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  • 1. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Strömsöe, Annelie
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    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.
    Prehospital suspicion and identification of adult septic patients:Experiences of a screening tool2016Conference paper (Refereed)
    Abstract [en]

    Introduction:  Sepsis  is life threatening  and  requires  urgent healthcare  to reduce  suffering  and death. Therefore it is important that septic patients are identified early to enable treatment.

     

    Aim: To investigate to what extent EMS personnel identified patients with sepsis using the "BAS

    90-30-90"  model, and to describe assessments and medical procedures that were  undertaken by the personnel.

     

    Methods: This was a retrospective study where  185 EMS medical records were  reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

     

    Results: A physician assessed the patients  in 74 of the EMS cases, which lead to exclusion  of these  records  in  regard  to  the  EMS  personnel's  ability  to  identify  sepsis.  The  personnel documented  suspicion  of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion  of patients  065 years  of age was 73% (n=135)  of which  37% (n=50) were over 80 years  old. Thirty-nine percent  (39%,  n=72)  were  females. The  personnel  documented blood pressure   in  91%  (n=168),  respiratory   rate  in  76%  (n=140),   saturation   in  100%  (n=185), temperature  in 76%  (n=141),  and  heart  rate  in  94%  (n=174)  of  the  records.  Systolic  blood pressure  <90 mmHg  was  documented  in 14,2%  (n=24),  respiratory  rate  030 in 36%  (n=50), saturation <90 in 49%   (n=91). temperature >38°C in 37.6% (n=53), and heart rate 090 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous  lines (70%, n=130), intravenous  fluids (10%, n=19) and administration  of oxygen (72%, n=133).

     

    Conclusion:  The EMS personnel identified  only a few septic patients  with the help of the BAS

    90-30-90  model when  all three criteria  would  be met for severe  sepsis. Either  advanced age (>65  years),   fever   (>38°C)   or  tachypnea (020  breaths/min)   appeared   to   increase  the personnel's suspicion  of sepsis. Oxygen, but not intravenous  fluids, was given in an adequate way.

  • 2.
    Andersson, Henrik
    University of Borås, School of Health Science.
    Medikaliserat och resultatstyrt vårdarbete på akutmottagning: en studie med utgångspunkt i medarbetares och chefers perspektiv2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis is to obtain an understanding of Emergency Healthcare Work (EHW) at the Emergency Department (ED), including the competencies required by EHW, and based on practitioners' and managers' perspectives. Methods: In study I, a quantitative method was employed. A questionnaire was sent to all Swedish EDs and data was analysed using descriptive statistics and content analysis. In studies II- IV, qualitative methods were used. In study II, participant observations and individual and group interviews were conducted. In studies III-IV individual and group interviews were conducted. In studies II-IV, data was analysed using qualitative content analysis. Results: According to head nurses, basic nursing education does not lead to sufficient competence for working at an ED and thus supplementary formal education is needed. A minority of head nurses perceive that they are completely responsible for creating preconditions for competence development (study I). The EHW is characterized by rapid, brief and standardized encounters with limited scope for providing individualized care. Practitioners strive to be adaptable by structuring EHW and they cooperate to achieve a good workflow (study II). Management is characterized by a command and control approach. Managers experience EHW as lifesaving work and they experience difficulties in meeting the expectations of their staff (study III). There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the possibilities to develop competencies in EHW. The focus on competence in EHW is on account of the emergency and lifesaving nature of its actions. Purely medical competencies are valued and caring competencies are subsequently downgraded. A medical competence approach consolidates the current view of competencies necessary in everyday work in EDs (study IV). Conclusions: EHW and the competencies required by EHW are defined from a purely medicalized and result-driven viewpoint. Patients' medical needs are given greater importance than their caring needs. Medicalized and result-driven EHW makes it difficult to provide individualized care. This difficulty is a hindrance to the implementation of a holistic view in EHW.

  • 3.
    Andersson, Henrik
    et al.
    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.
    Larsson, Anna
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    Bång, Angela
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ljungström, Lars
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed)
    Abstract [en]

    Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

    Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

    Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

    Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

  • 4.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gabre, Marita
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dehre, Andreas
    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.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Simulation in Virtual World to Promote Communication2018In: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Conference paper (Other academic)
    Abstract [en]

    Introduction

    Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016).

     

    Aim

    The aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS).

     

    Methods

    A qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis.

     

    Results

    The participants’ experiences generated three themes:

     

    Understanding the virtual world

    It was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL.

     

    Technological challenges

    One challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient.

     

    Learning through avatars

    Learning through avatars requires that the participants take responsibility for delivering a convincing performance.  Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour.

     

    Conclusion

    The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.  

  • 5.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gabre, Marita
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dehre, Andreas
    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.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Simulation in Virtual World to Promote Communication2018In: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Conference paper (Refereed)
    Abstract [en]

    Introduction

    Communication between ambulance professionals and patients is essential for understanding the patient's lifeworld (Wireklint Sundström & Dahlberg 2010). Simultaneously, communication is challenging to teach and learn within the framework of specific courses. However, simulation in virtual worlds can support the development of new skills such as communication (Combs, Sokolowski & Banks 2016).

     

    Aim

    The aim of this work was to design a simulation-based platform for communication training among ambulance nurse students (ANS).

     

    Methods

    A qualitative action research approach was used (Coghlan & Casey 2001). Second Life® (SL) was selected since it was an existing virtual world. SL is a web-based flexible three-dimensional platform that allows customization. Interaction and communication with other virtual people can be done through avatars in real time (Hodge, Collins & Giordano 2011). Three ANS and five teachers participated, none of the participants had prior experience of SL. Observations and interviews were used as data and analysed using thematic analysis.

     

    Results

    The participants’ experiences generated three themes:

     

    Understanding the virtual world

    It was easy to interact and communicate with other virtual people. However, it took time to feel comfortable to navigate in SL.

     

    Technological challenges

    One challenge was related to audio-visual problems e.g. not compatible headset, interfering echoes and that the image was distorted at times, which made it difficult to act and move the avatar. Another challenge was associated with the 3D modelling e.g. the capability to use of coordinates, positioning, object dimensioning and the fact that accidental deletions could not be restored. A third challenges that influenced the communication was the difficulty of visualizing clinically relevant care measures such as diagnostic examinations or drug treatment. Finally, there was a challenge to customize the avatars to look like ambulance professionals or a severely ill patient.

     

    Learning through avatars

    Learning through avatars requires that the participants take responsibility for delivering a convincing performance.  Immersion was limited since actions do not take place from a first-person viewpoint. There is a need that the scenario is based on realistic conditions e.g. interiors, equipment, clothing, avatar appearance and behaviour.

     

    Conclusion

    The present system is not suitable for training of medical assessment. Teachers who are considering using virtual worlds in the training for future ambulance professionals should note that an appropriate design is crucial for how the simulation is experienced.  

  • 6.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Jakobsson, E
    Furåker, C
    Nilsson, K
    The everyday work at a Swedish emergency department: The practitioners’ perspective2012In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, no 2, p. 58-68Article in journal (Refereed)
    Abstract [en]

    In the everyday work at emergency departments (EDs), the patients being cared for have different needs and perceived symptoms. To meet their need for emergency care, knowledge of the work is important. The aim of this study is to explore the everyday work at a Swedish ED from a practitioner’s perspective. Method This study has a qualitative, exploratory design with observations and interviews at two EDs. Data were analysed by content analysis. Findings The everyday work is characterised by a rapid, short and standardised encounter with limited scope to provide individualised care, which leads to a mechanical approach. It is also characterised by an adaptive approach in which practitioners strive to be adaptable by structuring everyday work and cooperation to achieve a good workflow. Conclusions The study shows that the practitioners’ encounter with patients and relatives is rapid and of limited duration. The care activities that practitioners mainly perform comprise standard medical management and are performed more mechanically than in a caring way. The practitioners strive to balance the requirements and the realisation of the everyday work through structures and in cooperation with other practitioners, although they work more in parallel than in integrated teams.

  • 7.
    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. 

  • 8.
    Andersson, Henrik
    et al.
    Sahlgrenska University Hospital.
    Nilsson, Kerstin
    Gothenburg University.
    QUESTIONING NURSING COMPETENCES INEMERGENCY HEALTH CARE2009In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 35, p. 305-311Article in journal (Refereed)
    Abstract [en]

    Introduction: Medical and technologic developments entailnew competence demands in emergency health care, and itfollows that head nurses must recognize and create prerequisites,as well as evaluate the competence of registered nurses. The aimof this study is to describe head nurses’ conceptions of emergencynursing competence needs and their responsibility for creatingprerequisites of competence development in emergency nursing.

    Methods: A 24-item questionnaire was sent to all the headnurses (N = 79) of all the existing emergency departments inSweden. The response rate was 73%, and in the analysis ofthe data, descriptive statistics were used.

    Results: According to the head nurses, basic nursing educationdoes not provide sufficient emergency nursing competence.Consequently, there is a need for supplementary formalemergency nursing education. Furthermore, most of the headnurses have inadequate strategies for evaluating competencedevelopment, and economic and personnel resources areinsufficient to meet the educational needs. A minority of the headnurses consider that they have full responsibility for creating theprerequisites of the competence development of nurses.

    Discussion: To ensure sufficient nursing competence inemergency health care organizations, there is a need to establishcompetence demands in emergency nursing and evaluate strategiesfor competence development. The establishment of a Swedishemergency nurses association would be important for thedevelopment of national guidelines of emergency nursing as wellas to facilitate the interpretation and concretizing of rules andlegislation and to promote questions related to research, development, and education in emergency nursing. With nationalguidelines and recommendations, the head nurses’ responsibilitiesfor the development of nurses’ skills would be clarified.

  • 9.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ullgren, Andreas
    Holmberg, Mats
    Karlsson, Thomas
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Acute coronary syndrome in relation to the occurrence of associatedsymptoms: A quantitative study in prehospital emergency care2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 43-47-Article in journal (Refereed)
    Abstract [en]

    Introduction: Acute chest pain is a common symptom among prehospital emergency care patients.Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assesspatients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrenceof dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associationswith patients’ outcome.

    Methods: This study has a quantitative design based on data from hospital records and from a previousinterventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systemsin western Sweden in the years 2008–2010.

    Results: In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38%and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presenceof dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis ofacute myocardial infarction (AMI).

    Conclusion: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and seriousdiagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influencethe ANs’ assessment and that special education in cardiovascular nursing is required.

  • 10.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Competencies in Swedish emergency departments: The practitioners’ and managers’ perspective2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 2, p. 81-87Article in journal (Refereed)
    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.

  • 11.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Management of everyday work in Emergency Departments: An exploratory study with Swedish Managers2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 81-87Article in journal (Refereed)
    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.

  • 12.
    Andersson, Ulf
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    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.
    Falchenberg, Åsa
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care2018In: 3rd Global Conference on Emergency Nursing & Trauma Care, Noordwijkerhout, October 4-6, 2018, 2018Conference paper (Other academic)
  • 13.
    Andersson, Ulf
    et al.
    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.
    Wireklint Sundström, Birgitta
    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.
    Clinical reasoning in the emergency medical services: an integrative review2019In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241Article in journal (Refereed)
    Abstract [en]

    Abstract: Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted.

    Aim: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review.

    Method: Data was collected through searches in electronic databases, networking among research teams ,colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding -namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes.

    Results: This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives.

    Conclusion: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.

  • 14.
    Axelsson, Christer
    et al.
    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.
    Karlsson, Anders
    Sjöberg, Henrik
    Jiménez-Herrera, Maria
    Bång, Angela
    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.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    Ljungström, Lars
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Purpose:  There is a lack of knowledge  about the early phase of severe infection. This reportdescribes the early chain of care in bacteraemia as follows:  (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start ofintravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

    Basic Procedures: All  patients  in the Municipality of Gothenburg  (Sweden) with apositive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

    Main Findings/Results:  In all, 696 patients fulfilled the inclusion criteria. Their mean agewas 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms  and signs.The EMS nurse  suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes  versus three hours and 21 minutes among the remaining patients (P = .0006). The corresponding figures for cases with “true pathogens” were one hour and19 minutes  versus three hours and 15 minutes  (P = .009).

    Conclusion:  Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms  and signs. The EMS nurse  suspected sepsis in six percent of cases. Regardless  of whether or not patients with true pathogens  were isolated,  a suspicion of sepsis by the EMS clinician at thescene was associated with a shorter delay to the start of antibiotic treatment.

  • 15.
    Holmberg, Mats
    et al.
    Ambulanssjukvården i Södermaland.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Winge, Karin
    Ambulanssjukvården Södra Älvsborgssjukhus.
    Lundberg, Camilla
    Ambulanssjukvården Södra Älvsborgssjukhus.
    Karlsson, Thomas
    Sahlgrenska akademin vid Göteborgs universitet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    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 syndrome2018In: BMC Cardiovascular Disorders, p. 1-10, article id 18:216Article in journal (Refereed)
    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.

  • 16.
    Maurin Söderholm, Hanna
    et al.
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Andersson, Henrik
    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.
    Backlund, Per
    School of Informatics, University of Skövde.
    Bergman, Johanna
    PICTA - Prehospital ICT Arena, Lindholmen Science Park AB.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sjöqvist, Bengt Arne
    Biomedical Signals and Systems, Department of Electrical Engineering, Chalmers University of Technology.
    Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.2019In: Advances in Simulation, ISSN 2059-0628, Vol. 4, article id 3Article in journal (Refereed)
    Abstract [en]

    There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.

  • 17.
    Olander, Agnes
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sundler, Annelie Johansson
    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. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Ljungström, Lars
    Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome2019In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, article id 19:43Article in journal (Refereed)
    Abstract [en]

    Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients withseps is are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays.

    Methods: This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed.

    Results: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serumglucose level and altered mental status during prehospital care were found to be associated with an adverse outcome.

    Conclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

  • 18.
    Olander, Agnes
    et al.
    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.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ljungström, Lars
    Skaraborg Hospital.
    Gellerstedt, Martin
    University West.
    Fridlund, Bengt
    Jönköping University.
    Bång, Angela
    University of Gothenburg.
    Identify the septic patient in prehospital care2017Conference paper (Refereed)
    Abstract [en]

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

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

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

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

  • 19. Wennberg, Pär
    et al.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature2018In: International Journal of Orthopaedic and Trauma NursingArticle in journal (Refereed)
  • 20.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmberg, Mats
    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.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Pre-hospital care for patients suffering from suspected acute coronary syndrome - educational intervention for pain and anxiety relief2016Conference paper (Refereed)
    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.

  • 21.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmberg, Mats
    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.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Sahlgrenska Universitetssjukhuset.
    Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 52Article in journal (Refereed)
    Abstract [en]

    Background

    Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses’ (ANs’) prehospital care of patients experiencing suspected ACS, related to pain intensity.

    Methods

    This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.

    Results

    The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.

    Conclusions

    An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.

    Trial registration

    The ClinicalTrials.gov Protocol Registration System (registration number NCT00792181).

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