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  • 1.
    Jonasson, Lise-Lotte
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training2019In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed)
    Abstract [en]

    Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.

    Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.

    Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.

    Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented

  • 2.
    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.

  • 3.
    Wireklint Sundström, Birgitta
    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.
    Lindström, Veronica
    Karolinska Institutet.
    Vicente, Veronica
    Karolinska Institutet.
    Caring science research in the ambulance services: an integrative systematic review.2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    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.

  • 4.
    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)
  • 5.
    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.

  • 6.
    Claesson, A
    et al.
    Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Svensson, L
    Karolinska Institute.
    Ottosson, L
    Sahlgrenska University Hospital.
    Bergfeldt, L
    Sahlgrenska University Hospital.
    Engdahl, J
    Karolinska Institutet.
    Ericson, C
    Sahlgrenska University Hospital.
    Sandén, P
    Sahlgrenska University Hospital.
    Axelsson, Christer
    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.
    Defibrillation before EMS arrival in western Sweden.2017In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, p. 1043-1048, article id S0735-6757(17)30117-1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

    METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

    RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

    CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

  • 7.
    Ågård, Anders
    et al.
    Sahlgrenska University Hospital.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sallin, Karl
    Uppsala University.
    Engström, Ingemar
    Örebro University.
    Ethical controversies when formulating new national guidelines on cardiopulmonary resuscitation in Sweden2017In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101XArticle in journal (Refereed)
    Abstract [en]

    The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

  • 8.
    Israelsson, Johan
    et al.
    Kalmar Maritime Academy.
    Bremer, Anders
    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.
    Axelsson, Åsa B
    The Sahlgrenska Academy, Gothenburg.
    Cronberg, Tobias
    Lund University.
    Djärv, Therese
    Karolinska Institutet.
    Kristofferzon, Marja-Leena
    Uppsala University.
    Larsson, Ing-Marie
    Uppsala University.
    Lilja, Gisela
    Lund University.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    Wallin, Ewa
    Uppsala University.
    Ågren, Susanna
    Linköping University.
    Åkerman, Eva
    Karolinska Institutet.
    Årestedt, Kristofer
    Kalmar County Hospital.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33, article id S0300-9572(17)30059-XArticle in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 9.
    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. 

  • 10.
    Heidenreich, Kaja
    et al.
    Faculty of Health and Medicine, University Health Care Research Center, Örebro University.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Materstvedt, Lars Johan
    Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU).
    Tidefelt, Ulf
    Faculty of Health and Medicine, University Health Care Research Center, Örebro University.
    Svantesson, Mia
    Faculty of Health and Medicine, University Health Care Research Center, Örebro University.
    Relational autonomy in the care of the vulnerable: Health care professionals' reasoning in Moral Case Deliberation (MCD)2017In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 35, p. 37-42Article in journal (Refereed)
    Abstract [en]

    In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while pro- tecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

  • 11.
    Nilsson, Christina
    et al.
    Örebro University.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Blomberg, Karin
    Örebro University.
    Svantesson, Mia
    Kalmar University.
    Responsibility and compassion in prehospital support to survivors of suicide victim – Professionals’ experiences2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 35, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Background: Death is not only an ending: it is also a beginning for the survivors. Early support can ease suicide victim survivors grieving and reduce the risk of negatively impacting one's mental health. However, knowledge is scant regarding this need and regarding the vital role that prehospital care can have in supporting survivors to regain their footing in life.

    Aim: To describe the care of suicide victim survivors from the perspectives of Emergency Medical Services (EMS) personnel, police officers and general practitioners.

    Design: Qualitative descriptive study.

    Method: Six focus group discussions with EMS personnel, police officers and general practitioners (n = 26), were conducted in a Swedish county. Data were analysed using content analysis.

    Results: The EMS personnel, police officers and general practitioners described their situation as being characterised by feelings of inadequacy as they faced the survivors’ emotional storm and despair. They made attempts to shield themselves and also the survivors. Focus was on the survivors, to give time, to be accessible and to find a person who could continue providing support. The professionals experienced a deep sense of uncertainty about their responsibility and feeling torn in their professional role and a frustration over lack of guidelines.

    Conclusions: This complex situation involves not only the ethical conflict of ‘should I stay or should I go’, i.e. whether to take responsibility or not, but also each professional’s capacity and courage to give compassionate care.

  • 12. Nord, Anette
    et al.
    Lundgren, Johan
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Carlsson, Jörg
    Israelsson, Johan
    Apropå! – HLR och rätten till en värdig död2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 20Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Dellve, Lotta
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wolmesjö, Maria
    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.
    Chefers stödresurser och ledarutbildning2016In: Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar / [ed] Lotta Dellve, Maria Wolmesjö, Borås: Högskolan i Borås, 2016, , p. 9p. 69-76Chapter in book (Other academic)
  • 14.
    Herlitz, Johan
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ravi-Fischer, Annica
    Svensson, Leif
    Bremer, Anders
    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.
    Circulation: Bröstsmärtor2016In: Prehospital Akutsjukvård / [ed] Björn-Ove Suserud och Lars Lundberg, Liber, 2016, 2, p. 308-321Chapter in book (Other academic)
  • 15.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dagens ambulanssjukvård2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber, 2016, 2, p. 48-64Chapter in book (Other academic)
  • 16.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Den mångfacetterade delaktigheten2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 65-71Chapter in book (Other academic)
  • 17.
    Sandman, Lars
    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.
    Etik inom ambulanssjukvården2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 26-39Chapter in book (Other academic)
  • 18.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandboge, Samuel
    Rosengren, Ewa
    Etiska ”knäckfrågor” inom HLR2016Conference paper (Other (popular science, discussion, etc.))
  • 19.
    Israelsson, Johan
    et al.
    Linnaeus University.
    Bremer, Anders
    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.
    Årestedt, Kristofer
    Linnaeus University, Ersta Sköndal University College.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex2016Conference paper (Refereed)
    Abstract [en]

    Introduction: Previous studies have demonstrated differences in characteristics and outcome between men and women in cardiac arrest (CA) populations. However, most studies have focused only on survival outcome. Knowledge about patient reported health and psychological distress among CA survivors is sparse, in particular among those suffering in-hospital cardiac arrest (IHCA). The aim was to describe health status and psychological distress among IHCA survivors in relation to sex.

    Methods: This national register study presents follow-up data of IHCA survivors from 64% of the eligible hospitals in Sweden. A questionnaire was sent to the survivors, 3-6 months post CA, including measures of health status (EQ-5D) and psychological distress (HADS).

    Results: Between 2013 and 2015, 594 IHCA survivors were included. Women reported more problems in all dimensions of EQ-5D, except for Self-care. They also had worse health status (EQ-index) (0.75 vs 0.79, p<0.001). The median value for EQ-VAS was 70 (q1-q3=50-80), significantly lower for women compared to men (65 vs 75, p<0.001). A majority reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (median 3 vs 2, p<0.001) and symptoms of depression (median 3 vs 2, p<0.001) compared to men. Being women was significantly associated with lower health status and more psychological distress in the regression models. No interaction effects for sex and age were found.

    Conclusions: Although the majority of the survivors reported acceptable health status and no psychological distress, a substantial group reported serious problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. All IHCA survivors should be screened for health problems during the post cardiac arrest follow-up, and offered support when needed.

  • 20.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kullén Engström, Agneta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fredman, Margareta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Per-Åke
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wolmesjö, Maria (Editor)
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ledarskap i äldreomsorgen: att leda integrerat värdeskapande i en röra av värden och förutsättningar2016Report (Refereed)
    Abstract [sv]

    Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

    Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

    Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

    De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

    Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

    Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

  • 21.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Mötet med närstående2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 211-227Chapter in book (Other academic)
  • 22.
    Holmberg, Mats
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rantala, Andreas
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Patient participation: A challenge within contemporary ambulance care?2016Conference paper (Other academic)
    Abstract [en]

    Background

    Patient participation should be understood in relation to vulnerability, power and responsibility. Patients in ambulance care have urgent care needs and are vulnerable in an asymmetrical relationship with the clinicians. This places great responsibility on the clinicians to use their power for the benefit of the patient. An invitation to participate requires an informed consent and depends on the patient’s willingness and ability to participate. Hence, as- sessment of the patient’s decision-making ability is central together with a caring approach to enhance trust and confidence. Undoubtedly, patient partici- pation is a challenge within contemporary ambu- lance care – where failure is likely to cause suffering.

    Methods

    Patient participation in ambulance care is discussed from philosophical, patient and person-centred perspectives in relation to empirical research of Bremer et al. (2012), Holmberg et al. (2014; 2015) and Rantala et al. (2015). 

    Results

    Patients are comfortable in their surrender to ambulance clinicians, obeying commands and being important while involved in the care. However, pa- tients are powerless when they experience ambulan- ce clinicians’ care as excessive, having a strong desire of being acknowledged in their suffering. This can be achieved by seeing the patient as capable and in- volve the patient and significant others in the deci- sion-making. In addition ambulance clinicians have an ambition to be pliable to the patient’s wishes, inviting the patient in a shared decision-making.

    Conclusions

    Patient participation in ambulance care can be understood as important for the patient’s wellbeing. However, unequal distribution of power within the ambulance clinician-patient relationship may challenge patient autonomy and interests. Is it pos- sible to achieve genuine patient participation in the context of ambulance care? 

  • 23.
    Israelsson, Johan
    et al.
    Linköping University, .
    Lilja, Gisela
    Lund University.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Stevenson-Ågren, Jean
    University of Sheffield.
    Årestedt, Kristofer
    Linnaeus University.
    Post cardiac arrest care and follow-up in Sweden – a national survey2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Background

    Recent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden.

    Methods

    An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis.

    Results

    Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up.

    Conclusions

    Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.

  • 24. 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 ˃65 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 ˃30 in 36% (n=50), saturation <90 in 49%  (n=91), temperature >38°C in 37.6% (n=53), and heart rate ˃90 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 (˃20 breaths/min) appeared to increase the personnel’s suspicion of sepsis. Oxygen, but not intravenous fluids, was given in an adequate way.

  • 25. 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.

  • 26.
    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.

  • 27.
    Bremer, Anders
    et al.
    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.
    Vårdvetenskaplig analys2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 318-321Chapter in book (Other academic)
  • 28.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Åsa B
    Vårdvetenskaplig analys – erfarenheter vid prehospitala hjärtstopp2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 345-349Chapter in book (Other academic)
  • 29. Strandmark, Rasmus
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Jimenez-Herrera, Maria
    Ravn-Fischer, Annica
    Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 15, no 1Article in journal (Refereed)
  • 30. Strandmark, Rasmus
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Jimenez-Herrera, Maria
    Ravn-Fischer, Annica
    Determinants of pre-hospitalpharmacological intervention and its association with outcome in acutemyocardial infarction2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 105Article in journal (Refereed)
  • 31.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ethical values among managers in elderly care2015In: Dilemmas 2015 Papers from the 18th Annual International Conference Dilemmas for Human Services: Organizing, Designing and Managing / [ed] Sisse Finken, Christina Mörtberg, Anita Mirijamdotter, 2015Conference paper (Other academic)
  • 32.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ethical values among managers in elderly care. Paper presented at the Dilemmas for Human Services 2015: Organizing, Designing and Managing2015Conference paper (Refereed)
  • 33.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Jiménez Herrera, María
    Axelsson, Christer
    University of Borås, School of Health Science.
    Burjalés Martí, Dolors
    Sandman, Lars
    University of Borås, School of Health Science.
    Casali, Gian Luca
    Ethical values in emergency medical services: A pilot study2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 8, p. 928-942Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambulance professionals often address conflicts between ethical values. As individuals' values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. OBJECTIVES: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals' value profiles in Spain and Sweden. METHODS: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. ETHICAL CONSIDERATIONS: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. FINDINGS: Spanish professionals favoured justice and Swedish professionals' rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. DISCUSSION: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals' moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer's professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. CONCLUSION: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally - especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

  • 34.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Jimenéz-Herrera, Maria
    Axelsson, Christer
    University of Borås, School of Health Science.
    Burjalés Martí, D
    Sandman, Lars
    University of Borås, School of Health Science.
    Casali, Luca
    Ethical values in emergency medical services: A pilot study.2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 8, p. 928-942Article in journal (Refereed)
    Abstract [en]

    Background: Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

  • 35.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Etiska värderingar inom spansk och svensk ambulanssjukvård2015Conference paper (Other academic)
  • 36.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Creutz, Tobias
    Pettersson Georgii, Johan
    Family members’ experiences of care provided by ambulance staff in out-of-hospital cardiac arrest situations2015In: Euro Heart Care 2015 Congress, 2015Conference paper (Other academic)
    Abstract [en]

    Purpose: Approximately 10 000 people in Sweden suffer from sudden cardiac arrest outside the hospital each year. Cardiopulmonary resuscitation (CPR) is started in about half of the cases. Treatment of patients with cardiac arrest in a pre-hospital context is complex and focus is placed first and foremost on the patient because of the acute and life-threatening condition. For relatives, it is a traumatic and upsetting experience to be present when a family member suffers from cardiac arrest. The purpose of this study was therefore to describe family members experiences of an out-of-hospital cardiac arrest (OHCA) situation and how the ambulance staff cared for them.

    Methods: This pilot study had a qualitative design, based on six individual interviews with family members who were present when the patient suffered OHCA. The interviews were conducted with an initial open-ended question and follow-up questions based on the responses. The data were analysed by qualitative content analysis with an inductive approach. The analysis generated subcategories, which were clustered into seven main categories.

    Results: The result describes the informants’ situation management, responsibility handover and their hope and hopelessness in the situation. The result also describes the staff’s care of family members by the categories closeness and distance, confirmation and exclusion, caring relationship and answered and unanswered questions. Family members described the OHCA situation as traumatic with feelings of panic, uncertainty, unreality, but also calm and rationality. Contentedness and gratitude for the ambulance staffs caring approach emerged. However, family members sometimes were not allowed to decide if they wanted to witness the resuscitation attempts or not, and a lack of information led to unnecessary frustration.

    Conclusions: Family members often have a need to talk to someone about their experiences of the OHCA situation, express their views on the care that was provided and receive feedback afterwards. Further research on family members’ situation at OHCAs is of great importance for the development of ambulance staff’s skills in caring approaches.

  • 37. Israelsson, Johan
    et al.
    Bremer, Anders
    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.
    Årestedt, Kristofer
    Health-related quality of life among in-hospital cardiacarrest survivors2015Conference paper (Other academic)
    Abstract [en]

    Purpose: A cardiac arrest can cause brain injury with cognitive dysfunctions, emotional reactions and negative effects on activities in daily life. However, most research has focused on survival and the knowledge about health-related quality of life (HRQoL) among survivors is limited. In addition, almost all studies are performed in an out-of-hospital context. The aim of the current study was therefore to describe HRQoL among in-hospital cardiac arrest (IHCA) survivors.

    Methods: This study has a cross-sectional design. In collaboration with the Swedish national register for cardiopulmonary resuscitation, data was collected 3-6 months after resuscitation by using a questionnaire including EuroQol-5 dimension (EQ-5D), the Hospital Anxiety and Depression Scale (HADS) and single questions on activities in daily life and mental/intellectual recovery. In addition, the Cerebral Performance Category (CPC) was scored.

    Results: In total, 286 IHCA survivors with a mean age of 67±12 were included. A majority of the survivors were men (65%), had a cerebral function of CPC 1 (88%) and had no need of assistance from other people in daily life (70%). A large proportion of the survivors had not made a complete mental and/or intellectual recovery (34%), causing problems in daily life for 65% of them. Pain was the dimension in EQ-5D where most survivors reported problems of some degree (64%). Problems within the dimensions anxiety/depression and mobility were reported by more than half of the survivors (53% vs. 51%). In the dimensions personal care and activities in daily life problems were reported by less than half of the survivors (24% vs. 49%). The individual variations of present health measured by the EQ-VAS were substantial (range 0-100), with a mean value of 67±22. Symptoms of anxiety and depression (measured by HADS) were reported by 15% and 16% respectively.

    Conclusions: Although the majority of the IHCA survivors reported satisfactory HRQoL, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of assessing HRQoL among IHCA survivors and the need of follow-up and structured post cardiac arrest care.

  • 38. Lingsarve, Johan
    et al.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Abelsson, Anna
    Svensson, Anders
    Wallin, Kim
    Kågström, Christer
    Rantala, Andreas
    Wihlborg, Jonas
    Ek, Bo
    Styrwoldt, Eva
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kompetens i ambulansen ger en säker akutsjukvård2015In: Dagens Medicin, ISSN 1104-7488Article in journal (Other (popular science, discussion, etc.))
  • 39. Israelsson, Johan
    et al.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Åsa
    Cronberg, Tobias
    Djärv, Therese
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kristofferzon, Marja-Leena
    Larsson, Ing-Marie
    Lilja, Gisela
    Sunnerhagen, Katharina
    Wallin, Ewa
    Ågren, Susanna
    Åkerman, Eva
    Årestedt, Kristofer
    Neurologic outcome, health-related quality of life, anxiety and symptoms of depression among in-hospital cardiac arrest survivors2015Conference paper (Refereed)
  • 40. Årestedt, Kristofer
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Israelsson, Johan
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Psychometric properties of the Hospital Anxiety and Depressionscale in sudden cardiac arrest survivors2015Conference paper (Refereed)
  • 41.
    Bremer, Anders
    University of Borås, School of Health Science.
    Etiska frågeställningar vid drunkning2014Conference paper (Other academic)
    Abstract [sv]

    WHO uppskattar att 450 000 människor årligen avlider i världen till följd av drunkning, varav majoriteten är barn. Hjärtstopp och plötslig död som orsakas av drunkning är betydligt vanligare i låginkomstländer. Detta innebär att många liv går förlorade till följd av drunkningsolyckor, samtidigt som fattiga länder drabbas särskilt hårt. Mot bakgrund av detta framträder den etiska frågan: Hur kan fler liv räddas? Även rättviseprincipen blir viktig och bör rimligen föranleda åtgärder för att förhindra drunkning och rädda drunkningsoffer i särskilt utsatta delar av världen. Vilket ansvar har vi i Sverige för detta arbete? Etiker använder ofta drunkning som exempel för att tydliggöra den moraliska plikten att rädda liv. Vid ett drunkningstillbud kräver denna plikt specifika förmågor, mod och självuppoffring. Ett fullgörande av plikten kan å ena sidan riskera egna förluster och ytterst det egna livet, och å andra sidan ge belöning i form av självaktning och framför allt minskat lidande och död för andra. Plikten att göra allt för patientens bästa grundas i godhetsprincipen som innebär att främja nyttan för den drabbade, samtidigt som riskerna med fortsatta återupplivningsförsök övervägs i ett senare skede. Här framträder den etiska frågan: Hur kan liv räddas, samtidigt som överlevnad till ett ovärdigt liv minimeras?

  • 42.
    Bremer, Anders
    University of Borås, School of Health Science. University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Etiska frågeställningar vid drunkning2014Conference paper (Other academic)
    Abstract [sv]

    WHO uppskattar att 450 000 människor årligen avlider i världen till följd av drunkning, varav majoriteten är barn. Hjärtstopp och plötslig död som orsakas av drunkning är betydligt vanligare i låginkomstländer. Detta innebär att många liv går förlorade till följd av drunkningsolyckor, samtidigt som fattiga länder drabbas särskilt hårt. Mot bakgrund av detta framträder den etiska frågan: Hur kan fler liv räddas? Även rättviseprincipen blir viktig och bör rimligen föranleda åtgärder för att förhindra drunkning och rädda drunkningsoffer i särskilt utsatta delar av världen. Vilket ansvar har vi i Sverige för detta arbete?

    Etiker använder ofta drunkning som exempel för att tydliggöra den moraliska plikten att rädda liv. Vid ett drunkningstillbud kräver denna plikt specifika förmågor, mod och självuppoffring. Ett fullgörande av plikten kan å ena sidan riskera egna förluster och ytterst det egna livet, och å andra sidan ge belöning i form av självaktning och framför allt minskat lidande och död för andra. Plikten att göra allt för patientens bästa grundas i godhetsprincipen som innebär att främja nyttan för den drabbade, samtidigt som riskerna med fortsatta återupplivningsförsök övervägs i ett senare skede. Här framträder den etiska frågan: Hur kan liv räddas, samtidigt som överlevnad till ett ovärdigt liv minimeras?

  • 43.
    Bremer, Anders
    University of Borås, School of Health Science.
    Nytta mot risker: etiska riktlinjer för HLR2014Conference paper (Other academic)
    Abstract [sv]

    När en person drabbas av plötsligt hjärtstopp gör sjukvårdspersonal i regel allt för att få igång hjärtat igen. Ibland kan det dock vara mer etiskt försvarbart att avstå från HLR. Här får vi inblick i Svenska Läkaresällskapet, Svensk sjuk-sköterskeförening och Svenska HLR-rådets etiska riktlinjer, som stöd till sjukvårdspersonalens ställningstagande om HLR ska påbörjas eller inte och skälen som kan motivera ett ställningstagande att avstå.

  • 44.
    Bremer, Anders
    University of Borås, School of Health Science.
    Specialistsjuksköterska med inriktning mot ambulanssjukvård2014In: Att bli specialistsjuksköterska eller barnmorska – utbildningar för framtiden / [ed] Sofia Almerud Österberg, Lena Nordgren, Studentlitteratur , 2014, p. 19-46Chapter in book (Other academic)
    Abstract [sv]

    Behovet av specialistutbildade sjuksköterskor ökar. I den här boken presenteras tolv utbildningar som leder till en examen som specialistsjuksköterska eller barnmorska. Vidare ger boken en inblick i vad de olika yrkena innebär. Boken presenterar arbetsplatser och karriärvägar och ger också konkreta exempel på vad specialistsjuksköterskor eller barnmorskor kan komma att möta en vanlig dag på jobbet. Därutöver presenteras Högskoleverkets examensmål för respektive inriktning samt länkar till fastställda kompetensbeskrivningar. Kapitlet "Specialistsjuksköterska med inriktning mot ambulanssjukvård" beskriver professionen, utbildningen och utmaningar inför framtiden.

  • 45.
    Hagiwara, M
    et al.
    University of Borås, School of Health Science.
    Bremer, A
    University of Borås, School of Health Science.
    Claesson, A
    University of Borås, School of Health Science.
    Axelsson, C
    University of Borås, School of Health Science.
    Norberg, Gabriella
    University of Borås, School of Health Science.
    Herlitz, J
    University of Borås, School of Health Science.
    The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis2014In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, no 67Article in journal (Refereed)
    Abstract [en]

    Background For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome. Methods Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality. Results Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%. Conclusion An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.

  • 46.
    Bremer, Anders
    University of Borås, School of Health Science.
    Vårdpersonal i ’dokusåpor’: är det etiskt försvarbart?2014Conference paper (Other academic)
    Abstract [sv]

    Att som vårdpersonal medverka i s.k. dokusåpor är förknippat med en rad etiska problem. Kan dessa problem lösas på ett etiskt försvarbart sätt, dvs. så att patienters och närståendes rätt till värdighet, integritet och autonomi säkerställs? Slutsatsen är att detta inte är möjligt. Risken att tillfoga skada är större än den potentiella nyttan.

  • 47.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Vårdrum: ett vårdande rum2014In: Akut omhändertagande av trauma - på skadeplats och akutmottagning / [ed] Carina Elmqvist, Sofia Almerud Österberg, Liber , 2014, p. 23-53Chapter in book (Other academic)
    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.

  • 48.
    Bremer, Anders
    University of Borås, School of Health Science.
    "Ej HLR”: Rätten att få dö2013Conference paper (Other academic)
  • 49.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Herrera Jiménez, María
    Ethical profiles in the Spanish and Swedish Emergency Medical Services2013Conference paper (Refereed)
    Abstract [en]

    Introduction: The ambulance crew faces in their daily work different kinds of ethical problems, such as conflicts between ethical values and standards that are critical for the health care. This gives a complexity of the situations and becomes a constant challenge in the care practice for these professionals. Sandman and Nordmark (2006) describe that decision-making in this area of care often creates high pressure and discomfort among the ambulance personnel. Adams, Arnold, Siminoff and Wolfson (1992) identified ethical conflicts in 14.4% of the alerts made by the ambulance crews. In Sweden, Sandman and Nordmark (2006) found ethical conflicts in out-of-hospital care regarding the care relationship, the patient’s autonomy, the patient’s best interest, professional ideals, the professional role and self-identity, family members and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. In Spain, Jiménez (2009) presented some ethical problems that arouse during CPR, pain relief, death and in situations when the right to autonomy was at stake. None of these studies are presenting tools for mapping or help for understand the different situation. The ethical value profile is a help to create tools for mapping and understanding. The first part of this project aims to translate, adapt and test a previous used instrument to map the ethical profile among ambulance crew in Spain and Sweden and in a pilot compare ethical values among the professionals. Result: The Managerial Value Profile (MVP) was translated from English to Swedish and Spanish. The translation was made forward and backward and then subjected to a psychometric test. To adapt the questions in regard to cultural aspects a pilot study was made in both countries (Sweden n=26, Spain n=20). In the pilot we found that ambulance personnel in Sweden and Spain tended to stress the value of individual rights and partly social justice while an utilitaristic approach was regarded as less important. On three items we found a huge difference between the two groups. In those items the Spanish professionals tended to consider social justice more often than the Swedish ambulance personnel that considered individual rights.

  • 50.
    Bremer, Anders
    University of Borås, School of Health Science.
    Etiska ställningstaganden vid hjärtstopp2013Conference paper (Other academic)
  • 51.
    Bremer, Anders
    University of Borås, School of Health Science.
    Vilka möjligheter finns att använda register för uppföljning?”2013Conference paper (Other academic)
    Abstract [sv]

    Svenska Hjärt-lungräddningsregistret innehåller sedan länge beskrivande data med kontinuerliga variabler som ålder och tidsfördröjningar till påbörjande av behandling. Det innehåller också kategoriska variabler om defibrillerbar rytm, hjärtstoppets inträffande i hemmet, kardiell etiologi etc. Cerebral funktion registreras med CPC-score. Sedan 1 maj 2013 kompletterades registret med patientskattningar och mätningar av kvalitativa livskvalitetsvariabler. Den hälsorelaterade livskvaliteten kommer framledes att bedömas med det generiska instrumentet Euro Quality Life Scale (EQ-5D-5L) som mäter rörlighet, egenvård, vardagsaktiviteter, smärta-obehag och ängslan-depression. Dessutom används EQ-VAS för skattning av upplevd hälsa. Ängslan, oro och depression kommer mer detaljerat att bedömas med The Hospital Anxiety and Depression Scale (HADS). Utöver detta inhämtas data om kognitiv funktion och sysselsättning, totalt sju frågor med fasta svarsalternativ. Denna uppföljning av livskvaliteten hos överlevande efter hjärtstopp är en intensifiering av det rutinmässiga omhändertagandet av patientgruppen. Men framför allt innebär detta initiala och systematiska inhämtande av kvalitativa data från patienterna själva en möjlighet att tidigt upptäcka hur de mår och de behov av uppföljande vård och stöd som kan finnas. Genom registrets datainsamling ges även anhöriga en möjlighet att diskutera problem relaterade till den överlevandes situation. Med den utökade datainsamlingen kommer ny och viktig kunskap om patientgruppens cerebrala funktion och hälsorelaterade livskvalitet att genereras över tid, till gagn för patienter och anhöriga.

  • 52.
    Bremer, Anders
    University of Borås, School of Health Science.
    Vilken livskvalitet har patienter efter hjärtstopp?2013Conference paper (Other academic)
  • 53.
    Bremer, Anders
    University of Borås, School of Health Science.
    Ambulanspersonalen måste ha utrymme för de närstående2012In: Vårdfokus, ISSN 2000-5717, no 3, p. 48-Article in journal (Other (popular science, discussion, etc.))
  • 54.
    Bremer, Anders
    University of Borås, School of Health Science.
    Att vara patient inom ambulanssjukvården2012In: Akut vård ur ett patientperspektiv / [ed] Sofia Almerud Österberg, Lena Nordgren, Studentlitteratur , 2012, p. 29-49Chapter in book (Other academic)
  • 55.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars
    University of Borås, School of Health Science.
    Balancing between closeness and distance: emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death2012In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 27, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members. PROBLEM: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel's knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel's experiences of caring for families when patients suffer cardiac arrest and sudden death. METHODS: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden. RESULTS: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people's existential questions and needs was essential. It was dependent on the EMS personnel's balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel's own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence. CONCLUSION: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.

  • 56.
    Bremer, Anders
    University of Borås, School of Health Science.
    Caring for families at sudden cardiac death: A balance between closeness and distance2012Conference paper (Refereed)
    Abstract [en]

    Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects more than half a million people in the United States and Europe each year. As resuscitation attempts are unsuccessful in most of the cases, ambulance professionals often face the needs of bereaved family members. Decisions to continue or terminate resuscitation attempts at OHCA are influenced by factors other than patient clinical characteristics, such as the personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. Research exploring how ambulance personnel are affected by family dynamics and the emotional context, and how they are able to provide care for bereaved family members is sparse. It is also a lack of research into why ambulance professionals sometimes administer physiologically futile cardiopulmonary resuscitation (CPR) to patients with cardiac arrest to benefit family members. This way of meeting families’ grief reactions implies ethical problems. Based on an empirical study of ambulance professional’s experiences of caring for families when patients suffer cardiac arrest and sudden death, and an ethical analysis exploring arguments for providing physiologically futile CPR, the issue of caring for bereaved family members in ethical good and bad ways is explored. The empirical study results show that ambulance personnel experience a concomitant responsibility, sometimes failing to prioritize between responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care imply a movement from well-structured guidance to a situational response where the personnel are forced to balance between interpretive reasoning and a more direct emotional response at their own discretion. With such affective response in decision-making, the personnel risk erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs is essential, and dependent on the ambulance personnel’s balance between closeness and distance, and on their courage to meet emotional expressions of the families, as well as the personnel’s own vulnerability. A need for ethical competence is invoked by the presence of family members, placing great demands on mobility in the decision-making process, between medical care of the patient and caring for family members. The conclusion is that the strategy of ambulance professionals in the care of bereaved family members should be to avoid additional suffering by focusing on the relevant care needs of the family members and provide support, arrange for a peaceful environment and administer acute grief counseling at the scene, which might call for a developed ethical caring competence. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Ambulance personnel also need training in awareness of the needs of families suffering sudden bereavement, as well as support and help to deal with personal discomfort.

  • 57.
    Bremer, Anders
    University of Borås, School of Health Science.
    En andra chans2012In: Forskning för hälsa, ISSN 1653-9753, no 3, p. 18-19Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Överlevare av plötsligt hjärtstopp utanför sjukhus är en unik och växande patientgrupp. Men hur blir livet efteråt? Frågeställningen finns med i den forskning Anders Bremer bedriver och som tidigare i år utmynnade i en avhandling. I syfte att beskriva samtliga inblandades erfarenheter vid plötsligt hjärtstopp intervjuade han överlevare, närstående och ambulanspersonal, som inte sällan ställs inför etiska frågeställningar vid hjärtstopp.

  • 58.
    Bremer, Anders
    University of Borås, School of Health Science.
    Etiska aspekter vid HLR2012Conference paper (Other academic)
  • 59.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hjärtstopp utanför sjukhus2012Conference paper (Other academic)
  • 60.
    Herlitz, Johan
    et al.
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Wireklint-Sundström, Birgitta
    University of Borås, School of Health Science.
    Axelsson, Christer
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hagiwara, Magnus
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Ljungström, Lars
    Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 42Article in journal (Refereed)
    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.

  • 61.
    Bremer, Anders
    University of Borås, School of Health Science.
    Vid existensens gräns: etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus2012Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems. Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis. Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families. Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

  • 62.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Etiska aspekter på HLR2011Conference paper (Refereed)
    Abstract [sv]

    Hälso- och sjukvårdens övergripande mål kan uttryckas som främjande av optimal livslängd med god livskvalitet och ett gott liv. Målet kan betraktas som etiskt. Vid en patients hjärt-stopp är målet med den medicinska behandlingen (hjärtlungräddning, HLR) att personen överlever med åtminstone acceptabel livskvalitet. I det akuta, prehospitala skedet är det dock svårt att bedöma utfallet avseende framtida livskvalitet förutom i vissa få och relativt välbestämda fall. Det är dessutom svårt att få vetskap om patientens eventuella önskemål om sin vård. Som regel påbörjas därför HLR. Etiska riktlinjer kan ge viss vägledning i beslut om att avbryta HLR när det finns skäl att tro att målet inte kan uppnås. Ramarna för sådana riktlinjer bygger på respekt för patientens autonomi och integritet, rättvisa samt rimlighet i vårdarens yrkesroll. Detta innebära exempel-vis respekt för patientens eventuella önskemål avseende HLR, undvikande av att patienten exponeras samt ansvar för att resurserna används så rättvist som möjligt. Det sistnämnda kan ibland innebära att ambulanspersonal avviker från en HLR-plats efter att HLR avbrutits för något som är viktigare än vården av närstående. Vård av närstående bör dock betraktas som en rimlig uppgift i ambulanspersonalens yr-kesroll där ansvaret handlar om att tillvarata närståendes kunskap och erfarenhet, visa dem omtanke och respekt samt ge stöd, vägledning och information. Närståendes delaktighet ska främjas och kommunikationen med dem ske respektfullt, lyhört och empatiskt. Närståendes initiala roll vid en patients hjärtstopp är viktig genom att de kan bidra med värdefull informa-tion om patienten och även återge patientens vilja i förekommande fall. I händelse av att pati-enten avlider är målet att lindra närståendes lidande. Forskning visar dock att ambulansperso-nalens uppfattningar om närståendevården och närståendes närvaro under HLR varierar från att anses som viktig för närståendes sorgeprocess och återhämtning, till att inte ingå i vår-darrollen, negativt påverka HLR-beslut och innebära emotionell belastning för vårdarna. När-ståendes närvaro vid HLR tycks för en del ambulanspersonal innebära svårigheter att ge när-stående emotionellt stöd och ibland leda till att HLR fortsätter längre än vad som är medici-niskt motiverat, antingen som ett sätt att lindra närståendes lidande eller för att vårdarna inte förmår att skifta från patientvård till vårdande av närstående. Att utföra HLR för någon annan skull än för patienten och längre än medicinskt motive-rat är emellertid etiskt tveksamt och flyttar dessutom fokus från närståendes behov. Närståen-des känslor av överväldigande ansvar och ofrivillig ensamhet belyser istället vikten av att uppmärksamhet på närståendes verkliga behov, främjande av kontrollkänsla och försök till skuldavlastning. Ambulanspersonalens uppriktighet, medmänsklighet och närvaro framstår som centrala aspekter i en etiskt god vård av närstående i samband med en patients hjärtstopp och plötsliga död.

  • 63.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis2011In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 4, p. 495-504Article in journal (Refereed)
    Abstract [en]

    It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field.

  • 64.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hagiwara, Magnus
    University of Borås, School of Health Science.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Nationella regler krävs för ambulanssjukvård2011In: Svenska Dagbladet, ISSN 1101-2412Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Ambulanssjukvården i Sverige saknar nationella riktlinjer. En konsekvens av detta är brister i tillgängligheten vilket fått allvarliga konsekvenser för flera personer under den senaste tiden. En av dem är Maximilian och hans mamma som blev påkörda på trottoaren av en 23-årig förare som hade tappat kontrollen över sin bil. Det tog nästan en timme innan pojken flögs till sjukhus med helikopter från olycksplatsen på Tjörn utanför Stenungsund. Maximilian blev bara tio veckor.

  • 65.
    Axelsson, Christer
    et al.
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hagiwara, Magnus
    University of Borås, School of Health Science.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Englund, Lotta
    University of Borås, School of Health Science.
    Så skapas världens bästa ambulanssjukvård2011In: Göteborgsposten, ISSN 1103-9345Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tiden från larm till dess att ambulans kommer har ökat dramatiskt de senaste tio åren i Västra Götaland. Samtidigt bedöms allt fler i behov av snabb utryckning. Kompetens finns att råda bot på detta – om den tillåts styra utvecklingen, skriver bland andra professor Johan Herlitz.

  • 66.
    Bremer, Anders
    University of Borås, School of Health Science.
    Ett överväldigande ansvar: att vara närstående vid hjärtstopp2010Conference paper (Other academic)
    Abstract [sv]

    Denna fenomenologiska livsvärldsstudie beskriver sju närståendes erfarenheter av att en nära person drabbats av hjärtstopp i hemmet eller ute i samhället. Resultatet visade hur närstående plötsligt upplevde kontrollförlust och en känsla av overklighet. De upplevde sig ensamt ansvariga, otillräckliga och med svårigheter att möta ett överväldigande ansvar. I den ensamma och utsatta situationen blev allt kaotiskt, ångestfyllt och omtumlande. När ambulanspersonal anlände väcktes närståendes hopp. Beroende på vilken föreställning eller kunskap närstående hade om patientens tillstånd kastades de mellan förhoppningar om överlevnad och tvivel över det meningsfulla med livräddande åtgärder. Efter händelsen kände sig närstående ofta lämnade ensamma med oro och frågor inför framtiden. Oron motverkade välbefinnande och hotade viktiga värden i ett gott liv eftersom de riskerade att bli ensamma i sorg efter den döde, eller i oro för den överlevandes framtid. Närstående försummade egna och viktiga behov. Resultatet visar att ambulanspersonal har en prima facie plikt att stödja närstående i samband med en patients hjärtstopp och död. Detta förutsätter uppmärksamhet, känslighet och öppenhet inför närståendes outsagda eller uttryckliga frågor och behov. Vid dödsfall i hemmet bör ambulanspersonal finnas till hands så länge som det krävs för att hjälpa närstående i kris.

  • 67.
    Bremer, Anders
    University of Borås, School of Health Science.
    Ambulanssjukvård mellan liv och död: ett etiskt perspektiv2009Conference paper (Other academic)
    Abstract [sv]

    Patienters hjärtstopp utanför sjukhus orsakar lidande och död. Det påverkar även närståendes fortsatta livssituation. Bakgrund: För ambulanspersonal kan det vara svårt ta etiskt riktiga beslut vid vård av patient med hjärtstopp. I balansen mellan nytta och risk med återuppliv-ning är det svårt att avgöra vad som är rätt eller fel och när det är meningslöst eller emot patientens vilja. De drabbades erfarenheter, och ett normativt per-spektiv, kan bidra med kunskap om vad etiskt god vård vid hjärtstopp kan vara. Syfte: Att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus re-spektive närvara vid närståendes hjärtstopp, samt belysa de etiska aspekter och problem som framträder. Metod: Kvalitativa intervjuer med fenomenologisk livsvärldsansats. Nio över-levande patienter och sju närstående intervjuades. Resultat: Överlevande patienter beskriver hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och för-lust av sammanhang. Efteråt, via andra människors berättelser och egna minnen, söker överlevande efter sammanhang så att händelsen och livssituationen kan ges mening och förklaring till tankar, känslor och upplevelser. I det fortsatta li-vet finns existentiell otrygghet där identiteten och meningen i livet omvärderas i takt med en växande insikt om hur kroppen påverkats. Där finns tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där det passerade livs-hotet införlivas i ett liv där nära relationer blivit viktigare. Närstående upplever patientens hjärtstopp som overkligt. Tiden tycks stanna upp. Samtidigt är verk-ligheten extremt påtaglig med ett överväldigande, ensamt ansvar med känsla av otillräcklighet. Ambulanspersonalens ankomst väcker närståendes hopp om att patienten ska överleva, samtidigt som allt är kaotiskt, ångestfyllt och omtumlan-de då närstående kastas mellan hopp och misströstan. Livets grundvalar skakas om. Efter händelsen finns frågor och oro. Närståendes ensamhet i sorg eller oro för den överlevandes framtid, riskerar att leda till uppoffringar av egna behov. Slutsats: I det akuta skedet är det svårt att avgöra om patienten kan räddas till ett fortsatt acceptabelt liv varför återupplivningsförsök bör göras vid behand-lingsbara hjärtstopp. Undantagsvis är det rätt att avstå från, eller avbryta, åter-upplivning och vid förekomst av giltigt förhandsdirektiv är det primära att främ-ja en värdig död. Ambulanssjuksköterskor kan antas kunna ta ett utökat etiskt ansvar när det gäller beslutsrätten att avstå/avbryta återupplivning vid hjärtstopp och i eftervården av överlevande patienter kan ambulanspersonal hjälpa till att återskapa förlorade sammanhang. Ett rimligt vårdansvar för närstående är att ge stöd i krissituationen, dels under pågående återupplivning och dels då patienten avlidit. Däremot är hjärtlungräddning utförd som en ritual för närstående skull inte att betrakta som ett gott akut vårdande.

  • 68. Svensson, Leif
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Cirkulation, Bröstsmärtor2009In: Prehospital akutsjukvård, Stockholm: Liber , 2009, p. 264-278Chapter in book (Other academic)
  • 69.
    Sandman, Lars
    et al.
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Svensson, Leif (Editor)
    Etik inom ambulanssjukvården2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, p. 167-179Chapter in book (Other academic)
  • 70.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars
    University of Borås, School of Health Science.
    Experiencing Out-of-Hospital Cardiac Arrest: Significant Others’ Lifeworld Perspective2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 10, p. 1407-1420Article in journal (Refereed)
    Abstract [en]

    When patients suffer out-of-hospital cardiac arrests (OHCA), significant others find themselves with no choice about being there. After the event they are often left with unanswered questions about the life-threatening circumstances, or the patient’s death, or emergency treatment and future needs. When it is unclear how the care and the event itself will affect significant others’ well-being, prehospital emergency personnel face ethical decisions. In this article we describe the experiences of significant others present at OHCA, focusing on ethical aspects and values. Using a lifeworld phenomenological approach, 7 significant others were interviewed. The essence of the phenomenon of OHCA can be stated as unreality in the reality, which is characterized by overwhelming responsibility. The significant others experience inadequacy and limitation, they move between hope and hopelessness, and they struggle with ethical considerations and an insecurity about the future. The study findings show how significant others’ sense of an OHCA situation, when life is trembling, can threaten values deemed important for a good life.

  • 71. Hollenberg, Jacob
    et al.
    Engdahl, Johan
    Axelsson, Åsa
    Bremer, Anders
    University of Borås, School of Health Science.
    Hjärtstopp2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, p. 295-304Chapter in book (Other academic)
  • 72.
    Bremer, Anders
    University of Borås, School of Health Science.
    Svensson, Leif (Editor)
    Mötet med närstående2009In: Prehospital akutsjukvård, Stockholm: Liber , 2009, p. 150-161Chapter in book (Other academic)
  • 73.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars.
    University of Borås, School of Health Science.
    To survive out-of-hospital cardiac arrest: a search for meaning and coherence2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 3, p. 323-338Article in journal (Refereed)
    Abstract [en]

    The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions, and actions should be based in the patient's beliefs about health and well-being. In this article, we describe patients' experiences of surviving OHCA. By using a phenomenological approach, we focus on how OHCA influences patients' well-being over time. Nine survivors were interviewed. Out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding, as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. The study findings show survivors' emotional needs and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.

  • 74.
    Bremer, Anders
    University of Borås, School of Health Science.
    När livet skakas om: patienters och närståendes erfarenheter av hjärtstopp utanför sjukhus2008Licentiate thesis, monograph (Other academic)
  • 75.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Rusner, Marie
    University of Borås, School of Health Science.
    Johansson Sundler, Annelie
    Berglund, Maria
    Meranius, Martina
    Thurang, Anna
    Karlsson, Ann-Christine
    Pettersson, Bengt-Olof
    Bremer, Anders
    University of Borås, School of Health Science.
    Varför vårdvetenskap?2008Report (Other academic)
  • 76.
    Bremer, Anders
    University of Borås, School of Health Science.
    Att överleva hjärtstopp2007Conference paper (Other academic)
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