Family-centered care in perioperative nursing: for the benefit of a pediatric patient and ones family

1. LAUREA UNIVERISTY OF APPLIED SCIENCES
Otaniemi Institute
PORTFOLIO
Family-centered care in perioperative nursing: for the benefit of a
pediatric patient and ones family
Marjut Uusmäe
Degree Programme in Nursing
Portfolio
May, 2014

2. 1. Introduction; purpose, objectives and chosen perspective
2. Family-centered care in perioperative nursing: for the benefit of pediatric
patient and ones family
2.1. Explanation of the definition
2.2. Family-centered care in perioperative nursing
2.3. Pediatric patient in perioperative nursing
2.4. Family centered care in day surgeries
2.5. Family centered care in major surgeries
2.6. Providing help and support for positive outcome
2.7. Future challenges
3. Personal curriculum and learning contract
3.1. Personal curriculum
3.2. Learning contracts in clinical studies
4. The development of the competence in perioperative nursing
4.1. Philosophical and scientific foundations
4.2. Professional decision making in nursing
4.3. Nursing in different cultures
4.4. Leadership and development in nursing
4.5. Consulting in nursing
4.6. Nursing substance in perioperative nursing
4.7. Planning a learning session in a clinical environment: HUCH Töölö Plastic
surgery unit
4.7. Log book of the lessons
4.8. Clinical studies
5. Thesis, maturity test and profile in the student portfolio
6. Conclusion and assessment of learning
6.3. Intensive clinicals Tudor`s evaluation short-cuts
7. References
8. Appendices

3. 1. Introduction
Perioperative nursing is an interesting and developing area. It has developed rapidly
during last decades due to technological and perioperative nursing innovations. This
portfolio will provide an overview of my professional growth and development during
my intensive studies in perioperative nursing. The portfolio consist examples of
theoretical and clinical learning in the Degree Programme of Nursing studies in Laurea
University of Applied Sciences.
The purpose of the portfolio is to reflect and assess my own learning as becoming a
Registered Nurse.
The objectives of the portfolio are to discuss and analyze pediatric patients family-
centered care in perioperative nursing based on professional nursing journals,
literature and professional experiences.
The second objective is to create the professional portfolio, reflect own learning
process and assess professional growth during intensive studies.
The chosen perspective of the portfolio is “Family-centered care in perioperative
nursing: for the benefit of the pediatric patient and ones family”. I chose the
perspective because of the professional interest in working with pediatric patient and
ones families. Becoming a mother was one of the factors which influenced while
choosing the topic for the portfolio. The portfolio provides possibility to reflect the
clinical skills and besides it develops evidence-based way of thinking and academic
writing skills for the nursing student.
2. Family-centered care in perioperative nursing: for the benefit
of pediatric patient and ones family
The following sections will explain the definitions used in this portfolio and will discuss
about the family centered care in perioperative nursing from various evidence-based
materials. The references for the portfolio were collected from the professional and
scientific nursing journals articles, studies and other reliable sources.
In the chosen perspective, family-centered care in perioperative nursing, purpose is to
find information related to the topic and discuss about the benefits for pediatric
patient and ones family.
Objectives of the topic are presented as questions which are following:
1. How family-centered care is implemented in perioperative nursing nowadays?
2. What are the pros and cons of family-centered care in perioperative nursing?

4. 3. How family-centered care influences pediatric patient and ones family in
perioperative nursing?
2.1. Explanation of the definition
Family- a social group consisting of parents or parent substitutes and children.*
Patient- an individual participating in the health care system for the purpose of
receiving therapeutic,diagnostic or preventive procedures.*
Pediatric nursing- the nursing care of children from birth to adolescence. It includes
the clinical and psychological aspects of nursing care.
Family nursing- the provision of care involving the nursing process, to families and
family members in health and illness situations*, used also as family-centered nursing
Perioperative nursing- nursing care of the surgical patient before (pre-operative),
during (intra-operative) and after surgery (post-operative)
Pediatric- pertaining to children
(http://www.medterms.com/script/main/art.asp+articlekey=4812)
*http://www.ncbi.nlm.nih.gov/mesh/
2.2. Family-centered care in perioperative nursing
According to Linda Shields (2009) family-centered care and perioperative nursing have
both developed since World War II due to many other scientific developments in
psychology and medicine.
“Family-centered is an extension of partnership in care and its close relative,
negotiated care, but is more. At its centre is the child. Anything that happens to this
child affects all members of the family and so the care of the child receives in relation
to its illness or condition for which it has entered the health service must be planned
around the whole family (Shields et al 2006, 2007).” (Shields 2010, 2631)
In perioperative nursing, patient´s ages varies and often their understanding of the
coming surgery is according to the age development. For example: the child under 5
old has different needs and expectations than teenager patient. Some patients need
more parent support and closeness than others. This aspect will be also considered in
Helsinki`s New Children Hospital Project.

5. 2.3. Pediatric patient in perioperative nursing
In the history, first pediatric surgery founder was William Ladd in 1936, while he
became full-time surgeon. He recognized the need for special care for children in
surgery and nursing to be provided. The development started in 1937, while he
developed several surgery techniques for pediatric patients. During 1954, in UK, Denis
Browne founded the British Association of Pediatric Surgeons and developed children`s
surgery. (Shields, 2009, 7)
In 1970s, there was also rapid development in perioperative nursing, while it became
more academic with its migration to the university sector. After that prenatal
surgeries have been milestones in perioperative care of children. (Shields, 2009, 8)
In perioperative nursing, nurses and the perioperative team members provide care for
different pediatric patients with various medical conditions and backgrounds.
Sometimes the procedures are planned, but however there are cases when patients
might have emergent need for surgery. Therefore the perioperative team has to
function well and have good teamwork and communications skills with collegues,
patients and ones relatives.
According to Andrea Tonge (2011, 613) pediatric patients with Down syndrome pose
considerable challenges for the entire perioperative team. Therefore the application
of the most current knowledge, evidence-based practice and careful planning are
crucial with these patients. The health care team can prevent complications and
provide a positive perioperative experience for the pediatric patients and the family.
(Tonge, 2011)
2.4. Family centered care in day surgery
During my studies I have worked in pediatric clinic, Lasten ja nuorten lääkäriasema
Pikkijätti. Family-centered care was part of the daily work. In the clinic we had day
surgeries and surgical procedures. In this chapter I will describe the pediatric patient
care path and how families were involved to the perioperative care.
Patients visit the pediatric clinic with their parents for many medical reasons.
Therefore pediatric nursing care is provided through out their patient path. Parent or
guardian is mostly involved to the minor`s care, according to the patient age and self-
determination rights.
As Tapiola Pikkujätti has also day surgery unit, the patient path for pediatric patient
includes similar perioperative nursing care stages as in the public hospital. These are
preoperative, intraoperative and postoperative nursing care. The family-centered care
is beneficial to perform in day surgery settings (Justus, Wyles, Wilson, Rode, Walther,
Lim-Sulit, 2006).

6. In day surgery, patients arrive with their parent to the clinic 30 minutes before the
perioperative procedure and family gave the medical history and health information
related to their children to the anesthesia nurse or doctor and met both of them. Child
got also pre-medication. After half of the hour, pediatric patient was asked to come
with ones parent to the operation room and the patient parent role was to hold the
child in ones arms when anesthesiologist administers via mask the “sleeping gas”.
After the child falls asleep, parent leaves from the operation room and the child is
positioned to the procedure table. Anesthesiologist puts the IV cannula and starts
anesthesia medications. The endotracheal tube has been positioned before IV
anesthetics. The anesthesiologist manages the anesthesia during the surgical
procedure and anesthesia nurse assist and monitors patient vital signs, given
medication and all the other important detail related to the surgical procedure, such
as replaced ear tubes etc.
As the studies suggest, family member presence during induction is permitted to
provide emotional support for the child and parents. The anesthesia care provider
gives permission for family member presence during induction after discussing it with
the parents and assessing the child. (Hudson, Mary E. 2009)
In the operation room, there is anesthesiologist, anesthesia nurse, surgeon, instrument
nurse, and the nurse, who checks that everything is proceeding well and assists, if its
needed. After surgery, the anesthetics have been stopped and the endotracheal tube
will be removed. The IV cannula will be used for post-operative pain management and
in case there will be some complications, it saves time to administer medicine directly
to the patient. The patient wakes up in the wakening room and will recover in the
postoperative room and under nurse supervison. The parents are involved to their
children post-operative recovery and can participate actively.
The surgeon will meet the pediatric patient and ones family with the anesthesiologist
after the surgery and give home instructions for the recovery and agree of the
postoperative appointment.
The child is the main person and the family is actively involved to ones care before
and after surgery. According to Susan M. Scully (2012) parental presence compared to
anesthesia might not have noticeable impact on child`s anxiety
The surgery path has to be has smooth as possible to be able to prevent traumatical
experience for the pediatric patient.
2.5. Family centered care in major surgeries
Family-centered care in perioperative units and multidisciplinary approach are very
important in a pediatric patient´s perioperative care. To provide best outcome and
meet the standards in different hospitals and countries, surgeries are often part of a

7. research and international co-operation is present in perioperative setting.
During my practise, I was mainly involved to the day surgeries, but in the same
perioperative setting in Töölö´s hospital we had also major surgeries. In different
countries the healthcare system is different, but international co-operation and
exchange of the surgeons takes place. This is very beneficial for the patients, because
it provides possibilities to use new techniques and innovations in major surgeries and
develop perioperative care.
During last decades pediatric heart surgeries have developed in Finland and also
internationally. According to Boston Children´s Hospital (19th of May, 2014) family-
centered care is implemented in a partnership with parents. They follow concepts of
Family-Centered Care and Patient-Centered Care Institutes, which are respect and
dignity, information sharing, participation and collaboration. They pay attention, how
much does the parents want to be involved to their child´s care and provide the latest
information of the child´s condition. (http://www.childrenshospital.org/patient-
resources/family-resources/family-partnerships)
According to the Kimberly Ann Stefan (2010) study programme of the nurse liaison in
perioperative services, having a nurse who informs the family, is communicating and
has family-centered approach in perioperative setting, the family feels more secure
and it reduces their anxiety while their family member is in surgery.
Major surgeries are often long and the approach to the family-members has to be
considered and reach the Family-Centered Care Institute suggestions, which could be
applied also in Finland. (http://www.ipfcc.org/advance/topics/better-together.html)
2.6. Providing help and support for positive outcome
“The best-known and most widely discussed application of family-centered approach
in the perioperative setting is parental presence during anesthesia induction.”
(Shields, 2007, 899)
Family members participate to the child´s perioperative care pre- and
postoperatively. During my perioperative intensive clinicals, me and my Tutor had
several patient cases. Sometimes there where families with more than 4 members,
who wanted to be present in their child´s anesthesia induction and they did not want
to follow the pre-operative guidance and hospital`s guidelines. They had different
cultural background and we had to explain the situation from several angles. Finally
we had possibility to reach the shared understanding that mother and father would be
present in the anesthesia induction, this went well and the other members of the
family were asked to wait in the hospital`s cafetheria. In Finland, there is usually one
parent present in the anesthesia induction and post-operatively in day surgeries.
Pediatric patients and families receive guidance and support from medical personel.
The surgeries and the needs of pediatric patients and their families are individual in
perioperative care. Therefore interviewing the family thoroughly and gathering all the
available health information is very important. From the other perspective, answering
to family questions and meeting the surgeon and anaesthesiologist preoperatively

8. might lower the anxiety and frightening of all the members in family.
“Effective of a range of issues including the physiology of pain, the potential
psychosocial-emotional impact of pain on the child/family and the sequel of
unrelieved or poorly managed pain. Appropriate nursing care can mediate and relieve
pain, and nurses need to utilize their clinical judgement and critical thinking skills,
reflection their practice and be active in solving pain management problems.”
(Shields, 2009, 40)
Another important area is pain management in perioperative nursing and in
rehabilitation process. According to Angela Banks (2007, 904) patients and health care
providers alike struggling with alleviating the postoperative pain in conservative way.
Therefore the technological innovations, such as continuous infusion of local
anesthetics and technological improvement of needles could relieve postoperative
pain and increase patients satisfaction in their recovery process.
2.7. Future opportunities
According to Helsinki Sanomat September 2013. Helsinki New Children Hospital pays
attention to the best quality of care and children and their parents well-being, to have
shorter hospital stays (http://www.hs.fi/kotimaa/a1379134579715).
In Finland the future development among pediatric patient is emphasizing to pay
attention to the quality of the care and family involvement in the perioperative
nursing. Families need help and support by nurses and other health care professionals.
The medical reasons and hospitalizations of the patients are different, but how to
support families in the hospital environment and in their own home environment.
Child´s care path and the continuum of the care after perioperative care needs to be
considered for the best positive outcome.
According to Shields (2007, 900) she recommends that family-centered care could be
more studied and controlled as a trial in the perioperative environment. There is not
enough evidence-based research done to show how effective outcome it has for
pediatric patients.
Finnish Parliament has publish very interesting document of 100 future possibilities
(http://web.eduskunta.fi/dman/Document.phx?documentId=ie27613151734377). In
the perioperative related sector, could be mentioned organ 3D printing, robot
surgeries, artificial muscles and self-repairing skin. Therefore also the development
and innovation is central part of university projects and could provide very interesting
co-operations with international universities. These suggestions and innovations will
influence and develop also perioperative nursing and rapidly, since the the last
decades the perioperative nursing has developed the way that emphasizes self-care

9. and shorter hospital stays. Parents have important role in their child´s home care and
rehabilitation.
According to Shields (2007, 899) family-centered care in Nordic Countries has been
implemented successfully due to family-centeredness in their hospitals.
In conclusion, cross-cultural studies and international co-operation provides good
opportunities to develop family-centered care in perioperative area. Pediatric patient
and the family need holistic approach from nurses and other perioperative team
members. We work as a team for the patient and to provide the best and safest care
that can be implemented in different perioperative environments domestically or
abroad.
3. Personal curriculum and learning contract
3.1. Personal curriculum
PERSONAL CURRICULUM
Student name Marjut Uusmäe 0300617/ SNG03SN
Study programme Degree Programme in Nursing Commencement date 25th
of
August 2003
BASIC EDUCATION
(X) Upper secondary school / matriculation examination has been taken in 2002.
Rocca al Mare School, Tallinn, Estonia
ANY OTHER PREVIOUS EDUCATION
Since 2002 Estonian Agricultural University, distance studies in economy and
entrepreneurship
WORK EXPERIENCE
Work experience in Health Care and Social Services and the length of the employment
● December 2004-October 2005 Espoo City, Puolarmetsä Hospital substituting
practical nurse
● November 2005-May 2006 HUS Jorvi´s Hospital substituting nurse in the
youths´acute psychiatric closed ward
● August 2006-2008 maternity and parental leave
● September 2008-February 2010: Medicity OY, Pikkujätti Tapiola, maternity
leave substituting nurse

10. ● February 2010- February 2013 maternity and parental leave
● February 2011- May 2011 Pikkujätti Tapiola, substitute nurse
● February 2013 -currently Eira Hospital, substituting nurse
● October 2013- currently International Childcare and Education Centre,Edutainer
1
WORK EXPERIENCE IN ANY OTHER SECTORSOF WORK
● August- September 2002 A-Selver AS, cashier
● December 2002- August 2003 Tallink Grupp AS, travel agent
● May-October 2003 Smart Contact OY, selling agent
● May 2012- currently entrepreneur/owner Sofia Store
OTHER ACTIVITIES
Like hobbies, acting as a member of any organisation or taking part in voluntary
work
I am interested about entrepreneurship in a field of digital health, quantified self and
eCommerce. My favorite hobbies are also related to that. I try to find interesting
projects that promote self-care and well-being.
Describe your own subjective view of your favourite future work
● I would like to be involved with a health care start-up company or work as a nurse
with pediatric patients in perioperative nursing.
● I would like to continue my education in Master Degree-level, because I am
interested about specialisation after becoming Bachelor in Nursing.
Describe what kind of knowing you will need in Health Care and Social Services
Knowing about: science of nursing; theoretical foundations of nursing,
psychology; anatomy and physiology; ethical and critical thinking; sociology;
medical calculation; nursing skills, languages, entrepreneurship, IT &
communication etc.
Assess your present knowing (e.g. your own strengths and your needs for
development)
I am motivated and self-directed leaner. I like to co-operate in small groups or
work independently. I believe that gathering experience is important, for example:
after going back to work after maternity leave or a break it is important to start
working by accepting challenges and by collaborating with other professionals,
networking.
What do you want to focus on in your theoretical studies and in your clinical
studies at this phase of your education?
● Perioperative and pediatric nursing both are very interesting areas.
THE STUDIES APPROVED TO BE ACCREDITED ON THE BASIS OF PREVIOUS

11. STUDIES
1. Universityof Helsinki, Kehitysmaiden lääketiede

12. DEGREE PROGRAMME IN NURSING
THE
STRUCTURE
140 CR/210 ECTS CREDITS
CODE STUDY MODULE/STUDY UNIT ECTS
SW1 BASIC STUDIES 30
HB10 FOUNDATION OF MULTIPROFESSIONAL SKILLS 15
HB1000 Introduction to Polytechnic studies 3
HB1001 Professional Skills, Information Technology 1,5
HB1002 Professional Skills, Introduction to Statistical Methods 1,5
HB1003/SW100
3*
Professional Skills, Communication 1,5
HB1004 Professional Skills, Project work 1,5
HB1005 Adapting to Change in the Professional World 4,5
HB1006 Professional Growth and Self-evaluation 1,5
SW11 FUNDAMENTALS OF HEALTH CARE AND SOCIAL WELFARE WORK AND REHABILITATION 15
SW1100 The Basis of Professional Action in Health Care and Social Welfare Work and
Rehabilitation
4,5
SW1101 Research and Development of Health Care and Social Welfare Work 4,5
SW1102 Swedish 0
SW1103/SY110
3*
English 3
SN2 PROFESSIONAL STUDIES 150
SN20 NURSING CLIENT AND ENVIRONMENT 15
SN2000 The Person as a Holistic Being 1,5
(1)
SN2001 The Person as a Organic Being 6
SN2002 The Person as a Conscious and Spiritual Being 4,5
SN2003 The Person as a Situational Being 1,5
SN2004 Nursing Environment 1,5
SN21 HEALTH 45
SN2100 Health as a Value and Subjective Experience 1,5
SN2101 Children and Adolescents` Health and its Promotion 7,5
SN2102 Adult`s Health and its Promotion 10,5
SN2103 Elderly People`s Health and its Promotion 6
SN2108 Medical Assessment, Examination and Therapeutic Methods in the Changes of Health 19,5
(18)
SN22 NURSING IN ACTION 90
SN2200 The Philosophical and Theoretical Foundations of Nursing 3
SN2201 Interaction in Nursing 3

13. SN2202 Nursing as a Process 3
SN2203 Primary Nursing and Community Orientation in Nursing 3
SN2204 Nursing Client in Transition 3
SN2205 Orientation to Expertise in Clinical Nursing 1,5
SN2206 Diagnosis and Observations in Nursing 6
SN2207 Help and Support in Nursing 15
SN2208 Guidance in Nursing 4,5
SN2209 Documentation in Nursing 6
SN2210 Quality Management in Nursing 6
(1,5
SN2211 Consulting in Nursing 3
SN2212 Entrepreneurship in Nursing 3
Professional Intensive Studies 30
SN2213 The Philosophical and Scientific Foundations of Nursing Science 4,5
SN2214 Nursing in Different Cultures 3
SN2215 Professional Decision-making in Nursing 3
SN2216 Leadership and Development in Nursing 4,5
SN2303 Perioperative Nursing 15
SW7 ELECTIVE STUDIES 15
SW7010 Guitarplaying for beginners 1,5
SY7501 Domestic violance-identification, prevention and care 1,5
YY7403 Basics of Japanese Language and Writing System 3
SW 00477 Job Hunting for the International Degree Students 3
SW 00525 Basic Spanish 2 5
HB7100 Learning to learn 1,5
TR SW7* Kehitysmaalääketiede 4,5
SW8 THESIS AND MATURITY TEST 15
SW8000 Brainstorming the Thesis 1,5
SW8001 Planning the Thesis 3
SW8002 Publishing the Thesis 9
SW8003 Maturity Test 1,5
SN9 CLINICAL STUDIES Are included in the above mentioned modules 75
Viheltäjä`s Day care (5 weeks)
SN2101 Children and Adolescents` Health and its Promotion 4,5c
SN2102 Adult`s Health and its Promotion 1,5c
SN2103 Elderly People`s Health and its Promotion 1,5c
Puolarmetsän Hospital (7 weeks)
SN2102 Adult`s Health and its Promotion 6cl

14. SN2103 Elderly People`s Health and its Promotion 1,5c
SN2201 Interaction in Nursing 1,5c
SN2203 Primary Nursing and Community Orientation in Nursing 1,5c
HUCH Eye clinic (5weeks)
SN2102 Adult`s Health and its Promotion 1,5c
SN2202 Nursing as a Process 1,5c
SN2206 Diagnosis and Observations in Nursing 4,5c
HUCH Jorvi Hospital , Neurological rehabilitation ward 3(5weeks)
SN2207 Help and Support in Nursing 4,5c
SN2208 Guidance in Nursing 3cl
HUCH Jorvi Hospital, adolescent`s acute psychiatric closed ward (5weeks)
SN2204 Nursing Client in Transition 3cl
SN2209 Documentation in Nursing 4,5c
HUCH Eye-ear clinic (4 weeks)
SN2207 Help and Support in Nursing 6cl
Intensive
clinicals
HUCH, Herttoniemi Hospital, orthopaedic day surgery unit (10 weeks)
SN2103 Elderly People`s Health and its Promotion 1,5c
SN2210 Quality Management in Nursing 1,5c
SN2213 The Philosophical and Scientific Foundations of Nursing Science 1,5c
SN2214 Nursing in Different Cultures 1,5c
SN2215 Professional Decision-making in Nursing 1,5c
SN2303 Perioperative Nursing 7,5c
HUCH Töölö`s Hospital, plastic surgery perioperative unit (5 weeks)
SN2303 Perioperative Nursing 7,5c
Matinkylä-Olari Home care nursing, team 3 (4 weeks)
SN2210 Quality Management in Nursing 3cl
SN2211 Consulting in Nursing 3cl

15. 3.2. Learning contracts in clinical studies
The list of clinical studies in the Degree Programme of Nursing. The list is in a
chronological order and learning contracts are in the appendices. The perioperative
nursing intensive clinical studies are at the end of the chapter.
Viheltäjä`s day care
From 19th
of April to 21st
of May 2004 (5 weeks)
(Appendix 1)
Puolarmetsä hospital, ward 2 E
From 25th
of October to 12th
of December 2004 (7 weeks)
(Appendix 2)
HUCH Eye Clinic, day surgery unit 7
From 21st
of March to 24th
of April 2005 (5 weeks)
(Appendix 3)
HUCH Jorvi Hospital, neurological ward NE 3
From 24th
of April to 29th
of May 2005 (5 weeks)
(Appendix 4)
HUCH Jorvi Hospital, youth psychiatric ward PN1
From 19th
of September to 23r d
of October 2005 (5 weeks)
(Appendix 5)
HUCH Ear Clinic, children`s day surgery unit
From 31st
of October to 28th
of November 2005 (5 weeks)
(Appendix 6)
The Intensive clinical studies of perioperative nursing
HUCH Herttoniemi Hospital, orthopedic surgery perioperative unit
From 13th
of February to 23r d
of April 2006 (10 weeks)
(Appendix 7)
HUCH Töölö Hospital, plastic surgery perioperative unit
From 22nd
of May to 25th
of June 2006 (5 weeks)
(Appendix 8)
Matinkylä-Olari Home care, team 3
From 1st
to 28th
of January 2007 (4 weeks)
(Appendix 9)

16. 4. The development of the competence in perioperative nursing
The chosen study path for my intensive studies was perioperative nursing.
During that time I had possibility to familiarize myself with perioperative nursing in
different clinical placements. I learnt theoretically and was a member of perioperative
team. I was able to practice several roles and resposibilities of perioperative nurse. I
also got familiar with the pediatric patients’ path in ENT surgergies and in plastic
surgery.
In the following sections I discuss about my competence development in perioperative
nursing during my nursing studies. The discussion is related to the following topics:
philosophical and scientific foundations; professional decision making in nursing;
nursing in different cultures; leadership and development in nursing, and consulting in
nursing.
4.1. Philosophical and scientific foundations
The lectures about philosophical and scientific foundation of nursing were very
interesting, because these gave possibility to understand nursing history and it in
modern times. Our lecturer, Anna-Liisa Pirnes, discussed with us and also taught us the
ontology and epistemology of nursing. She described the grand theories and middle
range nursing theories. Patient centered care and cultural diversity concept. The
overall picture of nursing research and the framework of nursing science were
explained. We talked about the possibilities to continue nursing studies and the
importance of the evidence-based nursing. This course was very good ground for the
other intensive study courses.
“Thus, a human science and human caring orientation differs from conventional
science and invites qualitatively different aspects to be honored as legitimate and
necessary when working with human experiences and human caring-healing, health,
and life phenomena.” (Watson J. 2005)
4.2. Professional decision making in nursing
“Theories of judgement and decision can be subdivided into three categories:
normative, descriptive and prescriptive. Normative theories assume that an individual
is rational and logical, concentrating on how decisions should be made in an ideal
world.” Thompson C. & Dowding D.
(http://www.us.elsevierhealth.com/media/us/samplechapters/9780443070761/97804
43070761.pdf)

17. In nursing practice, circumstances are several and professional decision making for a
graduating student is an area which develops in practice. In a teamwork with
colleagues and other healthcare professional, student is able to learn, if one is willing
to learn. Co-operation provides possibilities to make right decisions in practise.
Lifelong learning after graduation and practice are very important. Being curious also
supports novice Registered Nurse`s professional growth.
During my intensive clinicals, I had very good mentors, who asked specific questions
related to various patients and their nursing care. I had also my own patients. I was
able to practice critical thinking, follow the patient´s care path, document and make
a nursing care plan for them. I enjoyed the practice and also working during my
studies, I have enjoyed the possibilities to practice and learn, specially in operating
room (OR).
“Nursing is never a superficial, meaningless activity. All acts in nursing are deeply
significant and require of the nurse a mind fully engaged in the practice of nursing.
This is the challenge of nursing; critical, reflective practice based on the sound
reasoning of intelligent minds committed to safe, effective client care.”
(https://www.criticalthinking.org/pages/critical-thinking-and-nursing/834)
In Finland, there are Nursing Ethical Guidelines and very beneficial seminars organized
by the Finnish Nurses Association. International Associations also offer guidelines,
standards and possibilities for conferences, networking and events. For a nurse,
evidence-based nursing and critical thinking are both very essential in practice,
because the decisions are made based on these. Knowing the latest guidelines for
treatments and providing the best possible nursing care for the patient is very
important and for example to minimize risks for patient injuries and mistreatment.
In conclusion, I would like to say that professional decision making in nursing is related
to ethical, critical and specially in perioperative nursing also in aseptic thinking. A
patient has rights and self-determination, which need to be considered on the decision
making.
The skills of making decisions in nursing are important to develop daily and also to
check and ask advice from the experienced Registered Nurses. Collegiality and how to
cooperate in the challenging situations, these skills can be developed in practise and
continues training.
4.3. Nursing in different cultures
Understanding cultural diversity and nursing in different cultures is important, because
as there are similar principles and guidelines, there are also differences in nursing
practices. Such as the quality of nursing care and reached standards in different
countries. Collaboration in nursing internationally is essential and provides possibilities
for the development and progress by setting similar guidelines world wide. Cultural
diversity is also present in Finnish nursing practice and education. Therefore the
course was very useful part in the intensive studies´ curriculum.

18. During the course of Nursing in different cultures students had assignments and
presentations of their chosen topic related to the nursing in a chosen culture.
The presentations provided a good introduction to some cultures that I was not
familiar with, such topics as “Nursing in Kenya” or “Motherhood in Talsania.”
The lectures were very interesting, because as an international group, we had
possibility to introduce various cultures and share our experiences with informative
discussion after presentations.
In the intensive clinicals at the HUCH hospitals our perioperative team, including
doctors, was multi-cultural and we had interesting discussions about nursing or
medicine studies in different countries in Europe and USA. Due to the multi-cultural
working environment and effective action, I got an idea for the learning session in the
clinical environment. The chosen topic was “A Conflict In A Working Environment”,
which was beneficial experience for me and an informative event for the clinical
placement.
In nursing, Madeleine Leininger is one the meaningful theorist and founders of such a
topic as understanding the cultural diversity in nursing. Her theory of Culture Care:
diversity and universality theory is very beneficial in nursing education.
“Culturally competent nursing care can only occur when clients’ beliefs and values are
thoughtfully and skillfully incorporated into nursing care plans. Caring is the core of
nursing. Culturally competent nursing guides the nurse to provide optimal holistic,
culturally based care. These practices also help the client to care for himself and
others within a familiar, supportive, and meaningful cultural context. Continual
improvement and expansion of modern technologies and other nursing and general
science knowledge are integrated into practice if they are appropriate. Today nurses
are faced daily with unprecedented cultural diversity because of the increasing
number of immigrants and refugees.”
(http://nursing.jbpub.com/sitzman/ch15pdf.pdf)
In conclusion, Finnish nurses work independently or as a team with different patients
in Finland or outside Finland. Cultural competence and understanding nursing in
different cultures is a skill what needs to be developed continuously and practiced
daily in the clinical environment. Therefore to educate continuously health care
professionals in the educational days or training events provides possibilities to
minimize misunderstandings in the working environment. Every professional in the
health care has a right to work in a healthy working environment and atmosphere with
ones colleagues.
4.4. Leadership and development in nursing
Nursing is a profession, where continues learning is present after graduating from the
nursing school. According to Jenni Middleton (2011), leadership is one of the key skills
in nursing at all levels.
(http://www.nursingtimes.net/Journals/2011/08/24/j/n/i/Leadership-Skills-for-
Nurses.pdf)
Leadership skills are needed in different situations during nursing career. In teamwork,

19. in the unit and by co-operating with different health care professionals, working as a
nurse in different conditions and environments for example in a refugee camps.
Registered Nurses and Head Nurses have several situations where they use their
leaderships skills and make decisions according to their rights and ethics.
“The leadership must be available 24/7. Leaders can help to create a deeply satisfying
organizational culture at the unit level by engaging staff in the development of
command-and control style of staff supervision toward a transformationalstyle of
leadership in which leaders enhance the motivation, morale, and performance of their
follower groups.” (Sherman, R., Pross, E, 2010)
Nursing students are having possibility to practice in several clinical environments.
During practical placement a student is involved to unit every day rutines and also co-
operates with unit manager and Head Nurse. Nursing students can also follow the units
working culture before practise. Therefore the open communication and good
teamwork is very essential. Clinical environment is providing several new situations for
a student and mentoring is very important during practice. Nowadays simulations are
integrated to nursing studies before going to the clinical environment and its very
beneficial. Patient safety is important throughout nursing studies and simulation
practise provides insights to the clinical environments and the possible situations
there.
Leadership in nursing is very interesting area for professional growth and how to
manage dynamically in the constantly developing environment and have positive
outcome in the patient safety and health care.
“Senior nurses must use their leadership behaviour to positively influence
organisational outcomes and need to appreciate the inter-relationship between
developing nursing practice, improving quality of care and optimising patient
outcomes. Healthcare organisations need nurse leaders who can develop nursing care,
are an advocate for the nursing profession and have a positive effect on health care
through leadership” (FrankelAndrew, 2011)
“Leadership skills begin with understanding one´s self” (Sherman, R. & Pross,E., 2010)
In conclusion, during the intensive studies, I had possibility to practice nursing in
several perioperative units, where they had very good head nurses. I enjoyed my
practical placements, which were very good and challenging at the same time. I
appreciated that I had good mentoring during my clinical studies in orthopaedic and
plastic surgery units. The units teamwork function well due to motivated staff and
good leadership in the units.
4.5. Consulting in nursing
Registered Nurses (RN) can work as consultants, health coaches or educators. There

20. are several possibilities for special trainings to become certified consultant or Legal
Nurse Consultant. Consulting in nursing provides possibilities to work independently, in
a team and also locally or remotely. Nurses can consult for example patients with
Diabetes Mellitus or other chronic diseases. (http://www.nnba.net/facts-
consultants.html)
Nurses work in a co-operation with physiotherapists, Doctors and with other health
care professionals. There are several skills that Nurse Consultants can develop since
self-care has important role in managing chronic diseases or in a patient´s
rehabilitation processes. There are various specific areas offered for a RN who likes to
work independently or to be self-employed.
In United Stated of America is an Association of Legal Nurse Consultants, which mission
is to promote the professional advancement of registered nurses consulting within the
legal arena by providing a forum for education, research and exchange of information.
(http://www.aalnc.org/?page=MissionStatement)
“Legal Nurse Consulting is an expanding nursing speciality practice. Legal Nurse
Consultants must maintain an active Registered Nurse licence as an integral
requirement of the practice discipline.”
(http://c.ymcdn.com/sites/www.aalnc.org/resource/resmgr/position_statements/pos
itionstatement.pdf)
“As knowledge based professionals, Legal Nurse Consultants use information
learned in the research and development of a case to improve future health care
for patients, to advocate for remedies for patients who have received inadequate
care, and to provide education to clients, patients, health care providers, and the
public as appropriate. Legal Nurse Consultants seek adequate protection of
patients and the public and promote accepted standards of care that will serve to
prevent injury and alleviate suffering.”
(http://c.ymcdn.com/sites/www.aalnc.org/resource/resmgr/position_statements/pos
itionstatement.pdf)
The Finnish Nurses Association (www.nurses.fi) provides several possibilities,
guidelines and information for professional growth in Finland. One of the interesting
possibilities in advanced nursing education is to become Advanced Practice Nurse,
which provide professional autonomy and independent practice by including consultant
services to health providers. (http://www.nurses.fi/8th-icn-international-nurse-
prac/what-is-apn/)
4.6. Nursing substance in perioperative nursing
In perioperative nursing, Registered Nurses have two important nursing areas:
anesthesia nursing and operating room nursing. The roles and resposibilities of
perioperative nurses are divided according to their roles in the perioperative working
environment and depending of the surgical procedure.
In OR, there are a nurse anesthetist, circulating nurse, instrument nurse, RN first
assistant. In the major surgeries depending of the surgery, there could be more nurses

21. and doctors involved to the surgery.
(http://www.elsevierhealth.com/media/us/samplechapters/9780702027574/97807020
27574.pdf)
In Finland, there are two associations for perioperative nurses, Finnish Operating Room
Nurses Association and Finnish Anesthesia Nurses Association, which co-operate with
other international associations. Association of periOperative Nurses is well known
internationally and it provides guidelines and seminars for perioperative nurses.
(http://www.aorn.org/)
4.7. Planning a learning session in a clinical environment: HUCH Töölö Plastic
surgery unit
Topic: A Conflict in Working Environment (Appendix 10)
Date: On the 16th
of June 2006 at 8:00 a.m.
Place: HUCH Töölö`s Hospital, plastic surgery perioperative unit
Presenter: Marjut Uusmäe
Equipment: PowerPoint and projector
Time: 15 minutes
Contents:
1. A conflict in working environment
2. What are the ordinary problems in working environment?
3. Relationship problems
4. Relationship conflicts and their development
5. Law and responsibilities
6. Options to solve contradictions
7. Succeeding and not succeeding in resolving a conflict
The aim of the learning session in the plastic surgery perioperative unit was to arrange an
informative and up-to-date meeting about well-being in perioperative working environment.
The learning session included a presentation, a small discussion afterwards and evaluation by
the substitute ward Sister RN Helena Inha (Appendix 11)
The assessment of learning session was based on the presentation, performance, time

22. management and relevance of the topic.
I believe that I reached my objectives to arrange a meeting that would be informative and
would develop my performing skills and would give grounds for further discussion in the unit
about the topic. I also developed my skills in planning and implementing professional meeting
and discussion by co-operating with my Tutor and ward Sister in the learning session planning
phase. It also developed my professional language skills in Finnish and time management in the
presentation performance.
4.7. Log book of the lessons
During my intensive studies I participated to several medical and other lectures or
events given by specialists, which were following:
Kaija Heikkilä, SN2215 Professional decision making
29.8.2006 12:30-15:45
Jouni Pitkänen
SN2108, Special issues in medicine, Tapiola Otaniemi
30th of August 2006, 8:30-11:45
31st of August 2006, 8:30-11:45
1st of September 2006, 12:30-15:45
Kehitysmaiden lääketiede, University of Helsinki, 2007
Peter Koehn, Transnational Health Care in Finland, University of Helsinki, Faculty of
Social Sciences
27th of March 2006, 9:00-15:30
MSD Finland OY, Pikkujätti seminar, Radisson SAS Royal, Helsinki
Päivi Lindahl
Maija Vedenpää
Teemu Arina, Mikko Ikola and Olli Sovijärvi MD,
QS and Biohacking event in Trainer´s House
10th of June 2013
5. Thesis, maturity test and profile in the student portfolio
The thesis of Rheumatic patient´s self-care is in a process at the moment.
The purpose of the Thesis is to produce a manuscript for patient education programme

23. of self-care for a patient having a rheumatic disease.
Maturity test will be written article to a nursing journal.
The concept, such as self-care and quantified self are very interesting, because these
provide insights how our own body reacts and functions in several ways and
circumstance. Since several adults and youths are curious about their own health and
want to take care of themselves. Mobile Health provides several possibilities for that
and the data what for example, a patient having a chronic diseases could collect, is
very valuable for their personal care plan or process.
(http://www.wired.com/2014/03/apple-healthbook-is-just-the-beginning/)
The area that I am curious about is closely related to quantified self and digital health.
The concepts that are is use and are new, but these describe well the possibilities that
each person can take of ones health while being healthy, having a disease or being
pregnant.
There are also several StartUp-companies from Finland, which have got funding and
significant parties internationally has seen a potential. For example: Health Puzzle
www.health-puzzle.com , Nurse Buddy www.nursebuddy.fi , Beddit www.beddit.com
In conclusion, I would like to say that having perioperative clinicals in the orthopedic
unit, it was natural to do the Thesis about patient´s self-care and related to the
rheumatic diseases. In these areas holistic approach is essential for the patient and
ones family.
6. Conclusion and assessment of learning
In conclusion I would like to say studying in Laurea University of Applied Sciences has
been fascinating and challenging journey to become a Registered Nurse. Nursing is a
profession, where lifelong learning is present. There are several challenges that
graduating RNs face in the working life nowadays. One of the major challenge is the
nurses shortage globally. It provides possibilities to choose where to work, but at the
same time it is challenging to work in an unit where shortage of nurses influence daily
work and the quality of nursing care.
Therefore, the challenge is how to keep the nursing quality as good as possible, enjoy
the working and have a long career as a RN. In the following section I will discuss the
learning process during my intensive studies and talk about the future challenges and
resources.
6.1. Theoretical learning and professional growth
During our nursing studies, in our courses, we often talked about Roy´s Adaptation
Model, holistic nursing, Leininger`s theories of cultural diversity and in my Bachelor
Thesis I focused in self-care and patient education.
Nowadays, I would emphasize and encourage patients to take care of themselves and

24. participate to their own care and rehabilitation as much it is possible according to
their health conditions.. This assumption is based on the experience while working
with pediatric and geriatric patients during my intensive studies and nowadays in
Eira`s Hospital and Lasten- ja nuorten lääkäriasema Pikkujätti. Patients place can
cope well in their own homes, if they have enought support and empowerment by the
healthcare professionals.
Self-care according to the patient condition and resources. The technical equipment
and good patient education provide several possibilities to the patients with chronical
diseases, such as Diabetes Mellitus I, II and rheumatic diseases.
The new terms, which have been used in health care, are Mobile Health, Digital Health
and Quantified Self. With mobile or digital devices people can measure, collect data
and keep track on their daily routines. I believe that the future in nursing will be
related to the preventive treatment of diseases, health promotion and self-care with
real-time patient education.
I was involved during my intensive studies also Hyvinvointi TV project. We made 4
programmes for the seniors and had very interesting live discussions with the group,
while our clients where in their homes or nursing homes.
Professionally I have enjoyed taking care of several patient´s from pediatric to senior
patients. I believe that changing units or the areas according the personal life
situations is important, since it helps to estimate the inner resources as a nurse to
care for the patients, to analyse the strengths and weaknesses during the career.
While caring for others, every nurse must understand that to be able to care for
others, they firstly need to take care of themselves and have balance in own life.
Nursing is demanding, responsible and challenging profession.
6.2. Students clinical self-assessment
I have enjoyed my nursing studies. Clinical placements provided very useful and
interesting learning situations and opportunities to get experiences with patients in
various age groups and with different health conditions. Mostly I enjoyed the intensive
clinicals in perioperative nursing. Clinical environment provided possibilities to
strengthen the practical skills and understand the importance of theories in nursing.
How these are implemented in practice and what kind of approached are used in
different hospitals.
I started my first intesive studies in January 2006 with the theoretical part of
perioperative nursing taught by Anna-Liisa Pirnes and other lecturers. The first clinical
placement started in February 2006 in Herttoniemi Hospital`s orthopedic day surgery
unit. I was pregnant during these clinicals. Due to that I also thought from various
angles every move or new experience in the clinical environment. For example: how to
avoid x-ray in orthopedic surgeries. I had to make decisions with my Tutors related to
the patient and own health safety, but I had continuously possibilities to practise
different roles in the operating theatre.
I was really motivated to learn and studied hard. After February 2007 I faced some
challenges in my personal life, which also influenced my motivation to study and

25. graduation delayed. I overcame the challenges step by step and now I am looking
forward to become a Registered Nurse and professional development. While studying
and having a family, ideal would be to focus on studies, but sometimes life has bigger
plans which have to be taken care of, such as children and all responsibilities that
parenthood brings.
The first intensive clinical placement was in the Helsinki University Central Hospital´s
(HUCH) Herttoniemi hospital orthopaedic day surgery perioperative unit. I was able to
practise there for 10 weeks. First five weeks I practised as circulating and scrub nurse
roles. Another five weeks, I had possibility to learn anaesthesia nursing in operation
room (OR) and in post-anaesthesia care unit (PACU).
I was able to follow the patient care path starting from the preoperative phase
through intraoperative and ending in the postoperatively.
I had also my own patients, who had knee and solder surgeries. Most interesting was to
be involved to multi-professional co-operation to improve patient`s/client`s well-
being and health.
The second intensive clinical placement was in HUCH Töölö`s hospital, plastic and
reconstructive surgery perioperative unit. The unit was fascinating and challenging
learning experience. The surgical treatments were mainly reconstructive plastic
surgeries for various medical reasons to improve a patient`s life quality, well-being
and health condition. The patients in the unit were from pediatric to geriatric
patients.
During Töölö clinical placement I was in OR and PACU. Where I realized that for the
patient to provide privacy and support was important, because patients experience
surgical treatments subjectively. Before, during or after operations they are more
sensitive for the external environmental factors than in normal circumstances. To
understand patient as a holistic being is very important and cultural diversity is
present in the University hospitals. Health care professionals and patients are often
from several nationalities. Professionals are working as a team to care for the patient.
I truly enjoyed my clinicals in Töölö, but due to my pregnancy few learning
experiences were limited. From that perspective I was able to learn hospital
environment safety and ergonomics in nursing.
The third part of intensive clinicals was home care in Matinkylä-Olari, which was good
experience to understand the holistic nursing process in home care, while caring for
adult or senior patients. I practised medical calculation, administered medications,
checked and followed clients health conditions, clinical nursing skills, PEG-nap
nutrition process and documentation. The nursing in home is different than in hospital
and how to respect clients rights in the other environment and ethical aspects in
nursing. Home care provided possibilities to learn from various patients.
In conclusion, I would like to say that intensive clinicals in perioperative nursing were
interesting and I was able to practise clinical skills continuously. Tutors were
experienced and very good specialist in their own area. HUCH Töölö plastic and
reconstructive unit had very interesting surgeries and I am glad that I was able to
accomplish perioperative intensive clinicals in this unit.

26. 6.3. Intensive clinical Tudors` evaluation short-cuts
“She is responsible and takes into account patient`s safety. Applies her-self to the
learning situations and searches independently for the information. She has trained
reporting, which has proceeded well.”
RN Sisko Teppanainen, HYKS Herttoniemi`s hospital
“During intensive clinicals Marjut`s aseptical managing developed and hands/practical
skills strengthened. She developed good understanding of patient care in a holistic
approach. She considered a patient as central part of action and not as an object
rather as involved partner in ones own care. Also the teamwork was well managed. As
a student, she is active, responsible and develops her skills.”
RN Minna Tavi-Jussila, HYKS Herttoniemi´s hospital
“It was obvious that Marjut was used to behave and act at the operating theatre
environment. The character of the unit brought plenty of new situations every day and
she could stand back when needed and help if she knew that she would handle the
situation. This is quite mature way.”
“In generally, Marjut has good starting position even to start the learning process to be
a nurse at operating theatre. She understands the different needs of different patients
and she is eager to take the challenges.”
RN Ulla Lucenius, HYKS Töölö`s hospital
“Special thanks for the following things:
-purposeful caring for the patient well-being in changing situations
-taking care of own learning and achieving the objectives
-appreciating various professions working performance
-active in attempt to structurize experiences in relation to the whole nursing process
and its successful outcome
-appreciating nursing
The practice has been completed excellently.”
RN Kirsi Malmgren, HYKS Töölö´s hospital
“Strength areas: interaction skills are strong and you meet the client subtly. Also you
know the skill of listening to, which is important tool in nursing. You make detailed
findings based on the client holistic notification and you also bring those up. You are
eager to take challenges and participate independently to the client care. You take
responsibility of your work by knowing your limits and areas that need development.
By asking questions you show your interest related to the work. You perceive well the
meaning of nursing and client`s well-being related to various sub-areas. Developing
areas: staying on schedule.”

27. RN Piia Takkinen, Matinkylä`s home care nursing
7. References
Institute for Patient- and Family-Centered Care
http://www.ipfcc.org/advance/topics/better-together.html
http://www.wired.com/2014/03/apple-healthbook-is-just-the-beginning/
Tonge, A. (2011). Perioperative care of the pediatric patientwith down syndrome. AORN Journal,94(6),
606-617.doi:10.1016/j.aorn.2011.09.005
Preparing Children and Families for Surgery: Mount Sinai's Multidisciplinary Perspective
Justus, Rachel; Wyles, Dana; Wilson, Joan; Rode, Diane; Walther, Virginia; Lim-Sulit, Nanita
AORN Journal
Issue: Volume 67(3), March 1998, pp 568-576
Copyright: Copyright © 1998 AORN
Publication Type: [Clinical: Home Study Program]
ISSN: 0001-2092
Accession: 00000703-199803000-00019
Dental Surgery in Pediatric Patients with Spina Bifida and Latex Allergy
HUDSON, MARY E. RN
AORN Journal
Issue: Volume 90(1), July 2009, p 132–133
Copyright: Copyright © 2009 AORN
Publication Type: [Departments: Evidence for Practice]
ISSN: 0001-2092
Accession: 00000703-200907000-00019
Shapira-Lishchinsky O. Simulations in nursing practice: toward authentic leadership. Journal Of

28. Nursing Management [serial online]. 2014;22(1):60-69. Available from: CINAHL with Full Text,
Ipswich, MA. Accessed March 12, 2014.
Suomen sata uutta mahdollisuutta: radikaalit teknologiset ratkaisut
http://web.eduskunta.fi/dman/Document.phx?documentId=ie27613151734377
Scully, S. M. (2012). Parental presence during pediatric anesthesia induction. Association of
Operating Room Nurses.AORN Journal, 96(1), 26-33.
doi:http://dx.doi.org/10.1016/j.aorn.2011.07.020
Madeleinen Leininger http://nursing.jbpub.com/sitzman/ch15pdf.pdf (1st of March 2014)
Sherman, R., Pross, E., (Jan. 31, 2010) "Growing Future Nurse Leaders to Build and Sustain
Healthy Work Environments at the Unit Level" OJIN: The Online Journal of Issues in Nursing Vol.
15, No. 1, Manuscript 1.
(http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofC
ontents/Vol152010/No1Jan2010/Growing-Nurse-Leaders.html)
Thompson C. & Dowding D.
(http://www.us.elsevierhealth.com/media/us/samplechapters/9780443070761/9780443070761
.pdf)
Patricia Benner “From novice to expert”
http://www.healthsystem.virginia.edu/pub/therapy-services/3%20-%20Benner%20-
%20Novice%20to%20Expert-1.pdf
The American Association of Legal Nurse Consultants
http://www.aalnc.org/?page=MissionStatement
Critical Thinking in Nursing, Penny Heaslip 1993
https://www.criticalthinking.org/pages/critical-thinking-and-nursing/834
What is APN?
http://www.nurses.fi/8th-icn-international-nurse-prac/what-is-apn/
Shields L (2010) Model of Care: Questioning Family-Centered Care, Journal of Clinical Nursing,
19, 2629-2628
Shields L, Tanner A (2009) Perioperative Care of the Child: A Nursing Manual, Wiley-Blackwell,
Hoboken, NJ USA
Wennström, Törnhage
Johnson Beverley H., Abraham Marie, MA; Shelton Terri L., PhD
Patient-and Family-Centered Care: partnerships for quality and safety
http://www.ncmedicaljournal.com/wp-content/uploads/NCMJ/Mar-Apr-09/Johnson.pdf
http://www.elsevierhealth.com/media/us/samplechapters/9780702027574/9780702027574.pd

29. f
Links:
Finnish Parlament has publish very interesting document for 100 future possibilities
(http://web.eduskunta.fi/dman/Document.phx?documentId=ie27613151734377)
Shields, L. (2007). Family-centered care in the perioperative area: an international
perspective. AORN Journal, 85(5), 893. doi:10.1016/j.aorn.2007.04.007
The institute of Family Centered Care http://www.familycenteredcare.org
Ahmann, Elizabeth; Dokken, Deborah New Year's Resolutions for Family-Centered Care!!.
Pediatric Nursing. 1(34):80-81, January/February 2008 (a lot of links)
Possible references: McEWEN, DONNA R. RN, BSN, CNOR, CNRN; BELANGER, GRETCHEN RN;
GOODE, PEARL M. RN, BSN, CNOR; NAJAR, YOLANDA RN, MSN; SHEAN, GLORIA RN, BSSW, CNOR;
TORRES, DIANE RN, BSN Family-centered perioperative nursing care takes on a new look. AORN
Journal. 68(1):97-100, July 1998
Cunningham, Maureen F. MSN, RN, OCN; Hanson-Heath, Cathy CNSC, RN, OCN; Agre, Patricia
EdD, RN, CHES A Perioperative Nurse Liaison Program: CNS Interventions for Cancer Patients
and Their Families. Journal of Nursing Care Quality. 18(1):16-21, January/February/March 2003
Nelson, Delores Privette BSN, RN; Polst, Gerald MD An Interdisciplinary Team Approach to
Evidence-Based Improvement in Family-Centered Care. Critical Care Nursing Quarterly.
31(2):110-118, April/June 2008
Titone, Jill; Cross, Russell; Sileo, Melissa; Martin, Gerard Taking Family-Centered Care to a
Higher Level on the Heart and Kidney Unit. Pediatric Nursing. 30(6):495-497,
November/December 2004.
Suitabel references:
Shields, Linda RN 1 Family-Centered Care in the Perioperative Area: An International
Perspective. AORN Journal. 85(5):893-894,896-902, May 2007
Kamerling, Susan N. RN, MSN, BC; Lawler, Linda Cunningham RN, BSN; Lynch, Marie RN;
Schwartz, Alan Jay MD, MSEd Family-Centered Care in the Pediatric Post Anesthesia Care Unit:
Changing Practice to Promote Parental Visitation. Journal of PeriAnesthesia Nursing. 23(1):5-
16, February 2008.
Romino, Stacy L. RN; Keatley, Virginia M. RN; Secrest, Janet RN; Good, Kelly RN Parental
presence during anesthesia induction in children. AORN Journal. 81(4):779-783,785-789,792,
April 2005.
Ono, Satomi, Hirabayashi, Yuko, Oikawa, Ikuko, Manabe, Yukiko Preparation of a Picture Book
to Support Parents and Autonomy In Preschool Children Facing Day Surgery. Pediatric Nursing.
1(34):82-83, January/February 2008.
Nuring care plan for pediatric patients:HARRINGTON, STELLA RN, BSN, CNOR; SIMMONS, KRISTY

30. RN, CNOR; THOMAS, CYNTHIA RN, BSN, CNOR; SCULLY, SUSAN RN, BSN, CNOR Pediatric
Laparoscopy. AORN Journal. 88(2):211-240, August 2008
Stein, Patricia RN Total Anomalous Pulmonary Venous Connection. AORN Journal. 85(3):509-
520, March 2007. ( heart surgery for infants and family care)
Cost-effectivenss and patient safety
Ponte, Patricia Reid; Connor, Maureen; DeMarco, Rosanna; Price, Jessica Linking Patient and
Family-Centered Care and Patient Safety: The Next Leap. Nursing Economics. 22(4):211-
213,215, July/August 2004.
Parents experiences:
Williams, Lawrie Family Matters: The Many Roles of Families in Family-Centered Care - Part III.
Pediatric Nursing. 33(2):144-146, March/April 2007.
History of Family centered care:
Dokken, Deborah MPA; Ahmann, Elizabeth ScD, RN The Many Roles of Family Members in
"Family-Centered Care" - Part I. Pediatric Nursing. 32(6):562-565, November/December 2006
More generally about the topic and perioperative nursing
Holmes, Susan P. RN Implementing a Perioperative Nursing: Elective in a Baccalaureate
Curriculum. AORN Journal. 80(5):902-904,906-910, November 2004.
Majasaari, Hilkka RN; Sarajarvi, Anneli RN; Koskinen, Helena RN; Autere, Sinikka RN;
Paavilainen, Eija RN Patients' Perceptions of Emotional Support and Information Provided to
Family Members. AORN Journal. 81(5):1030-1031,1033-1036,1038-1039, May 2005.
Gruendemann, Barbara J. RN Distance Learning and Perioperative Nursing. AORN Journal.
85(3):574-576,578-586, March 2007.
Smith, Sandra RN Preparing RNs for the OR Through a Certificate in Perioperative Nursing
Program. AORN Journal. 80(4):690-692,694,697-698, October 2004.
Koch, Frances RN, MSN, CNOR; Huggins, Karen A. RN, MN, CNOR Perioperative Care of
Environmentally Sensitive Patients. AORN Journal. 68(3):375-377,379,381-382, September 1998.
Future challenges (Robotic-assisted surgeries):
Francis, Paula; Winfield, Howard N. Medical Robotics: The Impact On Perioperative Nursing
Practice. Urologic Nursing. Special Issue: Robotic-Assisted Urologic Surgery. 26(2):99-108, April
2006.
Model of family-centered care in perioperative nursing

31. 8. Appendices