Background: Shared decision-­ making aims to ensure that healthcare professionals and patients jointly make decisions regarding the patient's care. However, professionals often find it challenging to implement shared decision-­ making with older patients who have cognitive impairments or diminished decision-­making capacity. Research indicates a significant gap in the understanding of how decision-­ making processes unfold in prehospital settings.

Aim: The objective of this scoping review was to explore how decision-­making involving older patients in acute prehospital situations is characterized.

Design and Method: This scoping review is based on the Joanna Briggs Institute's guidelines for scoping reviews and is reportedusing the Preferred Reporting Items for Systematic Reviews and Meta-­Analyses extension for Scoping Review (PRISMA-­ScR).

Data Sources: CINAHL, PubMed, Scopus, PsychINFO and Web of Science were searched to identify relevant studies published between the years 2000 and 2024.

Results: The results are based on 26 studies and indicate that decision-­making among older patients is a conditional process,characterised by collaborative support involving the patient, significant others and healthcare professionals. Barriers to this process include hierarchical dynamics, fear of reprisals and uncertainty regarding the risk–benefit ratio. Factors that support decision-­making include situationally relevant competence, organisational resources and the presence of specific symptoms and signs.

Conclusion: Shared decision-­making with older patients in acute prehospital settings is conditional, often resulting in decisions being made primarily by healthcare professionals. There is considerable room for improvement in how this process is systematically approached. A structured approach is needed—one that assesses the older patient's decision-­ making capacity, considers the perspectives of family members, and incorporates input from individuals who know the patient well, all while minimizing hierarchical barriers.

The transition process for newly graduated registered nurses (NGN) entering hospital work is critical in managing challenges like insecurity and stress, while also supporting role navigation, learning, job satisfaction and retention. This study aimed to explore NGNs’ perceptions and experiences during their first four months transitioning to hospital work. A cross-sectional survey with Likert-scale questions and two open-ended free text questions was conducted with NGNs enrolled in a regional transition program at five Swedish hospitals, gathering data from 216 nurses between September 2021 and September 2022. Descriptive statistics and qualitative content analysis were used to assess the data. The findings revealed that 61% of NGNs felt well prepared by their undergraduate nursing education, and 85% enjoyed their profession as nurses. Most reported they were integrated into their teams, satisfied with their support, and understood their responsibilities. However, only 28% reported feeling fully recovered for work, and 44% expressed fear of making mistakes. Qualitative responses highlighted feelings of unpreparedness for the workload, pace and ward-specific routines, although opportunities for learning, building relationships and validating their skills were viewed positively. The transition experience was influenced by individual, social, and organisational factors. Ongoing improvement in transition processes requires shared responsibility between nurses, educational institutions and hospitals.

Background

Emergency care faces increasing pressure, with extended waiting times and strained resources. Medical Emergency Teams (METs) combine expertise from emergency departments and ambulance services to deliver coordinated emergency care in patients’ homes. This study explores nurses’ and physicians’ experiences and actions when providing such care.

Method

This qualitative study used the Critical Incident Technique with an inductive approach. Seventeen individual interviews were conducted with nurses and physicians from two METs in southwestern Sweden. All 22 clinicians were eligible and invited to participate, and no exclusion criteria were applied. Data were collected between November 2023 and January 2024 and analyzed using content analysis.

Results

Participants reported that collaboration within MET was sometimes insufficient, limiting the full use of team skills. However, in time-critical situations, teamwork became more cohesive. Actions included understanding patients situations and preferences and fostering collaboration with other care providers. Experience over time helped clinicians identify which patients could safely remain at home.

Conclusion

Delivering emergency care at home allows clinicians to gain deeper insight into patients’ everyday lives and provide more comprehensive care. This shift may reduce care fragmentation and help identify contextual risks often overlooked in hospital-based settings.

Simulation-based education is commonly used in undergraduate training but has gained increased utilization in postgraduate education. Ambulance nursing programs struggle to provide suitable simulations, as ambulance care can involve any possible situation. Simulation-based education in ambulance nursing programs commonly includes basic assessment and treatment of various conditions. However, there seems to be a lack of knowledge regarding students' experience of simulating pediatric emergency care in an ambulance care setting. Thus, the aim of this study was to explore specialist nursing students' experiences of simulating pediatric emergency care in an ambulance care setting. A qualitative design was deployed, utilizing field notes, individual and group interviews to capture the students' experiences. The results show that students immerse themselves in the simulations when the environment and facilitators support this. The simulation can elicit both emotional and physical responses among the students. Students gain insights into their knowledge deficit regarding certain topics, such as pediatric emergency care, as well as the rules and regulations governing what they are allowed to do for a child's safety and well-being. During simulation, students understand the importance of using adequate communication and recognize that there might be several aspects influencing this. Finally, the students gain insight into their emotional and behavioral responses when encountering patients and relatives in situations that conflict with their own views. In conclusion, simulation-based education can be a useful pedagogical tool if barriers to immersion are reduced. It can provide students with insights into their emotional and behavioral responses when encountering unexpected events. If properly discussed in debriefing sessions, these matters lead to increased learning that students can carry with them into their future careers. However, more research is needed on the feasibility of this kind of simulation in the ambulance nurse education setting.

Introduction

Registered nurses play a critical role in disaster response and patient care during crises. Recent global events underscore the importance of preparedness for disaster response. However, the readiness of registered nurses and their educational preparation vary. In Sweden, this prompted the National Board of Health and Welfare to introduce a new national curriculum for disaster response. This study aimed to assess how education for undergraduate and specialist registered nurses aligns with this curriculum.

Methods

A descriptive cross-sectional study was conducted among universities and university colleges in Sweden offering undergraduate and specialist nursing programs. Surveys were sent to all 25 higher education institutions providing nursing education in November 2023, comprising 29 questions related to the new curriculum.

Results

Findings revealed that half of the respondents had discussed the new curriculum, with 15 reporting some form of learning activities. Traditional lectures were the most commonly used format, and 11 respondents had designated teachers for the subject. Reasons for lacking disaster response education included prioritizing other acute care areas or a limited perspective at the academy.

Discussion

In conclusion, this study suggests that nursing education may not sufficiently prepare registered nurses for disaster response and armed conflicts. Education tends to focus more on acute care rather than taking a broader perspective. As a result, registered nurses may lack the competence and readiness required to effectively respond to disasters.

Introduktion: Sjuksköterskor har en nyckelroll i beredskapen för och vården av patienter under katastrofmedicinska insatser. I Sverige har händelseförloppet de senaste åren, till exempel gängkriminalitet, terrorattentat, covid 19-pandemin och Rysslands fullskaliga invasion av Ukraina ökat uppmärksamheten på sjuksköterskors kompetens att möta olika typer av katastrofer. År 2022 presenterade Socialstyrelsen en rapport där de beskrev detaljerade kunskaps- och färdighetsmål för utbildningar och övningar i katastrofmedicin. Samtidigt visar en nyligen publicerad svensk studie att sjuksköterskestudenter uppfattar sig ha otillräckliga kunskaper i katastrofmedicin.

Syfte: Undersöka i vilken utsträckning sjuksköterskeutbildningarna på grundläggande och avancerad nivå i Sverige bedriver utbildning i katastrofmedicinsk beredskap och civilt försvar.

Metod: En enkät skickades i november 2023 till alla de lärosäten i Sverige som erbjuder grund- och specialistutbildningar för sjuksköterskor (n=25). Enkäten bestod av 29 frågor relaterade till de kunskaps- och färdighetsmål för utbildning och övning i katastrofmedicin som Socialstyrelsen angett ut.

Resultat: 18 av 25 lärosäten besvarade enkäten och förekomst av utbildning var enligt följande:

• Sortering och prioritering av personer på skadeplats (n=16) eller på sjukhus (n=15)

• Sjukvårdens organisation och ledning på skadeplats/ sjukhus (n=15)

• Bedömning och omhändertagande av personer som utsatts för högenergetiskt våld (n=11)

• Principerna för sjukvård under höjd beredskap och krig (n=9)

• Sjukvårdens roll i totalförsvaret (n=5)

• Försvarsmaktens sjukvårdsorganisation och dess funktion vid väpnad konflikt/krig (n=2)

Konklusion: Resultatet tyder på att den utbildning som ges främst fokuserar på akutvård under normalförhållanden. Däremot brister utbildningen när det gäller att förbereda blivande sjuksköterskor på grundläggande och avancerad nivå att möta samt hantera situationer som inryms inom det civila försvaret.

ReferenserSocialstyrelsen. (2022). Nationella utbildnings- och övningsplaner för katastrofmedicinsk beredskap och civilt försvar samt nationell samordning av utbildning och övning. Redovisning av regeringsuppdraget S2021/02922

Robinson et al. (2023) Teaching extent and military service improve undergraduate selfassessed knowledge in disaster medicine: An online survey study among Swedish medical and nursing students. Front. Public Health 11:1161114.

Andersson et al. (2024). Are you ready: disaster response in nursing education: a cross‑sectional survey among Swedish universities and university colleges. Discover Health Systems 3:74

Introduktion: I en försämrad global situation blir den civila sjukvårdens beredskap inför väpnade konflikter avgörande. Sjuksköterskor med eller utan specialistutbildning är ofta bland de första att bevittna hot och våld mot sjukvården. Därför är det av yttersta vikt att sjuksköterskor har kunskap om internationell humanitär rätt (IHL) för att fullt ut förstå sina rättigheter och skyldigheter i samband med väpnad konflikt.

Syfte: Undersöka i vilken utsträckning sjuksköterskeutbildningarna på grundläggande och avancerad nivå i Sverige bedriver utbildning i IHL

Metod: En enkät skickades i november 2023 till alla de lärosäten i Sverige som erbjuder grund- och specialistutbildningar för sjuksköterskor (n=25). Enkäten bestod av 9 frågor relaterade till grundläggande kunskaper om IHL.

Resultat: 18 av 25 lärosäten besvarade enkäten och förekomst av utbildning var enligt följande:

• Den civila sjukvårdens beredskap och organisation vid väpnad konflikt/krig (n=4)

• Grundprinciperna som finns i IHL (n=2)

• Relationen mellan IHL och de mänskliga rättigheterna (n=2)

• Vilka skyddade personalkategorier det finns i ett krig enligt IHL (n=2)

• Sjukvården och IHL (n=2)• Vilka skyddssymboler som finns och vad de avser att skydda (n=2)

• Hur krig får föras och vilka vapen som får användas (n=1)

• Konventioner till skydd för krigets offer (n=1)

• Vad som händer när IHL kränks (n=1)

Konklusion: Resultatet tyder på att utbildningen brister när det gäller att förbereda blivande sjuksköterskor på grundläggande och avancerad nivå att förstå sina rättigheter och skyldigheter i samband med väpnad konflikt.

Referenser

Blanchet, K., et al., Have attacks on healthcare become the new normal? a public health call to action for armed conflicts before it is too late. Conflict and health, 2023. 17(1): p. 56.

Sassòli, M. and P.S. Nagler, International humanitarian law: rules, controversies, and solutions to problems arising in warfare. 2019, Cheltenham: Edward Elgar Publishing.

SOU (2022). Hälso- och sjukvårdens beredskap – struktur för ökad förmåga. Slutbetänkande av utredningen om hälso- och sjukvårdens beredskap (2022:6). Regeringskansliet

The growing global instability has increased the demand for healthcare and disaster response skills among registered nurses (RNs). However, research shows that RNs are not sufficiently prepared for disaster situations. Although RNs are responsible for managing injuries during armed conflicts in accordance with International Humanitarian Law (IHL), nursing education lacks specific training in this area. A national survey revealed that only two universities in Sweden offer IHL-related education for nursing students. These findings highlight the urgent need to revise nursing education in Sweden to better prepare RNs for the challenges posed by global crises, including armed conflicts.

Background

It is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds.

Methods

This was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis.

Results

Two themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue.

Conclusion

Incorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.

Background

It has been suggested that the university environment, to improve students’ health status and educational outcomes, should be based on a health promoting approach. More knowledge is needed about health promoting resources and lifestyle factors that may be of value for students in higher education and their future work-life balance. The aim of this study was to explore health-promoting resources, general health and wellbeing, and health promoting lifestyle factors among fourth and final semester students in higher education in healthcare and social work.

Methods

This longitudinal study is based on self-reported data collected through a web-based questionnaire that included questions about general health, wellbeing, and healthy lifestyle factors and made use of instruments: the Sense of Coherence (SOC) scale, the Salutogenic Health Indicator Scale (SHIS), and five questions from the General Nordic Questionnaire (QPS Nordic). The questionnaire was distributed among students enrolled in seven different healthcare and social work programmes at six universities in Sweden. Data was collected when students were in their fourth (2019/2020) and final (2020/2021) semesters analysed with multiple linear and logistic regressions.

Results

The survey included responses from students during the fourth (n = 498) and the final (n = 343) semester of higher education programmes in health and social work. Total SOC scores decreased between the fourth semester and the final semester. The prevalence of the health promoting lifestyle factor of physical exercise decreased between the fourth and final semesters. Students in their final semester reported valuing group work more highly than did students in their fourth semester. Despite this, students in both the fourth and the final semester reported high SOC, low levels of good general health and perceived wellbeing, and sleeping problems.

Conclusions

Students’ report of good general health were associated with wellbeing, high-intensity physical training, and no sleeping problems A high SOC level was associated with good general health, perceived wellbeing, and no sleeping problems. A higher SHIS level was also associated with wellbeing and no sleeping problems. Therefore, we suggest further research focusing on how to prepare students in healthcare and social work during higher education for a future work-life in balance targeting effects on sleep quality.