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Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel
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.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.ORCID iD: 0000-0003-0242-0343
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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.

Place, publisher, year, edition, pages
2023.
National Category
Nursing
Identifiers
URN: urn:nbn:se:mdh:diva-62178DOI: 10.1111/scs.13162ISI: 000947937400001PubMedID: 36908069Scopus ID: 2-s2.0-85150591793OAI: oai:DiVA.org:mdh-62178DiVA, id: diva2:1749033
Available from: 2023-04-05 Created: 2023-04-05 Last updated: 2024-01-09Bibliographically 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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