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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
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Publications (10 of 143) Show all publications
Agerström, J., Andréll, C., Bremer, A., Strömberg, A., Årestedt, K. & Israelsson, J. (2024). All else equal: Examining treatment bias and stereotypes based on patient ethnicity and socioeconomic status using in-hospital cardiac arrest clinical vignettes. Heart & Lung, 63, 86-91
Open this publication in new window or tab >>All else equal: Examining treatment bias and stereotypes based on patient ethnicity and socioeconomic status using in-hospital cardiac arrest clinical vignettes
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2024 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 63, p. 86-91Article in journal (Refereed) Published
Abstract [en]

BackgroundResearch on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination – whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed.ObjectiveThe primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals’ (HCP) stereotypical beliefs about these groups.MethodsHCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes).ResultsNo significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients.ConclusionsSwedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-124935 (URN)10.1016/j.hrtlng.2023.09.011 (DOI)001097657300001 ()2-s2.0-85174048692 (Scopus ID)
Available from: 2023-09-28 Created: 2023-09-28 Last updated: 2024-01-11Bibliographically approved
Frank, C., Rantala, A., Svensson, A., Green, J., Sterner, A., Bremer, A. & Holmberg, B. (2024). Ethics rounds in the ambulance service: A qualitative evaluation. BMC Medical Ethics, 25(8)
Open this publication in new window or tab >>Ethics rounds in the ambulance service: A qualitative evaluation
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2024 (English)In: BMC Medical Ethics, E-ISSN 1472-6939, Vol. 25, no 8Article in journal (Refereed) Published
Abstract [en]

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 sixteeninterviews 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.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Ambulance clinicians, Ethics rounds, Intervention, Qualitative, Evaluation, Ethical competence, Decision- making, Patient autonomy
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-126976 (URN)10.1186/s12910-024-01002-6 (DOI)001144485400002 ()2-s2.0-85182686416 (Scopus ID)
Available from: 2024-01-21 Created: 2024-01-21 Last updated: 2024-02-06Bibliographically approved
Waldemar, A., Bremer, A., Strömberg, A. & Thylén, I. (2024). Family presence during in-hospital cardiopulmonary resuscitation: effects of an online intervention on self-confidence and attitudes of healthcare professionals. European Journal of Cardiovascular Nursing
Open this publication in new window or tab >>Family presence during in-hospital cardiopulmonary resuscitation: effects of an online intervention on self-confidence and attitudes of healthcare professionals
2024 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Article in journal (Refereed) In press
Abstract [en]

Aims

Guidelines support family-witnessed resuscitation (FWR) during cardiopulmonary resuscitation in hospital if deemed to be safe, yet barriers amongst healthcare professionals (HCPs) still exist. This study aimed to evaluate the effects of an educational online video intervention on nurses’ and physicians’ attitudes towards in-hospital FWR and their self-confidence in managing such situations.

Methods and results

A pre- and post-test quasi-experimental study was conducted October 2022 to March 2023 at six Swedish hospitals involving the departments of emergency care, medicine, and surgery. The 10 min educational video intervention was based on previous research covering the prevalence and outcome of FWR, attitudes of HCP, patient and family experiences, and practical and ethical guidelines about FWR. In total, 193 accepted participation, whereof 91 answered the post-test survey (47.2%) with complete data available for 78 and 61 participants for self-confidence and attitudes, respectively. The self-confidence total mean scores increased from 3.83 to 4.02 (P < 0.001) as did the total mean scores for attitudes towards FWR (3.38 to 3.62, P < 0.001). The majority (71.0%) had positive views of FWR at baseline and had experiences of in hospital FWR (58.0%). Self-confidence was highest amongst participants for the delivery of chest compressions (91.2%), defibrillation (88.6%), and drug administration (83.3%) during FWR. Self-confidence was lowest (58.1%) for encouraging and attending to the family during resuscitation.

Conclusion

This study suggests that a short online educational video can be an effective way to improve HCP’s self-confidence and atti- tudes towards the inclusion of family members during resuscitation and can support HCP in making informed decisions about FWR.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
Attitudes, Education, Family-witnessed resuscitation, Healthcare professionals, In-hospital cardiac arrest, Self- confidence
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-126180 (URN)10.1093/eurjcn/zvad111 (DOI)001134819600001 ()
Available from: 2024-01-02 Created: 2024-01-02 Last updated: 2024-01-19
Svensson, A., Nilsson, B., Lantz, E., Bremer, A., Årestedt, K. & Israelsson, J. (2024). Response times in rural areas for emergency medical services, fire and rescue services and voluntary first responders during out-of-hospital cardiac arrests. Resuscitation Plus, 17, Article ID 100548.
Open this publication in new window or tab >>Response times in rural areas for emergency medical services, fire and rescue services and voluntary first responders during out-of-hospital cardiac arrests
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2024 (English)In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 17, article id 100548Article in journal (Refereed) Published
Abstract [en]

Aim: To increase survival in out-of-hospital cardiac arrests (OHCA), great efforts are made to improve the number of voluntary first responders (VFR). However, evidence of the potential utility of such efforts is sparse, especially in rural areas. Therefore, the aim was to describe and compare response times for emergency medical services (EMS), fire and rescue services (FRS), and VFR during OHCA in relation to population density.

Methods: This observational and comparative study was based on data including positions and time stamps for VFR and response times for EMS and FRS in a region in southern Sweden.ResultsIn total, 285 OHCAs between 1 July 2020 and 31 December 2021 were analysed. VFR had the shortest median response time in comparison to EMS and FRS in all studied population densities. The overall median (Q1–Q3) time gain for VFR was 03:07 (01:39–05:41) minutes. A small proportion (19.2%) of alerted VFR accepted the assignments. This is most problematic in rural and sub-rural areas, where there were low numbers of alerted VFR. Also, FRS had shorter response time than EMS in all studied population densities except in urban areas.

Conclusion: The differences found in median response times between rural and urban areas are worrisome from an equality perspective. More focus should be placed on recruiting VFR, especially in rural areas since VFR can potentially contribute to saving more lives. Also, since FRS has a shorter response time than EMS in rural, sub-rural, and sub-urban areas, FRS should be dispatched more frequently.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-126711 (URN)10.1016/j.resplu.2023.100548 (DOI)2-s2.0-85182349591 (Scopus ID)
Available from: 2024-01-15 Created: 2024-01-15 Last updated: 2024-01-22Bibliographically approved
Hammarbäck, S., Holmberg, M., Wiklund Gustin, L. & Bremer, A. (2023). Ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. Nursing Ethics, 30(6), 857-870
Open this publication in new window or tab >>Ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process
2023 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 30, no 6, p. 857-870Article in journal (Refereed) Published
Abstract [en]

Background: Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process.

Aim: The aim of this study was to describe ambulance clinicians’ conceptions of responsibility when en- countering patients in a suicidal process.

Research design: A qualitative inductive design using a phenomenographic approach was used. Participants and research context: Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed.

Ethical considerations: The study was approved by the Swedish Ethical Review Authority.

Findings: Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient’s mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient’s life story.

Conclusions: An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Ambulance clinicians, emergency medical services, ethical responsibility, phenomenography, suicidal ideation
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-120129 (URN)10.1177/09697330221149102 (DOI)000963458300001 ()37026403 (PubMedID)2-s2.0-85152260693 (Scopus ID)
Available from: 2023-04-07 Created: 2023-04-07 Last updated: 2024-01-18Bibliographically approved
Bennesved, A., Bremer, A., Svensson, A., Rantala, A. & Holmberg, M. (2023). Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study. Nursing Ethics, 1-13
Open this publication in new window or tab >>Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study
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2023 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, p. 1-13Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.

Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.

Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.

Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.

Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.

Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.

Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
ambulance clinicians, autonomy, decision-making, ethics, older patient, self-determination
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-124656 (URN)10.1177/09697330231196230 (DOI)001066116800001 ()2-s2.0-85171431839 (Scopus ID)
Funder
The Kamprad Family Foundation, 20180157
Available from: 2023-09-15 Created: 2023-09-15 Last updated: 2023-10-05
Israelsson, J., Koistinen, L., Årestedt, K., Rooth, M. & Bremer, A. (2023). Associations between comorbidity and health-related quality of life among in-hospital cardiac arrest survivors – A cross-sectional nationwide registry study. Resuscitation, 188, Article ID 109822.
Open this publication in new window or tab >>Associations between comorbidity and health-related quality of life among in-hospital cardiac arrest survivors – A cross-sectional nationwide registry study
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2023 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 188, article id 109822Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore associations between comorbidities and health-related quality of life (HRQoL) among in-hospital cardiac arrest (IHCA) survivors.

Methods: This registry study is based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) collected during 2014–2017. HRQoL was assessed using the EQ-5D-5L, the EQ Visual Analogue Scale (EQ VAS) and the Hospital Anxiety and Depression Scale (HADS). In total, 1,278 IHCA survivors were included in the study, 3–6 months after the cardiac arrest (CA). Data were analysed with descriptive and inferential statistics. The comorbidities analysed in this study were the patients’ status for diabetes, previous myocardial infarction, previous stroke, respiratory insufficiency, and heart failure.

Results: Overall, the IHCA survivors reported high levels of HRQoL, but there was great variation within the population, e.g., EQ VAS median (q1- q3) = 70 (50–80). Survivors with one or more comorbidities reported worse HRQoL in 6 out of 8 outcomes (p < 0.001). All studied comorbidities were each associated with worse HRQoL, but no comorbidity was associated with every outcome measure. Previous stroke and respiratory insufficiency were significantly associated with every outcome measure except for HADS Anxiety. The linear regression models explained 4–8% of the total vari- ance in HRQoL (p < 0.001).

Conclusion: Since IHCA survivors with comorbidities report worse HRQoL compared to those without comorbidities, it is important to pay directed attention to them when developing and providing post-CA care, especially in those with respiratory insufficiency and previous stroke.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Cardiac arrest, Comorbidity, Health, Quality of life
National Category
Cardiac and Cardiovascular Systems Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-120807 (URN)10.1016/j.resuscitation.2023.109822 (DOI)001002238600001 ()37150395 (PubMedID)2-s2.0-85159601483 (Scopus ID)
Available from: 2023-05-19 Created: 2023-05-19 Last updated: 2024-01-11Bibliographically approved
Holmberg, B., Bennesved, A. & Bremer, A. (2023). Caring for older patients with reduced decision-making capacity: a deductive exploratory study of ambulance clinicians’ ethical competence. BMC Medical Ethics, 24, Article ID 60.
Open this publication in new window or tab >>Caring for older patients with reduced decision-making capacity: a deductive exploratory study of ambulance clinicians’ ethical competence
2023 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 24, article id 60Article in journal (Refereed) Published
Abstract [en]

Background: As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complexand difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability.

Methods: A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis.

Results: Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting.

Conclusions: Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Ambulance clinicians, Ambulance service, Content analysis, Decision-making, Ethical competence, Older patients
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-123559 (URN)10.1186/s12910-023-00941-w (DOI)001044894700002 ()2-s2.0-85167533747 (Scopus ID)
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2023-08-25Bibliographically approved
Waldemar, A., Strömberg, A., Thylén, I. & Bremer, A. (2023). Experiences of family-witnessed cardiopulmonary resuscitation in hospital and its impact on life: An interview study with cardiac arrest survivors and their family members. Journal of Clinical Nursing, 32(19-20), 7412-7424
Open this publication in new window or tab >>Experiences of family-witnessed cardiopulmonary resuscitation in hospital and its impact on life: An interview study with cardiac arrest survivors and their family members
2023 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 19-20, p. 7412-7424Article in journal (Refereed) Published
Abstract [en]

Aim: To explore experiences of cardiac arrest in-hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation.

Background: Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family-witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family.

Design: A qualitative design consisting of joint in-depth interviews with patients and family members.

Methods: Family interviews were conducted with seven patients and their eight cor- responding family members (aged 19–85 years) 4–10 months after a family-witnessed in-hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist.

Results: The participants felt insignificant and abandoned following the in-hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death—powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed—feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again—making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future.

Conclusion: Surviving and witnessing a cardiac arrest in-hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation.

Relevance to clinical practice: It is important to provide support to family members who witness the resuscitation of a loved one in-hospital. Structured follow-up care is crucial for cardiac arrest survivors and their families. To promote person-centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow-up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed.

Patient or public contribution: In-hospital cardiac arrest patients and family members were involved when designing the study.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
cardiac arrest, experiences of survival, family, in-hospital, interpretative phenomenological analysis, witnessed resuscitation
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-121625 (URN)10.1111/jocn.16788 (DOI)001004500300001 ()37300340 (PubMedID)2-s2.0-85161693954 (Scopus ID)
Available from: 2023-06-10 Created: 2023-06-10 Last updated: 2023-11-07Bibliographically approved
Heidenreich, K., Svantesson, M., Karlsson, M. & Bremer, A. (2023). Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice. BMC Medical Ethics, 24, Article ID 1.
Open this publication in new window or tab >>Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice
2023 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 24, article id 1Article in journal (Refereed) Published
Abstract [en]

Background: Vascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons’ moral reasoning of what ought to be done for the patient.

Methods: Qualitative, semi-structured interviews were conducted with 19 vascular surgeons working at three Swed- ish university hospitals. Data were analysed according to systematic text condensation.

Results: The surgeons’ moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one ́s perspective from the vessels to the whole person, to balance patient’s conflicting needs and to place responsibility for right decision on one ́s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowl- edge in pondering of what is best, struggling with one ́s authority for surgery through dialogue, and building rela- tionship for mutual security. To balance patient’s conflicting needs implied weighing the patient’s independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one ́s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one’s power of proficiency, and managing time during the illness course.

Conclusions: This study contributes to uncovering how moral reasoning is embodied in the vascular surgeons’ every- day clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considera- tions in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Decision-making, Medical ethics, Physicians, Qualitative research, Surgeons
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-118175 (URN)10.1186/s12910-022-00881-x (DOI)000911437200001 ()36624427 (PubMedID)2-s2.0-85145956386 (Scopus ID)
Available from: 2023-01-09 Created: 2023-01-09 Last updated: 2023-02-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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