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Holmberg, Mats, Med.Dr.ORCID iD iconorcid.org/0000-0003-1878-0992
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Publications (10 of 11) Show all publications
Svensson, C., Bremer, A. & Holmberg, M. (2019). Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: A qualitative exploration. Clinical Ethics, 14(2), 70-79
Open this publication in new window or tab >>Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: A qualitative exploration
2019 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 14, no 2, p. 70-79Article in journal (Refereed) Published
Abstract [en]

Background: The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations. Aim: The aim of the study was to explore ambulance nurses’ experiences of relationships with patients in urgent and emergency situations. Methods: Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis. Results: Relationships with patients during urgent and emergency assignments emerged as three themes: “Ambiguous silence,” “Professional competence” and “Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship. Conclusions: Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important. Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses.

Place, publisher, year, edition, pages
SAGE Publications Ltd, 2019
Keywords
Clinical ethics, emergency medical services, nursing values, patient relationships, professional ethics in nursing, qualitative interviews
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-46544 (URN)10.1177/1477750919851050 (DOI)2-s2.0-85067664953 (Scopus ID)
Available from: 2019-12-17 Created: 2019-12-17 Last updated: 2020-01-30Bibliographically approved
Andersson, H., Ullgren, A., Holmberg, M., Karlsson, T., Herlitz, J. & Wireklint Sundström, B. (2017). Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care.. International Emergency Nursing, 33, 43-47
Open this publication in new window or tab >>Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care.
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2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 43-47Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-35985 (URN)10.1016/j.ienj.2016.12.001 (DOI)000407530200008 ()28438478 (PubMedID)2-s2.0-85018660866 (Scopus ID)
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-01-30Bibliographically approved
Holmberg, M., Fagerberg, I. & Wahlberg, A. C. (2017). The knowledge desired by emergency medical service managers of their ambulance clinicians - A modified Delphi study. International Emergency Nursing, 34, 23-28
Open this publication in new window or tab >>The knowledge desired by emergency medical service managers of their ambulance clinicians - A modified Delphi study
2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 34, p. 23-28Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians.

BACKGROUND: Emergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers' approach to this knowledge.

DESIGN: A modified Delphi method in three rounds.

METHODS: In total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round.

RESULTS: Five categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category 'Knowledge to assess the patient's situation from a holistic perspective' was the highest ranked, followed by 'Medical knowledge to assess and care for different diseases' and 'Knowledge to be able to care for critically ill patients'.

CONCLUSIONS: Taken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge.

Keywords
Ambulance care, Ambulance clinician, Delphi technique, Emergency medical services, Emergency nursing, Holistic nursing, Knowledge, Managers, Paramedic
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-35983 (URN)10.1016/j.ienj.2017.03.007 (DOI)000417589600006 ()28545930 (PubMedID)2-s2.0-85019608404 (Scopus ID)
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-01-30Bibliographically approved
Holmberg, M., Wahlberg, A. C., Fagerberg, I. & Forslund, K. (2016). Ambulance clinicians' experiences of relationships with patients and significant others. Nursing in Critical Care, 21(4), e16-e23
Open this publication in new window or tab >>Ambulance clinicians' experiences of relationships with patients and significant others
2016 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. e16-e23Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Ambulance clinicians (ACs) have to provide advanced care and treatment to patients in a challenging and emotionally demanding environment, therefore they establish interpersonal relationships embracing both patients and significant others. Relationships in emergency care were earlier found to be short-lived and lacking a holistic understanding of the patient. In their relationship with the ambulance clinicians, it is for patients to surrender and become dependent, which may be interpreted as both a negative and a positive experience.

AIM: The aim of this study was to elucidate ambulance clinicians' experiences of relationships with patients and significant others.

METHODS: Data were collected from four focus group conversations, with a total of 18 participating ambulance clinicians. An inductive qualitative content analysis method was chosen.

FINDINGS: The analysis resulted in one main category: 'To be personal in a professional role' and three generic categories: 'To be there for the affected person', 'To be personally involved' and 'To have a professional mission'. There were subsequently nine sub-categories. The main category was described as intertwining the experience of being both personal and professional. The ambulance clinicians adapt to a situation while having the affected person in focus. They involve themselves as persons but at the same time use the power of their professional role.

CONCLUSION: The relationship with patients and significant others from the ambulance clinicians' perspective can be understood as embracing both personal and professional aspects.

RELEVANCE TO CLINICAL PRACTICE: This study provides an understanding of the ambulance clinicians' professional role as embracing a personal perspective, which is important when developing an emergency ambulance service focusing on care that involves more than just emergency medical treatment.

Keywords
Ambulance care, Ambulance clinicians, Focus groups, Nursing, Professional relationship
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-32607 (URN)10.1111/nicc.12196 (DOI)26184114 (PubMedID)2-s2.0-84975144056 (Scopus ID)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2020-01-30Bibliographically approved
Holmberg, M. (2016). Den prehospitala vårdkedjan: Överlämnande till nästa vårdenhet (2ed.). In: Suserud, Björn-Ove och Lundberg, Lars (Ed.), Prehospital akutsjukvård: (pp. 172-175). Stockholm: Liber
Open this publication in new window or tab >>Den prehospitala vårdkedjan: Överlämnande till nästa vårdenhet
2016 (Swedish)In: Prehospital akutsjukvård / [ed] Suserud, Björn-Ove och Lundberg, Lars, Stockholm: Liber, 2016, 2, p. 172-175Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2016 Edition: 2
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:mdh:diva-32610 (URN)978-91-47-11474-0 (ISBN)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2020-01-30Bibliographically approved
Holmberg, M., Rantala, A. & Bremer, A. (2016). Patient participation: A challenge within contemporary ambulance care?. In: : . Paper presented at The 7th PreHospen Conference in Prehospital Emergency Care at the University of Borås, 10th-11th March.
Open this publication in new window or tab >>Patient participation: A challenge within contemporary ambulance care?
2016 (Swedish)Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background

Patient participation should be understood in relation to vulnerability, power and responsibility. Patients in ambulance care have urgent care needs and are vulnerable in an asymmetrical relationship with the clinicians. This places great responsibility on the clinicians to use their power for the benefit of the patient. An invitation to participate requires an informed consent and depends on the patient’s willingness and ability to participate. Hence, as- sessment of the patient’s decision-making ability is central together with a caring approach to enhance trust and confidence. Undoubtedly, patient partici- pation is a challenge within contemporary ambu- lance care – where failure is likely to cause suffering.

Methods

Patient participation in ambulance care is discussed from philosophical, patient and person-centred perspectives in relation to empirical research of Bremer et al. (2012), Holmberg et al. (2014; 2015) and Rantala et al. (2015). 

Results

Patients are comfortable in their surrender to ambulance clinicians, obeying commands and being important while involved in the care. However, pa- tients are powerless when they experience ambulan- ce clinicians’ care as excessive, having a strong desire of being acknowledged in their suffering. This can be achieved by seeing the patient as capable and in- volve the patient and significant others in the deci- sion-making. In addition ambulance clinicians have an ambition to be pliable to the patient’s wishes, inviting the patient in a shared decision-making.

Conclusions

Patient participation in ambulance care can be understood as important for the patient’s wellbeing. However, unequal distribution of power within the ambulance clinician-patient relationship may challenge patient autonomy and interests. Is it pos- sible to achieve genuine patient participation in the context of ambulance care? 

Keywords
Patient participation, ambulance care, vulnerability, power, responsibility
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:mdh:diva-32613 (URN)
Conference
The 7th PreHospen Conference in Prehospital Emergency Care at the University of Borås, 10th-11th March
Available from: 2016-03-20 Created: 2016-08-23 Last updated: 2020-01-30Bibliographically approved
Holmberg, M., Forslund, K., Wahlberg, A. C. & Fagerberg, I. (2016). The relationship with the ambulance clinicians as experienced by significant others. Nursing in Critical Care, 21(4), e1-e8
Open this publication in new window or tab >>The relationship with the ambulance clinicians as experienced by significant others
2016 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. e1-e8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Interpersonal relationships between clinicians and patients are important aspects of the ambulance care, requiring a balance between objectified acute medical treatment and a holistic care. Being a significant other (SO) in the ambulance care setting is described as being caught between hope and dread. Little research has focused on SOs' experiences of the relationship with the ambulance clinicians.

AIM: To elucidate meanings of the relationship with the clinicians in the ambulance care setting as experienced by the patients' SOs.

DESIGN: Qualitative lifeworld design.

METHODS: Data was collected using open-ended interviews with nine SOs. The verbatim transcribed interviews were analysed with a phenomenological hermeneutic method.

FINDINGS: The structural analysis resulted in one main theme: 'Being lonely together'. The main theme comprises three themes: 'Being in a shared struggle', 'To hand over the affected person in trust' and 'Being the second person in focus' and six subthemes. The main theme is for the SOs to share the struggles of the affected person with the ambulance clinicians and to be comforted while handing over the responsibility for the affected person. Hence the SO is excluded and lonely and on his/her own, while not the primary focus of the ambulance clinicians.

CONCLUSIONS: The relationship with the ambulance clinicians from the perspective of the SOs can be understood as complex, involving both being lonely and together at the same time. The findings support a holistic approach towards the ambulance care involving SOs.

RELEVANCE FOR CLINICAL PRACTICE: This study outlines the importance of an emergency ambulance care involving SOs as affected persons and supports a balance between emergency medical treatment to the patient and a holistic care, involving the SOs' suffering.

Keywords
Ambulance care, Nursing, Phenomenological hermeneutic, Professional relationship, Significant others
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-32606 (URN)10.1111/nicc.12144 (DOI)25571767 (PubMedID)2-s2.0-84923086509 (Scopus ID)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2020-01-30Bibliographically approved
Holmberg, M. (2016). Vårdprogram i den prehospitala miljön: Medvetande, Stroke, Vårdvetenskaplig analys (2ed.). In: Suserud, Björn-Ove och Lundberg, Lars (Ed.), Prehospital akutsjukvård: (pp. 377-379). Stockholm: Liber
Open this publication in new window or tab >>Vårdprogram i den prehospitala miljön: Medvetande, Stroke, Vårdvetenskaplig analys
2016 (Swedish)In: Prehospital akutsjukvård / [ed] Suserud, Björn-Ove och Lundberg, Lars, Stockholm: Liber, 2016, 2, p. 377-379Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2016 Edition: 2
National Category
Other Medical Sciences Nursing
Identifiers
urn:nbn:se:mdh:diva-32611 (URN)978-91-47-11474-0 (ISBN)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2020-01-30Bibliographically approved
Holmberg, M. (2015). Being secure in insecurity: Aspects of caring in the ambulance service. (Doctoral dissertation). Stockholm: Karolinska Institutet
Open this publication in new window or tab >>Being secure in insecurity: Aspects of caring in the ambulance service
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. p. 56
Keywords
caring science, professional relationships, qualitative methods, prehospital emergency care, ambulance
National Category
Health Sciences Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-32608 (URN)978-91-7676-071-0 (ISBN)
Public defence
2015-12-11, Hörsal H2 Grön, Alfred Nobels Allé 23, Huddinge, 10:00 (Swedish)
Opponent
Supervisors
Note

Med.Dr examen

Available from: 2016-08-23 Created: 2016-08-22 Last updated: 2020-01-30Bibliographically approved
Holmberg, M., Forslund, K., Wahlberg, A. C. & Fagerberg, I. (2014). To surrender in dependence of another: The relationship with the ambulance clinicians as experienced by patients.. Scandinavian Journal of Caring Sciences, 28(3), 544-551
Open this publication in new window or tab >>To surrender in dependence of another: The relationship with the ambulance clinicians as experienced by patients.
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 544-551Article in journal (Refereed) Published
Abstract [en]

Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care.

Keywords
ambulance care, caring science, patients, phenomenological hermeneutic method, prehospital emergency care, professional patient relationship
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-32605 (URN)10.1111/scs.12079 (DOI)24067194 (PubMedID)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2020-01-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1878-0992

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