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Being provided with a safe haven: Care-dependent older persons' participation in prehospital emergency care
Mälardalen University, School of Health, Care and Social Welfare. (CAREH)ORCID iD: 0000-0002-5758-7610
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 [en]
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: urn:nbn:se:mdh:diva-62228ISBN: 978-91-7485-593-7 (print)OAI: oai:DiVA.org:mdh-62228DiVA, id: diva2:1751097
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
List of papers
1. Characteristic Patterns of Emergency Ambulance Assignments for Older Adults Compared with Adults Requiring Emergency Care at Home in Sweden: A Total Population Study
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
2. 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
3. A matter of participation?: A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services
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
4. Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel
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

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