EMPIRICAL STUDIES Experience of anaesthesia nurses of perioperative communication in hip fracture patients with dementia Ferid Krupic RNA, DMSci, PhD (Researcher) 1 , Thomas Eisler MD, PhD (Orthopaedic Surgeon) 2 , Olof Sk € oldenberg MD, PhD (Orthopaedic Surgeon) 2 and Nabi Fatahi RN, PhD (Senior Lecturer) 3 1 Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2 Unit of Orthopedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden and 3 Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden Scand J Caring Sci; 2016; 30; 99–107 Experience of anaesthesia nurses of perioperative communication in hip fracture patients with dementia Background: Perioperative care in hip fracture patients with dementia can be complex. There is currently little scientific evidence on how care should be undertaken. Aims: The aim of the study was to describe the experi- ence of anaesthesia nurses of the difficulties that emerge in care situations and how communication with patients can be maintained in the perioperative setting of hip fracture surgery. Methods: Individual interviews were conducted with ten anaesthesia nurses (5 men and 5 women). The inter- views were carried out at a university hospital in Goth- enburg (Sweden), and the data were analysed using qualitative content analysis. Findings: Three main response categories were discerned: ‘Communication’, ‘Dementia as a special issue’ and ‘Prac- tical issues’. Dementia was viewed as one of the most dif- ficult and shifting diseases an individual may suffer from. Time must be allocated to communicate clearly and patiently, to meticulously plan and carry out care while providing distinct information to enable patient participa- tion. Establishing a mental bridgehead by confirming the patients’ perceptions/feelings significantly reduced dis- tress in a majority of the patients. A holistic and respect- ful approach was deemed mandatory at all times. Patients are sometimes dependent on recognition, so that small personal items brought close to the patient during surgery can calm the patient. State-of-the-art analgesia and anxiolytic medications are mandatory. Conclusions: Perioperative problems can be overcome with patience, empathy and profound knowledge of how patients with dementia respond prior to surgery. Our results may serve as a source for future care and provide information about hospital settings for better periopera- tive care in patients with dementia. Keywords: dementia, nursing, perioperative care, hip fracture, communication. Submitted 5 November 2014, Accepted 14 February 2015 Introduction There is currently a rapidly increasing incidence of dementia in hip fracture patients (1). Their mortality rate is greater than those without a diagnosis of dementia and the patients who survive may never return to their previ- ous mental and physical functional level. Patients are generally fragile and frail in most settings and require specific health resources to individualise care in relation to their disease level (2). To the best of our knowledge, there is currently little evidence on how these patients in need of imminent hip fracture surgery should be approached. Caregivers in the acute perioperative situa- tion, apart from purely medical data, often lack informa- tion about the patient’s social circumstances, personality, coping behaviour or life history. Since a majority of patients should have surgery within 24 hours after admission in order to reduce morbidity and mortality, most of these factors remain unknown when the patient is prepared for surgery (3). In elective surgery, pre-opera- tive appointments have proved to be of importance (4), but in the acute fracture situation, anaesthesia nurses obviously face other problems in demanding situations with the pressure of time (5). Glover et al. (6) argued that when a patient with dementia is affected by acute trauma, severe stress is experienced due to sudden psy- chological and physical deterioration, and it is not uncommon that patients become aggressive, paranoid Correspondence to: Ferid Krupic, Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, G€ oteborgsv€ agen 31, Gothenburg, Sweden. E-mail: ferid.krupic@gu.se 99 © 2015 Nordic College of Caring Science doi: 10.1111/scs.12226