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  • 1.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine. Department of Anaesthesiology and Intensive Care, Örebro University Hospital ,Örebro,Sweden.
    Berg, Katarina
    Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Idvall, Ewa
    Research Section, Kalmar County Council, Kalmar,Sweden; Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Nilsson, Ulrica
    Örebro University, Department of Nursing and Caring Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro,Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital , Örebro, Sweden.
    Postoperative recovery: a concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed)
    Abstract [en]

    Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.

    Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.

    Method. Walker and Avant´s concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.

    Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.

    Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.

  • 2.
    Arenhall, Eva
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Steinke, Elaine
    School of Nursing, Wichita State University, Wichita, USA.
    Fridlund, Bengt
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Decreased sexual function in partners after patients’ first-time myocardial infarction2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 521-526Article in journal (Refereed)
    Abstract [en]

    Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied.

    Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner.

    Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics.

    Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency.

    Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction.

  • 3.
    Arenhall, Eva
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Kristofferzon, Marja-Leena
    Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Fridlund, Bengt
    School of Health and Caring Sciences, Linnéaus University, Växjö, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Malm, Dan
    School of Health Sciences, Jönköping University, Jönköping, Sweden; Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönkoping, Sweden.
    Nilsson, Ulrica
    Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    The male partners' experiences of the intimate relationships after a first myocardial infarction2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 2, p. 108-114Article in journal (Refereed)
    Abstract [en]

    Background: Stress in the intimate relationship is found to worsen the prognosis in women suffering from myocardial infarction (MI). Little is known about how male spouses experience the intimate relationship.

    Aim: This study aimed to explore and describe the experience of men's intimate relationships in connection to and after their female partner's first MI.

    Methods: An explorative and qualitative design was used. Interviews were conducted with 16 men having a partner who the year before had suffered a first MI. The data were analysed with qualitative content analysis.

    Results: Three themes emerged: masculine image challenged; life takes another direction; and life remains unchanged. The men were forced to deal with an altered image of themselves as men, and as sexual beings. They were hesitant to approach their spouse in the same way as before the MI because they viewed her to be more fragile. The event also caused them to consider their own lifestyle, changing towards healthier dietary and exercise habits.

    Conclusions: After their spouse's MI, men experienced a challenge to their masculine image. They viewed their spouse as being more fragile, which led the men to be gentler in sexual intimacy and more hesitant to invite sexual activity. This knowledge about how male spouses experience the intimate relationship could be helpful for health personnel in hospitals and primary care when they interact with couples where the woman suffers from cardiac disease or other chronic disorders. (C) 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 4.
    Arenhall, Eva
    et al.
    Örebro University, School of Health and Medical Sciences. Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Kristofferzon, Marja-Leena
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköpings University, Jönköping, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences. Department of Anaesthesia and Intensive Care, Örebro University Hospital,Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    The female partners' experiences of intimate relationship after a first myocardial infarction2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11-12, p. 1677-1684Article in journal (Refereed)
    Abstract [en]

    Aim. This study aimed to explore and describe women's experience of intimate relationships in connection to and after their partner's first myocardial infarction. Background. Support from partners is important for recovery, but little is known about partners' experience of intimate relationships after myocardial infarction. Design. The study used an explorative, qualitative design. Methods. The first author interviewed 20 women having a partner who had suffered a first myocardial infarction during the preceding year. Qualitative content analysis was used to analyse the data. Findings. Three themes emerged: 'limited life space', 'sense of life lost' and 'another dimension of life'. The women described how their self-assumed responsibility led to a more stifling and limited life. Their sense of life lost was described in terms of deficits and feeling the loss. The women also described experiencing another dimension of life characterised by three subthemes: 'uncertainty of life', 'certain of relationship' and 'share life more'. Conclusions. The partners' myocardial infarction had an impact on the interviewees' intimate relationships; they suffered a major loss and missed their 'former' partner, both emotionally and sexually. They struggled with the new asymmetry in their intimate relationship and felt compelled to adapt to their partners' lack of sexual desire or function. Also, their partner controlled them, which lead towards a stifling, more limited life space. Relevance to clinical practice. Caregivers in hospital and primary care settings could apply the findings in their efforts to help couples recover or maintain intimate relationships following myocardial infarction. 

  • 5.
    Berg, Katarina
    et al.
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden.
    Idvall, Ewa
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden; Research Section, Västervik Hospital, Kalmar County Council, Västervik, Sweden.
    Nilsson, Ulrica
    Department of Anesthesia and Intensive Care/Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Franzén Årestedt, Kristofer
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden; School of Human Sciences, University of Kalmar, Kalmar, Sweden.
    Unosson, Mitra
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Psychometric evaluation of the post-discharge surgical recovery scale2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIM AND OBJECTIVES: Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patient's recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness.

    METHODS: Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach's alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearson's correlation coefficient. Patients' ability to work and their self-rated health on postoperative day 14 were used as external indicators of change.

    RESULTS: Six items showed floor or ceiling effects. Cronbach's coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63).

    CONCLUSIONS: The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 6.
    Berg, Katarina
    et al.
    Department of Medical and Health Sciences/Division of Nursing Science, Linköping University, Linköping, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University, Malmö, Sweden; Skåne University Hospital, Lund, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Healthcare Sciences, Örebro University Hospital, Örebro, Sweden; Department of Nursing, Umeå University, Umeå, Sweden.
    Unosson, Mitra
    Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Postoperative recovery after different orthopedic day surgical procedures2011In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 15, no 4, p. 165-175Article in journal (Refereed)
    Abstract [en]

    Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2 weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2 weeks after surgery compared to the other patient groups (p < 0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

  • 7.
    Bramhagen, Ann-Cathrine
    et al.
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Harden, Sue
    CSN, e-Learning/Content Developer, Skåne University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Self-reported post-operative recovery in children: development of an instrument2016In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 2, p. 180-188Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives: According to the United Nations (1989) , hildren have the right to be heard and to have their opinions respected. Since post-operative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures.

    Methods: Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by the Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo question- naire was developed to determine whether the children’s participation would increase compared with the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4–12 years, who underwent tonsil surgery at four hospitals in Sweden.

    Results: A total o f238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbach’s alpha for the total instrument was 0.83 and the item-total correlations for 22 of the items were ≥0.20.

    Conclusion: Our results support use of the PRiC instrument to assess and follow-up on children’s self-reported post-operative recovery after tonsil operation, both in clinical praxis as well in research. 

  • 8.
    Brännström, Margareta
    et al.
    Strategic Research Program in Health Care Sciences (SFO-V), Karolinska Institutet, Stockholm, Sweden; Department of Nursing, Umeå University, Umeå, Sweden.
    Kristofferzon, Marja-Leena
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala, University, Uppsala, Sweden.
    Ivarsson, Bodil
    Department of Cardiothoracic Surgery, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svedberg, Petra
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Thylén, Ingela
    Division of Nursing Sciences, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
    Sexual knowledge in patients with a myocardial infarction and their partners2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 4, p. 332-339Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexual health and sexual activity are important elements of an individual's well-being. For couples, this topic is often affected after a myocardial infarction (MI). It has become increasingly clear that, after an MI, patients are insufficiently educated on how to resume normal sexual activity. However, sufficient data on the general knowledge that patients and partners have about sexual activity and MI are lacking.

    OBJECTIVE: The aims of this study were to explore and compare patients' and partners' sexual knowledge 1 month after a first MI and 1 year after the event and to compare whether the individual knowledge had changed over time. A second aim was to investigate whether patients and their partners report receiving information about sexual health and sexual activity from healthcare professionals during the first year after the event and how this information was perceived.

    SUBJECTS AND METHODS: This descriptive, comparative survey study enrolled participants from 13 Swedish hospitals in 2007-2009. A total of 115 patients with a first MI and their partners answered the Sex After MI Knowledge Test questionnaire 1 month after the MI and 1 year after the event. Correct responses generated a maximum score of 75.

    RESULTS: Only 41% of patients and 31% of partners stated that they had received information on sex and relationships at the 1 year follow-up. The patients scored 51 ± 10 on the Sex After MI Knowledge Test at inclusion into the study, compared with the 52 ± 10 score for the partners. At the 1-year follow-up, the patients' knowledge had significantly increased to a score of 55 ± 7, but the partners' knowledge did not significantly change (53 ± 10).

    CONCLUSIONS: First MI patients and their partners reported receiving limited information about sexual issues during the cardiac rehabilitation and had limited knowledge about sexual health and sexual activity.

  • 9.
    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)
  • 10.
    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.

  • 11.
    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.

  • 12.
    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)
  • 13.
    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)
  • 14.
    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)
  • 15.
    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.

  • 16.
    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.

  • 17.
    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)
  • 18.
    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)
  • 19.
    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

  • 20.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Bramhagen, Ann-Cathrine
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Harden, Sue
    Skåne University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Experiences of a new self-report instrument for post-operative recovery in children2017Conference paper (Refereed)
    Abstract [en]

    The objective was to develop and test an instrument that provides children, also of a younger age, with a quality recovery self-report measure after tonsil surgery.

    Methods: The development of Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. It includes 23 items covering different aspects of recovery. PRiC was developed both as a traditional text-based instrument and as a version where each item is illustrated by a photo. It was distributed to 260 children undergoing tonsillotomy or total tonsillectomy in day-surgery, to be answered on post-operative days 1, 4 and 10.

    Results: In the photo-version, 27% of the children marked the answers on the instrument themselves, compared to 19% in the text-version (n.s.). Parents of 64% of the children in the photo-group reported that their child participated in answering the questions to a very high degree, compared to 58% in the text-group (n.s.). Some parents described that their children were very proud to fill in the instrument and return them by mail. The questions were mainly described as easy to understand and respond to, especially when illustrated with a photo. Some parents highlighted pain issues and asked for specific questions about what pain medication was given at home. One parent asked for the possibility to respond to the instrument online.

    Conclusion: PRiC can serve as a patient-reported outcome measure for children. PRiC can also provide parents with a tool for communicating with their child about post-operative recovery, especially when using the photo version.

  • 21.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Bramhagen, Ann-Cathrine
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017Conference paper (Refereed)
    Abstract [en]

    Background: Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this aspect.

    Methods: 238 children (4-12 years) with a history of obstructive problems and/or recurrent tonsillitis were included. 48% were operated with tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument, Postoperative Recovery in Children (PRiC), which includes 23 items covering different aspects of recovery after tonsil surgery.

    Results: Daily life activities (sleeping, eating and playing), and physical (e.g., headache, stomach ache, throat ache, otalgia, dizziness, nausea, defecation, urination) and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

    The TE-girls showed higher scores than the boys in many factors. Children above 6 years of age reported higher values for the physical comfort variables while the younger group showed worse emotional states. Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group had lower recovery compared to the TT-group (p < 0.01 – 0.001) in most items.

    Conclusion: The goal of postoperative management is to minimise or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery after tonsil surgery, and thus, PRiC can serve as a PROM to obtain patient-centred data after tonsil surgery.

  • 22.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Bramhagen, Ann-Cathrine
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Self-reported post-operative recovery in children after tonsillotomy and tonsillectomy 2016In: 13th Congress of the European Society of Pediatric Otorhinolaryngology, 2016Conference paper (Refereed)
  • 23.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Idvall, Eva
    Malmö University, Malmö, Sweden.
    Bramhagen, Ann-Cathrine
    Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Experiences of a new self-report instrument for post-operative recovery in children2017Conference paper (Refereed)
    Abstract [en]

    OBJECTIVES

    According the United Nations, children have the right to be heard and to have their opinions respected. Since postoperative recovery is an individual and subjective experience, our aim was to develop and test an instrument that provides children, also of a younger age, with a quality recovery self-report measure after tonsil surgery.

    METHODS

    The development of Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. It includes 23 items covering different aspects of recovery. PRiC was developed both as a traditional text-based instrument and as a version where each item is illustrated by a photo. It was distributed to 260 children undergoing tonsillotomy or total tonsillectomy in day surgery, to be answered on post-operative days 1, 4 and 10. The children and their parents were also asked to give their opinion about the instrument. The free-text answers were categorised to reflect the content and presentation of the two instrument versions.

    RESULTS

    In the photo version, 27% of the children marked the answers on the instrument themselves, compared to 19% in the text version (n.s.). Parents of 64% of the children in the photo group reported that their child participated in answering the questions to a very high degree, compared to 58% in the text group (n.s.).  Some parents described that their children were very proud to fill in the instrument and return them by mail.

    The questions were mainly described as easy to understand and respond to, especially when illustrated with a photo. Some parents highlighted pain issues and asked for specific questions about what pain medication was given at home. One parent asked for the possibility to respond to the instrument online.

    CONCLUSION

    PRiC can serve as a patient-reported outcome measure for children. PRiC can also provide parents with a tool for communicating with their child about post-operative recovery, especially when using the photo version.

  • 24.
    Ericsson, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Idvall, Ewa
    Malmö University, Malmö, Sweden.
    Bramhagen, Ann-Cathrine
    Malmö University, Malmö, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017Conference paper (Refereed)
    Abstract [en]

    OBJECTIVES

    Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this aspect.

    METHODS

    Totally, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.

    Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children, which includes 23 items covering different aspects of recovery after tonsil surgery. PRiC was distributed both as a traditional text instrument and with photo illustrations. 

    RESULTS

    Daily life activities (sleeping, eating and playing), and physical (e.g., headache, stomach ache, throat ache, otalgia, dizziness, nausea, defecation, urination) and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

    The TE-girls showed significantly higher scores than the boys in many factors.

    Children above 6 years of age reported higher values for the physical comfort variables while the younger group showed worse emotional states.

    Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group had lower recovery compared to the TT-group (p < 0.01 – 0.001) in most items.

    CONCLUSION

    The goal of postoperative management is to minimise or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery after tonsil surgery, and thus, PRiC can serve as a PROM to obtain patient-centred data after tonsil surgery.

  • 25.
    Eriksson, Mats
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Bramhagen, Ann-Cathrine
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Harden, Sue
    Skåne University Hospital, Malmö, Sweden.
    Idvall, Ewa
    Fakulty of Health and Society, Department of Care Science, Malmö University ,Malmö, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Experiences of a new self-report instrument for post-operative recovery in children2016In: 13th Congress of the European Society of Pediatric Otorhinolaryngology, 2016Conference paper (Refereed)
  • 26.
    Eriksson, Mats
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Bramhagen, Ann-Cathrine
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Fakulty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy2017In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 96, p. 47-54Article in journal (Refereed)
    Abstract [en]

    Objectives: Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect.

    Methods: In total, 238 children (4–12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.

    Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items.

    Results: Daily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

    The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness.

    Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states.

    Postoperative recovery improved from day 1–10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01–0.001) in most items.

    Conclusion: The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.

  • 27.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden; .
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences; Department of Nursing, Umeå University, Umeå, Sweden.
    Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes2013In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 15, no 2, p. 242-248Article in journal (Refereed)
    Abstract [en]

    Surgical site contamination, for example, with coagulase-negative staphylococci, probably derives from both the patient’s own skin flora and those of the surgical team. Despite preoperative antiseptic preparation with chlorhexidine solution, complete sterilization of the skin is not possible and gradual recolonization will occur. Plastic adhesive drape is an established method used to prevent direct wound contamination from adjacent skin. In this study, the time to skin recolonization after antiseptic preparation was measured and the impact of using plastic adhesive drape on this recolonization was evaluated. Repeated bacterial sampling using three different methods over 6 hr was conducted after antiseptic preparation in 10 volunteers. Recolonization of skin was observed after 30 min with plastic drape and after 60 min without plastic drape; there were significantly more positive cultures with the plastic drape than without (31% vs. 7.5%, respectively, p < .001). Sampling with a rayon swab was the most sensitive sampling method. In conclusion, covering the skin with a plastic adhesive drape seems to hasten recolonization of the skin after antiseptic preparation. However, clinical trials to confirm this finding are warranted.

  • 28.
    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)
  • 29.
    Falk-Brynhildsen, Karin
    et al.
    Department of Cardiothoracic Surgery, Örebro University Hospital, Sweden.
    Nilsson, Ulrica
    Department of Cardiothoracic Surgery and Centre for Health Care Sciences, Örebro University Hospital, Sweden.
    Cardiac surgery patients' evaluation of the quality of theatre nurse postoperative follow-up visit2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 2, p. 105-111Article in journal (Refereed)
    Abstract [en]

    Theatre nurses at the Department of Cardiothoracic Surgery in Orebro, Sweden, have since 2001 routinely conducted a follow-up visit to postoperative cardiac patients. A model with a standardized information part and an individual-caring conversation including both a retrospective and a prospective part designed the visit. The purpose of this study was to evaluate the quality of the postoperative follow-up visit conducted by the theatre nurses and find out if the quality was related to gender or type of admission. The method was prospective and explorative, including 74 cardiac surgery patients who had had a postoperative follow-up visit by a theatre nurse in Sweden. The instrument measuring quality, from the patient's perspective, measured the quality of the visit, and consisted of 16 items modified to suit the study. The results showed an overall high quality rating, with statistically significant higher scores for six items between patients who had undergone emergency surgery, in comparison with elective patients. When comparing gender, women had statistically significant higher scores in two items. In conclusion, this postoperative follow-up visit by the theatre nurse was a valuable and useful tool especially for the patients who had undergone emergency surgery. In the follow-up visit the theatre nurse creates a caring relationship by meeting the patient as an individual with his/her own experience and needs for information about the surgery, intra and postoperative care, and recovery.

  • 30.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology ,Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant2014In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, no 11, p. 1981-1987Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

  • 31.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.
    Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 84, no 2, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Background: Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.

    Aim: To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.

    Methods: This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.

    Results: Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).

    Conclusion: Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.

  • 32.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Response to MH Stevens and NM Klinger, re: Bacterial recolonization of the skin and wound contamination during cardiac surgery2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 85, no 4, p. 325-325Article in journal (Refereed)
  • 33.
    Fransson, Eleonor
    et al.
    School of Health Sciences, Jönköpings University, Jönköping, Sweden.
    Arenhall, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Steinke, Elaine E
    Sch Nursing, Wichita State University, Wichita KS, USA.
    Fridlund, Bengt
    School of Health Sciences, Jönköpings University, Jönköping, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Perceptions of intimate relationships in partners before and after a patient's myocardial infarction2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, p. 2196-2204Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe and explore how partners rate their intimate relationship before and after the patients' first myocardial infarction. A further aim was to investigate the association between partners' rating of their intimate relationship and self-rated health.

    BACKGROUND:

    To date, information on how partners experience the intimate relationship before and after a patient's myocardial infarction is sparse.

    DESIGN:

    A descriptive and exploratory design with longitudinal data collection.

    METHODS:

    The study comprised 127 partners, aged 34-87 years. Data collection included self-reported information on socio-demographic data, intimate relationship and self-rated health one year before and one year after patients' first myocardial infarction. Intimate relationship was assessed by the Swedish version of the Relationship Assessment Scale. Self-rated health was evaluated by the EuroQoL visual analogue scale.

    RESULTS:

    In general, partners reported high satisfaction with their intimate relationship both before and after the patients' myocardial infarction. Women reported somewhat lower ratings in their intimate relationship than men before the myocardial infarction. Women increased their ratings after one year, while men on average decreased their ratings. Partners with higher education reported lower ratings for intimate relationship after one year. Those with children living at home rated intimate relationship lower than those without children living at home after one year. Partners' self-rated health status was stable over time. No significant association between intimate relationship and self-rated health was found.

    CONCLUSIONS:

    This study provides important insights regarding couples' relationships from the perspective of the partner. Socio-demographic factors such as sex, educational level, having children living at home and employment status may influence how the relationship, from the partners' perspective, is affected by a myocardial infarction event.

    RELEVANCE TO CLINICAL PRACTICE:

    This study provides insight into how partners rate their intimate relationship and self-rated health over time before and after patients' myocardial infarction.

  • 34.
    Fredriksson, Ann-Charlotte
    et al.
    Dep. Anesthesia and Intensive Care, Malmö University Hospital, Sweden; Faculty of Health and Society, Department of Nursing, Malmö University, Sweden.
    Hellström, Leif
    Faculty of Health and Society, Department of Nursing, Malmö University, Sweden.
    Nilsson, Ulrica
    Dep. Anesthesia and Intensive Care/Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Patients' perception of music versus ordinary sound in a postanaesthesia care unit: a randomised crossover trial2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 4, p. 208-213Article in journal (Refereed)
    Abstract [en]

    We performed an experimental single-blind crossover design study in a postanaesthesia care unit (PACU): (i) to test the hypothesis that patients will experience a higher degree of wellbeing if they listen to music compared to ordinary PACU sounds during their early postoperative care, (ii) to determine if there is a difference over time, and (iii) to evaluate the importance of the acoustic environment and whether patients prefer listening to music during their stay. Two groups received a three-phase intervention: one group (n=23) experienced music-ordinary sound-music and the second group (n=21) experienced ordinary sound-music-ordinary sound. Each period lasted 30 min, and after each period the patients assessed their experience of the sound. The results demonstrated a significant difference (p<0.001) between groups in the proportions of patients reporting that the acoustic environment was of great importance for their wellbeing during the three-phase intervention, and most participants (n=36 versus n=8) noticed that they were exposed to different sounds during the PACU period. The results also revealed that most participants (n=32) preferred listening to music versus listening to ordinary sound (n=3) while in the PACU (p<0.001). These findings promote use of listening to music to establish a healing environment for patients in a postanaesthesia care unit.

  • 35.
    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.

  • 36.
    Gornall, B. F.
    et al.
    Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Clayton VIC, Australia; Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Myles, Paul S.
    Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University,Clayton VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne Vic, Australia.
    Smith, C. L.
    Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Burke, J. A.
    Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne Vic, Australia.
    Leslie, K.
    Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne Vic, Australia.
    Pereira, M. J.
    Department of Anaesthesia, Central Lisbon Hospital Center, Lisbon, Portugal.
    Bost, J. E.
    Biostatistics and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA, USA; Center for Research on Health Care (CRHC) Data Cente, University of Pittsburgh, Pittsburgh PA, USA.
    Kluivers, K. B.
    Department of Obstetrics and Gynecology, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anaesthesia and Intensive Care, Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Centre for Health Care, Örebro University Hospital, Örebro, Sweden.
    Tanaka, V.
    Department of Anesthesiology, Nara Medical University, Kashihara, Japan.
    Forbes, A.
    Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Measurement of quality of recovery using the QoR-40:a quantitative systematic review2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, no 2, p. 161-169Article in journal (Refereed)
    Abstract [en]

    Background.Several rating scales have been developed to measure quality of recovery aftersurgery and anaesthesia, but the most extensively used is the QoR-40, a 40-itemquestionnaire that provides a global score and subscores across five dimensions: patientsupport, comfort, emotions, physical independence, and pain. It has been evaluated in avariety of settings, but its overall psychometric properties (validity, reliability, ease of use,and interpretation) and clinical utility are uncertain.

    Methods.We undertook a quantitative systematic review of studies evaluatingpsychometric properties of the QoR-40. Data were combined in meta-analyses usingrandom effects models. This resulted in a total sample of 3459 patients from 17 studiesoriginating in nine countries.

    Results.We confirmed content, construct, and convergent [pooled r¼0.58, 95% confidenceinterval (CI): 0.51–0.65] validity. Reliability was confirmed by excellent intraclass correlation(pooleda¼0.91, 95% CI: 0.88–0.93), test–retest reliability (pooled r¼0.90, 95% CI: 0.86–0.92), and inter-rater reliability (intraclass correlation¼0.86). The clinical utility of theQoR-40 instrument was supported by high patient recruitment into evaluation studies(97%), and an excellent completion and return rate (97%). The mean time to completethe QoR-40 was 5.1 (95% CI: 4.4–5.7) min.

    Conclusions.The QoR-40 is a widely used and extensively validated measure of quality ofrecovery. The QoR-40 is a suitable measure of postoperative quality of recovery in arange of clinical and research situations.Keywords:health status; meta-analysis; outcomes

  • 37.
    Göras, Camilla
    et al.
    Örebro University, School of Health Sciences. Department of Anesthesia, Intensive Care Unit, Falu Lasarett, Falun, Sweden; Centre for Clinical Research, Falun, Sweden.
    Maria, Unbeck
    Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e015607Article, review/survey (Refereed)
    Abstract [en]

    Background: A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors’ estimations of their staffs’ attitudes to patient safety.

    Methods: A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate.

    Results: Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors’ estimations of their staffs’ ratings of the safety climate cohered fairly well.

    Conclusions: This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.

  • 38.
    Göras, Camilla
    et al.
    Anesthesia and Intensive Care Unit, Falu Lasarett, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallentin, Fan Yang
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version)2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 104, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Tens of millions of patients worldwide suffer from avoidable disabling injuries and death every year. Measuring the safety climate in health care is an important step in improving patient safety. The most commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the present study was to establish the validity and reliability of the translated version of the SAQ.

    Methods: The SAQ was translated and adapted to the Swedish context. The survey was then carried out with 374 respondents in the operating room (OR) setting. Data was received from three hospitals, a total of 237 responses. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument.

    Results: The Cronbach's alpha values for each of the factors of the SAQ ranged between 0.59 and 0.83. The CFA and its goodness-of-fit indices (SRMR 0.055, RMSEA 0.043, CFI 0.98) showed good model fit. Intercorrelations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate to high correlation with each other. The factor stress recognition had no significant correlation with teamwork climate, perception of management, or job satisfaction.

    Conclusions: Therefore, the Swedish translation and psychometric testing of the SAQ (OR version) has good construct validity. However, the reliability analysis suggested that some of the items need further refinement to establish sound internal consistency. As suggested by previous research, the SAQ is potentially a useful tool for evaluating safety climate. However, further psychometric testing is required with larger samples to establish the psychometric properties of the instrument for use in Sweden.

  • 39.
    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

  • 40.
    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
  • 41.
    Idvall, Ewa
    et al.
    Kalmar County Council, Kalmar, Sweden; 2 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Berg, Katarina
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Unosson, Mitra
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Brudin, Lars
    Kalmar County Council, Kalmar, Sweden; 2 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesia and Intensive Care,University Hospital, Örebro,Örebro, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Assessment of recovery after day surgery using a modified version of quality of recovery-402009In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 5, p. 673-677Article in journal (Refereed)
    Abstract [en]

    A recent nationwide survey in Sweden found that day surgery accounts for 43% of all in-hospital procedures.1 Orthopaedic, general, and gynaecological procedures were the most common. About 40% of the day surgery units followed up with telephone calls within 1–2 days, and found pain to be the most common complaint. Quality of recovery had not been systematically evaluated with instruments tested for validity and reliability, and follow-ups beyond 2 days post-operative were not found.

    Quality of Recovery-40 (QoR-40)2,3 is a 40-item instrument to assess the quality of post-operative recovery. The instrument is divided into five dimensions; emotional state, physical comfort, psychological support, physical independence, and pain. These dimensions represent aspects of good-quality recovery after anaesthesia and surgery. QoR-40 has been used for patients undergoing different surgical procedures and tests for validity and reliability yielded initial support for the instrument. Myles et al.3 concluded that QoR-40 would be a useful outcome measure to assess the impact of changes in health care delivery on quality of care, but anaesthesia and surgery studies have rarely used this approach. Although QoR-40 has not been used exclusively for day surgery patients, some day surgery patients were included when the instrument was developed.2,3 Another study on day surgery patients4 used eight items from QoR-40 relevant to that study. In a systematic review of post-operative recovery outcomes measurements after ambulatory surgery, the QoR-40 was the only instrument that fulfilled the criteria that were set up but was not specifically designed for day surgery and anaesthesia.5 Another systematic review from 2008 also advises to use the QoR-40 in future validation and application studies.6 Day surgery is increasing, and it is important to measure the quality of care and the impact of change. When using an instrument such as QoR-40, each item must be carefully considered for the purpose and context it will be used in, especially when it differs from the original context, both concerning cultural differences between countries and the type of surgical procedure used. Therefore, our study created and used a modified version of the QoR-40 to measure the quality of recovery in day surgery patients. The study aimed to test this modified version in a Swedish context for day surgery patients, to assess the quality of recovery on days 1, 7, and 14 post-operative.

  • 42.
    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.

  • 43.
    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.

  • 44.
    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)
  • 45.
    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)
  • 46.
    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.

  • 47.
    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.

  • 48.
    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)
  • 49.
    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.

  • 50.
    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.

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