Rönnberg Linda, Melin-Johansson Christina, Hellzén Ove, Nilsson Ulrica, Häggström Marie
Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden.
Department of Health Care Sciences, Ersta Sköndal Bräcke University college, Stockholm, Sweden.
BMC Nurs. 2022 Mar 9;21(1):56. doi: 10.1186/s12912-022-00817-1.
The process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist.
To obtain a deeper understanding of Registered Nurse Anesthetists' main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia.
A total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II).
A classic grounded theory approach with a qualitative design was used for this study.
The RNAs' main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: 'Having a back-up plan', 'Getting into the right frame of mind', 'Evaluating the patient's reactions', 'Using one's own experience', 'Dealing with uncertainty', 'Pressure from others', and 'Being interrupted'. The theory, Safeguarding the patient in the process of extubation, emerged.
To be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR.
拔管过程很复杂，因为它发生在手术室这个技术要求高且具有挑战性的环境中。拔管与不同严重程度的并发症相关，对患者来说是一个关键时刻，患者在从麻醉中苏醒时处于脆弱状态。瑞典的注册护士麻醉师（RNA）接受过专业培训，可独立或与麻醉医生合作进行拔管操作。
更深入地了解注册护士麻醉师在全身麻醉期间护理患者时，在拔管过程中的主要关注点以及他们如何解决这些问题。
共有17名RNA参与研究，其中8名男性，9名女性。12名RNA参与数据收集的第一步（I）；5名RNA参与数据收集的第二步（II）。
本研究采用具有定性设计的经典扎根理论方法。
RNA在拔管过程中的主要关注点是在高科技环境中保护患者，他们通过保持适应性来解决这一问题。促进因素和挑战影响了RNA解决主要关注点的方式，并代表了以下类别：“有备用计划”、“进入正确的思维模式”、“评估患者的反应”、“运用自身经验”、“应对不确定性”、“他人的压力”和“被打断”。由此形成了“在拔管过程中保护患者”这一理论。
为了能够在高科技环境中保护患者，RNA必须在促进因素和挑战之间进行权衡。通过保持适应性，RNA解决了权衡的困难，这表明需要在保持对拔管过程中确保患者安全的重要事项的关注与手术室中存在的所有干扰之间找到平衡。
