| 1. |
- Bjurling-Sjöberg, Petronella, 1968-, et al.
(författare)
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Resilient performance in healthcare during the COVID-19 pandemic (ResCOV) : study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety.
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Since early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic's rampage, the processes involved and the consequences on working conditions, ethics and patient safety.METHODS: An emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants' first-person stories are complemented with data from the healthcare organisations' internal documents and national and international official documents.ANALYSIS: Experiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic.ETHICS AND DISSEMINATION: This project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.
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| 2. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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A matter of participation? : A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. METHODS: An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. RESULTS: Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. CONCLUSIONS: Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
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| 3. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Balancing power : Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:3, s. 766-776
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient participation is considered to promote well- being and is, there-fore, central in care contexts. Care- dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.Aim: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.Method: A phenomenological hermeneutical method was used to analyse tran-scripts of narrative interviews with 11 ambulance personnel.Results: The ambulance personnel's lived experience of older persons' participa-tion includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that em-powers participation. The main theme ‘Balancing dignity in relation to manipulat-ing the body’ included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well- being and being guided by reactions. The main theme ‘Balancing influence in relation to per-ceived health risks’ included the themes Agreeing on a common perspective, Directing decision- making mandate, and Sharing responsibility for well- being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.Conclusion: Care- dependent older persons' participation in care from the per-spective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balanc-ing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve am-bulance care to benefit older persons in critical life situations.
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| 4. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden : a total population study
- 2020
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Ingår i: BMC Emergency Medicine. - : BioMed Central. - 1471-227X. ; 20, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18– 69 years requiring emergency care at home in Sweden.Methods: A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns.Results: Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00– 11:59 interval (p < 0.001, χ2 = 1224.08).Conclusion: The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.
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| 5. |
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| 6. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Entrusting life to professionals : A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services.
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.Aim: This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.Design: This study has a qualitative design with a lifeworld approach.Method: A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70–93 years.Results: Care-dependent older persons' participation in prehospital emergency care means ‘Entrusting life to professional caregivers’ when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.Conclusion: Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.Implications for practice: Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.
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| 7. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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When older persons need Emergency Medical Services at home : a critical incident study on Swedish municipal care personnel
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Older persons in Sweden can continue to live at home, assisted by the municipal home care services. Older age raises the risk of emergency situations that require involvement of the emergency medical services (EMS). Such situations intersect two different organizations, the municipal social care services and the regional EMS. The transfer of care between the organizations might impact the older persons´ health, and quality of life or death. Research question: How do municipal care personnel describe their experiences of and actions in situations when older persons are in need of EMS? Design: The study has a qualitative inductive design. Sample: Municipal care personnel (n=19) consisting of home care personnel and security alarm responders. Data collection and analysis: Data was collected through group interviews and free text written critical incidents analyzed according to critical incident technique. Results: Experiences related to the two main areas Lifesaving competence, and Collaborative care, which encompass the four categories Emergency knowledge, Companionship in a vulnerability, Limited caring options and Conditions for EMS collaboration. Actions related to the one main area Adjusting actions to actual conditions, which encompasses the three categories Adapting care to emergency needs, Safeguarding the person, and Adapting actions to EMS leadership.
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| 8. |
- Holmberg, Mats, Med.Dr. 1976-, et al.
(författare)
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Dyadic teams and nursing care : a critical incident study of nurses in the emergency medical service
- 2020
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 29:19-20, s. 3743-3753
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Tidskriftsartikel (refereegranskat)abstract
- Aim and objectives: The aim of the study was to describe Emergency Medical Services (EMS) nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.Background: Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient's suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.Design: The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.Methods: A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.Results: The experiences of critical incidents emerged to form two main areas: “Functional co‐operation” and “Dysfunctional co‐operation,” comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas: “Adapting oneself” and “Adapting nursing care and the colleague,” comprising four categories and eight sub‐categories.Conclusions: Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.Relevance to clinical practice: This study underlines the importance of strengthening the dyadic EMS team's ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.
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| 9. |
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| 10. |
- Andersson, Henrik, 1968-, et al.
(författare)
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Acute coronary syndrome in relation to the occurrence of associated symptoms : A quantitative study in prehospital emergency care.
- 2017
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Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 33, s. 43-47
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome.METHODS: This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010.RESULTS: In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI).CONCLUSION: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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| 11. |
- Andersson, Henrik, 1968-, et al.
(författare)
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Competency requirements for the assessment of patients with mental illness in somatic emergency care : A modified Delphi study from the nurses’ perspective
- 2020
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 40:3, s. 162-170
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Tidskriftsartikel (refereegranskat)abstract
- Patients suffering from mental illness are vulnerable, and they do not always have access to proper emergency care. The aim of this study was to identify competency requirements for the assessment of patients with mental illness by soliciting the views of emergency care nurses. A modified Delphi method comprising four rounds was used. Data were collected in Sweden between October 2018 and March 2019. The data were analyzed using content analysis and descriptive statistics. The panel of experts reached the highest level of consensus regarding basic medical knowledge: the capability to listen and show respect to the patient are essential competency requirements when assessing patients with mental illness in emergency care. Awareness of these competency requirements will enhance teaching and training of emergency care nurses.
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| 12. |
- Andersson, Henrik, et al.
(författare)
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Ethics education to support ethical competence learning in healthcare : an integrative systematic review
- 2022
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Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 23
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Forskningsöversikt (refereegranskat)abstract
- Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethi- cal values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.Methods: In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 arti- cles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.Results: The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previ- ously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.Conclusions: The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
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| 13. |
- Barrientos, Christian, et al.
(författare)
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The care of patients assessed as not in need of emergency ambulance care : registered nurses' lived experiences
- 2018
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Ingår i: International Emergency Nursing. - Amsterdam : Elsevier. - 1755-599X .- 1878-013X. ; 38, s. 10-14
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to describe the care of patients assessed as not in need of emergency ambulance care, from Registered Nurse's lived experiences.Background: Non-emergency patients in need of ambulance care are described as vulnerable and patients in ambulance care have earlier been found to be dependent on the Registered Nurse. However, little is known about the care of non-emergency patients in the ambulance setting, from the perspective of Registered Nurses.Methods: A reflective lifeworld research design was chosen. Five Registered Nurses with experience of ambulance care were individually interviewed.Results: The result reveals the essence of the phenomenon as a desire to provide good care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged in the description; Being in a struggle between different expectations, Being in a questioned professional role, and Being in lack of support and formal directives.Conclusion: Registered Nurses' care for patients assessed as not in need of emergency ambulance care, is a complex struggle between different expectations. This may be related to the encounter between the nurse's and the patient's lifeworld.
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| 14. |
- Barrientos, Christian, et al.
(författare)
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The care of patients assessed as not in need of emergency ambulance care : the perspective of registered nurses
- 2019
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Konferensbidrag (refereegranskat)abstract
- Background: Non-emergency patients are described as vulnerable and in need of being taken seriously in the ambulance care. Ambulance care has a natural and obvious focus onemergency medical care. Research has found patients as being dependent of the RegisteredNurse (RN) in the ambulance care. This is experienced as putting the life into the hands of the RN. RNs in the ambulance care encounter those patients on daily basis, and there is a need ofdeepened knowledge based on their experiences.Aim: The aim was to describe the care of patients assessed as not in need of emergencyambulance care, from RNs' lived experiences.Methods: The study had a qualitative design. A reflective lifeworld research method was usedand five RNs in the ambulance service were individually interviewed.Results:The general structure of the phenomenon is described in the essence together with thedescription of the meaning constituents.The essence of the phenomenon is a desire to providegood care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged; 'Being in a struggle between different expectations', 'Being in aquestioned professional role', and 'Being in lack of support and formal directives'.Conclusion: RNs' care for patients assessed as not in need of emergency ambulance care, is alonely struggle between different expectations and related to the encounter between thepatient's and the RN's lifeworld. This study calls for developing care-strategies and interventionsin order strengthen and support RNs in this care.
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| 15. |
- Bennesved, Anna, et al.
(författare)
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Ambulance clinicians’ understanding of older patients’ self-determination : A vignette study
- 2023
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; , s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.
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| 16. |
- Berglund, Annika, et al.
(författare)
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Stroke
- 2016. - 2
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Ingår i: Prehospital akutsjukvård. - Stockholm : Liber. - 9789147114740 ; , s. 373-379
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 17. |
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| 18. |
- Bratt, Anna S., 1969-, et al.
(författare)
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An internet-based compassion course for healthcare professionals : Rationale and protocol for a randomised controlled trial
- 2022
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 28
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Tidskriftsartikel (refereegranskat)abstract
- Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research has shown that compassion interventions for healthcare professionals can decrease work-related stress through the introduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations. Internet-based stress management interventions have hitherto shown promising results in reducing stress. However, further research is needed to examine the effectiveness of internet-based compassion interventions for healthcare professionals. Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effects of an internet-based compassion course for healthcare professionals on work-related stress and stress of conscience. Method: Healthcare professionals will be offered an internet-based stress management course of five modules across a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled in one of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n = 120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stress management course (n = 36). We hypothesise that the internet-based compassion course would reduce the participants' stress of conscience to a greater degree compared to the other two groups. The secondary hypothesis is that the compassion course would increase the participants' professional quality of life (i.e., higher job satisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion course is expected to reduce the participants' work-related stress and sick leave rates to the same degree (non-inferiority) as the cognitive behavioural stress management course and to a higher degree when compared to the waitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondary outcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related Stress Copenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will be performed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10 weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimating equation for repeated measurements to examine whether changes over time differ between the groups and whether the improvements persist over time. Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and add to the existing knowledge of internet-based interventions for stress management in healthcare professionals.
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| 19. |
- Bremer, Anders, Docent, 1957-, et al.
(författare)
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Ambulance nurse students’ experiences of ethical problems in patient-relationships
- 2019
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Ingår i: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
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Konferensbidrag (refereegranskat)abstract
- Background: Ambulance nurse education in Sweden is a one-year master’s degree program for registered nurses leading to a postgraduate diploma in specialist nursing. Ambulance nurses face unpredictable and ethically challenging situations with multi-dimensional suffering, requiring the ability to provide medical care and simultaneously creating a trustful relationship. Students undergoing their specialist education face the same challenges.Aim: The aim was to describe ambulance nurse students’ (ANS) experiences of ethical problems in patient relationships during clinical studies.Method: Written exams (n=69) in ANS’ clinical placements studies were collected between 2014- 2016 in three courses. In the exam the ANS were asked to describe and problematize a selfexperienced ethical problem in the care relationship with a specific patient. The thematic analysis commenced with being familiarized with the text as a whole before condensation and coding. The exams were read and re-read several times. After coding followed further analysis, re-analysis and validation in several linear and circular steps to finally compile sub-themes and themes.Results: Ethical problems emerged as six themes; 1) Insecurity in considering patient autonomy, 2) Conflicting assessments of the patients best, 3) Inadequate access to patient narratives, 4) Absence of trustful relationships, 5) Disturbance of patient focus and 6) Limited possibility to provide proper care.Conclusions and implications: The result emphasizes ethical problem within patient-relationships in the ambulance care as multifaceted and strongly connected to patient’s autonomy. Outgoing from the results an intervention project regarding older patients’ autonomy in ambulance care started in January 2019.
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| 20. |
- Bremer, Anders, Docent, 1957-, et al.
(författare)
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Ethical conflicts in patient relationships : experiences of ambulance nursing students
- 2020
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:4, s. 946-959
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Tidskriftsartikel (refereegranskat)abstract
- Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts.Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies.Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses.Participants: The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university.Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study.Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care.Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation.Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.
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| 21. |
- Carnesten, Hillewi, et al.
(författare)
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Caring approach for patients with chest pain : Swedish registered nurses’ lived experiences in Emergency Medical Services
- 2021
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Encountering patients with chest pain is common for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care . From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective . The aim of this study is to describe the caring approach when RNs encounter patients with chest pain.Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden.Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust . Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team.Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives.
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| 22. |
- Fager, Cecilia, et al.
(författare)
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Nurses' use of an advisory decision support system in ambulance services : A qualitative study
- 2024
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648.
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients.Design: Inductive and descriptive approaches.Method: Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis.Results: The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations.Conclusion: Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven.Implications for Profession and/or Patient Care: These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems.Reporting Method: Consolidated criteria for reporting qualitative research (COREQ).Patient or Public Contribution: None.
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| 23. |
- Frank, Catharina, 1961-, et al.
(författare)
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Older patients’ autonomy when cared for at emergency departments
- 2022
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 29:5, s. 1266-1279
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based on these pref- erences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted.Aim: To describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs).Research design: This study adopted reflective lifeworld theory and a phenomenological design. Participants and research context: A total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden.Ethical considerations: The study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent.Findings: Nurses’ experiences of dealing with older patients’ autonomy in EDs are characterized by moving in a conflicting uphill struggle, indicating obscure thoughts on how patient autonomy can be protected in an ethically challenging context. The phenomenon is further described with its meaning constituents: ‘Being hampered by prioritization under stress’, ‘Balancing paternalism and patient autonomy’, ‘Making decisions without consent in the patient’s best interests’ and ‘Being trapped by notions of legitimate care needs’.Conclusion: Stressful work conditions and lacking organizational strategies in EDs contribute to nurses maintaining unjustified paternalistic care, regardless of the patient’s ability and medical condition, and questioning who has legitimacy for participating in decisions about care. The nurses’ protection and pro- motion of older patients’ autonomy is dependent on the opportunity, ability and willingness to create a patient relationship where the patient’s voice and preferences are valued as important. Consequently, strategies are needed to improve patient autonomy in EDs based on the idea of ‘relational autonomy’.
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| 24. |
- Grimell, Jan, et al.
(författare)
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Identifying and mapping professional identities among Swedish ambulance nurses : A multiple qualitative case study
- 2022
-
Ingår i: Theory & psychology. - : Sage Publications. - 0959-3543 .- 1461-7447. ; 32:5, s. 714-732
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Tidskriftsartikel (refereegranskat)abstract
- Research on ambulance culture and identity is globally scant and nonexistent within a Swedish context. This study on Swedish ambulance nurses serves as a first step and an important entry point into this topic. The purpose was to describe professional ambulance identities among four participants who had served between several years and decades in the ambulance services. Qualitative data was obtained through initial in-depth interviews and follow-up data gathering at a later stage. The theoretical underpinnings adhered to both narrative psychology and dialogical self theory, strengthening the capacity to develop new knowledge about professional identities. The findings present four distinct types of identities among the participants. Individuality and diversity amongst the development of core identities is shown to be cultivated by the dialogue between professional and personal identities. This dialogical process began at a stage in the ambulance career when the strict demarcation line between professional and personal identities was crossed.
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| 25. |
- Hammarbäck, Staffan, 1981-, et al.
(författare)
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Ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process
- 2023
-
Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 30:6, s. 857-870
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process.Aim: The aim of this study was to describe ambulance clinicians’ conceptions of responsibility when en- countering patients in a suicidal process.Research design: A qualitative inductive design using a phenomenographic approach was used. Participants and research context: Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed.Ethical considerations: The study was approved by the Swedish Ethical Review Authority.Findings: Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient’s mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient’s life story.Conclusions: An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.
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| 26. |
- Hammarbäck, Staffan, 1981-, et al.
(författare)
-
Ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process
- 2022
-
Ingår i: Presented at the 4th International Nordic College of Caring Science & the European Academy of Caring Science Conference: "Caring in a changing world", Eskilstuna, Sweden, April 27-28, 2022.
-
Konferensbidrag (refereegranskat)abstract
- Introduction: Ambulance clinicians encounter patients in both obvious and non-obvious phases of a suicidal process. Regardless of phase, ambulance clinicians could have an important role in suicide prevention. However, the main focus in ambulance care is on emergency medicine while the patient’s mental ill-health is not necessarily included in the clinician’s assessment. Aim: To describe ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. Method: With a phenomenographic approach, semi structured interviews were conducted with twenty-seven Swedish ambulance clinicians with a variation in competence, working experience, gender and age. Results: Three categories of description were found. Conventional responsibility, in which responsibility mainly concerns emergency medical treatment and assessment. Conditional responsibility, which to a limited extent includes the patient’s mental ill-health in responsibility but only if certain conditions are met. Ethical responsibility emerges from the encounter with the patient and responsibility is understood as providing care based on the patient’s needs, regardless of physical or mental origin. These categories are found on a spectra moving from responding to the call to responding to the patient. Responding to the patient is impaired by language deficiency or tiredness. Working with a supportive colleague, training in mental health and conversations skills were perceived as facilitating responding to the patient. Conclusion: In suicide prevention, ambulance clinicians understanding of responsibility as responding to the call is unfavorable. Responding to the patient is more favorable and means to primarily appear to the patient as fellow human being. Engaging in a relationship with the patient could cause vulnerability in the clinician, however this vulnerability could be reduced with training and education. This could be vital as it is in the relationship that suicidality could be disclosed and understood.
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| 27. |
- Hammarbäck, Staffan, et al.
(författare)
-
Ambulance clinicians’ responsibility when encountering patients in a suicidal process
- 2023
-
Ingår i: Nursing Ethics. - : SAGE Publications Ltd. - 0969-7330 .- 1477-0989.
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process. Aim: The aim of this study was to describe ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. Research design: A qualitative inductive design using a phenomenographic approach was used. Participants and research context: Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed. Ethical considerations: The study was approved by the Swedish Ethical Review Authority. Findings: Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient’s mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient’s life story. Conclusions: An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.
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| 28. |
- Hammarbäck, Staffan, 1981-, et al.
(författare)
-
Navigating oneself through the eyes of the other : Meanings of encountering ambulance clinicians whilst being in a suicidal process
- 2024
-
Ingår i: The 5th International NCCS & EACS Conference, University of Stavanger, Norway, Caring science – the heart of multi-professional care. ; , s. 12-12
-
Konferensbidrag (refereegranskat)abstract
- Background:Being in a suicidal process has been described as lonely and painful but there is also a longing for someone to see, listen and understand. There is an ambivalence about living or dying and while there is a wish for an endurable future, it seems to be out of reach. Ambulance clinicians describe a lack of competence and variation in conceptualized responsibility, moving between mainly emergency medicine to an ethical responsibility to engage in a caring relationship. Since little is known what meaning this encounter has to the patients, the aim of this study was to elucidate meanings of encountering ambulance clinicians whilst being in a suicidal process. Methods:A phenomenological hermeneutical approach was used, and data were collected through fifteen individual interviews with eight participants with lived experience of encountering ambulance clinicians whilst being in a suicidal process. Results:The analysis resulted in the main theme ´Navigating oneself through the eyes of the other´. In the encounter, patients navigate their position in terms of value, and direction as expectations of the future. Three subthemes; ‘Being impacted by representatives of society’, ‘Being unsure of one´s own value’ and ‘Regaining hope in moments of togetherness’ substantiated the main theme.Conclusion: It is in in the clinicians’ power to consolidate the feeling of being a burden but also to instil hope of an endurable life. Through caring conversations clinicians can support the patients’ first steps in the journey of recovery.Ethical considerations:The Swedish Ethical Review Authority approved the study.
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| 29. |
- Hammarbäck, Staffan, 1981-, et al.
(författare)
-
The encounter between ambulance clinicians and patients in a suicidal process
- 2023
-
Ingår i: Presented at the 4th Global Conference on Emergency Nursing & Trauma Care, Gothenburg, Sweden, November 9-11, 2023, 2023.
-
Konferensbidrag (refereegranskat)abstract
- Background: Most patients have contact with healthcare in the year prior to suicide and ambulance clinicians encounter these patients in all stages of the suicidal process (Rees. Traditionally, the focus in ambulance care is on emergency medicine and encountering patients with suicidal ideation can be challenging to the clinicians. Patients describe an ambivalence between living and dying and being in the process is characterized by loneliness and darkness, but there is also a longing for someone who truly see, listen and understand the situation.Aim: To illuminate the encounter between ambulance clinicians and patients in a suicidal process.Method: The presentation is founded in two qualitative interview studies. The first study has a phenomenographic approach and describes ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. The second study has a phenomenological hermeneutical approach and illuminates meaning of patients’ lived experience of encountering ambulance clinicians whilst being in a suicidal process.Ethical considerations: Both studies included in the presentation were approved by the Swedish Ethical Review Authority.Results: Ambulance clinicians describe lack of competence regarding suicidality. However, the competence that patients desire is compassion and humanity which impacts on the ambivalence between living and dying. Both clinicians and patients experience vulnerability in the encounter. To the clinicians, this vulnerability comes from coming forth as a person in the encounter. At the same time, it is the personal in clinicians that remind patients of human community and convey hope of a bearable life. Conclusions: The encounter with ambulance clinicians could be the start of the patients’ recovery. Not only can the clinicians offer a safe haven, but they can also support the patients in reclaiming their life stories.
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| 30. |
- Hammarbäck, Staffan, et al.
(författare)
-
The meaning of the encounter with ambulance clinicians whilst being in a suicidal process
- 2023
-
Ingår i: International Association for Suicide Prevention. - : International Association for Suicide Prevention. ; , s. 229-230
-
Konferensbidrag (refereegranskat)abstract
- Background: Patients in suicidal processes describe ambivalence about living or dying, and that there are feelings of loneliness, shame and failure, and longing for someone to truly see and understand. When encountering hospital emergency care, the experiences range from hostility to gentleness. However, a positive relationship is understood as part of recovery. It can be challenging for ambulance clinicians to encounter patients in suicidal processes, and suicidal ideation is not necessarily considered to be within the scope of their responsibility. Ambulance clinicians encounter patients in all stages of the suicidal process, and they could have responsibility in preventing future suicide. Nevertheless, there is scarce research on how patients experience this encounter and what meaning it has to them.Aim: The aim of the study was to elucidate meanings of encountering ambulance clinicians whilst being in a suicidal process.Method: A qualitative inductive design was used. Fifteen individual interviews were conducted with eight participants with experience of encountering ambulance clinicians whilst being in a suicidal process. The interviews were transcribed and the data was analysed using phenomenological hermeneutics.Ethical considerations: The study was approved by the Swedish Ethical Review Authority.Results: Preliminary findings presents three themes. Being under ambulance clinicians’ authority which means to be inferior in the power balance to the clinicians. However, the power balance is highlighted through body language, tone or focusing on diagnosis, but it could also be balanced through a personal and empathic encounter. Being unsure of one’s own value where one keeps up a façade to protect both one’s vulnerability but also to avoid putting one’s burden upon the clinicians. Being a problem to solve, and not a person in need of help, is elucidated when the clinicians use impeaching language. Regaining hope in moments of togetherness where the brief relationship with the clinicians can rise hope when one is seen as a unique person. Having an everyday conversation reminds of human community. An opportunity to share one’s story and to be supported in approaching what is distressful, arises when clinicians have an understanding attitude.Conclusions: Encountering ambulance clinicians means to be inferior. Clinicians’ communication highlights the power imbalance and can increase feelings of loneliness and being a burden. But there is also in the clinicians’ power to equalize the imbalance, to convey hope and remind of human community. Thus, the encounter could be the start of the patients’ recovery.
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| 31. |
- Hjalmarsson, Anna, 1976-
(författare)
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Being provided with a safe haven : Care-dependent older persons' participation in prehospital emergency care
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Participation in care is a key concept in many welfare societies and serves to guide clinical practice and adapt care to personal preferences and needs in order to promote well-being and quality of life. Previous research has shown that practicing participation in care is complex due to the concept not being clearly defined. A significant risk is, therefore, that participation in care is practiced based on the professional caregivers' own definitions, which might be inconsistent with the cared-for persons' perceptions of what participation is.Older persons can continue to live in their own homes with the support of municipal home care services that meet everyday care needs. Care-dependent older persons are known to have increased emergency care needs, which in Sweden require inter-organizational and inter-professional collaboration involving a care transfer between welfare levels. This thesis aimed to deepen the understanding of care-dependent older persons' participation in prehospital emergency care from lifeworld and welfare perspectives. The inductive design was based on a lifeworld approach and included triangulation of the phenomenon of participation in care using descriptive, interpretative, and comparative methods.From the perspective of care-dependent older persons, participation in prehospital emergency care means a forced transfer of life responsibility to professional caregivers when being existentially unsafe and incapacitated due to acute illness. Through authorized representation, the professional caregivers act for the older person, with the power to bring about change and create opportunities for existence. Care-dependent older persons' participation in prehospital emergency care involves a deepened dependence that necessitates coexistence and being provided with a 'safe haven' through the entire emergency care chain. A 'safe haven' can be understood as an unconditional, calm, and sheltered interpersonal space for emotional rest that is provided to the older person during an existentially challenging situation. From the perspective of care-dependent older persons, the emergency care chain transcends organizational boundaries and includes mobile safety alarm services and emergency department attendance.The involved professionals must be supported in practicing participation in care based on a comprehensive understanding of the concept, and emergency care options must be aligned with the care-dependent older persons' need for coordinated and continuous care. Collaborative challenges related to unstructured collaboration and professional hierarchy need to be addressed to support well-functioning collaboration in situations involving acutely ill older persons. The involved organizations need to recognize care-dependent older persons' deepened dependence when acutely ill, as well as their extended view of the prehospital emergency care chain.
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| 32. |
- Holmberg, Dan, et al.
(författare)
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Association of CD247 (CD3ζ) gene polymorphisms with T1D and AITD in the population of northern Sweden
- 2016
-
Ingår i: BMC Medical Genetics. - : Springer Science and Business Media LLC. - 1471-2350. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: T1D and AITD are autoimmune disorders commonly occurring in the same family and even in the same individual. The genetic contribution to these disorders is complex making uncovering of susceptibility genes very challenging. The general aim of this study was to identify loci and genes contributing to T1D/AITD susceptibility. Our strategy was to perform linkage and association studies in the relatively genetically homogenous population of northern Sweden. We performed a GWLS to find genomic regions linked to T1D/AITD in families from northern Sweden and we performed an association study in the families to test for association between T1D/AITD and variants in previously published candidate genes as well as a novel candidate gene, CD247. Methods: DNA prepared from 459 individuals was used to perform a linkage and an association study. The ABI PRISM Linkage Mapping Set v2.5MD10 was employed for an initial 10-cM GWLS, and additional markers were added for fine mapping. Merlin was used for linkage calculations. For the association analysis, a GoldenGate Custom Panel from Illumina containing 79 SNPs of interest was used and FBAT was used for association calculations. Results: Our study revealed linkage to two previously identified chromosomal regions, 4q25 and 6p22, as well as to a novel chromosomal region, 1q23. The association study replicated association to PTPN22, HLA-DRB1, INS, IFIH1, CTLA4 and C12orf30. Evidence in favor of association was also found for SNPs in the novel susceptibility gene CD247. Conclusions: Several risk loci for T1D/AITD identified in published association studies were replicated in a family material, of modest size, from northern Sweden. This provides evidence that these loci confer disease susceptibility in this population and emphasizes that small to intermediate sized family studies in this population can be used in a cost-effective manner for the search of genes involved in complex diseases. The linkage study revealed a chromosomal region in which a novel T1D/AITD susceptibility gene, CD247, is located. The association study showed association between T1D/AITD and several variants in this gene. These results suggests that common susceptibility genes act in concert with variants of CD247 to generate genetic risk for T1D/AITD in this population.
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| 33. |
- Holmberg, Mats A., et al.
(författare)
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A versatile bacterial expression vector designed for single-step cloning of multiple DNA fragments using homologous recombination
- 2014
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Ingår i: Protein Expression and Purification. - : Elsevier BV. - 1046-5928 .- 1096-0279. ; 98, s. 38-45
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Tidskriftsartikel (refereegranskat)abstract
- Production of recombinant proteins is the starting point for biochemical and biophysical analyses and requires methodology to efficiently proceed from gene sequence to purified protein. While optimized strategies for the efficient cloning of single-gene fragments for bacterial expression is available, efficient multiple DNA fragment cloning still presents a challenge. To facilitate this step, we have developed an efficient cloning strategy based on yeast homologous recombination cloning (YHRC) into the new pET-based bacterial expression vector pSUMO-YHRC. The vector supports cloning for untagged expression as well as fusions to His6-SUMO or His6 tags. We demonstrate that YHRC from single PCR products of 6 independent genes into the vector results in virtually no background. Importantly, in a quantitative assay for functional expression we find that single-step YHRC of 7 DNA fragments can be performed with very high cloning efficiencies. The method and reagents described in this paper significantly simplifies the construction of expression plasmids from multiple DNA fragments, including complex gene fusions, chimeric genes and polycistronic constructs.
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| 34. |
- Holmberg, Mats, 1976-, et al.
(författare)
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Ambulance clinicians' experiences of relationships with patients and significant others
- 2016
-
Ingår i: Nursing in Critical Care. - Hoboken, NJ : Wiley-Blackwell Publishing Inc.. - 1362-1017 .- 1478-5153. ; 21:4, s. e16-e23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ambulance clinicians (ACs) have to provide advanced care and treatment to patients in a challenging and emotionally demanding environment, therefore they establish interpersonal relationships embracing both patients and significant others. Relationships in emergency care were earlier found to be short-lived and lacking a holistic understanding of the patient. In their relationship with the ambulance clinicians, it is for patients to surrender and become dependent, which may be interpreted as both a negative and a positive experience.Aim: The aim of this study was to elucidate ambulance clinicians' experiences of relationships with patients and significant others.Methods: Data were collected from four focus group conversations, with a total of 18 participating ambulance clinicians. An inductive qualitative content analysis method was chosen.Findings: The analysis resulted in one main category: 'To be personal in a professional role' and three generic categories: 'To be there for the affected person', 'To be personally involved' and 'To have a professional mission'. There were subsequently nine sub-categories. The main category was described as intertwining the experience of being both personal and professional. The ambulance clinicians adapt to a situation while having the affected person in focus. They involve themselves as persons but at the same time use the power of their professional role.Conclusion: The relationship with patients and significant others from the ambulance clinicians' perspective can be understood as embracing both personal and professional aspects.Relevance to critical practice: This study provides an understanding of the ambulance clinicians' professional role as embracing a personal perspective, which is important when developing an emergency ambulance service focusing on care that involves more than just emergency medical treatment.
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| 35. |
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| 36. |
- Holmberg, Mats, 1976-, et al.
(författare)
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Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome : a study on patients with acute chest pain and presumed acute coronary syndrome
- 2018
-
Ingår i: BMC Cardiovascular Disorders. - : Springer. - 1471-2261 .- 1471-2261. ; 18, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain 4 on the visual analogue scale. Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.
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| 37. |
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| 38. |
- Holmberg, Mats, Med.Dr. 1976-, et al.
(författare)
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Delfimetoden
- 2023. - 3
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Ingår i: Vetenskaplig teori och metod. - Lund : Studentlitteratur AB. - 9789144161389 ; , s. 407-422
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 39. |
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| 40. |
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| 41. |
- Holmberg, Mats, Med.Dr. 1976-
(författare)
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Hur vårdar man en trasig själ?
- 2018
-
Ingår i: Samverkan 112. - : On Road Communications. - 1650-7487. ; :5-6, s. 8-8
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 42. |
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| 43. |
- Holmberg, Mats, 1976-
(författare)
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Möt din medmänniska
- 2009
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Ingår i: Omvårdnadsmagasinet. - Stockholm : Svensk Sjuksköterskeförening. - 1652-0858. ; :5, s. 39-39
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 44. |
- Holmberg, Mats, 1976-
(författare)
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Patientens perspektiv på ambulanssjukvård - vad behöver vi veta?
- 2019
-
Ingår i: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Ambulance clinicians encounter different kinds of illness/injury in all different ages and life-situations, requiring their ability to provide a multidimensional care. Being in need of ambulance care is to be vulnerable and exposed in a dramatic life-event, and refers to an existential suffering. The care of this suffering is often described as being based on common sense diminishing the advanced, complex and professional competence this requires. This is not exclusively rooted in a biomedical perspective on the patient’s illness, but in an understanding of an existential wellbeing. Those two perspectives have to be equal in a contemporary ambulance care. The starting point for this has to be the patient’s subjective experience of his/her illness/injury. To develop this the French philosopher Paul Ricoeur’s theory about explanationand understandingis used. Ricoeur suggests a dialectic differentiation between those concepts, giving them an intimate relationship. Explanationcorresponds to the structural study of an object as a reality in itself, such as a biomedical explanation of the patient’s illness. Understandingon the other hand is to interpret an object as a part of a greater reality and generated by a subjective interpretation, such as understanding the illness from the perspective of the patient’s unique experience. Those concepts have to be intertwined and given equal priority in the ambulance care. Thus, the ambulance clinicians have to both understand and explain the patient and his/her situation, in order to properly assess and provide care based on the patient’s perspective.
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| 45. |
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| 46. |
- Holmberg, Mats, Med.Dr. 1976-, et al.
(författare)
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Registered nurses’ experiences of assessing patients with mental illness in emergency care : A qualitative descriptive study
- 2020
-
Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 40:3, s. 151-161
-
Tidskriftsartikel (refereegranskat)abstract
- Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.
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| 47. |
- Holmberg, Mats, 1976-, et al.
(författare)
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Suffering and Togetherness On-scene in Prehospital emergency care (STOP) : a middle range theory
- 2019
-
Ingår i: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
-
Konferensbidrag (refereegranskat)abstract
- Background: Prehospital emergency care provides care for patients of all ages and life situations and with a variety of suffering, diseases and injuries. Different caring aspects are required in order to respond to the patients’ needs, in parallel with medical assessment and treatment. In order to manage care in these unpredictable and complex contexts, the contextual caring science perspective needs to be developed. Aim: To develop a middle-range theory aimed at prehospital emergency care within a caring science framework. Method: A deductive and inductive design was used to generate understanding of the central concepts; the suffering human being, the caring relationship and the caring environment within prehospital emergency care. Result: The STOP theory comprises the concepts; acute suffering (S), act of togetherness (T), on-scene caring space (O) within in the contextual framework of prehospital emergency care (P). Acute suffering affects us without a clear warning, becoming acute. It means recognizing and accepting that one’s own resources are insufficient and completely exhausted. The ambulance clinician and the patient are in an act of togetherness from different positions and understandings, being dependent on each other to create conditions for continued care. This represents for patients an alteration from being in an involuntary and lonely struggle, to be cared for in a shared struggle to alleviate suffering. The on-scene caring space in which the clinician and the patient are situated are both a prerequisite for care and caring in itself. The space is not static but constantly changing and thus dynamic and elusive. Conclusion and implications: The STOP theory is important for clinical care, education and research in the prehospital emergency care setting as the theory is developed with an understanding of suffering as a wider phenomenon than the narrower biomedical perspective.
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| 48. |
- Holmberg, Mats, 1976-, et al.
(författare)
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The encounter with the unknown : Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service
- 2010
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 5:2, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being.
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- Holmberg, Mats, 1976-
(författare)
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The EXPAND-model : a hermeneutical application of a lifeworld-led prehospital emergency care
- 2019
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Ingår i: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
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Konferensbidrag (refereegranskat)abstract
- Background: Prehospital emergency care means to respond to patients’ life-threatening and critical medical conditions out of hospitals. Patients experience this as an existential suffering together with a physical suffering. Thus a need of combining the medical care and treatment with a caring science perspective in order to provide a lifeworld-led care is stated. Aim: The aim was to develop a model for application of a lifeworld-led prehospital emergency care. Method: The model was developed using Paul Ricoeur’s hermeneutical philosophy, bringing together the concepts explanation (EXP) and understanding (AND). Results: The EXPAND-model comprises the three phases; 1) primary understanding, 2) structural explanation and 3) secondary understanding that together integrate medical care with a lifeworld perspective on the patient’s illness/injury. The primary understanding refers to the intuition and first impression of the patient as a person and his/her multifaceted needs, adapting to the patient and his/her surroundings. The structural explanation belongs to the emergency medical assessment and care using different structural systems. This aims to quickly identify and provide care for life-threating conditions. In the secondary understanding the primary understanding and the structural assessment are brought together into a whole, creating a comprehensive understanding of the patient’s lifeworld as intertwined with his/her illness/injury. Conclusion and implications: In the EXPAND-model the three phases cooperate in order to expand the assessment and care of the patient, based on a lifeworld perspective. The implication of this is two folded. Firstly, this is of importance in order to develop a lifeworld-led prehospital emergency care, which goes beyond fixed medical diagnosis. Secondly, the model may structure the training of professionals to unfold the uniqueness of a person’s experience of illness/injury in relation to a complex world and the existential aspects of being human.
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