ABSTRACTBackground: People with colorectal cancer undergoing rectum amputation get a permanent colostomy, which affects the social life. It may be valuable for health care what these people experience living with colostomy in order to provide the greatest possible support. Objective: The aim of this study is to describe how people who received a colostomy experience their daily lives and the support they have received from the health services.Method: Qualitative interview study with six people, with a descriptive phenomenological approach.Results: The analysis of the interviews about how it's like to live with a colostomy resulted in three themes: 1) Living with a colostomy gives an uncertainty that affect the social life, 2) Physical and psychological impact of getting a colostomy and 3) Support for health care and relatives.Conclusion: Subjects had a positive attitude towards life, which contributed to that they could adjust to living with a colostomy and feel a meaningfulness of life. The study shows that all the interviewed people overall were satisfied with the information provided by the healthcare personnel. It was good with both oral and written information and very appreciated with repeated information. One aspect that could be improved was the information given aboute the closure of anus during surgery and the following complications.

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety.Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist.Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden.Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower.

Introduction Postoperative wound infections leads to increased patient suffering and cost society money because it leads to longer hospital stays. Previous research shows that patient related risk factors such as smoking, diabetes, Chronic Obstructive Pulmonary Disease (COPD), advanced age (>65 years) a low preoperative hemoglobin level (<140g/L) and a high BMI (> 30) increases the risk of suffering a postoperative wound infection. Aim To investigate whether patients that underwent surgery with Coronary artery Bypass Graft (CABG) in a university hospital in central Sweden in 2013 and had any of these risk factors more often suffer from post-operative wound infection.MethodThe study has a descriptive design and is based on an ongoing infection registration area of operations. The study included 148 patients out of 255 (58%) undergoing CABG in 2013. Possible risk factors were collected through medical record review.Results There was no significant correlation between surgical wound infection and patient-related risk factors such as smoking (not quit smoking four weeks before surgery), diabetes, COPD, advanced age (>65 years), low preoperative hemoglobin (<140g/L) or a high BMI (>30) and suffered a postoperative wound infection.Conclusion More research and a larger sample is needed in the field to produce a reliable result could be presented..

ABSTRACTIntroduction: An increasing number of patients undergo surgery under local anesthesia and are thereforeawake during the procedure. Nursing care that is provided to these patients can differ from those thatreceive general anesthesia. Previous research has focused on patients? general experiences of being awakeintraoperative. But there is no research that focuses on patients perceptions of security.

Sahlgrenska Academyat University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: BCAA supplementation in patients undergoing resection for liver cancerAuthor: Mikael Semaan and Viktor SjölingSupervisor: Fredrik BertzExaminer: Frode SlindeProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: April 10, 2013BackgroundLiver cancer is the fifth most common cancer worldwide and the third largest to cause death. Protein-energy malnutrition is common in patients with liver disease and they often suffer from changes in the hepatic metabolism of nutrients and other substances. There is a basis for recommending BCAA supplementation in other certain liver diseases. Given the similar clinical picture of liver cancer surgery, it is possible that supplementation of BCAA can be beneficial for these patients as well.ObjectiveThe aim was to study the scientific basis for the effect of branched chain amino acid (BCAA) supplementation in liver cancer patients. Can it improve their recovery in terms of nutritional status and albumin levels, and does it changes the duration of hospital stay, after surgery?Search strategyFive extensive searches were performed on PubMed and Cochrane after appropriate study material.

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety.Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist.Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden.Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower.

Background: Vacuum assisted closure, VAC, is a method which can benefit wound closure. There are not many reliable studies about the effects of VAC in different types of wounds. Previous studies have shown that patients have experienced pain during dressing changes.Aim: The aim of the study was to survey in what kind of wounds the vascular surgery ward have been using VAC, to study the treatment process of VAC and how it has been documented and also to investigate if patients with VAC experienced pain during dressing changes.Method: The patients were chosen from a ledger, which contained 77 patients that had been treated with VAC on the vascular surgery ward. Data were collected with a journal survey protocol.Results: The result is based on 67 patients with a total of 79 wounds. VAC was shown to have a good effect on wound healing and infected surgical wounds were the most commonly wound category undergoing treatment with VAC.

The main objective of this research was to study how increased arterial oxygenation by the use of Pulsed Inhaled Nitric-Oxide (PiNO) influenced the metabolic and cardiovascular parameters on horses undergoing acute abdominal surgery because of colic. The parameters blood lactate, blood glucose, pH and heart rate were evaluated before and during anesthesia and closely after recovery. The study showed that blood lactate concentrations decreased significantly during anaesthesia in horses treated with PiNO compared to non-treated horses. It was also seen that the lactate concentration decreased most in horses with the highest levels before PiNO treatment. Since enhanced oxygen extraction ratio was evident in the PiNO group, improved oxygen delivery to the tissue may be a possible explanation for the improved situation.

ABSTRACTAim. To describe intensive care nurses´ experiences of caring for patients with postoperative delirium after heart surgery.Background. Delirium is a common condition after heart surgery. Previous research has focused more on pathophysiology, incidence, etiology, prevention, detection and management, and less on how nurses caring for patients with delirium experience it.Design. A qualitative interview study.Method.

Bakgrund: ERAS (Enhanced Recovery After Surgery) är ett standardiserat multimodalt vårdprogram vid elektiv kolorektalkirurgi, som syftar till snabbare återhämtning och kortare vårdtider genom ett tvärprofessionellt samarbete.  En vecka innan planerad operation träffar sjuksköterskan patienten för ett samtal om vårdförloppet. Syfte: Att identifiera och beskriva patientens upplevelse av sjuksköterskans ERAS- samtal och dess betydelse för patientens delaktighet i sin vård.   Metod: Datainsamlingen skedde genom kvalitativa intervjuer. Tolv patienter, nio män och tre kvinnor har intervjuats. De ljudinspelade samtalen har transkriberats ordagrant och analyserats med hjälp av tolkande fenomenologisk analys (Interpretative Phenomenological Analysis). Resultat: Analysarbetet resulterade i fem olika teman; bli sedd, trygghet, tillit, ansvar samt delaktighet. Alla teman relaterar till varandra och illustrerar en positiv och en negativ sida av den upplevda erfarenheten. Tillsammans bildar en helhet av upplevelsen; ERAS- samtalet och dess betydelse för patientens delaktighet. Konklusion: Resultatet visar att patienterna känner sig sedda under informationssamtalet.

BAKGRUND: CABG blir en allt vanligare åtgärd vid kranskärlssjukdom inom svensk sjukvård. Målet med operationen är att lindra symtom vid kärlkramp och hjärtinfarkt samt att reducera mortaliteten. SYFTE: Syftet var att beskriva patienters emotionella upplevelser under det första året efter en CABG operation. METOD: En allmän litteraturstudie som grundades på kvalitativa vetenskapliga artiklar genomfördes. Resultatet baserades på sju vetenskapliga artiklar som söktes fram via elektroniska databaser och därefter granskades och analyserades.

Bakgrund: Transsexualism är en könsidentitetsstörning som innebär att en individ identifierar sig med det motsatta könet, och innefattar oftast en önskan om att korrigera sitt kön till det upplevda. I och med denna önskan kommer transsexuella ofta i kontakt med vården och därför krävs vårdpersonal som är kunnig och professionell i sitt bemötande.Syfte: Syftet med denna studie var att belysa transsexuellas upplevelse av vårdpersonalens bemötande under den könskorrigerande processen.Metod: Studien gjordes med en kvalitativ design och datainsamlingen skedde genom intervjuer av sex transsexuella personer. Insamlad data analyserades med en kvalitativ innehållsanalys.Resultat: Respondenterna upplevde ett bra bemötande när mötet och samtalet genomsyrades av kunskap och professionalism och när personalen utgick ifrån deras livsvärld genom att ha en förstående och bekräftande inställning. När personalen istället tedde sig okunnig och oförstående upplevde sig respondenterna sårbara då de behövde övertala och anpassa sig till personalen för att få önskad vård.Slutsats: Studiens resultat visar tydligt att vårdpersonalens bemötande på många sätt påverkar de transsexuella patienternas väg genom den könskorrigerande behandlingen, som för de allra flesta transsexuella är helt livsavgörande. Det är därför av stor vikt att medvetandegöra transsexuella patienters upplevelser, för att på bästa sätt kunna försäkra ett gott bemötande.Klinisk betydelse: Belysandet av transsexuellas upplevelse av bemötandet i vården kan bidra till en ökad medvetenhet om transsexualism och transsexuellas vårdbehov, för att de i framtiden ska kunna erbjudas bättre vård..

Dystocia, or difficult birth, is a commonly seen complication to natural birth in veterinary hospitals. Although other methods of resolving dystocia exist, 60 % of dystocias will need to undergo caesarean section. To perform a caesarean section, the bitch will have to undergo anesthesia. The purpose of this literary study was to provide a deeper understanding regarding how the physiologic changes that occur during pregnancy influence anesthetic management in the bitch and puppies. Which anesthetic drugs and drug combinations indicated was also investigated as well as how a veterinary nurse can optimize care of the mother throughout the procedure and how resuscitation of the puppies should be carried out for best possible outcome.

Transsexualism innebär en upplevelse av att det juridiska könet inte stämmer överens med könsidentiteten och följs ofta av en önskan om att korrigera sitt kön så att det överensstämmer med det upplevda. Rösten är en identitetsmarkör och utgör en betydande aspekt av könskorrigeringen. Denna studie utgjordes av en enkät riktad till 24 verksamma röstlogopeder samt 49 personer i könskorrigeringsprocess i Uppsala-Örebro sjukvårdsregion. Enkätstudien ämnade undersöka transsexuella personers upplevda behov av logopediska insatser och i vad mån de tillgodoses, vilka kunskaper logopederna upplever som nödvändiga, faktorer som kan försvåra arbetet samt behandlingsinnehåll. Ett ytterligare syfte var att jämföra resultaten från föreliggande studie med de resultat som framkom i studien av Andersson och Aronsson (2008)  som kartlade logopediskt omhändertagande av transsexuella i norra regionen.

Thisbachelorthesisdealswithhealthcare.Whichisacurrentandurgentsubject.ItconcernsspecificallySkaraborg´sHospital,oneoutoffourhospitalgroupswithintheVästragötaland´sRegion.ThishospitalgroupinturnconsistsofthehospitalsinFalköping,inLidköping,inMariestadandinSkövde.Skaraborg´sHospitalisafterarecentreorganizationofanextensivedegree,dividedintofourdifferentmainareas(divisions)withatotalofapproximately4200employees.Thefourmainareas(divisions)are(1)Surgery(K),(2)MedicineandPsychiatry(M),(3)ResearchandEducationalDevelopment(FoUU),and(4)StabincludingHumanRelations(HR)andEconomy.TherearetodaysomespecificdifficultiestoinadequatewaysmonitorandunderstandthedifferentactivitieswithinSkaraborg´sHospital.Suchrelationshipsnaturallycreatesobstaclesforexampletocarryoutorganizationalandoccupationalwork.Onesuchexampleisthelackofopportunitytolinkmainareas(i.e.divisions),sub-­?divisionsandorganizationalunitswiththesurfacesandpremisesthattheseusestoday.Theaimofthebachelorthesisis(fortheseandotherreasons)toconnectthedifferentorganizationalunits,etc.withinSkaraborg´sHospitaltothesurfacesandpremisesthattheyuse,andtothusmakeitpossibletodescribethemainareas(divisions),sub-­?divisionsandorganizationalunitswithmoreaccurateandpracticaldenotations,sothattheycanbeunderstoodbybusinessrepresentatives(patients)andemployees.DuetothefactthatSkaraborg´sHospitalisalargeandcomplexorganization,Ihaveenclosedthethesisbyprimarilystudyonlyonemedicalsubdivision,whichisM.3andconsistsofseventeenorganizationalunitsprovidingcarebymeansofmainlythreemedicalspecialties,namelycardiology,skininfectionandrenalmedicin.SubdivisionofM.3waschosenforthisentireactivityislocatedinthesamelocality,whichisinSkövde.Butalsoduetothefactthatthiswasoneofthemorecomplexorganizationalunitscontributedtothischoice.Thebachelorthesiscontainssevenappendices,inwhichthethesisso-­?calledmethodstepsaredetailedfurther,whichalsoincludestheappropriatesub-­?results.Therebyaretheresultscomprisedintheseappendixes.Observe,thatsomeofwhatarepresentedarecontributionsfromotherauthors,i.e.resultsfromaprogressiveresearchprojectwithinSkaraborg?sHospital.Theseappendicesarecalled(1)?Skaraborg´sHospitalashortdescription?,(2)?TheworkwiththefourExceldocuments?,(3)?BuildingswithinSkövdehospitalillustratedwithcurrentbuildingdrawingsfromVästfastigheter,incombinationwithadevelopedschemetoshowsuchbuildings?,(4)?ResultsfromthephysicalinventoriesofthesurfacesandpremiseswithinthesubdivisionM.3?,(5)?Suggestionsformoreaccurateandpracticaldenotationsonareas(divisions),sub-­?divisionandorganisationalunits?,(6)?ExampleofasurveyproposedtobesenttounitmanagerswithinthesubdivisionM.3toensuretheresultsofthephysicalinventory?and(7)?Commentsonsomeresultsobtainedfromasemi-­?structuredinterviewwithoneofthemanagers(i.e.adoctorresponsibleforsomeoftheactivitieswhithinResearchandEducationalDevelopmentFoUU).ThethesisisbasedonanumberofExcel-­?documentsobtainedfromSkaraborg´sHospitalanddrawingsofthepremisesobtainedfromVästfastigheter.ItisalsobasedonavarietyoffieldtripswhereIhavebeenabletovisitandtherebycarryoutthephysicalinventoriesofthesurfacesandpremisesoftheselectedorganizationalunitsandinterviewsofanumberofkeyemployees.Thetheoreticalframeworkforthisthesisispartlybasedonorganizationandorganizationalmanagement,organizationalcultureandworkofchangewithinanorganizationandtheworkingenvironmentandsafetyresponsibilities.Thethesisisalsobasedontheoriesandstudiesthathavebeendoneonhealthcareorganizationsandhealthcaremanagement.ThethesisworkhashelpedtoidentifyallsurfacesandpremisesthatorganizationalunitswithinthesubdivisionM.3exploits,andtoprovidesuggestionsformoreaccurateandfunctionaldenotationsfortheseorganizationalunits.ThisthesisalsoprovidesabetterfoundationforvariousongoingandfutureinitiativestoimproveefficienciesaswellasworkandworkconditionswithinSkaraborg´sHospital.Anexampleoftheresultstherebygained,isthatthemethodusedtoidentifyboththesurfacesandpremisessubdivisionM.3uses,whichcanbeusedforalloftheothersubdivisionsandorganizationalunitsthanthosethathavebeenstudiedinthisthesisframes..