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  • 1.
    Andersson, Henrik
    et al.
    University of Borås, Sweden.
    Carlsson, Jonas
    Karolinska University Hospital, Functional Area of Emergency Medicine Huddinge, Sweden.
    Karlsson, Lene
    Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden.
    Holmberg, Mats
    Linnaeus University, Växjö, Sweden.
    Competency requirements for the assessment of patients with mental illness in somatic emergency care: A modified Delphi study from the nurses’ perspective2020Inngår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 40, nr 3, s. 162-170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients suffering from mental illness are vulnerable, and they do not always have access to proper emergency care. The aim of this study was to identify competency requirements for the assessment of patients with mental illness by soliciting the views of emergency care nurses. A modified Delphi method comprising four rounds was used. Data were collected in Sweden between October 2018 and March 2019. The data were analyzed using content analysis and descriptive statistics. The panel of experts reached the highest level of consensus regarding basic medical knowledge: the capability to listen and show respect to the patient are essential competency requirements when assessing patients with mental illness in emergency care. Awareness of these competency requirements will enhance teaching and training of emergency care nurses.

  • 2.
    Andersson, Henrik
    et al.
    University of Borås, Sweden.
    Ullgren, Andreas
    University of Borås, Sweden.
    Holmberg, Mats
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. 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.2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, s. 43-47Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3. Barrientos, Christian
    et al.
    Holmberg, Mats
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    The care of patients assessed as not in need of emergency ambulance care: the perspective of registered nurses2019Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Non-emergency patients are described as vulnerable and in need of being taken seriously in the ambulance care. Ambulance care has a natural and obvious focus onemergency medical care. Research has found patients as being dependent of the RegisteredNurse (RN) in the ambulance care. This is experienced as putting the life into the hands of the RN. RNs in the ambulance care encounter those patients on daily basis, and there is a need ofdeepened knowledge based on their experiences.

    Aim: The aim was to describe the care of patients assessed as not in need of emergencyambulance care, from RNs' lived experiences.

    Methods: The study had a qualitative design. A reflective lifeworld research method was usedand five RNs in the ambulance service were individually interviewed.

    Results:The general structure of the phenomenon is described in the essence together with thedescription of the meaning constituents.The essence of the phenomenon is a desire to providegood care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged; 'Being in a struggle between different expectations', 'Being in aquestioned professional role', and 'Being in lack of support and formal directives'.

    Conclusion: RNs' care for patients assessed as not in need of emergency ambulance care, is alonely struggle between different expectations and related to the encounter between thepatient's and the RN's lifeworld. This study calls for developing care-strategies and interventionsin order strengthen and support RNs in this care.

  • 4.
    Bratt, A S
    et al.
    Linnaeus Univ, Fac Hlth & Life Sci, Dept Psychol, S-35195 Vaxjo, Sweden.
    Johansson, M
    Linnaeus Univ, Fac Hlth & Life Sci, Dept Psychol, S-35195 Vaxjo, Sweden.
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Linnaeus Univ, Fac Hlth & Life Sci, Dept Hlth & Caring Sci, Vaxjo, Sweden; Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.
    Fagerstrom, C
    Linnaeus Univ, Fac Hlth & Life Sci, Dept Hlth & Caring Sci, Vaxjo, Sweden.
    Elmqvist, C
    Linnaeus Univ, Fac Hlth & Life Sci, Dept Hlth & Caring Sci, Vaxjo, Sweden.
    Rusner, M
    Sodra Alvsborg Hosp, Dept Res Educ & Innovat, Boras, Region Vastra G, Sweden.
    Kaldo, V
    Linnaeus Univ, Fac Hlth & Life Sci, Dept Psychol, S-35195 Vaxjo, Sweden.
    An internet-based compassion course for healthcare professionals: Rationale and protocol for a randomised controlled trial2022Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 28Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research has shown that compassion interventions for healthcare professionals can decrease work-related stress through the introduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations. Internet-based stress management interventions have hitherto shown promising results in reducing stress. However, further research is needed to examine the effectiveness of internet-based compassion interventions for healthcare professionals. Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effects of an internet-based compassion course for healthcare professionals on work-related stress and stress of conscience. Method: Healthcare professionals will be offered an internet-based stress management course of five modules across a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled in one of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n = 120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stress management course (n = 36). We hypothesise that the internet-based compassion course would reduce the participants' stress of conscience to a greater degree compared to the other two groups. The secondary hypothesis is that the compassion course would increase the participants' professional quality of life (i.e., higher job satisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion course is expected to reduce the participants' work-related stress and sick leave rates to the same degree (non-inferiority) as the cognitive behavioural stress management course and to a higher degree when compared to the waitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondary outcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related Stress Copenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will be performed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10 weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimating equation for repeated measurements to examine whether changes over time differ between the groups and whether the improvements persist over time. Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and add to the existing knowledge of internet-based interventions for stress management in healthcare professionals.

  • 5.
    Bremer, Anders
    et al.
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Holmberg, Mats
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Ambulance nurse students’ experiences of ethical problems in patient-relationships2019Inngår i: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Ambulance nurse education in Sweden is a one-year master’s degree program for registered nurses leading to a postgraduate diploma in specialist nursing. Ambulance nurses face unpredictable and ethically challenging situations with multi-dimensional suffering, requiring the ability to provide medical care and simultaneously creating a trustful relationship. Students undergoing their specialist education face the same challenges. 

    Aim: The aim was to describe ambulance nurse students’ (ANS) experiences of ethical problems in patient relationships during clinical studies. 

    Method: Written exams (n=69) in ANS’ clinical placements studies were collected between 2014-2016 in three courses. In the exam the ANS were asked to describe and problematize a self-experienced ethical problem in the care relationship with a specific patient. The thematic analysis commenced with being familiarized with the text as a whole before condensation and coding. The exams were read and re-read several times. After coding followed further analysis, re-analysis and validation in several linear and circular steps to finally compile sub-themes and themes. 

    Results: Ethical problems emerged as six themes; 1) Insecurity in considering patient autonomy, 2) Conflicting assessments of the patients best, 3) Inadequate access to patient narratives, 4) Absence of trustful relationships, 5) Disturbance of patient focus and 6) Limited possibility to provide proper care. 

    Conclusions and implications: The result emphasizes ethical problem within patient-relationships in the ambulance care as multifaceted and strongly connected to patient’s autonomy. Outgoing from the results an intervention project regarding older patients’ autonomy in ambulance care started in January 2019.

  • 6.
    Bremer, Anders
    et al.
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Holmberg, Mats
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Ethical conflicts in patient relationships: experiences of ambulance nursing students2020Inngår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 27, nr 4, s. 946-959Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts.

    Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies.

    Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses.

    Participants: The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university.

    Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study.

    Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care.

    Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation.

    Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.

  • 7.
    Carnesten, Hillewi
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Asp, Margareta
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Region of Sörmland, Eskilstuna, Sweden; Uppsala University, Sweden.
    Caring approach for patients with chest pain–Swedish registered nurses’ lived experiences in Emergency Medical Services2021Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, nr 1, artikkel-id 1901449Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Purpose: Encountering patients with chest pain iscommon for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care. From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective. The aim of this study is to describe the caring approach when RNs encounter patients with chest pain. Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden. Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust. Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team. Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives. 

  • 8.
    Hammarbäck, Staffan
    et al.
    Linnaeus University, Sweden; Region Sörmland, Sweden; Uppsala University, Sweden.
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden; Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Wiklund, Lena
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Health and Care Sciences, UiT/The Arctic University of Norway, Norway.
    Bremer, Anders
    Linneaus University, Sweden.
    Ambulance clinicians’ responsibility when encountering patients in a suicidal process2023Inngår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process. Aim: The aim of this study was to describe ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. Research design: A qualitative inductive design using a phenomenographic approach was used. Participants and research context: Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed. Ethical considerations: The study was approved by the Swedish Ethical Review Authority. Findings: Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient’s mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient’s life story. Conclusions: An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.

  • 9.
    Hjalmarsson, Anna
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd.
    Asp, Margareta
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    When older persons need Emergency Medical Services at home: a critical incident study on Swedish municipal care personnel2021Konferansepaper (Annet vitenskapelig)
    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.

  • 10.
    Hjalmarsson, Anna
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Asp, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Kerstis, Birgitta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Linneaus Univ, Fac Hlth & Life Sci, Växjö, Sweden.;Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.;Region Sormland, Dept Ambulance Serv, Eskilstuna, Sweden..
    A matter of participation?: A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services2022Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 17, nr 1, artikkel-id 2082062Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 11.
    Hjalmarsson, Anna
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Asp, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Kerstis, Birgitta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Ambulance Services, Region Sörmland, Katrineholm, Sweden.
    Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel2023Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Hjalmarsson, Anna
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Asp, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Kerstis, Birgitta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Faculty of Health and Life Sciences Linnaeus University, Växjö, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Ambulance Services, Region Sörmland, Katrineholm, Sweden.
    Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services2023Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 13.
    Hjalmarsson, Anna
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Asp, Margareta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Kerstis, Birgitta
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Entrusting life to professionals: Older persons’ lived experience of participation in prehospital emergency care involving municipal home care and ambulance services.Manuskript (preprint) (Annet vitenskapelig)
  • 14.
    Holmberg, Mats
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Being secure in insecurity: Aspects of caring in the ambulance service2015Doktoravhandling, med artikler (Annet vitenskapelig)
  • 15.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Den prehospitala vårdkedjan: Överlämnande till nästa vårdenhet2016Inngår i: Prehospital akutsjukvård / [ed] Suserud, Björn-Ove och Lundberg, Lars, Stockholm: Liber, 2016, 2, s. 172-175Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 16.
    Holmberg, Mats
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hur vårdar man en trasig själ?2018Inngår i: Samverkan 112, ISSN 1650-7487, nr 5-6, s. 8-8Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 17. Holmberg, Mats
    Möt din medmänniska2009Inngår i: Omvårdnadsmagasinet, ISSN 1652-0858, nr 5, s. 39-39Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 18.
    Holmberg, Mats
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Patientens perspektiv på ambulanssjukvård - vad behöver vi veta?2019Inngår i: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019, 2019Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Ambulance clinicians encounter different kinds of illness/injury in all different ages and life-situations, requiring their ability to provide a multidimensional care. Being in need of ambulance care is to be vulnerable and exposed in a dramatic life-event, and refers to an existential suffering. The care of this suffering is often described as being based on common sense diminishing the advanced, complex and professional competence this requires. This is not exclusively rooted in a biomedical perspective on the patient’s illness, but in an understanding of an existential wellbeing. Those two perspectives have to be equal in a contemporary ambulance care. The starting point for this has to be the patient’s subjective experience of his/her illness/injury. To develop this the French philosopher Paul Ricoeur’s theory about explanationand understandingis used. Ricoeur suggests a dialectic differentiation between those concepts, giving them an intimate relationship. Explanationcorresponds to the structural study of an object as a reality in itself, such as a biomedical explanation of the patient’s illness. Understandingon the other hand is to interpret an object as a part of a greater reality and generated by a subjective interpretation, such as understanding the illness from the perspective of the patient’s unique experience. Those concepts have to be intertwined and given equal priority in the ambulance care. Thus, the ambulance clinicians have to both understand and explain the patient and his/her situation, in order to properly assess and provide care based on the patient’s perspective. 

  • 19.
    Holmberg, Mats
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    The EXPAND-model: a hermeneutical application of a lifeworld-led prehospital emergency care2019Inngår i: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Prehospital emergency care means to respond to patients’ life-threatening and critical medical conditions out of hospitals. Patients experience this as an existential suffering together with a physical suffering. Thus a need of combining the medical care and treatment with a caring science perspective in order to provide a lifeworld-led care is stated. 

    Aim: The aim was to develop a model for application of a lifeworld-led prehospital emergency care. 

    Method: The model was developed using Paul Ricoeur’s hermeneutical philosophy, bringing together the concepts explanation (EXP) and understanding (AND)

    Results: The EXPAND-model comprises the three phases; 1) primary understanding, 2) structural explanation and 3) secondary understanding that together integrate medical care with a lifeworld perspective on the patient’s illness/injury. The primary understanding refers to the intuition and first impression of the patient as a person and his/her multifaceted needs, adapting to the patient and his/her surroundings. The structural explanation belongs to the emergency medical assessment and care using different structural systems. This aims to quickly identify and provide care for life-threating conditions. In the secondary understanding the primary understanding and the structural assessment are brought together into a whole, creating a comprehensive understanding of the patient’s lifeworld as intertwined with his/her illness/injury. 

    Conclusion and implications: In the EXPAND-model the three phases cooperate in order to expand the assessment and care of the patient, based on a lifeworld perspective. The implication of this is two folded. Firstly, this is of importance in order to develop a lifeworld-led prehospital emergency care, which goes beyond fixed medical diagnosis. Secondly, the model may structure the training of professionals to unfold the uniqueness of a person’s experience of illness/injury in relation to a complex world and the existential aspects of being human.

  • 20.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Vårdprogram i den prehospitala miljön: Medvetande, Stroke, Vårdvetenskaplig analys2016Inngår i: Prehospital akutsjukvård / [ed] Suserud, Björn-Ove och Lundberg, Lars, Stockholm: Liber, 2016, 2, s. 377-379Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 21.
    Holmberg, Mats
    et al.
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Bremer, Anders
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Ambulance nurse students’ experiences of handling ethical problems in patient-relationship2019Inngår i: Presented at the 120th International Council of Nurses (ICN) congress, Singapore, June 27-July 1, 2019, 2019Konferansepaper (Fagfellevurdert)
  • 22.
    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 service2010Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, nr 2, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 23.
    Holmberg, Mats
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. 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 study2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 34, s. 23-28Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 24.
    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 others2016Inngår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, nr 4, s. e1-e8Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 25.
    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.2014Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, nr 3, s. 544-551Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 26.
    Holmberg, Mats
    et al.
    Centre for Clinical Research Sormland, Uppsala University, Eskilstuna, Sweden; Department of Ambulance Service, Katrineholm, Sweden; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Hammarbäck, Staffan
    Centre for Clinical Research Sormland, Uppsala University, Eskilstuna, Sweden; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden; Department of Ambulance Service, Katrineholm, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study2020Inngår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 40, nr 3, s. 151-161Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.

  • 27.
    Holmberg, Mats
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Linnaeus Linnaeus Univ, Växjö, Sweden..
    Hoeck, Bente
    Univ Southern Denmark, UCL Univ Coll, Odense, Denmark..
    Bremer, Anders
    Linnaeus Univ, Växjö, Sweden..
    Kaldestad, Kari
    Univ Stavanger, Stavanger, Norway..
    Koskinen, Monika
    Borås Univ, Borås, Sweden..
    The Nordic College of Caring Science develops, supports and disseminates caring science2023Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, nr 2, s. 313-315Artikkel i tidsskrift (Annet vitenskapelig)
  • 28.
    Holmberg, Mats
    et al.
    Linnéuniversitetet,Sweden.
    Nørgaard, Jockum
    Region Sörmland, Sweden.
    Eriksson, Mats
    Region Sörmland, Sweden.
    Svensson, Anders
    Linnéuniversitetet, Sweden.
    Dyadic teams and nursing care: a critical incident study of nurses in the emergency medical service2020Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 29, nr 19-20, s. 3743-3753Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim and objectives: The aim of the study was to describe Emergency Medical Services (EMS) nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.

    Background: Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient's suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.

    Design: The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.

    Methods: A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.

    Results: The experiences of critical incidents emerged to form two main areas: “Functional co‐operation” and “Dysfunctional co‐operation,” comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas: “Adapting oneself” and “Adapting nursing care and the colleague,” comprising four categories and eight sub‐categories.

    Conclusions: Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.

    Relevance to clinical practice: This study underlines the importance of strengthening the dyadic EMS team's ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.

  • 29.
    Holmberg, Mats
    et al.
    Högskolan i Borås, Sweden.
    Rantala, Andreas
    Bremer, Anders
    Högskolan i Borås, Sweden.
    Patient participation: A challenge within contemporary ambulance care?2016Konferansepaper (Annet vitenskapelig)
    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? 

  • 30.
    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 others2016Inngår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, nr 4, s. e16-e23Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 31.
    Johanna, Zetterberg
    et al.
    Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden..
    Elin, Visti
    Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden..
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden..
    Henrik, Andersson
    Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden..
    Jonas, Aléx
    Nurses’ experiences of encountering patients with mental illness in prehospital emergency care – a qualitative interview study2022Inngår i: BMC Nursing, E-ISSN 1472-6955, Vol. 21, nr 1, artikkel-id 89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

     Background:  Nurses working in prehospital emergency care (PEC) encounter patients with all types of health conditions. Increasingly, they are encountering patients suffering from mental illness and this trend reflects the worldwide increase in mental illness. There is very little current knowledge of encounters between nurses and patients with mental illness in 'PEC', especially from the nurses' perspectives.

     Aim:  The aim of the study is to investigate nurses' experiences of encountering patients with mental illness in 'PEC'.

     Methods:  The participants were recruited in a region in southeast Sweden (that covers approximately 5600 km2 and has 300,000 inhabitants). In total, 17 nurses consented to participate. The participants were asked to narrate their individual experience of encountering patients with mental illness. The interviews were transcribed verbatim, then analysed with qualitative content analysis.

     Results:  The result is presented in terms of three themes and eight sub-themes. The main themes are 'Lacking trust in the patient and one's own abilities', 'Being under internal and external influences' and 'Moving towards a genuine nurse-patient relationship'.

     Conclusion:  The results show that nurses strive to lay the foundation for a trusting relationship. Simultaneously nurses encountering is characterized by a mistrust and it is influenced by pre-understanding and emotions when they take care for patients. The findings could be used to develop nurses' readiness and capability to encounter patients with mental illness and to respond appropriately to the patients somatic and mental care needs.

  • 32.
    Kayambankadzanja, Raphael Kazidule
    et al.
    Kamuzu Univ Hlth Sci, Publ Hlth, Blantyre, Malawi.;Queen Elizabeth Cent Hosp, Anaesthesia & Intens Care, Blantyre, Malawi..
    Schell, Carl Otto
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden.;Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.;Nyköping Hosp, Internal Med, Nyköping, Sweden..
    Warnberg, Martin Gerdin
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden.;Karolinska Univ Hosp, Periopei Ative Med & Intens Care, Stockholm, Sweden..
    Tamras, Thomas
    Södertälje Hosp, Internal Med, Stockholm, Sweden..
    Mollazadegan, Hedi
    Sankt Goran Hosp, Addict Med, Stockholm, Sweden..
    Holmberg, Mats
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden; Linnaeus Univ, Ctr Interprofess Collaborat Emergency Care, Växjö, Sweden.
    Alvesson, Helle Molsted
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden..
    Baker, Tim
    Karolinska Inst, Global Publ Hlth, Stockholm, Sweden.;London Sch Hyg & Trop Med, Clin Res, London, England.;Muhimbili Univ Hlth & Allied Sci, Emergency Med, Dar Es Salaam, Tanzania..
    Towards definitions of critical illness and critical care using concept analysis2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 9, artikkel-id e060972Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective As 'critical illness' and 'critical care' lack consensus definitions, this study aimed to explore how the concepts' are used, describe their defining attributes, and propose potential definitions. Design and methods We used the Walker and Avant approach to concept analysis. The uses and definitions of the concepts were identified through a scoping review of the literature and an online survey of 114 global clinical experts. We used the Arksey and O'Malley framework for scoping reviews and searched in PubMed and Web of Science with a strategy including terms around critical illness/care and definitions/etymologies limited to publications in English between 1 January 2008 and 1 January 2020. The experts were selected through purposive sampling and snowballing, with 36.8% in Africa, 25.4% in Europe, 22.8% in North America, 10.5% in Asia, 2.6% in South America and 1.8% in Australia. They worked with anaesthesia or intensive care 59.1%, emergency care 15.8%, medicine 9.5%, paediatrics 5.5%, surgery 4.7%, obstetrics and gynaecology 1.6% and other specialties 3.9%. Through content analysis of the data, we extracted codes, categories and themes to determine the concepts' defining attributes and we proposed potential definitions. To assist understanding, we developed model, related and contrary cases concerning the concepts, we identified antecedents and consequences to the concepts, and defined empirical referents. Results Nine and 13 articles were included in the scoping reviews of critical illness and critical care, respectively. A total of 48 codes, 14 categories and 4 themes were identified in the uses and definitions of critical illness and 60 codes, 13 categories and 5 themes for critical care. The defining attributes of critical illness were a high risk of imminent death; vital organ dysfunction; requirement for care to avoid death; and potential reversibility. The defining attributes of critical care were the identification, monitoring and treatment of critical illness; vital organ support; initial and sustained care; any care of critical illness; and specialised human and physical resources. The defining attributes led to our proposed definitions of critical illness as, 'a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility', and of critical care as, 'the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions.' Conclusion The concepts critical illness and critical care lack consensus definitions and have varied uses. Through concept analysis of uses and definitions in the literature and among experts, we have identified the defining attributes of the concepts and proposed definitions that could aid clinical practice, research and policy-making.

  • 33.
    Svensson, C.
    et al.
    Ambulance Department, South Älvsborg Hospital, Borås, Sweden.
    Bremer, A.
    Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Holmberg, Mats
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. epartment of Ambulance Service, Region Sörmland, Eskilstuna, Sweden.
    Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: A qualitative exploration2019Inngår i: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 14, nr 2, s. 70-79Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations. Aim: The aim of the study was to explore ambulance nurses’ experiences of relationships with patients in urgent and emergency situations. Methods: Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis. Results: Relationships with patients during urgent and emergency assignments emerged as three themes: “Ambiguous silence,” “Professional competence” and “Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship. Conclusions: Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important. Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses.

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