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Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)ORCID iD: 0000-0002-1789-8158
University of Borås, Faculty of Librarianship, Information, Education and IT. University of Borås, Faculty of Caring Science, Work Life and Social Welfare. PreHospen – Centre for Prehospital Research, University of Borås, Sweden;PICTA – Prehospital Innovation Arena, Lindholmen Science Park, Sweden.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Academy for Caring Science, Work Life & Social Welfare, University of Borås, Sweden;PreHospen – Centre for Prehospital Research, University of Borås, Sweden;Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Sweden;Department of Health and Caring Sciences, Linnaeus University, Sweden.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)ORCID iD: 0000-0001-8536-1910
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2023 (English)In: Paramedicine, ISSN 2753-6386Article in journal (Refereed) Published
Abstract [en]

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.

 

Place, publisher, year, edition, pages
Sage Publications, 2023.
Keywords [en]
health and well-being, qualitative analysis and interpretation, clinical reasoning, decision making, emergency medicalservices, work and healthcare environment
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-30241DOI: 10.1177/27536386231189011Scopus ID: 2-s2.0-85175415486OAI: oai:DiVA.org:hb-30241DiVA, id: diva2:1787167
Available from: 2023-08-11 Created: 2023-08-11 Last updated: 2024-02-01Bibliographically 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, UlfMaurin Söderholm, HannaAndersson, HenrikWireklint Sundström, BirgittaAndersson Hagiwara, MagnusPuaca, Goran

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