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  • 2851. Wikström, E
    et al.
    Tengelin, E
    Arman, R
    Dellve, Lotta
    [external].
    Regulating time commitments in healthcare organizations: managers’ boundary approaches at work and in life2011Inngår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 25, nr 5, s. 578-599Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this paper is to explore managers' boundary setting in order to better understand their handling of time commitment to work activities, stress, and recovery during everyday work and at home. DESIGN/METHODOLOGY/APPROACH: The paper has qualitatively-driven, mixed method design including observational data, individual interviews, and focus group discussions. Data were analyzed according to Charmaz' view on constructivist grounded theory. FINDINGS: A first step in boundary setting was to recognize areas with conflicting expectations and inexhaustible needs. Second, strategies were formed through negotiating the handling of managerial time commitment, resulting in boundary-setting, but also boundary-dissolving, approaches. The continuous process of individual recognition and negotiation could work as a form of proactive coping, provided that it was acknowledged and questioned. RESEARCH LIMITATIONS/IMPLICATIONS: These findings suggest that recognition of perceived boundary challenges can affect stress and coping. It would therefore be interesting to more accurately assess stress, coping, and health status among managers by means of other methodologies (e.g. physiological assessments). PRACTICAL IMPLICATIONS: In regulating managers' work assignments, work-related stress and recovery, it seems important to: acknowledge boundary work as an ever-present dilemma requiring continuous negotiation; and encourage individuals and organizations to recognize conflicting perspectives inherent in the leadership assignment, in order to decrease harmful negotiations between them. Such awareness would benefit more sustainable management of healthcare practice. ORIGINALITY/VALUE: This paper highlights how managers can handle ever-present boundary dilemmas in the healthcare sector by regulating their time commitments in various ways.

  • 2852. Wikström, Ewa
    et al.
    Arman, Rebecka
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Vad gör chefer med sin tid och hur kan tid och engagemang hanteras på2013Inngår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. Tema Ledarskap, nr 6, s. 830-837Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    En studie om chefers tidsanvändning har genomförts med syftet att undersöka hur man kan understödja mer hållbar tidsanvändning och hållbart engagemang. Chefer hade många korta aktiviteter och många möten men kommunicerade sällan med sin egen chef på tu man hand. Arbetet präglades av ständiga förhandlingar, prioriteringar och omprioriteringar. Om chefer inte har enskild tid för att kommunicera med sin överordnade får det konsekvenser avseende att kunna göra välavvägda och acceptabla prioriteringar och i förlängningen för legitimiteten i ledarskapet. Vården och dess chefer har mycket att vinna på att utveckla kommunikationen om vardagsarbetetes dilemman. Utifrån våra resultat har ett studiematerial utvecklats som syftar till att stödja chefer och ledningsgrupper i det vardagliga arbetet avseende hållbart ledarskap, chefskap och tidsanvändning

  • 2853. Williamsson, Anna
    et al.
    Eriksson, Andrea
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The organization and work practice of change agents in health care organizations; effects on health care professionals’ engagement and participation in improvement work.2014Konferansepaper (Fagfellevurdert)
  • 2854.
    Williamsson, Anna
    et al.
    1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Karltun, Anette
    Jönköping University.
    Dellve, Lotta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. 1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Visual management in hospitals during organizational developments - benefits and contributions for working conditions and efficacy2015Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction

    Many hospitals choose to use certain tools related to lean, such as visual management (VM) during organizational development (OD) and daily processes. By using VM in the strategic planning process and depending on what is visualized in what stage of the planning process, different cognitive, social and emotional benefits may be gained. Research on VM in healthcare has so far concerned case studies of VM in surgical departments or during OD, and there is a lack of studies with rich empirical data. The aim of this paper was to explore VM use at hospital units undergoing OD; the main VM focus, and the benefits and perceived VM contributions concerning working conditions and efficacy.

    Material and Methods

    Photos of VM (120) at 16 units were taken during 2013-2015 and categorized by content analysis into VM focus and main content. A questionnaire concerning use of and perceived VM contributions in daily work (regarding; a) overview work, b) focus important information, c) detection of improvement opportunities) as well as working conditions, efficacy and quality of care was distributed to registered nurses and assistant nurses at five hospitals (21 units) at two occasions, 2013 (N=926) and 2014 (N=632). Comparative analysis’ within and between higher and lower use units were conducted.

    Results

    Content analysis of the photos showed three main VM foci; results, flow and improvements.  Five of the 21 units were considered to have higher VM and 16 units had lower. In comparative analysis, higher VM was associated with higher predictability and influence as well as with cognitive and social benefits of importance when participating in OD. Higher VM was also associated with higher degree of goal monitoring and evaluation, patient flow and efficacy in health care service.

    Conclusions

    Daily use of VM in hospitals undergoing OD had importance for employees’ working conditions as well as  perception of OD; overview of work, focus on results,  detection of improvement opportunities and outcomes in terms of patient flow and efficacy.

  • 2855. Williamsson, Anna
    et al.
    Karltun, Annette
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Visualizing improvements of care processes- a contribution to shared understanding and engagement, or cognitive strain?2014Konferansepaper (Fagfellevurdert)
  • 2856.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Aktuella forskningfrågor inom ambulanssjukvård vid PreHospen: Lindra projektet2008Konferansepaper (Annet vitenskapelig)
  • 2857.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap. Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Att lära sig vårdande bedömning2015Inngår i: Reflektion i lärande och vård: en utmaning för sjuksköterskan / [ed] Mia Berglund, Margaretha Ekebergh, Lund: Studentlitteratur , 2015, s. 163-174Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

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

  • 2858. Wireklint Sundström, Birgitta
    Fear of childbirth2008Inngår i: / [ed] Nilsson, C, 2008Konferansepaper (Annet vitenskapelig)
  • 2859.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Forskning i PreHospital akutsjukvård: varför och hur?2008Konferansepaper (Annet vitenskapelig)
  • 2860.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kompetensbeskrivning. Legitimerad sjuksköterska med specialistsjuksköterskeexamen med inriktning mot ambulanssjukvård.2012Rapport (Annet vitenskapelig)
    Abstract [sv]

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

  • 2861.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kunskapscentrum PreHospen: att vidareutveckla akutsjukvård utanför sjukhus i professionssamverkan2009Rapport (Annet vitenskapelig)
  • 2862.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindra ska lätta trycket i ambulansen2008Inngår i: Forskning: tidning för studenten, forskare, företag, inom teknik och naturvetenskap, ISSN 1654-8876, Vol. 3, s. 46-47Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 2863.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    PreHospen Conference 2016: Where all care begins2016Konferanseproceedings (Fagfellevurdert)
  • 2864.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Johansson Sundler, Annelie ()
    Roxberg, Åsa ()
    Vårdvetenskap + medicin är sant?2008Rapport (Annet vitenskapelig)
  • 2865.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Brink, Peter
    NU-Hospital Organisation.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, Per-Olof
    University of Gothenburg.
    The early chain of care and risk of death in acute stroke in relation to the priority given at the dispatch centre: A multicentre observational study2017Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 16, nr 7, s. 623-631Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 2866.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Annetorp, M.
    Sjöstrand, F.
    Vicente, V.
    Optimal vårdnivå för multisjuka äldre2016Inngår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 263-277Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2867.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Aronsson, K.
    Larsson, G.
    Patienter med misstänkt höftfraktur: Vårdvetenskaplig analys2016Inngår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 410-469Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2868.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindström, Veronica
    Karolinska Institutet.
    Vicente, Veronica
    Karolinska Institutet.
    Caring science research in the ambulance services: an integrative systematic review.2018Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.

    AIM: This integrative systematic review aims to describe caring science research content and scope in the ambulance services.

    DATA SOURCES: Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.

    REVIEW METHODS: The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five-stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3-level scale, and data relevance was evaluated on a 2-level scale.

    RESULTS: After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision-making; Public environment and patient safety; Life-changing situations; and Ethics and values.

    CONCLUSION: Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional-patient relation, with special focus on value conflicts in emergency situations.

  • 2869.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, Thomas
    Winge, Karin
    Lundberg, Camilla
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Anxiolytics in patients suffering a suspected acute coronary syndrome: Multi-centre randomised controlled trial in Emergency Medical Service2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 4, s. 3580-3587Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 2870.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dahlberg, Karin
    Being Prepared for the Unprepared: A Phenomenology Field Study of Swedish Prehospital Care2012Inngår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, ISSN 0099-1767, Vol. 38, nr 6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 2871.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dahlberg, Karin
    Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions2011Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 19, nr 3, s. 113-119Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 2872.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ekebergh, Margaretha
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    How caring assessment is learnt: reflective writing on the examination of Specialist Ambulance Nurses in Sweden2013Inngår i: Reflective Practice, ISSN 1462-3943, E-ISSN 1470-1103, Vol. 14, nr 2, s. 271-287Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 2873.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hansson, Per Olof
    Brink, Peter
    Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: Results of an observational studyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

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

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

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

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

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

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

  • 2874.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Pre-hospital care for patients suffering from suspected acute coronary syndrome - educational intervention for pain and anxiety relief2016Konferansepaper (Fagfellevurdert)
    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.

  • 2875.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmberg, Mats
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    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 trial2016Inngår i: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, nr 52Artikkel i tidsskrift (Fagfellevurdert)
    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).

  • 2876.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jylli, Leena
    Winge, Karin
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif ()
    Barn och smärta2009Inngår i: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, s. 452-459Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2877.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sjöstrand, Fredrik
    Vicente, Veronica
    Svensson, Leif ()
    Optimal vårdnivå vid icke-akuta tillstånd2009Inngår i: Prehospital akutsjukvård, Stockholm: Liber , 2009, s. 199-212Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2878.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Vicente, Veronica
    Den äldre personens delaktighet i vårdval vid akut behov av vård: Ett exempel från ambulanssjukvård. Webbdelen.2013Inngår i: Omvårdnad på avancerad nivå. Kärnkompetenser inom sjuksköterskans specialistområden. Webbdelen. / [ed] Anna-Karin Edberg, Anna Ehrenberg, Febe Friberg, Lars Wallin, Helle Wijk, Joakim Öhlén, Studentlitteratur , 2013Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    Ambulanssjuksköterskor ansvarar för avancerad omvårdnad av äldre personer. Centralt i omvårdnaden är att bedöma vårdbehov och på plats besluta om optimal vårdnivå. Betydelsen understryks av att det ibland kan krävas snabba beslut som avgör vad som är det optimala vårdvalet för den unika patienten. Bedömning utgår från att lyssna på patientens berättelse ibland även på anhörigas, och ta ställning till olika tecken på sjukdom och ohälsa hos patienten. Äldre personer uppskattar att bli delaktiga i sin vård och få möjligheten till att göra vårdval. Att bli erbjuden ett direktspår till närakutmottagning eller geriatrisk vårdavdelning har visat sig vara en positiv invit till delaktighet. Tidigare vårderfarenheter från akutsjukvård har varit av traditionell vård på akutmottagning utan att kunna välja andra alternativ. Minnen av’icke vård’ på en akutmottagning lever kvar, vilket bör betraktas som ett vårdlidande. Således är det betydelsefullt att patienten bjuds in till ett vårdande möte och får känna tilliten till ambulanssjusköterskans kompetens, vilket kan bli avgörande för hur patienten kommer att känna fortsatt förtroende för vården. Då förutsätts det en mellanmänsklig relation med en ambulanssjuksköterska som upplevs vara närvarande och engagerad. En sådan mellanmänsklig relation kan ge den äldre personen djupa intryck.

  • 2879.
    Wireklint Sundström, Birgitta
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Öberg, M.
    Jylli, L.
    Nilsson, R.S.
    Barn och smärta: frakturmisstanke vid fallolycka2016Inngår i: Prehospital akutsjukvård / [ed] B-O. Suserud & L. Lundberg, Stockholm: Liber, 2016, 2, s. 526-533Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2880.
    Wireklint-Sundström, B
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Petersson, E
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sjöholm, M
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gelang, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    A pathway care model allowing low-risk patients to gain direct admissionto a hospital medical ward a pilot study on ambulance nurses and Emergency Department phycisians2014Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, nr 1, s. 72-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward¿¿¿a pilot study on ambulance nurses and Emergency Department physicians.BackgroundPatients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED.MethodsThe pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N¿=¿51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N¿=¿51) received traditional care at the ED. All p-values are age-adjusted.ResultsPatients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p¿=¿0.02). The median delay from arrival at the patient¿s side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p¿<¿0.0001). However, the median delay time from the ambulance¿s arrival at the patient¿s side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p¿<¿0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p¿=¿0.16).ConclusionThe pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.

  • 2881.
    Wireklint-Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Winge, Karin
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    LINDRA-studien2009Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Erfarenheter av att genomföra en forskningsstudie i ambulanssjukvård. LINDRA-studien syftar till att öka ambulanssjuksköterskors möjligheter att bedöma, lindra och behandla bröstsmärta och oro hos patienter som söker ambulanssjukvård. Datainsamlingen startade i maj 2008; Ambulanssjukvården i Göteborg/SU, Skaraborgs sjukhus, Södra Älvsborgs Sjukhus och Halmstad (öster). Våren 2009 gjordes en utökning; Norra Älvsborgs Sjukhus och Uddevalla sjukhus, Kungälvs Sjukhus och Halmstad (väster). Det innebär att ca 500 ambulanssjuksköterskor ingår i studien, som i övrigt involverar 60 ambulanser och en båt i Västsverige. Hittills har knappt 600 patienter deltagit, som när studien är klar sommaren 2010 omfattar ca 1800 patienter. Preliminära resultat beräknas kunna presenteras under slutet av 2010. I hälso- och sjukvården ska forsknings- och utvecklingsarbete (FoU) ingå som en naturlig del (HSL, 1982:763). Däremot saknas tradition och rutin för FoU inom ambulanssjukvård. LINDRA-studiens genomförande har gett oss en rad erfarenheter av möjligheter och svårigheter att bedriva prehospital forskning. Vi kommer att berätta om hur ambulanssjukvård och forskning går att kombinera.

  • 2882.
    Wismén, Snezhana
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ambulanspersonalens förmåga att identifiera patienter med bacteriaemi eller sepsis med fokus på överlevnad de första 30 dagarna: En kvantitativ studie2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Bacteriaemi eller sepsis är ett vanligt förekommande tillstånd som kännetecknas av ett snabbt och diffust insjuknande inom akuta verksamheter. Tillståndet kräver en snabb handläggning, vilket innebär tidig identifiering med en snabb insättning av behandling för att undvika det livshotande tillståndet som kan leda till en dödlig utgång. Detta kräver att vårdpersonalen tidigt ska kunna kartlägga och behandla patienter där det föreligger allvarliga infektioner som sepsis.

    Syftet: med studien är att belysa den kliniska presentationen hos patienter med svåra infektioner som här definieras som att patienten antingen fick slutdiagnosen sepsis eller uppvisade en positiv blododling i prehospital miljö i relation till utfall. Dessutom belyses ambulanspersonalens förmåga att upptäcka tillståndet redan prehospitalt i relation till utfall.

    Metod: En retroperspektiv registergranskning med en kvantitativ ansats. Utfall definieras som död inom de första 30 dagarna.

    Resultat: Totalt deltog 854 patienter i studien. Bland dem dog 20% under de första 30 dagarna. Insjuknandet föreföll ofta att vara ospecifikt. Av de patienter som dog inom 30 dagar var luftvägarna den vanligaste organpåverkan och bland dem som överlevde 30 dagar var infektion i urinvägar den vanligaste orsaken. Det förelåg ingen könsskillnad med avseende på prognos. Tid från larm till start av antibiotikabehandling var kortare bland dem som dog   De som dog var i genomsnitt äldre.  De patienter som dog hade också en lägre grad av vakenhet, ett lägre blodtryck, en lägre syresättning, och en lägre kroppstemperatur samt högre andningsfrekvens jämfört med de som överlevde.  Bara i ca 15% av fallen noterade ambulanspersonalen en misstanke om sepsis och en sådan misstanke var lika ovanligt i båda grupperna.

    Diskussion: Bland patienter med slutdiagnosen sepsis eller bakterieami så är risken att dö under de första 30 dagarna hög. Det föreligger redan i den prehospitala miljön påtagliga skillnader mellan de patienter som kommer att överleva och de som kommer att dö med avseende på patientkaraktäristik, etiologi och vitalparametrar. Denna kunskap kanske i framtiden skulle kunna utnyttjas på ett mera systematiskt sätt eventuellt med hjälp av ett datorstöd. Men andelen fall där ambulanspersonalen misstänker sepsis är alltjämt för låg. En ökad utbildning och förbättrade beslutsstöd kan möjligen förbättra denna siffra.

  • 2883. Wnent, Jan
    et al.
    Masterson, Siobhán
    Gräsner, Jan-Thorsten
    Böttiger, Bernd W
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Koster, Ruud W
    Rosell Ortiz, Fernando
    Tjelmeland, Ingvild
    Maurer, Holger
    Bossaert, Leo
    EuReCa ONE - 27 Nations, ONE Europe, ONE Registry: a prospective observational analysis over one month in 27 resuscitation registries in Europe - the EuReCa ONE study protocol.2015Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, nr 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: There is substantial variation in the incidence, likelihood of attempted resuscitation and outcomes from out-of-hospital cardiac arrest (OHCA) across Europe. A European, multi-centre study provides the opportunity to uncover differences throughout Europe and may help find explanations for these differences. Results may also have potential to support the development of quality benchmarking between European Emergency Medical Services (EMS).

    METHODS/DESIGN: This prospective European study involves 27 different countries. It provides a common Utstein-based dataset, data collection tool and a common data collection period for all participants. Study research questions will address the following: OHCA incidence in different European regions; incidence of cardiopulmonary resuscitation (CPR); initial presenting rhythm in patients where bystanders or EMS start CPR or any other resuscitation intervention; proportion of patients with any return of spontaneous circulation (ROSC); patient status at the end of pre-hospital treatment i.e. ROSC at handover to hospital, ongoing CPR, dead; proportion of patients still alive 30 days after OHCA; proportion of patients discharged alive from hospital. All patients who suffered an OHCA during October 2014 and were attended and/or treated by an EMS and documented in one of the participating registries will be included in the study. Each National Coordinator is responsible for data collection and quality control in his/her country and will transfer unprocessed anonymised data via secure electronic transfer. Descriptive analysis will be performed at European, national and registry level. For endpoints like ROSC, admission or survival, multivariate logistic regression analysis will be performed.

    DISCUSSION: Documenting differences in epidemiology, treatment and outcome in out-of-hospital cardiac arrest throughout Europe is a first step in finding explanations for these differences. Study results might also support the development of quality benchmarking between Emergency Medical Services (EMS) which in turn will facilitate initiatives to improve OHCA outcome in Europe.

    TRIAL REGISTRATION: The EuReCa ONE Study is registered by ClinicalTrials.gov National Coordinator T02236819 ).

  • 2884. Woods, S
    et al.
    Sandman, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Continental Philosophy and Nursing Ethics2002Inngår i: Ethics In Nursing Education, Research And Management. Perspectives from Europe / [ed] W Tadd, Palgrave , 2002, s. 14-34Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2885. Wramsten Wilmar, Maria
    et al.
    Ahlborg, Gunnar
    Jacobsson, Christian
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Healthcare managers in negative media focus: a qualitative study of personification processes and their consequences2014Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, nr 8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach.Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization.

  • 2886.
    Wramsten Wilmar, Maria
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jacobsson, Christian
    Ahlborg, Gunnar
    Health care managers handling negative media focus: Individual and Organizational quagmire increases personification processes and personal consequences2012Konferansepaper (Fagfellevurdert)
  • 2887.
    Wramsten Wilmar, Maria
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jacobsson, Christian
    Ahlborg, Gunnar
    Health care managers handling negative media focus: Individual and Organizational quagmire increases personification processes and personal consequences2012Konferansepaper (Fagfellevurdert)
  • 2888.
    Wulcan, Ann-Charlotte
    et al.
    Northern Älvsborg County Hospital, NU-Hospital Group.
    Nilsson, Christina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study2019Inngår i: Sexual and Reproductive Healthcare, ISSN 1877-5756, Vol. 19, s. 24-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    Fear of childbirth is a well-known problem affecting women’s wellbeing and health. The prevalence of intense fear varies across countries from 4.8 to 14.8%. During the past 25 years in Sweden women with intense fear of childbirth have been offered counselling at specialised clinics staffed by midwives. Although the counselling demonstrates positive results, the training, education, supervision and organisation differ between clinics. It is still unclear which approaches and practices are the most beneficial. The aim was to explore and describe the counselling of women with intense fear of childbirth from the viewpoint of midwives who provide counselling in specialised fear of childbirth clinics in one region of Sweden.

    Methods

    A qualitative study of 13 midwives using focus group interviews and inductive content analysis.

    Results

    The midwives’ counselling of women with intense fear of childbirth is described as ‘striving to create a safe place for exploring fear of childbirth’, comprising the following categories: Providing a reliable relationship; Investigating previous and present fears; and A strong dedication to the women.

    Conclusion

    Although there are no guidelines for the counselling the midwives described similar frameworks. Some approaches were general, while others were specific and related to the individual woman’s parity. The midwives achieved professional and personal development through counselling experiences. The findings add to the existing literature on counselling and can be used to inform the development of midwife-led interventions for women with intense fear of childbirth and previous traumatic births, as well as for the formal education of midwives.

  • 2889. Yamasaki, Y
    et al.
    Helou, K
    Watanabw, TK
    Sjöling, Å
    Suzuki, M
    Okuno, S
    Ono, T
    Takagi, T
    Nakamura, Y
    Ståhl, Fredrik
    Tanigami, A
    Mouse Chromosome 19 and Distal Rat Chromosome 1: a Chromosome Segment Conserved in Evolution2001Inngår i: Hereditas, ISSN 0018-0661, E-ISSN 1601-5223, Vol. 134, nr 1, s. 23-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Through a combination of radiation hybrid mapping and studies by FISH and zoo-FISH we have made a comparative investigation of the distal portion of rat chromosome 1 (RNO1) and the entire mouse chromosome 19(MMU19). It was found that homologous segments of RNO1 and MMU19 are similar in banding morphology and in length as determined by several different methods, and that the gene order of the 46 genes studied appears to be conserved across the homologous segments in the two species. High-resolution zoo-FISH techniques showed that MMU19 probes highlight only a continuous segment on RNO1 (Iq43-qter), with no detectable signals on other rat chromosomes. We conclude that these data suggest the evolutionary conservation of a chromosomal segment from a common rodent ancestor. This segment now constitutes the entire MMU19 and a large segment distally on RNO1q in the mouse and rat, respectively.

  • 2890. Youcel, A
    et al.
    Bardaji Ruiz, A
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Chest Injuries during resuscitation following the current guidelines: First results of the Recapta Study2014Konferansepaper (Fagfellevurdert)
  • 2891. Yusuf, S
    et al.
    Estrada-Yamamoto, M
    Reyes, CP
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjalmarson, Å
    Factors of Importance for QRS Complex Recovery after Acute Myocardial Infarction1982Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 211, nr 3, s. 157-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The regression of the ECG signs of myocardial infarction has been studied in 101 patients. A significant increase in R wave amplitude and decrease in Q wave depth on the standard ECG was observed over three months. In 21% of the patients, Q waves disappeared completely. In inferior infarction, these changes were more apparent in the lateral V leads than in the inferior limb leads. Patients with intraventricular conduction defects were excluded. Two factors associated with the Q and R wave changes have been identified. Lower heart rates appeared to facilitate the recovery of R waves, and smaller infarcts, as assessed by peak LDH, showed greater ECG recovery. This study raises the interesting possibility that modification of the heart rate may affect favourably the healing process after an acute myocardial infarction.

  • 2892.
    Zamani, Akram
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Superabsorbent Polymers from the Cell Wall of Zygomycetes Fungi2010Doktoravhandling, monografi (Annet vitenskapelig)
    Abstract [en]

    The present thesis presents new renewable, antimicrobial and biodegradable superabsorbent polymers (SAPs), produced from the cell wall of zygomycetes fungi. The cell wall was characterized and chitosan, being one of the most important ingredients, was extracted, purified, and converted to SAP for use in disposable personal care products designed for absorption of different body fluids. The cell wall of zygomycetes fungi was characterized by subsequent hydrolysis with sulfuric and nitrous acids and analyses of the products. The main ingredients of the cell wall were found to be polyphosphates (4-20%) and copolymers of glucosamine and N-acetyl glucosamine, i.e. chitin and chitosan (45-85%). The proportion of each of these components was significantly affected by the fungal strain and also the cultivation conditions. Moreover, dual functions of dilute sulfuric acid in relation to chitosan, i.e. dissolution at high temperatures and precipitation at lowered temperatures, were discovered and thus used as a basis for development of a new method for extraction and purification of the fungal chitosan. Treatment of the cell wall with dilute sulfuric acid at room temperature resulted in considerable dissolution of the cell wall polyphosphates, while chitosan and chitin remained intact in the cell wall residue. Further treatment of this cell wall residue, with fresh acid at 120°C, resulted in dissolution of chitosan and its separation from the remaining chitin/chitosan of the cell wall skeleton which was not soluble in hot acid. Finally, the purified fungal chitosan (0.34 g/g cell wall) was recovered by precipitation at lowered temperatures and pH 8-10. The purity and the yield of fungal chitosan in the new method were significantly higher than that were obtained in the traditional acetic acid extraction method. As a reference to pure chitosan, SAP from shellfish chitosan, was produced by conversion of this biopolymer into water soluble carboxymethyl chitosan (CMCS), gelation of CMCS with glutaraldehyde in aqueous solutions (1-2%), and drying the resultant gel. Effects of carboxymethylation, gelation and drying conditions on the water binding capacity (WBC) of the final products, were investigated. Finally, choosing the best condition, a biological superabsorbent was produced from zygomycetes chitosan. The CMCS-based SAPs were able to absorb up to 200 g water/g SAP. The WBC of the best SAP in urine and saline solutions was 40 and 32 g/g respectively, which is comparable to the WBC of commercially acceptable SAPs under identical conditions (34-57 and 30-37 g/g respectively).

  • 2893.
    Zamani, Akram
    et al.
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Jeihanipour, Azam
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Edebo, Lars
    Niklasson, Claes
    Taherzadeh, Mohammad J.
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Determination of glucosamine and N-acetyl glucosamine in fungal cell walls2008Inngår i: Journal of Agricultural and Food Chemistry, ISSN 0021-8561, E-ISSN 1520-5118, Vol. 56, nr 18, s. 8314-8318Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A new method was developed to determine glucosamine (GlcN) and N-acetyl glucosamine (GlcNAc) in materials containing chitin and chitosan, such as fungal cell walls. It is based on two steps of hydrolysis with (i) concentrated sulfuric acid at low temperature and (ii) dilute sulfuric acid at high temperature, followed by one-step degradation with nitrous acid. In this process, chitin and chitosan are converted into anhydromannose and acetic acid. Anhydromannose represents the sum of GlcN and GlcNAc, whereas acetic acid is a marker for GlcNAc only. The method showed recovery of 90.1% of chitin and 85.7-92.4% of chitosan from commercial preparations. Furthermore, alkali insoluble material (AIM) from biomass of three strains of zygomycetes, Rhizopus oryzae, Mucor indicus, and Rhizomucor pusillus, was analyzed by this method. The glucosamine contents of AIM from R. oryzae and M. indicus were almost constant (41.7 +/- 2.2% and 42.0 +/- 1.7%, respectively), while in R. pusillus, it decreased from 40.0 to 30.0% during cultivation from 1 to 6 days. The GlcNAc content of AIM from R. oryzae and R. pusillus increased from 24.9 to 31.0% and from 36.3 to 50.8%, respectively, in 6 days, while it remained almost constant during the cultivation of M. indicus (23.5 +/- 0.8%).

  • 2894. Zedigh, C
    et al.
    Alho, A
    Hammar, E
    Karlsson, Thomas
    Kellerth, T
    Svensson, L
    Grimbrandt, E
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial2010Inngår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 21, nr 2, s. 113-120Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The primary aim of this study was to evaluate the pain relief and tolerability of two pain-relieving strategies in the prehospital phase of presumed acute coronary syndrome (ACS), and the secondary aim was to assess the relationship between the intensity and relief of pain and heart rate, blood pressure, and ST deviation. Patients with chest pain judged as caused by ACS were randomized (open) to either metoprolol 5 mg intravenously (i.v.) three times at 2-min intervals (n = 84; metoprolol group) or morphine 5 mg i.v. followed by metoprolol 5 mg three times i.v (n = 80; morphine group). Pain was assessed on a 10-grade scale before randomization and 10, 20, and 30 min thereafter. The mean pain score decreased from 6.5 at randomization to 2.8 30 min later, with no significant difference between groups. The percentages with complete pain relief (pain score <=1) after 10, 20, and 30 min were 11, 16, and 21%, respectively, with no difference between groups. Hypotension was less frequent in the metoprolol group compared with the morphine group (0 vs. 6.3%; P=0.03), as was nausea/vomiting (7.2 vs. 24.0%; P=0.004). At randomization intensity of pain was associated with degree of ST elevation (P=0.009). The degree of pain relief over 30 min was associated with decrease in heart rate (P=0.03) and decrease in ST elevation (P=0.01). In conclusion, in the prehospital phase of presumed ACS, neither a pain-relieving strategy including an anti-ischemic agent alone nor an analgesic plus anti-ischemic strategy in combination resulted in complete pain relief. Fewer side effects were found with the former strategy. Other pain-relieving strategies need to be evaluated.

  • 2895.
    Zhang, Yanru
    et al.
    University of Shanghai for Science and Technology.
    Jiménez-Herrera, María
    Universitat Rovira I Virgili.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Cheng, Yunzhang
    University of Shanghai for Science and Technology.
    Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study2017Inngår i: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 7, s. 665-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To evaluate, using a simulated haemodynamic circulation model, whether passive leg raising (PLR) is able to improve the effect during cardiopulmonary resuscitation (CPR); to expose the possible reasons why PLR works or not.

    Materials and Methods: We adapted a circulatory model for CPR with PLR. First we compared cardiac output (CO), coronary perfusion pressure (CPP), blood flow to heart (Qheart), and blood flow to neck and brain (Qhead) of standard chest compression-only CPR with and without PLR; second we simulated the effects of PLR in different situations, by varying the thoracic pump factor (TPF) from 0 to 1; third we simulated the effects when the legs are lifted to the different heights. Finally, we compared our results with those obtained from a published clinical study.

    Results: According to the simulation model, (1) When TPF is in the interval (0,1), CPP, CO, Qheart, and Qhead are improved with PLR, among them with half-thoracic/half-cardiac pump effect (TPF is 0.5), CPP, CO, Qhead, and Qheart increase the most (by 14, 14, 15, and 17%). (2) When TPF is 1 (pure thoracic pump, with an emphysema or extremely thick thorax), PLR has almost no effect on CPP, CO, and Qheart (-1, 2, and 0%), whereas Qhead is increased by 9%; (3) Regardless of whether there is a cardiac or thoracic pump effect, PLR is able to increase Qhead by 9-15%. (4) When the legs are lifted to 30 degrees to the ground, the volume transferred from legs to upper body is 36% of the initial volume in legs; when the legs are lifted to 45 degrees , the volume transferred is 43%; when the legs are lifted to 60 degrees , the volume transferred is 47%; when the legs are lifted to 90 degrees , the volume transferred is 50%.

    Conclusion: Generally PLR is able to achieve improved cerebral perfusion and coronary perfusion. In some extreme situations, it has no effect on cardiac output and coronary perfusion, but still improves cerebral perfusion. PLR could be a beneficial supplement to CPR, and it is not necessary to lift the legs too high above the ground.

  • 2896.
    Zijlstra, Jolande A
    et al.
    Department of Cardiology, Academic Medical Center.
    Koster, Rudolph W
    Department of Cardiology, Academic Medical Center.
    Blom, Marieke T
    Department of Cardiology, Academic Medical Center.
    Lippert, Freddy K
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Svensson, Leif
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kramer-Johansen, Jo
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital.
    Ringh, Mattias
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet.
    Palsgaard Møller, Thea
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Tan, Hanno L
    Department of Cardiology, Academic Medical Center.
    Beesems, Stefanie G
    Department of Cardiology, Academic Medical Center.
    Hulleman, Michiel
    Department of Cardiology, Academic Medical Center.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Folke, Fredrik
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Olasveengen, Theresa Mariero
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology.
    Wissenberg, Mads
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Hansen, Carolina Malta
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Viereck, Soren
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Hollenberg, Jacob
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.2018Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, nr 23, s. 1929-1936Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.

    METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.

    RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.

    CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.

  • 2897. Ågård, A
    et al.
    Bentley, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Experiences and concerns among patients being treated for atypical chest pain2005Inngår i: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 16, nr 5, s. 339-344Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Many patients who are discharged from the hospital without receiving a clear-cut diagnosis of their chest pain continue to consume health care because of disabling physical and psychological symptoms. By identifying their experiences and concerns following hospitalization, an empirical basis for discussions on ways of improving the care of these particular patients will be obtained. Methods A qualitative analysis of semi-structured interviews with 38 patients with a diagnosis of unspecified chest pain was carried out. Results Two-thirds of the respondents had unanswered questions and concerns that had not been addressed. They found it difficult to understand why they had not undergone more tests. They requested an explanation for their chest pain, at the very least, or were worried about the future. Some respondents accepted the fact that they had not been given a sufficient amount of time and information. They referred to the stressful working situation of the physicians, the view that their admission could be regarded as unnecessary or that physicians at the hospital could not be expected to do more than exclude serious diseases. Conclusions Health professionals should address their patients' questions and fears properly and provide them with the most probable explanation for their symptoms. When taking the harmlessness of their symptoms or the situation of their caregivers into account, patients may find it inappropriate to impose further demands on care.

  • 2898. Ågård, A
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castrén, M
    Jonsson, L
    Sandman, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Guidance for ambulance personnel on decisions and situations related to out-of-hospital CPR2012Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, nr 1, s. 27-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Ethical guidelines on out-of-hospital cardio-pulmonary resuscitation (CPR) are designed to provide substantial guidance for the people who have to make decisions and deal with situations in the real world. The crucial question is whether it is possible to formulate practical guidelines that will make things somewhat easier for ambulance personnel. The aims of this article are to address the ethical aspects related to out-of-hospital CPR, primarily to decisions on not starting or terminating resuscitation attempts, using the views and experience of ambulance personnel as a starting point, and to summarise the key points in a practice guideline on the subject.

  • 2899. Ågård, A
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Hermerén, G
    Obtaining informed consent from patients in the early phase of acute myocardial infarction: physicians’ experiences and attitudes2004Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 90, nr 2, s. 208-210Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It is possible to question whether patients suffering from the early phase of an acute myocardial infarction (AMI) are able to give free and informed consent and whether or not it is ethically defensible to include them—those patients suffering from more severe symptoms, in particular—in research projects. In fact, it has been shown that a reasonable number of patients who have given their consent in this situation are only able to recall very little of the information they received about the study and that only a minority read through the consent form before signing it. The aim of this study is to determine how physicians, who have been involved in including patients in intervention trials in the early phase of their AMIs, experienced the informed consent procedures. In our view, data obtained from those people who are actually confronted by the research subjects and who are responsible for carrying out the consent procedure should also be taken into account, when the most appropriate ways of including these patients in studies are discussed. To our knowledge no survey of physicians relating to this issue has previously been undertaken.

  • 2900. Ågård, A
    et al.
    Hermerén, G
    Herlitz, Johan
    [external].
    Informed consent: Are there ethically justified conditions for exceptions?2002Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 87, nr 2, s. 105-106Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    Are good clinical practice and informed consent inseparable? This depends, to some extent at least, on what is meant by “inseparable”. Does this refer to a logical relation, on the assumption that “good clinical practice” by definition includes informed consent, to an empirical generalisation about current medical practice, or a normative statement about how it ought to be? Different arguments pro and contra are relevant depending on whether the statement is interpreted as a logical statement, an empirical generalisation, or as a normative statement.We do not dispute the moral ground for the requirement of informed consent in general,1 and we agree with the statement that “the clinical duty to obtain proper informed consent is now widely believed to be an essential component of good clinical practice”. Neither do we dispute that improved training in communication skills and more time for doctors to communicate with their patients would be a good thing—and probably make more patients participate in the decision process.2What we wished to do in our paper3 was to discuss whether there might not be situations in which exceptions from the general requirement of informed consent would be acceptable. We hope that such a debate could help to define stringent and precise conditions when such exceptions could be morally and legally acceptable. One general assumption we share is the idea that such an exception is reasonable, if insisting on the requirement of informed consent causes more harm than good. In its turn, this presupposes a discussion of criteria of harm and benefit and who should decide about the relative magnitude of harm and benefit. Verification after the event by the patients in question could in certain situations be worth investigating. If there is a verification by the patients concerned, in the sense that they afterwards confirm that they think that an exception from the general requirement was ethically justified, then the concept of an exception from the general main rule is supported by referring to what the patients themselves want. If autonomy is taken seriously, references to what the patients say they want cannot be dismissed lightly.Our ambition with the study published3 was not to suggest any radical changes regarding the informed consent procedure when a patient is suffering from an acute myocardial infarction and is a potential research subject, nor to draw any general conclusions from the results obtained. Instead, we wanted to elucidate the possible problems and disadvantages associated with the process of obtaining informed consent in this particular situation. Primarily we wanted to stimulate the debate on the following two issues:1. Does a patient in the midst of a life crisis have to put his/her signature on a consent form in order to be included in an intervention trial?2. Are there ethically justified alternatives to informed consent when a researcher wants to include a patient in a study, who is not capable of giving a free and informed consent in research?We stated: “All possible measures to increase the autonomy of the patients under the prevailing circumstances should be carried out”. Thus, we do not suggest that all patients with acute myocardial infarction should be treated as incompetent. However, what we have tried to do in our study is to bring forth and highlight empirical evidence, which seems to show that in this particular situation some patients do not have the capacity to give a true informed consent for study participation.Professor Doyal adds another argument, to the effect that even if the patients afterwards do not remember anything, this does not reduce the moral importance of relevant information disclosure. The main question is what is meant by “relevant information disclosure”, and who decides what this is. Suppose (a) that it is left to the patient to decide what is relevant information disclosure, (b) that additional information does not change the decision of the patient, and (c) they do not want this additional information, which conclusion should be drawn from this?We claim that it is time to adjust the informed consent procedure to the patients' capacity in this particular situation. Moreover, the patient should be spared the “actual demand” of signing the consent form in the early phase of an acute myocardial infarction.

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