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  • 1.
    Andersson, Henrik
    et al.
    University of Borås, Sweden.
    Ullgren, Andreas
    University of Borås, Sweden.
    Holmberg, Mats
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. University of Borås, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care.2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 43-47Article in journal (Refereed)
    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.

  • 2.
    Barrientos, Christian
    et al.
    Norrtälje Hospital, Sweden.
    Holmberg, Mats
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Sörmland County Council, Eskilstuna, Sweden.
    The care of patients assessed as not in need of emergency ambulance care: registered nurses' lived experiences2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 38, p. 10-14Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe the care of patients assessed as not in need of emergency ambulance care, from Registered Nurse's lived experiences. Background: Non-emergency patients in need of ambulance care are described as vulnerable and patients in ambulance care have earlier been found to be dependent on the Registered Nurse. However, little is known about the care of non-emergency patients in the ambulance setting, from the perspective of Registered Nurses. Methods: A reflective lifeworld research design was chosen. Five Registered Nurses with experience of ambulance care were individually interviewed. Results: The result reveals the essence of the phenomenon as a desire to provide good care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged in the description; Being in a struggle between different expectations, Being in a questioned professional role, and Being in lack of support and formal directives. Conclusion: Registered Nurses' care for patients assessed as not in need of emergency ambulance care, is a complex struggle between different expectations. This may be related to the encounter between the nurse's and the patient's lifeworld.

  • 3.
    Holmberg, Mats
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Being secure in insecurity: Aspects of caring in the ambulance service2015Doctoral thesis, comprehensive summary (Other academic)
  • 4.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Den prehospitala vårdkedjan: Överlämnande till nästa vårdenhet2016In: Prehospital akutsjukvård / [ed] Suserud, Björn-Ove och Lundberg, Lars, Stockholm: Liber, 2016, 2, p. 172-175Chapter in book (Other academic)
  • 5.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Vårdprogram i den prehospitala miljön: Medvetande, Stroke, Vårdvetenskaplig analys2016In: Prehospital akutsjukvård / [ed] Suserud, Björn-Ove och Lundberg, Lars, Stockholm: Liber, 2016, 2, p. 377-379Chapter in book (Other academic)
  • 6.
    Holmberg, Mats
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Andersson, Henrik
    PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Winge, Karin
    Ambulance Department, South Älvsborgs Hospital, Borås, Sweden.
    Lundberg, Camilla
    PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Herlitz, Johan
    PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Wireklint Sundström, Birgitta
    PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome2018In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, no 216Article in journal (Refereed)
    Abstract [en]

    Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain 4 on the visual analogue scale. Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.

  • 7.
    Holmberg, Mats
    et al.
    Sömlands County Council, Ambulance Service Department.
    Fagerberg, Ingegerd
    Ersta Sköndal Högskola, Institutionen för vårdvetenskap.
    The encounter with the unknown: Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being.

  • 8.
    Holmberg, Mats
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Fagerberg, Ingegerd
    Wahlberg, Anna Carin
    Knowledge desired by EMS-managers of their ambulance clinicians2018Conference paper (Refereed)
  • 9.
    Holmberg, Mats
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Fagerberg, Ingegerd
    Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Stockholm, Sweden.
    The knowledge desired by emergency medical service managers of their ambulance clinicians - A modified Delphi study2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 34, p. 23-28Article in journal (Refereed)
    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.

  • 10.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Sweden.
    Forslund, Kerstin
    Örebro Universitet, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Sweden.
    Fagerberg, Ingegerd
    Ersta Sköndal Högskola, Sweden.
    The relationship with the ambulance clinicians as experienced by significant others2016In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. e1-e8Article in journal (Refereed)
    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.

  • 11.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society.
    Forslund, Kerstin
    Örebro Universitet, Institutionen för hälsovetenskaper och medicin.
    Wahlberg, Anna Carin
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society.
    Fagerberg, Ingegerd
    Ersta Sköndal Högskola, Institutionen för vårdvetenskap.
    To surrender in dependence of another: The relationship with the ambulance clinicians as experienced by patients.2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 544-551Article in journal (Refereed)
    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.

  • 12.
    Holmberg, Mats
    et al.
    Högskolan i Borås, Sweden.
    Rantala, Andreas
    Bremer, Anders
    Högskolan i Borås, Sweden.
    Patient participation: A challenge within contemporary ambulance care?2016Conference paper (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? 

  • 13.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Sweden.
    Fagerberg, Ingegerd
    Ersta Sköndal Högskola, Sweden.
    Forslund, Kerstin
    Örebro Universitet, Sweden.
    Ambulance clinicians' experiences of relationships with patients and significant others2016In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. e16-e23Article in journal (Refereed)
    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.

  • 14.
    Wireklint-Sundström, Birgitta
    et al.
    Högskolan i Borås, Sweden.
    Holmberg, Mats
    Högskolan i Borås, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Sweden.
    Karlsson, Thomas
    Göteborgs Universitet, Sweden.
    Andersson, Henrik
    Högskolan i Borås, Sweden.
    Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1, article id 52Article in journal (Refereed)
    Abstract [en]

    Background:Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses' (ANs') prehospital care of patients experiencing suspected ACS, related to pain intensity.

    METHODS: 

    This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.

    RESULTS: 

    The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.

    CONCLUSIONS: 

    An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.

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