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Clinical Reasoning among Registered Nurses in Emergency Medical Services: A Case Study
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. University of Borås. (PreHospen)ORCID iD: 0000-0002-1789-8158
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)ORCID iD: 0000-0001-8536-1910
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)
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2022 (English)In: Journal of Cognitive Engineering and Decision Making, ISSN 1555-3434, E-ISSN 2169-5032Article in journal (Refereed) Published
Abstract [en]

In emergency medical services (EMS), the clinical reasoning (CR) of registered nurses (RNs) working in ambulance care plays an important role in providing care and treatment that is timely, accurate, appropriate and safe. However, limited existing knowledge about how CR is formed and influenced by the EMS mission hinders the development of service provision and decision support tools for RNs that would further enhance patient safety. To explore the nature of CR and influencing factors in this context, an inductive case study examined 34 observed patient–RN encounters in an EMS setting focusing on ambulance care. The results reveal a fragmented CR approach involving several parallel decision-making processes grounded in and led by patients’ narratives. The findings indicate that RNs are not always aware of their own CR and associated influences until they actively reflect on the process, and additional research is needed to clarify this complex phenomenon.

Place, publisher, year, edition, pages
2022.
Keywords [en]
Clinical reasoning, decision-making, problem-solving, naturalistic studies, field study, healthcare delivery, emergency medical services
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-27921DOI: 10.1177/15553434221097788ISI: 000800553600001Scopus ID: 2-s2.0-85131073033OAI: oai:DiVA.org:hb-27921DiVA, id: diva2:1660892
Projects
Bedömning och beslutsfattande i ambulanssjukvårdAvailable from: 2022-05-25 Created: 2022-05-25 Last updated: 2023-10-03Bibliographically approved
In thesis
1. Clinical reasoning among emergency medical service clinicians: An iterative and fragmented process involving the collaborative effort(s) of many
Open this publication in new window or tab >>Clinical reasoning among emergency medical service clinicians: An iterative and fragmented process involving the collaborative effort(s) of many
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the thesis was to generate knowledge and understanding of clinical reasoning in the context of EMS from the perspective of EMS clinicians.

Method: Three different methodologies were employed to describe various aspects of clinical reasoning. In Study I, an integrative literature review was conducted to summarise the existing literature related to clinical reasoning in EMS. After conducting systematic searches and screening, 38 articles were identified and analysed through an inductive thematic analysis. Studies II and III were conducted as case studies within an EMS organisation to capture clinical reasoning as it takes place in the naturalistic environment. In total, 34 patient encounters were observed, and group and individual interviews were conducted with EMS clinicians and organisational representatives at various hierarchical levels within the EMS organization. The data were analysed through pattern matching and triangulation in a computerised software program for qualitative analysis. Study IV was conducted as a goal-directed task analysis which focused on what EMS clinicians need in terms of achieving situation awareness. An online survey was created and answered by 30 EMS subject matter experts, consisting of active EMS clinicians, academic teachers in specialist ambulance nursing programmes, and researchers in the field of EMS. The data were analysed using qualitative content analysis and descriptive statistics.

Main results: Clinical reasoning in EMS is a continuously ongoing, iterative, and fragmented process. Information is gathered, analysed, and utilised at any given point during the mission. This information is then reasoned against various goals or instructions provided by the EMS organisation or what is perceived as the most suitable action by the EMS clinician. In the reasoning process, the clinicians take the patients’ and their relatives’ points of interest into account, striving to fulfil these. The clinical reasoning process continues after and between the missions well, and clinicians constantly evaluate their decisions and care provision for future improvement. Even if medical and caring interventions are the focus of clinical reasoning, this process involves the consideration of other aspects as well, such as logistics and safety for everyone present. Nevertheless, there seems to be a vague mandate for decision making among EMS clinicians in relation to other collaborative partners. Furthermore, organisational support for clinical reasoning and development is lacking, often due to economic limitations.

Conclusion: This thesis contributes to the caring science field with an increased understanding of the complexity of clinical reasoning in EMS. EMS clinicians today need to rely on themselves or their partners to have sufficient knowledge or experience to handle the situation encountered and provide safe patient care. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. EMS clinicians today need to rely on themselves or their partner to have sufficient knowledge or experience to handle situations encountered and provide patient safe care. 

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2023
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 142
Keywords
Emergency medical services, Clinical reasoning, Ambulance, Pre-hospital, Health and well-being
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29844 (URN)978-91-89833-11-1 (ISBN)978-91-89833-12-8 (ISBN)
Public defence
2023-11-10, C203, Allégatan 1, Borås, 09:00 (Swedish)
Opponent
Available from: 2023-10-20 Created: 2023-05-29 Last updated: 2023-12-12Bibliographically approved

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Andersson, UlfAndersson Hagiwara, MagnusWireklint Sundström, BirgittaAndersson, HenrikMaurin Söderholm, Hanna

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