Peri-operative nursing practice is constantly changing and demanding specialist knowledge, skills and expertise to embrace these changes. All patients in need of anaesthesia are entitled to the same high quality peri-operative care and therefore those assisting the anaesthetist must be competent and effective practitioners. With this in mind the authors shall give a reflective account highlighting the role of Anaesthetic Nurse Specialist (ANS) in promoting leadership within the peri-operative environment and how it can be nurtured and facilitated to achieve professional autonomy and promote patient advocacy.

Parental refusal to consent for medical and surgical consent can present children's nurses with a professional dilemma and can potentially negatively impact the care provided for the both the paediatric patient and their family. With in this article, the legal, ethical and professional aspects associated with this dilemma are presented and discussed from the parental, child and nurse point of view.

The purpose of the study was to describe the day-surgery patients’ shoulder operation counselling from the patients’ perspective. The aim was to produce information for patient counselling on the day-surgery unit. For the study, nine patients who had shoulder operations as day-surgery patients were interviewed during spring 2012 using thematic interviews approximately one week after the operation. As a method of a qualitative study, inductive content analysis was used.

The results indicate that, as a result of counselling, patients experience feelings of safety and trust as long as they receive enough information and are included in decision making. Professional staff and a positive care environment promote the feeling of safety and trust. The results also demonstrate that lack of counselling and factors that affect the patients’ internalisation of the counselling leads to feelings of insecurity. The study showed that patients possess their own individual coping mechanisms, which support counselling.

With regard to counselling in relation to shoulder surgery the results produce new knowledge, as there is no previous research regarding patients’ experiences of counselling for shoulder surgery in the day-surgery setting in Finland. The results indicate that the patient's personal counselling experiences are wide ranging, and the findings call for a new approach when developing nursing care in the future.

Recommendations from this study produce information that can be incorporated into post-graduate nurses’ induction, training, and the results can also enhance written patient instructions.