The overall aim of this thesis was to describe the conditions for learning inthe ambulance service during clinical practice, and to develop an understanding of how to support the professional development of caring in this context.

The findings of this thesis are based on four qualitative interview studies.The study group consisted of 28 specialist ambulance nursing students (I), 20 preceptors (II), 27 preceptors (III), and 16 specialist ambulance nursingstudents (IV), from all parts of Sweden. The data were collected by individual, dyadic, and focus group interviews. The study designs and analytical approach were guided by the critical incident technique, latent content analysis, reflexive thematic analysis, and a phenomenographic approach.

The findings indicate that the contextual complexities of ambulance care contradict the students’ fundamental need to independently care for the patients in their development of all domains of knowledge. Caring and learning in the ambulance service requires a structured approach in medical, technical, and practical aspects to create a basic security for preceptors and students in dealing with the diversity in care situations, patient needs, and student needs. However, this structured approach may hinder an individualized and situationally adapted approach unless the preceptors and students develop a flexible and reflective questioning approach in the phronetic domains of knowledge. The support, educational strategies, and learning objectives needed for enhancing educational clarity and quality during clinical practice in ambulance care are presented at an organizational, environmental, situational, and interpersonal level.

It is proposed in the conclusions that a reflective questioning approach and an embodied understanding of ambulance service work supported by critical reflections are fundamental to support professional development in this field. Higher education institutions and the ambulance departments should address the professional development as a mutual concern, where supporting the development of a caring competence should be viewed as a lifelong continuum of learning. The expanding scope of ambulance care requires professional judgement to manage the ethical complexities of clinical decision-making to safeguard the patient perspective in ambulance care.

Ambulance service organizations worldwide report about an expanding professional role, responsibilities and scope of practice for ambulance clinicians, resulting in discussions concerning educational design and desired professional competencies. To face the contemporary demands in ambulance care, non-technical skills are advocated and clinical practice considered fundamental for the development of these abilities. However, there is very little research concerning educational strategies for supporting the desired competencies for novice registered nurses in the ambulance service.

Aim: To describe and explore nurse preceptors' experience-based strategies for sup- porting registered nurses learning in the ambulance service.

Design: The study had an inductive and data-driven approach, guided by phenomeno- logical epistemology.

Methods: Twenty-seven Swedish nurse preceptors were interviewed in three focus groups and four dyadic interviews between October 2019 and April 2020. The data were analysed with reflexive thematic analysis.

Findings: The nurse preceptors use several learning strategies, focusing on a socialization process and a clinical competence process, intertwined during clinical practice to support the development of a situated professional identity and a clinical decision-making competence. Supportive structures facilitate a progressive learning strategy when addressing desired skills and cognitive abilities in teamwork processes and clinical judgement.

Conclusion: Supporting novice clinicians, prior to and during clinical practice in the ambulance service, should include medical assessment skills, situation awareness and processes for effective teamwork. Further, novice clinicians need to develop complex cognitive abilities to deal with the dynamic nature of decision-making in ambulance care.

Impact: The study findings show contextual strategies, previously not described and desired competencies when supporting learning for registered nurses in the ambu- lance service. A theoretical grounding in episteme, techne, phronesis and situation awareness may guide educators at universities, managers in the ambulance service, preceptors and novice clinicians worldwide in the planning and performance of teaching and learning in the ambulance service.

Police patrol officers (PPOs) face different types of encounters with acutely ill and injured people as first responders. The study aim was to explore and describe the emergency care competence needed for Swedish PPOs. The study had an exploratory design, and the data was collected using the Delphi technique from 43 experts in Sweden: police program educators (n=10), police authority instructors (n=11), and PPOs (n= 22). The results generated an understanding of emergency care competence that is relevant for PPOs. Basic assessment and basic life support measures for traumatic injuries and cardiac arrest (e.g., airway management, cardiopulmonary resuscitation (CPR), and hemorrhage control) received the highest levels of agreement among the experts, whereas more advanced assessments (taking care of people suffering from mental/medical illness or with drug/alcohol abuse) received lower levels of agreement. These results provide support for educators at the police programs and for the police authority in preparing PPOs to perform relevant out-of-hospital emergency care.

ObjectiveTo explore and describe the ways specialist ambulance nursing (SAN) students understand the work in the ambulance service.Design, sample, and measurementsAn explorative descriptive design was carried out through individual interviews with 16 SAN students from all parts of Sweden and analysed in accordance with the phenomenographic tradition.FindingsFive different ways of understanding the work were described and each was assigned a metaphor; The medical role; The practical role; The patient-oriented role; The commanding role; and The comprehensive role. Several aspects concerning personal, organizational, and situational conditions affecting the understanding and the distribution of these roles in the specific care assignment were identified and presented in a hierarchical model of the outcome space.ConclusionsThis study contributes with a new perspective on supporting role clarity for registered nurses (RN) working in the ambulance service (AS). Specialization and experiential learning are needed to support an understanding of all aspects of the work in order to develop a professional competence aligned with the challenges faced in the AS. The development of expertise in the AS needs a contextualized understanding rooted in a theoretical framework that addresses a holistic perspective towards patients’ needs.

Vilken sjukvårdskunskap behöver en polis bemästra? Tills nu har frågan varit i stort sett obesvarad, men i en ny studie fastslås: Blödning, fri luftväg och hjärt- och lungräddning är viktigt, medan medicinsk sjukdom och psykisk ohälsa värderas lägre.

Police patrol officers (PPO) are challenged by various encounters with sick and injured persons in their role as first responders. The study aim was to explore what is considered as necessary emergency medical competence for Swedish PPO. With an exploratory design, the data was collected with the Delphi technique from 43 experts covering all parts of Sweden; educators at police academies (n=10), instructors in the police department (n=11) and active PPO (n= 22). The results provides a detailed understanding of emergency medical competencies, relevant for PPOs. Basic assessment and basic life support measures (e.g. airway management, CPR and hemorrhage control) for traumatic injuries are among the most important competencies. Whereas, advanced assessments, psychiatric/medical complaints and care for persons with alcohol/drug use receives lower levels of agreement among the experts. These results can support educators at universities and the police department in preparing active PPO to perform relevant out-of-hospital care for acutely ill and injured persons. 

Poliser inom ingripande verksamhet (IGV) utmanas av olika möten med sjuka och skadade personer i sin roll som första hjälpare. Studiens syfte var att undersöka vad som anses vara nödvändig akutmedicinsk kompetens för svensk IGV-polis. Med en utforskande design samlades data in med Delphi-teknik från 43 experter som täckte alla delar av Sverige; lärare vid polisprogrammen (n = 10), instruktörer inom polismyndigheten (n = 11) och aktiva IGV-poliser (n = 22). Resultaten ger en detaljerad förståelse för akutmedicinsk kompetens, relevant för IGV-poliser. Grundläggande bedömning och grundläggande livräddande åtgärder (t.ex. luftvägshantering, HLR och blödningskontroll) för traumatiska skador är bland de viktigaste kompetenserna. Medan avancerade bedömningar, psykiatriska/medicinska tillstånd, och vård av personer med alkohol/droganvändning, når en lägre nivå av överensstämmelse bland experterna. Dessa resultat kan hjälpa lärare vid universitet och polismyndigheten att förbereda IGV-poliser att utföra relevant vård utanför sjukhuset för akut sjuka och skadade personer.

Background

Clinical placements play a central part in the education of future emergency medical services (EMS) staff and their development of clinical skills and competence. A key aspect of students' integration of theory and praxis and development into an independent clinician is a supportive mentorship with the preceptor. However, students report barriers for learning within the EMS, while the preceptors' experiences of their role have received scant attention in research.

Objectives

To describe preceptors' experiences of student supervision in the EMS during clinical placements.

Design

A descriptive qualitative design was used.

Participants and setting

Twenty specialist nurses were recruited among EMS staff from all parts of Sweden.

Methods

Data were collected using individual interviews and analyzed with latent qualitative content analysis.

Findings

EMS preceptors develop a competence in combining caring and learning adapted to individual student needs when facing students with varying needs in an ever-changing healthcare setting. A trustful relationship between student and preceptor is fundamental when coping with a dual responsibility for student and patient needs. However, several aspects in the EMS setting hinders the preceptors' ability to support the development of the students' independence. Surrounding support structures are important if the preceptors are to feel safe and secure in their role as assessor, teacher and ambulance nurse.

Conclusions

Preceptors need to develop a didactic flexibility through preceptor courses adapted to the complex premises found in the EMS. Ambulance services and universities should recognize the importance of preceptors´ colleagues, student continuity, university support and cooperation for improving quality and clarity in supervision during clinical placements.

Background: The importance of clinical placements for nursing students to be able to integrate theory and practice and develop clinical competence are described in literature. Recent research in the Swedish prehospital context has shown that there possibly are differences in the preparations among ambulance nursing students before entering their clinical placements in accordance with studies in other countries. Studies have also highlighted difficulties in creating a good learning environment in the context of prehospital emergency care. The role of the mentor in supporting these students during clinical placements via an individualized mentorship model has proven to be of most importance. At the same time the role of the mentor is described as demanding, undefined and lacking support from both universities and ambulance services. In the Swedish educational system, the voice of the mentor is missing in research in order to develop and enhance the learning environment during clinical placements.

Purpose: To describe mentors ‘experiences of enablers and barriers for supervision during ambulance clinical placements.

Methods: Individual interviews were conducted with 20 mentors from 10 ambulance districts from all parts of Sweden. The interviews were analysed according to qualitative content analysis.

Results/Conclusions: Preliminary findings indicates that the mentors need specific competence, further education and improved support from universities and ambulances services to feel competent and safe. They are forced to adjust their learning strategies to the unique context of prehospital emergency care and are constantly drawn between responsibilities towards the patient and the student. The role and the assignment are unclear and they are in need of support and structure. The competence and attitudes of the team colleague are of high importance for the mentors’ perceived support.

Tidig och avancerad bedömning krävs när patienter möter personal inom ambulanssjukvården. Hur är det möjligt att frågan om sänkta kompetenskrav inom svensk ambulanssjukvård överhuvudtaget har väckts? undrar Nät­verket för ut­bildning av ambulanssjuksköterskor.