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Value conflicts in perioperative practice
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0002-6291-0654
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0002-8836-5842
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0002-9363-5667
2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 7-8, p. 2213-2224, article id 969733018798169Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves.

OBJECTIVES:: This study describes operating theatre nurses' experiences of ethical value conflicts in perioperative practice.

RESEARCH DESIGN:: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation.

ETHICAL CONSIDERATION:: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee.

FINDINGS:: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient's care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient's best. This occurred when operating theatre nurses' competence was not taken seriously and was ignored in patient care.

CONCLUSION:: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations.

Place, publisher, year, edition, pages
Sage Publications, 2019. Vol. 26, no 7-8, p. 2213-2224, article id 969733018798169
Keywords [en]
Care ethics, perioperative practice, theatre nurses, value conflicts
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-70021DOI: 10.1177/0969733018798169ISI: 000486024000029PubMedID: 30345880OAI: oai:DiVA.org:kau-70021DiVA, id: diva2:1260189
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2019-10-10Bibliographically approved
In thesis
1. Operationssjuksköterskans vårdande och kompetens inom perioperativ vård
Open this publication in new window or tab >>Operationssjuksköterskans vårdande och kompetens inom perioperativ vård
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
The operating theatre nurses' caring and competence within perioperative nursing :
Abstract [en]

The overall aim was to describe and deepen the understanding of what operating theatre nurses experience as caring and responsibility as well as ethical problems in perioperative practice. The aim was also to investigate how operating theatre nurses perceive clinical competence in perioperative nursing.

Methods: This research has a hermeneutic design. Qualitative, quantitative and mixed method was used. In the study (I), data were collected through interviews and analysed with phenomenographic method. In studies (II-III) the interview texts from the study (I) was reused. Secondary analysis were performed with hermeneutic text interpretation. In the study (IV), data were collected through a modified questionnaire PROFFSNurse SAS I, which was supplemented with an open question. These data were analysed using statistics and qualitative conventional content analysis.

Results: Operating theatre nurses have the will to meet the patient, be involved and created continuity in the perioperative nursing process (I). Operating theatre nurses experience that they have a formal responsibility to ensure that patients are not at risk and maintain patient integrity and dignity based on personal ethical values (II). Ethical problems and value conflicts can occur if routines and habits prevent operating theatre nurses from caring and when their clinical competence are not utilized in perioperative practice (III). The operating theatre nurses’ self-assessment of clinical competence showed that academic degree, professional experience and interprofessional learning were important for the development of clinical competence. On the other hand, existing routines and habits, as well as inadequate resources, were an obstacle (IV).

Conclusion: Perioperative nursing care includes a nursing process and the operating theatre nurses have responsibility based on ethical values. When the operating theatre nurses are prevented from being a caregiver or that their clinical competence is not utilized, stress of conscience can be caused. Important for the development of clinical competence is an academic degree, professional experience and interprofessional learning.

Abstract [sv]

Operationssjuksköterskans vårdande omfattar patientens pre-, intra- och postoperativ vård. Det perioperativa vårdarbetet ställer krav på att kunna integrera vårdandet med medicinsk teknik för att skapa en god och säker vård i en högteknologisk miljö. 

Genom att ge tid och möjlighet för operationssjuksköterskorna att möta patienter före, under och efter operationen kan deras vårdande bli till för patienten som skall genomgå en operation. Det finns en vilja att vara delaktiga och skapa kontinuitet i den perioperativa vårdprocessen. I det perioperativa vårdarbete tar de ansvar för att skydda patienten i en utsatt och sårbar situation och utifrån inre personliga etiska värderingar upprätthålls integritet och värdighet. Etiska problem uppstår i det perioperativa vårdarbete när vården styrs av rutiner och vanor som kan skapa värdekonflikter vilket hindrar operationssjuksköterskorna från att vara vårdande.

När operationssköterskorna självskattat sin kompetens framkom att akademisk examen och lång yrkeserfarenhet är av betydelse för att kunna hantera komplexa situationer och ta ansvar för de beslut som fattas i vårdandet av patienten.  Vetenskaplig kunskap, medicinsk teknik, omvårdnad/vårdande och interprofessionellt utveckling av lärande är av betydelse för klinisk kompetens.

Utifrån denna avhandlings resultat framkom ny fördjupad förståelse för vad operationssjuksköterskorna uppfattar som att vara en professionell vårdande operationssjuksköterska och behov av utveckling av klinisk kompetens.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2019. p. 83
Series
Karlstad University Studies, ISSN 1403-8099 ; 2019:6
Keywords
operating theatre nurse, perioperative nursing, responsibility, competence, hermeneutics, mixed methods, ansvar, hermeneutik, klinisk kompetens, mixad metod, operationssjuksköterska, perioperativ vård, PROFFNurse SAS
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-70022 (URN)978-91-7063-893-0 (ISBN)978-91-7063-988-3 (ISBN)
Public defence
2018-04-05, Nyquistsalen, 9C 203, Universitetsgatan 2, 651 87 Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Note

Artikel 4 ingick som manuskript i avhandlingen, nu publicerad.

Available from: 2019-03-15 Created: 2018-11-01 Last updated: 2019-08-29Bibliographically approved

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Blomberg, Ann-CatrinBisholt, BirgittaLindwall, Lillemor

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