differences (III-IV). Following a laryngeal mask airway (LMA) 19% of the patients had POST and 33% of the patients reported PH. Patients with POST do seem to be able to localize their pain in the throat (IV). Different risk factors are shown to contribute to both POST and PH in men and women (II-III). To intubate with a smaller ETT size, 6.0 vs. 7.0 decreased POST in women in the early postoperative period as well as their discomfort from their POST (I). Only 6% of men who needed a laryngeal mask airway had POST compared to 26% of women. The symptoms are more discomforting after an ETT vs. an LMA up to 24 hours (IV). More patients have sore throat and hoarseness in the early postoperative period, but the symptoms can remain up to almost 5 days postoperatively (I, IV). In summary, sore throat and hoarseness following general anesthesia, affects many patients postoperatively. To intubate women with endotracheal size 6.0 decreases both sore throat and hoarseness postoperatively. Women are more likely than men to have a sore throat when a laryngeal mask airway is used.

    List of papers
    1. Endotracheal tube size and sore throat following surgery: a randomized-controlled study
    Open this publication in new window or tab >>Endotracheal tube size and sore throat following surgery: a randomized-controlled study
    2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 2, p. 147-153Article in journal (Refereed) Published
    Abstract [en]

    Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia.

    Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1–2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h.

    Results: After 1–2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P50.006. This difference between the groups was also evident, P50.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P 50.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size.

    Conclusion:Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit.

    Keywords
    Adult, Anesthesia Recovery Period, Anesthesia Intravenous, Anesthetics Intravenous, Anti-Inflammatory Agents Non-Steroidal, Antiemetics, Atracurium, Double-Blind Method, Equipment Design, Female, Fentanyl, Follow-Up Studies, Hoarseness, Humans, Intubation Intratracheal, Middle Aged, Narcotics, Neuromuscular Nondepolarizing Agents, Pain Measurement, Pharyngitis, Preanesthetic Medication, Propofol, Surface Properties, Surgical Procedures Elective, Time Factors
    National Category
    Anesthesiology and Intensive Care Nursing
    Research subject
    Nursing Science; Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-24529 (URN)10.1111/j.1399-6576.2009.02166.x (DOI)000273448700005 ()19930246 (PubMedID)2-s2.0-74549185000 (Scopus ID)
    Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2017-12-07Bibliographically approved
    2. Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis
    Open this publication in new window or tab >>Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis
    2012 (English)In: AANA Journal, ISSN 2162-5239, Vol. 80, no 4 (Suppl), p. 67-73Article in journal (Refereed) Published
    Abstract [en]

    Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness. For data analysis, the χ2 test and the odds ratio were used. Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04),and endotracheal tube No. 7.0 (size 7 mm; P = .02).The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors.

    Place, publisher, year, edition, pages
    West Sussex, United Kingdom: AANA Publishing, Inc, 2012
    Keywords
    Endotracheal intubation, hoarseness, postoperative complications, risk factors, sore throat
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-24526 (URN)23248834 (PubMedID)2-s2.0-84867579727 (Scopus ID)
    Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2018-05-09Bibliographically approved
    3. Gender differences in risk factors for airway symptoms following tracheal intubation
    Open this publication in new window or tab >>Gender differences in risk factors for airway symptoms following tracheal intubation
    2012 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 10, p. 1306-1313Article in journal (Refereed) Published
    Abstract [en]

    Background: A common complaint after endotracheal intubation is sore throat and hoarseness. The aim of this study was to describe gender differences and independent risk factors in the development of post-operative sore throat and hoarseness after endotracheal intubation in adults.

    Methods: This prospective cross-sectional observational study was conducted at a university hospital in Sweden. A total of 495 patients were included (203 men and 292 women) and enrolled from a total of eight different surgical departments. Outcome variables were post-operative sore throat and hoarseness evaluated post-operatively in the post-anaesthesia care unit. A total of 31 variables were recorded which described the intubation process, intraoperative factors as well as the extubation process. Bivariate and multivariate analyses were performed.

    Results: The overall incidence of post-operative sore throat was 35% and hoarseness 59%. The results show different predictors for men and women in the development of airway symptoms. The main risk factor for developing sore throat in men was intubation by personnel with <?3 months' work experience. In women, it was endotracheal tube size 7.0 and multiple laryngoscopies during intubation. The main risk factors for hoarseness were cuff pressure for both men and women, and oesophageal temperature probe in women.

    Conclusion: Post-operative sore throat and hoarseness result from several factors, and the cause of these symptoms are multifactorial and differs by gender. Identification of these factors pre-operatively may increase awareness among anaesthesia personnel and possibly reduce the incidence of these minor but distressing symptoms.

    Place, publisher, year, edition, pages
    Hoboken, USA: Wiley-Blackwell, 2012
    Keywords
    Adult, Age Factors, Aged, Anesthesia Inhalation, Cross-Sectional Studies, Female, Hoarseness, Humans, Intubation Intratracheal, Laryngoscopy, Logistic Models, Male, Middle Aged, Multivariate Analysis, Pharyngitis, Postoperative Complications, Prospective Studies, Risk Factors, Sex Factors
    National Category
    Medical and Health Sciences Nursing Anesthesiology and Intensive Care
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-26523 (URN)10.1111/j.1399-6576.2012.02771.x (DOI)000309714000013 ()22998099 (PubMedID)2-s2.0-84867582026 (Scopus ID)
    Available from: 2012-11-27 Created: 2012-11-27 Last updated: 2017-12-07Bibliographically approved
    4. Sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study
    Open this publication in new window or tab >>Sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-32041 (URN)
    Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-10-17Bibliographically approved
  • 23.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dahlberg, Karuna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Grönlund, Åke
    Örebro University, Örebro University School of Business.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The developement of the recovery assessment by phone points (RAPP): A mobile phone application for postoperative recovery monitoring and assessment2015In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 3, no 3, article id e86Article in journal (Other academic)
    Abstract [en]

    Background: In Sweden, day surgery is performed in almost 2 million patients per year. Patient satisfaction is closely related to potential adverse events during the recovery process. A way to empower patients and give them the opportunity to affect care delivery is to let them evaluate their recovery process. The most common evaluation method is a follow-up telephone call by a nurse one or two days after surgery. In recent years, mHealth apps have been used to evaluate the nurse-patient relationship for self-management in chronic diseases or to evaluate pain after surgery. To the best of our knowledge, no previous research has explored the recovery process after day surgery via mobile phone in a Swedish cohort.

    Objective: The objective of the study is to describe the process of developing a mobile phone app using a Swedish Web-based Quality of Recovery (SwQoR) questionnaire to evaluate postoperative recovery after day surgery.

    Methods: The development process included five steps: (1) setting up an interdisciplinary task force, (2) evaluating the potential needs of app users, (3) developing the Swedish Web version of a QoR questionnaire, (4) constructing a mobile phone app, and (5) evaluating the interface and design by staff working in a day-surgery department and patients undergoing day surgery. A task force including specialists in information and communication technology, eHealth, and nursing care worked closely together to develop a Web-based app. Modifications to the QoR questionnaire were inspired by instruments used in the field of recovery for both children and adults. The Web-based app, Recovery Assessment by Phone Points (RAPP) consists of two parts: (1) a mobile app installed on the patient’s private mobile phone, and (2) an administrator interface for the researchers.

    Results: The final version of the SwQoR questionnaire, which includes 31 items, was successfully installed in RAPP. The interface and the design were evaluated by asking for user opinions about the design and usefulness of the app with 10 day surgery patients. Some minor adjustments were made concerning text size and screen color.

    Conclusions: Taking advantage of joint expertise, a useable Web-based app adaptable to different technical platforms was constructed. In addition, the SwQoR was successfully transferred into digital format for use on mobile phones.

  • 24.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1030-1038Article in journal (Refereed)
    Abstract [en]

    Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.

    Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.

    Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.

    Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.

  • 25.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    How are you?: A systematic e-assessment of postoperative recovery2017Conference paper (Refereed)
  • 26.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    How are you?: A systematic e-assessment of postoperative recovery2017Conference paper (Refereed)
  • 27.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Sex Similarities in Postoperative Recovery and Health Care Contacts Within 14 Days With mHealth Follow-Up: Secondary Analysis of a Randomized Controlled Trial2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 3, article id e2Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have shown that women tend to have a poorer postanesthesia recovery than men. Our research group has developed a mobile phone app called Recovery Assessment by Phone Points (RAPP) that includes the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire to monitor and assess postoperative recovery.

    Objective: The aim of this study was to investigate sex differences in postoperative recovery and the number of health care contacts within 14 postoperative days in a cohort of day-surgery patients using RAPP.

    Methods: This study was a secondary analysis from a single-blind randomized controlled trial. Therefore, we did not calculate an a priori sample size regarding sex differences. We conducted the study at 4 day-surgery settings in Sweden from October 2015 to July 2016. Included were 494 patients (220 male and 274 female participants) undergoing day surgery. The patients self-assessed their postoperative recovery for 14 postoperative days using the RAPP.

    Results: There were no significant sex differences in postoperative recovery or the number of health care contacts. Subgroup analysis showed that women younger than 45 years reported significantly higher global scores in the SwQoR questionnaire (hence a poorer recovery) on postoperative days 1 to 10 than did women who were 45 years of age or older (P=.001 to P=.008). Men younger than 45 years reported significantly higher global scores on postoperative days 2 to 6 than did men 45 years of age or older (P=.001 to P=.006). Sex differences in postoperative recovery were not significant between the age groups.

    Conclusions: This study found sex similarities in postoperative recovery and the number of health care contacts. However, subgroup analysis showed that age might be an independent factor for poorer recovery in both women and men. This knowledge can be used when informing patients what to expect after discharge.

  • 28.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Gillespie, Brigid M.
    Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, Australia.
    Wallentin, Fan Y.
    Department of Statistics, Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Psychometric Validation of the Perceived Perioperative Competence Scale-Revised in the Swedish Context2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 4, p. 499-511Article in journal (Refereed)
    Abstract [en]

    Purpose: To psychometrically test the Perceived Perioperative Competence Scale-Revised (PPCS-R) in the Swedish context.

    Design: Cross-sectional survey.

    Methods: The 40-item PPCS-R was translated into Swedish using a forward-translation approach. A census of 2,902 registered nurse anesthetists (RNAs) and operating room (OR) nurses was drawn from a database of a national association in Sweden.

    Finding: The response rate was 39% (n = 1,033; 528 RNAs and 505 OR nurses). Cronbach alpha for each factor was 0.78 to 0.89 among OR nurses and 0.79 to 0.88 among RNAs. Confirmatory factor analysis showed good model fit in the six-factor model.

    Conclusions: Psychometric testing of the Swedish translation of the PPCS-R suggests a good construct validity, and the construct and its six factors are conceptually relevant among the Swedish OR nurses and RNAs.

  • 29.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gender differences in Risk factors for Airway Symptoms following Tracheal Intubation2013Conference paper (Refereed)
  • 30.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Centre of Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Gender differences in risk factors for airway symptoms following tracheal intubation2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 10, p. 1306-1313Article in journal (Refereed)
    Abstract [en]

    Background: A common complaint after endotracheal intubation is sore throat and hoarseness. The aim of this study was to describe gender differences and independent risk factors in the development of post-operative sore throat and hoarseness after endotracheal intubation in adults.

    Methods: This prospective cross-sectional observational study was conducted at a university hospital in Sweden. A total of 495 patients were included (203 men and 292 women) and enrolled from a total of eight different surgical departments. Outcome variables were post-operative sore throat and hoarseness evaluated post-operatively in the post-anaesthesia care unit. A total of 31 variables were recorded which described the intubation process, intraoperative factors as well as the extubation process. Bivariate and multivariate analyses were performed.

    Results: The overall incidence of post-operative sore throat was 35% and hoarseness 59%. The results show different predictors for men and women in the development of airway symptoms. The main risk factor for developing sore throat in men was intubation by personnel with <?3 months' work experience. In women, it was endotracheal tube size 7.0 and multiple laryngoscopies during intubation. The main risk factors for hoarseness were cuff pressure for both men and women, and oesophageal temperature probe in women.

    Conclusion: Post-operative sore throat and hoarseness result from several factors, and the cause of these symptoms are multifactorial and differs by gender. Identification of these factors pre-operatively may increase awareness among anaesthesia personnel and possibly reduce the incidence of these minor but distressing symptoms.

  • 31.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Division of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, no 56Article in journal (Refereed)
    Abstract [en]

    Background and objective. Postoperative sore throat and hoarseness are common minor complications following airway manipulation. This study was primarily done to determine gender differences in the incidence of these symptoms and the location of POST after laryngeal mask airway (LMA) and endotracheal tube (ETT).

    Methods. A total of 112 men and 185 women were included during a four month period. All patients were evaluated postoperatively and after 24 hours about the occurrence of sore throat, its location and hoarseness. If the patients had any symptom, they were followed-up at 48, 72 and 96 hours until the symptoms resolved.

    Results. There was no significant gender difference in postoperative sore throat (POST) and postoperative hoarseness (PH) when analyzing both airway devices together. The incidence of sore throat and hoarseness were higher postoperatively after an ETT than an LMA (32% vs. 19%, p= 0.012) and 57% vs. 33% (p< 0.001) respectively. Significantly more women than men had POST after an LMA (26% vs. 6%, p=0.004). No significant gender difference was found in either POST or PH after an ETT or in the incidence of PH after an LMA. More patients located their pain below the larynx after an ETT vs. an LMA (24% vs. 4%). Pain above the larynx was more common after an LMA than an ETT (52 % vs. 37 %).

    Conclusions.  In a clinical setting where women are intubated with a smaller size ETT than men, there were no significant differences in POST or PH between genders. Additionally, more women than men have POST when an LMA is used. Awareness of POST and PH may help streamline patients in whom the best airway device could be used during anesthesia and surgery.

  • 32.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälsa för halsen: Forskning om ont i halsen och heshet efter generell anestesi2014Conference paper (Other academic)
  • 33.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Secondary analysis of risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women2012Conference paper (Refereed)
    Abstract [en]

    Introduction with Hypothesis: Postoperative sore throat (POST) and postoperative hoarseness (PH) are common but disturbing complications following endotracheal intubation. Previously recognized risk factors for POST are: female gender, the size of endotracheal tube, grade of difficulty in intubation, duration of surgery (1, 2) and increased cuff pressure. There is inconsistency in the literature as to the age group that is at greatest risk for developing POST (1). Risk factors associated with PH are endotracheal tube size (3) and non-optimal intubation conditions . Therefore, identification of risk factors associated with POST and PH would add to our knowledge of predictors of poor outcome in our patients.

    Methods: This was a secondary analysis of prospective, cross-sectional data collected from patients previously enrolled in a randomized controlled trial (n=100 women). Eight different variables were analyzed in order to detect possible association between endotracheal intubation and the development of POST or PH. At the Post-Anaesthesia Care Unit, the patients rated their POST on a four-point scale (0=none, 1= mild, 2=moderate, 3=severe). The data was dichotomized, to sore throat (grade 1-3 on the four-grade scale) and no sore throat (grade 0 on the same scale). PH was assessed on a binary scale. The independent variables were analyzed against the dependent variables  using the Chi-Square test, and the odds ratio (OR) and confidence interval (CI) were calculated for each significant variable.  

    Results: Three patients were excluded. Thus, a total of 97 women completed the study.Three variables were found to be significant risk factors for the development of POST: age >60 yrs n=14/22 (63%) vs. 18-60: n=24/75 (32%) (P  = 0.008), endotracheal tube size 7.0 i.e n=25/49 (51 %) vs. ETT 6.0: n= 13/48 (27 %) (P = 0.016) and the use of throat pack i.e n= 9/14 (64 %) vs. no throat pack: n=29/ 83 (35%) (P  = 0.037). The corresponding odds ratio (OR) for these three risk factors were: age 3.71 (95% CI 1.4-10.1), ETT 2.80 (95% CI 1.2-6.6) and throat pack  3.35 (95% CI 1.0-10.9) respectively. 20 cm i.e n= 17/29 (59 %) vs. > 20 cmH2O: 24/67 (36%) (P= 0.038). The OR was 2.5 (95 % CI 1.0-6.1) if the cuff pressure was < 20 cm H2O compared to if the cuff pressure was > 20 cm H2O. 

    Discussion and Conclusion: Patient-reported outcome measures research is based on the knowledge that we, as nurse anesthetists, get some insight into how the patient perceives different situations. Therefore, it is important to increase our knowledge of the patients at risk and the conditions under which this risk increases. In conclusion, we found that women over 60 years, a larger size on the endotracheal tube or the use of a throat pack are at an increased risk for developing postoperative sore throat. A lower cuff pressure was the only factor that contributed towards postoperative hoarseness. 

  • 34.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anestesiology and Intensive Care, Örebro University Hospital, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anestesiology and Intensive Care, Örebro University Hospital, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective studyManuscript (preprint) (Other academic)
  • 35.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Department of Nursing, Umeå University, Umeå, Sweden; Center of Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis2012In: AANA Journal, ISSN 2162-5239, Vol. 80, no 4 (Suppl), p. 67-73Article in journal (Refereed)
    Abstract [en]

    Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness. For data analysis, the χ2 test and the odds ratio were used. Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04),and endotracheal tube No. 7.0 (size 7 mm; P = .02).The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors.

  • 36.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lassinantti Olowsson, Lena
    Örebro University, School of Health and Medical Sciences.
    Omvårdnadsåtgärder för att lindra patientens postoperativa halsbesvär med endotrakeal intubation2007In: Ventilen, Vol. 42, no 2, p. 26-30Article in journal (Other academic)
  • 37.
    Jaensson, Maria
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Lassinantti Olowsson, Lena
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Does the size of the endotracheal tube affect the risk for sore throat following surgery in woman?: a randomized controlled study2010Conference paper (Refereed)
    Abstract [en]

    Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects quality of recovery. This study was done with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia.

    Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and postoperatively sore throat and discomfort was assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Postoperatively the assessments were made after 1-2 hours, 24 hours and if discomfort at 24 h, a follow-up call was made at 72 and 96 hours.

    Results: After 1-2 hours postoperatively there were a higher proportion of patients with sore throat in ETT 7.0 versus ETT 6.0 (51.1 % vs. 27.1 %), p= 0.006. When comparing changes between the pre- and postoperative values, this difference between the groups was also evident, p= 0.002. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8 %) compared to ETT 6.0 (18.8%), p=0.02. No differences were found in the incidence of hoarseness between the groups. Remaining symptoms lasts up to 96 hours postoperatively in 11 %, irrespectively of tube size.

    Conclusion: To use a smaller size of the endotracheal tube can alleviate women’s suffering from sore throat and discomfort at the PACU.

     

     

     

     

  • 38.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lassinantti Olowsson, Lena
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences.
    Har tubstorlek någon betydelse vid intubation?2010Conference paper (Other academic)
  • 39.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lassinantti Olowsson, Lena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Påverkar endotrakealtubens storlek uppkomsten av ont i halsen hos kvinnor: en randomiserad kontrollerad studie2010In: Ventilen, ISSN 0348-6257, Vol. 4, no 45, p. 12-13Article in journal (Other (popular science, discussion, etc.))
  • 40.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Aniva-kliniken, Universitetssjukhuset Örebro, Örebro, Sverige.
    Lassinantti Olowsson, Lena
    Aniva-kliniken, Universitetssjukhuset Örebro, Örebro, Sverige.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Storlek på endotrakealtuben påverkar kvinnors halssmärta2010In: Vårdfokus, ISSN 2000-5717, Vol. 3Article in journal (Other (popular science, discussion, etc.))
  • 41.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lassinantti-Olowsson, Lena
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences.
    Omvårdnadsåtgärder för att lindra patientens postoperativa halsbesvär i samband med endotrakeal intubation: En litteraturstudie2007Conference paper (Other academic)
  • 42.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Impact of changing positively worded items to negatively worded items in the Swedish web‐version of the Quality of Recovery (SwQoR) questionnaire2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 3, p. 502-507Article in journal (Refereed)
    Abstract [en]

    Rationale, aims, and objectives: The Swedish web-version of the Quality of Recovery questionnaire is used to evaluate a person's postoperative recovery after anesthesia and surgery. An earlier study found an increased risk of answering incorrectly when the questionnaire included both positive and negative items. Therefore, this study investigated the effect of changing positively worded items to negatively worded items.

    Methods: This was a cross-sectional study including 90 second-year nursing students. Seven pairs of positively and negatively worded items were evaluated for differences in response as well as agreement between the items.

    Results: Two pairs of items showed higher mean values if the item was negatively worded. Between-item agreement for positively worded item scores and their corresponding reverse-coded negatively worded item scores was poor-to-moderate (intraclass correlation coefficient: 0.35-0.76). A moderate agreement was found when testing all positively worded items against the recoded negatively worded items (intraclass correlation coefficient: 0.65). Internal consistency was 0.86 for the positively worded items and 0.76 for the negatively worded items.

    Conclusions: Changing from positive to negative wording produced some differences in Swedish web-version of the Quality of Recovery item scores. Internal consistency was acceptable, but 2 items (not having a general feeling of well-being and not speaking normally) need further refinement.

  • 43.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences.
    Ont i halsen och heshet efter en intubation: Förväntat eller oväntat?2011Conference paper (Other academic)
  • 44.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Simulation-based examination for registered nurse anesthetist students in Sweden2016Conference paper (Refereed)
  • 45.
    Jaensson, Maria
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Olowsson, Lena L.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    NIlsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Endotracheal tube size and sore throat following surgery: a randomized-controlled study2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 2, p. 147-153Article in journal (Refereed)
    Abstract [en]

    Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia.

    Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1–2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h.

    Results: After 1–2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P50.006. This difference between the groups was also evident, P50.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P 50.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size.

    Conclusion:Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit.

  • 46.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study2017In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 5, no 12, article id e188Article in journal (Refereed)
    Abstract [en]

    Background: The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP.

    Objective: The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR.

    Methods: We conducted a prospective psychometric evaluation study including 494 patients aged ≥18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14.

    Results: All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1%. An exploratory factor analysis found 5 components explaining 57.8% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect.

    Conclusions: SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients’ postoperative recovery.

  • 47.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Falk Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hur har ni det med kompetensen?2016Conference paper (Other (popular science, discussion, etc.))
  • 48.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health Sciences.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hur har ni det med kompetensen?2017Conference paper (Other academic)
  • 49.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Anestesiologisk omvårdnad2017In: Ventilen, ISSN 0348-6257, no 2, p. 24-24Article in journal (Other (popular science, discussion, etc.))
  • 50.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Anesthetic Nursing: Keep in Touch, Watch Over, and Be One Step Ahead2016In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 31, no 6, p. 550-551Article in journal (Refereed)
12 1 - 50 of 52
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