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Maurin Söderholm, Hanna
Alternative names
Publications (10 of 26) 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
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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
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
Andersson Hagiwara, M., Lundberg, L., Sjöqvist, B. A. & Maurin Söderholm, H. (2019). The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment. Journal of Healthcare Informatics Research
Open this publication in new window or tab >>The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment
2019 (English)In: Journal of Healthcare Informatics Research, ISSN 2509-4971Article in journal (Refereed) Epub ahead of print
Abstract [en]

Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.

Keywords
Stroke, Decision support, EMS team, Prehospital process
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-21183 (URN)10.1007/s41666-019-00053-4 (DOI)
Projects
PrehospIT
Funder
Vinnova
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-06-17Bibliographically approved
Sundler, A. J., Gustafsson, T., Lindberg, E., Maurin Söderholm, H. & Holmström, I. K. (2018). ACTION - A person-centred communication intervention in home care of older persons. In: : . Paper presented at The 16th International Conference on Communication in Healthcare (ICCH), Porto, Portugal, 1-4 September, 2018.
Open this publication in new window or tab >>ACTION - A person-centred communication intervention in home care of older persons
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15148 (URN)
Conference
The 16th International Conference on Communication in Healthcare (ICCH), Porto, Portugal, 1-4 September, 2018
Projects
ACTION - A person-centred communication intervention
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-12-13Bibliographically approved
Backlund, P., Maurin Söderholm, H., Engström, H., Andersson Hagiwara, M. & Lebram, M. (2018). Breaking Out of the Bubble Putting Simulation Into Context to Increase Immersion and Performance. Simulation & Gaming, Article ID 1046878118772612.
Open this publication in new window or tab >>Breaking Out of the Bubble Putting Simulation Into Context to Increase Immersion and Performance
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2018 (English)In: Simulation & Gaming, article id 1046878118772612Article in journal (Refereed) Published
Abstract [en]

Objective: Simulation based training with full-size mannequins is a prominent means of training within the healthcare sector. Prehospital missions include all parts of the healthcare process which take place before a patient is handed over to the receiving hospital. This implies that the context for prehospital care is varied and potentially challenging or dangerous in several ways. In this article we present a study which explores immersion and performance by emergency medical services (EMS) professionals in in a training situation which takes the specifics of prehospital interventions into account.

Methods: The study was carried out as a field experiment at an ambulance unit. The experiment was designed to compare the differences between two types of medical scenarios: basic and contextualized. We analyzed the levels of immersion throughout the scenarios and then team performance was evaluated by independent experts. Both analyses were made by observing video recordings from multiple camera angles with a custom made analysis tool.

Results: Our results show that the contextualization of a medical scenario increases both immersion as measured by the Immersion Score Rating Instrument (ISRI) and team performance as measured by the Global Rating Scale (GRS). The overall ISRI score was higher in the contextualized condition as compared to the basic condition, with an average team wise difference of 2.94 (sd = 1.45). This difference is significant using a paired, two-tailed t-test (p<.001). The GRS score was higher for overall clinical performance in the contextualized scenario with an average team wise difference of 0.83 (sd = 0.83, p=.005).Conclusions. Full-size mannequin simulation based training for EMS professionals may be enhanced by contextualizing the medical scenarios. The main benefits are that the contextualized scenarios better take prehospital medical challenges into account and allow participants to perform better.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-14277 (URN)10.1177/1046878118772612 (DOI)2-s2.0-85047428895 (Scopus ID)
Projects
SAREK
Funder
Region Västra Götaland
Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-12-07Bibliographically 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
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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) (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
Backlund, P., Engström, H., Johannesson, M., Lebram, M., Danielsson, M., Andersson Hagiwara, M., . . . Maurin Söderholm, H. (2017). The S.A.R.E.K Simulation Environment: Technical description of a flexible training environment for prehospital care.. Skövde
Open this publication in new window or tab >>The S.A.R.E.K Simulation Environment: Technical description of a flexible training environment for prehospital care.
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2017 (English)Report (Other academic)
Abstract [en]

This report contains a technical description of the result of the S.A.R.E.K (Simulation – Ambulance – Research – Education - Kinship) collaboration project and the Sim2020 project. The projects are collaborations between researchers in healthcare and IT, and prehospital care practitioners, with the aim to design, develop and test a contextualized simulation environment for prehospital care. We built a simulation environment representing the full depth and width of a prehospital care process. Breadth refers to including all phases of a prehospital mission, from dispatch to handover; while depth refers to detailed representations and recreation of artefacts, information and context for each of these phases. This report outlines the details of the overall design, all equipment and practical solutions used to create this. Apart from the installation which is described in this report we have also developed methods and carried out a variety of tests and experiments which are reported elsewhere. The focus of this report is the system and its components.

Place, publisher, year, edition, pages
Skövde: , 2017
Keywords
prehospital simulation
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-14993 (URN)
Projects
SAREK
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-17Bibliographically approved
Engström, H., Andersson Hagiwara, M., Backlund, P., Lebram, M., Lundberg, L., Johannesson, M., . . . Maurin Söderholm, H. (2016). The impact of contextualization on immersion in healthcare simulation. Advances in Simulation, 1(1), 1-11
Open this publication in new window or tab >>The impact of contextualization on immersion in healthcare simulation
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2016 (English)In: Advances in Simulation, ISSN 2059-0628, Vol. 1, no 1, p. 1-11Article in journal (Refereed) Published
Abstract [en]

The aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score.

National Category
Other Medical Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9517 (URN)10.1186/s41077-016-0009-y (DOI)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2017-05-04Bibliographically approved
Backlund, P., Engström, H., Andersson Hagiwara, M., Johannesson, M. & Maurin Söderholm, H. (2015). Enhancing Immersion with Contextualized Scenarios: Role-Playing in Prehospital Care Training. In: 2015 7th International Conference on Games and Virtual Worlds for Serious Applications (VS-Games): . Paper presented at 2015 7th International Conference on Games and Virtual Worlds for Serious Applications (VS-Games), Skövde, 16-18 September, 2015. Skövde
Open this publication in new window or tab >>Enhancing Immersion with Contextualized Scenarios: Role-Playing in Prehospital Care Training
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2015 (English)In: 2015 7th International Conference on Games and Virtual Worlds for Serious Applications (VS-Games), Skövde, 2015Conference paper, Published paper (Refereed)
Abstract [en]

This paper reports on a field experiment with 12 paramedic teams (n=24) exploring how they perceive a novel training approach. The feeling of being engaged in training (i.e. being immersed) is often held forward as a major benefit of roleplaying exercises. Engagement is expected to raise the quality of training as well as improving learning and retention. However, much simulation-based training in prehospital care is decontextualized, meaning that medical care is trained without taking other characteristics of prehospital care into account. In this paper we investigate how a richer setting (contextualization), which includes more of the complicating aspects of prehospital care, affects the perceived immersion of the participants. The results show that contextualization has a significant positive impact on perceived immersion. These results are important for further studies on how to organize and design role-playing exercises.

Place, publisher, year, edition, pages
Skövde: , 2015
Keywords
Training, Context, Medical services, Biomedical imaging, Games, Accidents, Instruments
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hb:diva-14994 (URN)10.1109/VS-GAMES.2015.7295772 (DOI)2-s2.0-84954554458 (Scopus ID)
Conference
2015 7th International Conference on Games and Virtual Worlds for Serious Applications (VS-Games), Skövde, 16-18 September, 2015
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-17Bibliographically approved
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