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Andersson, Henrik
Publications (10 of 21) Show all publications
Andersson, U., Maurin Söderholm, H., Wireklint Sundström, B. & Andersson Hagiwara, M. (2019). Clinical reasoning in the emergency medical services: an integrative review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Open this publication in new window or tab >>Clinical reasoning in the emergency medical services: an integrative review
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241Article in journal (Refereed) Published
Abstract [en]

Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.

Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.

Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.

Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.

Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.

Keywords
Clinical reasoning, Decision-making, Emergency Medical Services, Ambulance, Clinicians
National Category
Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-21633 (URN)10.1186/s13049-019-0646-y (DOI)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-26Bibliographically approved
Olander, A., Andersson, H., Sundler, A. J., Bremer, A., Ljungström, L. & Andersson Hagiwara, M. (2019). Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome. BMC Emergency Medicine, Article ID 19:43.
Open this publication in new window or tab >>Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome
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2019 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, article id 19:43Article in journal (Refereed) Published
Abstract [en]

Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients withseps is are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays.

Methods: This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed.

Results: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serumglucose level and altered mental status during prehospital care were found to be associated with an adverse outcome.

Conclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

National Category
Infectious Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-21573 (URN)10.1186/s12873-019-0255-0 (DOI)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Maurin Söderholm, H., Andersson, H., Andersson Hagiwara, M., Backlund, P., Bergman, J., Lundberg, L. & Sjöqvist, B. A. (2019). Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.. Advances in Simulation, 4, Article ID 3.
Open this publication in new window or tab >>Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.
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2019 (English)In: Advances in Simulation, ISSN 2059-0628, Vol. 4, article id 3Article in journal (Refereed) Published
Abstract [en]

There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.

Keywords
Laboratory, Prehospital, Simulation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15823 (URN)10.1186/s41077-019-0090-0 (DOI)30783539 (PubMedID)
Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-02-25Bibliographically approved
Holmberg, M., Andersson, H., Winge, K., Lundberg, C., Karlsson, T., Herlitz, J. & Wireklint Sundström, B. (2018). Association between the reported intensityof an acute symptom at first prehospital assessment and the subsequent outcome:a study on patients with acute chest painand presumed acute coronary syndrome. BMC Cardiovascular Disorders, 1-10, Article ID 18:216.
Open this publication in new window or tab >>Association between the reported intensityof an acute symptom at first prehospital assessment and the subsequent outcome:a study on patients with acute chest painand presumed acute coronary syndrome
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2018 (English)In: BMC Cardiovascular Disorders, p. 1-10, article id 18:216Article in journal (Refereed) Published
Abstract [en]

Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development ofpotentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) areimportant. The aim of this study has therefore been to explore the possible association between patients’ estimatedintensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcomebefore and after arrival in hospital.

Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raisingsuspicion 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) moreheart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest painafter 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 forpossible 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 wasassociated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospitaladmission, the final diagnosis and the number of days in hospital.

National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-15352 (URN)10.1186/s12872-018-0957-3 (DOI)000451531300001 ()30486789 (PubMedID)
Available from: 2018-11-30 Created: 2018-11-30 Last updated: 2018-12-07Bibliographically approved
Andersson, U., Andersson, H., Bremer, A. & Falchenberg, Å. (2018). Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care. In: 3rd Global Conference on Emergency Nursing & Trauma Care, Noordwijkerhout, October 4-6, 2018: . Paper presented at 3rd Global Conference on Emergency Nursing & Trauma Care, Noordwijkerhout, October 4-6, 2018..
Open this publication in new window or tab >>Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care
2018 (English)In: 3rd Global Conference on Emergency Nursing & Trauma Care, Noordwijkerhout, October 4-6, 2018, 2018Conference paper, Poster (with or without abstract) (Other academic)
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15175 (URN)
Conference
3rd Global Conference on Emergency Nursing & Trauma Care, Noordwijkerhout, October 4-6, 2018.
Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2018-10-09Bibliographically approved
Wennberg, P., Andersson, H. & Wireklint Sundström, B. (2018). Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature. International Journal of Orthopaedic and Trauma Nursing
Open this publication in new window or tab >>Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature
2018 (English)In: International Journal of Orthopaedic and Trauma NursingArticle in journal (Refereed) In press
Keywords
Hip fractures, Emergency care, Pain assessment
National Category
Orthopaedics
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13979 (URN)10.1016/j.ijotn.2017.11.002 (DOI)000432461300004 ()29631852 (PubMedID)2-s2.0-85046756618 (Scopus ID)
Available from: 2018-04-16 Created: 2018-04-16 Last updated: 2018-12-21Bibliographically approved
Andersson, H., Gabre, M., Dehre, A., Andersson Hagiwara, M. & Maurin Söderholm, H. (2018). Simulation in Virtual World to Promote Communication. In: Pre-hospital care- Education and training of ambulance professionals: . Paper presented at 3rd Global Conference on Emergency Nursing and Trauma Care, Leeuwenhorst, 4-6 October, 2018.. Noordwijkerhout, The Netherlands
Open this publication in new window or tab >>Simulation in Virtual World to Promote Communication
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2018 (English)In: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Introduction

Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016).

 

Aim

The aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS).

 

Methods

A qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis.

 

Results

The participants’ experiences generated three themes:

 

Understanding the virtual world

It was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL.

 

Technological challenges

One challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient.

 

Learning through avatars

Learning through avatars requires that the participants take responsibility for delivering a convincing performance.  Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour.

 

Conclusion

The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.  

Place, publisher, year, edition, pages
Noordwijkerhout, The Netherlands: , 2018
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15170 (URN)
Conference
3rd Global Conference on Emergency Nursing and Trauma Care, Leeuwenhorst, 4-6 October, 2018.
Available from: 2018-10-07 Created: 2018-10-07 Last updated: 2018-10-09Bibliographically approved
Andersson, H., Gabre, M., Dehre, A., Andersson Hagiwara, M. & Maurin Söderholm, H. (2018). Simulation in Virtual World to Promote Communication. In: Pre-hospital care- Education and training of ambulance professionals: . Paper presented at 3rd Global Conference on Emergency Nursing and Trauma Care, Leeuwenhorst, 4-6 October 2018. Noordwijkerhout, The Netherlands
Open this publication in new window or tab >>Simulation in Virtual World to Promote Communication
Show others...
2018 (English)In: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction

Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016).

 

Aim

The aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS).

 

Methods

A qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis.

 

Results

The participants’ experiences generated three themes:

 

Understanding the virtual world

It was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL.

 

Technological challenges

One challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient.

 

Learning through avatars

Learning through avatars requires that the participants take responsibility for delivering a convincing performance.  Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour.

 

Conclusion

The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.  

Place, publisher, year, edition, pages
Noordwijkerhout, The Netherlands: , 2018
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15171 (URN)
Conference
3rd Global Conference on Emergency Nursing and Trauma Care, Leeuwenhorst, 4-6 October 2018
Available from: 2018-10-07 Created: 2018-10-07 Last updated: 2018-10-17Bibliographically approved
Andersson, H., Axelsson, C., Larsson, A., Bremer, A., Gellerstedt, M., Bång, A., . . . Ljungström, L. (2018). The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care. American Journal of Emergency Medicine
Open this publication in new window or tab >>The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care
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2018 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

Keywords
Bacteraemia, Prehospital emergency care
National Category
Infectious Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13974 (URN)10.1016/j.ajem.2018.04.004 (DOI)000451027100014 ()29653787 (PubMedID)2-s2.0-85045050891 (Scopus ID)
Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-01-09Bibliographically approved
Andersson, H., Ullgren, A., Holmberg, M., Karlsson, T., Herlitz, J. & Wireklint Sundström, B. (2017). Acute coronary syndrome in relation to the occurrence of associatedsymptoms: A quantitative study in prehospital emergency care. International Emergency Nursing, 33, 43-47
Open this publication in new window or tab >>Acute coronary syndrome in relation to the occurrence of associatedsymptoms: A quantitative study in prehospital emergency care
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2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 43-47-Article in journal (Refereed) Published
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 assesspatients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrenceof dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associationswith patients’ outcome.

Methods: This study has a quantitative design based on data from hospital records and from a previousinterventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systemsin 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 presenceof dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis ofacute myocardial infarction (AMI).

Conclusion: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and seriousdiagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influencethe ANs’ assessment and that special education in cardiovascular nursing is required.

National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-12444 (URN)10.1016/j.ienj.2016.12.001 (DOI)000407530200008 ()28438478 (PubMedID)2-s2.0-85018660866 (Scopus ID)
Available from: 2017-07-26 Created: 2017-07-26 Last updated: 2017-12-13Bibliographically approved
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