Ethical considerations The studies were approved by the Regional Ethical Review Board (reg. no. 2011/061) and were conducted according to the medical research ethical standards of the Declaration of Helsinki104 and the ethical guidelines for nursing research.105 Ethical considerations concerning the principles of autonomy, beneficence, non-maleficence and justice105 were made. The principle of autonomy “with respect for the participant’s dignity, integrity and vulnerability”105 (p.3) was complied with through voluntariness, informed consent, the right to withdraw from research project and confidentiality. The author verbally informed the personnel about the study at workplace meetings (Paper I, II and Paper III). Written information was delivered to all personnel (Paper I, II and Paper III) and to all adult patients planned for surgery during the observation period (Paper I and Paper III). Before the focus group interviews, the heads of the department provided written information about the study as well as the moderator’s e-mail address and telephone numbers to the participants (Paper IV). The information dealt with what the study entails; the study aim; the method and that the personnel and patients could withdraw from the study at any time without explanation; that the data would be coded and handled strictly confidentially and that the results would be presented on a group level (Paper I-III) so that no person could be identified (Paper I-IV). The personnel (Paper I-IV) and patients (Paper I and III) were also informed that they could contact the researchers if they had any questions about the study. In Paper I and III, the handover was included if a written consent form from the patient was attached to the anaesthetic record upon arrival at the PACU and the sender and receiver during handover had agreed to participate. In Paper II, written information was attached to the questionnaires and the participants gave their consent by completing the questionnaires. In Paper IV, verbal information was used to inform the informants about the study and their written consent was received
The principle of beneficence was followed in the sense that “the research can be justified and brings new knowledge to promote and restore health, to prevent illness and to alleviate suffering”.105 (p. 4) As lack of communication between personnel is the most common cause of low quality in care, results of research on factors that affect communication and technics that improve communication may enhance quality, patient safety and alleviate suffering. Regarding the principle of non-maleficence or not causing harm to participants, the measures using a digital recorder, observations, anaesthetic record (Paper I and Paper III) questionnaires and incident reports (Paper II) as well as focus group interviews (Paper IV) were considered not to harm participants, even though some of them may have felt uncomfortable. The principle of justice was followed by inviting all personnel at the anaesthetic clinic to take part in the study