Background

Early recognition and decision-making are critical in acute stroke care. Prehospital video consultation may support collaboration and inform triage decisions between ambulance nurses (ANs) and neurologists. However, organizational and geographical factors may delay access to reperfusion therapies. This feasibility study explored whether prehospital video consultation between ANs and neurologists could be implemented in routine stroke care and how such consultations might influence workflow and perceptions of patient safety.

Methods

We conducted a mixed-methods feasibility study with parallel collection of quantitative and qualitative data. Quantitative data on processing times and patient flow were extracted from ambulance and hospital records. Qualitative data were obtained from semi-structured interviews and evaluation forms. The intervention was implemented in 12 ambulances across four districts over a 13-month period. Patients with suspected large vessel occlusion (LVO) and a modified NIH Stroke Scale (mNIHSS) score ≥ 6 were eligible.

Results

Forty-four patients met the inclusion criteria; however, only five video consultations were successfully completed, partly due to limited equipment availability. Quantitative findings were therefore presented descriptively. Among the five completed video consultations, two patients were transported directly to the regional stroke center, compared to 24 of 148 patients in the non-video group. The qualitative analysis identified three themes: (1) interprofessional collaboration and trust (2), practical use of video, and (3) barriers and facilitators to implementation.

Conclusions

Prehospital video consultation in suspected stroke was technically feasible in individual cases and perceived as supportive by clinicians. However, technical and organizational barriers substantially limit routine use. The findings provide important insights into professional, organizational, and technical factors influencing feasibility, but do not permit conclusions regarding clinical effectiveness.

In this article, we approach the significance of moral stands in professional practices among practitioners in Support and Service for Persons with Certain Functional Impairments from the perspective of Bourdieu's concept of symbolic order and ethos.  Our study illustrates how negotiations about agency takes place within a network of relationships, where the normative and professional judgment of staff in practice becomes crucial in relation to how self-determination for users is conditioned in everyday life. This involves questions about how rights, obligations and norms are conveyed, negotiated and implemented. These everyday practices involve individual planning, follow-up, and relationships with support staff in various professional categories. The results illustrate how staff motivation in regard of their work to support and help others rests on emotional and ethical attributes linked to the professions. These ethic dispositions become indicative of the meaning that the concept of self-determination has for the staff. Ethos, is in this context regarded as a focal professional attribute of being able to place the ideal of users as active subjects within a social service context.

Healthcare is often conducted by interprofessional teams. Research has shown that diverse groups with their own terminology and culture greatly influence collaboration and patient safety. Previous studies have focused on interhospital teams, and very little attention has been paid to team collaboration between intrahospital and prehospital care. Addressing this gap, the current study simulated a common and time-critical event for ambulance nurses (AN) that also required contact with a stroke specialist in a hospital. Today such consultations are usually conducted over the phone, this simulation added a video stream from the ambulance to the neurologist on call. The aim of this study was to explore interprofessional collaboration between AN’s and neurologists when introducing video-support in the prehospital stroke chain of care. The study took place in Western Sweden. The simulated sessions were video recorded, and the participants were interviewed after the simulation. The results indicate that video has a significant impact on collaboration and can help to facilitate better understanding among different professional groups. The participants found the video to be a valuable complement to verbal information. The result also showed challenges in the form of a loss of patient focused care. Both ANs and neurologists saw the video as benefiting patient safety.

Introduction

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

Methods

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

Results

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

Conclusion

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

This article concerns how spaces of professional autonomy are defined and formed in Swedish higher education institutions (HEIs). Swedish HEIs have become increasingly characterised by rivalling principles of management and professional autonomy. The relational aspects of how a professional habitus is formed and negotiated in relation to management ideals and practices are investigated. The research methods used in this study were interviews with HEI management, strategic human resource management (HRM) representatives and research and teaching staff at three HEIs under different conditions of collegial influence and forms of management. The results show that professional negotiations are undergoing conversion pressures under New Public Management (NPM)-implemented governance, but because professional identities are strongly rooted in academic core values, they are relatively resistant to NPM imposition and encroachment. In light of this, the article offers a discussion on the dilemma of conforming to managerial demands and priorities without losing a professional self.

This article investigates professional identities in Swedish Higher Education Institutions (HEIs). The aim is to explore how professional negotiation takes place by incorporating the perspectives of teachers, managers, and strategic human resource management (HRM) representatives through a case study of three HEIs with different conditions for collegial influence and forms of management. The study examines how spaces of professional autonomy are defined and formed and how authenticity and legitimacy are established (Davies & Petersen, 2005; Deem & Lucas, 2007). The project was designed with the intention to relate analytical distinctions of different actors’ perceptions and objectives within the institutional conditions that form the meaning and objectives of education (Vaughan, 2002). The methods used are interviews with HEI management, strategic HRM representatives, and research and teaching staff. Contemporary researchers and teachers in academia have to handle increased evaluation pressure and, in many cases, strategic planning and organization of HEIs subjected to market-based principles (Widmalm et al., 2016). One question that has been raised in the research field is whether current trends in organizing academic work also contribute to changed academic identities (Clegg, 2008). By contextualizing the objectives of HEIs from the perspectives of teachers, management, and HRM departments, the results show that professional negotiations undergo conversion pressures under New Public Management (NPM)-implemented governance. However, professional identities are, at the same time, strongly rooted in academic core values, and the article offers a discussion via the aid of Pierre Bourdieu (1998) of the possibilities of forming autonomous professional identities and independent knowledge claims in NPM-inspired HEIs.