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  • 1.
    Brattwall, M.
    et al.
    Department of Anaesthesia, The Sahlgrenska Academy, Institute for Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden.
    Warren Stomberg, Margareta
    University of Skövde, School of Life Sciences. The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    Rawal, N.
    Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Segerdahl, M.
    Department of Clinical Science, Intervention and Technology, Unit for Anaesthesia, Karolinska Institute, Stockholm, Sweden.
    Jakobsson, J.
    Department of Anaesthesia and Intensive Care, Division for Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
    Houltz, E.
    Department of Anaesthesia, The Sahlgrenska Academy, Institute for Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden.
    Patients' assessment of 4-week recovery after ambulatory surgery2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 1, p. 92-98Article in journal (Refereed)
    Abstract [en]

    Background: Patients’ own assessment of recovery after ambulatory surgery has not been well studied. The aim was to study patients’ self-assessed recovery, the occurrence and time course of post-operative problems in relation to the type of ambulatory surgery.Methods: A questionnaire was filled in by 355 patients at five time points: pre-operative, first day at home, 1, 2 and 4 weeks post-operatively. Consecutive patients who underwent either inguinal hernia repair (IHR), arthroscopic procedures (AS) or cosmetic breast augmentation (CBA) were included.Results: Unplanned return to hospital was rare (3/355). Health care contacts were noted for 9% of the patients during the first week; a total of 70 contacts occurred during the entire period. Pain was the most frequently reported symptom; 40% of the patients reported pain or mobility problems at 1 week, 28% after 2 weeks and 20% after 4 weeks. Pre-operative pain was associated with an increased level of pain during the early post-operative course, in the recovery room and at 1 week post-operatively. IHR was associated with an overall rapid recovery, while AS patients experienced a slower restitution. All AS patients who reported pain after 4 weeks had reported pain problems already pre-operatively. Pain was not present pre-operatively in the CBA group, but was common at 1 and 2 post-operative weeks and was still reported by 11% at 4 weeks.Conclusion: Self-assessed recovery was found to cover several weeks with procedure-specific recovery patterns. Pain and mobility impairment were still frequently reported 4 weeks post-operatively.

  • 2.
    Brattwall, M.
    et al.
    Sahlgrenska University Hospital.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Rawal, N.
    Örebro University Hospital.
    Segerdahl, M.
    Karolinska Institute.
    Houltz, E.
    Sahlgrenska University Hospital.
    Jakobsson, J.
    Karolinska Institute.
    Patient assessed health profile: A six-month quality of life questionnaire survey after day surgery2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 6, p. 574-579Article in journal (Refereed)
    Abstract [en]

    Aim: Patient assessed quality of life is one of the principal end-points after day surgery. The aim of the present study was to describe the natural course, differences and timing of final evaluation for three common day surgical procedures; inguinal hernia repair (IHR), arthroscopic procedures (AS); and cosmetic breast augmentation (CBA). Method: A total of 355 patients prospectively completed an extended eight-item EQ-5D questionnaire (pain, mobility, mood, self-care, activities, sleep, sex, need for analgesic), preoperatively and at one, three and six months postoperatively. Results: Pain and mobility problems were frequently reported prior to surgery among IHR and AS patients, while CBA patients had less deviation from normal in the preoperative health profile. The proportions of patients reporting surgery-related deviations were 35%, 20% and 5% at one, three and six months respectively. After one month, 50% of AS patients still suffered subjective discomfort as compared to 13% and 20% of the IHR and CBA patients, respectively. Pain and ambulation problems were the most common symptoms in all groups. Six months after surgery, 94% of IHR, 89% of AS and 97% of CBA patients were fully recovered. Conclusions: No major morbidity or severe complications were observed and patients’ satisfaction was high overall. We found procedure-specific changes in the postoperative health profile after day surgery. AS patients recovered more slowly compared with IHR and CBA patients. We conclude that time for final evaluation differs significantly between procedures.

  • 3.
    Brattwall, M.
    et al.
    Sahlgrenska University Hospital.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Rawal, N.
    Örebro University Hospital.
    Segerdahl, M.
    Karolinska Institute.
    Houltz, E.
    Sahlgrenska University Hospital.
    Jakobsson, J.
    Karolinska Institute.
    Postoperative impact of regular tobacco use, smoking or snuffing, a prospective multi-center study2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 3, p. 321-327Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to study the effects of different tobacco administration routes on pain and post-operative nausea and vomiting (PONV), following three common day surgical procedures: cosmetic breast augmentation (CBA), inguinal hernia repair (IHR) and arthroscopic procedures (AS). We have prospectively investigated the effects of regular tobacco use in ambulatory surgery.

    Methods: The 355 allocated patients were followed during recovery and the first day at home.

    Results: Thirty-two percent of the patients used tobacco regularly, 33% of CBA, 27% of IHR and 34% of AS. Pain was well controlled in the post-anesthesia care unit at rest; during ambulation, 37% of all patients reported VAS>3. Tobacco use had no impact on early post-operative pain. Post-operative nausea was experienced by 30% of patients during recovery while in hospital. On day 1, 14% experienced nausea. We found a significant reduction of PONV among tobacco users (smoking and/or snuffing). Smoking or snuffing reduced the risk of PONV by nearly 50% in both genders on the day of surgery and at the first day at home. The reduction of PONV was equal, regardless of tobacco administration routes.

    Conclusion: We found that regular use of tobacco, both by smoking and snuffing, had a significant effect on PONV during the early post-operative period. Non-tobacco users undergoing breast surgery were found to have the highest risk for PONV. We could not see any influence of nicotine use on post-operative pain. Thus, it seems of value to identify regular tobacco use, not only smoking, as a part of the pre-operative risk assessment.

  • 4.
    Gunnarsson, Britt-Marie
    et al.
    University of Skövde, School of Life Sciences.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Factors influencing decision making among ambulance nurses in emergency care situations2009In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 17, no 2, p. 83-89Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate which factors that influences decision making among Swedish ambulance nurses in emergency care situations. Nurses in ambulance are sometimes forced to make decisions without adequate information. Data collected from interviews with 14 ambulance nurses was analyzed. The informants described 30 incidents during which they had to make fast decisions. A qualitative content analysis of the text was made, from which different categories were identified. It was found that when nurses are called to an emergency, the extent and degree of difficulty of the incident is decisive for how decisions are made. In addition, the nurses’ experience is important for decision making, because the experience factor constitutes a qualitative difference between a novice nurse and a more experienced nurse’s influence on decision-making. Furthermore, external factors, such as the uncertainty of a prehospital environment, expectations and pressures from an environment in which one is working while being observed by other people, and collaborating with many different operators, all contribute to making decisions in an urgent situation even more complex. Further studies are needed to understand the complexity of decision making in emergency situations.

  • 5. Haljamäe, Hengo
    et al.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative pain management: clinical practice is still not optimal2004In: Current Anaesthesia & Critical Care, ISSN 0953-7112, Vol. 14, no 5-6, p. 207-210Article in journal (Refereed)
    Abstract [en]

    Major progress in clinical pain assessment and management has been achieved in the last decade. More effective analgesic drugs and improved techniques for pain management have been introduced. However, medical reports published during the last few years on postoperative pain management (POPM) indicate that moderate or even severe pain is still rather commonly experienced by surgical patients in the early postoperative period and that worst-pain-episodes may occur even in the late postoperative phase. Insufficient relief of postoperative pain seems a more common problem on surgical wards than on a postanaesthesia care unit (PACU). The aims of POPM are to inhibit autonomic trauma-induced nociceptive impulses that may result in functional disturbances of vital organs and thereby affect the incidence of potentially severe complications influencing clinical outcome. Considering that recent studies continue to show sub-optimal pain management despite the availability of effective drugs and analgesic techniques it must be considered essential to identify possible barriers to effective pain management in clinical practice so that necessary improvements in POPM routines can be carried out.

  • 6. Haljamäe, Hengo
    et al.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative pain management: practice guidelines2004In: Current Anaesthesia & Critical Care, ISSN 0953-7112, Vol. 14, no 5-6, p. 203-206Article in journal (Refereed)
    Abstract [en]

    Establishment of an acute pain management programme is considered essential to reduce the incidence and severity of postoperative pain experiences of surgical patients in surgical wards. Several quality assurance standards and practice guidelines on pain management for professionals involved in the treatment of pain have been presented. Assessment of pain, using accepted approaches, should be undertaken at regular intervals at rest, during movements and at an appropriate interval after any intervention. It is essential to document pain scores and also to include assessment of patient satisfaction with the postoperative pain management provided so that pain and its treatment is made clearly visible in the clinical setting. A program for acute pain management should also include assessment of the adherence to the accepted postoperative pain management standards over time within the organization.

  • 7.
    Kilic, Mert
    et al.
    Istanbul University, Turkey.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Jakobsson, Jan
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Clinical Performance of a Novel Main-Stream Anaesthetic End-Tidal Gas Monitors during Routine Low Flow Anaesthesia2010In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, E-ISSN 2155-6148, Vol. 1, no 3, article id 112Article in journal (Refereed)
    Abstract [en]

    End-tidal anaesthetic gas concentration monitoring during inhalation anaesthesia has become standard of care. Explorative study comparing the end-tidal anaesthetic gas measured by a new main-stream anaesthetic gas monitor (IRMA, Phasein, Stockholm, Sweden) as compared to standard Datex side-stream monitoring during routine low flow anaesthesia Day surgical centre in StockholmThirty two healthy, ASA 1-2, patients undergoing elective day case anaesthesia with low flow 0.2-0.5 L/min. Simultaneous recording of the end-tidal gas concentration during routine day case anaesthesia with low flow sevoflurane or desflurane anaesthesia. The new monitor was found to be clinically acceptable. The mean bias between IRMA and Datex measures -0.125 vol % (± 0.145, limits of agreement were -0.41 – 0.16). The new main stream gas monitor is clinically acceptable alternative for end-tidal anaesthetic gas monitoring during routine anaesthesia with low flow, 0.2-0.5 L/min.

  • 8.
    Modin, Marina
    et al.
    Department of Surgery, Central Hospital, S-541 85 Skövde, Sweden.
    Ramos, Telmo
    Department of Orthopaedic, Central Hospital, Skövde, Sweden.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation.2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

     

     

    Aims and objectives. To describe patients’ experience of the impact of their health-related life situation on their daily life two and four weeks after primary fracture treatment with Ilizarov external fixation.

    Background. A few studies have been conducted postoperatively focussing on fracture treatment with Ilizarov fixation.

    Design. A prospective descriptive research design.

    Method. Patients who had been treated for a proximal/distal tibial fracture were invited to participate in the study. Data were collected with a semi-structured questionnaire where 20 patients described in their own words their situation at home two and four weeks postoperatively. The process used when analysing the data was similar to content analysis.

    Results. Four key themes were identified: 'limitations in the home environment', 'limitations outside the home', 'limitations to social relations' and 'experience of having an Ilizarov fixation'. The patient's life situation was strongly affected during the first postoperative month. This took the form of clear limitations on activities outside the home and a degree of limitation on coping with household chores and personal hygiene. These limitations became less severe after between 2-4 weeks and were very much a consequence of using crutches.

    Conclusion. This study points to limitations in the patient's daily life situation in the home. The results from the study make it obvious that the information given to patients prior to discharge, concerning the value of putting weight on the leg, had not been clear or that the patients had not understood it. This had a negative impact on the patient's daily life after discharge. Further data are needed to uncover the extent of the issue to be able to optimise patient outcomes.

    Relevance to clinical practice. There is a need for clearer and more active information from the nurse before discharge but also a need to follow up how the information given is understood.

     

     

  • 9.
    Nilsson, Kerstin
    et al.
    University of Skövde, School of Life Sciences.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Nursing students motivation toward their studies: a survey study2008In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 7, article id 6Article in journal (Refereed)
    Abstract [en]

    Background

    This study focuses on Swedish nursing students' motivation toward their studies during their three year academic studies. Earlier studies show the importance of motivation for study commitment and result. The aim was to analyze nursing students' estimation of their degree of motivation during different semester during their education and to identify reasons for the degree of motivation.

    Methods

    A questionnaire asking for scoring motivation and what influenced the degree of motivation was distributed to students enrolled in a nursing programme. 315 students who studied at different semesters participated. Analyzes were made by statistical calculation and content analysis.

    Results

    The mean motivation score over all semesters was 6.3 (ranked between 0–10) and differed significantly during the semesters with a tendency to lower score during the 5th semester. Students (73/315) with motivation score <4 reported explanations such as negative opinion about the organisation of the programme, attitude towards the studies, life situation and degree of difficulty/demand on studies. Students (234/315) with motivation score >6 reported positive opinions to becoming a nurse (125/234), organization of the programme and attitude to the studies. The mean score value for the motivation ranking differed significantly between male (5.8) and female (6.8) students.

    Conclusion

    Conclusions to be drawn are that nursing students mainly grade their motivation positive distributed different throughout their entire education. The main motivation factor was becoming a nurse. This study result highlights the need of understanding the students' situation and their need of tutorial support.

  • 10.
    Segerdahl, M.
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, CLINTEC Unit for Anesthesia, Karolinska Universitetssjukhuset Huddinge, Stockholm, Sweden.
    Warren-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Rawal, N.
    Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Brattwall, M.
    Sahlgrenska University Hospital/Mölndal, Unit of Day Care Surgery, Göteborg, Sweden.
    Jakobsson, J.
    Department of Physiology and Pharmacology, Unit for Anesthesia, Karolinska Institute, Stockholm, Sweden / Department of Anaesthesia at the Foot & Ankle Surgery Clinic, Stockholm, Sweden.
    Children in day surgery: clinical practice and routines. The results from a nation-wide survey2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 6, p. 821-828Article in journal (Refereed)
    Abstract [en]

    Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking. Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail. Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy. Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

  • 11.
    Segerdahl, M.
    et al.
    Karolinska Inst, Unit Anesthesia, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Rawal, N.
    Örebro Univ Hosp, Dept Anesthesia & Intens Care, Örebro, Sweden .
    Brattwall, M.
    Sahlgrenska Univ Hosp Molndal, Unit Day Care Surg, Gothenburg, Sweden.
    Jakobsson, J.
    Karolinska Inst, Unit Anesthesia, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Clinical practice and routines for day surgery in Sweden2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 1, p. 117-124Article in journal (Refereed)
    Abstract [en]

    Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking.

    Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail.

    Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1–6-year-olds, and in 7–16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1–6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1–3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy.

    Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

  • 12.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Guest at Hospice: Time for Consideration2009In: The American Journal of Hospice and Palliative Medicine, ISSN 1049-9091, Vol. 26, no 4, p. 277-280Article in journal (Refereed)
    Abstract [en]

    This study focuses on daily life situation of terminally ill guests residing at a hospice. In the study, interviews were conducted with 9 such guests. Data were analyzed using a method similar to content analysis. Categories emerged that were related to aspects regarding as external and internal essentials for the well-being of the individual at the hospice. These essentials were as follows: encouragement from the staff, the alleviation of pain, a pleasant and calm atmosphere at the hospice, the significance of visits from relatives, the regret of not being able to take care of oneself, and time to reconcile to one's life. These results not only show the need for close community with both family and staff but also the need for privacy to reflect on life.

  • 13.
    Warrén Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences. The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences. The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Nursing Students' Self-Graded Motivation to Complete their Programme of Study2010In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 4, p. 42-47Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore variation in nursing students’ motivation to complete their programme of study,  as  well  as  factors  relating  to  low  versus  high  motivation  and  students’  opinions  of  what  would  increase  their motivation to complete their programme of study. A study was carried out between April 2006 and December 2007. A total of 872 students registered in a 3-year nursing programme  randomly  participated  in  self-rating  their  motivation  score  once  each  semester.  Descriptive  statistics, statistical calculations and content analysis regarding open-ended questions were performed. Most of the students, 73%, rated their motivation as ≥6 on a 0-10 Likert scale; and 16% gave a rating of ≤4. The desire to become  a registered nurse (RN)  and having  a positive  attitude towards the  studies were  the main factors influencing high motivation to complete the programme of study. Having a negative attitude towards the studies was an explanation of decreased motivation. There was a significant decrease (p=0.001) in the motivation score with respect to number of semesters, and motivation increased with the student’s age (p=0.0119). Suggestions for increasing motivation given by those who rated their motivation as ≤4 mainly focused on improvements in didactics and study organisation.

  • 14.
    Warrén Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Tronstad, Svein - Erik
    Skaraborgs Hosp Skövde, Dept Obstet & Gynecol, SE-54185 Skövde, Sweden.
    Hedberg, Karin
    Department of Health Employment, Hälsan och arbetslivet, Skövde, Sweden.
    Bengtsson, Jan
    University of Skövde, School of Life Sciences.
    Jonsson, Peter
    University of Skövde, School of Life Sciences.
    Johansen, Lars
    Skaraborgs Hosp Skövde, Dept Surg, SE-54185 Skövde, Sweden.
    Lindvall, Birgitta
    University of Skövde, School of Life Sciences.
    Work-related musculoskeletal disorders when performing laparoscopic surgery.2010In: Surgical laparoscopy, endoscopy & percutaneous techniques, ISSN 1530-4515, E-ISSN 1534-4908, Vol. 20, no 1, p. 49-53Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to survey the occurrence of musculoskeletal disorders in the population of gynecologists and general surgeons performing laparoscopic surgery.

    Methods: A questionnaire was distributed to 558 general surgeons and gynecologists and 378 were answered (68%). Descriptive data analysis and statistical calculations were performed.

    Results: One or more disturbing symptoms were common among laparoscopists. More than 70% of the laparoscopists had one or more symptom. Pain was the most common symptom followed by fatigue and stiffness. Lower back, neck, and shoulders were most frequently affected. Headache and visual discomfort were also reported. Longer workload over time and ageing resulted in significantly more disorders (P<0.01). Female physicians had significantly more disorders (P<0.01).

    Conclusions: This study revealed musculoskeletal disorders in a majority of laparoscopists. The laparoscopic technique often requires static and tiring work positions, sometimes extreme, which can explain musculoskeletal disorders among general surgeons and gynecologist.

  • 15.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Observation vid anestesi ger viktig kunskap2006In: Vårdfacket, ISSN 0347-0911, Vol. 30, no 3, p. 55-56Article in journal (Other (popular science, discussion, etc.))
  • 16.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperativ smärta2005In: Incitament, ISSN 1103-503X, Vol. 14, no 2, p. 211-213Article in journal (Refereed)
    Abstract [en]

    Trots att det idag finns kraftfulla och skonfulla läkemedel, tekniker och kunskap som möjliggör smärtlindring, upplever omkring 50% av patienterna moderat till svår smärta efter operation. Akut smärta efter kirurgisk intervention kan utlösa ogynnsamma effekter. Det är med andra ord fortfarande angeläget att vidareutveckla den postoperativa smärthanteringen. Denna avhandling fokuserar på möjligheter att optimera smärthanteringen efter operation.

  • 17.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative pain management: Nurse perspectives on acute pain services2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Postoperative pain management (POPM) has remained an area of concern despite major efforts to improve pain assessment and management by the introduction of specified guidelines, advanced techniques for pain alleviation, and education of staff members. Different nurse specialists are involved in the perioperative care of surgical patients. It is still not known to what extent the specific information noted by the nurses about the individual surgical patient at the different steps of the perioperative management is taken into consideration so that a potentially more optimal, individualised POPM as part of acute pain services (APS) can be provided.

    The aims of the present study were to assess if information of potential value for the POPM is noted by nurse anaesthetists involved in the perioperative management of surgical patients and to what extent such information could be of value for an individualised POPM of surgical patients and if nurse involvement is of importance for the adequacy and efficacy of POPM routines in a nurse-based, anaesthesiologist-supervised acute pain service (APS) model on surgical wards.

    Semistructured interviews of nurse anaesthetists (n=40), questionnaire responses of staff members (n=375)/surgical patients (n=110) and assessment of medical records (n=135)/database data (n=222) were included for evaluation of factors of importance in the perioperative care and POPM of surgical patients. Descriptive statistics, non-parametric and parametric tests were used for the analysis of the data.

    It was found that nurse anaesthetists continuously monitor different stress evoked physiological signs induced by surgical interventions during general anaesthesia. Nurses considered the signs indicative of pain evoked stimuli and/or insufficient depth of anaesthesia. The intraoperative information of the response pattern and anaesthetic drug requirements of the individual patient noted by the nurse anaesthetist was considered at present not to be routinely taken into consideration but could be a successful strategy in an optimal multi-professional approach to postoperative pain management. The introduction of APS, using a nurse-based anaesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with information about POPM, and increased confidence in pain management among nurses on the surgical wards than was noted for the outcome data for the hospital not having introduced such an APS model. Database documentation of outcome measures of POPM for patients receiving postoperative epidural analgesia was found to provide valuable information about the adequacy of the POPM. The feedback of information from the anaesthesia services to the surgical ward nurses was found not to be efficient enough to make ward nurses properly aware of the importance of their own direct involvement in the documentation process of POPM and that such involvement could further optimise POPM outcome

  • 18.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative pain management: Nurse perspectives on acute pain services2005In: Smärta, ISSN 1402-1048, Vol. 10, no 1, p. 5-6Article in journal (Other (popular science, discussion, etc.))
  • 19.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Specialistsjuksköterskan viktig för nyopererades smärtlindring2005In: Perspektiv på högskolan i Skövde, ISSN 1653-8242, Vol. 1, no 2, p. 16-17Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Det är viktigt med kontinuerlig kommunikation mellan all personal som bedömer, behandlar och dokumenterar patientens smärta i samband med kirurgi. Här har specialistsjuksköterskan en viktig roll för att föra information om patienten vidare. Det visar en avhandling från Sahlgrenska akademin.

  • 20.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, Department of Health Sciences.
    Haljamäe, Hengo
    Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg.
    Acute pain services2003In: Current Anaesthesia and Critical Care, ISSN 0953-7112, E-ISSN 1532-2033, Vol. 14, no 5-6, p. 211-215Article in journal (Refereed)
    Abstract [en]

    An interdisciplinary acute pain service (APS) team seems the most attractive clinical organization model for postoperative pain management (POPM) to fulfil the intentions of pain management guidelines in practice. The specific knowledge of anaesthesiologists in the use of drugs and techniques for pain alleviation is of specific importance. Therefore, the anaesthetist is usually the team leader and works together with nurses in the postanaesthesia care unit (PACU), acute pain nurses (APN) and surgical ward nurses. A nurse-based anaesthesiologist supervised type of APS seems in several respects to be a suitable model for POPM in clinical practice.

  • 21.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Haljamäe, Hengo
    Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg.
    Postoperative pain management: impact of quality assurance and audit documentation on clinical outcome2003In: Current Anaesthesia & Critical Care, ISSN 0953-7112, Vol. 14, no 5-6, p. 217-221Article in journal (Refereed)
    Abstract [en]

    Progress in postoperative clinical pain assessment and management is not only dependent on optimal choice of analgesic drugs and techniques but also of quality assurance of the clinical routines, i.e. the overall organization of the acute pain services. Proper revision of present routines on the basis of accepted quality assurance standards and practice guidelines on pain management is an essential part of improved postoperative pain management. The present survey reflects the impact of organizational revision of pain management routines on the audit of pain management and on the attitudes of staff members involved in the acute pain service. Monitoring and documentation of relevant audit variables are essential and such outcome variables should continuously be analysed and constitute a feedback channel between all staff members involved in the APS so that remaining problems can be identified and properly managed

  • 22.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Lorentzen, Per
    Skaraborgs Hospital, Skövde, Sweden.
    Joelsson, Håkan
    Skaraborgs Hospital, Skövde, Sweden.
    Lindquist, Helene
    Skaraborgs Hospital, Skövde, Sweden.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Postoperative pain management on surgical wards: impact of database documentation of anesthesia organized services2003In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 4, no 4, p. 155-164Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient’s level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.

  • 23.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Segerdahl, M.
    Karolinska Institutet.
    Rawal, N.
    Örebro University Hospital.
    Jakobsson, J.
    Karolinska Institutet.
    Brattwall, M.
    Sahlgrenska University Hospital, Gothenburg.
    Clinical Practice and Routines for Day Surgery in Sweden: Implications for Improvement in Nursing Interventions2008In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 23, no 5, p. 311-320Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to examine nursing practice in day surgery settings in Sweden. A questionnaire focusing on the routines of the day surgery process of patients in Sweden was administered. Based on these findings, appropriate nursing interventions are outlined and discussed. Day surgery routines were in accordance with general worldwide practice. The study revealed that nursing involvement was rare in the preoperative routine. In addition, the major part of the recovery process, including assessments of discharge eligibility and information about pain management, was managed by PACU nurses. The nurse follow-up revealed a number of subjective queries and symptoms that, in a seemingly easy way, could have been prevented by further perianesthesia/perioperative patient education. There is an obvious place for nursing interventions when the decision for day surgery is taken. These interventions should focus on providing the patient with information before surgery, preoperative patient health screening, and information/education at discharge. Furthermore, nursing interventions should include quality assurance, such as follow-up calls for the evaluation of care, as well as providing information and coaching for the patient at home.

  • 24.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Haljamae, Hengo
    Routine intra-operative assessment of pain and/or depth of anaesthesia by nurse anaesthetists in clinical practice2001In: Journal of Clinical Nursing, ISSN 1365-2702, Vol. 19, no 4, p. 429-436Article in journal (Refereed)
    Abstract [en]

    • Patient safety and comfort during general anaesthesia and surgery are to a considerable extent dependent on the capability of anaesthesia personnel to interpret directly monitored as well as indirect clinical signs of pain and/or depth of anaesthesia.

    • The aim of the present study was to evaluate how nurse anaesthetists in their clinical routine work assess and interpret intra-operative responses evoked by pain stimuli and/or insufficient depth of anaesthesia.

    • A questionnaire was designed to assess the perceived relevance and validity of cardiovascular, respiratory, mucocutaneous, eye-associated, and muscular responses for routine assessment of intra-operative pain and/or insufficient depth of anaesthesia in patients undergoing surgery under general anaesthesia.

    • Data were obtained from 223 nurse anaesthetists working at nine different university anaesthesia departments in Sweden.

    • A number of significant indicators for pain and depth of anaesthesia could be identified for spontaneously breathing as well as for mechanically ventilated patients. No variable was considered entirely specific for either intra-operative pain or depth of anaesthesia. Changes in breathing rate/volume, central haemodynamics (BP, HR), lacrimation, and presence of moist and sticky skin were given higher score values as indicators of pain than as indicators of depth of anaesthesia. Occurrence of grimaces, attempted movements, and presence of non-centred pupils were variables considered more indicative of insufficient depth of anaesthesia than intra-operative pain.

    • In conclusion, it is obvious from the present data that indirect physiological signs of intra-operative pain and depth of anaesthesia are still considered of importance by Swedish anaesthesia nurses in the anaesthetic management of surgical patients.

  • 25.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, Department of Health Sciences.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences. Göteborg University.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg.
    Assessing Pain Responses During General Anesthesia2001In: AANA Journal, ISSN 0094-6354, Vol. 69, no 3, p. 218-222Article in journal (Refereed)
    Abstract [en]

    Major technical and pharmacological achievements in recent years have greatly influenced the practice of anesthesia. Clinical signs related to the main aspects of anesthesia, i.e., hypnosis, analgesia, and muscular relaxation, are increasingly obtainable from variables supplied by the monitoring equipment. It is not known, however, to what extent more indirect, patient-associated clinical signs of pain/depth of anesthesia are still considered of importance and relied on in the intraoperative management of surgical patients. The aims of the present study were to assess what clinical signs, indirect as well as monitor-derived, are considered indicative of intraoperative pain or depth of anesthesia by nurse anesthetists during general anesthesia. In connection with anesthetic management of surgical patients, Swedish nurse anesthetists (N = 40) were interviewed about clinical signs that they routinely assessed and were asked if the observed signs were considered indicative mainly of intraoperative pain or depth of anesthesia. It was found that skin-associated responses (temperature, color, moisture/stickiness) were commonly considered to indicate intraoperative pain rather than depth of anesthesia. Respiratory movements, eye reactions, and circulatory responses were considered to be indicative of either pain or insufficient depth of anesthesia. The present data indicate that indirect physiological signs are still considered of major importance by anesthesia nurses during the anesthetic management of surgical patients.

  • 26.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences. University of Göteborg.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Haljamäe, Hengo
    Sahlgrenska University Hosptial, University of Göteborg.
    The role of the nurse anesthetist in the planning of postoperative pain management2003In: AANA Journal, ISSN 0094-6354, Vol. 71, no 3, p. 197-202Article in journal (Refereed)
    Abstract [en]

    Adequate pain relief after surgery is essential for avoiding pain-associated stress and patient comfort in the postoperative period. The Swedish nurse anesthetist has an important role in the intraoperative management of the surgical patient by assessing and moderating individual physiological response evoked by surgical stimuli during general anesthesia. The extent to which knowledge of specific individual response patterns are used to plan postoperative pain management is unknown. The aim of the present study was to assess the role of the nurse anesthetist in planning early postoperative pain management for surgical patients. Nurse anesthetists (N = 101) at 4 academic hospitals in Sweden responded to a questionnaire focusing, in addition to demographic data, on intraoperative routines for postoperative pain management, perceived clinical relevance of used routines, personal involvement (in addition to existing routines) in postoperative pain management, factors influencing pain alleviation requirements, and the potential role of the nurse anesthetist for improved postoperative pain management. We found that type of anesthesia and type of surgical procedure were both factors considered important for postoperative pain management. A majority of the participants believed that pain management approaches were not appropriately individualized to the patient.

  • 27.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Wickström, Kerstin
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Joelsson, Håkan
    University of Skövde, School of Life Sciences. Skaraborgs Hospital, Skövde, Sweden.
    Sjöström, Björn
    University of Skövde, School of Life Sciences. Sahlgrenska University Hospital, Göteborg, Sweden.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Postoperative pain management on surgical wards: do quality assurance strategies result in long-term effects on staff member attitudes and clinical outcomes?2003In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 4, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management (POPM) remains suboptimal on surgical wards in many countries despite the availability of effective analgesics, new technologies for drug administration, and clinical practice guidelines for pain management. The aim of the present study was to assess remaining long-term effects on pain management routines, patient experiences, and staff member attitudes in surgical wards more than 3 years after introduction of a quality assurance program for POPM and compare the findings to those of an organization where a corresponding systematic, entire hospital, quality assurance program had not been completed. A descriptive and comparative design, based on survey data from both patients (N = 110) and staff members (N = 51) on urologic surgery wards, was used. Significant (p < .05 to p < .0002) overall relationships were observed for identified shortages in pain management routines (lack of preoperative information, inadequate preoperative discussions on pain management, wait for pain killer) and reported experience of pain, nausea, or vomiting in the postoperative period. The quality assurance program, anesthesia-based pain services using a nurse-based anesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with POPM, and increased confidence in pain management among nurses on the surgical wards. On the basis of the present study it may be concluded that more than 3 years after the introduction of a quality assurance program for POPM in surgical wards, the pain management routines, patient experiences, and staff member attitudes have remained markedly improved and in accordance with the aims of accepted clinical practice guidelines for surgical pain management.

  • 28.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Öhman, Ulla-Britt
    Surgical Department, Hospital of Falköping, Sweden.
    Patients undergoing total hip arthroplasty: a perioperative pain experience2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 4, p. 451-458Article in journal (Refereed)
    Abstract [en]

    Aim. The aim was to evaluate patient’s perioperative pain experience after total hip replacement and patients’ satisfaction with pain management.

    Background. Total hip arthroplasty is a common surgical procedure intended to reduce pain and return patients to better function. Realistic expectations about total hip arthroplasty is important for optimal postoperative recovery and the information must be adapted to fit the individual patient.

    Methods. A descriptive design was used comparing patients outcome data. Pitman’s test was used for statistical analyses. Adult patients (n ¼ 112) undergoing surgical hip replacement procedures answered a 17-item questionnaire on the fourth postoperative day. The questionnaire included given alternatives and visual analogue scales (0–100 mm) for the pain assessment.

    Result. The patients’ postoperative pain experience after hip replacement surgery was in average low, 33Æ1 mm on a 100 mm visual analogue scale. Patient’s pain experience was reported to be highest on the first postoperative day for most of the patients. The preoperative pain experience tends to be higher than the postoperative

    pain experience. Older patients reported less average pain level postoperatively. Satisfaction with pain management was high.

    Conclusion. The pain experience tends to be higher preoperatively than postoperatively. Patients who reported a higher pain experience postoperatively reported that their pain experience was significant higher than preoperative expected.

    Relevance to practice. It is important for the postoperative outcome measure that the patients have a realistic expectation of pain experiences after total hip arthroplasty. The nurse is one of the staff members responsible for information to the individual patient.

  • 29.
    Wennerström, Berith
    et al.
    Skaraborg Hospital, Kärnsjukhuset.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Modin, Marina
    Skaraborg Hospital, Kärnsjukhuset.
    Skullman, Stefan
    Skaraborg Hospital, Kärnsjukhuset.
    Patient symptoms after colonic surgery in the era of enhanced recovery - a long-term follow-up2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 5-6, p. 666-672Article in journal (Refereed)
    Abstract [en]

    Aims. The main purpose of this study was to analyse, prospectively, patient symptoms during the first four weeks following elective colon surgery. A secondary aim was to find areas to improve inpatient information and postoperative care.

    Background. Fast-track recovery following colon surgery has been proven beneficial to patients in the early postoperative phase. Less is known about the continuous recovery at home.

    Design. A prospective follow-up survey.

    Methods. Consecutive patients (n = 32) planned for elective colon surgery were evaluated. Both open and laparoscopic operations were included. All followed a fast-track protocol in hospital. Patient symptoms were recorded by validated quality of life questionnaires (EORTC QLQ-C 30, EORTC QLQ-CR 38 and Brief Pain Inventory). An interview was conducted five weeks and one year after surgery.

    Results. The hospital stay was six days, and 10% of patients were readmitted. The fast-track concept worked well. The main problems after discharge were fatigue, nausea and bowel disturbances. Pain was not a significant issue. Most symptoms had disappeared after four weeks.

    Conclusions. The first period at home is troublesome, and better information about common symptoms is needed. A direct telephone line has been set up to answer questions and to lower patient anxiety.

    Relevance to clinical practice. Clinical guidelines for patient’s discharge planning can be performed based on the results from this study. Further improvement regarding the epidural anaesthesia is needed to reduce minor side effects.

  • 30.
    Wickerts, L.
    et al.
    Danderyds Univ Hosp, Dept Anaesthesia & Intens Care, Stockholm, Sweden .
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Brattwall, Metha
    Mölndals Univ Hosp, Dept Anaesthesia, Sahlgrenska Acad, Gothenburg, Sweden .
    Jakobsson, Jan
    Karolinska Inst, Inst Physiol & Pharmacol, Sect Anaesthesia & Intens Care, Stockholm, Sweden.
    Coxibs: is there a benefit when compared to traditional non-selective NSAIDs in postoperative pain management?2011In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 77, no 11, p. 1084-1098Article, review/survey (Refereed)
    Abstract [en]

    A multi-modal approach for the management of postoperative pain has become increasingly popular. Strategies to avoid the use of opioids and thus any opioid analgesic related side-effect is an important part of the expansion of ambulatory surgery Combining long acting local anesthesia in the wound area and non-opioid analgesics are today a basic concept in management of day care, short stay patients. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) is often sufficient to provide satisfactory pain relief after minor and intermediate procedures. The use of multimodal or balanced analgesia has since long been shown to facilitate resumption of activities of daily living. The opioid sparing effects of the addition of NSAIDs to morphine patient-controlled analgesic (PCA) after major surgery has also shown repeatedly. The development and introduction of the most selective cyclo-oxygenase-2-inhibitors (Coxibs) was primarily indicated to reduce the risk and severity of gastrointestinal bleeding. The Coxibs have become an interesting option in postoperative pain management. The less pronounced effect on platelet function and subsequent lower risk for impaired hemeostasis makes them, in theory, a preferred option to the nonselective traditional NSAIDs. The benefit versus risk for a more generalized use of Coxibs must, however, be based on a thorough evaluation of the overall benefits and risks for the use of NSAIDs and a further evaluation on whether the specific therapeutic features of the Coxibs provide benefits outweighing their increased cost. This review aims at providing a background and an overview of the benefits versus risks for the use of Coxibs as part of a multimodal postoperative pain management. (Minerva Anestesiol 2011;77:1084-98)

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