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EMPIRICALSTUDIES doi: 10.1111/scs.

12172

Making the invisible visible – operating theatre nurses’


perceptions of caring in perioperative practice

Ann-Catrin Blomberg RN, RNT, RNOR, MSc (PhD Student), Birgitta Bisholt RN, PhD (Senior Lecturer), Jan
Nilsson RN, PhD (Senior Lecturer) and Lillemor Lindwall RN, PhD (Professor)
Department of Health Sciences, Karlstad University, Karlstad, Sweden

Scand J Caring Sci; 2015; 29; 361–368 watchful eye. The operating theatre nurses got to know the patient
and as a result became responsible for the patient. They protected
Making the invisible visible – operating theatre nurses’
the patient’s body and preserved patient dignity in perioperative
perceptions of caring in perioperative practice
practice. The findings show different aspects of caring in
The aim of this study was to describe operating theatre nurses’ perioperative practice. OTNs wanted to be more involved in
(OTNs’) perceptions of caring in perioperative practice. A patient care and follow the patient throughout the perioperative
qualitative descriptive design was performed. Data were collected nursing process. Although OTNs have the ambition to make the
with interviews were carried out with fifteen strategically selected care in perioperative practice visible, there is today a medical
operating theatre nurses from different operating theatres in the technical approach which promotes OTNs continuing to offer care
middle of Swe-den. A phenomenographic analysis was used to in secret.
analyse the interviews. The findings show that operating theatre
nurses’ perceptions of caring in perioperative practice can be
summarised in one main category: To follow the patient all the Keywords: care, perioperative nursing, operating theatre nurse.
way. Two descriptive categories emerged: To ensure continuity of
patient care and keeping a
Submitted 25 February 2014, Accepted 7 July 2014

Nursing has a long tradition, and working in an oper-ating


Introduction
theatre was identified as the first area of specialisa-tion for nurses
This study presents operating theatre nurses’ (OTNs’) per- (4). The foundation of perioperative practice was laid by
ceptions of caring in perioperative practice. According to Nightingale (5) who made efforts to maintain patient health by
Richardson (1), the profession is considered to be medi-cally and stressing the importance of clean water and sanitation as well as
technically oriented. Blegeberg et al. (2) revealed that other ventilation in the room where the patient was treated. In the late
professionals within health care per-ceived OTNs as fragmented 19th century, progress in medicine led to increased knowledge
carers who were present only during the patient’s surgery. and awareness in prevention and control of infections, and OTNs
were considered a suitable profession to take the responsibility for
Since the 1960s, different education reforms and an increased hygiene in the operating theatre. According to Holder (6), nurses
demand on OTNs led to various training initia-tives, meaning were recruited during the First World War to the armed forces to
OTNs were less involved in patient pre-and postoperative care (3). be responsible for patients’ perioperative nursing care. During the
There is a clear requirement for productivity in today’s Sec-ond World War, more advanced surgery was performed in
perioperative practice, and patients in surgery have limited field hospitals and required more technical equipment, which
opportunities to converse with OTNs. The OTNs’ responsibility resulted in a reinforced professional function for OTNs (4). A new
for patients’ nursing care is based on their specific knowledge, group of health professionals was devel-oped, called technicians,
and it is there-fore important to highlight the caring that takes whose role was to perform the OTNs’ technical tasks in the
place in perioperative practice. operating theatre. The OTN was the scrub nurse responsible for
assisting and instru-mentation during surgery, while technicians
worked as circulating staff. The OTN was responsible for the
coordi-nation of the surgical team and the patient’s pre-, intra-and
postoperative care (7, 8). The trend of training
Correspondence to:
Ann-Catrin Blomberg, Department of Health Science, Karlstad
University, Karlstad, Sweden.
E-mail: Ann-Catrin.Blomberg@kau.se

© 2014 Nordic College of Caring Science 361


362 A.-C. Blomberg et al.

technicians continued after the war ended and resulted in Design


replacing the scrub nurse with technicians because of their
technical knowledge (7). Several studies (8–10) dis-cussed that This qualitative study had a phenomenographic method, which is
this development may have contributed to the fact that the OTN derived from Swedish pedagogical research and has been used
profession is considered to be tech-nically oriented. extensively in nursing research (25). The focus of the method is
directed towards meaning rather than explanations, connections
The Association of Operating Room Nurses (AORN) defined and frequencies and aims to describe the qualitative variations in
perioperative nursing in order to change the per-ception of the people’s experiences of a phenomenon (26). Phenomenography
OTN profession as technically oriented (11). During the 1970s, distinguishes between ‘what something is’ and ‘how it is
there were revisions meaning OTNs would follow the nursing perceived to be’. The for-mer directs interest towards what the
process (12, 13). After a few years, the perioperative ‘role’ was phenomenon is, which is called the first-order perspective. The
changed to ‘prac-tice’ because ‘role’ did not describe who the latter focuses attention on how people perceive or experience the
OTN was, and the OTN’s care function was unclear (14). The phenomenon, that is how the phenomenon appears and is known
Lind-wall and von Post (15) work on perioperative practice as the second-order perspective (27). It is the second-order
concluded that it is something more than working tech-nically and perspective that is unique to the phenomenographic variations, that
carrying out ordinations. A further attempt was made to develop is the variations in how the phenomenon is perceived (28).
the profession towards a nursing process-based approach although
OTNs still only cared for patients intra-operatively (13). Since
perioperative nursing is organised differently in Sweden, it had to
be defined in relation to Swedish conditions (15). Some
intervention studies with the perioperative dialogue have shown
Sample
that patients considered it valuable to receive information about
the surgery and possibility to describe feelings about the situation The sample consisted of 15 strategically selected OTNs (14
and felt that the operating theatre nurse took personal women and one man) from 34 to 60 years (md = 45 years), and
responsibility for them (16, 17). Previous research about OTN work experience ranged from 6– 36 years (md = 20 years). The
caring focussed on the intra-operative phase and from different participants were identified by the head nurse of the operating
perspectives to promote patient safety. Mitchell and Flin (18) theatre, and selection was based on the following criteria: having
described the OTN function in the surgical team and pointed to at least three years experience in perioperative practice, both
the importance of effective communication between the OTN and women and men and working in operating theatres at university,
surgeon which influences their collaboration (19). Riley and central and county hospitals in the middle of Sweden. The
Manias (20, 21) pointed to the impor-tance of having knowledge participants were RNs and had different educational back-grounds.
about the surgeon’s wishes for being aware of the situation (22, Some had clinical training to become a theatre nurse, and others
23). The fact that OTNs operate behind closed doors in the had postgraduate education in theatre care. Only three OTNs had
operating the-atre means that their value is based on their work in an academic degree.
relation to the surgeon (10). Blegeberg et al. (2) showed that
OTNs are perceived by other professionals as doc-tors’ assistants.
According to Meretoja et al. (24), OTNs have little contact with
Data collection
patients despite the fact that they have a professional
responsibility for patient care during the intra-operative phase. In this study, the data collection took the form of individ-ual
The literature review revealed that there is international research interviews. All interviews were conducted by the first author
that focused on patients’ care in operating theatre nursing, but (ACB). The interviews commenced with a general discussion to
there were no studies and empirical research on the care of the establish a relation with the respondents followed by an open
patient. question: What is caring for you as an OTN? Additional
follow-up questions were then posed to deepen the understanding
of nursing and to catch unre-flective thoughts among the
participants (29). The inter-views took place from June to
September 2012 and were carried out in a secluded room within
the operating the-atre. They lasted between 45–60 minutes. The
interviews were digitally recorded and transcribed verbatim.

The study

Aim Data analysis

The aim was to describe operating theatre nurses’ percep-tions of The analysis of the data was conducted according to Dahlgren and
caring in perioperative practice. Fallsberg’s (30) seven steps: (i)

© 2014 Nordic College of Caring Science


Making the invisible visible 363

Familiarisation – all interviews were read several times to The main category describes: ‘To follow the patient all the
become familiar with the material; (ii) Condensation – the way’. There were two descriptive categories: To ensure con-
analysis of the material initiated by each interview was entered tinuity of the patient care and keeping a watchful eye. These
into an analysis scheme, and specific statements about the descriptive categories were built on four perceptions that are
phenomenon of caring in perioperative practice were identified described below and elucidated by quotations from the interviews
and separated from the text. The atten-tion was on WHAT the (see Table 1).
participants focused on and HOW they described the phenomenon
that was shown; (iii) Comparison – the various statements were To ensure continuity of patient care. This descriptive cate-
compared to find similarities and differences in the material; (iv) gory consists of two perceptions: getting to know the patient
Grouping – Similar statements were grouped into percep-tions. and to be responsible for the patient.
Differences and similarities were compared, and the possible Getting to know the patient. The perceptions consist of how
categories were tested by comparing them with the interview the OTNs acquired knowledge of the patient through being
material. A new document was cre-ated where the statements present for each other and how the OTNs created continuity.
were sorted into preliminary categories. These steps were
performed by the first author (ACB); (v) Articulating – meant OTNs had the ambition to get to know the patient as a human
finding similarities between the statements in the various being by reading medical records and becoming involved in the
categories and dis-cussing how great the variation within a patient’s history as well as the current operation. OTNs looked for
category could be without creating a new category; (vi) Labelling the opportunity for a brief meeting and conversation in order to
– nam-ing the descriptive categories took time, and different pre-operatively pre-pare the patient before surgery. In the
names were tried to capture the meaning of the different meeting, they received confirmation that the planning was
perceptions of caring in perioperative practice; (vii) Con-trasting consistent with the patient’s problems, needs and desires. An
– the descriptive categories were compared with each other to important factor was that it took courage for OTNs to meet the
ensure that each category had a unique character. The different patient in this situation.
perceptions related to each other, and after many discussions and
reflections in the research group, a main category emerged ‘To Time to read the journal and talk to the patient is very
follow the patient all the way’. The main category with descriptive important. There is only this conversation. The longer you
categories each containing two perceptions was organised have worked and the more secure you are in your routines
hierarchi-cally and horizontally in an outcome space. Quotations the more you can find the time; if you are that way inclined.
were chosen based on enhancing meaning; the fourth step of I think you should talk to the patient and have the courage
seven needed to be repeated several times by all co-authors. for the meeting.
The participants came forward by meeting patients face-to-face.
At that moment, patients might have per-ceived the OTNs’
presence and the desire to do well. The participants requested that
all OTNs should have this ability. When the patient did not want
to have a rela-tionship, they kept in the background.
Rigour
It can be eye contact, to see and confirm. That you are
The concepts of credibility, fittingness, auditability and present; that they feel that you see them and that you want to
conformability have been suggested as valuable in describing do the best for them. You can con-vey a lot with body
rigour in qualitative studies (31). The credibil-ity of this study is language and I think that is important. Sometimes I can feel
supported by the use of quotations that have enriched the results. that the patient does not want contact.
A good fittingness has been determined based on the fact that the
results of the study have been presented to active OTNs who Another issue that emerged was the ability of OTNs to
affirmed the results of the study. The OTNs recognised implement perioperative conversation. They asked for
themselves and confirmed that the results reflected their
Table 1 Operating theatre nurses’ perceptions of caring
perceptions of caring in perioperative practice. The study’s
auditabili-ty was strengthened by the use of a well-defined
The main category: to follow the patient all the way
research process, and a consistent use of an open question posed
to all participants through interviews to capture different views of Descriptive categories Operating theatre nurses’
the phenomenon. Comparing results from the current study with perceptions of caring in perioperative
other equivalent studies has demon-strated conformability. practice
Throughout the analysis process, the authors were aware of their To ensure continuity Getting to know the patient
pre-understanding as nurses in perioperative practice and caring of patient care To be responsible for the patient
Keeping a watchful eye To protect the patient’s body
science.
To preserve the patient’s dignity

© 2014 Nordic College of Caring Science


364 A.-C. Blomberg et al.

more time to meet with patients both pre- and postoper-atively other members of the surgical team about what was hap-pening in
and above all to meet the anxious patients pre-operatively as well the surgical wound. The OTNs responsibilities included being
as to exist in the intra- and postopera-tive phase. Participants prepared for the unexpected.
wanted to follow the patient from the time they arrived at surgery I always set up in the same way regardless of whether it is
to the moment of deliv-ery to the postoperative department as well the right or left side to be operated on, so I know where
as evaluating the completed care. OTNs believed that they had everything is. Ensuring that you have enough dressings and
impor-tant knowledge that contributed to a different under- that you have things inside the operating theatre . . . you
standing of the patient’s postoperative care. always want to be one step ahead and be there if something
happens.
Then I had the opportunity to follow the patient all the way
and the patient had the opportunity to talk to me if there was Based on the OTNs’ specific knowledge, skills and topographic
anything special that they were thinking about. It may be a anatomy, they had responsibility to select the right operating table
previously experienced situation and make it something bad with accessories and for patient positioning based on the patient’s
again. Such time, I’d really like to have a perioperative individual needs. Patient positioning on the operating table was
conversa-tion. It must be gold. . . I also had the opportunity con-ducted jointly in the surgical team, but the surgical team
afterwards to know how they had perceived me and the always wanted confirmation from the OTNs before the pre-
situation . . . would like to have more time to meet patients operative preparation was started, in order to avoid intra-operative
before and after, maybe even a little more. consequences. The function of all medical equipment was checked
in order to ensure patient safety.

To be responsible for the patient. The perceptions con-sisted


of how OTNs could be responsible and promote safety in patient It is my job to choose the right operating table, and ensure
care through knowledge. that the patient is placed in the right posi-tion. I think that the
Responsibility for patient care started for OTNs in the pre- rest of the surgical team often relies on us. The ultimate
operative phase when they were told which patient they would responsibility is on me, because when the patient is sterilely
care for during surgery. Important aspects were if the patient was gowned I have to answer how the patient is positioned. I am
overweight, infectious, had aller-gies or ongoing medical responsible for making sure that the equipment works that is
treatment that risked increased bleeding. The pre-operative patient connected to our care for the patient, this cannot go wrong.
preparation was extensive, and OTNs felt it was an important part
in patients’ care.
Another safety aspect was to verify the patient’s iden-tity, and
Patients are of different sizes and different ages, and that can when operating on a paired organ that the cor-rect side was
dictate what you take to the surgery even though it is the selected, which was a joint responsibility of the surgical team. The
same operation; it can be clothing and things like that, that OTNs assured themselves further by ensuring that patient data
you should not tape too much if the patient has fragile skin, were consistent with the planning. Checking all the material and
things like that you think a lot of so that it will be as good as ensuring that nothing was left inside, the patients was included in
possible. the professional responsibility and was a part of their care of the
patient.
Intra-operatively, the OTNs strove to ensure that the patient’s
time in the operating theatre would be mini-mised and took I have to check that I have the right patient and am prepared
responsibility for the coordination of the surgical team. The with the right things, for me it’s important to know. Patients
intention was to prevent subsequent patients being at risk of might be premeditated so they are not aware of anything, but
removal from the operating pro-gramme. They considered that the I am there in any case and look in the anaesthesia record that
efficiency included accuracy and speed to avoid unnecessary the ID is checked and that it is marked on the side to be oper-
waiting time for the patient. ated on. You must have the whole picture.

Patients should not be put to sleep unnecessarily. The


circulating nurse wants to find the surgeons but the OTNs Keeping a watchful eye. This descriptive category consists of
said no, because she was not ready. At the same time, the two perceptions: To protect the patient’s body and to pre-
situation is that if you do not seek in time, it is not we who serve patient’s dignity.
wait but the patient . . . It is not good care when the patient To protect the patient’s body. The perceptions consist of how
gets dismissed because things have been too slow. OTNs respect the patient’s autonomy and protect the patient’s
body from injury and risks.
One aspect of caring is that OTNs kept track of instru-ments The patient’s need was to feel well in a high-tech envi-ronment,
and other materials and conveyed information to and this was met by the OTNs who set the

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Making the invisible visible 365

conditions for peace and quiet. There was an ambition to meet the operation and took the initiative to interrupt lengthy operations for
patient’s wishes and needs. Continuous infor-mation was given exercise. The OTN was observant if any of the surgical team
about occurring activities in the oper-ating theatre. The OTNs’ pushed or placed heavy instru-ments on the patient.
notions of what good care was formed the basis of planning the
patient’s care. The whole time I check for leaks, that the draping holds and
The patient may choose whether he wants radio or that no one stands and presses when the patient has leg
headphones when he goes to sleep, so we ask if they want it. supports. Even when the patient has leg sup-ports we raise
Just a little thing like information can calm things down and lower the legs every half hour.
tremendously. We do not do anything dangerous here but To preserve patients’ dignity. The perceptions consisted of dignity was preserved and integrity

now we are rustling because we are picking up things . . . it’s how patient
important to put your-self in the patient’s situation and treat respected.
the patient as you would want to be treated yourself. The patient is in a vulnerable position, and the OTN ‘kept a
watchful eye’ over the whole patient. The OTN prevented
By protecting patients from undergoing postoperative unprofessional conduct in front of the patient involving
infections, the OTNs kept ‘a watchful eye’ over the steril-ity of unnecessary talk and condescending comments in the operating
the surgical area and the operating theatre. To pre-vent the spread theatre and noted afterwards that it was not appropriate behaviour.
of infection, they had control of the traffic flow in the operating
theatre. Assistants and stu-dents who attended the operation were I monitor the patient and have to take into account the
supervised by the OTNs, dictating how they should behave in patient’s interests; I am probably the one who thinks from
order to maintain sterility. They reacted intuitively when they felt the patient’s perspective.
that someone or something was unsterile. The number of health It is not perceived as safe and secure if you have three people
professionals present during the surgery, increased the risk of rambling on around you and talking about various things. It
postoperative infections and the OTNs decided when the number should not be too playful around the patient. You make signs
should be reduced. or somehow say that now we have to keep it down.

Sterility is up to me, and then you are very careful to check . All were focused on the patient’s body but on differ-ent parts.
. .not only that you are there close to the wound, but you The OTN respected the patient’s privacy in the context of intimate
should also have full control of what others are doing so they interventions. They considered themselves more intimate with the
do not contaminate. I also decide if there is a student or patient because they were involved in the surgical wound. They
someone else in the theatre. I am involved by saying you prevented the patient’s body from being uncovered and had an
cannot go there, you cannot stand there. ethical stance, whether the patient was awake or anesthetised.

The patient’s body temperature was monitored to pre-vent


cooling. The patient received a warm quilt, warm fluids and moist The nurse anaesthetist is focused on head and arms. We do a
towels to cover the wound. Protecting the patient from being cold lot more involving the patient’s body. The body is more
could reduce the risk of post-operative infections. intimate and sensitive to a patient. Head and arms, that is
more public.
Acts such as fixing pillows and heat cost little and are pure It is important to cover the patient, maintaining integrity.
thoughtfulness. I raise the temperature of the operating When we have someone in the operating theatre lying in leg
theatre. I make sure that he does not bleed in vain, cover supports, we pull down the blinds whether they are sleeping
with moist compresses so that it does not cool down the or not. We do not have them lying naked if we do not have to
patient unnecessarily if you have an open abdomen. It is but just when we need to have access, otherwise we try to
caring, to maintain body temperature. cover them.

The patients were continuously monitored, in order to protect Various aspects of caring in the perioperative practice showed
against perioperative pressure and nerve damage. The OTN that the OTN had the ambition to get to know the patient in order
expressed the importance of looking at the whole human being to acquire knowledge about the patient in order to plan patient
during draping and being aware of the risks associated with care. When the OTN had knowledge of the patient, she was
different positions on the operating table. At certain times during responsible for provid-ing continuity of patient care. She protected
the opera-tion, the surgeon needed better access to the surgical the patient by keeping a watchful eye on them so that the patient’s
site. In these cases, the OTN protected the patient so they were not body was not put at risk and the patient’s dignity was preserved.
subjected to unnecessary risks for a long time. They gave the The prerequisite was that she could follow the patient the whole
patient massage during the way.

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366 A.-C. Blomberg et al.

patient pre-operatively and participating in the reporting of the


Discussion
patient postoperatively. Some OTNs reported that their knowledge
The results show different aspects of care in the perioper-ative was not used in the patient’s postoper-ative care (33). There was
practice where the widespread desire of OTN’s is to follow the the desire to implement peri-operative conversations with patients
patient all the way through the perioperative process. Breakiron and contribute to the continuity of patient care (38). In Sweden,
(32) showed the importance of caring acts where the OTNs were OTNs are given the opportunity to work with an ideal model ‘the
present for the soldiers when they needed a shoulder to cry on. perioperative dialogue’ (38, 39), and it showed that patients
This historic develop-ment of being visible later became more experienced continuity in care by meeting a known face in
invisible as med-ical technological progress advanced, a claim for perioperative practice (38, 40). Several attempts have been made
greater productivity and an increased demand for trained OTNs in by AORN to introduce a nursing process in perioperative practice,
perioperative practice (7). The training has been influ-enced by but OTNs even internationally continue to only care for the patient
various organisational and policy decisions that resulted in the intra-operatively (33, 41).
OTNs of today being merely responsible and involved in the
patient’s intra-operative care (3). McGarvey (4, 33) showed that
active OTNs had difficulty in describing their care of the patient, The OTNs cooperated in the surgical team with specific
although they described care from various medical and technical knowledge of hygiene and topographic anatomy, medical
func-tions and how their collaboration with the surgeon con- technology, surgical methodology and nursing, which involved
tributed to good patient care. responsibility for the patient’s care. According to previous
research, OTNs have their own planning (2) which includes
preparing materials and performance test-ing of medical devices
OTNs got to know the patient by reading medical records and pre-operatively, which Bull and FitzGerald (10) state combines
giving priority to meet and having conver-sations with the patient. technical competence with caring aspects. Intra-operative OTNs
There was a desire to see the whole person but also to convey that have full control and keep track of the instruments to be prepared
they were present through eye contact. According to Martinsen for the unexpected which according to Mitchell et al. (23) is used
(34), health professionals are present in the moment and at the to be aware of the situation or ‘to being ahead’ (22). Martinsen
same time pay attention to what the patient wants to convey with (34) argues that nurses get an idea that is preceded by concentrated
his body language. OTNs see themselves as listening and work which starts mental activity, and the OTN sees the situation
receptive and become involved in the moment. You can never in a different way and acts intuitively for the patient. To be
fully understand another human being without having a effective in caring meant according to Arakelian et al. (42) to
relationship, there is always something that remains unknown to coordi-nate the surgical team by ‘doing things right’ and to have
us. It turned out that the meeting with the patient brought OTNs personal knowledge of the surgeon’s requirements and preferences
knowledge that changed or confirmed the plan-ning of patient for surgery (20). The goal was that surgery time would be better
care. The participants perceived caring as being able to ‘read the used, and the patients’ time in the operating theatre minimised. In
patient’ and respond to tasks that required experience, which conjunction with posi-tioning on the operating table, OTNs
Benner (35) states newly qualified graduates lack. The study perceived that their knowledge of operating methodology helped
revealed that meeting with the patient pre-operatively was usually to avoid intra-operative consequences. Even if the patient
or-ganisationally impossible for the OTNs. There was an expressed that they were in a good position, OTNs con-sidered
opportunity to meet and talk to the day surgery patients, but that they took responsibility that the positioning was optimal.
participants perceived that there was a lack of time and too much Seeing with the heart is like wanting the best for the other person
stress that prevented having more. Perioperative practice is (43). According to Andersson et al. (44), the traffic flow in the
characterised by a pro-duction approach that shapes care culture operation theatre increases the risk for the patient to be subjected
that is not perceived to be in line with ethical values (36). The to a postoperative infection. OTNs considered it to be a big part of
care culture is created from traditions, rituals and values as their care of the patient under surgery (19).
Rytterstrom€ et al. (37) state that each care culture has their own
values. OTNs were present when the patients needed them but
were organisationally pre-vented from following the patient ‘all
the way’. Experi-ence helped to set aside time for a meeting with
the patient, but also personality emerged as a factor for wanting or OTNs kept a watchful eye on the patient during the
not wanting to meet the patient. The OTNs desire was to have the perioperative process. Martinsen (34) argues that imagi-nation
opportunity to get to know the needs thinking about and is preceded by putting yourself in
another person’s situation, ‘the golden rule’. They showed an
ethical responsibility by their desire to do good for the patient, and
this may, according to von Post (45), be related to OTNs
professional natural care. The results reveal how OTNs protect the
patient’s body

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Making the invisible visible 367

and maintain the patient’s dignity in a vulnerable situa-tion. a watchful eye during surgery to protect the patient’s body from
Lindstrom€ et al. (46) describe Erikssons theory of caritative being exposed and preserved the dignity of the patient when the
caring which emphasises that good care is based on the innermost patient no longer had control over their body. They stated that
core of caring, the core of caring involves a caring relationship they had a desire to be more involved in patient care and wanted
between nurse and patient, it is an open invitation that contains to follow the patient throughout the perioperative nursing process.
affirmation that the patient is welcome. According to Baillie (47), Although OTNs have the ambition to make care visible in
it is impor-tant in the perioperative caring to welcome the patients perioper-ative practice, organisations today advise a medical tech-
and preserve dignity. The participants described how they were nical approach which promotes OTNs continuing to nurture in
present and saw when the patient’s dignity was violated, and secret.
through their caring responsibility drew attention to those
concerned to show respect for the patient’s integrity. Patients that
must undergo surgery usually find themselves in a vulnerable
Acknowledgement
situation (48). The OTNs considered the importance of an ethical
stance, whether the patient was asleep or awake. Thanks to all participants who shared valuable time and stories in
the study.

Author contributions
Limitations
Ann-Catrin Blomberg was responsible for the study con-ception
The selection of participants was guided by set criteria, though the and design. She collected and analysed the data and wrote the
head nurse in each county conducted the actual procedure to manuscript. Lillemor Lindwall acted as the main supervisor,
identify whom to ask for potential participation in the study. The participated in analysing the data and took the main responsibility
limitation with this selec-tion process was that the first author did for writing the manuscript. Birgitta Bisholt and Jan Nilsson acted
not have full control over the selection of the participants. as co-supervisor and participated in analysing the data and in
writing the manuscript.

Conclusion
Ethical approval
This study has confirmed that the phenomenon caring in the
perioperative practice described when OTNs got to know the The local university ethics committee approved the study (Dnr
patient as a human being. OTN caring in peri-operative practice C2012/306). The study followed research ethical principles in
became visible by gaining knowledge about and from the patient, accordance with the Helsinki Declaration.
and they wanted to follow the patient all the way and to continue
in the patient’s care. The OTNs caring was given a new meaning
through the act of caring; care for, to protect and to preserve the
Funding
patient’s dignity.
This research received no specific grant from any funding agency
The meeting with the patient gave rise to them feeling in the public, commercial or not-for-profit sectors.
responsible for the continuity of patient care. OTNs kept

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