Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses' assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers.

Objective:To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.Design:Longitudinal cohort study.Setting:Cardiothoracic Division, Umeå University Hospital, Sweden.Patients:Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.Intervention:Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.Measurements and Main Results:Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.Conclusions:Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.

Aim.  This study illuminates the meaning of living with malodorous, exuding ulcers. Background.  Difficulties for patients with chronic ulcers and the ulcers’ impact on patients’ daily life are described in the literature. Suffering and consolation are also addressed in the literature as important issues in nursing care. Design.  The first author interviewed seven women and two men, aged 41–95, with various diagnoses. Method.  We interpreted the transcribed interviews using a phenomenological hermeneutic method. Results.  Two processes were identified: ‘being struck down’– themes: feeling dirty, being trapped, losing confidence, losing hope, becoming frustrated and protecting oneself; and ‘finding consolation’– themes: experiencing kinship, encountering genuineness and gaining control. The meaning of living with malodorous and exuding ulcers can be understood as being trapped in a debilitating process that slowly strikes one down. There is a longing for purity and wholeness and for one's life to improve. When people with malodorous, exuding ulcers encounter genuineness and feel loved, regarded and respected as fully human despite their ulcers, they feel purified. The contaminated body no longer contaminates their self‐image and self‐esteem and they feel restored and fully human again. Only when they feel fully human can they regain control and see life beyond their ulcers. Conclusion.  Although nurses cannot make ulcers or smell disappear, they can contribute significantly to improve the patients’ life. Finding consolation makes patients feel purified despite their contaminated body. Relevance to Clinical Practice.  This study points to the importance of seeing the human being beyond the ulcer and considering not only the body but the whole person.

Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations.

The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.

Newly trained operating room nurses' experiences of nursing care in the operating room There is limited research on nurses' experiences of nursing care in the operating room. The operating room nurses' responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses' experiences of nursing care in an operating room. Semistructured interviews were performed with ten operating room nurses with a maximum three years' work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses' searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses' experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients' well-being and working in teams for the patients' best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.

BackgroundCardiovascular disease is common among old people and many undergo cardiac surgery. Scientific knowledge is available on cardiac surgery from several perspectives. However, we found few studies focusing on older patients’ experiences of cardiac surgery. The aim of this study was to illuminate experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium, a one year follow-up.MethodsQualitative interviews were conducted with 49 participants (aged ≥70 years) diagnosed with delirium after cardiac surgery. Data were collected in Sweden during 2010 through individual, semi-structured interviews in participants’ homes one year after surgery. The interviews were analyzed using qualitative content analysis.ResultsFour themes with sub-themes were formulated: Feeling drained of viability includes having a body under attack, losing strength and being close to death. Feeling trapped in a weird world describes participants having hallucinations, being in a nightmare and being remorseful for their behavior. Being met with disrespect includes feeling disappointed, being forced, and feeling like cargo. On the other hand, Feeling safe, including being in supportive hands and feeling grateful, points to participants’ experiences of good care and the gift of getting a second chance in life.ConclusionsEven one year after cardiac surgery, participants described in detail feelings of extreme vulnerability and frailty. They also had felt completely in the hands of the health care professionals. Participants described experiences of hallucinations and nightmares during hospitalization. Cardiac surgery was a unique, fearful, traumatic and unpleasant experience yet could also include pleasant or rewarding aspects. It seems that health care professionals need deeper knowledge on postoperative delirium in order to prevent, detect and treat delirium to avoid and relieve the suffering these experiences might cause.