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- Johansson, Ingela, 1968-
(författare)
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When time matters : Patients’ and spouses’ experiences of suspected acute myocardial infarction in the pre-hospital phase
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe patients’ and spouses’ experiences of suspected acute myocardial infarction in the pre-hospital phase. A descriptive survey study was conducted to identify various factors influencing patient delay in 381 patients with suspected myocardial infarction hospitalised at a Coronary Care Unit (I) and ambulance utilisation among 110 myocardial infarction patients (II). In order to obtain a deeper understanding of the myocardial infarction patients’ own conceptions about the event, an interview study with a phenomenographic approach was conducted with 15 strategically selected myocardial infarction patients (III), within 72 hours after admission to hospital. Finally, the pre-hospital experiences of 15 spouses of myocardial infarction patients were also studied through interviews with a phenomenographic approach, within 48 hours after the affected partner’s admittance to hospital (IV). The results showed that 59% of the patients with suspected acute myocardial infarction delayed > 1 hour after onset of symptoms. The most common reasons given for delay in seeking hospital admittance were: (1) Did not consider the symptoms as to be severe enough that they warranted hospital care, (2) thought the symptoms to be temporary and that they would disappear, (3) the chest pain was more of a dull pain, (4) or, as one third of the patients chose to do, contacted the general practitioner instead of going directly to the hospital (I). Furthermore, as a first action, 59% consulted their spouse for advice about what to do henceforth. The most common reason for additional delay when the decision to go to hospital had already been taken was that the myocardial infarction patients stated that they were unaware of the advantages of a rapid decision-making process. Sixty percent went by ambulance, but it was the spouse (40%) or the personnel at the general practitioner’s office (32%) who called the emergency service number, rather than the patient him/her self (5%). The most frequently given reasons for not choosing ambulance, were that the patients did not perceive their symptoms as being serious enough to require ambulance transportation (43%), followed by that they had not thought about ambulance as an alternative at all (38%). As a third reason for not going by ambulance, the patients stated that it was unnecessary to call an ambulance when being affected by symptoms related to a myocardial infarction (26%). The patients who called an ambulance differed in some respects from those who went by private alternatives; patients with large infarctions (ST-Elevation Myocardial Infarction) went by ambulance more frequently, as did patients suffering from nausea and severe chest pain (II). The patients expressed in the interviews how the interaction with others, described as the need for supportive environment, worries for the family and the utilisation of the health-care resources, was of great importance in the pre-hospital phase. Likewise, symptom awareness, with earlier experiences of a similar situation to compare with, denying the seriousness of the situation and the use of different self-care strategies, were important in order to manage the situation. Vulnerability, expressed as anxiety and a lack of control, also influenced the decision-making process in the pre-hospital phase (III). Spouses seemed to have a strong influence on the course of events when their partner suffered an acute myocardial infarction and it emerged from the interviews how the spouses in many cases were influenced into sharing the denial of the affected partner by respecting his/her independence. The spouses accepted the partner’s need for control; took earlier marital roles and experiences into account; restraining own emotions and seeking agreement with their partners, contributing to delay. However, being resourceful by sharing the experience; having knowledge; understanding the severity; being rational and consulting others when needed, seemed to have a positive influence on the decision time in the pre-hospital phase (IV).Conclusion: The reasons for delaying or not in the pre-hospital phase, as well as the reasons for utilising the ambulance services or not, varied considerably between individuals. Earlier experiences of MI did not influence what actions to take; instead patients’ feelings, emotional attitudes to MI symptoms, inadequate coping strategies, and spouses’ influences were important components in the pre-hospital phase.
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- Svensson, Anders, 1977-
(författare)
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Räddningsaktörers tidiga närvaro vid akuta situationer på svensk landsbygd
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to describe the first responders´ (FRs) experiences ofarriving early at emergency situations in rural areas in Sweden and the characteristicfeatures of the assignments they encounter. The four studies aimed 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 (I), explore and describe experiences of the First Incident Person (FIP) assignment within an Fire Department (FD) (II), describe experiences of the While Waiting for the Ambulance (WWFA) assignment, as experienced by home healthcare nurses (III) and map out and describe WWFA assignments focusing on frequency, event time,CardioPulmonary Resuscitation (CPR) and survival >30 days after performed CPR (IV).Methods: The four studies in this thesis had both descriptive and explorative designs. They were analysed with qualitative and quantitative analysis methods.Results: By dispatching FRs in rural areas an early presence at the scene of anaccident or emergency situation can be secured, which prevent full scenarios to happen and increase the possibility to save lives. However, FRs are worried about specific emergency situations as well as situations related to their work environment.Leaving ongoing work tasks cause ethical dilemmas and inner emotional worries why support before, during and after an FR assignment is sought for.Conclusions: Generating effective interprofessional collaboration during FR assignment requires that the FRs work conditions are adopted to the assignment requirements for immediate response. The feeling of security disappears when the FRs are excluded from the group affiliation and the need to feel support in new interprofessional collaboration structures becomes clear. Support function based on individual requests is to be designed. Continuous collaborative exercises are required where all involved FRs participate.
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- Södersved Källestedt, Marie-Louise, 1976-
(författare)
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In-Hospital Cardiac Arrest : A Study of Education in Cardiopulmonary Resuscitation and its Effects on Knowledge, Skills and Attitudes among Healthcare Professionals and Survival of In-Hospital Cardiac Arrest Patients
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigated whether outcome after in-hospital cardiac arrest patients could be improved by a cardiopulmonary resuscitation (CPR) educational intervention focusing on all hospital healthcare professionals. Annually in Sweden, approximately 3000 in-hospital patients suffer a cardiac arrest in which CPR is attempted, and which 900 will survive. The thesis is based on five papers: Paper I was a methodological study concluding in a reliable multiple choice questionnaire (MCQ) aimed at measuring CPR knowledge. Paper II was an intervention study. The intervention consisted of educating 3144 healthcare professionals in CPR. The MCQ from Paper I was answered by the healthcare professionals both before (82% response rate) and after (98% response rate) education. Theoretical knowledge improved in all the different groups of healthcare professionals after the intervention. Paper III was an observational laboratory study investigating the practical CPR skills of 74 healthcare professionals’. Willingness to use an automated external defibrillator (AED) improved generally after education, and there were no major differences in CPR skills between the different healthcare professions. Paper IV investigated, by use of a questionnaire, the attitudes to CPR of 2152 healthcare professionals (82% response rate). A majority of healthcare professionals reported a positive attitude to resuscitation. Paper V was a register study of patients suffering from cardiac arrest. The intervention tended not to reduce the delay to start of treatment or to increase overall survival. However, our results suggested indirect signs of an improved cerebral function among survivors. In conclusion, CPR education and the introduction of AEDs in-hospital – improved healthcare professionals knowledge, skills, and attitudes – did not improve patients’ survival to hospital discharge, but the functional status among survivors improved.
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- Tenerz, Åke
(författare)
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Diabetes mellitus and related glucometabolic disturbances in acute myocardial infarction : Diagnosis, prevalence and prognostic implications
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In patients with diabetes mellitus (DM), acute myocardial infarction (AMI) is a major cause of death. We have studied two populations with respect to the relationship between DM or related glucometabolic disturbances and AMI.In the first population, the prevalence of DM and the importance of the glycaemic state for the long-term prognosis in non-diabetic patients were investigated in patients with AMI admitted to the Coronary Care Unite at Västerås Central Hospital.In the second population, the prevalence of impaired glucose tolerance (IGT), DM and other metabolic abnormalities was investigated in patients with AMI and without known DM admitted to the Coronary Care Units at Västerås and Karolinska Hospital, Stockholm.21% of the patients with AMI had previously known DM and 4% had newly detected DM if diagnosis is based upon fasting blood glucose (F-BG). The glycemic state, measured as HbA1c, at a 5.5 years follow-up was a risk factor for re-infarction and/or death in non-diabetic patients after AMI.If an oral glucose tolerance test (OGTT) is performed, 40-45% of all patients with AMI have DM and in addition about 30% have IGT. Both an OGTT and a single post-challenge blood glucose value after 60 minutes performed at hospital discharge, were independent predictors of IGT or DM at follow-up. Insulin resistance, measured by homeostatic model assessment (HOMA-IR), decreased during hospital stay, with no further decrease from hospital discharge to follow-up.In summary, the studies in this dissertation have revealed an unexpectedly high prevalence of abnormal glucose tolerance in patients with AMI. The glycaemic state, reflected by HbA1c, in non-diabetic patients after AMI has an impact on the long-term prognosis. Consequently, in all patients with AMI, HbA1c and casual blood glucose should be measured at admission and, at least, F-BG at hospital discharge.
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- Thuresson, Marie, 1963-
(författare)
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The initial phase of an acute coronary syndrome : symptoms, patients' response to symptoms and opportunity to reduce time to seek care and to increase ambulance use
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to describe the initial phase of an acute coronary syndrome (ACS) in overall terms from a national perspective and to evaluate the impact of an information campaign designed to inform the public about how to act when suspecting an ACS. A total of 1939 patients at 11 hospitals in Swedenwith diagnosed ACS and symptom onset outside hospital completed a questionnaire(I-IV).In Study V, a questionnaire was completed by 116 patients withACS before the campaign and 122 after it. Register data were followed every year to evaluate ambulance use and emergency department (ED) visits. With regard to symptoms, patients with ST-elevation ACS (STE-ACS) more frequently had associated symptoms and pain with an abrupt onset reaching maximum intensity within minutes. However, fewer than half the patients with STE-ACS had this type of symptom onset. There were more similarities than differences between genders and differences between age groups were minor (I). Three-quarters of the patients interpreted the symptoms as cardiac in origin. The majority contacted a family member after symptom onset, whereas few called directly for an ambulance. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter pre-hospital delay (II). Half the patients went to hospital by ambulance. Independent factors for ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when experiencing chest pain, severe symptoms, abrupt onset of pain, STE-ACS, increasing age and distance to hospital of > 5 km. Reasons for not calling for an ambulance were thinking self-transport would be faster or not being ill enough (III). Pain with abrupt onset, STE-ACS, symptoms such as vertigo or near syncope, experiencing the pain as frightening, interpreting the pain as cardiac in origin and knowledge were major factors associated with a short delay between symptom onset and decision to seek medical care, patient decision time (IV). The information campaign did not result in a reduction in patient decision time, but it appeared to increase ambulance use and the number of patients seeking the ED for acute chest pain (V).
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