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.

Introduction

Healthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exacerbate crowding and boarding problems in the ED, negatively impacting patient safety and the work environment. In Sweden a hybrid of prehospital and intrahospital emergency care has been established, referred to in this article as Medical Emergency Team (MET), to meet the increasing demand for emergency care. MET, consisting of physicians and nurses, moving emergency care from EDs to patients’ home. Physicians and nurses may encounter challenges in their healthcare work, such as limited resources for example medical equipment, sampling and examination, in unfamiliar varying home environments. There is a lack of knowledge about how these challenges can influence patient care. Therefore, the aim of this study was to explore the healthcare work of the METs when addressing patients’ emergency care needs in their homes, with a focus on the METs reasoning and actions.

Methods

Using a qualitative multiple case study design, two METs in southwestern Sweden were explored. Data were collected from September 2023 – January 2024 and consist of field notes from participant observations, short interviews and written reflections. A qualitative manifest content analysis with an inductive approach was used as the analysis method.

Result

The result of this study indicates that physicians and nurses face several challenges in their daily work, such as recurring interruptions, miscommunication and faltering teamwork. Some of these problems may arise because physicians and nurses are not accustomed to working together as a team in a different care context. These challenges can lead to stress, which ultimately can expose patients to unnecessary risks.

Conclusion

When launching a new service like METs, which is a hybrid of prehospital and intrahospital emergency care, it is essential to plan and prepare thoroughly to effectively address the challenges and obstacles that may arise. One way to prepare is through team training. Team training can help reduce hierarchical structures by enabling physicians and nurses to feel that they can contribute, collaborate, and take responsibility, leading to a more dynamic and efficient work environment.

Introduction: Ethical competence in professional practice can be considered essential among nurses and nurses in ambulance care encounter ethical dilemmas frequently. To enhance ethical competence among students in the ambulance specialist nursing program, high-fidelity simulation scenarios including ethical dilemmas were introduced as a learning activity. Research aim: The research aim was to investigate the usefulness of high-fidelity simulation in ambulance specialist nurse education to teach ethical reasoning when caring for children. Research design: This study was conducted as a qualitative interview study, complemented with observations and using field notes and qualitative interviews for data collection. Data was analysed using deductive qualitative content analysis based on a care ethical model. Participants and research context: Participants (n = 35) were recruited from an ambulance nurse educational program at a Swedish university. Data was collected after the students took part in two high-fidelity simulations involving children in an ambulance care setting. Ethical considerations: The study has been vetted and approved by the ethical council at the University of Borås, Sweden. The study follows the Helsinki Declaration?s advice on ethical principles. Results: The results showed that most of the students expressed some form of ethical reasoning during the simulation sessions, which were elaborated and reflected upon during the debriefing part of the sessions. The simulation design seemed to have a great impact on the outcome of the student's ethical reasoning, where increased immersion led to deeper emotional engagement among the students which increased awareness of their personal preconceptions. Conclusions: This study aimed to investigate whether high-fidelity simulations could be useful to stimulate ethical reflections and contribute to increased ethical competence among students. In conclusion, a well-designed high-fidelity simulation can be useful as an educational tool to learn and enhance ethical competence among specialist ambulance nursing students.

Aim: The overall aim of the thesis was to generate knowledge and understanding of clinical reasoning in the context of EMS from the perspective of EMS clinicians.

Method: Three different methodologies were employed to describe various aspects of clinical reasoning. In Study I, an integrative literature review was conducted to summarise the existing literature related to clinical reasoning in EMS. After conducting systematic searches and screening, 38 articles were identified and analysed through an inductive thematic analysis. Studies II and III were conducted as case studies within an EMS organisation to capture clinical reasoning as it takes place in the naturalistic environment. In total, 34 patient encounters were observed, and group and individual interviews were conducted with EMS clinicians and organisational representatives at various hierarchical levels within the EMS organization. The data were analysed through pattern matching and triangulation in a computerised software program for qualitative analysis. Study IV was conducted as a goal-directed task analysis which focused on what EMS clinicians need in terms of achieving situation awareness. An online survey was created and answered by 30 EMS subject matter experts, consisting of active EMS clinicians, academic teachers in specialist ambulance nursing programmes, and researchers in the field of EMS. The data were analysed using qualitative content analysis and descriptive statistics.

Main results: Clinical reasoning in EMS is a continuously ongoing, iterative, and fragmented process. Information is gathered, analysed, and utilised at any given point during the mission. This information is then reasoned against various goals or instructions provided by the EMS organisation or what is perceived as the most suitable action by the EMS clinician. In the reasoning process, the clinicians take the patients’ and their relatives’ points of interest into account, striving to fulfil these. The clinical reasoning process continues after and between the missions well, and clinicians constantly evaluate their decisions and care provision for future improvement. Even if medical and caring interventions are the focus of clinical reasoning, this process involves the consideration of other aspects as well, such as logistics and safety for everyone present. Nevertheless, there seems to be a vague mandate for decision making among EMS clinicians in relation to other collaborative partners. Furthermore, organisational support for clinical reasoning and development is lacking, often due to economic limitations.

Conclusion: This thesis contributes to the caring science field with an increased understanding of the complexity of clinical reasoning in EMS. EMS clinicians today need to rely on themselves or their partners to have sufficient knowledge or experience to handle the situation encountered and provide safe patient care. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. EMS clinicians today need to rely on themselves or their partner to have sufficient knowledge or experience to handle situations encountered and provide patient safe care.