| 1. |
- Andersson, Ulf, 1985-
(författare)
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Clinical reasoning among emergency medical service clinicians : An iterative and fragmented process involving the collaborative effort(s) of many
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to generate knowledge and understanding of clinical reasoning in the context of EMS from the perspective of EMS clinicians.Method: Three different methodologies were employed to describe various aspects of clinical reasoning. In Study I, an integrative literature review was conducted to summarise the existing literature related to clinical reasoning in EMS. After conducting systematic searches and screening, 38 articles were identified and analysed through an inductive thematic analysis. Studies II and III were conducted as case studies within an EMS organisation to capture clinical reasoning as it takes place in the naturalistic environment. In total, 34 patient encounters were observed, and group and individual interviews were conducted with EMS clinicians and organisational representatives at various hierarchical levels within the EMS organization. The data were analysed through pattern matching and triangulation in a computerised software program for qualitative analysis. Study IV was conducted as a goal-directed task analysis which focused on what EMS clinicians need in terms of achieving situation awareness. An online survey was created and answered by 30 EMS subject matter experts, consisting of active EMS clinicians, academic teachers in specialist ambulance nursing programmes, and researchers in the field of EMS. The data were analysed using qualitative content analysis and descriptive statistics.Main results: Clinical reasoning in EMS is a continuously ongoing, iterative, and fragmented process. Information is gathered, analysed, and utilised at any given point during the mission. This information is then reasoned against various goals or instructions provided by the EMS organisation or what is perceived as the most suitable action by the EMS clinician. In the reasoning process, the clinicians take the patients’ and their relatives’ points of interest into account, striving to fulfil these. The clinical reasoning process continues after and between the missions well, and clinicians constantly evaluate their decisions and care provision for future improvement. Even if medical and caring interventions are the focus of clinical reasoning, this process involves the consideration of other aspects as well, such as logistics and safety for everyone present. Nevertheless, there seems to be a vague mandate for decision making among EMS clinicians in relation to other collaborative partners. Furthermore, organisational support for clinical reasoning and development is lacking, often due to economic limitations.Conclusion: This thesis contributes to the caring science field with an increased understanding of the complexity of clinical reasoning in EMS. EMS clinicians today need to rely on themselves or their partners to have sufficient knowledge or experience to handle the situation encountered and provide safe patient care. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. EMS clinicians today need to rely on themselves or their partner to have sufficient knowledge or experience to handle situations encountered and provide patient safe care.
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| 2. |
- Berlin, Johan, 1975, et al.
(författare)
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Backsourcing in the private and public sectors — A systematic review
- 2023
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Ingår i: Financial Accountability and Management. - 0267-4424 .- 1468-0408. ; 39:3
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Tidskriftsartikel (refereegranskat)abstract
- This article provides a systematic review of the literature on backsourcing. The aim is to synthesize existing literature in order to compare and analyze similarities and differences in backsourcing in the private and public sectors. The study asks questions about: which methods and theories have been used, why backsourcing has been implemented, and what reasons have been described for backsourcing. The study is based on an analysis of 500 articles about backsourcing and 33 articles in the final data set. The results show that backsourcing is primarily caused by: increased costs, lack of quality, and contract problems in the private sector, along with loss of control, cost saving, and changed strategy in the public sector. The study's synthesis highlights three explanations for how backsourcing is managed and interpreted in both the sectors. The article contributes specifically to summarizing current research on backsourcing, synthesizing how backsourcing has been studied, illustrating gaps in the research, as well as explaining relevant differences between private and public backsourcing.
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| 3. |
- Berlin, Johan, 1975, et al.
(författare)
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Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample
- 2023
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings. Methods Here, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximumsecurity forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses. Results The ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting a and. values = 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity. Conclusion Despite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.
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| 4. |
- Berlin, Johan, 1975-
(författare)
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Överbelastning i människobehandlande organisationer : en jämförelse mellan socialtjänst, sjukvård och polis
- 2023. - 2.
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Ingår i: Människobehandlande organisationer. - : Natur och kultur. - 9789127462205 ; , s. 234-252
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Bokkapitel (refereegranskat)abstract
- Bokinfo: Människobehandlande organisationer är en antologi som ger en bred överblick över välfärdens kärnverksamheter, vården, skolan och omsorgen, och beskriver vad som utmärker och skiljer dessa verksamheter från privata företag och organisationer när det gäller uppdrag, organisation, ledarskap och förändringsarbete.I den första utgåvan från 2015 var utgångspunkten de förändringar som globaliseringen, teknikutvecklingen och marknadiseringen i form av New Public Management (NPM) medfört för de människobehandlande organisationerna. I denna andra utgåva har författarna, förutom att uppdatera och förnya innehållet utifrån aktuell forskning, även tagit hänsyn till andra betydande händelser i omvärlden, som flyktingkrisen i mitten av 2010-talet och coronapandemin. Dessutom har de följt upp det ökande intresset för granskning och kontroll och den växande kritiken mot NPM. Är alternativet en mer tillitsbaserad ledning och styrning inom välfärdssektorn?Sex nya kapitel har tillkommit. De tar upp kunskapsbildning och forskning om människobehandlande organisationer, migration och flyktingmottagande, hur man hanterar hög belastning inom grässrotsbyråkratier, standardisering och horisontell kunskapsstyrning, chefers roll och vardag inom socialtjänsten samt tillsyn inom social barnavård.Människobehandlande organisationer vänder sig till studerande på socionom-, läkar-, vård- och lärarutbildningar liksom studerande inom ekonomi, statsvetenskap, psykologi, sociologi och offentlig förvaltning. Den är även avsedd för praktiskt verksamma i människobehandlande organisationer.Bokens redaktörer Staffan Johansson, Peter Dellgran och Staffan Höjer är professorer i socialt arbete vid Göteborgs universitet. Övriga författare är forskare inom socialt arbete eller angränsande områden vid ett flertal svenska universitet.
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| 5. |
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| 6. |
- Sultan, Mohammed Ali Salem, et al.
(författare)
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Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context
- 2023
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Ingår i: International Journal of Disaster Risk Science. - 2095-0055. ; 14, s. 183-193
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.
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| 7. |
- Berlin, Johan, 1975, et al.
(författare)
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How do street-level bureaucrats manage high workloads? Collegial mechanisms at the organisational level—experiences from public healthcare organisations
- 2022
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Ingår i: European Management Review. - : Wiley. - 1740-4754 .- 1740-4762. ; 19:2, s. 299-312
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to understand and explain how street-level bureaucrats manage high workloads in public healthcare organisations. Data was collected through observations, interviews and documents. The results show that high workloads are reduced through use of collegial mechanisms at the organisation level. The study shows that workloads are reduced in a two-step process, the first is a negotiation between professionals and the second in the meeting with patients. The two-step process explains the limitation problems in more detail and makes an important contribution by explaining how high workloads are reduced in public health services.
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| 8. |
- Berlin, Johan, 1975, et al.
(författare)
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Involuntary backsourcing in the public sector ‐ From conflict to collaboration
- 2022
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Ingår i: Public Administration. - : Wiley. - 0033-3298 .- 1467-9299. ; 100:3, s. 674-691
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to contribute to the literature on how involuntary backsourcing in public organisations is performed in practice and how it affects the relationship between principal and agent. The study focuses on two questions; 1) Which stages characterise the process when public contracts are involuntary terminated? 2) How does involuntary backsourcing affect the relationship between principal and agent during the transfer period? The study's case concerns public backsourcing in Sweden, in particular, how a metropolitan municipality manages involuntary backsourcing. This study provides in‐depth insights into backsourcing and its practice, as well the degree to which the conflict dimension between the parties is affected. The study shows ‐ paradoxically ‐ that the relationship between principal and agent during the transition phase is characterised by dependence, mutual exchange of information, collaboration and less conflict. The study contributes to developing the theory of backsourcing, particularly the behaviour that is played out between principal and agent in the transition stage. The findings identify the need for public organisations which make outsourcing decisions to have contingency plans for bringing operations back in‐house.
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| 9. |
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| 10. |
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| 11. |
- Meddeb, Adam, et al.
(författare)
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Adverse childhood experiences do not moderate the association between aggressive antisocial behavior and general disinhibition in a forensic psychiatric inpatient sample
- 2022
-
Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Adverse childhood experiences (ACE) and high levels of disinhibition have been associated with a variety of negative outcomes such as aggressive antisocial behavior (AAB). However, forensic psychiatric populations remain an understudied group in this field of research. This study aimed to fill that gap by investigating associations between ACE, AAB, and disinhibition in a forensic psychiatric sample. Furthermore, we aimed to explore such findings by investigating whether ACE might have a moderating effect on the association between disinhibition and AAB. A sample of forensic psychiatric patients (n = 89) was recruited from a high-security forensic psychiatric facility in Sweden. All study variables were moderately to strongly related to each other, although we found no moderating effect of ACE. Post hoc analysis indicated that our ACE items had differential effects on AAB scores, with placement outside the family home, absent parents, and parental drug abuse producing the largest effect on AAB levels. Our findings are in line with previous research demonstrating a significant and robust relationship between ACE, AAB, and disinhibition. Forensic psychiatric populations are exposed to high levels of both self-reported and documented ACE. This calls for trauma-informed care and highlights the importance of considering ACE in risk assessment, preventive work, and policy making.
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| 12. |
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| 13. |
- Berlin, Johan, et al.
(författare)
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Self-report versus clinician-ratings in the assessment of aggression in violent offenders
- 2021
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Ingår i: Criminal Behaviour and Mental Health. - : Wiley. - 0957-9664 .- 1471-2857. ; 31:3, s. 198-210
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Tidskriftsartikel (refereegranskat)abstract
- Background The construct of aggression is central to work with violent offenders, but it is a broad construct that can be assessed by many different methods and instruments. Its measurement may, however, have profound implications for treatment planning. We need more knowledge about how different methods for assessing aggression relate to each other. Aims Our aims were to investigate, first, the convergence and concordance of two methods of assessing aggression: self-report and clinical assessment and, second, to determine the degree to which aggression can be discriminated from neighbouring constructs, such as hostility, anger and criminal behaviour. Methods A nationally representative Swedish cohort of 269 18-25-year-old incarcerated violent offenders was recruited. Data were collected through structured self-reports of aggression, anger and hostility traits (Aggression Questionnaire-Revised Swedish Version) and clinical assessments of lifetime prevalence of aggressive and antisocial behaviours (Life History of Aggression). Criminal records were retrieved from the Swedish National Crime Register. Results Self-ratings and clinician-ratings of aggression were highly convergent and concordant, especially regarding physical aggression. Violent offence records were weakly, if at all, correlated, while self-reported hostility was weakly, or not at all, correlated with self-reported or with clinician-rated aggression. There was an inverse relationship between aggression and criminal records of sexual offences. Conclusions and Implications Even though a combination of self-reports and clinician-ratings may provide a better overview of an individual's aggressive behaviours, our results indicate that they yield such similar information that either alone would be sensitive enough. Our results do not, however, support using one of these methods as a proxy for the other since choice of measure and accepted concordance between them depend on the context within which the assessment is conducted. We reconfirmed that official records of violent offending are unlikely to be adequate measures of outcome after interventions to reduce aggressive behaviours.
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| 14. |
- Berlin, Johan, 1975-, et al.
(författare)
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Styrning av hälso- och sjukvård
- 2021. - Andra upplagan
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Hälso- och sjukvården står i dag inför en rad ekonomiska, demografiska och medicinska utmaningar. Hur den ska styras och organiseras blir därför en angelägen fråga. Den här boken, som nu kommer i sin andra upplaga, beskriver några av de styrmodeller som har tillämpats inom vården under de senaste decennierna. Hit hör exempelvis beställarstyrning, kundvalsmodellen, balanserad styrning, teamarbete, prestationsfinansering och processorientering. Författarna lyfter fram fördelar och nackdelar med de olika modellerna och visar vad de tenderar att leda till på kort respektive lång sikt.
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| 15. |
- Carlström, Eric, 1957, et al.
(författare)
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Quasi-backsourcing in the Public Sector : The Challenge of Withdrawing from an Intertwined and Long-standing Relationship
- 2021
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Ingår i: International Journal of Public Administration. - : Taylor & Francis Group. - 0190-0692 .- 1532-4265. ; 46:4, s. 302-311
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to map the process involved in terminating a long-standing business relationship in a public context. It employed an exploratory study to interview 35 politicians, senior- and middle managers, ambulance- and dispatch centre staff and representatives of a regional alliance of patients. Growing criticism from a county council towards a contractor ended in a decision to bring services back in-house. However, terminating the contract failed and instead a state of quasi-backsourcing emerged. Only parts of the services were taken back in-house, with few reported benefits. The study suggests that caution is needed in relation to backsourcing services from a closely intertwined contractor.
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| 16. |
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| 17. |
- Jansson, Magnus, 1970, et al.
(författare)
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Drivers of outsourcing and backsourcing in the public sector : From idealism to pragmatism
- 2021
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Ingår i: Financial Accountability and Management. - : Wiley. - 0267-4424 .- 1468-0408. ; 37:3, s. 262-278
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Tidskriftsartikel (refereegranskat)abstract
- Local governments are bringing previously outsourced services back in‐house. Research into explanations for sourcing decisions in the public sector is growing, however, few researchers have investigated drivers of both outsourcing and backsourcing in local public‐governance organizations. In this study we utilize transaction cost economic theory (TCE) and political ideology to investigate underlying motives of sourcing in local public governance organizations. Based on a 2018 survey of chief financial officers (CEO) in all of Sweden's 290 municipalities, this study shows that backsourcing is strongly associated with outsourcing and that outsourcing and backsourcing should not be understood as opposite phenomena, rather as interdependent phenomena in a dynamic sourcing strategy. Outsourcing and backsourcing are driven in part by different factors: Outsourcing by political ambitions and economic factors relating to TCE, while managerial and pragmatic concerns are foregrounded for backsourcing.
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| 18. |
- Liljegren, Andreas, 1970, et al.
(författare)
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The police and ‘the balance’— managing the workload within Swedish investigation units
- 2021
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Ingår i: Journal of Professions and Organizations. - : Oxford University Press (OUP). - 2051-8811 .- 2051-8803. ; 8:1, s. 70-85
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Tidskriftsartikel (refereegranskat)abstract
- Professionals within street-level organizations are essential for the delivery of public services to citizens. However, among a number of difficult dilemmas, they have to deal with an extensive workload. The police can be seen as a good example of this; they are expected to solve most crimes, including the so-called mass crimes and the more spectacular cases that make it into media headlines, and often on a continually decreasing budget. A key regulating mechanism for investigation departments in the Swedish police is the so-called balance. The balance can be described as a basket in which they put the cases that there is a desire and potential to work on but not in the immediate term. The purpose of this article is to analyse the balance as a way of rationing the workload within the Swedish police. Working with the balance consists of two processes: limiting and buffering the workload. Limiting is the practice of reducing the work in a situation. Buffering is the process of putting some work on hold to deal with later, of which the article identifies five kinds; functional, problematic, quasi, progressive, and symbolic buffering. The exploration of ‘the balance’ contributes to our understanding of how street level organizations attempt to defend their professional jurisdictions, their well-being, and their ability to complete their duties.
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| 19. |
- Pedersen, Sven H., et al.
(författare)
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Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research
- 2021
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Participant representativeness and statistical power are crucial elements of robust research with human participants, both of which relate to the successful recruitment of research participants. Nevertheless, such core features may often not be fully reported or duly considered in psychiatric research. Building on our experiences of collecting data in the context of forensic mental health services, we discuss issues regarding participant recruitment and representativeness in our field with its particular characteristics. A quick sampling and brief overview of the literature in four specialized forensic mental health journals is presented, demonstrating that published manuscripts rarely describe the data in sufficient detail for the reader to assess sample representativeness and statistical power. This lack of transparency leads not only to difficulties in interpreting the research; it also entails risks relating to the already meager evidence base of forensic mental health services being relevant only to a subset of patients. Accordingly, we provide suggestions for increased transparency in reporting and improved recruitment of research participants. We also discuss the balance of ethical considerations pertinent to the pursuit of increased participation rates in forensic mental health research.
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| 20. |
- Sultan, Mohammed Ali Salem, et al.
(författare)
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Impact of Virtual Disaster Collaboration Exercises on Disaster Leadership at Hospitals in Saudi Arabia
- 2021
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Ingår i: International Journal of Disaster Risk Science. - : Springer Science and Business Media LLC. - 2095-0055 .- 2192-6395. ; 12, s. 879-889
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Tidskriftsartikel (refereegranskat)abstract
- This study measured the impact of virtual three-level collaboration (3LC) exercises on participants' perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning. An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 healthcare managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises. The response rate was 100%, although not all questions were answered in some cases. The results show that most participants strongly agreed that the exercises focused on collaboration (r(2) = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises and perceived learning (r(2) = 0.793), as well as between perceived learning and utility (r(2) = 0.811). The collaboration exercises enhance the perceived effects of CLU. They also improve the ability of participants to adapt situational strategies to achieve a safer society. Although exercises were conducted virtually, they were well received by the participants and achieved a value M = 4.4 CLU score, which opens up new dimensions in collaboration simulation exercises.
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| 21. |
- Böling, Susanna, et al.
(författare)
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No ordinary consultation : a qualitative inquiry of hospital palliative care consultation services
- 2020
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Ingår i: Journal of Health Organization and Management. - : Emerald Group Publishing Limited. - 1477-7266. ; 34:6, s. 621-638
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Considering the great need for palliative care in hospitals, it is essential for hospital staff to havepalliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care.However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need forfurther knowledge about the process of palliative consultations. The purpose of this study therefore was toexamine how palliative consultations in hospitals are practised, as perceived by consultants and health careprofessionals on receiving wards.Design/methodology/approach – Focus groups with palliative care consultation services, health carepersonnel from receiving wards and managers of consultation services. Interpretive description and constantcomparative method guided the analysis.No ordinaryconsultationThe authors would like to thank participating colleagues for sharing their knowledge and experiencesabout palliative consultations.Ethics approval and consent to participate: The project received ethical approval from the SwedishEthical Review Authority, No. 809–16. Informed consent preceded participation for all of the participants.Consent for publication: Not applicable.Availability of data and material: The datasets generated and analysed during the current study are notpublicly available due to the inclusion of potentially sensitive individual data about health status. Theethical approval includes a statement that the data will be kept in a private repository but are availablefromthe corresponding author on reasonable request.Funding: Sahlgrenska Academy at the University of Gothenburg.Authors' contributions: JO, HB and JB planned the study. All authors conducted focus group €interviews. Analysis and interpretation of focus group data was performed by SB with support from JO, €HB and JB. SB wrote the first draft of the manuscript, JO, HB and JB commented on the manuscript and €contributed to the final version. The final manuscript was read and approved by all authors.Competing interests: The authors declare that they have no competing interests.The current issue and full text archive of this journal is available on Emerald Insight at:https://www.emerald.com/insight/1477-7266.htmReceived 14 April 2020Revised 24 June 2020Accepted 2 July 2020Journal of Health Organization andManagement© Emerald Publishing Limited1477-7266DOI 10.1108/JHOM-04-2020-0130Findings – Variations were seen in several aspects of practice, including approach to practice and representedprofessions. The palliative consultants were perceived to contribute by creating space for palliative care,adding palliative knowledge and approach, enhancing cooperation and creating opportunity to amelioratetransition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultationservices utilised proactive practices that took the initiative in relation to the receiving wards.Originality/value – A lack of policy and divergent views on how to conceptualise palliative care appeared tobe associated with variations in consultation practices, tentative approaches and a bottom-up drivendevelopment. This study adds knowledge, implying theoretical transferability as to how palliative careconsultations can be practised, which is useful when designing and starting new consultation services.
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| 22. |
- Carlström, Eric, 1957, et al.
(författare)
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Inter-Organisational Exercises in Dry and Wet Context-Why Do Maritime Response Organisations Gain More Knowledge from Exercises at Sea Than Those on Shore?
- 2020
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Ingår i: Sustainability. - : MDPI AG. - 2071-1050. ; 12:14
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Tidskriftsartikel (refereegranskat)abstract
- This is a study of inter-organisational exercises arranged by on-shore organisations (ONSOs) and off-shore organisations (OFFSOs). The aim was to compare findings from trained emergency staffs' perceptions of the impact of exercises. The data were retrieved from surveys conducted by the research team in conjunction with exercises. The surveys included staff from the coast guard, sea rescue, police department, fire department and ambulance services. A total of 94 professional emergency personnel participated in the ONSO exercises and 252 in the OFFSO exercises. The study was based on the suggestion that collaborative elements during an inter-organisational exercise promote learning, and learning is important to make the exercises useful. Collaboration proved to be a predictor for some of the items in learning, and learning was a predictor for some of the items in utility. There was, however, a stronger covariation between collaboration, learning and utility in the OFFSOs exercises than in the ONSOs. One reason might be the different cultures of emergency staff involved in on-shore and off-shore organisations. The OFFSOs' qualifications may be dominated by seamanship, together with professional practice, and all parties are expected to act as first responders. ONSOs, on the other hand, practice exercises from a strict professional and legal perspective.
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| 23. |
- Hernborg, Martin N., et al.
(författare)
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First initiatives in prehospital care : Basing assessments on incomplete preliminary information
- 2020
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Ingår i: Journal of Nursing Education and Practice. - : Sciedu Press. - 1925-4040 .- 1925-4059. ; 0:6, s. 47-54
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Rationale and aim: Ambulance staff, i.e. registered nurses and assistant nurses, receive assignments from emergency dispatch centres including information on level of priority, address and patient’s care requirements. One problem is that the preliminary information the dispatcher gives to the ambulance staff may be incomplete. The purpose of this study was to determine how ambulance staff base their assessments on incomplete preliminary information when assessing care requirements.Methods: Fifteen ambulance staff working at seven ambulance stations were interviewed for this study. Interviews were transcribed and analysed using content analysis.Results: Incomplete preliminary information means that ambulance staff may be misdirected. This means that if the preliminary information from the dispatcher is incomplete, the ambulance staff need to reassess, and this is perceived to be difficult. Ambulance staff tend to stick to the first initiative that is taken after they receive an alert from the dispatcher.Conclusions: When ambulance staff receive incomplete preliminary information, they need to consider the possibility of conducting a reassessment. Based on the results, there is a need for new procedures to improve preparedness to conduct a reassessment after receiving incomplete preliminary information.
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| 24. |
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| 25. |
- Nord-Ljungquist, Helena
(författare)
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Vem har och tar ansvar! : – I Väntan På Ambulans (IVPA)-uppdrag i Glesbygdsmiljö
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to explore and describe experiences from the perspective of different actors in While Waiting for Ambulance (WWFA) assignments in a rural environment. The four studies aimed: to describe WWFA and ambulance assignments in rural environments, focusing on frequency, event time and actions of firefighters before an ambulance arrives at the scene, and to evaluate these actions (I); to describe emergency situations involving WWFA assignment in a rural environment from the caller´s perspective (II); to describe compliance with the telephone-assisted cardiopulmonary resuscitation (T-CPR) protocol, the performance of the laypersons in a simulated T-CPR situation, and the communication between laypersons and EMDs during these actions (III); to describe WWFA assignment in a rural environment from the firefighters’ and the ambulance staff’s perspective (IV).Methods: The studies had a descriptive and comparative design. They were analysed with a qualitative and quantitative methods.Results: In event time showed the process time between ambulance staff and firefighters as significantly statistically different, to firefighters' disadvantage. Nevertheless, firefighters arrived first at the scene for 95 % of assignments after 17 minutes in the median, while ambulance staff took nearly twice the time. Access to help in the immediate area is experienced as valuable to the callers, but there is also a sense of being lone and lonely with vulnerability. Instructions from T-CPR protocol were difficult to comply with both from EMDs and laypersons, especially airway control. Regardless of the quality of communication between EMD and lay people, performance of CPR did not improve. Firefighters and ambulance staff experienced a directedness of responsibility towards affected persons; simultaneously, they were each other’s support. WWFA assignment is, itself, in a gray zone between the involved organisations, and strategies are lacking for the assignment.Conclusions: WWFA assignments are an underutilized resource in individual’s local environments, where a coordinated picture of identified organisational gray zones provide better conditions for future action by the organisations involved, with increased opportunities to save lives in people's local environments.
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- Raidla, Annelie, et al.
(författare)
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Outcomes of Establishing an Urgent Care Centre in the Same Location as an Emergency Department
- 2020
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Ingår i: Sustainability. - : MPDI. - 2071-1050. ; 12:19
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Tidskriftsartikel (refereegranskat)abstract
- The emergency department (ED) is one of the busiest facilities in a hospital, and it is frequently described as a bottleneck that limits space and structures, jeopardising surge capacity during Major Incidents and Disasters (MIDs) and pandemics such as the COVID 19 outbreak. One remedy to facilitate surge capacity is to establish an Urgent Care Centre (UCC), i.e., a secondary ED, co-located and in close collaboration with an ED. This study investigates the outcome of treatment in an ED versus a UCC in terms of length of stay (LOS), time to physician (TTP) and use of medical services. If it was possible to make these parameters equal to or even less than the ED, UCCs could be used as supplementary units to the ED, improving sustainability. The results show reduced waiting times at the UCC, both in terms of TTP and LOS. In conclusion, creating a primary care-like facility in close proximity to the hospitals may not only relieve overcrowding of the hospital's ED in peacetime, but it may also provide an opportunity for use during MIDs and pandemics to facilitate the victims of the incident and society as a whole.
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