The results are presented in two categories: A mutual meeting (the preoperative dialogue) and On the basis of the patient’s needs and wishes (the intraoperative dialogue) based on the NA’s stories from their meetings with the patients.
A mutual meeting (the preoperative dialog)
The NA described how, in the first meeting, they wanted to create personal contact with the patient. This meeting laid the foundation for how the relationship would continue. Therefore, in the first meeting with the patient, the NA describes how they made a little extra effort. To greet the patient and to introduce themselves with name and title was described as important. The introduction gave the patient the feeling of safety and confidence in the meeting and a relationship. A relaxed and pleasant meeting enabled a relationship while, in contrast, a tense meeting resulted in a substantial amount of work for the NA to get a working relationship with the patient.
Through the experience of having met many patients with different needs, the NA had the ability to reach the patient in the initial meeting. This ability also made it possible for the NA to reach the patient in the short amount of time given for the first meeting. Because the meetings were short, the NA had to compress the content of the meeting. Compressing was possible by briefing the information provided and quickly building a perception of the patient. However, regardless of how compressed the meeting was, the NAs described that they always strived for good quality.
When it comes to being able to reach people, you bring out everything you learned as well as sharpen the discussion to get as good a meeting as possible in a short amount of time.
When a relationship between the patient and the NA had been established, the patients seemed to experience confidence in the NA. Confidence was based on that the NA had an honest interest in the patient. A mutual contact resulted in a natural meeting. The NA described that the patient was involved and seen as a person who was important in the meeting. The patient was able to talk about themselfs, and the NA was present and took the time to listen. The NAs describe the importance of being both physically and mentally present in the meeting with the patient. Not being present meant having their thoughts somewhere else, which patients felt and resulted in a meeting where only one party was participating. When the NA was stressed and in a hurry, there was no reciprocity because the NA described how they did not wholeheartedly participate in the conversation and the meeting with the patient.
The patient feels that you are stressed. Sometimes you are in a hurry and maybe thinking about something else. The patients can feel it.
It was evident how important it was to focus on the conversation with the patient and let the patient decide the pace of the conversation. In the conversation, the NA created a picture of each patient and the needs of the individual patient. It was described how all patients were individuals with different needs who would be treated in different ways. It was the ability of the NAs to read the individual patient and their needs that determined what information the patient was ready for during the course of the meeting.
You cannot run the same concept on each patient, but you are considering whether the patient is taking in the information and what information does the patient need to have.
In the conversation with the patient, the NA described how they could get a feeling for the patient based on the patient’s personality, which helped the NA to provide an adapted treatment. With questions, the NA could understand what mood the patient was in. Being responsive to the answers helped the NA to respond to the patient.
One can quickly see if it is a person who looks terrified or a person who seems safe, sad, or angry. You try to find a good way to approach the patient. You have to be perceptive.
Being perceptive helped the NA in knowing how much information the NA should share with the patient. The NA described how they could sense which patients wanted information and who did not want to know anything about anesthesia. By informing patients about the essentials and then listening to the patient, the NA decided to what degree they shared information.
Some patients want short answers, and some want to know everything to gain control. My answers are adapted to the patient. Some patients just want to be cared for and not have information at all.
So, this sorts itself out.
Informing the patient about what was going to happen in the operating room was considered to soothe the patient. When patients had an informed picture of their anesthesia, the NA felt that the patient was prepared. Lack of information before anesthesia was described as causing fear in the patient. The NA described how they wanted to avert the patient’s fear of anesthesia. By sitting down with the scared patient, the meeting could focus on what worried the patient. By asking direct questions about patients’ fears, the NA could answer questions and sort out misunderstandings or incorrect knowledge.
Some patients say directly- I’m really scared. I think this is very uncomfortable and I’m very nervous. Then I take the time to sit down and talk a little longer. Then I can ask the patient what they are afraid of and often easily answer them.
Conversing with the patient also meant observing a patient’s body language. It was revealed how the need for information for nonverbal patients was more difficult to identify. The patients who were nonverbal could instead be observed by their body language that showed if they were feeling safe or scared. An assessment could also be made via vital parameters such as heart rate and blood pressure.
The fear of anesthesia was described as being afraid of losing control of their body and life. A common fear described by the NA was that the patient would not wake up after the anesthesia. It was, therefore, described how important it was to create a sense of safety in a situation where the patients experienced being unsafe and frightened.
The NA described how a sincere interest in the patient showed the patients that they could dare to put the responsibility of their breathing and their lives in the hands of the NA. When the NA was there for the patient and replied to the questions and informed the patient, the NA and the patient came closer together, creating trust in the relationship.
We can explain this in 10 seconds, instead of the patient getting into the operating room with the thought of -will I wake up? I talk to the patient about this, and then it feels like I gain their trust.
A NA acting professional in their work gave the patient a sense of safety, and the NA’s calmness was transferred to the patient. Patients also gave signs of gaining increased confidence in the NA when the NA talked about their experience and knowledge of anesthesia and prior involvement in surgeries. Patients then could understand that anesthesia was often not difficult, and rather a routine task performed daily. The NA answered the patients’ questions on similar surgeries based on previous experiences.
Patients can be very focused on whether the surgery they are undergoing tend to fail or if there are typical problems during the surgery. And I can answer that easily as I have been in many similar surgeries.
The NA’s experience was also needed when patients expressed personal experiences of previous anesthesia. A previous negative experience required a greater effort from the NA to get the patient to feel safe and calm. It was more difficult to create confidence in a patient who was afraid because of past experiences.
When a patient lacked important information from the operating surgeon, the NA described that the patients were not able to create an understanding of what was going to happen. The patients had a hard time to feel safe. The NA then described how they arranged a meeting with the surgeon to inform the patient before the surgery.
To meet the patient and establish a working relationship where the patient trusted the NA and could feel safe with the NA was described as the most important aspect of the pre-operative conversation. The goal was that the patient would be given a good experience and not be afraid or anxious about the anesthesia.
On the basis of the patient’s needs and wishes (the intraoperative dialogue)
When the patient entered the operating room, the NA wanted the patient to be treated and feel like a human being. The opposite was when the human aspect was forgotten, and the focus was solely on the surgery. The NA described how the staff in the operating room could greet and confirm the patient with a nod and eye contact. The staff of the operating room could confirm the patient by seeing the patient, not necessarily by approaching the patient. All staff in the room were not considered to have to introduce themselves and shake hands with the patient. Even as the patient was to be confirmed, it was considered too intrusive when too many people leaned over the bed where the patient was. To greet all the staff could also be described as stressful and something the patient could not always be able to do.
The patient is not just a person lying in bed. If all of us storming in and there are 20 of us leaning over the patient. It is really quite threatening. It is important that you have the time or try to think about seeing the person lying there. Becoming blind to the person is easy.
The NA described how they were constantly aware that the patient heard and saw much of what happened inside the operating room. To handle the patient’s fears of the anesthesia, the NA told the patient about what would happen during the anesthesia and showed the devices that were surrounding the patient.
When NA was aware that a patient was in extraordinary need of feeling safe, much like as a patient with mental retardation or a child, the staff in the operating room were asked to lower their tempo and work quieter. This gave the patient peace and quiet without disturbing or frightening them.
It was described how the NA through different strategies came closer to the patient the operating room.NA could then focus on the patient and interpret the wishes of the patient. It meant to approach the patient in a way that was adapted to the patient’s personality and needs. The patient was listened to and was involved in the impending anesthesia.
To listen to what the patient says and take them seriously. Not to over-rule the patient without reason. I believe that it is a question of listening and of having them understanding the reasoning. Then it will be a good anesthesia.
Interpreting the needs of patients resulted in the NA being able to identify the patients who, during the anesthesia, wanted to talk about the anesthesia, those who wanted to talk about other things or those who did not want to talk at all. Adapting based on the patient’s needs created a calmness of the patient. The NAs described how they could get close to the patient in the conversation. It created a feeling of safety, and the patients relaxed when the NA encouraged the patient to speak up or ask if they had any questions during the anesthesia.
To provide patients safety in the operating room, the NA also used eye contact, body language, and touch. An anxious patient was spoken to while the NA looked the patient in the eyes and had physical contact. Consolation could be given with a pat on the cheek or by putting a hand on the patient’s shoulder. Through a body language that invited the patient to participate and by showing a genuine involvement in the patient, the NAs could create a safe environment and situation in the operating room. The patient seeing and recognizing the NA at the head of the bed could sometimes replace words that did not need to be said.
They should feel that you are still present and not talking too much as it can make some patients feeling stressed. I try to adapt to the patient, both what the patient says and what they radiate purely physically.
The anesthesia was individualized and adapted to the patient’s preferences. Some patients wanted to fall asleep immediately and experienced information as a burden. Some patients could be described as nervous and stiff and angry. Regardless of how the patient’s fear of anesthesia expressed itself, the NA saw it as an important task to create a safe environment for the patient. The NA told the patient that they would be with the patient when they fell asleep, while sleeping, and when they woke up. The aim was to get the patient to dare to release control and hand over responsibility for their breathing to the NA.
I want a patient to feel confident that I will anesthesia them and that it is I who will guard them while they are asleep. Then I have a calm patient when they fall asleep and a calm patient when they wake up.; they even if they do not remember me specifically, they will have a positive experience of the anesthesia.
The NA described that with experience and confidence in their profession, the NA could involve some of their duties to the patient. Patients who wanted control were given control to create calmer sedation. For example, patients who wanted could hold their mask during anesthesia.
For those patients who wanted information, the NA shared the information step by step to make it understandable. Information could mean describing how the surgery would be performed, to speak about the equipment inside the operating room or the effect of different medicines on the body. However, it was revealed how information sometimes risked creating confusion for the patient as opposed to helping the patient. The NA was, therefore, careful to always adapt the information based on the patient and his or her ability to digest the information.
Patients who wished were allowed to be involved in the care. If the patients wanted and could cope, in surgeries where this was a choice, they could decide whether they wanted to have sedation or how much sedation they wanted. The NA let the patients choose and at the same time, informed them that the patient could always change their decision during the surgery. If they changed their mind, they got sedated afterward. Making decisions could, however, be perceived as a burden during the anesthesia, and in those cases, the patient often chose to transfer decisions to the NA. Patients showing signs of panic could be persuaded to receive some anesthesia to help them cope with the surgery. A slumber was considered more humane than the fear during a surgery.
The environment around the patient was also adapted according to their wishes. Pillows, blankets, and sleeping postures could be determined by the patient as long as it worked purely surgically. Offering music in headphones allowed patients to be awake but not to hear what happened in the room.
You try to engage the patients and get them to participate, they should be able to influence. If the patient is in focus, it prevents them from being made into objects.
An awake patient meant that the NA could communicate with the patient during the anesthesia. This allowed the NA to feel the patient’s need for closeness, safety, or the sedation that the patient needed. The NA was able to interpret, understand, and accepted the different wishes of the patient. If the patient wanted to talk, they had a conversation, but if the patient wanted to be silent or slumber, the NA respected it. However, they always informed and showed the patient that they were at the head of the patient during the entire surgery, regardless of whether they were speaking or not.