| 1. |
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| 2. |
- Brante, Thomas, et al.
(författare)
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Profession och vetenskap : idéer och strategier för ett professionslärosäte
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Förord av Björn Brorström, Prorektor Högskolan i Borås Ett professionslärosäte bedriver utbildning och forskning på vetenskaplig grund. Vetenskapliga metoder tillämpas och framkomna resultat prövas för att säkra tillförlitlighet och relevans. Förmågan att problematisera, formulera frågor och välja lämpliga metoder för att besvara frågor är egenskaper för god forskning och utmärkande för en stark utbildnings- och forskningsmiljö. Vid ett professionslärosäte finns samtidigt en stark strävan efter att i utbildning och forskning ta till vara den kunskap och de erfarenheter som professioner besitter och därigenom säkra en hög grad av praktisk relevans. Växelverkan mellan teori och praktik och erfarenhetsutbyte mellan forskare och praktiker är ständigt pågående. Det finns ingen avslutning på processen utan den pågår utan avbrott. En nödvändig förutsättning för ett fruktbart samarbete är en ömsesidig respekt och vilja att stödja och ifrågasätta varandra. Forskaren måste vara beredd på kritik för bristen på praktisk relevans och professionsföreträdaren måste vara beredd på att förtrogenhetskunskapens lämplighet ifrågasätts. Det är en fråga om med- och mothåll från båda håll i syfte att långsiktigt utveckla teori och praktik. Det är en utmaning att utveckla, etablera och därefter kontinuerligt försvara och förbättra professionslärosätet. Ett led i utvecklingen är att inom ramen för Högskolan i Borås föra en debatt om innebörden av ett professionslärosäte och vad vi behöver göra för att förbättra verksamheten. På uppdrag av rektor Lena Nordholm har medarbetare vid Bibliotekshögskolan utvecklat och ansvarat för en seminarieserie benämnd Profession och vetenskap. Seminarierna spände över ett brett fält. En av många viktiga frågor som diskuterades flitigt var huruvida vi ska forska om professioner, i för eller med, eller kanske alltihop samtidigt. Bidragen publiceras nu i denna antologi som ges ut inom ramen för Högskolan i Borås rapportserie Vetenskap för profession. Rapporten Profession och vetenskap – idéer och strategier för ett professionslärosäte, som redigerats av universitetsadjunkt Maria Lindh, kommer att få stor betydelse inom lärosätet och i vårt samarbete med företrädare för näringsliv, kulturliv och offentlig verksamhet. Jag ser det som en intressant fortsättning att anordna ett antal seminarier med inbjudna representanter för professioner där artiklarna i denna rapport kan ligga till grund för erfarenhetsutbyte och diskussioner.
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| 3. |
- Herlitz, Johan, 1949, et al.
(författare)
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Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities.
- 2010
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Ingår i: Scandinavian journal of trauma, resuscitation and emergency medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.
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| 4. |
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| 5. |
- 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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| 6. |
- Andersson, Henrik, et al.
(författare)
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Competencies in Swedish emergency departments - The practitioners' and managers' perspective.
- 2014
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Ingår i: International emergency nursing. - : Elsevier BV. - 1878-013X .- 1755-599X. ; 22:2, s. 81-87
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Tidskriftsartikel (refereegranskat)abstract
- The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs.
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| 7. |
- Andersson, Henrik, 1968, et al.
(författare)
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Management of Everyday Work in Emergency Departments – an Exploratory Study with Swedish Managers
- 2014
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Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 22:4, s. 190-196
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Through their formal mandate, position and authority, managers are responsible for managing everyday work in Emergency Departments (EDs) as well as striving for excellence and dealing with the individual needs of practitioners and patients. The aim of the present study is to explore managers’ experiences of managing everyday work in Swedish EDs. Method: A qualitative and exploratory design has been used in this study. Seven managers were interviewed at two EDs. Data was analysed using qualitative content analysis with focus on latent content. Results: Managers experience everyday work in the ED as lifesaving work. One of the characteristics of their approach to everyday work is their capability for rapidly identifying patients with life-threatening conditions and for treating them accordingly. The practitioners are on stand-by in order to deal with unexpected situations. This implies having to spend time waiting for the physicians’ decisions. Management is characterised by a command and control approach. The managers experience difficulties in meeting the expectations of their staff. They strive to be proactive but instead they become reactive since the prevailing medical, bureaucratic and production-orientated systems constrain them. Conclusion: The managers demonstrate full compliance with the organisational systems. This threatens to reduce their freedom of action and influences the way they perform their managerial duties within and outside the EDs.
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| 8. |
- Andersson Hagiwara, Magnus, et al.
(författare)
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A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service
- 2018
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 137:5, s. 523-530
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesWe compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke. Materials & methodsThe Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital. ResultsOf 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital. ConclusionsPatients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.
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| 9. |
- Andersson Hagiwara, Magnus, et al.
(författare)
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Vårdande och systematisk bedömning
- 2016. - 2
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Ingår i: Prehospital akutsjukvård. - Stockholm : Liber. - 9789147114740 ; , s. 178-210
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Clinical Reasoning among Registered Nurses in Emergency Medical Services : A Case Study
- 2022
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Ingår i: Journal of Cognitive Engineering and Decision Making. - : Sage Publications. - 1555-3434 .- 2169-5032. ; 16:3, s. 123-156
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Tidskriftsartikel (refereegranskat)abstract
- In emergency medical services (EMS), the clinical reasoning (CR) of registered nurses (RNs) working in ambulance care plays an important role in providing care and treatment that is timely, accurate, appropriate and safe. However, limited existing knowledge about how CR is formed and influenced by the EMS mission hinders the development of service provision and decision support tools for RNs that would further enhance patient safety. To explore the nature of CR and influencing factors in this context, an inductive case study examined 34 observed patient-RN encounters in an EMS setting focusing on ambulance care. The results reveal a fragmented CR approach involving several parallel decision-making processes grounded in and led by patients' narratives. The findings indicate that RNs are not always aware of their own CR and associated influences until they actively reflect on the process, and additional research is needed to clarify this complex phenomenon.
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| 11. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Clinical reasoning in the emergency medical services: an integrative review
- 2019
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241.
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.
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| 12. |
- Andersson, Ulf, 1985-, et al.
(författare)
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Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study
- 2023
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Ingår i: Paramedicine. - : Sage Publications. - 2753-6386 .- 2753-6386.
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionClinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR.MethodsUsing a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources.ResultsThe results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates.ConclusionThe conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.
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| 13. |
- Aronsson, Kenneth, et al.
(författare)
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Prehospital emergency care for patients with suspected hip fractures after falling : older patients’ experiences
- 2014
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Ltd.. - 0962-1067 .- 1365-2702. ; 23:21-22, s. 3115-3123
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The aim of this study was to describe and explain elderly patients’ lived experiences of prehospital emergency care in cases of suspected hip fractures after falling. Background: Hip fractures represent a major health problem for older people and are a common assignment for the Emergency Medical Services (EMS), but there is little information on how patients experience prehospital emergency care. Design: A reflective lifeworld approach based on phenomenological epistemology was used in an interview study within the context of healthcare science. Methods: Ten elderly patients were interviewed. These depth interviews were tape-recorded, transcribed verbatim and analysed for meanings. Results: The comprehensive understanding of the phenomenon is: ‘Happy to have been rescued, despite bad experiences as well as good’. The elderly patient is offered care in an open and friendly atmosphere concurrently with feeling anxiety about the treatment. Intervention with streamlined care and treatment can thus simultaneously be beneficial as well as doing harm. Patients experience confusion and the need to ask questions about what really happened in the ambulance. Bad experiences remain unexplained. This study is based on three themes with relevant sub-themes: efficiency, concerned encounters and suffering from care. Conclusions: Our study contribute to this field of discussion, showing that administering drugs which cause side effects in already fragile older people is compatible with neither evidence-based care nor evidenced-based medicine. The side effects of pain relief – however efficient that pain relief may be – are taken seriously. Relevance to clinical practice: Pain relief in the EMS should be individualised. Responsibility for patients’ safety regarding pain relief is emphasised. This development should focus on care that is already good and gradually eradicate compassionless care. Keywords: caring science, hip fracture, lived experiences, phenomenology, emergency medical services, ambulance, care pathway, prehospital emergency nurse
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| 14. |
- Berg, Lena M
(författare)
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Patient safety at emergency departments : challenges with crowding, multitasking and interruptions
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Several challenges with patient safety in the emergency department (ED) context have beenpreviously identified, and some commonly mentioned are crowding, multitasking, andinterruptions. The ED is a complex, high-risk work environment where multiple clinicians(physicians, registered nurses [RNs], and licensed practical nurses [LPNs]) are constantlyworking in parallel work processes, in an often crowded ED, while conducting tasksinvolving cognitively demanding decision-making processes. ED crowding has for the past20 years been identified as a problem internationally, resulting in extended ED length of stay(LOS) and increased morbidity and mortality for patients. ED crowding is also considered tohave negative effects on the clinicians' workload and work satisfaction.Both multitasking and interruptions have been identified as risk factors for patient safety byhaving negative effects on a clinician's decision-making processes and thus increasing therisk of forgetting important details and events because of memory overload. However,information has been lacking about what specific work assignments ED clinicians conduct,and thus there is little information about the types of assignments they perform whilemultitasking and being exposed to interruptions. Further, because not all interruptions lead toerrors and because they are not all preventable, a more refined account of interruptions iscalled for. Moreover, it seems that previous studies have not identified which specific factorsinfluence the ED clinicians' perceptions of interruptions. The work environment has beenreferred to as a possible influencing factor, but specific details on the relationship between thework environment and negative effects from interruptions are pending.The overall aim of the thesis was to describe ED crowding, and its influence on EDclinicians' work processes (activities, multitasking, and interruptions) and patient outcomes,from a patient safety perspective. The thesis addressed six research questions: 1) How has EDcharacteristics, patient case mix and occurrence of ED crowding changed over time? 2) Whatwork activities are performed by ED clinicians? 3) What kind of multitasking situations areclinicians exposed to during ED work? 4) What kind of interruptions are clinicians exposedto during ED work? 5) How do ED clinicians perceive interruptions? 6) Is there anassociation between ED crowding and mortality for stable patients without the need for acutehospital care upon departure from the ED?The data in the thesis were generated from two data collections: 1) registry data containingpatient characteristics and measures of ED crowding (ED occupancy ratio [EDOR], ED LOS,and patient/clinician ratios) extracted from the patients' electronic health records (paper I andIV) and 2) observations and interviews with ED clinicians (physicians, RNs, and LPNs)(paper II and III). Nonparametric statistics were used in paper I and III, quantitative and qualitative content analysis were used in paper II and III, and multivariate logistic regressionanalysis was used in paper IV.The main results in the thesis are presented based on Asplin's conceptual model of EDcrowding, from the aspect of input-throughput-output, and how parts of a sub-optimalthroughput influence patient safety through ED clinicians' work processes and patientoutcomes. During 2009 – 2016 there has been a change in patient case mix at the EDs at thestudy hospital, primarily with an increase in unstable patients (input) and a decrease in thenumber of patients admitted to in-hospital care (output). The median for ED LOS over thestudy period increased, and the largest increases occurred among the subgroups of unstablepatients, patients ≥80 years of age, and those admitted to in-hospital care (throughput).Further, an increase in crowding, in terms of median EDOR and median patients per RNratios, was identified, with an increase in EDOR from 0.8 in 2009 to 1.1 in 2016 and anaverage increase of 0.164 patients/RN/year (throughput). The ED clinicians' workassignments consisted of 15 categories of activities, and information exchange was found tobe the most common activity (42.1%). In contrast, the clinicians only spent 9.4% of theiractivities on direct interaction with patients and their families (ED clinicians' workprocesses). The clinicians multitasked during 23% of their total number of performedactivities, and there was an overall interruption rate of 5.1 interruptions per hour. Themajority of the observed multitasking situations and interruptions in the ED clinicians' workoccurred during demanding activities that required focus or concentration (ED clinicians'work processes). Finally, an association was identified between an increase in ED LOS andEDOR and 10-day mortality for stable patients without the need for acute hospital care upondeparture from the ED (patient outcomes).This thesis illustrates how a sub-optimal throughput, affected by conditions in both the inputand output components, negatively influence the ED clinicians' work processes as well aspatient outcomes.
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| 15. |
- Bremer, Anders, Docent, 1957-, et al.
(författare)
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Emergency Medical Services physicians’ perceptions of ambulance nurses’ responsibility for referring patients to primary care and self-care - a Swedish national survey
- 2018
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 8:Suppl 1, s. A6-A6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Based on guidelines developed by EMS physicians, registered nurses in the Swedish ambulance services sometimes by-pass the emergency department and refer non-urgent patients to primary care and self-care. However, these referrals are associated with problems that may jeopardize patient safety and patient participation.Aim: To identify the EMS physicians’ perceptions of ambulance nurses’ responsibilities and prerequisites to refer patients to primary care and self-care.Methods: A national survey of all EMS physicians (n=51) using study specific questions with close-ended and open response options, analysed with descriptive statistics and thematic analysis.Results: The response rate was 78% (n=40). The majority of the physicians (95%) perceived that nurses should be able to refer patients to primary care and self-care. One fourth (25%) perceived specialist nurses in ambulance care as the most appropriate professionals. The majority of the physicians (65%) perceived that referral to primary care maintain patient safety, whereas fewer (50%) assessed the referral as safe for the patient. All perceived that feedback should be given to nurses when the referral was incorrect. The majority perceived it important to extend the nurses’ authority to refer to primary care (63%) and self-care (55%).Conclusion: There is no consensus among the EMS physicians regarding responsibilities and conditions for nurses’ referral of patients. Registered nurses with basic education are expected to be able to refer, while there is varying opinion regarding requirements of specialist trained ambulance nurses to refer patients. Professional experience as a nurse is perceived more important than formal education.
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| 16. |
- Bremer, Anders, 1957-, et al.
(författare)
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Vårdrum : ett vårdande rum
- 2014
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Ingår i: Akut omhändertagande av trauma. - : Liber. - 9789144086774 ; , s. 23-53
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med detta kapitel är att bidra med fördjupad förståelse av begreppet vårdrum och samtidigt presentera en vårdvetenskaplig ram. I detta kapitel beskrivs skadeplatsens oordnade miljö och skiftande villkor, kännetecken och utmaningar som finns för ambulanspersonal att planera för och upprätta vårdrum för patienter som utsatts för trauma, i samverkan med räddningstjänst och polis. Därefter beskrivs villkor för patienternas och de närståendes vårdrum på akutmottagningen. I kapitlet ges exempel på hur vårdande rum kan främjas och upprättas samt hur vårdrummet kan upplevas av de närvarande, vilket gestaltas utifrån forskning och erfarenheter som gjorts av vårdare, patienter och närstående. Kapitlet bygger främst på vårdvetenskaplig forskning.
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| 17. |
- Bremer, Anders, Docent, 1957-, et al.
(författare)
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Vårdrum – ett vårdande rum
- 2019. - 2
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Ingår i: Akut omhändertagande av trauma. - Lund : Studentlitteratur AB. - 9789144127613 ; , s. 23-49
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 18. |
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| 19. |
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| 20. |
- Ek, Bosse, 1951-
(författare)
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Prioritering vid utlarmning i prehospital vård
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, emergency medical dispatch centres (EMD) cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Increased knowledge about the triage in the prehospital care can make it possible to optimize the use of resources. Traditionally nurses have an important role in triage on emergency departments and in telephone advisory. In Sweden there is a trend towards more triage by nurses at EMDs. It is important to survey experiences of nurses’ of prioritization at EMDs.Aim: The overall aim in this thesis was to measure effectivity in prioritisation of ambulance dispatches, and to elucidate experiences from these prioritizations and decisions.Method: In study I sensitivity and specificity in 4086 dispatches was calculated, by comparison of the priority given by the EMD and the assessment performed by the ambulance-nurse according to Medical Emergency Triage and Treatment System. In study II were 15 nurses interviewed about their experiences from prioritizations at an EMD.Result: The result showed that 84,5 % of the dispatches were correct prioritised and that the sensitivity was high (94,5 %) but the specificity was low (15,4 %). Content analysis was performed and two themes emerged: “Having a profession with opportunities and obstacles” and “Meeting serious and difficult situations”. Conclusions are that over- prioritizations are made concerning patients with low or no need of medical care. Also that nurses with experience from emergency care, who are allowed to make their own decisions independent of the medical index, can improve and nuance the prioritization of resources in prehospital care. However, there is an obvious risk that their assessments will tend to be on the safe side. Important for avoiding this is improving internal support systems at the EMDs and also striving for a blame-free culture, where the nurses are not pushed by threats of being reported.
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| 21. |
- Falchenberg, Åsa, et al.
(författare)
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Clinical practice guidelines for comprehensive patient assessment in emergency care : A quality evaluation study
- 2021
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 41:4, s. 207-215
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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.
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| 22. |
- Gabre, Marita, Ass professor, 1970-, et al.
(författare)
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'A little good with the bad' : Newly diagnosed type 2 diabetes patients' perspectives onself-care: A phenomenological approach
- 2018
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Ingår i: Nordic journal of nursing research. - : SAGE Publications. - 2057-1585 .- 2057-1593.
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Tidskriftsartikel (refereegranskat)abstract
- Increased knowledge is needed about what self-care means from the patients’ perspective, especially since the patient population with type 2 diabetes has been rising. The aim was to describe self-care, as experienced by patients with newly diagnosed type 2 diabetes. This study adopted a phenomenological approach. Eight patients were interviewed. A combination of photos and interviews were used. The essential meaning of self-care was found to be an existential struggle that evokes feelings of being in-between one’s old unhealthy life and a new healthier one. In this in-between condition, tension exits between contradictorily emotions of anxiety, hopelessness and hope. This struggle also means questioning one’s identity. It is important that diabetes nurses create an opening for reflection and dare to challenge their patients to reflect on this existential struggle.
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| 23. |
- Hagiwara, Magnus, et al.
(författare)
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Vård och bedömning
- 2009
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Ingår i: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 117-145
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 24. |
- Hansson, Per-Olof, 1958, et al.
(författare)
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Prehospital assessment of suspected stroke and TIA: An observational study
- 2019
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 140:2, s. 93-99
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Tidskriftsartikel (refereegranskat)abstract
- Background Symptoms related to stroke diverge and may mimic many other conditions. Aims To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). Methods An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. Results Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up. Conclusions Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.
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| 25. |
- Hansson, Per-Olof, 1958, et al.
(författare)
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Prehospital identification of factors associated with death during one-year follow-up after acute stroke
- 2018
-
Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 8:6
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke. Material and Methods: All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria. Results: In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of < 90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03. Conclusions: Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.
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| 26. |
- Herlitz, Johan, et al.
(författare)
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Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? Both relief of pain and anxiety are needed
- 2011
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 149:2, s. 147-151
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Tidskriftsartikel (refereegranskat)abstract
- Background Many patients who suffer from acute chest pain are transported by ambulance. It is not known how often treatment prior to hospital admission is optimal and how optimal pain-relieving treatment is defined. It is often difficult to delineate pain from anxiety. Aim To describe various aspects of chest pain in the pre-hospital setting with the emphasis on a) treatment and b) presumed acute coronary syndrome. Methods In the literature search, we used PubMed and the appropriate key words. We included randomised clinical trials and observational studies. Results Four types of drug appear to be preferred: 1) narcotic analgesics, 2) nitrates, 3) beta-blockers and 4) benzodiazepines. Among narcotic analgesics, morphine has been associated with the relief of pain at the expense of side-effects. Alfentanil was reported to produce more rapid pain relief. Nitrates have been associated with the relief of pain with few side-effects. Beta-blockers have been reported to increase the relief of pain when added to morphine. The combination of beta-blockers and morphine has been reported to be as effective as beta-blockers alone in pain relief, but this combination therapy was associated with more side-effects. Experience from anxiety-relieving drugs such as benzodiazepines is limited. It is not known how these 4 drugs should be combined. The results indicate that various pain-relieving treatments might modify the disease. Conclusion Our knowledge of the optimal treatment of chest pain and associated anxiety in the pre-hospital setting is insufficient. Recommendations from existing guidelines are limited. Large randomised clinical trials are warranted.
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| 27. |
- Herlitz, Johan, 1949-, et al.
(författare)
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Prehospital akutsjukvård: ett potentiellt forskarutbildningsämne : populärvetenskaplig rapport från de första 82 doktorsavhandlingarna i Sverige
- 2022
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Rapport (populärvet., debatt m.m.)abstract
- Syfte: Att beskriva prehospital akutsjukvård som ett potentiellt forskarutbildningsämne utifrån avhandlingar som skrivits och försvarats i Sverige inom detta kunskapsområde.Metod: Systematisk och manuell sökning har gjorts via MEDLINE (PubMed) och kontakt med lärosäten.Resultat: Totalt har 80 doktorsavhandlingar och två licentiatavhandlingar identifierats inom kunskapsområdet prehospital akutsjukvård. Avhandlingarna har försvarats under tidsperioden 1982–2021. Produktiviteten har succesivt ökat med 31 avhandlingar som försvarats under den senaste femårsperioden. Flest avhandlingar har skrivits vid Göteborgs Universitet (n=27) Karolinska Institutet (n=22) och Umeå Universitet (n=9). Avhandlingarna har skrivits av 51 sjuksköterskor, 28 läkare, en statistiker, en socionom, en präst och en folkhälsovetare (en avhandling redovisade två professioner; sjuksköterska och läkare). Kvinnor har varit författare i 48%. Avhandlingarna har delats in i följande övergripande kunskapsområden med i några fall även tillhörande undergrupper: A. Akut sjukdom, A1) Prognostiska faktorer (n=25) samt A2) Patient och anhörigperspektiv (n=8); B. Katastrof (n=6); C. Etik och värderingar (n=3); D. Vård- och arbetsmiljö (n=2); E. Kompetens, lärande och utbildning, E1) Ambulanssjuksköterska (n=5) samt E2) Hjärt-lungräddning (n=2 ); F. Trauma och smärta, F1) Skador och räddning (n=4 ), F2) Smärta (n=1) samt F3) Hypotermi (n=4); G. Akuta vårdprocesser och prioritering, G1) Resursutnyttjande (n=1) samt G2) Larmcentral och samverkan (n=8); H. Vårdande bedömning och beslut, H1) Vårdande förhållningssätt (n=3), H2) Diagnostisk bedömning och beslutsstöd (n=6) samt H3) Identifikation av sjukdom och vårdnivå (n=4).Konklusion: Antalet doktorsavhandlingar inom prehospital akutsjukvård är i ökande. Majoriteten av författarna är sjuksköterskor. Avhandlingarna täcker ett brett spektrum av kunskapsområden, men prognostiska faktorer vid Akut sjukdom är dominerande. Könsfördelningen är acceptabel. Patient- och anhörigperspektivet är sparsamt belyst liksom vissa patientgrupper, t.ex. infektioner och trauma. Forskningen inom kunskapsområdet inleddes med fokus på överlevnad vid hjärtstopp utanför sjukhus. Under åren har forskningsområdet vidgats till allt bredare problemområden; vård på rätt vårdnivå är ett sådant exempel.
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| 28. |
- Herlitz, Johan, et al.
(författare)
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Suspicion and treatment of severe sepsis : An overview of the prehospital chain of care
- 2012
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 20:42
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundSepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis.AimTo describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis.MethodsA literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.ResultsIn overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis.Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT.There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers.ConclusionSevere sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.
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| 29. |
- Herlitz, Johan, 1949-, et al.
(författare)
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Över 100 doktorsavhandlingar inom den prehospitala akutsjukvården i Sverige
- 2023
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 1652-7518. ; 120
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Forskningsöversikt (refereegranskat)abstract
- HUVUDBUDSKAPÖver 100 avhandlingar har i dagsläget skrivits om den prehospitala akutsjukvården i Sverige.Dessa täcker ett omfattande kunskapsfält, allt ifrån prognostiska faktorer vid akut sjukdom till ambulans personalens psykiska och fysiska hälsa.Endast ett kunskapsområde har belysts mera om fattande, och det är hjärt–lungräddning vid plötsligt hjärtstopp.Vården av patienter med psykisk ohälsa har inte belysts i någon avhandling.Det finns stora kunskapsluckor, och vidare forskning inom området behövs.
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| 30. |
- 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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| 31. |
- Hugelius, Karin, 1977-
(författare)
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Disaster response for recovery : survivors experiences, and the use of disaster radio to promote health after natural disasters
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Disasters occur all over the world, and affect a rising number of people. The health effects of natural disasters depend on several factors present before, during, and after a disaster event. However, there is only limited knowledge of survivors experiences, needs, and health after natural disasters. Disaster radio means a temporary radio station that broadcasts information, music, and support to the affected population. Disaster radio has the potential to function even in a severely affected area, but its effects need to be further evaluated from a health perspective. The context of this thesis was the Haiyan supertyphoon that hit parts of the Philippines in November 2013.The overall aim was to describe survivors’ and health professionals’ experiences during and in the immediate aftermath of a natural disaster, the health effects from such a disaster, and how disaster radio as a disaster response intervention can be used and evaluated from a health perspective. The thesis includes four studies using qualitative research methods, including content analysis and a phenomenological hermeneutic method, and quantitative methods with statistical analysis.The results show that the Haiyan typhoon affected physical, psychological, and social dimensions of health. Disaster radio was used to broadcast health-related information and psychosocial support, and made a positive contribution to recovery from the perspective of the survivors. Being a health professional deployed during the disaster was an experience of being both a helper and a victim. The use of a self-selected internetbased sample recruited via Facebook for a web-based survey mitigated several practical challenges related to disaster research, but also raised questions about the generalizability of the results.Based on the findings, the importance of an integrated physical, psychological, and social health response to natural disasters is emphazized. Also, the health care system should prepare to use disaster radio as disaster response. In addition, the results suggest that disaster training for health professionals should include personal preparation and coping strategies. Internet-based methods in disaster research need to be further evaluated.
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| 32. |
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| 33. |
- Murphy, Jason
(författare)
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Disaster response and preparedness : Focus on hospital incident command groups and emergency department registered nurses
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: While disasters per definition are rare, incidents that cause mass casualties that threaten to overwhelm its limited resources are an ever-present risk. Disaster medicine is a specific discipline of medicine dedicated to providing adequate health care to patients of major incidents through the development of preventive-, preparedness-, response and recovery interventions. Emergency department registered nurses are among the first to receive, assess and treat patients of a major incident, highlighting the importance of their preparedness and disaster medicine competencies. However, when an incident threatens to overwhelm health care’s resources, a specific type of management group may be required to aid and guide hospital response. The hospital incident command group aids in hospital response through timely decision-making and allocation of resources. Despite these two groups being recognized as vital components of disaster response, little has been known concerning the disaster preparedness of these two groups. emergency department registered nurses’ disaster preparedness. The overall aim of the thesis was to assess disaster medicine preparedness in Stockholm, Sweden through the evaluation of hospital incident command groups and emergency department registered nurses.The aim of study I was to identify the essential disaster nursing competencies. Sixty-nine specific disaster medicine competencies were identified through a modified Delphi method in which experts within the field of emergency- or disaster medicine reached consensus concerning necessary disaster medicine competencies for emergency department registered nurses.The aim of study II was to assess emergency department registered nurses’ self-perceived disaster preparedness using the results in study one as the basis of a questionnaire. A cross- sectional method was used to assess the preparedness of nurses in the study setting. The results of this study indicate that emergency department registered nurses may be less than competent and overestimate their preparedness.The aim of study III was to assess hospital incident command groups’ preparedness. This was done through an observational study in which measurable indicators were used to evaluate hospital incident command groups during simulations. The results in this study indicate that proactive decision-making correlates with overall command group response. Shortly after the simulations in study III, an antagonistic incident occurred in Stockholm, Sweden. This provided a unique opportunity to compare planned preparedness with actual preparedness. through exploration of disaster preparedness coordinators' experiences of hospital response during a major incident.Thus, the aim of study IV was to explore registered nurses’ experiences as disaster preparedness coordinators (DPC) of hospital incident command groups during an MI. This was done through one focus group discussion with six disaster preparedness coordinators and six follow-up interviews with the same coordinators were conducted. Data were analyzed using inductive content analysis. One main category, Expectations, prior experiences, and uncertainty affect HICG response during a major incident and three categories. Gaining situational awareness, transitioning to management, and actions taken during uncertainty were identified.The thesis concludes that disaster medicine preparedness in the study setting may be adequate but that response may be dependent upon several factors including the type and timing of the incident, frequency and type of training, education, experience, and the ability to reduce uncertainty in order to make timely and relevant decisions.
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| 34. |
- Norberg Boysen, Gabriella, 1966-, et al.
(författare)
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Patient trust and patient safety for low-priority patients : A randomized controlled trial pilot study in the prehospital chain of care
- 2019
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 46
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.Aim: To evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).Methods: This randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).Results: There was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.Conclusion: Patient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.
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| 35. |
- Norberg Boysen, Gabriella, 1966-, et al.
(författare)
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Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective
- 2017
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 12:1
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for non-urgent condition and been referred to the healthcare centre.Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patient participated: seven female and three male. The setting is the early chain of healthcare in south-wetern Sweden.Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of lifeworld" enables the patient to feel trust.Conclusion: Trust in the early chain of healthcare entails caregivers' ability to play attention to both medical and existentioal issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessment and decisions concerning his or her own healthcare, in a credible manner and using everyday language.
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| 36. |
- Norberg Boysen, Gabriella, 1966-, et al.
(författare)
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Use of the Medical emergency services by patients with suspected acte primary healthcare problems : Developing av questionnaire measure patient trust in healthcare
- 2016
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5648 .- 2052-5656. ; 4:3, s. 444-452
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Tidskriftsartikel (refereegranskat)abstract
- Rationale aims and objectives: The objective of this study was to develop a questionnaire measuring the level of trust and its constituents in patients calling the Emergency Medicak Services (EMS) for suspected acute primary healthcare problems. The questionnaire is called the Patient Trust Questionnaire (PTQ). The following frontline service providers were involved: 1) The Dispatch Centre, 2) the Emergency Medical Services and 3) the recieving unit (the Emergency Department/Healthcare Centre)Method: Cross-sectional data were collected repeately and redundant items were discarded using a step-by-step approach. Based on litterature review, the PTQ was developed in line with the folowing 4-step procedure: 1) item construction, 2) a face-to-face evaluation of separate items, 3) an emerical pre-evaluation targeting each separate frontline service provider and 4) an emperical full-scale evaluation. The inclusion criteria for participating were that the patient must be 18 years of age or older and suspected having a suspected acute primary care problem when calling the EMS. In the finale full-scale evaluation of the questionnaire, 427 patients were included.Results: A set of 8 items with good phsycometric properties remained through the developing procedure. Two constituents of trust emerged (labelled credibility and accessibility), witch were robust across all fronline service providers.Conclusion: A new measuring instrument has been developed for this particular healthcare chain, for patients with suspected acute primary care problem calling the EMS. Althought not yet validated, the PTQ is a potentially usefull tool in future healthcare research with reference to the concept of patient trust.
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| 37. |
- Norberg, Gabriella, et al.
(författare)
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Swedish emergency medical services' identification of potential candidates for primary healthcare : Retrospective patient record study.
- 2015
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 33:4, s. 311-317
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.DESIGN: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.SETTINGS: The study was completed at the EMS and five hospital areas in the western region of Sweden.SUBJECTS: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%.MAIN OUTCOME MEASURES: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.RESULTS: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.CONCLUSION: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.IMPLICATIONS: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare. Key points Patients calling the emergency medical services do not always end up at an appropriate level of healthcare. In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare. These patients were younger and healthier than those needing care at the emergency department. They were found at all priority levels and within all symptom groups.
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| 38. |
- Palmér, Lina, 1979-, et al.
(författare)
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Caring Science With a Focus on Existential Issues in a Caring Context : A Research Area Inspired by Existential Philosophy
- 2022
-
Ingår i: International journal for human caring. - 1091-5710. ; 26:3, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- This article examines and exemplifies how existential philosophy can provide a deeper understanding of existential issues in a caring context. Existential philosophy, including lifeworld theory, is treated both as an epistemology for the development of research methods and inspiration for analysis and discussions in caring science research. The significance of the lifeworld is also highlighted as a guide to perform and enable caring and caring didactics, along with short descriptions where existential philosophy has previously influenced the development of caring science. The concept of existential caring science is suggested as a research area for research on existential and meaning-oriented phenomena.
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| 39. |
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| 40. |
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| 41. |
- Sundberg, Fredrika
(författare)
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A room designed for caring : Experiences from an evidence-based designed intensive care environment
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this doctoral thesis was to examine and evaluate if and how an intensive care unit (ICU) room, which had been designed using the principles of evidence-based design (EBD), impacted the safety, wellbeing and caring for patients, their family members and staff.Methods: Paper I explored the nursing staff experiences of working in an EBD intensive care patient room through 13 interviews that were analysed by qualitative content analysis. Paper II focussed on the meaning of caring and nursing activities performed in two patient rooms—one EBD refurbished and one standard. Ten non-participant observations were conducted, which were followed by interviews. The data were analysed using a phenomenological hermeneutical approach. Paper III evaluated the relationship between a refurbished intensive care room and adverse events (AE) in critically ill patients. A total of 1,938 patients’ records were included in the analysis. Descriptive statistics and binary logistic regressions were conducted. Paper IV studied visitors’ (N = 99) experiences of different healthcare environmental designs of intensive care patient rooms through questionnaires. Descriptive statistics and linear regressions were conducted for the analysis.Main results: The refurbished intervention room was reported as a positive experience for the working nursing staff and the visiting family members. The nursing staff additionally indicated the intervention room strengthened their own wellbeing as well as their caring activities. Although there were no observed, objective differences regarding the caring and nursing activities due to the different environments, the differences were instead interpreted as being due to different developed nursing competencies. The visitors reported the enriched healthcare environment to have a higher everydayness and a feeling that it was a safer place compared to the control rooms. The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previous described in literature. The likelihood for adverse events were not significantly lower in the intervention room compared to the control rooms.Conclusion: This dissertation contributed to the existing knowledge on how a refurbished patient room in the ICU was experienced by nursing staff and visiting family members. The dissertation also showed the complexity of conducting interventional research in high-tech environments. The new knowledge on the importance of the healthcare environment on wellbeing, safety and caring must be considered by stakeholders and decision-makers and implemented to reduce suffering and increase health and wellbeing among patients, their families and staff.
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| 42. |
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| 43. |
- Svendsen, Susanne, et al.
(författare)
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Sjukvårdsrådgivning
- 2009
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Ingår i: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 79-82
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 44. |
- Tegelberg, Alexander, 1974-
(författare)
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Managers and health professionals in the acute care chain : – A need for a shared understanding in the care of patients with acute abdominal pain
- 2021
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care. Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain. Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II.Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain. Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.
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| 45. |
- Thang, Nguyen Dang, et al.
(författare)
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Pre-hospital prediction of death or cardiovascular complications during hospitalisation and death within one year in suspected acute coronary syndrome patients.
- 2015
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 185, s. 308-312
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To identify pre-hospital predictors of a) death or the development of cardiovascular complications during hospitalisation (primary objective) and b) all-cause death during one year of follow-up (secondary objective), in chest pain patients with suspected acute coronary syndrome (ACS).METHODS: A prospective study that comprised patients in western Sweden, who were transported to hospital by the emergency medical service (EMS) due to chest pain and suspected ACS. Multiple logistic regression was used to identify independent predictors of adverse outcomes.RESULTS: Among all 1600 eligible patients, 21% died or had a cardiovascular complication during hospitalisation and 10% died during one year of follow-up. Nine factors were identified pre-hospitalisation as independent predictors of death or cardiovascular complications during hospitalisation. They were increasing age, a history of congestive heart failure, nausea and/or vomiting, rapid breathing rate, low oxygen saturation, high heart rate, together with ST-segment elevation, ST-segment depression and right bundle branch block on the pre-hospital electrocardiogram (ECG). For the secondary objective of death during one year of follow-up, the following five factors were identified as independent predictors: increasing age, a history of congestive heart failure, dyspnea, low oxygen saturation and left bundle branch block on the pre-hospital ECG.CONCLUSIONS: In the pre-hospital setting of chest pain and suspected ACS, we identified nine predictors of the primary adverse outcome. They were factors representing previous history, symptoms and ECG findings. This information may contribute to the development of a decision support system for the EMS, which then needs to be clinically tested.
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| 46. |
- Thang, ND, et al.
(författare)
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ECG signs of acute myocardial ischemiain the prehospital setting of a suspected acute coronary syndrome and its association with outcomes
- 2014
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 32:6, s. 601-605
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest pain patients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.
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| 47. |
- Vicente, Veronica, et al.
(författare)
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Developing a decision support system for geriatric patients in prehospital care.
- 2013
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 20:4, s. 240-247
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To develop a feasible and safe prehospital decision support system (DSS) for the emergency medical services (EMS), facilitating safe steering of geriatric patients to an optimal level of healthcare. Methods The development process involves four consecutive steps. The first step was gathering data from patients transported by EMS, with the electronic patient care record, to retrospectively identify appropriate patient categories for steering. The second step was to allow a group of medical experts to give advice and suggestions for further development of the DSS. The third step was validation of the decision support tool and the fourth step was validation of the entire prehospital DSS in a pilot study. Results The patient categories relevant to steering were those medical conditions that the geriatric clinicians felt confident in receiving from the EMS. A prehospital DSS was then developed for these 11 medical conditions. The evaluation and validation of the DSS showed a high degree of compliance with the patients’ final level of healthcare. The pilot study included 110 randomized patients; 33.9% were triaged to an alternative level of healthcare, that is geriatric care or primary care. No medical inaccuracies or secondary transports from alternative care to the hospital emergency department were identified. Conclusion Using this prehospital DSS – developed for 11 medical conditions – the Swedish prehospital nurse can safely decide on the level of healthcare to which an elderly patient can be steered. Keywords: ambulance, assessment, emergency medical service, geriatrics, prehospital nurse, triage
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| 48. |
- Vicente, Veronica, et al.
(författare)
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Differentiating frailty in older people using the Swedish ambulance service : A retrospective audit
- 2012
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Ingår i: International Emergency Nursing. - : Elsevier Ltd. - 1755-599X .- 1878-013X. ; 20:4, s. 228-235
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Tidskriftsartikel (refereegranskat)abstract
- The elderly population in Sweden is increasing. This will lead to an increased need for healthcare resources and put extra demands on healthcare professionals. Consequently, ambulance personnel will be faced with the challenge of meeting extra demands from increasing numbers of older people with complex and atypical clinical presentations. Therefore we highlight that great problems exist for ambulance personnel to understand and meet these patients’ care needs. Using a caring science approach, we apply the patient’s perspective, and the aim of this study is to identify and illuminate the conditions that affect elderly people assessed with the assessment category “general affected health condition”. Thus, we have analyzed the characteristics belonging to this specific condition. The method is a retrospective audit, involving a qualitative content analysis of a total of 88 emergency service records. The conclusion is that by using caring science, the concept of frailty which is based on a comprehensive understanding of human life can clarify the state of “general affected health condition”, as either illness or ill-health. This offers a new assessment category and outlines care and treatment that strengthen and support the health and wellbeing of the individual elderly person. Furthermore, the concept of frailty ought to be included in “The International Statistical Classification of Diseases and Related Health Problems” (ICD-10).
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| 49. |
- Vicente, Veronica, et al.
(författare)
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Randomized Controlled Trial of a Prehospital Decision System by Emergency Medical Services to Ensure Optimal Treatment for Older Adults in Sweden
- 2014
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 62:7, s. 1281-1287
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Evaluate the safety and feasibility of a prehospital system (“system”) and a support tool (“tool”) that allow the ambulance nurse to transport geriatric patients, depending on their medical needs, directly to a geriatric ward (GW), to a community emergency care centre (CECC) at a community-based hospital (CH) or to an emergency department (ED). DESIGN: Randomised controlled trial. SETTING: The Emergency Medical Services in Stockholm, Sweden. PARTICIPANTS: 806 geriatric patients who had rung the emergency telephone number 112 were randomised into an intervention group [n=410] and a control group [n=396]. INTERVENTION: The patients were randomised by the dispatcher either to an ambulance that could steer geriatric patients to alternative destinations instead of the ED, depending on the patient’s medical needs (intervention), or to an ambulance that transported all patients to the ED (control). MEASUREMENTS: The primary endpoint; number of patients steered directly to the community-based hospital [effect] i.e. the GW or CECC. The secondary endpoint; number of subsequent transfers [safety] from the CH to the ED within 24 hours after initial admittance. RESULTS: Twenty percent, 90 patients out of 449, [Confidence interval (Cl) 16.6-24.0] could be steered directly to the CH with the help of the prehospital “system” and 6.7%, 6 patients out of 90, [Cl 3.1-13.8] requested subsequent transfer from the GW or CECC to the ED. CONCLUSION: Ambulance nurses could safely and effectively steer geriatric patients to an alternative healthcare facility with the help of a prehospital decision support system and an associated decision support tool. This new system in Stockholm is a better and more effective way of using the under-dimensioned emergency care resources. It is also better for the geriatric patients. Key words: Emergency medical service; Triage; Geriatric patients.
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| 50. |
- Vincente, Veronica, et al.
(författare)
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Elderly patients’ participation in emergency medical services when
- 2013
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Co-Action Publishing. - 1748-2623 .- 1748-2631. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient’s medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as ‘‘There was a ray of hope about a caring encounter and about being treated like a unique human being’’. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.
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