Work-related trauma: the experiences of perioperative nurses

Traumatic experiences in the workplace are an integral part of the role of the perioperative nurse. The atypical nature and characteristics of these experiences is such that perioperative nurses may suddenly encounter reactions and feelings that are very different and more intense than anything they will have encountered previously. Furthermore, these events may increase the risk of them experiencing subsequent trauma stress reactions and place them at risk of profound distress and significantly impaired functioning. A survey of 233 nurses working in rural and metropolitan operating theatres assessed the range and types of traumatic work experiences. Results showed that exposure to traumatic events was reported by 161 (69%) of all respondents and a wide range of traumatic experiences were reported to have affected their well-being. The findings have implications for the formulation of trauma management strategies, both at individual and organisational levels and suggest new directions for education and research in promoting a recovery environment in which perioperative nurses can work.     

Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.     

The use of patient diaries in an intensive care unit

Many patients experience posttraumatic stress disorder following a stay in intensive care; this can be due to a lack of recall of their stay. Retrospective patient diaries (n = 8) with follow-up have been used to try and help patients' recovery but have been found to be impersonal. Prospective diaries (n= 35) were implemented and trialled with follow-up at 2, 6 and 12 months postdischarge. Patients' and relatives' initial feedback regarding diaries is extremely positive. Benefits included better understanding of the events of the critical illness, helping with more realistic goal setting during the recovery period, improving communication within families through discussion of the diary and providing a source of comfort for the bereaved. More formal audit of these diaries is required and is currently being undertaken.     

Intensive care patient diaries in Scandinavia: a comparative study of emergence and evolution

Critical illness and intensive care therapy are often followed by psychological problems such as nightmares, hallucinations, delusions, anxiety, depression, and symptoms of posttraumatic stress. Intensive care patient diaries have been kept by nurses and the patients' family since the early 1990s in the Scandinavian countries to help critically ill patients come to terms with their illness after hospital discharge. The aim of the study was to describe and compare the emergence and evolution of intensive care patient diaries in Denmark, Norway, and Sweden. The study had a comparative international design using secondary analysis of qualitative data generated by key-informant telephone interviews with intensive care nurses (n=114). The study showed that diaries were introduced concurrently in the three Scandinavian countries as a grass-roots initiative by mutual cross-national inspiration. The concept has evolved from a pragmatic practice to an evidence-based domain of inquiry propelled by academically prepared nurses. Several schools of thought were identified in our study: diaries as (i) a therapeutic instrument, (ii) an act of caring, (iii) an expression of empathy, and (iv) a hybrid of the above. Diaries have the potential to fulfill the existential needs of patients who struggle to make sense of their experiences and construct their own illness narrative.     

The impact of work-related trauma on the well-being of perioperative nurses

Perioperative nurses are confronted daily with the reality of trauma, of experiencing abuse and conflict in the workplace, dealing with practice issues such as gruesome motor vehicle accidents, as well as the heartbreaking tragedy of death (Michael 1999, Michael & Jenkins 2000). This study explored the reported impact of traumatic events upon the well-being of perioperative nurses, using both qualitative and quantitative methods of inquiry. Of the 233 respondents in this study, 161 (69%) reported being exposed to traumatic events. The types of described reactions following trauma were predominantly negative and included negative feelings, negative team member relationship issues, negative behaviour from others, physical concerns and negative working conditions. Intrusion and avoidance behaviour was reported to a significant degree. Performance distress, somatic distress, general feelings of distress and self-related health were significantly poorer in perioperative nurses who had experienced trauma, than their colleagues without such experiences. Conversely, some respondents were able to construe positive outcomes from trauma and grow from the experience. Positive outcomes included gains from the experience, team building, positive feelings and action taken. The current study contributes to understanding of the role of environmental factors, associated work-related trauma and recovery following such events. The outcomes have implications for effective trauma stress management interventions and continuing education of nurses.     

针对性健康教育对股骨干骨折患者术后康复的影响

目的观察针对性健康教育对股骨干骨折患者术后康复的影响。方法随机选择股骨干骨折术后患者60例,随机分为实验组(n=30)和对照组(n=30),实验组进行针对性的健康教育,对照组进行常规教育,比较2组患者术后康复知识水平及肢体功能恢复情况。结果实验组术后康复知识水平明显高于对照组(P<0.01);肢体功能恢复情况优于对照组(P<0.01)。结论健康教育可以提高股骨干骨折住院患者术后康复知识水平,促进肢体功能恢复。     

Hospital experiences of young adults with congenital heart disease: divergence in expectations and dissonance in care.

BACKGROUND: Despite increasing survival for adults with congenital heart disease, little is known about hospitalization for young adult patients with this disease and for their families. Because of the complexity of the disease and its management during the life span, young adults are often hospitalized on both pediatric and adult units during a stay in the hospital. OBJECTIVES: To explore the experience of hospitalization of young adults with congenital heart disease, the experience of their families, and the views of the nurses who cared for these patients and to generate substantive theory on interactions between patients, patients' families, and nurses. METHODS: Semistructured interviews and naturalistic observations were conducted with young adults with congenital heart disease (mean age, 28.6 years), their family members, and nurses who cared for the patients during hospitalization (N=34). Dimensional analysis was used to analyze interviews and field notes from observations. RESULTS: A grounded theory was derived, explaining how the hospital context and relationships between patients, patients' families, and nurses affect patients' hospital experiences. Expectations differed among the groups, leading to dissonance in care, as exemplified by role confusion and power struggles over control of care. This dissonance resulted in interpersonal conflict, distrust, anxiety, and dissatisfaction with the care and caring experiences. CONCLUSIONS: Changes in hospital units, a better understanding of the healthcare needs of young adults with congenital heart disease, and acknowledgment of the expertise of patients and patients' families are needed to improve nursing care for these patients and their families.     

Experiences of caretime during hospitalization in a medical ward: older patients' perspective

The population is ageing the world over, and there is an increasing prevalence of chronic illness and complex conditions. Older people are at greater risk of having several complications than the general population, leading to more time spent in hospital and an increased risk of readmission. The most specific need of older patients is often the multiple need of care. The aim of this study was to describe older patients' experiences of caretime during a hospitalization in a medical ward. Data were collected with semi-structured interviews with nine older patients, and analysed using qualitative thematic content analysis. The analysis resulted in two themes and five categories. The results show that caretime during hospitalization includes a lot of waiting and that patients manage the waiting in different ways. The results also point out the importance of patients developing good relationships with professionals since good relations creates feelings of security and can reduce anxiety and fear during a hospital stay. The patients pointed out the importance of being more involved in their own care and asked for more detailed information about the hospital stay. The results revealed that information makes patients' more secure and safe during a hospitalization and makes them participate and affect their own care and treatment more.     

综合康复治疗体系对54例地震致下肢骨折患者功能康复的影响

目的：探讨综合康复治疗体系对54例地震致下肢骨折患者功能恢复的影响。方法：采用综合康复治疗方法治疗“5·12”汶川大地震所致54例下肢骨折患者,临床观察患者伤口的愈合情况和骨折的复位情况,有无骨折并发症,分析比较治疗前后患者下肢功能恢复情况及日常生活活动能力的改善。结果：康复治疗后关节活动度明显改善,由入院时的平均218．61°增加至出院时的237．5°（P〈0．001）。Barthel指数由入院时的平均55．4增加至出院时的70．8（P〈0．001）,日常生活活动能力有较大幅度提高。结论：综合康复治疗体系对于地震伤致下肢骨折患者的功能恢复至关重要,一套完善的体系应包括：①康复治疗早期介入,功能锻炼长期坚持;②发挥大型综合性医院的优势,多学科交叉,多部门合作;③功能康复和心理康复并重;④专业人士与社会团体共同参与。     

Hip fracture patients' cognitive state affects family members' experiences - a diary study of the hip fracture recovery

Scand J Caring Sci; 2011; 25; 451–458
Hip fracture patients’ cognitive state affects family members’ experiences – a diary study of the hip fracture recovery Background: Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members – spouses, daughters, sons, or even neighbours become informal carers. Aim: To explore how hip fracture patients’ cognitive state affect family members’ experiences during the recovery period. Methods: Eleven diaries written by family members’ of hip fracture patients were analysed by means of qualitative content analysis. Findings: The analysis generated two main categories with four categories. The first main category was; ‘Being a family member of a cognitively impaired patient’ with the categories ‘Dissatisfaction with lack of support’ and ‘Emotional distress due to the patient’s suffering’. The second main category was ‘Being a family member of a cognitively intact patient’ with the categories ‘Satisfaction with a relative’s successful recovery’ and ‘Strain due to their caring responsibilities’. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients’ suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members. Conclusions: The findings suggest the hip fracture patient’s cognitive state is more decisive than the hip fracture itself for the family members’ experiences.     

Deprivation of liberty in psychiatric hospital care: the patient's perspective

Deprivation of liberty in psychiatric hospitals is common world-wide. The aim of this study was to find out whether patients had experienced deprivation of their liberty during psychiatric hospitalization and to explore their views about it. Patients (n = 51) in two acute psychiatric inpatient wards were interviewed in 2001. They were asked to describe in their own words their experiences of being deprived of their liberty. The data were analysed by inductive content analysis. The types of deprivation of liberty in psychiatric hospital care reported by these patients were: restrictions on leaving the ward and on communication, confiscation of property, and various coercive measures. The patients' experiences of being deprived of their liberty were negative, although some saw the rationale for using these interventions, considering them as part of hospital care.     

Exploring the diary as a recovery‐oriented therapeutic tool

Diary writing is a centuries‐old method of recording events, experiences, thoughts, and feelings that might offer potential as a tool that consumers and nurses could utilize in recovery‐oriented practice. While the diary has been used within health disciplines to detail and communicate personal experiences to enable collaborative examination of progress, a diary can also provide a more complete picture of what life is like; not only within the confines of a health service environment, but also outside. In recent times, the diary appears to be experiencing a renewed interest in terms of health care. People experiencing a mental health challenge might use diary‐based forms of communication to promote understanding between themselves and mental health workers, and ultimately the use of this form of narrative therapy might facilitate person‐centred, recovery‐based actions. The present study paper, therefore, explores multiple perspectives on the use of diaries in the therapeutic context. Suggesting that diaries have not yet been utilized to their fullest potential by and with consumers and clinicians, this discussion raises issues and offers clarity about diary forms and their uses in the health context. It also discusses the barriers to their use and how to engage consumers and clinicians in recovery‐oriented work.     

Recovering from cardiac surgery: what patients want you to know.

BACKGROUND: Care of cardiac surgery patients has changed substantially in the past decade, with an emphasis on streamlined procedures and shortened hospital stays. The few qualitative reports of patients' perspectives of this experience focus primarily on physical complications and discomforts during the immediate postoperative period. OBJECTIVE: To examine patients' perceptions of the quality of the nursing and medical care they received during their hospital stay after cardiac surgery. METHODS: Data were collected from a consecutive sample of 89 cardiac surgical patients who consented to participate in 2 telephone interviews at 1 week and 6 weeks after hospitalization. Patients responded to a single open-ended question: "What do you want your nurses and doctors to know to help them do a better job?" Thematic extraction analysis of patients' responses was conducted by using commercially available statistical software. Extracted themes were applied to the structure-process-outcome framework of quality of care. RESULTS: Four major themes (and 12 subthemes) were identified: (1) being satisfied (having a positive experience, getting information), (2) not being cared for (feeling depersonalized, having expectations that did not match recovery experiences, not being listened to, experiencing unprofessional behavior by care providers, experiencing continued care needs after going home), (3) physical needs unmet (sleep, pain, complications, physical environment), and (4) informational needs unmet (needing more or different information). CONCLUSIONS: Patients want nurses and doctors to provide a smooth transition to home, recognize the patients as individuals, prepare them honestly for their experiences with specific information, and manage pain and sleep.     

Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge.

There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. Conclusions: Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.     

Working conditions and the possibility of providing good care

Background An open and tolerant climate characterized by joy in work where the personnel can mature as people and develop their professional competence was postulated as essential to working conditions under which good care can be provided in line with a care policy accepted for healthcare in a northern Swedish county. AIM: This study aimed to examine working conditions before and 3 years after the implementation of the care policy. METHOD: All personnel working on four hospital wards in the county described their experiences in questionnaires in a baseline measure in 1995 (n = 119) and a follow-up measure in 1998 (n = 106). FINDINGS: Lower ratings for working conditions were found in many respects in the follow-up measure. Fewer respondents from three wards expressed satisfaction with their current work situation. More respondents in one of these wards expressed, in addition, an inability to keep up with their work and fewer also evaluated their immediate superiors as good leaders. More of the respondents from one ward expressed the intention of looking for alternative employment and wanted to have another job. More respondents in two wards reached scores indicating burnout risk or burnout, and lower means were seen in two to 10 work climate dimensions per ward, out of 10 possible, in the follow-up measure compared with the baseline. CONCLUSION: The working conditions seen as requisite for the possibility of providing good care seem to have deteriorated in a number of respects on the wards studied over a three-year period and improvements are needed if the care offered is to be in line with the stated care policy. A concurrent study investigating patient satisfaction of the care quality in the same county showed a deterioration in their assessments between measurements carried through with a three-year interval, implying a relationship between the working conditions of the personnel and the patients' experiences of care.     

Orthopaedic patients' experience of motor vehicle accident in Singapore

Aim:  The purpose of this paper is to present a study that explored the experiences of orthopaedic patients injured in motor vehicle accidents (MVAs), from the time of the accident until 6 months after being discharged from hospital.
Background:  Trauma injuries from MVAs are increasing, with the number of deaths from such injuries continuing to rise. Victims often sustain open fractures to more than one part of their body and need rehabilitation and support to adjust to long-term chronic or permanent disability. In the last decade, research pertaining to trauma nursing has concentrated on neurologically injured patients. Although there is a paucity of research on the nursing perspective of psychological care for non-neurologically injured patients, the majority of studies located were mainly quantitative in nature and did not analyse the personal experiences of orthopaedic patients.
Method:  A qualitative naturalistic inquiry approach was used, which provided a first-hand account of the traumatic MVA event experienced by six orthopaedic participants in Singapore. Data were collected from face-to-face in-depth interviews. Participants were voluntarily recruited through purposeful sampling and 'snowballing'. Interviews were audiotaped and transcribed verbatim in preparation for analysis.
Findings:  The analysis of information explicated four main themes: the experience of the event, the effect of hospitalization, surviving the event and self-transformation.
Conclusion:  The study provided an understanding of orthopaedic patients' experience of MVA in Singapore. The findings of the study have the potential to contribute to the limited qualitative research available concerning victims' experiences of MVAs and nurses caring for MVA victims.