| 1. |
- Elmqvist, Carina, 1964-, et al.
(författare)
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”Vi vill ha en statlig nationell översikt över mobil vård”
- 2019
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Ingår i: Dagens medicin. - : Bonnier Business Media AB. - 1104-7488 .- 1402-1943. ; :2019-09-26
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Den mobila vården behöver definieras nationellt och bli en egen organisationsform och vårdnivå, skriver företrädare från Centrum för interprofessionell samverkan inom akut vård.
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| 2. |
- Forsgärde, Elin-Sofie
(författare)
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Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to describe and compare pathways for older patients and the involved actors’ experiences of decision-making in acute situations in ambulatory care.Methods: The overall three-fold design, comprising exploratory, descriptive as well as comparative ones, was conducted inductively, including a mixed method with a convergent integrated approach to empirical data. The four involved studies were analysed using either quantitative or qualitative analysis methods.Results: Most older patients’ pathways when being assessed by ambulance personnel involved receiving care at hospitals. However, an increasing trend of non-conveyance to hospitals was identified during a five-year period (2014–2018), which means receiving care, for example, at home or primary healthcare (PHC) centres. Decision-making about the level-of-care for older patients was more or less uncertain for all involved actors, i.e. older patients, significant others and healthcare professionals such as ambulance personnel, registered nurses, specialists in general practice at PHC centres and community health nurses. To increase the level of certainty in the decision-making process, all actors was supported by both an individual and external dialogue. Individual dialogue gave support by using own experience and knowledge. For ambulance personnel and community health nurses, support was also partially gained from decision support tools but was regarded as insufficient when older patients had non-specific symptoms. External dialogue provided support through mutuality, and via collaboration, a common goal, trust and responsibility. Mutuality gave support through experience and knowledge being shared with all involved actors, which provided a common comprehensive understanding that facilitated consensus in the decision-making.Conclusion: The increasing level of non-conveyance to hospitals and uncertainty during decision-making highlights the need to develop and extend the availability of dialogue-based collaborations as support in ambulatory care. Dialogue-based support involves all actors contributing to the decision-making. Healthcare professionals need to be aware of the prerequisites and the support that mutuality in external dialogues brings. Healthcare organisations need to develop and extend dialogue-based collaboration in ambulatory care by combining different expertise and providing conditions to increase support in decisions adapted to older patients' needs.
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| 3. |
- Forsgärde, Elin-Sofie, et al.
(författare)
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Patients' aged ≥ 65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital : a longitudinal and comparative study
- 2020
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:11, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Patients >= 65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged >= 65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients >= 65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season. Results The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. Conclusions The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients >= 65 years old.
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| 4. |
- Forsgärde, Elin-Sofie, et al.
(författare)
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Physicians’ experiences and actions in making complex level-of-care decisions during acute situations within older patients’ homes : a critical incident study
- 2023
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians’ decision-making during acute situations in older patients’ homes is limited. Therefore, this study aimed to describe physicians’ experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes. Methods: Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included. Results: In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients’ and their significant others’ needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians’ actions involved searching for an understanding of older patients’ and their significant others’ wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved. Conclusion: Physicians strive to individualize complex level-of-care decisions based on older patients’ and their significant others’ wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 − 7 collaboration between organizations and health care professionals.
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| 5. |
- Forsgärde, Elin-Sofie, et al.
(författare)
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Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study
- 2023
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318 .- 1471-2318. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved.Methods: The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse.Results: Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence.Conclusions: The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.
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| 6. |
- Forsgärde, Elin-Sofie, et al.
(författare)
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The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called
- 2021
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 16:8
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.
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| 7. |
- Lantz, Emelie, et al.
(författare)
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Serving the community while balancing multiple responsibilities : experiences of working as a paid part-time firefighter
- 2023
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Ingår i: International Journal of Emergency Services. - : Emerald Group Publishing Limited. - 2047-0894 .- 2047-0908. ; :1, s. 17-38
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this study was to describe experiences of working as a paid part-time firefighter (PTF) in Swedish rural areas.Design/methodology/approachAn inductive explorative design was used, based on interviews with 18 paid PTFs in Sweden. Data were analyzed using qualitative latent content analysis.FindingsThree themes emerged from the interviews and describe paid PTFs’ experiences. The findings provide insights into how firefighters share a strong commitment, how support plays a crucial role, and how training and call-outs contribute to their experiences. Paid PTFs’ experiences are nuanced, ranging from personal limitations and challenges to satisfaction and the contrast with ordinary life.Practical implicationsThe implications for fire and rescue service organizations are that they can encourage firefighters’ commitment and pride, as well as the commitment and support of their families and main employers. Further, highlighting the importance of support and facilitating flexibility when on call is crucial. Finally, acknowledging and promoting personal development and facilitating an inclusive culture are important factors for both motivation and satisfaction.Originality/valuePaid PTFs are under-represented in the literature, despite the reliance on them in Sweden, and this study begins to address the knowledge gap. To improve retention, it is vital to understand paid PTFs work situation: what motivates them, what barriers they face, and how those challenges influence their experiences.
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| 8. |
- Svensson, Anders, 1977-, et al.
(författare)
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Experiences of and actions towards worries among ambulance nurses in their professional life : a critical incident study
- 2008
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X .- 0965-2302 .- 1532-9267. ; 16:1, s. 35-42
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Tidskriftsartikel (refereegranskat)abstract
- Nurses working in the ambulance service are frequently exposed to situations in which they have to take sole responsibility for sick or injured patients, many of which can be emotionally trying. The purpose of this study was therefore to describe critical incidents in which ambulance nurses experience worry in their professional life and the actions they take in order to prevent and cope with it. The sample consisted of 13 male and 12 female nurses working in ambulance services in three small to medium-sized counties in the south of Sweden. The data were collected by means of interviews and analysed according to Critical Incident Technique (CIT). The result showed that nurses worried about specific emergency situations as well as situations related to their working environment. Worry was alleviated by their own actions or with help from others. It was also shown that, with increasing experience, came a responsibility to be able to cope with all kinds of situations. This responsibility was experienced as worrying. However, if the nurse felt confident in their colleague, the worry could ease. It was concluded that the worry experienced by ambulance nurses in specific emergency situations requires flexibility on the part of the ambulance service. Nurses must be given the opportunity to address their worries in the way that is most appropriate for each individual.
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| 9. |
- Svensson, Anders, 1977-, et al.
(författare)
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Firefighters as First Incident Persons : breaking the chain of events and becoming a new link in the chain of survival
- 2018
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Ingår i: International Journal of Emergency Services. - : Elsevier. - 2047-0894 .- 2047-0908. ; 7:2, s. 120-133
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Tidskriftsartikel (refereegranskat)abstract
- Purpose In order to shorten the response time, two part-time fire departments (FDs) in Sweden initialize a first incident person (FIP) assignment. This is done by alarming the crew manager as an FIP, responding in a separate emergency vehicle, and by arriving at the scene before rest of the crew. The purpose of this paper is to explore and describe experiences of the FIP assignment within an FD. Design/methodology/approach A multimethod design was used, influenced by Creswell and Plano Clark's (2011) explanatory sequential mixed method design including emergency reports, a questionnaire and interviews. Findings The results show that the FIP assignment was a function that secured an early presence at the scene of an accident or emergency situations, which is beneficial for society in the form of a safety factor, for the firefighters in the form of early prior information on what to expect at the scene and for the patient in the form of early existential support and increased chances of survival. Originality/value In order to prevent full scenarios to happen and get the chance to save lives, an early response must be ensured. Hence, studies must be made in different settings, based on its unique conditions. This study indicates that by implementing FIP in FDs placed in a rural area, the FIP can break the chain of events and becoming a new link in the chain of survival.
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| 10. |
- Svensson, Anders, 1977-, et al.
(författare)
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Home healthcare nurses’ experiences of being on stand by as a first responder in a ‘While Waiting For the Ambulance’ assignment
- 2016
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 36:4, s. 184-191
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study is to describe experiences of the ‘While Waiting for the Ambulance’ (WWFA) assignment, as described by home healthcare nurses (HHCNs). Since the early 1990s, municipal resources in Sweden, preferably firefighters, have been dispatched on WWFA. In order to further assist the local residents on an island in the southwest of Sweden, HHCNs have recently begun accompanying firefighters on WWFA. A reflective lifeworld approach was used for data analysis including in-depth interviews with eight HHCNs. When WWFA was established, the HHCNs experienced lack of clarity in where their responsibilities start and end. A split role is described, and there is a paradox in that the responders are meant to collaborate toward saving lives, when the assignment itself has a lack of collaborative structure. Ethical dilemmas and inner emotional worries led to the nurses expressing a need for support before, during and after WWFA.
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