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  • 1.
    Ahl, Caroline
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjälte, L
    Johansson, C
    Wireklint-Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Culture and care in the Swedish ambulance services2005Ingår i: Emergency Nurse, ISSN 1354-5752, E-ISSN 2047-8984, Vol. 13, nr 8, s. 30-36Artikel i tidskrift (Refereegranskat)
  • 2.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Vårdande och systematisk bedömning2016Ingår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 178-210Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 3.
    Andersson Hagiwara, Magnus
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, P
    Högskolan väst.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, P-O
    University of Gothenburg.
    A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.2018Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke.

    MATERIALS & METHODS: The Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital.

    RESULTS: Of 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital.

    CONCLUSIONS: Patients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.

  • 4.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Competencies in Swedish emergency departments: The practitioners’ and managers’ perspective2014Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, nr 2, s. 81-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs. Methods: This study used a qualitative, exploratory design. Interviews were conducted in two EDs. Data were analysed using inductive content analysis. Results: The competence focus in everyday work in EDs is on emergency and life-saving actions. There is a polarisation between medical and caring competencies. There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the ability to develop competencies in everyday work. Medical competencies are valued more and caring competencies are subsequently downgraded. A medical approach to competencies consolidates the view of necessary competencies in everyday work in EDs. Conclusions: The study shows that the competencies that are valued consolidate the prevailing medical paradigm. There is a traditional, one-sided approach to competencies, a hierarchical distinction between professional groups and unclear occupational functions.

  • 5.
    Andersson, Henrik
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Management of everyday work in Emergency Departments: An exploratory study with Swedish Managers2014Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, nr 4, s. 81-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Through their formal mandate, position and authority, managers are responsible for managing everyday work in Emergency Departments (EDs) as well as striving for excellence and dealing with the individual needs of practitioners and patients. The aim of the present study is to explore managers’experiences of managing everyday work in Swedish EDs. Method: A qualitative and exploratory design has been used in this study. Seven managers were interviewed at two EDs. Data was analysed using qualitative content analysis with focus on latent content. Results: Managers experience everyday work in the ED as lifesaving work. One of the characteristics of their approach to everyday work is their capability for rapidly identifying patients with life-threatening conditions and for treating them accordingly. The practitioners are on stand-by in order to deal with unexpected situations. This implies having to spend time waiting for the physicians’ decisions. Management is characterised by a command and control approach. The managers experience difficulties in meeting the expectations of their staff. They strive to be proactive but instead they become reactive since the prevailing medical, bureaucratic and production-orientated systems constrain them. Conclusion: The managers demonstrate full compliance with the organisational systems. This threatens to reduce their freedom of action and influences the way they perform their managerial duties within and outside the EDs.

  • 6. Aronsson, Kenneth
    et al.
    Björkdahl, Ida
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Prehospital emergency care for patients with suspected hip fractures after falling: older patients’ experiences2014Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, nr 21-22, s. 3115-3123Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: The aim of this study was to describe and explain elderly patients’ lived experiences of prehospital emergency care in cases of suspected hip fractures after falling. Background: Hip fractures represent a major health problem for older people and are a common assignment for the Emergency Medical Services (EMS), but there is little information on how patients experience prehospital emergency care. Design: A reflective lifeworld approach based on phenomenological epistemology was used in an interview study within the context of healthcare science. Methods: Ten elderly patients were interviewed. These depth interviews were tape-recorded, transcribed verbatim and analysed for meanings. Results: The comprehensive understanding of the phenomenon is: ‘Happy to have been rescued, despite bad experiences as well as good’. The elderly patient is offered care in an open and friendly atmosphere concurrently with feeling anxiety about the treatment. Intervention with streamlined care and treatment can thus simultaneously be beneficial as well as doing harm. Patients experience confusion and the need to ask questions about what really happened in the ambulance. Bad experiences remain unexplained. This study is based on three themes with relevant sub-themes: efficiency, concerned encounters and suffering from care. Conclusions: Our study contribute to this field of discussion, showing that administering drugs which cause side effects in already fragile older people is compatible with neither evidence-based care nor evidenced-based medicine. The side effects of pain relief – however efficient that pain relief may be – are taken seriously. Relevance to clinical practice: Pain relief in the EMS should be individualised. Responsibility for patients’ safety regarding pain relief is emphasised. This development should focus on care that is already good and gradually eradicate compassionless care. Keywords: caring science, hip fracture, lived experiences, phenomenology, emergency medical services, ambulance, care pathway, prehospital emergency nurse

  • 7. Brante, Thomas
    et al.
    Nolin, Jan
    Högskolan i Borås, Institutionen Biblioteks- och informationsvetenskap / Bibliotekshögskolan.
    Grimen, Harald
    Brorström, Björn
    Högskolan i Borås, Gemensamma förvaltningen.
    Lööf, Staffan
    Högskolan i Borås, Gemensamma förvaltningen.
    Sundström, Malin
    Högskolan i Borås, Institutionen Handels- och IT-högskolan.
    Oudhuis, Margareta
    Högskolan i Borås, Institutionen för Pedagogik.
    Kammensjö, Peter
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Torstensson, Håkan
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Wireklint Sundström, Birgitta
    Eriksson, Catarina
    Högskolan i Borås, Institutionen Biblioteks- och informationsvetenskap / Bibliotekshögskolan.
    Lindh, Maria
    Högskolan i Borås, Institutionen Biblioteks- och informationsvetenskap / Bibliotekshögskolan.
    Adamson, Lena
    Profession och vetenskap: idéer och strategier för ett professionslärosäte2009Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Förord av Björn Brorström, Prorektor Högskolan i Borås Ett professionslärosäte bedriver utbildning och forskning på vetenskaplig grund. Vetenskapliga metoder tillämpas och framkomna resultat prövas för att säkra tillförlitlighet och relevans. Förmågan att problematisera, formulera frågor och välja lämpliga metoder för att besvara frågor är egenskaper för god forskning och utmärkande för en stark utbildnings- och forskningsmiljö. Vid ett professionslärosäte finns samtidigt en stark strävan efter att i utbildning och forskning ta till vara den kunskap och de erfarenheter som professioner besitter och därigenom säkra en hög grad av praktisk relevans. Växelverkan mellan teori och praktik och erfarenhetsutbyte mellan forskare och praktiker är ständigt pågående. Det finns ingen avslutning på processen utan den pågår utan avbrott. En nödvändig förutsättning för ett fruktbart samarbete är en ömsesidig respekt och vilja att stödja och ifrågasätta varandra. Forskaren måste vara beredd på kritik för bristen på praktisk relevans och professionsföreträdaren måste vara beredd på att förtrogenhetskunskapens lämplighet ifrågasätts. Det är en fråga om med- och mothåll från båda håll i syfte att långsiktigt utveckla teori och praktik. Det är en utmaning att utveckla, etablera och därefter kontinuerligt försvara och förbättra professionslärosätet. Ett led i utvecklingen är att inom ramen för Högskolan i Borås föra en debatt om innebörden av ett professionslärosäte och vad vi behöver göra för att förbättra verksamheten. På uppdrag av rektor Lena Nordholm har medarbetare vid Bibliotekshögskolan utvecklat och ansvarat för en seminarieserie benämnd Profession och vetenskap. Seminarierna spände över ett brett fält. En av många viktiga frågor som diskuterades flitigt var huruvida vi ska forska om professioner, i för eller med, eller kanske alltihop samtidigt. Bidragen publiceras nu i denna antologi som ges ut inom ramen för Högskolan i Borås rapportserie Vetenskap för profession. Rapporten Profession och vetenskap – idéer och strategier för ett professionslärosäte, som redigerats av universitetsadjunkt Maria Lindh, kommer att få stor betydelse inom lärosätet och i vårt samarbete med företrädare för näringsliv, kulturliv och offentlig verksamhet. Jag ser det som en intressant fortsättning att anordna ett antal seminarier med inbjudna representanter för professioner där artiklarna i denna rapport kan ligga till grund för erfarenhetsutbyte och diskussioner.

  • 8.
    Bremer, Anders
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Vårdrum: ett vårdande rum2014Ingår i: Akut omhändertagande av trauma - på skadeplats och akutmottagning / [ed] Carina Elmqvist, Sofia Almerud Österberg, Liber , 2014, s. 23-53Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [sv]

    Syftet med detta kapitel är att bidra med fördjupad förståelse av begreppet vårdrum och samtidigt presentera en vårdvetenskaplig ram. I detta kapitel beskrivs skadeplatsens oordnade miljö och skiftande villkor, kännetecken och utmaningar som finns för ambulanspersonal att planera för och upprätta vårdrum för patienter som utsatts för trauma, i samverkan med räddnings- tjänst och polis. Därefter beskrivs villkor för patienternas och de närståen- des vårdrum på akutmottagningen. I kapitlet ges exempel på hur vårdande rum kan främjas och upprättas samt hur vårdrummet kan upplevas av de närvarande, vilket gestaltas utifrån forskning och erfarenheter som gjorts av vårdare, patienter och närstående. Kapitlet bygger främst på vårdveten- skaplig forskning.

  • 9.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindra och behandla bröstsmärta/hjärtproblem hos patienter som söker ambulanssjukvård. LINDRA: en klinisk interventionsstudie2007Ingår i: Samverkan 112, ISSN 1650-7487Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 10.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Smärta och ångest engagerar forskare i ambulanssjukvård2007Ingår i: Samverkan 112, ISSN 1650-7487, Vol. 6, nr 4, s. 70-71Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 11.
    Gabre, Marita
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Olausson, Sepideh
    'A little good with the bad': Newly diagnosed type 2 diabetes patients' perspectives onself-care: A phenomenological approach2018Ingår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Increased knowledge is needed about what self-care means from the patients’ perspective, especially since the patient population with type 2 diabetes has been rising. The aim was to describe self-care, as experienced by patients with newly diagnosed type 2 diabetes. This study adopted a phenomenological approach. Eight patients were interviewed. A combination of photos and interviews were used. The essential meaning of self-care was found to be an existential struggle that evokes feelings of being in-between one’s old unhealthy life and a new healthier one. In this in-between condition, tension exits between contradictorily emotions of anxiety, hopelessness and hope. This struggle also means questioning one’s identity. It is important that diabetes nurses create an opening for reflection and dare to challenge their patients to reflect on this existential struggle.

  • 12.
    Hagiwara, Magnus
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove (Redaktör)
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Vård och bedömning2009Ingår i: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, s. 117-145Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 13.
    Hansson, Per-Olof
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, Peter
    University West.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital identification of factors associated with death during one-year follow-up after acute stroke.2018Ingår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, artikel-id e00987Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke.

    MATERIAL AND METHODS: All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria.

    RESULTS: In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of <90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03.

    CONCLUSIONS: Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.

  • 14.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint-Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, Christer
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ljungström, Lars
    Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.2012Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  • 15.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Berglund, A
    Svensson, L
    Blomstrand, C
    Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities2010Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 18, nr 48, s. 13-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method: A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results: In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women). With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion: Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.

  • 16.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Omerovic, E
    Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? Both relief of pain and anxiety are needed2011Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 149, nr 2, s. 147-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Many patients who suffer from acute chest pain are transported by ambulance. It is not known how often treatment prior to hospital admission is optimal and how optimal pain-relieving treatment is defined. It is often difficult to delineate pain from anxiety. Aim To describe various aspects of chest pain in the pre-hospital setting with the emphasis on a) treatment and b) presumed acute coronary syndrome. Methods In the literature search, we used PubMed and the appropriate key words. We included randomised clinical trials and observational studies. Results Four types of drug appear to be preferred: 1) narcotic analgesics, 2) nitrates, 3) beta-blockers and 4) benzodiazepines. Among narcotic analgesics, morphine has been associated with the relief of pain at the expense of side-effects. Alfentanil was reported to produce more rapid pain relief. Nitrates have been associated with the relief of pain with few side-effects. Beta-blockers have been reported to increase the relief of pain when added to morphine. The combination of beta-blockers and morphine has been reported to be as effective as beta-blockers alone in pain relief, but this combination therapy was associated with more side-effects. Experience from anxiety-relieving drugs such as benzodiazepines is limited. It is not known how these 4 drugs should be combined. The results indicate that various pain-relieving treatments might modify the disease. Conclusion Our knowledge of the optimal treatment of chest pain and associated anxiety in the pre-hospital setting is insufficient. Recommendations from existing guidelines are limited. Large randomised clinical trials are warranted.

  • 17.
    Holmberg, Mats
    et al.
    Ambulanssjukvården i Södermaland.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Winge, Karin
    Ambulanssjukvården Södra Älvsborgssjukhus.
    Lundberg, Camilla
    Ambulanssjukvården Södra Älvsborgssjukhus.
    Karlsson, Thomas
    Sahlgrenska akademin vid Göteborgs universitet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Association between the reported intensityof an acute symptom at first prehospital assessment and the subsequent outcome:a study on patients with acute chest painand presumed acute coronary syndrome2018Ingår i: BMC Cardiovascular Disorders, s. 1-10, artikel-id 18:216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development ofpotentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) areimportant. The aim of this study has therefore been to explore the possible association between patients’ estimatedintensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcomebefore and after arrival in hospital.

    Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raisingsuspicion of ACS and a reported intensity of pain ≥4 on the visual analogue scale.

    Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) moreheart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest painafter hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation.However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment forpossible confounders including age, a history of smoking and heart failure showed similar results.

    Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team wasassociated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospitaladmission, the final diagnosis and the number of days in hospital.

  • 18. Lingsarve, Johan
    et al.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, Andreas
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Abelsson, Anna
    Svensson, Anders
    Wallin, Kim
    Kågström, Christer
    Rantala, Andreas
    Wihlborg, Jonas
    Ek, Bo
    Styrwoldt, Eva
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kompetens i ambulansen ger en säker akutsjukvård2015Ingår i: Dagens Medicin, ISSN 1104-7488Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 19.
    Norberg Boysen, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Department of Nursing, Jönköping University, Jönköping, Sweden.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jutengren, Göran
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Use of the Medical emergency services by patients with suspected acte primary healthcare problems: Developing av questionnaire measure patient trust in healthcare2016Ingår i: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 4, nr 3, s. 444-452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale aims and objectives: The objective of this study was to develop a questionnaire measuring the level of trust and its constituents in patients calling the Emergency Medicak Services (EMS) for suspected acute primary healthcare problems. The questionnaire is called the Patient Trust Questionnaire (PTQ). The following frontline service providers were involved: 1) The Dispatch Centre, 2) the Emergency Medical Services and 3) the recieving unit (the Emergency Department/Healthcare Centre)

    Method: Cross-sectional data were collected repeately and redundant items were discarded using a step-by-step approach. Based on litterature review, the PTQ was developed in line with the folowing 4-step procedure: 1) item construction, 2) a face-to-face evaluation of separate items, 3) an emerical pre-evaluation targeting each separate frontline service provider and 4) an emperical full-scale evaluation. The inclusion criteria for participating were that the patient must be 18 years of age or older and suspected having a suspected acute primary care problem when calling the EMS. In the finale full-scale evaluation of the questionnaire, 427 patients were included.

    Results: A set of 8 items with good phsycometric properties remained through the developing procedure. Two constituents of trust emerged (labelled credibility and accessibility), witch were robust across all fronline service providers.

    Conclusion: A new measuring instrument has been developed for this particular healthcare chain, for patients with suspected acute primary care problem calling the EMS. Althought not yet validated, the PTQ is a potentially usefull tool in future healthcare research with reference to the concept of patient trust.

  • 20.
    Norberg Boysen, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Jönköpings universitet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective2017Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for non-urgent condition and been referred to the healthcare centre.

    Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patient participated: seven female and three male. The setting is the early chain of healthcare in south-wetern Sweden.

    Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of lifeworld" enables the patient to feel trust.

    Conclusion: Trust in the early chain of healthcare entails caregivers' ability to play attention to both medical and existentioal issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessment and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

  • 21.
    Norberg, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Swedish emergency medical services' identification of potential candidates for primary healthcare: Retrospective patient record study.2015Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 33, nr 4, s. 311-317Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.

    DESIGN: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.

    SETTINGS: The study was completed at the EMS and five hospital areas in the western region of Sweden.

    SUBJECTS: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%.

    MAIN OUTCOME MEASURES: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.

    RESULTS: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.

    CONCLUSION: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.

    IMPLICATIONS: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare. Key points Patients calling the emergency medical services do not always end up at an appropriate level of healthcare. In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare. These patients were younger and healthier than those needing care at the emergency department. They were found at all priority levels and within all symptom groups.

  • 22.
    Suserud, Björn-Ove
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ahl, Caroline
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjälte, L
    Johansson, C
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint-Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Unique characteristics of ambulance care2005Konferensbidrag (Refereegranskat)
  • 23. Svendsen, Susanne
    et al.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif (Redaktör)
    Sjukvårdsrådgivning2009Ingår i: Prehospital akutsjukvård, Stockholm: Liber , 2009, s. 79-82Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 24.
    Thang, ND
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, BW
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    ECG signs of acute myocardial ischemiain the prehospital setting of a suspected acute coronary syndrome and its association with outcomes2014Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 32, nr 6, s. 601-605Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest pain patients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.

  • 25.
    Thang, Nguyen Dang
    et al.
    Göteborgs Universitet.
    Karlson, Björn Wilgot
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Herlitz, Johan
    Pre-hospital prediction of death or cardiovascular complications during hospitalisation and death within one year in suspected acute coronary syndrome patients.2015Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 185, s. 308-312Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To identify pre-hospital predictors of a) death or the development of cardiovascular complications during hospitalisation (primary objective) and b) all-cause death during one year of follow-up (secondary objective), in chest pain patients with suspected acute coronary syndrome (ACS).

    METHODS: A prospective study that comprised patients in western Sweden, who were transported to hospital by the emergency medical service (EMS) due to chest pain and suspected ACS. Multiple logistic regression was used to identify independent predictors of adverse outcomes.

    RESULTS: Among all 1600 eligible patients, 21% died or had a cardiovascular complication during hospitalisation and 10% died during one year of follow-up. Nine factors were identified pre-hospitalisation as independent predictors of death or cardiovascular complications during hospitalisation. They were increasing age, a history of congestive heart failure, nausea and/or vomiting, rapid breathing rate, low oxygen saturation, high heart rate, together with ST-segment elevation, ST-segment depression and right bundle branch block on the pre-hospital electrocardiogram (ECG). For the secondary objective of death during one year of follow-up, the following five factors were identified as independent predictors: increasing age, a history of congestive heart failure, dyspnea, low oxygen saturation and left bundle branch block on the pre-hospital ECG.

    CONCLUSIONS: In the pre-hospital setting of chest pain and suspected ACS, we identified nine predictors of the primary adverse outcome. They were factors representing previous history, symptoms and ECG findings. This information may contribute to the development of a decision support system for the EMS, which then needs to be clinically tested.

  • 26. Vicente, Veronica
    et al.
    Ekebergh, Margaretha
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castren, Maaret
    Sjöstrand, Fredrik
    Svensson, Leif
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Differentiating frailty in older people using the Swedish ambulance service: A retrospective audit2012Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, nr 4, s. 228-235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The elderly population in Sweden is increasing. This will lead to an increased need for healthcare resources and put extra demands on healthcare professionals. Consequently, ambulance personnel will be faced with the challenge of meeting extra demands from increasing numbers of older people with complex and atypical clinical presentations. Therefore we highlight that great problems exist for ambulance personnel to understand and meet these patients’ care needs. Using a caring science approach, we apply the patient’s perspective, and the aim of this study is to identify and illuminate the conditions that affect elderly people assessed with the assessment category “general affected health condition”. Thus, we have analyzed the characteristics belonging to this specific condition. The method is a retrospective audit, involving a qualitative content analysis of a total of 88 emergency service records. The conclusion is that by using caring science, the concept of frailty which is based on a comprehensive understanding of human life can clarify the state of “general affected health condition”, as either illness or ill-health. This offers a new assessment category and outlines care and treatment that strengthen and support the health and wellbeing of the individual elderly person. Furthermore, the concept of frailty ought to be included in “The International Statistical Classification of Diseases and Related Health Problems” (ICD-10).

  • 27. Vicente, Veronica
    et al.
    Sjöstrand, Fredrik
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif
    Castrén, Maaret
    Developing a decision support system for geriatric patients in prehospital care.2013Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 20, nr 4, s. 240-247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To develop a feasible and safe prehospital decision support system (DSS) for the emergency medical services (EMS), facilitating safe steering of geriatric patients to an optimal level of healthcare. Methods The development process involves four consecutive steps. The first step was gathering data from patients transported by EMS, with the electronic patient care record, to retrospectively identify appropriate patient categories for steering. The second step was to allow a group of medical experts to give advice and suggestions for further development of the DSS. The third step was validation of the decision support tool and the fourth step was validation of the entire prehospital DSS in a pilot study. Results The patient categories relevant to steering were those medical conditions that the geriatric clinicians felt confident in receiving from the EMS. A prehospital DSS was then developed for these 11 medical conditions. The evaluation and validation of the DSS showed a high degree of compliance with the patients’ final level of healthcare. The pilot study included 110 randomized patients; 33.9% were triaged to an alternative level of healthcare, that is geriatric care or primary care. No medical inaccuracies or secondary transports from alternative care to the hospital emergency department were identified. Conclusion Using this prehospital DSS – developed for 11 medical conditions – the Swedish prehospital nurse can safely decide on the level of healthcare to which an elderly patient can be steered. Keywords: ambulance, assessment, emergency medical service, geriatrics, prehospital nurse, triage

  • 28. Vicente, Veronica
    et al.
    Svensson, Leif
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sjöstand, Fredrik
    Castren, Maaret
    Randomized Controlled Trial of a Prehospital Decision System by Emergency Medical Services to Ensure Optimal Treatment for Older Adults in Sweden2014Ingår i: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 62, nr 7, s. 1281-1287Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Evaluate the safety and feasibility of a prehospital system (“system”) and a support tool (“tool”) that allow the ambulance nurse to transport geriatric patients, depending on their medical needs, directly to a geriatric ward (GW), to a community emergency care centre (CECC) at a community-based hospital (CH) or to an emergency department (ED). DESIGN: Randomised controlled trial. SETTING: The Emergency Medical Services in Stockholm, Sweden. PARTICIPANTS: 806 geriatric patients who had rung the emergency telephone number 112 were randomised into an intervention group [n=410] and a control group [n=396]. INTERVENTION: The patients were randomised by the dispatcher either to an ambulance that could steer geriatric patients to alternative destinations instead of the ED, depending on the patient’s medical needs (intervention), or to an ambulance that transported all patients to the ED (control). MEASUREMENTS: The primary endpoint; number of patients steered directly to the community-based hospital [effect] i.e. the GW or CECC. The secondary endpoint; number of subsequent transfers [safety] from the CH to the ED within 24 hours after initial admittance. RESULTS: Twenty percent, 90 patients out of 449, [Confidence interval (Cl) 16.6-24.0] could be steered directly to the CH with the help of the prehospital “system” and 6.7%, 6 patients out of 90, [Cl 3.1-13.8] requested subsequent transfer from the GW or CECC to the ED. CONCLUSION: Ambulance nurses could safely and effectively steer geriatric patients to an alternative healthcare facility with the help of a prehospital decision support system and an associated decision support tool. This new system in Stockholm is a better and more effective way of using the under-dimensioned emergency care resources. It is also better for the geriatric patients. Key words: Emergency medical service; Triage; Geriatric patients.

  • 29. Vincente, Veronica
    et al.
    Castrén, Maaret
    Sjöstrand, Fredrik
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Elderly patients’ participation in emergency medical services when2013Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient’s medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as ‘‘There was a ray of hope about a caring encounter and about being treated like a unique human being’’. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.

  • 30. Wennberg, Pär
    et al.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature2018Ingår i: International Journal of Orthopaedic and Trauma NursingArtikel i tidskrift (Refereegranskat)
  • 31.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Aktuella forskningfrågor inom ambulanssjukvård vid PreHospen: Lindra projektet2008Konferensbidrag (Övrigt vetenskapligt)
  • 32.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap. Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Att lära sig vårdande bedömning2015Ingår i: Reflektion i lärande och vård: en utmaning för sjuksköterskan / [ed] Mia Berglund, Margaretha Ekebergh, Lund: Studentlitteratur , 2015, s. 163-174Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [sv]

    Att kunna utföra vårdande bedömningar är något som sjuksköterskor ständigt ställs inför oavsett inom vilket vårdområde de är verksamma. Alla vårdmöten med patienter är mer eller mindre oförberedda och det är därför viktigt att med öppenhet kunna möta patientens behov så att inte rutinmässiga och oreflekterade bedömningar av patientens tillstånd och situation görs. Utmaningen i varje vårdmöte är att med hjälp av reflexion och vårdvetenskaplig kunskap kunna göra en bedömning med patientperspektivet som utgångspunkt. Detta kapitel syftar till att ge förståelse för vad vårdande bedömning innebär, hur du kan lära den under utbildningen och vad som begränsar sådant lärande. Exempel på denna lärandeprocesse ges från studenter i ambulanssjuksköterskeutbildningen.

  • 33.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Forskning i PreHospital akutsjukvård: varför och hur?2008Konferensbidrag (Övrigt vetenskapligt)
  • 34.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Förberedd på att vara oförberedd: en fenomenologisk studie av vårdande bedömning och dess lärande i ambulanssjukvård2005Doktorsavhandling, monografi (Övrigt vetenskapligt)
  • 35.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kompetensbeskrivning. Legitimerad sjuksköterska med specialistsjuksköterskeexamen med inriktning mot ambulanssjukvård.2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Historiskt sett har ambulanssjukvård till största del utförts av icke legitimerad personal1. Under 1960-talet påtalades behov av vårdutbildad ambulanspersonal för första gången men först år 1982 skrevs ambulanssjukvård in i Hälso- och sjukvårdslagen (SFS, 1982:763). Under 1980- och 1990-talen gjordes betydande framsteg inom akutsjukvård och medicinsk behandling vilket ökade efterfrågan på en utbildning som kunde ge kunskaper både inom omvårdnadsvetenskap och medicinsk vetenskap (Suserud, 2005; Suserud & Svensson, 2009). År 1997 fastslog Socialstyrelsen att sjuksköterskors yrkesutövning inom ambulanssjukvård utgör ett specialområde och utarbetade därefter den första kompetensbeskrivningen för sjuksköterska inom ambulanssjukvård. Samma år färdigställdes en vidareutbildning inom akutsjukvård med inriktning mot ambulanssjukvård omfattande 40–45 poäng, som år 2001 övergick i Specialistsjuksköterskeutbildning med inriktning mot ambulanssjukvård omfattande 60 högskolepoäng (hp). Det är en reglerad utbildning som ger yrkesexamen på avancerad nivå, samt en skyddad yrkesbeteckning. Utbildningen kan även, efter examensarbete på avancerad nivå (15 hp), leda till en magisterexamen i omvårdnad/vårdvetenskap. Den specialistutbildade ambulanssjuksköterskan behöver utveckla en handlingsberedskap inför oförutsedda och varierande uppdrag, ofta med bristfällig information, i skiftande vårdmiljöer och under omgivande förhållanden som ibland är ogynnsamma. Kompetensen omfattar vård av patienter med akuta vårdbehov. Det innebär både att snabbt bedöma och prioritera vårdåtgärder för patienter med livshotande tillstånd och vårda i situationer som traditionellt sett inte betraktas som akuta. Kompetensen inbegriper kunskap om sjuka och/eller skadade patienter i alla åldrar, med hälsoproblem, liksom barnafödande. Vårdarbetet präglas av ett etiskt förhållningssätt, vilket innebär att möta patienten som en unik individ med individuella behov och egna erfarenheter av akut sjukdom, skada och ohälsa. Att visa omsorg och respekt för patientens integritet och värdighet är alltid viktigt men speciellt viktigt i vårdsituationer på offentliga platser och i samband med flera skadade. Vårdmötet baseras på närhet och en strävan att försöka förstå vad som hänt samt hur en plötsligt inträffad förändring påverkar patientens och närståendes liv. Ett etiskt förhållningssätt förutsätter ett personligt ansvar och förmåga att kunna åsidosätta ett slentrianmässigt omhändertagande. Reflektion och handledning utgör viktiga redskap för att vidhålla ett medvetet förhållningssätt i mötet med patienter. Den specialistutbildade ambulanssjuksköterskan skall medverka till att patienten erhåller rätt vårdnivå2 via samverkan med specialistvård, primärvård och kommunal vård. Ambulanssjukvård utövas även i tvärprofessionella vård- och räddningsteam som samverkar för att i en trygg och säker miljö uppnå största möjliga patientnytta. Det inbegriper att den specialistutbildade ambulanssjuksköterskan har den kompetens som en personcentrerad, evidensbaserad, jämlik och tillgänglig ambulanssjukvård fordrar. 4 1 Det skulle dröja till år 2005 innan Socialstyrelsen föreskrev att minst en av vårdarna i en ambulans ska vara legitimerad sjuksköterska för att möjliggöra läkemedelsbehandling inom ambulanssjukvård. 2 Inledningsvis prioriteras patientens vårdbehov av larmcentralen, som även dirigerar ambulansen till patienten.

  • 36.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kunskapscentrum PreHospen: att vidareutveckla akutsjukvård utanför sjukhus i professionssamverkan2009Rapport (Övrigt vetenskapligt)
  • 37.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindra ska lätta trycket i ambulansen2008Ingår i: Forskning: tidning för studenten, forskare, företag, inom teknik och naturvetenskap, ISSN 1654-8876, Vol. 3, s. 46-47Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 38.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindra-projektet2007Konferensbidrag (Övrigt vetenskapligt)
  • 39.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    PreHospen Conference 2016: Where all care begins2016Proceedings (redaktörskap) (Refereegranskat)
  • 40.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Johansson Sundler, Annelie (Redaktör)
    Roxberg, Åsa (Redaktör)
    Vårdvetenskap + medicin är sant?2008Rapport (Övrigt vetenskapligt)
  • 41.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, Peter
    NU-Hospital Organisation.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, Per-Olof
    University of Gothenburg.
    The early chain of care and risk of death in acute stroke in relation to the priority given at the dispatch centre: A multicentre observational study2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 16, nr 7, s. 623-631Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:The early chain of care is critical for stroke patients. The most important part is the so-called 'system delay' i.e. the delay time from call to the emergency medical services until a diagnosis is established (computer tomography).Aim:The purpose of this study was to relate the initial priority level given by the dispatch centre to the early chain of care in acute stroke and to short-term and long-term mortality.Methods:All patients hospitalised with the first and the final diagnosis of acute stroke, 15 December 2010?15 April 2011, were recruited across nine hospitals, each hospital with a stroke care unit.Results:In all, 897 stroke patients were included. Priority at the dispatch centre: 54% received highest priority 1, 41% priority 2 and 5% priority 3. Median system delay from call to emergency medical services until diagnosis by computer tomography was 2 h and 52 min, 4 h and 49 min and 6 h and 33 min respectively in the three priority groups (p<0.0001). There was a similarly strong association between priority level at the dispatch centre and system delay to arrival in a hospital ward, suspicion of stroke by the emergency medical services nurse as well as the physician on hospital admission and the proportion of patients given thrombolysis. Mortality during the subsequent 30 days was 22% among patients with priority 1 and 14% among patients with priority 2.Conclusion:Patients given a lower priority level at the dispatch centre had the longest system delay. Although many of these patients died, the risk of death was highest among those given the highest priority.

  • 42.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Annetorp, M.
    Sjöstrand, F.
    Vicente, V.
    Optimal vårdnivå för multisjuka äldre2016Ingår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 263-277Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 43.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Aronsson, K.
    Larsson, G.
    Patienter med misstänkt höftfraktur: Vårdvetenskaplig analys2016Ingår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 410-469Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 44.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindström, Veronica
    Karolinska Institutet.
    Vicente, Veronica
    Karolinska Institutet.
    Caring science research in the ambulance services: an integrative systematic review.2018Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikel i tidskrift (Refereegranskat)
    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.

  • 45.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, Thomas
    Winge, Karin
    Lundberg, Camilla
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Anxiolytics in patients suffering a suspected acute coronary syndrome: Multi-centre randomised controlled trial in Emergency Medical Service2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 4, s. 3580-3587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The prehospital treatment of pain and discomfort among patients who suffer from acute coronary syndrome (ACS) needs a treatment strategy which combines relief of pain with relief of anxiety. Aim: The aim of the present study was to evaluate the impact on pain and anxiety of the combination of an anxiolytic and an analgesic as compared with an analgesic alone in the prehospital setting of suspected ACS. Methods: A multi-centre randomised controlled trial compared the combination of Midazolam (Mi) + Morphine (Mo) and Mo alone. All measures took part: Prior to randomisation, 15 min thereafter and on admission to a hospital. Inclusion criteria were: 1) pain raising suspicion of ACS and 2) pain score ≥4. Primary endpoint: Pain score after 15 min. Results: In all, 890 patients were randomised to Mi + Mo and 873 to Mo alone. Pain was reduced from a median of 6 to 4 and finally to 3 in both groups. The mean dose of Mo was 5.3 mg in Mi + Mo and 6.0 mg in Mo alone (p b 0.0001). Anxiety was reported in 66% in Mi + Mo and in 64% in Mo alone at randomisation (NS); 15 min thereafter in 31% and 39% (p = 0.002) and finally in 12% and 26% respectively (p b 0.0001). On admission to a hospital nausea or vomiting was reported in 9% in Mi + Mo and in 13% in Mo alone (p = 0.003). Drowsiness differed; 15% and 14% were drowsy in Mi + Mo versus 2% and 3% in Mo alone respectively (p b 0.001). Conclusion: Despite the fact that the combination of anxiolytics and analgesics as compared with analgesics alone reduced anxiety and the requirement of Morphine in the prehospital setting of acute coronary syndrome, this strategy did not reduce patients' estimation of pain (primary endpoint). More effective pain relief among these patients is warranted.

  • 46.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dahlberg, Karin
    Being Prepared for the Unprepared: A Phenomenology Field Study of Swedish Prehospital Care2012Ingår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, ISSN 0099-1767, Vol. 38, nr 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: This paper presents a study of prehospital care with particular focus on how ambulance personnel prepare themselves for their everyday assignments. Methods: The caring science field study took a phenomenological approach, where data were analyzed for meaning. Two specialist ambulance nurses, three registered nurses, and six paramedics participated. Results: The previously known discrepancy between in-hospital care and prehospital care was further interpreted in this study. The pre-information from an emergency medical dispatch (EMD) center provides ambulance personnel with basic expectations as to what they will have to take care of. At the same time that they maintain their certainty and control, our major findings indicate that prehospital care in emergency medical service requires the personnel to be prepared for an open and flexible encounter with the patient; to be prepared for the unprepared, i.e., to be open and to avoid being governed by predetermined statements. Discussion: Our findings suggest that the outcomes of good prehospital care affect patient security. The seemingly time-consuming dialogue with the patient facilitates understanding and decision-making regarding the patient's medical needs, and it is comforting to the patient. The ambulance personnel need to be well prepared for this task and fully understand that the situation might differ considerably from the information provided by the EMD centers. All objective information is of great value in this care context, but ultimately it is the patient who provides reliable information about her/his own situation.

  • 47.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dahlberg, Karin
    Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions2011Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 19, nr 3, s. 113-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study has a health care science approach and explores pre-hospital emergency care with emphasis on assessment. Health care science is focused on the patient with the general aim to describe care that strengthens and supports health. Assessment in the ambulance services has not been explored earlier from this perspective, despite the emphasis on ‘coming close’ to the acute suffering patient. The aim of the study is to describe and analyse assessment in caring situations. Data was collected by participant observations. The major findings point out the importance of professional carers’ recognition of the patient’s lifeworld as an essential part of assessment. The carers’ openness to the situation and to the patient’s suffering and needs vary from being of minor interest to complete focus of the assessment. It seems that assessments that focus solely on a patient’s medical condition can be an obstacle to a full understanding of the individual, and thereby the illness per se. A caring assessment based on an encounter and a dialogue between patient and carer, characterised by inviting the patient to participate, adds further dimensions to the objective data. Therefore, the inclusion of the patient perspective relieves suffering and enables more safe decisions.

  • 48.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ekebergh, Margaretha
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    How caring assessment is learnt: reflective writing on the examination of Specialist Ambulance Nurses in Sweden2013Ingår i: Reflective Practice, ISSN 1462-3943, E-ISSN 1470-1103, Vol. 14, nr 2, s. 271-287Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper presents a research study that aims to describe and analyse how caring assessment is learnt in the Specialist Nursing, Prehospital Care Programme for educating specialist ambulance nurses. The study is based on a contextual and didactic model for learning. The focus was on the final course, Prehospital Emergency Care, with clinical studies and clinical practice amounting to 15 credits, plus one of two theoretical examinations. We are testing the model to explore what characterises the students’ learning when the model is applied. The informants were 37 students (registered nurses). Written data from all 37 examinations were analysed by means of the phenomenological Reflective lifeworld research approach. The results stress the significance of a didactic model constructed according to the specific circumstances prevailing in the learning context. With the help of the model an attitude of reflective awareness is adopted, showing that knowledge in caring science and medical science are equally valuable and, are applied simultaneously. Furthermore, the model generates knowledge that underlines the significance of the encounter with the patient in the care-giving context of the prehospital environment, in order for the student to be able to develop understanding and to learn caring assessment in prehospital emergency care. Thus the result reveals that it is the encounter with the patient that is most effective for the student’s learning process. Keywords: didactic model; reflections; reflective awareness; specialist ambulance nurses; nursing training

  • 49.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, Per Olof
    Brink, Peter
    Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: Results of an observational studyManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To identify weak links in the early chain of care for acute stroke.

    Setting: Nine emergency hospitals in western Sweden, each with a stroke unit, and the emergency medical services (EMS).

    Participants: All patients hospitalised with a first and a final diagnosis of stroke − between December 15, 2010 and April 15, 2011. The university hospital in the city of Gothenburg was compared with six county hospitals.

    Primary and secondary measures: (1) The system delay, i.e. median delay time from call to the EMS until diagnosis was designated as the primary endpoint. Secondary endpoints were: (2) the system delay time from call to the EMS until arrival in a hospital ward, (3) the use of the EMS, (4) priority at the dispatch centre and (5) suspicion of stroke by the EMS nurse.

    Results: In all, 1,376 acute patients with stroke (median age 79 years; 49% women) were included. The median system delay from call to the EMS until (1) diagnosis (CT scan) and (2) arrival in a hospital ward was 3 hours and 52 minutes and 4 hours and 22 minutes respectively. The system delay (1) was significantly shorter in the county hospitals. (3) The study showed that 76% used the EMS (Gothenburg 71%; the county 79%) (p <0.0001). (4) Priority 1 was given at the dispatch centre in 54% of cases. (5) Stroke was suspected  in 65%. A prenotification was sent in 32% (Gothenburg 52%; the county 20%) (p <0.0001).

    Conclusion: System delay is still long and only a small fraction of patients received thrombolysis. Three of four used the EMS (more frequent in the county). They were given highest priority at the dispatch centre in half of the cases. Stroke was suspected in two thirds of the cases, but a prenotification was seldom sent to the hospital.

  • 50.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Pre-hospital care for patients suffering from suspected acute coronary syndrome - educational intervention for pain and anxiety relief2016Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Pre-hospital care for patients from suffering acute coronary syndrome (ACS) has been shown to be a challenge. Associated symptoms appear together with typical ones. The symptoms have been reported to be more intense in the pre-hospital setting than after hospital admission. Special education could benefit for ambulance nurses (AN).

     

    Purpose: A. To describe the prevalence of dyspnea and nausea or vomiting and their associa­ tion with outcome. B.To explore the possible connection between the patients' estimated inten­ sity of pain before arrival to the hospital and clinical findings. C. To evaluate the possible effect of education in cardiovascular nursing on pain intensity in patients suffering from suspected ACS.

     

    Methods:  A randomised controlled trail: an educational and a medical intervention. There is also a retrospective design. In the trial: The inclusion criteria were symptoms of pain 4 on the coloured analogue scale raising suspicion of ACS. In total 1,603 patients participated. The edu­ cational intervention was a course including care assessment and treatment as well as clinical cardiology. The medical intervention was Midazolam.

     

    Results: A. One in three patients has symptoms of dyspnea and the same number of patients has symptoms of nausea or vomiting, which increases the suspicion of ACS. B. More intensive pain was associated with: 1) lower age and a higher prevalence of previous smoking; 2) more complications before hospital admission in terms of hypotension and  AV-block-  bradycardia which required treatment and 3) a higher incidence of heart failure, anxiety, and pain after hos­ pital admission that required treatment. C. On admission to hospital, the pain score was signifi­ cantly lower for patients treated by an AN with special education compared with those treated by an AN without such education. The AN with special education used higher doses of mor­ phine to treat patients.

     

    Conclusion: An assessment and treatment strategy that combines all symptoms, both the typical symptoms and the associated ones, is needed. The estimated in­ tensity of pain can predict outcomes. The possible effect of special education for ANs is shown but needs to be confirmed in further trials.

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