Bakgrund: Barns möjligheter att involveras i den perioperativa vårdkontexten kan förbättras med ett barncentrerat förhållningssätt. För att uppnå detta behöver hänsyn både tas till att barn är beroende av sin familj och att de som enskilda individer ska involveras och vara medaktörer i sin vård. Barns involvering i den perioperativa vården har många fördelar. Det bidrar till minskad oro och rädsla och att barnet kan stärka sin kompetens och bli behandlad med respekt. Barn upplever dock att det är svårt för dem att vara delaktiga och att ha kontroll i den främmande och skrämmande perioperativa sjukhusmiljön. Barns möjligheter att vara delaktiga i den perioperativa vården är därför beroende av föräldrar och hälso-och sjukvårdspersonal liksom rutiner och fördelning av resurser i vården. Det är därför viktigt att de vuxna som ska stödja barnen har förståelse för att barn är unika och uppfattar saker ur sitt eget perspektiv baserat på sina erfarenheter.

Syfte: Det övergripande syftet med avhandlingen var att öka förståelsen för vad ett barncentrerat förhållningssätt innebär inom perioperativ vård - utifrån barn, föräldrars och ett organisatoriskt perspektiv. 

Metod: I delarbete I användes en deskriptiv kvalitativ design med intervjuer av 10 barn (8 till 11år). Delarbete II hade en explorativ kvalitativ design med intervjuer av 20 föräldrar. Delarbete I och II analyserades med kvalitativ innehållsanalys för att beskriva barn och föräldrars erfarenheter av delaktighet i pediatrisk perioperativ vård. I delarbete III användes en explorativ kvalitativ design med intervjuer av hälso-och sjukvårdpersonal. Analysen genomfördes med grundad teori för att utforska processen av ett organisatoriskt förbättringsarbete för barn som genomgick sedering för intratekal cytostatikabehandling. I delarbete IV användes en deduktiv kvantitativ design med registerdata och analys med deskriptiv statistik för att beskriva tidsintervall och använd Propofol-dos vid sedering för intratekal cytostatikabehandling i tre olika miljöer. 

Resultat: Delarbete I visar att barns upplevelse av delaktighet påverkats av hur de informerats inför och under det perioperativa vårdförloppet. Vidare har relationen till hälso-och sjukvårdspersonalen haft betydelse för barns möjligheter att involveras i beslutsfattande. Dessutom har sjukhusmiljön, väntetid och möjligheter att förströ sig haft inflytande på barns upplevelse av delaktighet. I delarbete II beskriver huvudkategorin att föräldrars delaktighet i pediatrisk perioperativa vård vid dagkirurgi betydde ”Having strength to participate despite an increased vulnerability ”. Tillsammans med underkategorierna; få information om vad som ska hända, att bli sedd som en resurs och att få tillgång till miljön. I delarbete III beskriver “The theory of a shielding place” hur hälso-och sjukvårdspersonalen med ett barncentrerat förhållningssätt utförde proceduren sedering för intratekal cytostatikabehandling på barnavdelningen. Resultatet i delarbete IV kontrollerar och kvantifierar objektivt delar av resultatet från delarbete III. Genom att visa att när proceduren utförs på barnavdelningen minskas väntetid och tidsåtgång för proceduren som helhet.  

Konklusion: För barn och föräldrar som genomgår dagkirurgi har information, samspelet med hälso-och sjukvårdspersonalen och miljön haft betydelse för upplevelsen av delaktighet. Ur ett organisatoriskt perspektiv påverkas ett barncentrerat förhållningssätt av de rutiner som har betydelse för hur barn och föräldrar förbereds. Resurser och rutiner påverkar också om sjukhusmiljöer är anpassade för barn, väntetid och tidsåtgång, liksom relationer mellan barn och hälso-och sjukvårdspersonal.

Background: Children's opportunities to be involved in the perioperative care context can be enhanced with a child-centered approach. To achieve this, consideration must be given both to the fact that children are dependent on their family and that they, as individuals, must be involved and be co-actors in their care. The involvement of children in perioperative care has many advantages. It contributes to reduced anxiety and fear and that the child can strengthen his or her skills and be treated with respect. However, children feel that it is difficult for them to be involved and to have control in the strange and frightening peri-operative hospital environment. Therefore, children's opportunities to participate in peri-operative care depend on parents and health care personnel, as well as routines and distribution of resources in the care. It is therefore important that the adults who support the children have an understanding that children are unique and perceive things from their own perspective based on their experiences.

Aim: The overall aim of this dissertation was to increase the understanding of what a child-centered approach means in perioperative care - from the perspective of children, parents and an organizational perspective.

Method: Study I was conducted with a descriptive qualitative design and interviews with 10 children (8 to 11 years). Study II had an explorative qualitative design with interviews of 20 parents. Study I and II were analyzed with qualitative content analysis to describe children and parents' experiences of participation in pediatric perioperative care. Study III used an explorative qualitative design with interviews with healthcare professionals. Analysis was conducted with grounded theory to explore the social processes of a quality improvement work for children undergoing sedation for intrathecal cytostatic therapy. Study IV had a deductive quantitative design with register data and analysis with descriptive statistics to describe time intervals and Propofol dose used during sedation for intrathecal cytostatic therapy for children in different environments. 

Results: Study I shows that children´s experience of participation was influenced by information before and during the perioperative care period. Furthermore, the relationship with the healthcare professionals was important for being involved in decision making. In addition, the hospital environment, waiting time and opportunities for distraction had an impact on children's experience of participation. The main category in study II describes that parental participation in the context of pediatric perioperative care in day surgery can be understood as "having strength to participate despite an increased vulnerability" and further described by the subcategories; gaining information about what will happen, being seen as a resource and gaining access to the environment. In study III, "The theory of creating a shielding place" described how healthcare professionals with a child centered approach performed sedation for intrathecal chemotherapy for pediatric leukaemia at the children´s ward. The result in study IV controlled and quantified objective tacit knowledge from study  III and confirmed that sedation for intrathecal chemotherapy at the pediatric ward reduced the waiting time and time for the procedure as a whole.

Conclusion: For children who undergo day surgery, and parents who participate in pediatric perioperative care, information, interaction with health care professionals and the environment had impact on their experience of participation. From an organizational perspective a child centered approach is influenced by routines that affect how children and parents are informed and prepared. Resources and routines also affect whether hospital environments are adapted for children´s needs, waiting time, expenditure of time, as well as relationships between children and the healthcare professionals.

Purpose: Childhood cancer invades the child's daily life and has a strong influence on their living conditions and lifestyle. The treatment is an unpleasant experience and the children often perceive the treatment as worse than the actual disease. The aim of the present study was thus to explore the process of how healthcare professionals improved care for children undergoing sedation for intrathecal chemotherapy.

Method: A constructivist grounded theory approach was applied and qualitative interviews with paediatricians (n = 2), anaesthetists (n = 2), paediatric nurses (n = 3) and nurse anaesthetists (n = 5).

Results: The theory of creating a shielding place emerged and conceptualized the pattern of behavior of healthcare professionals throughout the procedure of sedation for intrathecal chemotherapy for pediatric leukaemia. The theory explains the core category ‘shielding’ and the process of how healthcare professionals developed strategies to resolve their main concern: a striving to reduce discomfort and suffering induced by the procedure and the treatment. These strategies, used throughout the procedure, were; de-dramatizing, de-exposing and minimizing trespassing.

Conclusions: The theory of creating a shielding place offers a greater understanding of how healthcare professionals included the child's perspective in their work and thereby enabled a more sensitive and supportive care that had an impact on both quality of care and patient safety. The results from the study contributes with theoretical knowledge that can be used for developing evidence-based care guidelines for the procedure of sedating a child with leukaemia for intrathecal chemotherapy. © 2019 Published by Elsevier Ltd.

Abstract: Increasing survival rates for childhood cancer have brought attention to the high level of burden of cancer and its treatment. Improving supportive care for children throughout their cancer trajectory is thus important and could reduce the difficulties related to treatment, including time-consuming treatments and the waiting time associated with treatment procedures. The aim of this study is to describe time intervals and the Propofol dose used during sedation for intrathecal chemotherapy in three different settings. The study is based on retrospective data from repeated treatment sessions recorded in operation planning programs and hospital records in the period 2011–2018 (n = 164). Children, 1–12 years old (n = 22), undergoing a varying number of treatments, were included in the study. The most crucial finding in this study is that the time from the child’s first meeting with the nurse anesthetist to the induction of sedation is significantly reduced if the procedure is performed in the children’s ward. The study highlights the importance of the setting for sedation for intrathecal chemotherapy when implementing a child-centered approach in pediatric oncology care

Background/Objectives: Children who are treated for childhood cancer are exposed to hospitalization, interaction with unfamiliar people in strange environments, and unpleasant, and sometimes, procedures. Having to wait for procedures is one of the worst situations, experienced by child patients. It is therefore important that hospitals provide environments that are non-stressful and safe for children in conjunction with procedures. Especially important, is the possibility for children who are hospitalized to sustain everyday activities, such as play, irrespective of their age and severity of illness.

Objective: To assess differences in expenditure of time and dose of anesthetic drugs during sedation for intrathecal chemotherapy in two different environments- the children's ward, where the child was hospitalized, and the operation theatre.

Design/Methods: The study is based on retrospective data from repeated treatment sessions recorded in operation planning programs and journals during 2011-2018 (n=164). Children of the ages 1-12 years (n=22) with varying number of treatments were included in the study. Data was analyzed with the Kruskal-Wallis test and post-hoc analyses included the Mann-Whitney Test with Bonferroni correction.

Results: The time from the start of the procedure until the start of sedation was significantly lower at the children's ward, which was also the case if including the waiting time before the start of the procedure. No significant differences could be found regarding the dose of anesthetic drugs used.

Conclusions: Sedation for intrathecal chemotherapy at the children's ward provides care to a higher extent in accordance with the needs of the child, by reducing the time for the procedure and thus the interference with the child’s everyday life at the hospital. © 2019 Wiley Periodicals, Inc.

Aims and objectives: To explore what it means for parents to participate in their children's paediatric perioperative care.

Background: Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care.

Design: Descriptive qualitative study.

Methods: The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences.

Results: The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'.

Conclusion: Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care.

Relevance to clinical practice: Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

Aims and objectives

To describe the experiences of participation in perioperative care of 8- to 11-year-old children.

Background

All children have the right to participate in decisions that affect them and have the right to express their views in all matters that concern them. Allowing children to be involved in their perioperative care can make a major difference in terms of their well-being by decreasing fear and anxiety and having more positive experiences. Taking the views of children into account and facilitating their participation could thus increase the quality of care.

Design

Descriptive qualitative design.

Methods

The study was conducted in 2013 and data were collected by narrative interviews with 10 children with experience from perioperative care in Sweden. Qualitative content analysis was chosen to describe the variations, differences and similarities in children's experiences of participation in perioperative care.

Results

The result showed that receiving preparatory information, lack of information regarding postoperative care and wanting to have detailed information are important factors for influencing children's participation. Interaction with healthcare professionals, in terms of being listened to, being a part of the decision-making and feeling trust, is important for children's participation in the decision-making process. Poor adaptation of the care environment to the children's needs, feeling uncomfortable while waiting and needs for distraction are examples of how the environment and the care in the operating theatre influence the children's experiences of participation.

Conclusions

Efforts should be made to improve children's opportunities for participation in the context of perioperative care and further research is needed to establish international standards for information strategies and care environment that promotes children's participation in perioperative care.

Relevance to clinical practice

Nurse anaesthetists need to acquire knowledge and develop strategies for providing preparatory visits and information to children prior to surgery as well as reducing waiting times and creating environments with meaningful and tailored opportunities for distraction in perioperative care. © 2015 John Wiley & Sons Ltd.