| 1. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Clinical Reasoning among Registered Nurses in Emergency Medical Services : A Case Study
- 2022
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Ingår i: Journal of Cognitive Engineering and Decision Making. - : Sage Publications. - 1555-3434 .- 2169-5032. ; 16:3, s. 123-156
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Tidskriftsartikel (refereegranskat)abstract
- In emergency medical services (EMS), the clinical reasoning (CR) of registered nurses (RNs) working in ambulance care plays an important role in providing care and treatment that is timely, accurate, appropriate and safe. However, limited existing knowledge about how CR is formed and influenced by the EMS mission hinders the development of service provision and decision support tools for RNs that would further enhance patient safety. To explore the nature of CR and influencing factors in this context, an inductive case study examined 34 observed patient-RN encounters in an EMS setting focusing on ambulance care. The results reveal a fragmented CR approach involving several parallel decision-making processes grounded in and led by patients' narratives. The findings indicate that RNs are not always aware of their own CR and associated influences until they actively reflect on the process, and additional research is needed to clarify this complex phenomenon.
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| 2. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Clinical reasoning in the emergency medical services: an integrative review
- 2019
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241.
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.
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| 3. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study
- 2023
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Ingår i: Paramedicine. - : Sage Publications. - 2753-6386 .- 2753-6386.
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionClinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR.MethodsUsing a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources.ResultsThe results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates.ConclusionThe conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.
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| 4. |
- Andersson, Henrik, 1968-, et al.
(författare)
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Simulation in Virtual World to Promote Communication
- 2018
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Ingår i: Pre-hospital care- Education and training of ambulance professionals. - Noordwijkerhout, The Netherlands.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016). AimThe aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS). MethodsA qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis. Results The participants’ experiences generated three themes: Understanding the virtual worldIt was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL. Technological challengesOne challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient. Learning through avatars Learning through avatars requires that the participants take responsibility for delivering a convincing performance. Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour. Conclusion The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.
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| 5. |
- Höglund, Erik, 1983-
(författare)
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Non-conveyance within the Swedish ambulance service : A prehospital patient safety study
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThere is an increasing demand for ambulance services and more patients than before are requesting ambulance assistance for low acuity conditions. Ambulance services non-convey patients because they lack acute care needs. Non-conveying patients can be a person-centred, resource- and cost-efficient measure and can allow the ambulance to become available sooner for patients with more acute illnesses or injuries. However, validated non-conveyance guidelines are lacking and non-conveying patients raises patient safety issues.AimThe overarching aim of the research project was to describe the patients that were non-conveyed, to explore if there were any potential patient safety issues with the regional non-conveyance guidelines, and to describe how patients and nurses experience non-conveyance.MethodsAll non-conveyance assignments during one year in a region in Sweden (n=2691) were consecutively and prospectively included. The quantitative data was described, compared, and analysed (Studies I and II). Two interview studies were carried out. Phenomenography and conventional content analysis were used to analyse the qualitative data. In total 14 patients were interviewed in Study III and 20 nurses were interviewed in Study IV.Conclusions Patients of all ages with varying characteristics and complaints were non-conveyed. No patient received intensive care, and few were admitted to in-hospital care or died within seven days after being non-conveyed. Older age increases the risk of hospitalisation and death. Patients could feel ashamed for being non-conveyed, and the ambulance nurse could feel frustration when believing that the ambulance resource was misused
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| 6. |
- Andersson Hagiwara, Magnus, et al.
(författare)
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A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service
- 2018
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 137:5, s. 523-530
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesWe compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke. Materials & methodsThe Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital. ResultsOf 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital. ConclusionsPatients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.
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| 7. |
- Hansson, Per-Olof, 1958, et al.
(författare)
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Prehospital assessment of suspected stroke and TIA: An observational study
- 2019
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 140:2, s. 93-99
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Tidskriftsartikel (refereegranskat)abstract
- Background Symptoms related to stroke diverge and may mimic many other conditions. Aims To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). Methods An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. Results Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up. Conclusions Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.
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| 8. |
- Hansson, Per-Olof, 1958, et al.
(författare)
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Prehospital identification of factors associated with death during one-year follow-up after acute stroke
- 2018
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke. Material and Methods: All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria. Results: In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of < 90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03. Conclusions: Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.
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| 9. |
- Herlitz, Johan, 1949-, et al.
(författare)
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Över 100 doktorsavhandlingar inom den prehospitala akutsjukvården i Sverige
- 2023
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 1652-7518. ; 120
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Forskningsöversikt (refereegranskat)abstract
- HUVUDBUDSKAPÖver 100 avhandlingar har i dagsläget skrivits om den prehospitala akutsjukvården i Sverige.Dessa täcker ett omfattande kunskapsfält, allt ifrån prognostiska faktorer vid akut sjukdom till ambulans personalens psykiska och fysiska hälsa.Endast ett kunskapsområde har belysts mera om fattande, och det är hjärt–lungräddning vid plötsligt hjärtstopp.Vården av patienter med psykisk ohälsa har inte belysts i någon avhandling.Det finns stora kunskapsluckor, och vidare forskning inom området behövs.
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