Possibilities of creating meaningful encounters in anesthesia nursing [article]

Karin Aagaard
2016 The PhD Series of theThe PhD Series of the Faculty of Medicine  
Published by: Aalborg University Press Skjernvej 4A, 2nd floor DK -9220 Aalborg Ø Phone: +45 99407140 aauf@forlag.aau.dk forlag.aau.dk © Copyright: Karin Aagaard Printed in Denmark by Rosendahls, 2016 V CV Karin Aagaard became a registered nurse in 2000. She has a background in cardiology and oncology nursing. In 2012, she graduated as a Master of Science in Nursing from Aarhus University and was enrolled as a PhD student at Aalborg University in April 2013. Using focused ethnography, her
more » ... nography, her research focuses on nursing in the highly technological environment of Anesthesia Nursing. During her work in clinical practice, Karin has always been particularly interested in the complexity of the nurse/patient relationship. This interest has resulted in an exploration of nurse anesthetist and patient interactions before general anesthesia. VII ENGLISH SUMMARY Anesthesia nursing is performed in a highly technological environment with restricted time for interaction with patients. Patients are in a vulnerable position, which can be characterized by anxiety regarding the anesthetic and surgical procedure. The bedrock of effective nursing care is to facilitate the execution of patients' basic care needs in a respectful, competent, empathic and personal way. This is achieved by establishing a relationship with the patient, integrating the individual patient's care needs and making sure that the setting is responsive and committed to these core tasks of nursing. The purpose of this dissertation is to explore the interactions between patients and nurse anesthetists before general anesthesia. Moreover, it will explore the professional identity of nurse anesthetists, in relation to the situation of preparing patients for general anesthesia. The research design of this dissertation is focused ethnography, containing participant observation, interviews and photographs. Grounded Theory provides the inspiration for the analysis. The dissertation is based on three articles, with the following results. Article 1 focuses on the interaction between patients and nurse anesthetists when preparing patients for general anesthesia. Creating emotional energy emerged as the core variable and is an integral component when nurse anesthetists interact with patients and perform highly technological procedures. Moreover, motivations for patient interaction are a central ingredient in developing anesthesia care. Article 2 focuses on the patients' perspectives of interacting with nurse anesthetists while being prepared for general anesthesia. The core variable of this article is betwixt and between worrying thoughts and keeping focus. The core variable demonstrates that there is a certain complexity and ambiguity in patients' psychosocial needs and feelings when being prepared for general anesthesia. Patients' psychosocial needs are related to coping strategies and care needs. Article 3 focuses on nurse anesthetists' professional identity, their expectations towards their professional self and expectations from the interdisciplinary team members. The core variable emerged as identifying the professional self. The hallmark of nurse anesthetists' professional self consists of downsizing patients' psychosocial and relational needs of care in favor of performing highly technological procedures. Moreover, nurse anesthetists find great value in professional independence when performing technical routines. A joint discussion of the three core variables from articles 1-3 leads to the conclusion of the dissertation. A micro-substantive theory is developed regarding the opportunities for creating meaningful encounters between patients and nurse anesthetists. The concepts of the theory can be used to explore the complex interactions between patients and nurse anesthetists in a highly technological POSSIBILITIES OF CREATING MEANINGFUL ENCOUNTERS IN ANESTHESIA NURSING VIII environment. The theory is based on three dominant motivations for patient interaction in anesthesia nursing and indicates that the context of care is not committed and responsive to the core elements of a nurse anesthetist-patient relationship. This results in focus on production-centered care instead of patient-centered care when preparing patients for general anesthesia. IX DANSK RESUME Anaestesisygepleje bliver udført i et højteknologisk miljø med begraenset tid til interaktion med patienter. Patienterne er i en sårbar position, som kan vaere karakteriseret af angst for den anaestesiologiske og kirurgiske procedure. Fundamentet for effektiv sygepleje er at fremme udførelsen af patienters grundlaeggende behov for omsorg på en respektfuld, kompetent, empatisk og personlig måde. Dette gøres ved at etablere en relation med patienten, integrere den individuelle patients omsorgsbehov og at sikre sig at omsorgsmiljøet omkring patienten er imødekommende og engageret over for disse kerneopgaver i sygepleje. Formålet med denne afhandling er at undersøge anaestesisygeplejerskers og patienters interaktion før generel anaestesi og ydermere at undersøge anaestesisygeplejerskers faglige identitet relateret til situationen, hvor patienten forberedes til generel anaestesi. Afhandlingens forskningsdesign er fokuseret etnografi, indeholdende deltager observation, interviews og fotografier. Analysen er inspireret af Grounded Theory. Afhandlingen er baseret på tre artikler med følgende resultater. Artikel 1 fokuserer på interaktionen mellem patienter og anaestesisygeplejersker under forberedelse af patienterne til generel anaestesi. At skabe emotionel energi fremkom som en kernevariabel og er en integreret komponent af anaestesisygeplejerskens interaktion med patienten og under udførelsen af højteknologiske procedurer. Ydermere er motivationerne for patientinteraktion en central del af udviklingen af anaestesisygepleje. Artikel 2 fokuserer på patientens perspektiv på interaktionen med anaestesisygeplejersken under forberedelsen til generel anaestesi. Kernevariablen i denne artikel er midt imellem bekymrende tanker og at holde fokus. Kernevariablen viser, at der er en saerlig kompleksitet og ambivalens i patienters psykosociale behov og følelser under forberedelserne til generel anaestesi. Patienternes psykosociale behov er relaterede til mestringsstrategier og omsorgsbehov. Artikel 3 fokuserer på anaestesisygeplejerskernes professionelle identitet, deres forventninger til det professionelle selv og forventninger fra tvaerfaglige gruppemedlemmer. Kernevariablen fremkommer som identificering af det professionelle selv. Kendetegnet ved anaestesisygeplejerskers professionelle selv består af en nedprioritering af patienters psykosociale og relationelle behov til fordel for udførsel af højteknologiske procedurer. Derudover finder anaestesisygeplejersker stor vaerdi i professionel selvstaendighed i udførelse af tekniske rutiner. Konklusionen på denne afhandling udledes af en samlet diskussion bestående af de tre kerne variabler fra artikel 1-3. Der udvikles en mikro teori om mulighederne for at skabe meningsfulde møder mellem patienter og anaestesisygeplejersker. Begreberne i teorien kan anvendes til at undersøge den komplekse interaktion mellem patient og anaestesisygeplejerske i et højteknologisk miljø. Teorien er baseret på tre dominerende POSSIBILITIES OF CREATING MEANINGFUL ENCOUNTERS IN ANESTHESIA NURSING X motivationsfaktorer for interaktion i anaestesisygepleje og viser at omsorgsmiljøet ikke er imødekommende og engageret i kerneelementerne af anaestesisygeplejerskepatient relationen. Dette resulterer i et fokus på produktionscentreret omsorg i stedet for patientcentreret omsorg under forberedelse af patienter til generel anaestesi. XI
doi:10.5278/vbn.phd.med.00054 fatcat:tplldy6zkzce7khihiemzlrp5u