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  • 1.
    Ahlgren, Ellinore
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hjalmarsson, Emelie
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Upplevelser av vården på BB vid första barnets födelse: Intervjuer med icke-bärande kvinnor i samkönade relationer2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    I barnmorskans kunskapsområde ingår att vårda kvinnor före, under och efter förlossning samt att ge stöd i föräldraskapet. Oftast sker vården efter ett barns födelse på BB. Enligt WHO ska vården innefatta hela familjen. Tidigare forskning visar att kvinnor som får barn i en samkönad relation önskar att båda kvinnorna blir bekräftade som likvärdiga föräldrar av vårdpersonal, samt att ett öppet, intresserat och kompetent förhållningssätt som utgår ifrån den enskilda familjens behov är betydelsefullt. Det finns begränsat med forskning som enbart handlar om den icke-bärande kvinnan i samband med barnafödande. I den forskning som finns framkommer dock att det finns en bristande kunskap hos barnmorskor för den icke-bärande kvinnans roll, och att kvinnorna ibland bemöts utifrån ett heteronormativt synsätt genom att ses som pappan i relationen.

    Syftet med studien är att beskriva hur vården på BB upplevs vid första barnets födelse av den icke-bärande kvinnan i en samkönad relation. Kvalitativ metod med en induktiv ansats har använts där datainsamlingen gjorts genom intervjuer med 14 kvinnor. Datan har analyserats med kvalitativ innehållsanalys och resulterat i temat Att bli stärkt eller begränsad i föräldrarollen. Under temat har de två kategorierna Vikten av att bli inkluderad i vården och Att möta vården utifrån att inte tillhöra heteronormen samt sju underkategorier presenterats. Studiens resultat påvisar vikten av att den icke- bärande kvinnan inkluderas i vården. För att den icke-bärande kvinnan ska uppleva en god vård krävs kunskaper om barnafödande i samkönade relationer samt ett öppet förhållningssätt för olika familjekonstellationer hos vårdpersonalen. Barnmorskan på BB har möjlighet att stärka den icke-bärande kvinnan i sin föräldraroll, samtidigt som negativa upplevelser i vården kan resultera i att kvinnan upplever sig begränsad i sin föräldraroll.

  • 2.
    Alsholm, Linda
    et al.
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Niva, My
    Department of Ambulance Care, Jönköping County Hospital.
    Claesson, Lisa
    Department of Ambulance Care, Halland County Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Magnusson, Carl
    Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital.
    Rosengren, Lars
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Jood, Katarina
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg.
    Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.2019In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, article id e01266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA.

    AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend.

    METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS.

    RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache.

    CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

  • 3.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindholm, Maria
    Pettersson, Margareta
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nurses competencies in Home health care: An interview study.2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, no 65Article in journal (Refereed)
    Abstract [en]

    Background:Nurses working in Home health care (HHC) are facing major challenges when more advanced care and treatment are performing in the patient's home. The aim of this study was to explore how nurses experiencing their competencies in HHC. 

    Methods:This study has a qualitative and explorative design. Ten nurses were interviewed and data were analysed by content analysis.

    Results:The themes “Being a capable nurse”, “Being a useful nurse” and “Being a subordinate and dependent nurse” were identified. Nurses want to be capable to take care of patients, develop their competencies and perform their duties in the way that are requested. They also want to be useful in their work and providing good and safe HHC. Finally, nurses want to improve the care in HHC with their competencies. Simultaneously, they are subordinate and dependent in the relation with their manager and manager's interest to encourage nurses’ competence development.

    Conclusions:Nurses in HHC are responsible for many seriously ill patients and they want to contribute to a good and safe patient care. To maintain patient safety, reduce the risk for burnout and staff turnover as well as to contribute to a sustainable development of the work, strategies for transfer competencies between nurses and efforts for competence development are needed. 

  • 4.
    Andersson, S-O
    et al.
    Linköping Universitet.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tingström, Pia
    Linköping Universitet.
    Abrandt Dahlgren, Madeleine
    Linköping Universitet.
    Fixing the wounded or keeping lead in the air-tactical officers' views of emergency care on the battlefield2015In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, no 2, p. 224-229Article, review/survey (Refereed)
    Abstract [en]

    The aim of this study was to identify tactical officers' views of prehospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat-oriented including being able to do one's specialist task, being able to talk with local people, and being able to give first aid, and (2) combat-oriented including soldiers' skills and roles in the unit, being able to act in the unit, and being able to lead the care of injured. These findings are important for officers' preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

  • 5. Andersson, Sten-Ove
    et al.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tingström, Pia
    Abrandt Dahlgren, Madeleine
    Doctors' and nurses' perceptions of military pre-hospital emergency care - When training becomes reality.2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 32, p. 70-77, article id S1755-599X(17)30010-1Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify physicians' and nurses' perceptions of military pre-hospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The results after pre-deployment training can be categorised as (1) learning about military medicine and (2) taking care of the casualty. The results after an international mission can be categorised as (1) collaborating with others, (2) providing general health care and (3) improving competence in military medicine. These results indicate that the training should be developed in order to optimise pre-deployment training for physicians and nurses. This may result in increased safety for the provider of care, while at the same time minimising suffering and enhancing the possibility of survival of the injured.

  • 6. Backlund, Per
    et al.
    Engström, Henrik
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Johannesson, Mikael
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Enhancing Immersion with Contextualized Scenarios: Role-Playing in Prehospital Care Training2015In: 2015 7th International Conference on Games and Virtual Worlds for Serious Applications (VS-Games), Skövde, 2015Conference 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.

  • 7.
    Backlund, Per
    et al.
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Engström, Henrik
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Johannesson, Mikael
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Lebram, Mikael
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Danielsson, Magnus
    Västra Götalandsregionen.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    The S.A.R.E.K Simulation Environment: Technical description of a flexible training environment for prehospital care.2017Report (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.

  • 8.
    Crafoord, Viveca
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Informerat samtycke och informerade val under graviditet och förlossning: En kvantitativ enkätstudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Women have the right to informed consent and informed choice with regard to examinations and treatment during pregnancy and childbirth on the basis of the human rights conducted by The United Nations, and according to Swedish law. Women have historically been far down in the hierarchical order in the birthing care system. There is a risk culture in Western modern society that is also noticeable in the care of pregnant women and women giving birth. Women undergo a variety of examinations and treatments during pregnancy and childbirth, some of which have unclear evidence. The midwife has an important role to give women the opportunity for informed consent and informed choices regarding examinations and treatments during pregnancy and childbirth. There is a need for more knowledge about how women in Sweden are given the opportunity to do so. The aim of the study is to investigate whether women are given the opportunity for informed consent and informed choices with regard to examinations and treatments during pregnancy and childbirth. The study was conducted as a quantitative cross-sectional study and questionnaires were used for data collection. The collected data was analysed with both descriptive and analytical statistics.

    The results suggest that women are not given opportunities for informed consent and informed choices based on their true sense when it comes to several specific examinations and treatments during pregnancy and childbirth except for the routine ultrasound examination. Nevertheless do women perceive that they are given opportunities to participate in decision making regarding examinations and treatments in general during pregnancy and childbirth. Hierarchical schemes and risk culture that prevails in the birthing care system is earlier identified factors that may pose obstacles to women's opportunities for informed consent and informed choice during pregnancy and childbirth. Through a care based on a patient perspective, the status of women and women's autonomy would be strengthened. For sustainable development, women's opportunities to make informed choices about their sexual and reproductive health are crucial.

  • 9. Engström, Henrik
    et al.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Backlund, Per
    Lebram, Mikael
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Johannesson, Mikael
    Sterner, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    The impact of contextualization on immersion in healthcare simulation2016In: Advances in Simulation, ISSN 2059-0628, Vol. 1, no 1, p. 1-11Article in journal (Refereed)
    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.

  • 10.
    Gunnarsson, Linn
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Törnblom, Helene
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Barnmorskors upplevelser av etiska svårigheter vid arbetet med att utföra rutinultraljud: En kvalitativ intervjustudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Nästan alla gravida kvinnor i Sverige väljer att omkring graviditetsvecka 17-18 göra ett rutinultraljud. Undersökningen syftar till att fastställa viabilitet och graviditetslängd, kontrollera hur många foster som finns, undersöka moderkakans placering samt att göra en anatomisk granskning. Det är en undersökning som ofta präglas av starka känslor då de blivande föräldrarna får se sitt väntade barn. I de allra flesta fall ser fynden vid undersökningen ut som förväntat, men det händer att situationer uppstår som kan skapa etiska svårigheter. Ofta uppstår dessa svårigheter i samband med att en avvikelse upptäcks men de kan också dyka upp när de blivande föräldrarna och barnmorskan på något sätt inte möts. Syftet med studien är att beskriva vad barnmorskor upplever som etiska svårigheter i sitt arbete med rutinultraljud. Studien utgår ifrån en kvalitativ innehållsanalys med induktiv ansats och åtta barnmorskor intervjuades. Analysen resulterade i fyra kategorier och tio underkategorier. Kategorierna Att känna sig splittrad, Att förhålla sig till ett avvikande fynd, Att möta blivande föräldrars orimliga krav och Att både gasa och bromsa beskriver resultatet. Barnmorskor upplever att mötet med etiska svårigheter är oundvikligt i arbetet med rutinultraljud. De medicinsk-etiska principerna ligger till grund för resultatdiskussionen.

  • 11.
    Hansson, P-O
    et al.
    Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Brink, P
    Intensive Care Unit, NU-hospital.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital assessment of suspected stroke and TIA: an observational study.2019In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Symptoms related to stroke diverge and may mimic many other conditions.

    AIMS: To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA) METHODS: An observational multi-centre study including nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the EMS clinician before hospital admission during a four-month period were included.

    RESULTS: Of 1,081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, p=0.007, a history of myocardial infarction (OR: 1.77, p= 0.01), facial droop (OR: 2.81, p<0.0001), arm weakness (OR: 2.61, p<0.0001), speech disturbance (OR: 1.92, p<0.0001) and high systolic blood pressure (OR: 1.50, p=0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, p=0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up.

    CONCLUSIONS: Seven factors including the three symptoms included in the Face Arm Speech Test (FAST) were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke. This article is protected by copyright. All rights reserved.

  • 12. Heldal, Ilona
    et al.
    Backlund, Per
    Johannesson, Mikael
    Lebram, Mikael
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Connecting the links: Narratives, simulations and serious games in prehospital training.2017In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 235, p. 343-347Article in journal (Refereed)
    Abstract [en]

    Due to rapid and substantial changes in the health sector, collaboration and supporting technologies get more into focus. Changes in education and training are also required. Simulations and serious games (SSG) are often advocated as promising technologies supporting training of many and in the same manner, or increasing the skills necessary to deal with new, dangerous, complex or unexpected situations. The aim of this paper is to illustrate and discuss resources needed for planning and performing collaborative contextual training scenarios. Based on a practical study involving prehospital nurses and different simulator technologies the often-recurring activity chains in prehospital training were trained. This paper exemplifies the benefit of using narratives and SSGs for contextual training contributing to higher user experiences. The benefits of using simulation technologies aligned by processes can be easier defined by narratives from practitioners. While processes help to define more efficient and effective training, narratives and SSGs are beneficial to design scenarios with clues for higher user experiences. By discussing illustrative examples, the paper contributes to better understanding of how to plan simulation-technology rich training scenarios.

  • 13. Heldal, Ilona
    et al.
    Lundberg, Lars
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Technologies Supporting Longitudinal Collaboration Along Patients’ Pathway: Planning Training for Prehospital Care2015Conference paper (Refereed)
  • 14.
    Hulldin, Martin
    et al.
    Southern Älvsborg Emergency Medical Services.
    Kängström, Jonas
    Southern Älvsborg Emergency Medical Services.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Karolinska Institute.
    Perceived exertion using two different EMS stretcher systems, report from a Swedish study.2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, article id S0735-6757(18)30157-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency medical services (EMS) facilitate out of hospital care in a wide variety of settings on a daily basis. Stretcher-related adverse events and long term musculoskeletal injuries are commonly reported. Novel stretcher mechanisms may facilitate enhanced movement of patients and reduce workload for EMS personnel.

    AIM: To describe EMS personnel's perceived exertion using two different stretcher systems.

    METHODS: The methodology of this explorative simulation study included enrolling twenty (n=20) registered nurses and paramedics who worked in ten pairs (n=10) to transport a conscious, 165lb. (75kg) patient using two different EMS stretcher systems: the Pensi stretcher labeled A and the ALLFA stretcher labeled B. The ten pairs (n=10) were randomized to use either an A stretcher or a B stretcher with subsequent crossover. The pairs performed six identical tasks with each stretcher, including conveying stretchers from an ambulance up to the first floor of a building via a staircase, loading a patient on to the stretcher, and using the stretcher to transport the patient back to the ambulance. The subjective Rating of Perceived Exertion (RPE) survey (Borg scale) was used to measure perceived exertion at predefined intervals during transport.

    RESULTS: No significant differences in workload were seen between stretcher groups A and B regarding unloading the stretcher (7.4 vs 8.2 p=0.3), transporting up a stairway (13.7 vs 12.5 p=0.06), lateral lift (12.1 vs 11.2 p=0.5), or flat ground transportation (10.4 vs 11.1 p=0.13). Pairs using stretcher A showed significantly less workload with regards to transporting down a stairway (11.0 vs 14.5 p<0.001) and loading into ambulance (11.1 vs 13.0 p<0.001).

    CONCLUSION: A structured methodology may be used for testing the exertion levels experienced while using different stretcher systems. The use of supporting stretcher system mechanisms may reduce perceived exertion in EMS personnel mainly during transports down stairs and during loading into ambulance vehicles.

  • 15.
    Höglund, Erik
    et al.
    Örebro University.
    Schröder, Agneta
    Örebro University.
    Möller, Margareta
    Örebro University.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ohlsson-Nevo, Emma
    Örebro University.
    The ambulance nurse experiences of non-conveying patients.2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 1, no 10Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.

    BACKGROUND: Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.

    DESIGN: A qualitative interview study was conducted using an inductive research approach.

    METHODS: The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.

    RESULTS: The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.

    CONCLUSION: If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.

    RELEVANCE TO CLINICAL PRACTICE: This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.

  • 16.
    Jonasson, Lise-Lotte
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training2019In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed)
    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

  • 17. Kuzmicova, Anezka
    et al.
    Dias, Patricia
    Vogrincic Cepic, Ana
    Albrechtslund, Anne-Mette
    Kotrla Topic, Marina
    Minguez Lopez, Xavier
    Nilsson, Skans Kersti
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Teixeira-Botelho, Ines
    Social Space in Silent Reading Practices2017Conference paper (Refereed)
  • 18. Lundberg, Lars
    BATLS (Battlefield Advanced Trauma Life Support): Ny traumautbildning i svenska Försvarsmakten2000In: Annales Medicinae Militaris Fenniae, ISSN 0300-8797, Vol. 1, p. 28-29Article in journal (Other academic)
  • 19.
    Magnusson, Carl
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg .
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nilsson, Lena
    Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University.
    Strömsöe, Anneli
    School of Education, Health and Social Studies, Dalarna University .
    Munters, Monica
    Department of Ambulance Care, Region of Dalarna.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The final assessment and its association with field assessment in patients who were transported by the emergency medical service.2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 111Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.

    AIM: In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.

    METHODS: Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.

    RESULTS: In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.

    CONCLUSION: Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

  • 20. Mosalanezhad, Zahra
    et al.
    Sotoudeh, Gholam
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Salavati, Mahyar
    Harms-Ringdahl, Karin
    Nilsson Wikmar, Lena
    Frändin, Kerstin
    A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 70, p. 123-129Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM:

    Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

    METHODS:

    Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

    RESULTS:

    The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

    CONCLUSION:

    Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

  • 21.
    Nilsson, Christina
    Göteborgs Universitet.
    The delivery room: is it a safe place? A hermeneutic analysis of women's negative birth experiences.2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 4, p. 199-204, article id S1877-5756(14)00063-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women's negative experiences in the delivery room can have significance for later fear of childbirth. Therefore, it is important to critically evaluate the care during childbirth. The aim was to gain a deeper understanding of women's negative experiences in the delivery room.

    METHODS: This study is based on original data from three qualitative studies on Swedish women's experiences of fear of childbirth. Data were collected from interviews with 21 women; 15 pregnant women (6 + 9) with intense fear of childbirth, and six women who had experienced intense fear of childbirth 7-11 years prior to the interview. The analysis had a hermeneutic approach, with focus on the women's descriptions of their previous negative birth experiences.

    FINDINGS: The interpretation showed that in the delivery room the women were objects of surveillance, and they endured suffering related to the care during childbirth. This involves experiences of midwives as uncaring, feelings of being suppressed, unprotected and lacking safety, of feeling disconnected and of the body as incompetent in giving birth. The birth environments are understood as power structures, containing views of women's birthing bodies as machines, and delivery rooms as surveillance environments, involving interventions such as foetal heart monitoring, induction and augmentation of labour.

    CONCLUSIONS: The delivery room was, for these women, a place creating fear of childbirth. To avoid negative birth experiences and future fear, women must be offered not only medical, but also emotional and existential safety in the delivery room.

  • 22.
    Sanfridsson, J
    et al.
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Sparrevik, J
    Västerbotten Emergency Medical Services.
    Hollenberg, J
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Nordberg, P
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Djärv, T
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Ringh, M
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Svensson, L
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Forsberg, S
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Nord, A
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, A
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Drone delivery of an automated external defibrillator - a mixed method simulation study of bystander experience.2019In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in Sweden have increased, novel methods are needed to facilitate early treatment. Unmanned aerial vehicles (i.e. drones) have potential to deliver automated external defibrillators (AED). The aim of this simulation study was to explore bystanders' experience of a simulated OHCA-situation where a drone delivers an AED and how the situation is affected by having one or two bystanders onsite.

    METHODS: This explorative simulation study used a mixed methodology describing bystanders' experiences of retrieving an AED delivered by a drone in simulated OHCA situations. Totally eight participants were divided in two groups of bystanders a) alone or b) in pairs and performed CPR on a manikin for 5 minutes after which an AED was delivered by a drone at 50 m from the location. Qualitative data from observations, interviews of participants and video recordings were analysed using content analysis alongside descriptive data on time delays during bystander interaction.

    RESULTS: Three categories of bystander experiences emerged: 1) technique and preparedness, 2) support through conversation with the dispatcher, and 3) aid and decision-making. The main finding was that retrieval of an AED as delivered by a drone was experienced as safe and feasible for bystanders. None of the participants hesitated to retrieve the AED; instead they experienced it positive, helpful and felt relief upon AED-drone arrival and were able to retrieve and attach the AED to a manikin. Interacting with the AED-drone was perceived as less difficult than performing CPR or handling their own mobile phone during T-CPR. Single bystander simulation introduced a significant hands-off interval when retrieving the AED, a period lasting 94 s (range 75 s-110 s) with one participant compared to 0 s with two participants.

    CONCLUSION: The study shows that it made good sense for bystanders to interact with a drone in this simulated suspected OHCA. Bystanders experienced delivery of AED as safe and feasible. This has potential implications, and further studies on bystanders' experiences in real cases of OHCA in which a drone delivers an AED are therefore necessary.

  • 23.
    Sjösten, Oscar
    et al.
    SÄS.
    Nilsson, Johanna
    SÄS.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jiménez-Herrera, Maria
    Universitat Rovira i Virgili.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The prehospital assessment of patients with a final hospital diagnosis of sepsis: Results of an observational study2019In: Australasian Emergency Care, ISSN 2588-994XArticle in journal (Refereed)
    Abstract [en]

    Background

    Sepsis is a severe condition which affects 300–800/100,000 persons each year. There are indications that the prehospital identification of patients with sepsis is difficult. The aim of the study was, among patients with a final hospital diagnosis of sepsis, to compare emergency medical service (EMS) field assessments of patients in whom there was a prehospital suspicion of sepsis with those without this suspicion.

    Methods

    The study had a retrospective, observational design. The data used in the study were retrieved from the prehospital and hospital medical records of patients with a final hospital diagnosis of sepsis, transported to hospital by the EMS within a region in the south west of Sweden during a period of one year.

    Results

    Among patients with a final diagnosis of sepsis (n = 353), the EMS identified the condition in 36% of the cases. These patients were characterised by more abnormal vital signs (a higher respiratory rate and heart rate and more frequent temperature abnormalities) and were more ambitiously assessed (more lung auscultations and more assessments of the degree of consciousness).

    Conclusion

    The EMS was already able to identify 36% of patients with a final diagnosis of sepsis in the prehospital phase. There were minor differences in the prehospital assessment between patients who were identified by the EMS nurse and those who were not.

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