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  • 951. Wijk, H
    et al.
    Öhlen, J
    Lidén, E
    German Millberg, L
    Jacobsson, C
    Söderberg, S
    Berg, L
    Engström, Å
    Höglund, I
    Lepp, Margret
    Lindström, I
    Nygren, B
    Person, C
    Petzäll, K
    Skär, L
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Söderlund, M
    Verksamhetsförlagd utbildning på avancerad nivå: ny utmaning för specialistutbildningar för sjuksköterskor2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, no 4, p. 41-43Article in journal (Other academic)
    Abstract [en]

    The aim of this article is to discuss challenges in the development of Specialist Nursing Educations as a result of the 2007 Swedish Higher Education Reform: the implementation of the so-called Bologna process. Certain challenges follow this reform, particularly since the specialist nursing programmes will be part of the second cycle of the higher education system, and it will be possible to combine the professional degree with a masters degree (one year). Possible strategies in four areas related to the Specialist Nursing Education are discussed: integration of researchbased knowledge, experienced-based knowledge, improvement knowledge, and strategies for collaboration between university institutions and clinics. Specific didactical issues are raised.

  • 952. Wikberg, Anita
    et al.
    Bondas, Terese
    University of Borås, School of Health Science.
    A patient perspective in research on intercultural caring in maternity care: A meta-ethnography2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 1, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Abstract The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare’s meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.

  • 953. Wikberg, Anita
    et al.
    Erikson, Katie
    Bondas, Terese
    University of Borås, School of Health Science.
    Intercultural caring in maternity care from a patient perspective: a metaethnography2009Conference paper (Refereed)
  • 954. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Bengtsson, A
    Hjalmarson, Å
    Long-term follow-up of health related quality of life in patients with suspected acute myocardial infarction when the diagnosis was not confirmed1991In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 9, no 1, p. 47-52Article in journal (Refereed)
    Abstract [en]

    This study describes the outcome in terms of health-related quality of life (QL) five years after onset of symptoms in 397 patients with an initial suspicion of acute myocardial infarction (MI) but in whom the diagnosis was not confirmed. The patients were approached by means of a postal inquiry that comprised two questionnaires. The most pronounced impairment in health-related QL was expressed as decreased energy, whereas social life was the least affected area. The overall QL was very similar to that in patients who had a confirmed MI. Subsets of patients with impaired QL were those given the diagnosis of angina pectoris or possible infarction.

  • 955. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Hjalmarson, Å
    Quality of life five years after myocardial infarction1989In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, no 5, p. 464-472Article in journal (Refereed)
    Abstract [en]

    In 539 patients 5 years after myocardial infarction (MI), quality of life and factors influencing life quality were studied. All patients originally participated in an early intervention trial with metoprolol. A cardiac follow-up questionnaire and the Nottingham Health Profile were answered by 82%. In the former, information about subjective symptoms, smoking, work and current medication was obtained; the latter described health-related quality of life in terms of energy, sleep, emotions, mobility, pain and social isolation. The rate of and the reasons for rehospitalization were registered in the patients' records. The MI patients reported a comparatively high quality of life. Compared with ‘normal’ population, a decrease was noted in energy, sleep and mobility, and in sex life, hobby-activity and holiday activity. A non-parametric multivariate analysis disclosed that dyspnoea, angina pectoris and anxiety were closely associated with decreased quality of life. In conclusion, 5 years after MI most patients seemed well-adjusted. Impaired quality of life was reported by patients suffering from angina pectoris, dyspnoea and emotional distress. No relationship was found between health-related quality of life and the beta blocker, metoprolol, which was the most frequently used drug.

  • 956. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Hjalmarson, Å
    Quality of life in postmyocardial infarction patients in relation to drug therapy1989In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 7, no 1, p. 13-18Article in journal (Refereed)
    Abstract [en]

    Quality of life (QL) was assessed in relation to drug therapy in 539 patients who were still alive five years after myocardial infarction (MI), and the interaction between drug therapy and QL was investigated. The patients originally participated in a double-blind trial that evaluated the effect of early administration of the beta blocker metoprolol. A cardiac follow-up questionnaire (CFQ) and the Nottingham Health Profile (NHP) were answered by 82%. In the CFQ, sel-fassessed cardiac symptoms, medication (diuretics, digitalis, antiarrhythmics, long-acting nitrates, beta blockers, psychoactive drugs), smoking habits, and work status were described. NHP described QL within the sections of mobility, energy, pain, sleep, emotional reactions, and social isolation. The independent relation between morbidity, drugs, and QL was analyzed multi variately. Apart from symptoms of angina pectoris and dyspnoea, anxiety resulted in impaired QL. A relation between diuretics and decreased QL was found, but no indications of adverse effects of the beta blocker metoprolol.

  • 957. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Johansson, S
    Bengtsson, A
    Karlson, BW
    Persson, NG
    Subjective symptoms and wellbeing differ in women and men after myocardial infarction1993In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, no 10, p. 1315-1319Article in journal (Refereed)
    Abstract [en]

    The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1±10.7 years, and 174 women, mean age 72.1±10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P≤0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P≤0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P≤0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

  • 958. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Risenfors, M
    Hjalmarson, Å
    Koronar bypass-kirurgi: Effekt på livskvalitet och återgång i arbete1987In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 84, no 43, p. 3509-3511Article in journal (Refereed)
  • 959. Wikström, Ewa
    et al.
    Arman, Rebecka
    Dellve, Lotta
    University of Borås, School of Health Science.
    Vad gör chefer med sin tid och hur kan tid och engagemang hanteras på2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. Tema Ledarskap, no 6, p. 830-837Article in journal (Refereed)
    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

  • 960. Williamsson, Anna
    et al.
    Eriksson, Andrea
    Dellve, Lotta
    University of Borås, School of Health Science.
    The organization and work practice of change agents in health care organizations; effects on health care professionals’ engagement and participation in improvement work.2014Conference paper (Refereed)
  • 961. Williamsson, Anna
    et al.
    Karltun, Annette
    Dellve, Lotta
    University of Borås, School of Health Science.
    Visualizing improvements of care processes- a contribution to shared understanding and engagement, or cognitive strain?2014Conference paper (Refereed)
  • 962.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Aktuella forskningfrågor inom ambulanssjukvård vid PreHospen: Lindra projektet2008Conference paper (Other academic)
  • 963.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science. University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Att lära sig vårdande bedömning2015In: Reflektion i lärande och vård: en utmaning för sjuksköterskan / [ed] Mia Berglund, Margaretha Ekebergh, Lund: Studentlitteratur , 2015, p. 163-174Chapter in book (Other academic)
    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.

  • 964.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Forskning i PreHospital akutsjukvård: varför och hur?2008Conference paper (Other academic)
  • 965.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Förberedd på att vara oförberedd: en fenomenologisk studie av vårdande bedömning och dess lärande i ambulanssjukvård2005Doctoral thesis, monograph (Other academic)
  • 966.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Kompetensbeskrivning. Legitimerad sjuksköterska med specialistsjuksköterskeexamen med inriktning mot ambulanssjukvård.2012Report (Other academic)
    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.

  • 967.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Kunskapscentrum PreHospen: att vidareutveckla akutsjukvård utanför sjukhus i professionssamverkan2009Report (Other academic)
  • 968.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Lindra ska lätta trycket i ambulansen2008In: Forskning: tidning för studenten, forskare, företag, inom teknik och naturvetenskap, ISSN 1654-8876, Vol. 3, p. 46-47Article in journal (Other (popular science, discussion, etc.))
  • 969.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Lindra-projektet2007Conference paper (Other academic)
  • 970.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Johansson Sundler, Annelie (Editor)
    Roxberg, Åsa (Editor)
    Vårdvetenskap + medicin är sant?2008Report (Other academic)
  • 971.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Karlsson, Thomas
    Winge, Karin
    Lundberg, Camilla
    Herlitz, Johan
    University of Borås, School of Health Science.
    Anxiolytics in patients suffering a suspected acute coronary syndrome: Multi-centre randomised controlled trial in Emergency Medical Service2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 4, p. 3580-3587Article in journal (Refereed)
    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.

  • 972.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Being Prepared for the Unprepared: A Phenomenology Field Study of Swedish Prehospital Care2012In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, ISSN 0099-1767, Vol. 38, no 6Article in journal (Refereed)
    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.

  • 973.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions2011In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 19, no 3, p. 113-119Article in journal (Refereed)
    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.

  • 974.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Ekebergh, Margaretha
    University of Borås, School of Health Science.
    How caring assessment is learnt: reflective writing on the examination of Specialist Ambulance Nurses in Sweden2013In: Reflective Practice, ISSN 1462-3943, E-ISSN 1470-1103, Vol. 14, no 2, p. 271-287Article in journal (Refereed)
    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

  • 975.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Jylli, Leena
    Winge, Karin
    University of Borås, School of Health Science.
    Svensson, Leif (Editor)
    Barn och smärta2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, p. 452-459Chapter in book (Other academic)
  • 976.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Sjöstrand, Fredrik
    Vicente, Veronica
    Svensson, Leif (Editor)
    Optimal vårdnivå vid icke-akuta tillstånd2009In: Prehospital akutsjukvård, Stockholm: Liber , 2009, p. 199-212Chapter in book (Other academic)
  • 977.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Vicente, Veronica
    Den äldre personens delaktighet i vårdval vid akut behov av vård: Ett exempel från ambulanssjukvård. Webbdelen.2013In: Omvårdnad på avancerad nivå. Kärnkompetenser inom sjuksköterskans specialistområden. Webbdelen. / [ed] Anna-Karin Edberg, Anna Ehrenberg, Febe Friberg, Lars Wallin, Helle Wijk, Joakim Öhlén, Studentlitteratur , 2013Chapter in book (Other academic)
    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.

  • 978.
    Wireklint-Sundström, B
    et al.
    University of Borås, School of Health Science.
    Petersson, E
    University of Borås, School of Health Science.
    Sjöholm, M
    University of Borås, School of Health Science.
    Gelang, C
    University of Borås, School of Health Science.
    Axelsson, C
    University of Borås, School of Health Science.
    Herlitz, J
    University of Borås, School of Health Science.
    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 phycisians2014In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, no 1, p. 72-Article in journal (Refereed)
    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.

  • 979.
    Wireklint-Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Winge, Karin
    University of Borås, School of Health Science.
    LINDRA-studien2009Conference paper (Refereed)
    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.

  • 980. Woods, S
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Continental Philosophy and Nursing Ethics2002In: Ethics In Nursing Education, Research And Management. Perspectives from Europe / [ed] W Tadd, Palgrave , 2002, p. 14-34Chapter in book (Other academic)
  • 981. Wramsten Wilmar, Maria
    et al.
    Ahlborg, Gunnar
    Jacobsson, Christian
    Dellve, Lotta
    University of Borås, School of Health Science.
    Healthcare managers in negative media focus: a qualitative study of personification processes and their consequences2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 8Article in journal (Refereed)
    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.

  • 982.
    Wramsten Wilmar, Maria
    et al.
    University of Borås, School of Health Science.
    Dellve, Lotta
    University of Borås, School of Health Science.
    Jacobsson, Christian
    Ahlborg, Gunnar
    Health care managers handling negative media focus: Individual and Organizational quagmire increases personification processes and personal consequences2012Conference paper (Refereed)
  • 983.
    Wramsten Wilmar, Maria
    et al.
    University of Borås, School of Health Science.
    Dellve, Lotta
    University of Borås, School of Health Science.
    Jacobsson, Christian
    Ahlborg, Gunnar
    Health care managers handling negative media focus: Individual and Organizational quagmire increases personification processes and personal consequences2012Conference paper (Refereed)
  • 984. Youcel, A
    et al.
    Bardaji Ruiz, A
    Axelsson, C
    University of Borås, School of Health Science.
    Chest Injuries during resuscitation following the current guidelines: First results of the Recapta Study2014Conference paper (Refereed)
  • 985. Yusuf, S
    et al.
    Estrada-Yamamoto, M
    Reyes, CP
    Herlitz, Johan
    University of Borås, School of Health Science.
    Hjalmarson, Å
    Factors of Importance for QRS Complex Recovery after Acute Myocardial Infarction1982In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 211, no 3, p. 157-162Article in journal (Refereed)
    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.

  • 986. Zedigh, C
    et al.
    Alho, A
    Hammar, E
    Karlsson, Thomas
    Kellerth, T
    Svensson, L
    Grimbrandt, E
    Herlitz, Johan
    University of Borås, School of Health Science.
    Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial2010In: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 21, no 2, p. 113-120Article in journal (Refereed)
    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.

  • 987. Ågrén-Bolmsjö, I
    et al.
    Edberg, A-K
    Sandman, Lars
    University of Borås, School of Health Science.
    Everyday Ethical Problems in Dementia Care: A teleological Model2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 4, p. 340-359Article in journal (Refereed)
    Abstract [en]

    In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

  • 988. Ågrén-Bolmsjö, I
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Andersson, E
    Everyday ethics in the care of elderly people2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 3, p. 249-263Article in journal (Refereed)
    Abstract [en]

    This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection.

  • 989. Ågård, A
    et al.
    Bentley, L
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Experiences and concerns among patients being treated for atypical chest pain2005In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 16, no 5, p. 339-344Article in journal (Refereed)
    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.

  • 990. Ågård, A
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Castrén, M
    Jonsson, L
    Sandman, Lars
    University of Borås, School of Health Science.
    Guidance for ambulance personnel on decisions and situations related to out-of-hospital CPR2012In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, no 1, p. 27-31Article in journal (Refereed)
    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.

  • 991. Ågård, A
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Hermerén, G
    Obtaining informed consent from patients in the early phase of acute myocardial infarction: physicians’ experiences and attitudes2004In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 90, no 2, p. 208-210Article in journal (Refereed)
    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.

  • 992. Öresland, Stina
    et al.
    Määttä, Sylvia
    University of Borås, School of Health Science.
    Norberg, Astrid
    Lützén, Kim
    Patients as 'Safeguard' and Nurses as 'Substitute' in Home Health Care2009In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 2, p. 219-230Article in journal (Refereed)
    Abstract [en]

    One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as ‘safeguard’, and the nurses’ subject position as ‘substitute’ for themselves. These subject positions provided the opportunities, and the obstacles, for the patients’ possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.

  • 993. Öresland, Stina
    et al.
    Määttä, Sylvia
    University of Borås, School of Health Science.
    Norberg, Astrid
    Winther Jörgensen, Marianne
    Lützén, Kim
    Nurses as guests or professionals in home health care2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 3, p. 371-383Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: `guest' and `professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.

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