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Hjalmarsson, A., Östlund, G., Asp, M., Kerstis, B. & Holmberg, M. (2023). Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel
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2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Published
Abstract [en]

Background: Patient participation is considered to promote well-being and is, therefore, central in care contexts. Care-dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.Aim: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.Method: A phenomenological hermeneutical method was used to analyse transcripts of narrative interviews with 11 ambulance personnel.Results: The ambulance personnel's lived experience of older persons' participation includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that empowers participation. The main theme 'Balancing dignity in relation to manipulating the body' included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well-being and being guided by reactions. The main theme 'Balancing influence in relation to perceived health risks' included the themes Agreeing on a common perspective, Directing decision-making mandate, and Sharing responsibility for well-being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.Conclusion: Care-dependent older persons' participation in care from the perspective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balancing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve ambulance care to benefit older persons in critical life situations.

National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-62178 (URN)10.1111/scs.13162 (DOI)000947937400001 ()36908069 (PubMedID)2-s2.0-85150591793 (Scopus ID)
Available from: 2023-04-05 Created: 2023-04-05 Last updated: 2024-01-09Bibliographically approved
Hjalmarsson, A. (2023). Being provided with a safe haven: Care-dependent older persons' participation in prehospital emergency care. (Doctoral dissertation). Västerås: Mälardalens universitet
Open this publication in new window or tab >>Being provided with a safe haven: Care-dependent older persons' participation in prehospital emergency care
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Participation in care is a key concept in many welfare societies and serves to guide clinical practice and adapt care to personal preferences and needs in order to promote well-being and quality of life. Previous research has shown that practicing participation in care is complex due to the concept not being clearly defined. A significant risk is, therefore, that participation in care is practiced based on the professional caregivers' own definitions, which might be inconsistent with the cared-for persons' perceptions of what participation is.

Older persons can continue to live in their own homes with the support of municipal home care services that meet everyday care needs. Care-dependent older persons are known to have increased emergency care needs, which in Sweden require inter-organizational and inter-professional collaboration involving a care transfer between welfare levels. This thesis aimed to deepen the understanding of care-dependent older persons' participation in prehospital emergency care from lifeworld and welfare perspectives. The inductive design was based on a lifeworld approach and included triangulation of the phenomenon of participation in care using descriptive, interpretative, and comparative methods.

From the perspective of care-dependent older persons, participation in prehospital emergency care means a forced transfer of life responsibility to professional caregivers when being existentially unsafe and incapacitated due to acute illness. Through authorized representation, the professional caregivers act for the older person, with the power to bring about change and create opportunities for existence. Care-dependent older persons' participation in prehospital emergency care involves a deepened dependence that necessitates coexistence and being provided with a 'safe haven' through the entire emergency care chain. A 'safe haven' can be understood as an unconditional, calm, and sheltered interpersonal space for emotional rest that is provided to the older person during an existentially challenging situation. From the perspective of care-dependent older persons, the emergency care chain transcends organizational boundaries and includes mobile safety alarm services and emergency department attendance.

The involved professionals must be supported in practicing participation in care based on a comprehensive understanding of the concept, and emergency care options must be aligned with the care-dependent older persons' need for coordinated and continuous care. Collaborative challenges related to unstructured collaboration and professional hierarchy need to be addressed to support well-functioning collaboration in situations involving acutely ill older persons. The involved organizations need to recognize care-dependent older persons'  deepened dependence when acutely ill, as well as their extended view of the prehospital emergency care chain.

Place, publisher, year, edition, pages
Västerås: Mälardalens universitet, 2023
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 381
Keywords
Acute illness; Ambulance care; Collaborative care; Municipal home care; Older persons; Participation in care; Prehospital emergency care
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-62228 (URN)978-91-7485-593-7 (ISBN)
Public defence
2023-06-16, Gamma och digitalt via zoom, Mälardalens universitet, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2023-04-18 Created: 2023-04-17 Last updated: 2023-05-26Bibliographically approved
Hjalmarsson, A., Östlund, G., Asp, M., Kerstis, B. & Holmberg, M. (2023). Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services
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2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.

Aim: This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.

Design: This study has a qualitative design with a lifeworld approach.

Method: A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70–93 years.

Results: Care-dependent older persons' participation in prehospital emergency care means ‘Entrusting life to professional caregivers’ when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.

Conclusion: Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.

Implications for practice: Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

Place, publisher, year, edition, pages
John Wiley and Sons Inc, 2023
Keywords
ambulance services, home care services, mobile safety alarm, older persons, participation in care, phenomenological hermeneutical method, prehospital emergency care
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-64750 (URN)10.1111/scs.13223 (DOI)001095083000001 ()2-s2.0-85175615979 (Scopus ID)
Available from: 2023-11-15 Created: 2023-11-15 Last updated: 2024-01-24Bibliographically approved
Hjalmarsson, A., Östlund, G., Asp, M., Kerstis, B. & Holmberg, M. (2022). A matter of participation?: A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services. International Journal of Qualitative Studies on Health and Well-being, 17(1), Article ID 2082062.
Open this publication in new window or tab >>A matter of participation?: A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services
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2022 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 17, no 1, article id 2082062Article in journal (Refereed) Published
Abstract [en]

Purpose This study aimed at describing municipal care personnel's experiences of and actions in situations when older persons need emergency medical services (EMS) at home. Methods An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. Results Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. Conclusions Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons' health, and ability to influence care when emergency situations occur at home. Municipal care personnel's actions as the older person's representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Ambulance dispatch personnel, ambulance personnel, critical incident technique, emergency medical services, emergency situations, experiences, inter-organizational collaboration, municipal care personnel, municipal home care services, older persons
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-59402 (URN)10.1080/17482631.2022.2082062 (DOI)000811326800001 ()35703409 (PubMedID)2-s2.0-85132078328 (Scopus ID)
Available from: 2022-06-29 Created: 2022-06-29 Last updated: 2023-04-17Bibliographically approved
Hjalmarsson, A. (2022). Care-dependent older persons´ participation in Swedish prehospital emergency care- Reflections in view of an ongoing demographic change. In: Caring in a changing world: . Paper presented at The 4th International NCCS & EACS Conference, Mälardalen University, Sweden, April 27th – 28th 2022.
Open this publication in new window or tab >>Care-dependent older persons´ participation in Swedish prehospital emergency care- Reflections in view of an ongoing demographic change
2022 (English)In: Caring in a changing world, 2022Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background: Care-dependent older persons in Sweden are encouraged to remain living at home in assistance of municipal home care, making older persons´ homes a growing arena for emergency care. The home care organization does not provide emergency care, and therefore depend on regional emergency medical services (EMS). The involvement of two organizations accentuates the older persons´ participation in care, to promote health, well-being and safety. 

Aim: To elucidate older persons´ participation in care that involve municipal care personnel and emergency medical services. 

Method: Register data from the ambulance services were explored using descriptive and analytical statistics. Qualitative data were collected by individual interviewing adhering to critical incident technique and phenomenological hermeneutics.   

Results: Aspects of participation were disclosed in relation to welfare organizations and interpersonal relations. Quantitative results indicated that older adults were more likely to receive lower priority levels compared with the adult population in emergencies involving ambulance response. Qualitative results displayed how municipal care personnel were subjected to the attitude and priority assessment of the EMS, affecting their ability to provide adequate care. The welfare organizations involved were not adapted to the complex needs of care-dependent older persons, and consequently the older persons were hindered to access and partake in societal welfare on equal terms. Municipal care personnel acted as the older persons´ representatives in emergencies, enabling active participation in care.

Conclusion and implications: Lack of organizational flexibility and inter-professional collaboration negatively affect older persons´ ability to influence care. To ensure safe and adequate care alternatives aligned to the needs of older persons living in dependence at home, welfare organizations need to acknowledge emergencies as a natural part of older persons´ lives and adapt services accordingly. The EMS need to consider the older persons´ whole life situation in care assessments, and respect the perspectives of care personnel involved.

National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-58141 (URN)
Conference
The 4th International NCCS & EACS Conference, Mälardalen University, Sweden, April 27th – 28th 2022
Available from: 2022-05-02 Created: 2022-05-02 Last updated: 2023-02-23Bibliographically approved
Hjalmarsson, A., Asp, M., Östlund, G. & Holmberg, M. (2021). When older persons need Emergency Medical Services at home: a critical incident study on Swedish municipal care personnel. In: : . Paper presented at Thinking qualitatively Virtual Conference, Online, 5-9 July 2021 (pp. 92-93). , 20
Open this publication in new window or tab >>When older persons need Emergency Medical Services at home: a critical incident study on Swedish municipal care personnel
2021 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Older persons in Sweden can continue to live at home, assisted by the municipal home care services. Older age raises the risk of emergency situations that require involvement of the emergency medical services (EMS). Such situations intersect two different organizations, the municipal social care services and the regional EMS. The transfer of care between the organizations might impact the older persons´ health, and quality of life or death. Research question: How do municipal care personnel describe their experiences of and actions in situations when older persons are in need of EMS? Design: The study has a qualitative inductive design. Sample: Municipal care personnel (n=19) consisting of home care personnel and security alarm responders. Data collection and analysis: Data was collected through group interviews and free text written critical incidents analyzed according to critical incident technique. Results: Experiences related to the two main areas Lifesaving competence, and Collaborative care, which encompass the four categories Emergency knowledge, Companionship in a vulnerability, Limited caring options and Conditions for EMS collaboration. Actions related to the one main area Adjusting actions to actual conditions, which encompasses the three categories Adapting care to emergency needs, Safeguarding the person, and Adapting actions to EMS leadership.

Keywords
care personnel, EMS, municipal home care, older persons
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-56143 (URN)000726772800252 ()
Conference
Thinking qualitatively Virtual Conference, Online, 5-9 July 2021
Available from: 2021-10-12 Created: 2021-10-12 Last updated: 2023-02-23Bibliographically approved
Hjalmarsson, A., Holmberg, M., Asp, M., Nilsson, K. W., Östlund, G. & Kerstis, B. (2020). Characteristic Patterns of Emergency Ambulance Assignments for Older Adults Compared with Adults Requiring Emergency Care at Home in Sweden: A Total Population Study. BMC Emergency Medicine, 20, Article ID 94.
Open this publication in new window or tab >>Characteristic Patterns of Emergency Ambulance Assignments for Older Adults Compared with Adults Requiring Emergency Care at Home in Sweden: A Total Population Study
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2020 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 20, article id 94Article in journal (Refereed) Published
Abstract [en]

Background: Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18–69 years requiring emergency care at home in Sweden. Methods: A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns. Results: Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00–11:59 interval (p < 0.001, χ2 = 1224.08). Conclusion: The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice. 

National Category
Medical and Health Sciences Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-53279 (URN)10.1186/s12873-020-00387-y (DOI)000595911100001 ()33267796 (PubMedID)2-s2.0-85096964129 (Scopus ID)
Available from: 2021-01-31 Created: 2021-01-31 Last updated: 2023-04-17Bibliographically approved
Hjalmarsson, A., Östlund, G., Asp, M., Kerstis, B. & Holmberg, M.Entrusting life to professionals: Older persons’ lived experience of participation in prehospital emergency care involving municipal home care and ambulance services..
Open this publication in new window or tab >>Entrusting life to professionals: Older persons’ lived experience of participation in prehospital emergency care involving municipal home care and ambulance services.
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(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-62231 (URN)
Available from: 2023-04-17 Created: 2023-04-17 Last updated: 2023-04-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5758-7610

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