Change search
Refine search result
1 - 41 of 41
CiteExportLink to result list
Permanent link
Cite
Citation style
  • harvard-cite-them-right
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Sterner, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sköld, Robert
    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. Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Effects of Blended Simulation on Nursing Students’ Critical Thinking Skills: A Quantitative Study2023In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 9Article in journal (Refereed)
    Abstract [en]

    Introduction

    Critical thinking is regarded as imperative to healthcare quality and patient outcomes; therefore, effective strategies in nursing education are required to promote students’ critical thinking abilities, leading to their success in clinical work. Accordingly, simulation-based education has been suggested as a measure for achieving this goal.

    Objective

    The aim of this study was to explore whether a nursing education course with blended simulation activities (hands-on simulations with high-fidelity manikins and a web-based interactive simulation program) could increase nursing students’ critical thinking skills.

    Method

    A quasiexperimental, one-group pretest and post-test design was utilized. Data were collected through premeasurement and postmeasurement using a critical thinking questionnaire and were analyzed using paired sample t-tests, independent sample t-tests, and the nonparametric Wilcoxon signed-rank test. The effect size was calculated using Cohen's d formula.

    Results

    Sixty-one nursing students (57 women and four men, mean age 30 years) participated in the study. Findings of the paired sample t-test showed a significantly higher mean score for posteducation than pre-education, indicating a significant change in nurses’ critical thinking capabilities (p < .001). The results for Cohen's d formula ( − 0.87) of the mean scores between pre-education and posteducation indicated a large effect size. The Wilcoxon signed-rank test also showed a statistically significant increase in the students’ critical thinking abilities between pre-education and posteducation measures (p < .001). No statistically significant differences were found in the mean score according to age or sex.

    Conclusion

    This study concluded that blended simulation-based education can increase nursing students’ critical thinking capabilities. As a result, this study builds on the use of simulation as a measure for developing and promoting critical thinking abilities during nursing education.

     

    Download full text (pdf)
    fulltext
  • 2.
    Falchenberg, Åsa
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. PreHospen.
    Sterner, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Norberg Boysen, Gabriella
    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.
    Emergency care at home - care that limps2023In: Emergency Care Delivery at Home – An innovative approach for taking care of patients needs for emergency care, 2023Conference paper (Other academic)
    Abstract [en]

    Introduction: The number of patients who perceive themselves to have need for emergency care needs has increased over time. Some of these care needs can be addressed at patients' home (1). Emergency care delivery at home can be better for some patients (2). This arises questions how to provide high-quality and cost-effective emergency care (3). Therefore, it is needed to explore how delivery models can be changed for taking care of patients needs for emergency care. 

    Aim: To explore emergency health care professionals’ experiences in caring for patients with emergency care needs in their homes.

    Methods: A qualitative study based on observations and interviews was used. Data was analyzed by content analysis.  Results: No results are currently available as data collection is ongoing. The poster will present preliminary results at the conference. 

    Conclusion: The findings can be assumed to contribute and stimulate to a continued discussion and development of new and additional models of emergency care delivery based on patient’s emergency care needs.

  • 3.
    Falchenberg, Åsa
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sterner, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Norberg Boysen, Gabriella
    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.
    Emergency Care Delivery at Home – An innovative approach for taking care of patients needs for emergency care2023In: Emergency Care Delivery at Home – An innovative approach for taking care of patients needs for emergency care, 2023Conference paper (Other academic)
    Abstract [en]

    Introduction: The number of patients who perceive themselves to have need for emergency care needs has increased over time. Some of these care needs can be addressed at patients' home (1). Emergency care delivery at home can be better for some patients (2). This arises questions how to provide high-quality and cost-effective emergency care (3). Therefore, it is needed to explore how delivery models can be changed for taking care of patients needs for emergency care. 

    Aim: To explore emergency health care professionals’ experiences in caring for patients with emergency care needs in their homes.

    Methods: A qualitative study based on observations and interviews was used. Data was analyzed by content analysis.  Results: No results are currently available as data collection is ongoing. The poster will present preliminary results at the conference. 

    Conclusion: The findings can be assumed to contribute and stimulate to a continued discussion and development of new and additional models of emergency care delivery based on patient’s emergency care needs.

  • 4.
    Andersson, Ulf
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT. University of Borås, Faculty of Caring Science, Work Life and Social Welfare. PreHospen – Centre for Prehospital Research, University of Borås, Sweden;PICTA – Prehospital Innovation Arena, Lindholmen Science Park, Sweden.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Academy for Caring Science, Work Life & Social Welfare, University of Borås, Sweden;PreHospen – Centre for Prehospital Research, University of Borås, Sweden;Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Sweden;Department of Health and Caring Sciences, Linnaeus University, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Puaca, Goran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study2023In: Paramedicine, ISSN 2753-6386Article in journal (Refereed)
    Abstract [en]

    Introduction

    Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR.

    Methods

    Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources.

    Results

    The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates.

    Conclusion

    The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.

     

    Download full text (pdf)
    fulltext
  • 5.
    Olander, Agnes
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Magnusson, Carl
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    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. Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    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.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study2023In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 38, no 2, p. 160-167Article in journal (Refereed)
    Abstract [en]

    Introduction: The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. 

    Study Objective: The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. 

    Methods: A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. 

    Results: A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. 

    Conclusions: As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.

    Download full text (pdf)
    fulltext
  • 6.
    Andersson, Ulf
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT. University of Borås, Faculty of Caring Science, Work Life and Social Welfare. PICTA – Prehospital Innovation Arena, Lindholmen Science Park, Göteborg, Sweden.
    Andersson Hagiwara, Magnus
    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. Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Situation awareness in Sweden’s emergency medical services: a goal-directed task analysis2023In: Discover Health Systems, ISSN 2731-7501, Vol. 2, article id 44Article in journal (Refereed)
    Abstract [en]

    Situation awareness is knowing what is going on in the situation. Clinicians working in the emergency medical services (EMS) encounter numerous situations in various conditions, and to be able to provide efficient and patient safe care they need to understand what is going on and possible projections of the current situation. The design of this study encompassed a Goal-Directed Task analysis where situation awareness information requirements were mapped in relation to goals related to various aspects of the EMS mission. A group of 30 EMS subject matter experts were recruited and answered a web-based survey in three rounds related to what they though themselves or a colleague might need to achieve situation awareness related to the specific goals of various situations. The answers were analysed using content analysis and descriptive statistics. Answers reached consensus at a predetermined level of 75%. Those who reached consensus were entered into the final goal-directed task analysis protocol. The findings presented that EMS clinicians must rely on their own, or their colleagues prior experience or knowledge to achieve situation awareness. This suggests that individual expertise plays a crucial role in developing situation awareness. There also seems to be limited support for situation awareness from organizational guidelines. Furthermore, achieving situation awareness also involves collaborative efforts from the individuals involved in the situation. These findings could add to the foundation for further investigation in this area which could contribute to the development of strategies and tools to enhance situation awareness among EMS clinicians, ultimately improving patient care and safety.

    Download full text (pdf)
    fulltext
  • 7.
    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.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    The onset of sepsis as experienced by patients and family members: A qualitative interview study2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Aims and Objectives: To explore the onset of sepsis based on patients' and family members' experiences.

    Background: Knowledge about the onset of sepsis is limited among patients and their families, which makes early recognition of sepsis difficult. Previous studies argue that their stories are important to recognising sepsis and reduced suffering and mortality.

    Design: A descriptive design with a qualitative approach was used.Methods: In total, 29 patients and family members participated in 24 interviews with open-ended questions, including five dyadic and 19 individual interviews. The interviews were conducted during 2021, and participants were recruited from a sepsis group on social media. A thematic analysis based on descriptive phenomenology was performed. The study followed the COREQ checklist.

    Findings: Two themes emerged from the experiences: (1) When health changes into something unknown, including the two subthemes; Bodily symptoms and signs being vague but still tangible and Feelings of uncertainty, and (2) Turning points when warnings signs are deemed as serious, including the two subthemes Passing borders when feeling out of control and Difficulties understanding the seriousness.

    Conclusions: Patients' and family members' stories of the onset of sepsis indicate that symptoms and signs appeared insidiously and then noticeably worsen. The symptoms and signs seemed not be attributed to sepsis; instead, there was uncertainty about what the symptoms and signs meant. It was mainly family members who possibly understood the seriousness of the disease.

    Implications for the profession and patient care: Patients' experiences of their symptoms and signs and family members' unique knowledge of the patient, indicate that healthcare professionals should listen and try to understand what the patient and family members are telling and take their concerns seriously. How the condition appears, and family members' concerns are important pieces of the assessment to recognise patients with sepsis.

    Patient or public contribution: Patients and family members contributed to the data collected.

    Download full text (pdf)
    fulltext
  • 8.
    Andersson, Ulf
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. University of Borås.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT. University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Clinical Reasoning among Registered Nurses in Emergency Medical Services: A Case Study2022In: Journal of Cognitive Engineering and Decision Making, ISSN 1555-3434, E-ISSN 2169-5032Article in journal (Refereed)
    Abstract [en]

    In emergency medical services (EMS), the clinical reasoning (CR) of registered nurses (RNs) working in ambulance care plays an important role in providing care and treatment that is timely, accurate, appropriate and safe. However, limited existing knowledge about how CR is formed and influenced by the EMS mission hinders the development of service provision and decision support tools for RNs that would further enhance patient safety. To explore the nature of CR and influencing factors in this context, an inductive case study examined 34 observed patient–RN encounters in an EMS setting focusing on ambulance care. The results reveal a fragmented CR approach involving several parallel decision-making processes grounded in and led by patients’ narratives. The findings indicate that RNs are not always aware of their own CR and associated influences until they actively reflect on the process, and additional research is needed to clarify this complex phenomenon.

    Download full text (pdf)
    fulltext
  • 9.
    Olsson, Martin
    et al.
    Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Svensson, Anders
    Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Dehre, Andreas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Elmqvist, Carina
    Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Rask, Mikael
    Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Wireklint, Sara
    Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Norberg Boysen, Gabriella
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Educational intervention in triage with the Swedish triage scale RETTS©, with focus on specialist nurse students in ambulance and emergency care – A cross-sectional study2022In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 63, article id 101194Article in journal (Refereed)
    Abstract [en]

    Aim

    To determine the reliability of application of the RETTS© triage scale after an educational intervention using paper-based scenarios in emergency care education.

    Background

    Knowledge about and education in triage are important factors in triagescale implementation. Presenting students with a large number of triage scenarios is a common part of triage education.

    Methods

    In this prospective cross-sectional study at two universities students undergoing education in emergency care used RETTS© to assess triage level in 46 paper-based scenarios.

    Results

    57 students in the study made 2590 final triage decisions. Fleiss Kappa for final triage was 0.411 which is in the lower range of moderate agreement. In 25 of 46 (53.4%) scenarios, final triage levels did not agree about whether the case was stable or unstable.

    Conclusion/Implications

    Application of the RETTS© triage scale after an educational intervention with paper-based simulation in emergency care education resulted in moderate agreement about the final levels of triage.

    Download full text (pdf)
    fulltext
  • 10.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Svensson, Anders
    Linnaeus University.
    Frank, Catharina
    Linnaeus University.
    Rantala, Andreas
    Linnaeus University.
    Holmberg, Mats
    Linnaeus University.
    Bremer, Anders
    Ethics education to support ethical competence learning in healthcare: an integrative systematic review2022In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 23, no 1, article id 29Article in journal (Refereed)
    Abstract [en]

    Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.

    Methods: In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.

    Results: The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.

    Conclusions: The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.

  • 11.
    Olander, Agnes
    et al.
    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.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lived experiences of the onset of sepsis2022In: The 4th International NCCS & EACS Conference April 27th – 28th 2022 at Mälardalen University, Sweden, 2022Conference paper (Refereed)
  • 12.
    Johanna, Zetterberg
    et al.
    Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden.
    Elin, Visti
    Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden.
    Holmberg, Mats
    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. Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.
    Jonas, Aléx
    Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden; Department of Nursing, Umeå University, 901 87, Umeå, Sweden.
    Nurses’ experiences of encountering patients with mental illness in prehospital emergency care – a qualitative interview study2022In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1Article in journal (Refereed)
    Abstract [en]

    Nurses working in prehospital emergency care (PEC) encounter patients with all types of health conditions. Increasingly, they are encountering patients suffering from mental illness and this trend reflects the worldwide increase in mental illness. There is very little current knowledge of encounters between nurses and patients with mental illness in ‘PEC’, especially from the nurses’ perspectives.

    Download full text (pdf)
    fulltext
  • 13.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sterner, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Simulerings som metod i handledning för att lära sig hantera akuta situationer2022In: Studenthandledning i vårdande verksamhet. Teoretiska utgångspunkter och didaktiska metoder / [ed] Sandvik, A-H.; Ekebergh, M., Stockholm: Liber, 2022, p. 208-219Chapter in book (Other academic)
  • 14.
    Wallin, Kim
    et al.
    Centre of Interprofessional Cooperation within Emergency care (CICE), Faculty of Health and Life sciences, Linnaeus University, Department of Ambulance Service, Region Kronoberg, Växjö, Sweden.
    Holmberg, Mats
    Centre of Interprofessional Cooperation within Emergency care (CICE), Faculty of Health and Life sciences, Linnaeus University, Växjö, Sweden, Department of Ambulance Service, Region Sörmland, Katrineholm and Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kronkvist, Ola
    Centre of Interprofessional Cooperation within Emergency care (CICE), Department of Police Work, Faculty of Social Sciences, Centre for Police Research and Development, Linnaeus University, Växjö, Sweden.
    Svensson, Anders
    The Emergency Care Competence Needed for Police Patrol Officers According to the Experts2022In: Nordic Journal of Studies in Policing, E-ISSN 2703-7045, Vol. 9, no 1, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Police patrol officers (PPOs) face different types of encounters with acutely ill and injured people as first responders. The study aim was to explore and describe the emergency care competence needed for Swedish PPOs. The study had an exploratory design, and the data was collected using the Delphi technique from 43 experts in Sweden: police program educators (n=10), police authority instructors (n=11), and PPOs (n= 22). The results generated an understanding of emergency care competence that is relevant for PPOs. Basic assessment and basic life support measures for traumatic injuries and cardiac arrest (e.g., airway management, cardiopulmonary resuscitation (CPR), and hemorrhage control) received the highest levels of agreement among the experts, whereas more advanced assessments (taking care of people suffering from mental/medical illness or with drug/alcohol abuse) received lower levels of agreement. These results provide support for educators at the police programs and for the police authority in preparing PPOs to perform relevant out-of-hospital emergency care.

    Download full text (pdf)
    fulltext
  • 15.
    Svensson, Anders
    et al.
    Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Rantala, Andreas
    Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Devenish, Scott
    Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
    Williams, Julia
    Paramedic Clinical Research Unit (ParaCRU), University of Hertfordshire, Hatfield, UK.
    Holmberg, Mats
    Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Ambulance clinicians’ attitudes to older patients’ self-determination when the patient has impaired decision-making ability: A Delphi study2021In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed)
    Abstract [en]

    Objective

    The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients’ self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care.

    Materials and methods

    An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale.

    Results

    Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus.

    Conclusions

    The findings highlight the complexity of ACs’ attitudes towards older patients’ self-determination. The respect of older patients’ self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs’ moral abilities within their professional practice.

    Implications for practice

    Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs’ abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.

  • 16.
    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.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Assessment of patients with suspected sepsis in ambulance services: a qualitative interview study2021In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 21, no 45Article in journal (Refereed)
    Abstract [en]

    Background: The initial care of patients with sepsis is commonly performed by ambulance clinicians (ACs). Earlyidentification, care and treatment are vital for patients with sepsis to avoid adverse outcomes. However, knowledgeabout how patients with sepsis are assessed in ambulance services (AS) by AC is limited. Therefore, the aim of thisstudy was to explore the meaning of ACs’ lived experiences in assessing patients suspected of having sepsis.

    Methods: A descriptive design with a qualitative approach was used. Fourteen ACs from three Swedish ambulanceorganizations participated in dyadic and individual semistructured interviews. A thematic analysis based ondescriptive phenomenology was performed.

    Results: AC experiences were grouped into four themes: (1) being influenced by previous experience; (2) searchingfor clues to the severity of the patient’s condition; (3) feeling confident when signs and symptoms were obvious;and (4) needing health-care professionals for support and consultation.

    Conclusions: This study indicates that several factors are important to assessments. ACs needed to engage in anongoing search for information, discuss the cases with colleagues and reconsider the assessment throughout theentire ambulance mission. A reflective and open stance based on professional knowledge could contribute torecognizing patients with sepsis.

    Download full text (pdf)
    fulltext
  • 17.
    Falchenberg, Åsa
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. South Älvsborgs Hospital, Emergency Department, Borås, Sweden.
    Andersson, Ulf
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    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.
    Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study2021In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 0, no 0Article in journal (Refereed)
    Abstract [en]

    Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

    Download full text (pdf)
    fulltext
  • 18.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Carlsson, Jonas
    Karolinska University Hospital, Functional Area of Emergency Medicine Huddinge, Sweden.
    Karlsson, Lene
    Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden.
    Holmberg, Mats
    Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden .
    Competency requirements for the assessment of patients with mental illness in somatic emergency care: A modified Delphi study from the nurses’ perspective2020In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Article in journal (Refereed)
    Abstract [en]

    Patients suffering from mental illness are vulnerable, and they do not always have access to proper emergency care. The aim of this study was to identify competency requirements for the assessment of patients with mental illness by soliciting the views of emergency care nurses. A modified Delphi method comprising four rounds was used. Data were collected in Sweden between October 2018 and March 2019. The data were analyzed using content analysis and descriptive statistics. The panel of experts reached the highest level of consensus regarding basic medical knowledge: the capability to listen and show respect to the patient are essential competency requirements when assessing patients with mental illness in emergency care. Awareness of these competency requirements will enhance teaching and training of emergency care nurses.

    Download full text (pdf)
    fulltext
  • 19.
    Holmberg, Mats
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Hammarbäck, Staffan
    Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden .
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study2020In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Article in journal (Refereed)
    Abstract [en]

    Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.

    Download full text (pdf)
    fulltext
  • 20.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tavares, Walter
    Paramedic and Senior Services, Community and Health Services Department, Regional Municipality of York, Newmarket, ON, Canada.
    Paakkonen, Heikki
    Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland .
    Nyström, Patrik
    Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland .
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Translation and further validation of a global rating scale for the assessmentof clinical competence in prehospital emergency care2020In: Nurse Education in Practice, Vol. 47, article id 102841Article in journal (Refereed)
    Abstract [en]

    Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions.The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contributevalidity evidence and instrument usefulness in training results and clinical competence assessments of studentsundergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The studyincluded translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturallyadapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated usingeight experts. IRR tests were performed with five registered nurses working as university lecturers, and with sixclinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment.Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI foritems and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agreementin the group of clinicians. This study provides validity evidence for a Swedish version of the scale, supportingits use in measuring clinical competence among students undergoing training to become ambulancenurses and paramedics.

    Download full text (pdf)
    fulltext
  • 21.
    Andersson, Ulf
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Clinical reasoning in the emergency medical services: an integrative review2019In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

    Download full text (pdf)
    fulltext
  • 22.
    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.

    Download full text (pdf)
    fulltext
  • 23.
    Maurin Söderholm, Hanna
    et al.
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Backlund, Per
    School of Informatics, University of Skövde.
    Bergman, Johanna
    PICTA - Prehospital ICT Arena, Lindholmen Science Park AB.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sjöqvist, Bengt Arne
    Biomedical Signals and Systems, Department of Electrical Engineering, Chalmers University of Technology.
    Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory.2019In: Advances in Simulation, ISSN 2059-0628, Vol. 4, article id 3Article in journal (Refereed)
    Abstract [en]

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

    Download full text (pdf)
    fulltext
  • 24.
    Holmberg, Mats
    et al.
    Ambulanssjukvården i Södermaland.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Winge, Karin
    Ambulanssjukvården Södra Älvsborgssjukhus.
    Lundberg, Camilla
    Ambulanssjukvården Södra Älvsborgssjukhus.
    Karlsson, Thomas
    Sahlgrenska akademin vid Göteborgs universitet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Association between the reported intensityof an acute symptom at first prehospital assessment and the subsequent outcome:a study on patients with acute chest painand presumed acute coronary syndrome2018In: BMC Cardiovascular Disorders, p. 1-10, article id 18:216Article in journal (Refereed)
    Abstract [en]

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

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

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

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

    Download full text (pdf)
    fulltext
  • 25.
    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)
    Download (pdf)
    presentationsbild
  • 26. Wennberg, Pär
    et al.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature2018In: International Journal of Orthopaedic and Trauma NursingArticle in journal (Refereed)
  • 27.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gabre, Marita
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dehre, Andreas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Simulation in Virtual World to Promote Communication2018In: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Conference paper (Other academic)
    Abstract [en]

    Introduction

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

     

    Aim

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

     

    Methods

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

     

    Results

    The participants’ experiences generated three themes:

     

    Understanding the virtual world

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

     

    Technological challenges

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

     

    Learning through avatars

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

     

    Conclusion

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

    Download full text (pdf)
    fulltext
  • 28.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gabre, Marita
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dehre, Andreas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Simulation in Virtual World to Promote Communication2018In: Pre-hospital care- Education and training of ambulance professionals, Noordwijkerhout, The Netherlands, 2018Conference paper (Refereed)
    Abstract [en]

    Introduction

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

     

    Aim

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

     

    Methods

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

     

    Results

    The participants’ experiences generated three themes:

     

    Understanding the virtual world

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

     

    Technological challenges

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

     

    Learning through avatars

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

     

    Conclusion

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

  • 29.
    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.

  • 30.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ullgren, Andreas
    Holmberg, Mats
    Karlsson, Thomas
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Acute coronary syndrome in relation to the occurrence of associatedsymptoms: A quantitative study in prehospital emergency care2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 43-47-Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 31.
    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. 

  • 32.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindholm, Maria
    Pettersson, Margareta
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nurses competencies in Home health care: An interview study.2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, no 65Article in journal (Refereed)
    Abstract [en]

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

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

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

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

    Download full text (pdf)
    fulltext
  • 33.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmberg, Mats
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Sahlgrenska Universitetssjukhuset.
    Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 52Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

    Trial registration

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

    Download full text (pdf)
    fulltext
  • 34.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmberg, Mats
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Pre-hospital care for patients suffering from suspected acute coronary syndrome - educational intervention for pain and anxiety relief2016Conference paper (Refereed)
    Abstract [en]

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

     

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

     

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

     

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

     

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

  • 35. 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.

    Download full text (pdf)
    fulltext
  • 36.
    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.

  • 37.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Competencies in Swedish emergency departments: The practitioners’ and managers’ perspective2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 2, p. 81-87Article in journal (Refereed)
    Abstract [en]

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

  • 38.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Nilsson, Kerstin
    Jakobsson Ung, Eva
    Management of everyday work in Emergency Departments: An exploratory study with Swedish Managers2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 81-87Article in journal (Refereed)
    Abstract [en]

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

  • 39.
    Andersson, Henrik
    University of Borås, School of Health Science.
    Medikaliserat och resultatstyrt vårdarbete på akutmottagning: en studie med utgångspunkt i medarbetares och chefers perspektiv2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

    Download full text (pdf)
    FULLTEXT01
    Download (pdf)
    SPIKBLAD01
  • 40.
    Andersson, Henrik
    et al.
    University of Borås, School of Health Science.
    Jakobsson, E
    Furåker, C
    Nilsson, K
    The everyday work at a Swedish emergency department: The practitioners’ perspective2012In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, no 2, p. 58-68Article in journal (Refereed)
    Abstract [en]

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

  • 41.
    Andersson, Henrik
    et al.
    Sahlgrenska University Hospital.
    Nilsson, Kerstin
    Gothenburg University.
    QUESTIONING NURSING COMPETENCES INEMERGENCY HEALTH CARE2009In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 35, p. 305-311Article in journal (Refereed)
    Abstract [en]

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

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

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

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

1 - 41 of 41
CiteExportLink to result list
Permanent link
Cite
Citation style
  • harvard-cite-them-right
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf