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Övergripande syfte Att undersöka kvinnors och mäns smärta efter hjärtkirurgi via sternotomi, med ett större perspektiv på kvinnors smärta samt om en dags utbildning i postoperativ smärta påverkar sjuksköterskors kunskaper och patienters smärta. MetodSåväl kvantitativ som kvalitativ metod har använts.Studie I var en icke-experimentell kvantitativ studie med statistisk analys, och datainsamling före samt tre månader efter utbildningsintervention. I studien ingick daglig smärtskattning med Visuell Analog Skala (VAS), en strukturerad intervju till patienterna för utskrivning för utvärdering av smärtbehandling samt ett frågeformulär om kunskaper och inställning till smärta och smärtbehandling.Studie II är en icke-experimentell och longitudinell studie med en kvalitativ och en kvantitativ del bestående av intervjuer och kvalitativ innehållsanalys, samt uppföljande strukturerad telefonintervju.ResultatSåväl studie I som studie II visar att patienter upplever smärta postoperativt efter hjärtkirurgin och 8% av patienterna (studie I) skattade smärtan som svår. De flesta patienter i såväl studie I som studie II var nöjda med smärtbehandlingen, även vid svår smärta.När patienterna (studie I) skattade smärtan retroaktivt, skattade de smärtan högre jämfört med de dagliga mätningarna, skillnaden var signifikant både före och efter utbildningsinterventionen. Utbildningsinterventionen (studie I) ledde till att patienterna fick större mängd opioider samt en signifikant minskning av smärtan. Sjuksköterskorna från intensivvårds- och vårdavdelningarna fick värdera opioiddoser vilka relaterades till noterade doser enligt patientjournalen. Det framkom att doserna som sjuksköterskorna ansåg att de gav var större jämfört med vad som dokumenterats i journalerna. Doserna enligt journalen var mindre än generella direktiv. I kvinnornas berättelser (studie II) framkom en ovilja gentemot att opioider. Denna ovilja kunde vara generell eller på grund av illamående. I berättelserna var illamåendet e

Background: Teamcare should, like all patient care, also contribute to evidence-based practice (EBP). Randomized controlled trials (RCTs) focusing on teamcare have been performed but no study has addressed its essentials. How far this EBP has progressed in different health aspects is generally established in systematic reviews of RCTs. Aim: The aim is to determine the essentials of teamcare including the nurse profession in RCTs of multi- or interdisciplinary interventions in somatic care focusing on the stated context, goals, strategies, content as well as effectiveness of quality of care. Methods: A systematic review was performed according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data selection process of 27 articles from PubMed and CINAHL. Results: Eighty-five percent of RCTs in somatic care showed a positive effectiveness of teamcare interventions, of which interdisciplinary ones showed a greater effectiveness compared with the multidisciplinary approach (100% vs 76%). Also theory-based RCTs presented higher positive effectiveness (85%) compared with non-theory-based RCTs (79%). The RCTs with positive effectiveness showed greater levels for professional-centered ambition in terms of goals and for team-directed initiatives in terms of strategy, and a significantly higher level for patient-team interaction plans in terms of content was shown. Conclusions: Teamcare RCTs are still grounded in the multidisciplinary approach having a professional-centered ambition while interdisciplinary approaches especially those that are theory-based appear to be essential with regard to positive effectiveness and preferable when person-centered careis applied.

Background: Nursing practice has to contribute to evidence pointing out why there is a need for more nurse-designed randomized control trials (RCTs) focusing on evidence-based practice (EBP).How far this EBP has progressed in different health aspects is usually established by systematic reviews of RCTs. Nurse-led RCTs exist but no study has addressed the essentials of nursing care. Aim: The aim was therefore to determine the essentials of nurses’ interventions by means of nurse-led RCTs in somatic care focusing on the stated context, goals, content, strategies as well as the nurse’s role related to effectiveness. Methods: A systematic review was realized according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data extraction process (n = 55) from PubMed and CINAHL. Results: Of the RCTs in somatic care, 71% showed a positive effectiveness of nurse-led interventions, of which the nurse had a significant role with regard to being the main responsible in 67% of the studies. Also, 47% of the RCTs presented a theoretical standpoint related to the nurse-led interventions and most prominent were international evidence-based guidelines. Goals were found to have either a patient-centered or a professional-centered ambition. Strategies were based on patient-directed initiatives, nurse-patient-directed initiatives or nurse-directed initiatives, while contents were built upon either a patient-nurse interaction or a nursing management plan. Conclusions: This review underlines the necessity of a holistic view of a person, as nurse-led RCTs comprising a patient-centered ambition, patient-directed initiative and patient-nurse interaction plan showed beneficial nursing care effectiveness, particularly if theory-based. In a nurse-led RCT, a basic theoretical perspective is advantageous as well as to elucidate the role of the nurse in relation to the estimated effect