Change search
Link to record
Permanent link

Direct link
BETA
Alternative names
Publications (10 of 76) Show all publications
Jonasson, L.-L., Sandman, L. & Bremer, A. (2019). Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training. Journal of Healthcare Leadership, 11(63-74)
Open this publication in new window or tab >>Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training
2019 (English)In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed) Published
Abstract [en]

Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.

Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.

Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.

Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented

Keywords
manager, ethical responsibility, municipal, older person, thematic analysis
National Category
Other Medical Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15232 (URN)10.2147/JHL.S199167 (DOI)
Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2019-06-20Bibliographically 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
Show others...
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
Wireklint Sundström, B., Bremer, A., Lindström, V. & Vicente, V. (2018). Caring science research in the ambulance services: an integrative systematic review.. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Caring science research in the ambulance services: an integrative systematic review.
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.

AIM: This integrative systematic review aims to describe caring science research content and scope in the ambulance services.

DATA SOURCES: Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.

REVIEW METHODS: The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five-stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3-level scale, and data relevance was evaluated on a 2-level scale.

RESULTS: After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision-making; Public environment and patient safety; Life-changing situations; and Ethics and values.

CONCLUSION: Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional-patient relation, with special focus on value conflicts in emergency situations.

Keywords
ambulance, caring science, emergency medical services, holistic approach, patient perspective, prehospital, review, systematic
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15212 (URN)10.1111/scs.12607 (DOI)30252151 (PubMedID)2-s2.0-85054421374 (Scopus ID)
Projects
PreHospen
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2018-11-16Bibliographically 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
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
Show others...
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
Claesson, A., Herlitz, J., Svensson, L., Ottosson, L., Bergfeldt, L., Engdahl, J., . . . Bremer, A. (2017). Defibrillation before EMS arrival in western Sweden.. American Journal of Emergency Medicine, 35(8), 1043-1048, Article ID S0735-6757(17)30117-1.
Open this publication in new window or tab >>Defibrillation before EMS arrival in western Sweden.
Show others...
2017 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, p. 1043-1048, article id S0735-6757(17)30117-1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

Keywords
Automated external defibrillator, Emergency medical services, First responder, Out-of-hospital cardiac arrest
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13342 (URN)10.1016/j.ajem.2017.02.030 (DOI)000407941000001 ()28238537 (PubMedID)2-s2.0-85013677603 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Ågård, A., Bremer, A., Sallin, K. & Engström, I. (2017). Ethical controversies when formulating new national guidelines on cardiopulmonary resuscitation in Sweden. Clinical Ethics
Open this publication in new window or tab >>Ethical controversies when formulating new national guidelines on cardiopulmonary resuscitation in Sweden
2017 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101XArticle in journal (Refereed) Published
Abstract [en]

The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

Keywords
Clinical ethics, advance directives, informed consent, professional ethics in medicine
National Category
Medical Ethics
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13530 (URN)10.1177/1477750917724331 (DOI)2-s2.0-85037615823 (Scopus ID)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-01-17Bibliographically approved
Israelsson, J., Bremer, A., Herlitz, J., Axelsson, Å. B., Cronberg, T., Djärv, T., . . . Årestedt, K. (2017). Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender.. Resuscitation, 114, 27-33, Article ID S0300-9572(17)30059-X.
Open this publication in new window or tab >>Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender.
Show others...
2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33, article id S0300-9572(17)30059-XArticle in journal (Refereed) Published
Abstract [en]

AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

Keywords
Anxiety, Depression, Gender, Health status, Heart arrest, Hospitals
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13344 (URN)10.1016/j.resuscitation.2017.02.006 (DOI)000402487800021 ()28216089 (PubMedID)2-s2.0-85014407099 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Olander, A., Bremer, A., Andersson, H., Ljungström, L., Gellerstedt, M., Fridlund, B. & Bång, A. (2017). Identify the septic patient in prehospital care. In: : . Paper presented at Advances in Health Care Sciences Conference, Stockholm Sweden, November 15-16, 2017.
Open this publication in new window or tab >>Identify the septic patient in prehospital care
Show others...
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

AIM: The aim was to determine the sensitivity of the new symptom based index test Altered Signs and Symptoms Emerge Sudden in Sepsis (ASSESS) in order to identify sepsis and compare it with four established index tests in the prehospital care.

METHOD: This is a quantitative study were the researchers collected data from medical records, and tested whether a new symptom based index test ASSESS was significantly better to identify sepsis compared to Rapid Emergency Triage and Treatment System (RETTS-ESS 47), BAS 90-30-90, Quick Sequential [Sepsis-related] (qSOFA) and The prehospital severe sepsis screening tool (PSSST). According to the Standards for Reporting of Diagnostic Accuracy (STARD-concept), a retrospective diagnostic accuracy and cohort study was conducted. The participants were 380 consecutive adult patients (age >18 years) who activated the Prehospital care-system and were transported to Skaraborgs County Hospital in west of Sweden , and subsequently discharged with an ICD-10-code consistent with sepsis, during a three-month period between January through April, 2012.

RESULTS: Of 380 patients 180 (47%) were female and 200 (53%) were male and with a mean age of 74±15 years. The ASSESS had a higher sensitivity to all four established index tests. Of the included symptoms in ASSESS the most common were sudden fever (63,9%), sudden breathing difficulties (60%), sudden muscle weakness (23,9%) and sudden gastrointestinal symptoms (20,2%).

CONCLUSION: ASSESS showed a higher sensitivity compared to the other four index test, which could in turn enable an earlier identification of sepsis patients in the prehospital care. Symptom presentation is included in the ASSESS index test as compared to the other four index tests which focus in major on vital signs alone. An inclusion of symptom presentation in a prehospital screening tool may thus increase the identification of sepsis. However, evidence on clinical benefit of the ASSESS index test need to be prospectively validated. 

Keywords
Sepsis, identification, prehospital care, index test, sensitivity
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13536 (URN)
Conference
Advances in Health Care Sciences Conference, Stockholm Sweden, November 15-16, 2017
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-01-17Bibliographically approved
Heidenreich, K., Bremer, A., Materstvedt, L. J., Tidefelt, U. & Svantesson, M. (2017). Relational autonomy in the care of the vulnerable: Health care professionals' reasoning in Moral Case Deliberation (MCD). Medicine, Health care and Philosophy, 35, 37-42
Open this publication in new window or tab >>Relational autonomy in the care of the vulnerable: Health care professionals' reasoning in Moral Case Deliberation (MCD)
Show others...
2017 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 35, p. 37-42Article in journal (Refereed) Published
Abstract [en]

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while pro- tecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

Keywords
Clinical ethics, Ethics consultation, Moral case deliberation, Health care professionals, Qualitative research
National Category
Medical Ethics
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15399 (URN)10.1007/s11019-017-9818-6 (DOI)000451022600004 ()29243015 (PubMedID)2-s2.0-85038102190 (Scopus ID)
Available from: 2018-12-02 Created: 2018-12-02 Last updated: 2019-01-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

Search in DiVA

Show all publications