Introduction

Registered nurses play a critical role in disaster response and patient care during crises. Recent global events underscore the importance of preparedness for disaster response. However, the readiness of registered nurses and their educational preparation vary. In Sweden, this prompted the National Board of Health and Welfare to introduce a new national curriculum for disaster response. This study aimed to assess how education for undergraduate and specialist registered nurses aligns with this curriculum.

Methods

A descriptive cross-sectional study was conducted among universities and university colleges in Sweden offering undergraduate and specialist nursing programs. Surveys were sent to all 25 higher education institutions providing nursing education in November 2023, comprising 29 questions related to the new curriculum.

Results

Findings revealed that half of the respondents had discussed the new curriculum, with 15 reporting some form of learning activities. Traditional lectures were the most commonly used format, and 11 respondents had designated teachers for the subject. Reasons for lacking disaster response education included prioritizing other acute care areas or a limited perspective at the academy.

Discussion

In conclusion, this study suggests that nursing education may not sufficiently prepare registered nurses for disaster response and armed conflicts. Education tends to focus more on acute care rather than taking a broader perspective. As a result, registered nurses may lack the competence and readiness required to effectively respond to disasters.

Introduktion: Sjuksköterskor har en nyckelroll i beredskapen för och vården av patienter under katastrofmedicinska insatser. I Sverige har händelseförloppet de senaste åren, till exempel gängkriminalitet, terrorattentat, covid 19-pandemin och Rysslands fullskaliga invasion av Ukraina ökat uppmärksamheten på sjuksköterskors kompetens att möta olika typer av katastrofer. År 2022 presenterade Socialstyrelsen en rapport där de beskrev detaljerade kunskaps- och färdighetsmål för utbildningar och övningar i katastrofmedicin. Samtidigt visar en nyligen publicerad svensk studie att sjuksköterskestudenter uppfattar sig ha otillräckliga kunskaper i katastrofmedicin.

Syfte: Undersöka i vilken utsträckning sjuksköterskeutbildningarna på grundläggande och avancerad nivå i Sverige bedriver utbildning i katastrofmedicinsk beredskap och civilt försvar.

Metod: En enkät skickades i november 2023 till alla de lärosäten i Sverige som erbjuder grund- och specialistutbildningar för sjuksköterskor (n=25). Enkäten bestod av 29 frågor relaterade till de kunskaps- och färdighetsmål för utbildning och övning i katastrofmedicin som Socialstyrelsen angett ut.

Resultat: 18 av 25 lärosäten besvarade enkäten och förekomst av utbildning var enligt följande:

• Sortering och prioritering av personer på skadeplats (n=16) eller på sjukhus (n=15)

• Sjukvårdens organisation och ledning på skadeplats/ sjukhus (n=15)

• Bedömning och omhändertagande av personer som utsatts för högenergetiskt våld (n=11)

• Principerna för sjukvård under höjd beredskap och krig (n=9)

• Sjukvårdens roll i totalförsvaret (n=5)

• Försvarsmaktens sjukvårdsorganisation och dess funktion vid väpnad konflikt/krig (n=2)

Konklusion: Resultatet tyder på att den utbildning som ges främst fokuserar på akutvård under normalförhållanden. Däremot brister utbildningen när det gäller att förbereda blivande sjuksköterskor på grundläggande och avancerad nivå att möta samt hantera situationer som inryms inom det civila försvaret.

ReferenserSocialstyrelsen. (2022). Nationella utbildnings- och övningsplaner för katastrofmedicinsk beredskap och civilt försvar samt nationell samordning av utbildning och övning. Redovisning av regeringsuppdraget S2021/02922

Robinson et al. (2023) Teaching extent and military service improve undergraduate selfassessed knowledge in disaster medicine: An online survey study among Swedish medical and nursing students. Front. Public Health 11:1161114.

Andersson et al. (2024). Are you ready: disaster response in nursing education: a cross‑sectional survey among Swedish universities and university colleges. Discover Health Systems 3:74

Introduktion: I en försämrad global situation blir den civila sjukvårdens beredskap inför väpnade konflikter avgörande. Sjuksköterskor med eller utan specialistutbildning är ofta bland de första att bevittna hot och våld mot sjukvården. Därför är det av yttersta vikt att sjuksköterskor har kunskap om internationell humanitär rätt (IHL) för att fullt ut förstå sina rättigheter och skyldigheter i samband med väpnad konflikt.

Syfte: Undersöka i vilken utsträckning sjuksköterskeutbildningarna på grundläggande och avancerad nivå i Sverige bedriver utbildning i IHL

Metod: En enkät skickades i november 2023 till alla de lärosäten i Sverige som erbjuder grund- och specialistutbildningar för sjuksköterskor (n=25). Enkäten bestod av 9 frågor relaterade till grundläggande kunskaper om IHL.

Resultat: 18 av 25 lärosäten besvarade enkäten och förekomst av utbildning var enligt följande:

• Den civila sjukvårdens beredskap och organisation vid väpnad konflikt/krig (n=4)

• Grundprinciperna som finns i IHL (n=2)

• Relationen mellan IHL och de mänskliga rättigheterna (n=2)

• Vilka skyddade personalkategorier det finns i ett krig enligt IHL (n=2)

• Sjukvården och IHL (n=2)• Vilka skyddssymboler som finns och vad de avser att skydda (n=2)

• Hur krig får föras och vilka vapen som får användas (n=1)

• Konventioner till skydd för krigets offer (n=1)

• Vad som händer när IHL kränks (n=1)

Konklusion: Resultatet tyder på att utbildningen brister när det gäller att förbereda blivande sjuksköterskor på grundläggande och avancerad nivå att förstå sina rättigheter och skyldigheter i samband med väpnad konflikt.

Referenser

Blanchet, K., et al., Have attacks on healthcare become the new normal? a public health call to action for armed conflicts before it is too late. Conflict and health, 2023. 17(1): p. 56.

Sassòli, M. and P.S. Nagler, International humanitarian law: rules, controversies, and solutions to problems arising in warfare. 2019, Cheltenham: Edward Elgar Publishing.

SOU (2022). Hälso- och sjukvårdens beredskap – struktur för ökad förmåga. Slutbetänkande av utredningen om hälso- och sjukvårdens beredskap (2022:6). Regeringskansliet

The growing global instability has increased the demand for healthcare and disaster response skills among registered nurses (RNs). However, research shows that RNs are not sufficiently prepared for disaster situations. Although RNs are responsible for managing injuries during armed conflicts in accordance with International Humanitarian Law (IHL), nursing education lacks specific training in this area. A national survey revealed that only two universities in Sweden offer IHL-related education for nursing students. These findings highlight the urgent need to revise nursing education in Sweden to better prepare RNs for the challenges posed by global crises, including armed conflicts.

Introduction

Healthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exacerbate crowding and boarding problems in the ED, negatively impacting patient safety and the work environment. In Sweden a hybrid of prehospital and intrahospital emergency care has been established, referred to in this article as Medical Emergency Team (MET), to meet the increasing demand for emergency care. MET, consisting of physicians and nurses, moving emergency care from EDs to patients’ home. Physicians and nurses may encounter challenges in their healthcare work, such as limited resources for example medical equipment, sampling and examination, in unfamiliar varying home environments. There is a lack of knowledge about how these challenges can influence patient care. Therefore, the aim of this study was to explore the healthcare work of the METs when addressing patients’ emergency care needs in their homes, with a focus on the METs reasoning and actions.

Methods

Using a qualitative multiple case study design, two METs in southwestern Sweden were explored. Data were collected from September 2023 – January 2024 and consist of field notes from participant observations, short interviews and written reflections. A qualitative manifest content analysis with an inductive approach was used as the analysis method.

Result

The result of this study indicates that physicians and nurses face several challenges in their daily work, such as recurring interruptions, miscommunication and faltering teamwork. Some of these problems may arise because physicians and nurses are not accustomed to working together as a team in a different care context. These challenges can lead to stress, which ultimately can expose patients to unnecessary risks.

Conclusion

When launching a new service like METs, which is a hybrid of prehospital and intrahospital emergency care, it is essential to plan and prepare thoroughly to effectively address the challenges and obstacles that may arise. One way to prepare is through team training. Team training can help reduce hierarchical structures by enabling physicians and nurses to feel that they can contribute, collaborate, and take responsibility, leading to a more dynamic and efficient work environment.

Introduction

Critical thinking is regarded as imperative to healthcare quality and patient outcomes; therefore, effective strategies in nursing education are required to promote students’ critical thinking abilities, leading to their success in clinical work. Accordingly, simulation-based education has been suggested as a measure for achieving this goal.

Objective

The aim of this study was to explore whether a nursing education course with blended simulation activities (hands-on simulations with high-fidelity manikins and a web-based interactive simulation program) could increase nursing students’ critical thinking skills.

Method

A quasiexperimental, one-group pretest and post-test design was utilized. Data were collected through premeasurement and postmeasurement using a critical thinking questionnaire and were analyzed using paired sample t-tests, independent sample t-tests, and the nonparametric Wilcoxon signed-rank test. The effect size was calculated using Cohen's d formula.

Results

Sixty-one nursing students (57 women and four men, mean age 30 years) participated in the study. Findings of the paired sample t-test showed a significantly higher mean score for posteducation than pre-education, indicating a significant change in nurses’ critical thinking capabilities (p < .001). The results for Cohen's d formula ( − 0.87) of the mean scores between pre-education and posteducation indicated a large effect size. The Wilcoxon signed-rank test also showed a statistically significant increase in the students’ critical thinking abilities between pre-education and posteducation measures (p < .001). No statistically significant differences were found in the mean score according to age or sex.

Conclusion

This study concluded that blended simulation-based education can increase nursing students’ critical thinking capabilities. As a result, this study builds on the use of simulation as a measure for developing and promoting critical thinking abilities during nursing education.

Introduction: The number of patients who perceive themselves to have need for emergency care needs has increased over time. Some of these care needs can be addressed at patients' home (1). Emergency care delivery at home can be better for some patients (2). This arises questions how to provide high-quality and cost-effective emergency care (3). Therefore, it is needed to explore how delivery models can be changed for taking care of patients needs for emergency care. 

Aim: To explore emergency health care professionals’ experiences in caring for patients with emergency care needs in their homes.

Methods: A qualitative study based on observations and interviews was used. Data was analyzed by content analysis.  Results: No results are currently available as data collection is ongoing. The poster will present preliminary results at the conference. 

Conclusion: The findings can be assumed to contribute and stimulate to a continued discussion and development of new and additional models of emergency care delivery based on patient’s emergency care needs.

Introduction: The number of patients who perceive themselves to have need for emergency care needs has increased over time. Some of these care needs can be addressed at patients' home (1). Emergency care delivery at home can be better for some patients (2). This arises questions how to provide high-quality and cost-effective emergency care (3). Therefore, it is needed to explore how delivery models can be changed for taking care of patients needs for emergency care. 

Aim: To explore emergency health care professionals’ experiences in caring for patients with emergency care needs in their homes.

Methods: A qualitative study based on observations and interviews was used. Data was analyzed by content analysis.  Results: No results are currently available as data collection is ongoing. The poster will present preliminary results at the conference. 

Conclusion: The findings can be assumed to contribute and stimulate to a continued discussion and development of new and additional models of emergency care delivery based on patient’s emergency care needs.

Introduction

Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR.

Methods

Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources.

Results

The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates.

Conclusion

The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.

Introduction: The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. 

Study Objective: The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. 

Methods: A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. 

Results: A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. 

Conclusions: As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.