| 1. |
- Elmqvist, Carina, 1964-, et al.
(author)
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”Vi vill ha en statlig nationell översikt över mobil vård”
- 2019
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In: Dagens medicin. - : Bonnier Business Media AB. - 1104-7488 .- 1402-1943. ; :2019-09-26
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Journal article (pop. science, debate, etc.)abstract
- Den mobila vården behöver definieras nationellt och bli en egen organisationsform och vårdnivå, skriver företrädare från Centrum för interprofessionell samverkan inom akut vård.
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| 2. |
- Forsgärde, Elin-Sofie
(author)
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Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim was to describe and compare pathways for older patients and the involved actors’ experiences of decision-making in acute situations in ambulatory care.Methods: The overall three-fold design, comprising exploratory, descriptive as well as comparative ones, was conducted inductively, including a mixed method with a convergent integrated approach to empirical data. The four involved studies were analysed using either quantitative or qualitative analysis methods.Results: Most older patients’ pathways when being assessed by ambulance personnel involved receiving care at hospitals. However, an increasing trend of non-conveyance to hospitals was identified during a five-year period (2014–2018), which means receiving care, for example, at home or primary healthcare (PHC) centres. Decision-making about the level-of-care for older patients was more or less uncertain for all involved actors, i.e. older patients, significant others and healthcare professionals such as ambulance personnel, registered nurses, specialists in general practice at PHC centres and community health nurses. To increase the level of certainty in the decision-making process, all actors was supported by both an individual and external dialogue. Individual dialogue gave support by using own experience and knowledge. For ambulance personnel and community health nurses, support was also partially gained from decision support tools but was regarded as insufficient when older patients had non-specific symptoms. External dialogue provided support through mutuality, and via collaboration, a common goal, trust and responsibility. Mutuality gave support through experience and knowledge being shared with all involved actors, which provided a common comprehensive understanding that facilitated consensus in the decision-making.Conclusion: The increasing level of non-conveyance to hospitals and uncertainty during decision-making highlights the need to develop and extend the availability of dialogue-based collaborations as support in ambulatory care. Dialogue-based support involves all actors contributing to the decision-making. Healthcare professionals need to be aware of the prerequisites and the support that mutuality in external dialogues brings. Healthcare organisations need to develop and extend dialogue-based collaboration in ambulatory care by combining different expertise and providing conditions to increase support in decisions adapted to older patients' needs.
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| 3. |
- Forsgärde, Elin-Sofie, et al.
(author)
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Patients' aged ≥ 65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital : a longitudinal and comparative study
- 2020
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:11, s. 1-7
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Journal article (peer-reviewed)abstract
- Objectives Patients >= 65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged >= 65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients >= 65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season. Results The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. Conclusions The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients >= 65 years old.
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| 4. |
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| 5. |
- Forsgärde, Elin-Sofie, et al.
(author)
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Physicians’ experiences and actions in making complex level-of-care decisions during acute situations within older patients’ homes : a critical incident study
- 2023
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In: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians’ decision-making during acute situations in older patients’ homes is limited. Therefore, this study aimed to describe physicians’ experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes. Methods: Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included. Results: In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients’ and their significant others’ needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians’ actions involved searching for an understanding of older patients’ and their significant others’ wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved. Conclusion: Physicians strive to individualize complex level-of-care decisions based on older patients’ and their significant others’ wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 − 7 collaboration between organizations and health care professionals.
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| 6. |
- Forsgärde, Elin-Sofie, et al.
(author)
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Powerlessness : dissatisfied patients' and relatives' experiences of their emergency department visit
- 2016
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In: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 25:March 2016, s. 32-36
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Journal article (peer-reviewed)abstract
- AimThe aim of this study was to disclose the meaning of patients and relatives lived experience of dissatisfaction when visiting an emergency department.IntroductionEven though most patients are pleased with the emergency department care, there are areas that dissatisfy them, for example lack of communication and unoccupied wait time. However, there are few studies that describe both patients and relatives experience of dissatisfaction.MethodsThis explorative study uses a phenomenological hermeneutic approach where patients and relatives were interviewed.ResultsPatients and relatives meaning of dissatisfaction mainly contain powerlessness, struggling for control over the situation, lacking knowledge and information, receiving and providing support.ConclusionsThe results showed that the experiences of dissatisfaction were similar among patients and relatives. They suffer in the same way when being treated like objects during their visits. Nursing rounds are one way to decrease dissatisfaction by making patients and relatives participating in the care continually updated with information.
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| 7. |
- Forsgärde, Elin-Sofie, et al.
(author)
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Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study
- 2023
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In: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved.Methods: The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse.Results: Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence.Conclusions: The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.
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| 8. |
- Forsgärde, Elin-Sofie, et al.
(author)
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The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called
- 2021
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In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 16:8
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Journal article (peer-reviewed)abstract
- Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.
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| 9. |
- Herault, Romain Christian, et al.
(author)
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Design and Evaluation of a 360 Degrees Interactive Video System to Support Collaborative Training for Nursing Students in Patient Trauma Treatment
- 2018
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In: 26TH INTERNATIONAL CONFERENCE ON COMPUTERS IN EDUCATION (ICCE 2018). - : Asia-Pacific Society for Computers in Education. ; , s. 298-303
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Conference paper (peer-reviewed)abstract
- Extreme catastrophe situations are rare in Sweden, which makes training opportunities important to secure the competence among emergency personnel that should be actively involved during those situations. There is a need to conceptualize, design and implement interactive learning environments that allow to educate, train and assess these catastrophe situations more often and in different settings, conditions and places. In order to address these challenges, a prototype system has been designed and developed containing immersive interactive 360 degrees educational videos that are available via a web browser. The content of these videos includes simulated learning scenes of a trauma team working at the hospital emergency department. Different types of interaction mechanisms are integrated within the videos in which learners should act upon and respond. The prototype was tested during the fall term 2017 with 17 students from the specialist nursing program, and four medical experts. These activities were assessed in order to get new insights into issues related to the proposed approach and feedback connected to the usefulness, usability and learnability of the suggested prototype. The initial outcomes of the evaluation indicate that the system can provide students with novel interaction mechanisms to improve their skills and it can be applied as a complementary tool to the methods used currently in their education.
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| 10. |
- Herault, Romain Christian, et al.
(author)
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Using 360-degrees interactive videos inpatient trauma treatment education : design, development and evaluationaspects
- 2018
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In: Smart Learning Environments. - : Springer. - 2196-7091. ; 5
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Journal article (peer-reviewed)abstract
- Extremely catastrophic situations are rare in Sweden, which makes training opportunities important to ensure competence among emergency personnel who should be actively involved during such situations. There is a requirement to conceptualize, design, and implement an interactive learning environment that allows the education, training and assessment of these catastrophic situations more often, and in different environments, conditions and places. Therefore, to address these challenges, a prototype system has been designed and developed, containing immersive, interactive 360-degrees videos that are available via a web browser. The content of these videos includes situations such as simulated learning scenes of a trauma team working at the hospital emergency department. Various forms of interactive mechanisms are integrated within the videos, to which learners should respond and act upon. The prototype was tested during the fall term of 2017 with 17 students (working in groups), from a specialist nursing program, and four experts. The video recordings of these study sessions were analyzed and the outcomes are presented in this paper. Different group interaction patterns with the proposed tool were identified. Furthermore, new requirements for refining the 360-degrees interactive video, and the technical challenges associated with the production of this content, have been found during the study. The results of our evaluation indicate that the system can provide the students with novel interaction mechanisms, to improve their skills, and it can be used as a complementary tool for the teaching and learning methods currently used in their education process.
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