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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
Publications (10 of 79) Show all publications
Wireklint Sundström, B., Bremer, A., Lindström, V. & Vicente, V. (2019). Caring science research in the ambulance services: an integrative systematic review. Scandinavian Journal of Caring Sciences, 33(1), 3-33
Open this publication in new window or tab >>Caring science research in the ambulance services: an integrative systematic review
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 3-33Article, review/survey (Refereed) Published
Abstract [en]

Background

The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.

Aim

This integrative systematic review aims to describe caring science research content and scope in the ambulance services.

Data sources

Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.

Review methods

The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five‐stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3‐level scale, and data relevance was evaluated on a 2‐level scale.

Results

After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision‐making; Public environment and patient safety; Life‐changing situations; and Ethics and values.

Conclusion

Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional–patient relation, with special focus on value conflicts in emergency situations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Ambulance, Caring science, Emergency medical services, Holistic approach, Prehospital, Patient perspective, Review, Systematic
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-78008 (URN)10.1111/scs.12607 (DOI)000462154100002 ()30252151 (PubMedID)
Available from: 2018-09-25 Created: 2018-09-25 Last updated: 2019-04-11Bibliographically approved
Bremer, A., Dahné, T., Stureson, L., Årestedt, K. & Thylén, I. (2019). Lived experiences of surviving in‐hospital cardiac arrest. Scandinavian Journal of Caring Sciences, 33(1), 156-164
Open this publication in new window or tab >>Lived experiences of surviving in‐hospital cardiac arrest
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2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 156-164Article in journal (Refereed) Published
Abstract [en]

Background

Out‐of‐hospital cardiac arrest survivors suffer from psychological distress and cognitive impairments. They experience existential insecurity and vulnerability and are striving to return to a life in which well‐being and the meaning of life have partly changed. However, research highlighting the experiences of in‐hospital cardiac arrest survivors is lacking. This means that evidence for postresuscitation care has largely been extrapolated from studies on out‐of‐hospital cardiac arrest survivors, without considering potential group differences. Studies investigating survivors’ experiences of an in‐hospital cardiac arrest are therefore needed.

Aim

To illuminate meanings of people's lived experiences of surviving an in‐hospital cardiac arrest.

Design

An explorative, phenomenological hermeneutic method to illuminate meanings of lived experiences.

Method

Participants were identified through the Swedish national register of cardiopulmonary resuscitation and recruited from two hospitals. A purposive sample of eight participants, 53–99 years old, who survived an in‐hospital cardiac arrest 1–3 years earlier, was interviewed.

Findings

The survivors were striving to live in everyday life and striving for security. The struggle to reach a new identity meant an existence between restlessness and a peace of mind, searching for emotional well‐being and bodily abilities. The search for existential wholeness meant a quest for understanding and explanation of the fragmented cardiac arrest event and its existential consequences. The transition from hospital to home meant a transition from care and protection to uncertainty and vulnerability with feelings of abandonment, which called for a search for security and belonging, away from isolation and loneliness.

Conclusion

Surviving an in‐hospital cardiac arrest can be further understood by means of the concept of hospital‐to‐home transition. Following hospital discharge, patients felt vulnerable and abandoned when pending between denial and acceptance of the ‘new’ life. Hence, the healthcare system should play a significant role when it comes to facilitate cardiac arrest survivors’ security during hospital‐to‐home transition.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Cardiac arrest, Hospitals, Lived experiences, Nursing, Phenomenological hermeneutics
National Category
Nursing Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-78359 (URN)10.1111/scs.12616 (DOI)000462154100016 ()30329171 (PubMedID)
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2019-04-11Bibliographically approved
Bremer, A., Kowalczyk, E., Årestedt, K. & Wireklint Sundström, B. (2018). Emergency Medical Services physicians’ perceptions of ambulance nurses’ responsibility for referring patients to primary care and self-care - a Swedish national survey. Paper presented at EMS2018, Copenhagen, Denmark, April 16-18, 2018. BMJ Open, 8(Suppl 1), A6-A6
Open this publication in new window or tab >>Emergency Medical Services physicians’ perceptions of ambulance nurses’ responsibility for referring patients to primary care and self-care - a Swedish national survey
2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no Suppl 1, p. A6-A6Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: Based on guidelines developed by EMS physicians, registered nurses in the Swedish ambulance services sometimes by-pass the emergency department and refer non-urgent patients to primary care and self-care. However, these referrals are associated with problems that may jeopardize patient safety and patient participation.

Aim: To identify the EMS physicians’ perceptions of ambulance nurses’ responsibilities and prerequisites to refer patients to primary care and self-care.

Methods: A national survey of all EMS physicians (n=51) using study specific questions with close-ended and open response options, analysed with descriptive statistics and thematic analysis.

Results: The response rate was 78% (n=40). The majority of the physicians (95%) perceived that nurses should be able to refer patients to primary care and self-care. One fourth (25%) perceived specialist nurses in ambulance care as the most appropriate professionals. The majority of the physicians (65%) perceived that referral to primary care maintain patient safety, whereas fewer (50%) assessed the referral as safe for the patient. All perceived that feedback should be given to nurses when the referral was incorrect. The majority perceived it important to extend the nurses’ authority to refer to primary care (63%) and self-care (55%).

Conclusion: There is no consensus among the EMS physicians regarding responsibilities and conditions for nurses’ referral of patients. Registered nurses with basic education are expected to be able to refer, while there is varying opinion regarding requirements of specialist trained ambulance nurses to refer patients. Professional experience as a nurse is perceived more important than formal education.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
EMS physicians, Ambulance nurses, Competence, Referral, Responsibility, Patient safety, National survey
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-73097 (URN)10.1136/bmjopen-2018-EMS.16 (DOI)
Conference
EMS2018, Copenhagen, Denmark, April 16-18, 2018
Available from: 2018-04-19 Created: 2018-04-19 Last updated: 2018-11-15Bibliographically approved
Hjelm, C., Hellström, A., Broström, A., Bremer, A. & Årestedt, K. (2018). Exploring sleep disturbances in cardiac arrest survivors: a phenomenographic interview study from registered nurses’ perspective. Paper presented at The Congress of the European Resuscitation Council, Bologna, Italy, September 20-22, 2018. Resuscitation, 130(s1), e129-e129
Open this publication in new window or tab >>Exploring sleep disturbances in cardiac arrest survivors: a phenomenographic interview study from registered nurses’ perspective
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e129-e129Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Sleep disturbances, Cardiac arrest, Phenomenographic, Registered nurses
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77923 (URN)10.1016/j.resuscitation.2018.07.276 (DOI)
Conference
The Congress of the European Resuscitation Council, Bologna, Italy, September 20-22, 2018
Note

Part of special issue: RESUSCITATION 2018 - New technologies in resuscitation: Abstracts

Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2019-02-26Bibliographically approved
Israelsson, J., Thylén, I., Strömberg, A., Bremer, A. & Årestedt, K. (2018). Factors associated with health status and psychological distress among cardiac arrest survivors treated with an implantable cardioverter-defibrillator. Paper presented at The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy.. Resuscitation, 130(s1), e85
Open this publication in new window or tab >>Factors associated with health status and psychological distress among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e85-Article in journal, Meeting abstract (Refereed) Published
Keywords
Health-related quality of life, Health status, Psychological distress, Cardiac arrest, Implantable cardioverter-defibrillator, Gender
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77918 (URN)
Conference
The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy.
Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-10-22Bibliographically approved
Israelsson, J., Thylén, I., Strömberg, A., Bremer, A. & Årestedt, K. (2018). Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator. Resuscitation, 132, 78-84
Open this publication in new window or tab >>Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 78-84Article in journal (Refereed) Published
Abstract [en]

Aim

To explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population.

Methods

This cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personality (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL.

Results

The CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p < 0.001). In contrast, they reported more problems in mobility and usual activities (p < 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personality. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models.

Conclusions

This extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Health-related quality of life, Health status, Psychological distress, Cardiac arrest, Implantable cardioverter-defibrillator, Gender
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-78034 (URN)10.1016/j.resuscitation.2018.09.002 (DOI)000446854900019 ()30201535 (PubMedID)
Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2018-10-24Bibliographically approved
Årestedt, K., Allert, C., Djukanovic, I., Israelsson, J., Schildmeijer, K., Agerström, J., . . . Bremer, A. (2018). Health-related quality of life among in-hospital cardiac arrest survivors in working age. Paper presented at The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy. Resuscitation, 130(s1), Article ID e18.
Open this publication in new window or tab >>Health-related quality of life among in-hospital cardiac arrest survivors in working age
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, article id e18Article in journal, Meeting abstract (Refereed) Published
Keywords
Health-related quality of life, in-hospital, cardiac arrest, working age, anxiety, depression
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77900 (URN)10.1016/j.resuscitation.2018.07.342 (DOI)
Conference
The Congress of the European Resuscitation Council, 20th – 22th September. Bologna, Italy
Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2019-04-12Bibliographically approved
Bremer, A., Dahné, T., Stureson, L., Årestedt, K. & Thylén, I. (2018). Lived experiences of surviving in-hospital cardiac arrest. Paper presented at The Congress of the European Resuscitation Council, Bologna, Italy, September 20-22, 2018. Resuscitation, 130(s1), e122-e122
Open this publication in new window or tab >>Lived experiences of surviving in-hospital cardiac arrest
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e122-e122Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Cardiac arrest, Hospitals, Lived experiences, Nursing, Phenomenological hermeneutics
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77921 (URN)10.1016/j.resuscitation.2018.07.258 (DOI)
Conference
The Congress of the European Resuscitation Council, Bologna, Italy, September 20-22, 2018
Note

Part of special issue: RESUSCITATION 2018 - New technologies in resuscitation: Abstracts

Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-10-30Bibliographically approved
Steel, K., Bremer, A., Gunnarsson, L.-L., Årestedt, K., Strömberg, A. & Hjelm, C. (2018). Nurses’ perceptions of cognitive function in survivors after cardiac arrest: a qualitative study. Paper presented at The Congress of the European Resuscitation Council, Bologna, Italy, September 20-22, 2018. Resuscitation, 130(s1), e128-e128
Open this publication in new window or tab >>Nurses’ perceptions of cognitive function in survivors after cardiac arrest: a qualitative study
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e128-e128Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Registered nurses, Perceptions, Cognitive function, Cardiac arrest, Phenomenographic
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-77922 (URN)10.1016/j.resuscitation.2018.07.273 (DOI)
Conference
The Congress of the European Resuscitation Council, Bologna, Italy, September 20-22, 2018
Note

Part of special issue: RESUSCITATION 2018 - New technologies in resuscitation: Abstracts

Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-10-30Bibliographically approved
Heidenreich, K., Bremer, A., Materstvedt, L. J., Tidefelt, U. & Svantesson, M. (2018). Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD). Medicine, Health care and Philosophy, 21(4), 467-477
Open this publication in new window or tab >>Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD)
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2018 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 21, no 4, p. 467-477Article in journal (Refereed) Published
Abstract [en]

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Clinical ethics, Ethics consultation, Moral case deliberation, Health care professionals, Qualitative research
National Category
Medical Ethics
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-69326 (URN)10.1007/s11019-017-9818-6 (DOI)000451022600004 ()29243015 (PubMedID)
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-12-07Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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