| 1. |
- Andersson, Ulf, 1985-, et al.
(författare)
-
Clinical Reasoning among Registered Nurses in Emergency Medical Services : A Case Study
- 2022
-
Ingår i: Journal of Cognitive Engineering and Decision Making. - : Sage Publications. - 1555-3434 .- 2169-5032. ; 16:3, s. 123-156
-
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.
|
|
| 2. |
- Andersson, Ulf, 1985-, et al.
(författare)
-
Clinical reasoning in the emergency medical services: an integrative review
- 2019
-
Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241.
-
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.
|
|
| 3. |
- Andersson, Ulf, 1985-, et al.
(författare)
-
Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study
- 2023
-
Ingår i: Paramedicine. - : Sage Publications. - 2753-6386 .- 2753-6386.
-
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.
|
|
| 4. |
- Andersson, Ulf, 1985-, et al.
(författare)
-
Situation awareness in Sweden’s emergency medical services : a goal-directed task analysis
- 2023
-
Ingår i: Discover Health Systems. - 2731-7501. ; 2
-
Tidskriftsartikel (refereegranskat)abstract
- Situation awareness is knowing what is going on in the situation. Clinicians working in the emergency medical services (EMS) encounter numerous situations in various conditions, and to be able to provide efficient and patient safe care they need to understand what is going on and possible projections of the current situation. The design of this study encompassed a Goal-Directed Task analysis where situation awareness information requirements were mapped in relation to goals related to various aspects of the EMS mission. A group of 30 EMS subject matter experts were recruited and answered a web-based survey in three rounds related to what they though themselves or a colleague might need to achieve situation awareness related to the specific goals of various situations. The answers were analysed using content analysis and descriptive statistics. Answers reached consensus at a predetermined level of 75%. Those who reached consensus were entered into the final goal-directed task analysis protocol. The findings presented that EMS clinicians must rely on their own, or their colleagues prior experience or knowledge to achieve situation awareness. This suggests that individual expertise plays a crucial role in developing situation awareness. There also seems to be limited support for situation awareness from organizational guidelines. Furthermore, achieving situation awareness also involves collaborative efforts from the individuals involved in the situation. These findings could add to the foundation for further investigation in this area which could contribute to the development of strategies and tools to enhance situation awareness among EMS clinicians, ultimately improving patient care and safety.
|
|
| 5. |
- Andersson, Ulf, 1985-, et al.
(författare)
-
Are you ready: disaster response in nursing education: a cross-sectional survey among Swedish universities and university colleges
- 2024
-
Ingår i: Discover Health Systems. - 2731-7501. ; 3:1
-
Tidskriftsartikel (refereegranskat)abstract
- IntroductionRegistered nurses play a critical role in disaster response and patient care during crises. Recent global events underscore the importance of preparedness for disaster response. However, the readiness of registered nurses and their educational preparation vary. In Sweden, this prompted the National Board of Health and Welfare to introduce a new national curriculum for disaster response. This study aimed to assess how education for undergraduate and specialist registered nurses aligns with this curriculum.MethodsA descriptive cross-sectional study was conducted among universities and university colleges in Sweden offering undergraduate and specialist nursing programs. Surveys were sent to all 25 higher education institutions providing nursing education in November 2023, comprising 29 questions related to the new curriculum.ResultsFindings revealed that half of the respondents had discussed the new curriculum, with 15 reporting some form of learning activities. Traditional lectures were the most commonly used format, and 11 respondents had designated teachers for the subject. Reasons for lacking disaster response education included prioritizing other acute care areas or a limited perspective at the academy.DiscussionIn conclusion, this study suggests that nursing education may not sufficiently prepare registered nurses for disaster response and armed conflicts. Education tends to focus more on acute care rather than taking a broader perspective. As a result, registered nurses may lack the competence and readiness required to effectively respond to disasters.
|
|
| 6. |
- Falchenberg, Åsa, et al.
(författare)
-
Clinical practice guidelines for comprehensive patient assessment in emergency care : A quality evaluation study
- 2021
-
Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 41:4, s. 207-215
-
Tidskriftsartikel (refereegranskat)abstract
- Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency depart- ments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home- based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.
|
|
| 7. |
|
|
| 8. |
- Andersson, Ulf, 1985-
(författare)
-
Clinical reasoning among emergency medical service clinicians : An iterative and fragmented process involving the collaborative effort(s) of many
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to generate knowledge and understanding of clinical reasoning in the context of EMS from the perspective of EMS clinicians.Method: Three different methodologies were employed to describe various aspects of clinical reasoning. In Study I, an integrative literature review was conducted to summarise the existing literature related to clinical reasoning in EMS. After conducting systematic searches and screening, 38 articles were identified and analysed through an inductive thematic analysis. Studies II and III were conducted as case studies within an EMS organisation to capture clinical reasoning as it takes place in the naturalistic environment. In total, 34 patient encounters were observed, and group and individual interviews were conducted with EMS clinicians and organisational representatives at various hierarchical levels within the EMS organization. The data were analysed through pattern matching and triangulation in a computerised software program for qualitative analysis. Study IV was conducted as a goal-directed task analysis which focused on what EMS clinicians need in terms of achieving situation awareness. An online survey was created and answered by 30 EMS subject matter experts, consisting of active EMS clinicians, academic teachers in specialist ambulance nursing programmes, and researchers in the field of EMS. The data were analysed using qualitative content analysis and descriptive statistics.Main results: Clinical reasoning in EMS is a continuously ongoing, iterative, and fragmented process. Information is gathered, analysed, and utilised at any given point during the mission. This information is then reasoned against various goals or instructions provided by the EMS organisation or what is perceived as the most suitable action by the EMS clinician. In the reasoning process, the clinicians take the patients’ and their relatives’ points of interest into account, striving to fulfil these. The clinical reasoning process continues after and between the missions well, and clinicians constantly evaluate their decisions and care provision for future improvement. Even if medical and caring interventions are the focus of clinical reasoning, this process involves the consideration of other aspects as well, such as logistics and safety for everyone present. Nevertheless, there seems to be a vague mandate for decision making among EMS clinicians in relation to other collaborative partners. Furthermore, organisational support for clinical reasoning and development is lacking, often due to economic limitations.Conclusion: This thesis contributes to the caring science field with an increased understanding of the complexity of clinical reasoning in EMS. EMS clinicians today need to rely on themselves or their partners to have sufficient knowledge or experience to handle the situation encountered and provide safe patient care. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. EMS clinicians today need to rely on themselves or their partner to have sufficient knowledge or experience to handle situations encountered and provide patient safe care.
|
|
| 9. |
- Andersson, Ulf, 1985-, et al.
(författare)
-
Simulation-based education as a provider of fieldwork insights – experiences of ambulance nurse specialist students
- 2023
-
Ingår i: BMC Nursing. - 1472-6955.
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Medicine is facing a global shortage of nurses, including those with postgraduate education. One suggested educational method for undergraduate and postgraduate education, such as specialist ambulance nurse education, is simulation-based education (SBE). The implementation of SBE is motivated, in part, by the desire to attract and retain students, but also to contribute to student learning. Consequently, the use of SBE is increasing in specialist ambulance nurse education. The aim of this study was to explore how specialist ambulance nursing students experience SBE.Methods: This qualitative survey study involved the collection of study data using a purposefully designed, paper-based survey comprising five open-ended questions that required participant free-text answers. The answers were analysed using inductive content analysis and searching for descriptions of the participants’ experiences. The survey was presented to 35 specialist ambulance nursing students.Results: The results are presented in two themes: SBE as learning and SBE as an educational method. Participating in SBE during the programme provides students with a realistic understanding of their future profession and its expected demands. The learning experience disregards prior work experience in ambulance services.Conclusions: Based on the findings, conclusions are that SBE is an appreciated educational method among nursing students, regardless of their prior experience in the field of prehospital care. To some extent, this differs from previous research findings related to this subject. Furthermore, SBE contributes to the provision of field work insights, preparing the ambulance nurse specialist students.
|
|
| 10. |
- Chen, Xiangrong, 1982, et al.
(författare)
-
AC and DC Pre-stressed Electrical Trees in LDPE and its Aluminum Oxide Nanocomposites
- 2016
-
Ingår i: IEEE Transactions on Dielectrics and Electrical Insulation. - : Institute of Electrical and Electronics Engineers (IEEE). - 1558-4135 .- 1070-9878. ; 23:3, s. 1506-1514
-
Tidskriftsartikel (refereegranskat)abstract
- Resistance of pure low density polyethylene (LDPE) and its aluminum oxide nanocomposites (up to 3.0 wt%) to degradation by electrical treeing under AC stress and DC pre-stress is analyzed. The experiments were carried out on wire-plane electrode specimens before and after exposure to thermal and DC electro-thermal ageing at 80 °C. The obtained results showed enhanced resistance of the nanocomposites to electrical tree inception under AC stress and the tree inception voltage (TIV) increased with nanoparticles content. It has been shown that there was an improved partial discharge (PD) resistance in the nanocomposites compared to the unfilled LDPE. The results also showed that the AC TIV in the nanocomposites consistently increased with the ageing and especially the DC electro-thermally aged specimens had about 30% higher the AC TIV as compared to the unaged material. This effect is attributed to significantly reduced mobility of charge carriers in the nanocomposites. The DC pre-stressed electrical trees generated in the investigated materials were of filamentary-branch structure and the branch channels content increases with the addition of nanoparticles. The mean tree number of the DC pre-stressed electrical trees decreased in the LDPE and its nanocomposites while the mean maximum tree length increased with the ageing treatments. It is postulated that material recrystallization and a very high electric field level on the wire electrode during the DC pre-stressed electrical tree test are the main reasons for the observed effects.
|
|
| 11. |
- Druvefors, Emma, 1985-, et al.
(författare)
-
Impaired Fertility in Women With Inflammatory Bowel Disease : A National Cohort Study From Sweden
- 2021
-
Ingår i: Journal of Crohn's & Colitis. - : Oxford University Press. - 1873-9946 .- 1876-4479. ; 15:3, s. 383-390
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Inflammatory bowel disease [IBD] has been associated with reduced female fertility. We analyse fertility in a national cohort of women with IBD.Methods: Fertility was assessed in women with IBD aged 15-44 years in 1964-2014, identified from the Swedish National Patient Register and a matched cohort [ratio 1:5]. Patients with indeterminate colitis or inconsistent IBD coding were classified as IBD-unclassified [IBD-U].Results: The cohorts included 27 331 women with IBD and 131 892 matched individuals. The fertility rate in IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years and 1.62 [SD 1.28] [p<0.001] in matched individuals. Fertility was impaired in all IBD subtypes compared with the matched cohort (hazard ratio Crohn's disease [CD] 0.88, 95% confidence interval [CI] 0.85-0.91; IBD-U 0.86, 95% CI 0.83-0.89; and ulcerative colitis [UC] 0.96, 95% CI 0.93-0.98). Fertility improved during the study period for the IBD cohort except for CD. Parity progression ratio, the proportion of IBD women progressing from one parity to the next compared with the matched cohort, was decreased at all parity levels for CD and IBD-U, but only for multiparous women in UC. Contraceptive usage was higher in IBD, both before and after the diagnosis. Disease severity, bowel resections, and perianal disease in CD affected fertility negatively.Conclusions: Fertility was impaired mainly in women with CD and IBD-U, and less so in UC. During the study period, fertility improved in women with UC or IBD-U. Some results suggest a role of voluntarily reduced fertility.
|
|
| 12. |
- Ismoilov, Abbos, 1985-, et al.
(författare)
-
MODEL-BASED PERFORMANCE COMPARISON OF TRACKED FORWARDERS
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The predominant forest harvesting method in northern Europe is the cut-to-length (CTL) harvesting methodthat is performed by specialized two-machines, a harvester and a forwarder, and both machines are usually sixoreight wheeled machines with pairs of wheels mounted on bogies. Under soft ground or snow conditions, bogietracks and bogie chains are used to improve mobility and tractive performance. The main engineering challengewhen developing the next generation of forwarders is to reduce whole-body vibrations and soil damage. Due tothe small global market for CTL-machines, these challenges preferably should be addressed with a singlemachine architecture.The focus of this study is to analyse and compare the interaction with very soft soil and the dynamicperformance on hard rough terrain of a medium-sized forwarder equipped with two conceptually differentforwarder track units, namely a track unit with pendulum arm suspended ground wheels and bogie suspendedground wheels, with the performance of a wheeled and bogie-type of forwarder.The simulation results show that tracked forwarders have less negative impact on the soil than wheeledforwarders due to its significantly larger footprint area. Furthermore, it is shown that tracked forwardersequipped with pendulum-arm suspended road wheels are slightly gentler for the operator in terms of whole-bodyvibrations, when operating on hard rough terrain, compared to wheeled forwarders. Furthermore, they are alsosignificantly better than the bogie-type of track unit.
|
|
| 13. |
- Ismoilov, Abbos, 1985-
(författare)
-
Suspended forestry machines for sustainable forestry
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cut-to-length (CTL) logging is a mechanized two-machine solution. The harvester processes treestems into smaller logs and a forwarder transports the logs from the logging site to a landing areaaccessible by trucks. The working machines for CTL logging are heavy and their suspension systemis generally rudimentary, basically the only damping is provided by the tires. To meet futuredemands on operator comfort, sustainable forestry, and climate concerns, significant challenges areto find means for reducing daily vibration dosage, soil damage, and rolling resistance.Paper A proposes a full-scale virtual model of a four-wheeled forwarder concept equipped with twopendulum axels with an actively controlled hydraulic suspension system mounted on each wheelaxle. The simulation results are then analyzed to determine the required actuation power.Paper B presents a performance comparison of a six-wheeled medium-sized pendulum-armsuspended forwarder, with three different suspension systems; active, semi-active, and passive. Amethodology to optimize and analyze forestry vehicle suspension performance based on multi-bodydynamic simulations are proposed and applied for the studied forwarder.Paper C is a model-based investigation of the dynamic behavior of a traditional eight-wheeledbogie type of forwarder with the main focus on identifying critical issues and suggesting criteria forassessing the performance of the machine while traveling on sloped and rough terrain.Paper D investigates the performance of a novel all-wheel-drive pendulum-arm suspendedmedium-sized forestry machine with passive and active chassis suspensions. The dynamicperformance of the pendulum-arm machine concept is quantified with simulations and comparedwith a “traditional” bogie-machine.Paper E investigates how to model a tracked forwarder and how the performance comparison canbe evaluated in multi-body simulation software like Adams ATV.Paper F presents a comparison of the dynamic behavior of forestry machines with different types ofpassive chassis suspensions from three perspectives: their gentleness to terrain, operator and theirpotential for improved fuel efficiency.Paper G proposes a 12 degrees-of-freedom multi-body dynamics simulation model of a standardeight-wheeled bogie type of medium-sized forwarder and verifies the simulation model withmeasured data from the field test that was carried out the actual machine.Paper H reconfigures the model presented in Paper G and compares a medium-sized forwarderequipped with two different track units with the performance of a wheeled and bogie-type offorwarder on hard rough ground, as well as on soft soil.
|
|
| 14. |
-
MODEL-BASED ANALYSIS OF A TRACKED FORWARDER FOR SUSTAINABLE FORESTRY
- 2015
-
Proceedings (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Cut-to-length logging (CTL) is a mechanized harvesting process where trees are delimbed and cut to length directly at the stump. CTL is typically a two-man, two-machine operation with a harvester felling, delimbing, and bucking trees, and a forwarder transporting the cut logs from the felling area to a landing area accessible by trucks, or trains. The main challenges for the manufacturers of forestry machines for CTL logging are to address new customer demands and tougher ergonomic and environmental legislations by finding means that: (1) further increase the harvesting and log transportation productivity, e.g. by enabling operation on eco-soils, (2) reduce the damage to the soil, e.g. by controlling the rut depth and preserving the root layer, (3) reduce exhaust emissions, e.g. by reducing the rolling resistance and evening the contact and tractive forces between all traction units and ground, and (4) reduce the daily vibration dosage for the machine operators, e.g. with efficient chassis and cabin suspension solutions.This paper presents a model-based study of a novel tracked medium-sized forestry machine. The machine is a standard eight-wheeled forwarder of bogie type with the four bogies replaced with four passively suspended track units adapted from an off-road military vehicle. The paper briefly summarize how a tracked forwarder can be modelled and simulated using multi-body simulation software like Adams ATV and how the performance parameters can be evaluated.
|
|
| 15. |
|
|
| 16. |
- Wahlgren, Weixiao Yuan, 1970, et al.
(författare)
-
Substrate-bound outward-open structure of a Na+-coupled sialic acid symporter reveals a new Na+ site.
- 2018
-
Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 9:1
-
Tidskriftsartikel (refereegranskat)abstract
- Many pathogenic bacteria utilise sialic acids as an energy source or use them as an external coating to evade immune detection. As such, bacteria that colonise sialylated environments deploy specific transporters to mediate import of scavenged sialic acids. Here, we report a substrate-bound 1.95Å resolution structure and subsequent characterisation of SiaT, a sialic acid transporter from Proteus mirabilis. SiaT is a secondary active transporter of the sodium solute symporter (SSS) family, which use Na+ gradients to drive the uptake of extracellular substrates. SiaT adopts the LeuT-fold and is in an outward-open conformation in complex with the sialic acid N-acetylneuraminic acid and two Na+ ions. One Na+ binds to the conserved Na2 site, while the second Na+ binds to a new position, termed Na3, which is conserved in many SSS family members. Functional and molecular dynamics studies validate the substrate-binding site and demonstrate that both Na+ sites regulate N-acetylneuraminic acid transport.
|
|
