| 1. |
- Ahl, Caroline, et al.
(author)
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Making up one's mind : patients' experiences of calling an ambulance
- 2006
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In: Accident and Emergency Nursing. - : Elsevier. - 0965-2302 .- 1532-9267 .- 1755-599X .- 1878-013X. ; 14:1, s. 11-19
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Journal article (peer-reviewed)abstract
- The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals' and caregivers' perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients' existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients' experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals' point of view but also take account of the patients' reactions when they experience a threat to their life and health.
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| 2. |
- Dalheim-Englund, Ann-Charlotte
(author)
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Skydda och frigöra : en studie av föräldrar till barn med astma och av professionella vårdare
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim of this thesis is, from the point of view of parents of a child with asthma, to describe meanings of being a parent, parents’ quality of life, and to describe how family relations are influenced by their child’s disease. The aim is also to increase the understanding of what strategies professional caregivers use in their work with teenagers suffering from asthma. Methods: Informants in the three qualitative studies were 29 parents (17 mothers and 12 fathers) of children with asthma and 7 professional caregivers. Informants in a quantitative quality of life study were 371 parents. The data collections were undertaken by means of interviews, observations and a questionnaire. The data was analysed by means of a phenomenological-hermeneutic method, grounded theory and statistics. Results: A meaning of being a parent of a child with asthma is to live a strenuous life and to fear that the child might die during a severe asthma attack. The parents’ actions involve both protecting and liberating and their feelings involve sadness as well as acceptance. Mostly the mothers act in a protecting manner and express feelings of sadness. The fathers mostly act in a liberating manner and express feelings of acceptance. The core concern in families of a child with asthma was found to be disease-engendered uncertainty. The mothers describe that feelings of uncertainty always are present owing to the unpredictability of the disease. These feelings make the mothers more or less available for family members. For the child with asthma the mothers’ experience that they are always available. Thus, control and tight bonds characterize the mother-child relationships. The mothers’ constant availability for the child with asthma is experienced to lead to a decreased availability for other family members and theses relationships are characterised by feelings of forsakenness and lack of understanding. However, when parents of children with asthma estimate their quality of life by a questionnaire, they estimate it as comparatively high. In the same family the parents scoring of separate items was to a large extent similar. The result also shows that professional caregivers’ central concern is to assist teenagers with asthma to conquer life. This gives rise to five strategies: showing respect, being at hand, promoting personal sense of responsibility, promoting exceeding boundaries, and promoting reflections. In professional caregivers’ attempt to assist teenagers to conquer life some differences are seen in the way they support boys and girls. Conclusion: One conclusion drawn from this thesis is that being a parent of a child with asthma involves feelings of uncertainty. In meeting the parents in question, caregivers should reflect upon these feelings and consider how the parents could be assisted. As mothers and fathers describe different attitudes in relation to the care of the child, it is also important to reflect upon how professional caregivers can assist the balance between the mothers’ protecting and the fathers’ liberating attitudes. It is also important for professional caregivers to reflect upon how they meet teenage girls and boys with asthma respectively, and to take their needs and understanding of the situation into consideration.
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| 3. |
- Efraimsson, Eva, 1955-
(author)
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Vårdplaneringsmötet. : En studie av det institutionella samtalet mellan äldre kvinnor, närstående och vårdare
- 2005
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis is to describe how elderly women’s encounters with an institutionalised world of health care manifest itself in a discharge planning conference (DPC). The thesis is based on eight video recorded DPCs and follow-up interviews with the women who took part in the conferences. The result of study I, a case study, showed that the woman’s experience of taking part in the DPC was characterised as a feeling of powerlessness. The women’s possibility to have influence on the care planning was small (Study II). Study III revealed that the participants adopted or were assigned to different roles during the DPC. As these roles collided dilemmatic situations occurred. Simultaneously the women and family members struggled to manage the institutional frame that surrounded the meeting by trying to find room within it or by challenging it. Study IV revealed that the women found themselves to be in a vulnerable situation. Their body had failed them, their future was insecure and they felt unprepared as they took part in the DPC. They felt as if they were being affiliated with the other participants in a joint project, as if they were standing outside the event or as if they were in focus for the conversation which. The last was a double edged experience: getting confirmative attention but also being exposed as dependent. Four themes characterise the care that was jointly constructed by all participants during the DPC. These themes are “Care as spirit of community and confirmation”, ”Care as alienation”, ”The incomprehensible care” and “The inflexible and betraitful care”.The result gives rise to questions about the relevance of DPCs in their present shape. Further research and developmental projects requested to achieve dicharge planning conferences that are corresponding better to official caring ideals and the patients needs.
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| 4. |
- Englund, Ann-Charlotte, et al.
(author)
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Assisting teens with asthma to take command
- 2006
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In: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Ltd.. - 0283-9318 .- 1471-6712. ; 20:2, s. 193-201
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Journal article (peer-reviewed)abstract
- In English To meet and work with teenagers may be a challenge for caregivers as adolescence is a period when youths try to establish autonomy. Although asthma is an increasing problem worldwide, few studies have addressed professional caregivers' motives and actions. Therefore, the aim of this study was to describe professional caregivers' strategies in their work with teenagers with asthma. Grounded theory, inspired by Glaser, was used to uncover the phenomenon. The informants were seven professional caregivers who worked at an eight-day asthma camp for teenagers in Sweden. Participant observations and interviews were used, and the first author collected the data and participated in the activities. Findings show that professional caregivers' core concern is to assist teenagers with asthma to take command. This core concern gives rise to five strategies: showing respect, being at hand, promoting own responsibility, promoting to exceed boundaries and promoting reflections. In professional caregivers' attempt to assist teenagers to take command some differences are seen in the way they support boys and girls. One conclusion drawn from our study is that the provisional theory of 'Assisting teenagers with asthma to take command' is not only suitable for professional caregivers working at asthma camps; it may, in some degree, also be used as a source of inspiration for professional caregivers in other settings.
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| 5. |
- Herlitz, Johan, 1949, et al.
(author)
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Association between interval between call for ambulance and return of spontaneous circulation and survival in out-of-hospital cardiac arrest
- 2006
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 71:1, s. 40-6
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Journal article (peer-reviewed)abstract
- AIM: To describe the association between the interval between the call for ambulance and return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest. PATIENTS: All patients suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was started, included in the Swedish Cardiac Arrest Registry (SCAR) for whom information about the time of calling for an ambulance and the time of ROSC was available. RESULTS: Among 26,192 patients who were included in SCAR and were not witnessed by the ambulance crew, information about the time of call for an ambulance and the time of ROSC was available in 4847 patients (19%). There was a very strong relationship between the interval between call for an ambulance and ROSC and survival to one month. If the interval was less than or equal to 5 min, 47% survived to one month. If the interval exceeded 30 min, only 5% (n = 35) survived to one month. The vast majority of the latter survivors had a shockable rhythm either on admission of the rescue team or at some time during resuscitation. CONCLUSION: Among patients who have ROSC after an out-of-hospital cardiac arrest, there is a very strong association between the interval between the call for ambulance and ROSC and survival to one month. However, even if this delay is very long (> 30 min after calling for an ambulance), a small percentage will ultimately survive; they are mainly patients who at some time during resuscitation have a shockable rhythm. The overall percentage of patients for whom CPR continued for more than 30 min who are alive one month later can be assumed to be extremely low.
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| 6. |
- Herlitz, Johan, 1949, et al.
(author)
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Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden
- 2005
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In: Coron Artery Dis. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 16:1, s. 51-7
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. METHODS: This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. RESULTS: In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P = 0.025) and an increase of females from 29 to 32% (P = 0.0001). There was a change in witnessed status (P < 0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P < 0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P < 0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P < 0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P = 0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). CONCLUSIONS: Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.
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| 7. |
- Herlitz, Johan, 1949, et al.
(author)
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Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden
- 2005
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 64:1, s. 37-40
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Journal article (peer-reviewed)abstract
- AIM: To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden. METHODS: Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990-2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants). RESULTS: In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2-58.1). CONCLUSION: Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.
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| 8. |
- Herlitz, Johan, 1949, et al.
(author)
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Characteristics and outcome amongst young adults suffering from out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation is attempted
- 2006
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In: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 260:5, s. 435-41
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Amongst patients suffering from out-of-hospital cardiac arrest, young adults represent a minority. However, these victims suffer from the catastrophe when they are in a very active phase of life and have a long life expectancy. This survey aims to describe young adults in Sweden who suffer from out-of-hospital cardiac arrest and in whom cardiopulmonary resuscitation (CPR) is attempted in terms of characteristics and outcome. DESIGN: Prospective and descriptive design. SUBJECTS AND METHODS: Young adults (18-35 years) who suffered from out-of-hospital cardiac arrest in whom CPR was attempted and who were included in the Swedish Cardiac Arrest Registry between 1990 and 2004. MAIN OUTCOME MEASURES: Survival to 1 month. RESULTS: In all, 1105 young adults (3.1% of all the patients in the registry) were included, of which 29% were females, 51% were nonwitnessed and 15% had a cardiac aetiology. Only 17% were found in ventricular fibrillation, 53% received bystander CPR. The overall survival to 1 month was 6.3%. High survival was found amongst patients found in ventricular fibrillation (20.8%) and those with a cardiac aetiology (14.8%). Ventricular fibrillation at the arrival of the rescue team remained an independent predictor of an increased chance of survival (odds ratio: 7.43; 95% confidence interval: 3.44-16.65). CONCLUSION: Amongst young adults suffering from out-of-hospital cardiac arrest and in whom CPR was attempted, a minority survived to 1 month. Subgroups with a higher survival could be defined (patients found in ventricular fibrillation and patients in whom there was a cardiac aetiology). However, only one independent predictor of an increased chance of survival could be demonstrated, i.e. ventricular fibrillation at the arrival of the rescue team.
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| 9. |
- Herlitz, Johan, et al.
(author)
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Characteristics of cardiac arrest and resuscitation by age group : an analysis from the Swedish Cardiac Arrest Registry
- 2007
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In: American Journal of Emergency Medicine. - : W. B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 25:9, s. 1025-1031
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Journal article (peer-reviewed)abstract
- AIM: The objective of this study was to describe patients who experienced an out-of-hospital cardiac arrest (OHCA) by age group.METHODS: All patients who suffered from an OHCA between 1990 and 2005 and are included in the Swedish Cardiac Arrest Registry (n = 40,503) were classified into the following age groups: neonates, younger than 1 year; young children, between 1 and 4 years; older children, between 5 and 12 years; adolescents, between 13 and 17 years; young adults, between 18 and 35 years; adults not retired, between 36 and 64 years; adults retired, between 65 and 79 years; and older adults, 80 years or older.RESULTS: Ventricular fibrillation was lowest in young children (3%) and highest in adults (35%). Survival to 1 month was lowest in neonates (2.6%) and highest in older children (7.8%). Children (<18 years), young adults (18-35 years), and adults (>35 years) survived to 1 month 24.5%, 21.2%, and 13.6% of cases, respectively (P = .0003 for trend) when found in a shockable rhythm. The corresponding figures for nonshockable rhythms were 3.8%, 3.2%, and 1.6%, respectively (P < .0001 for trend).CONCLUSIONS: There is a large variability in characteristics and outcome among patients in various age groups who experienced an OHCA. Among the large age groups, there was a successive decline in survival with increasing age in shockable and nonshockable rhythms.
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| 10. |
- Herlitz, Johan, 1949, et al.
(author)
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Efficacy of bystander CPR: intervention by lay people and by health care professionals
- 2005
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 66:3, s. 291-5
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Journal article (peer-reviewed)abstract
- BACKGROUND: Early cardiopulmonary resuscitation (CPR) by bystanders prior to the arrival of the rescue team has been shown to be associated with increased survival after out-of-hospital cardiac arrest. The aim of this survey was to evaluate the impact on survival of no bystander CPR, lay bystander CPR and professional bystander CPR. METHODS: Patients suffering an out-of-hospital cardiac arrest in Sweden between 1990 and 2002 who were given CPR and were not witnessed by the ambulance crew were included. RESULTS: In all, 29,711 patients were included, 36% of whom received bystander CPR prior to the arrival of the rescue team. Among the latter, 72% received CPR from lay people and 28% from professionals. Survival to 1 month was 2.2% among those who received no bystander CPR, 4.9% among those who received bystander CPR from lay people (p<0.0001) and 9.2% among those who received bystander CPR from professionals (p<0.0001 compared with bystander CPR by lay people). In a multivariate analysis, lay bystander CPR was associated with improved survival compared to no bystander CPR (OR: 2.04; 95% CI: 1.72-2.42), and professional bystander CPR was associated with improved survival compared to lay bystander CPR (OR: 1.37; 95% CI: 1.12-1.67). CONCLUSION: Among patients suffering an out-of-hospital cardiac arrest, bystander CPR by lay persons (excluding health care professionals) is associated with an increased chance of survival. Furthermore, there is a distinction between lay persons and health care providers; survival is higher when the latter perform bystander CPR. However, these results may not be explained by differences in the quality of CPR.
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