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A matter of participation?: A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (CAREH)ORCID iD: 0000-0002-5758-7610
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (SAMPRODUKTION)ORCID iD: 0000-0002-3068-5384
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-3307-6779
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (CHIP)ORCID iD: 0000-0003-0242-0343
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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. Vol. 17, no 1, article id 2082062
Keywords [en]
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: urn:nbn:se:mdh:diva-59402DOI: 10.1080/17482631.2022.2082062ISI: 000811326800001PubMedID: 35703409Scopus ID: 2-s2.0-85132078328OAI: oai:DiVA.org:mdh-59402DiVA, id: diva2:1678551
Available from: 2022-06-29 Created: 2022-06-29 Last updated: 2023-04-17Bibliographically approved
In thesis
1. Being provided with a safe haven: Care-dependent older persons' participation in prehospital emergency care
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

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Hjalmarsson, AnnaÖstlund, GunnelAsp, MargaretaKerstis, BirgittaHolmberg, Mats

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