| 1. |
- Frank, Catharina, 1961-, et al.
(author)
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Ethics rounds in the ambulance service: a qualitative evaluation
- 2024
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In: BMC Medical Ethics. - : Springer Nature. - 1472-6939. ; 25:1
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Journal article (peer-reviewed)abstract
- BackgroundIt is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds.MethodsThis was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis.ResultsTwo themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue.ConclusionIncorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.
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| 2. |
- Andersson, Henrik, et al.
(author)
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Ethics education to support ethical competence learning in healthcare : an integrative systematic review
- 2022
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In: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 23
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Research review (peer-reviewed)abstract
- Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethi- cal values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.Methods: In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 arti- cles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.Results: The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previ- ously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.Conclusions: The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
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| 3. |
- Bennesved, Anna, et al.
(author)
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Ambulance clinicians’ understanding of older patients’ self-determination : A vignette study
- 2023
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In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; , s. 1-13
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Journal article (peer-reviewed)abstract
- Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.
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| 4. |
- Carlsson, Nina, 1979-
(author)
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Sorgereaktioner hos närstående till personer som avlidit till följd av plötsligt hjärtstopp
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Syfte: Avhandlingens övergripande syfte var att utforska sorgereaktioner hos närstående till personer som avlidit till följd av plötsligt hjärtstopp. De specifika syftena var att: belysa innebörder av levda erfarenheter av att förlora en nära person som avlidit till följd av plötsligt hjärtstopp (I), beskriva symtom på förlängd sorg och självskattad hälsa hos närstående, samt att jämföra partners och icke-partners (II), undersöka samband mellan symtom på förlängd sorg och psykisk ohälsa samt identifiera associerade faktorer (III), undersöka sorgereaktioner i relation till socialt och professionellt stöd, sex och tolv månader efter förlusten (IV).Metod: Datainsamlingen genomfördes genom kvalitativa intervjuer (n=12) (I) samt via enkäter sex (n=108) (I-III) och tolv (n=69) (IV) månader efter dödfallet. Enkäterna innehöll bakgrundsfrågor samt mätinstrumenten: Prolonged Grief Disorder (PG-13), RAND-36, Health Index (HI), Minimal Insomnia Symptom Scale (MISS), Hospital Anxiety and Depression Scale (HADS), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Multidimensional Scale of Perceived Social Support (MSPSS). Intervjudata analyserades utifrån fenomenologisk hermeneutik (I) och enkätdata analyserades med beskrivande och inferentiell statistik (II-IV).Resultat: Under hjärtstoppshändelsen befann sig närstående i ett gränsland mellan liv och död. Efter dödsfallet var närståendes berättande betydelsefullt i sökandet efter förståelse och mening. Att sakna svar kunde hålla kvar närstående i liminalitet och försvåra sorgeprocessen (I). Var femte närstående (18%) rapporterade symtom på förlängd sorg sex månader efter förlusten. Även symtom på ångest (30%) och depression (19%) var vanligt medan få rapporterade symtom på posttraumatisk stress (6%) (II). Dessa symtom samexisterade i hög grad (rs=0,69-0,79) (III) och kunde även kvarstå eller förvärras över tid (IV). Både socialt och professionellt stöd var signifikant associerat med symtom på förlängd sorg och psykisk ohälsa (III-IV). En majoritet (86%) rapporterade att de inte erbjudits stöd från hälso- och sjukvården vid dödsfallet (II).Slutsats: För att underlätta sorgeprocessen bör närstående erbjudas professionellt stöd under hjärtstoppshändelsen och uppföljande samtal efter dödfallet. Genom ett proaktivt professionellt stöd och användning av validerade mätinstrument kan närstående i behov av ytterligare psykologiskt stöd identifieras.
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| 5. |
- Fager, Cecilia, et al.
(author)
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Nurses' use of an advisory decision support system in ambulance services : A qualitative study
- 2024
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In: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648.
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Journal article (peer-reviewed)abstract
- Aim: To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients.Design: Inductive and descriptive approaches.Method: Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis.Results: The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations.Conclusion: Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven.Implications for Profession and/or Patient Care: These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems.Reporting Method: Consolidated criteria for reporting qualitative research (COREQ).Patient or Public Contribution: None.
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| 6. |
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| 7. |
- Holmberg, Bodil, 1970-, et al.
(author)
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Self-determination in older patients: Experiences from nurse-dominated ambulance services
- 2024
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In: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; , s. 1-11
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Journal article (peer-reviewed)abstract
- Aim: To describe ambulance clinicians' experiences of self-determination in older patients.Design: The study had an inductive and explorative design, guided from a life-world perspective.Methods: Thirty-two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes.Findings: The ambulance clinicians assessed the older patients' exercise of self-determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision-making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision-makers.Conclusion: Expectations that older patients with impaired decision-making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision-making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role.Implications and Impact: The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision-making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes.Reporting Method: This study adhered to COREQ guidelines.Patient and Public Contribution: None.
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| 10. |
- Högstedt, Åsa, et al.
(author)
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Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests
- 2022
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 30:1
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Journal article (peer-reviewed)abstract
- Background: There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. Methods: In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. Results: A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). Conclusion: This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.
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