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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
Publications (10 of 87) Show all publications
Holmberg, M. & Bremer, A. (2019). Ambulance nurse students’ experiences of handling ethical problems in patient-relationship. In: : . Paper presented at International Council of Nurses (ICN) 120th congress, Singapore..
Open this publication in new window or tab >>Ambulance nurse students’ experiences of handling ethical problems in patient-relationship
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-86128 (URN)
Conference
International Council of Nurses (ICN) 120th congress, Singapore.
Available from: 2019-07-02 Created: 2019-07-02 Last updated: 2019-07-02
Svensson, C., Bremer, A. & Holmberg, M. (2019). Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: a qualitative exploration. Clinical Ethics, 14(2), 70-79
Open this publication in new window or tab >>Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: a qualitative exploration
2019 (English)In: Clinical Ethics, ISSN 14777509, Vol. 14, no 2, p. 70-79Article in journal (Refereed) Published
Abstract [en]

Background: The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations. Aim: The aim of the study was to explore ambulance nurses’ experiences of relationships with patients in urgent and emergency situations. Methods: Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis. Results: Relationships with patients during urgent and emergency assignments emerged as three themes: “Ambiguous silence,” “Professional competence” and “Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship. Conclusions: Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important. Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses.

Keywords
Clinical ethics, professional ethics in nursing, patient relationships, emergency medical services, qualitative interviews, nursing values
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-84648 (URN)10.1177/1477750919851050 (DOI)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-08-12
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
Wallin, K., Hörberg, U., Werkander Harstäde, C., Elmqvist, C. & Bremer, A. (2019). Enablers and barriers in ambulance clinical placements – a mentor perspective. In: : . Paper presented at Ambulans2019Prehospen,Upplands Väsby 2-3 april.
Open this publication in new window or tab >>Enablers and barriers in ambulance clinical placements – a mentor perspective
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2019 (Swedish)Conference paper, Oral presentation only (Refereed)
Keywords
Handledare, erfarenheter, ambulanssjukvård, ambulanssjuksköterska, intervju
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-82021 (URN)
Conference
Ambulans2019Prehospen,Upplands Väsby 2-3 april
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-06-10
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
Jonasson, L.-L., Sandman, L. & Bremer, A. (2019). Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training. Journal of Healthcare Leadership, 11, 63-74
Open this publication in new window or tab >>Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training
2019 (English)In: Journal of Healthcare Leadership, ISSN 1179-3201, E-ISSN 1179-3201, Vol. 11, p. 63-74Article in journal (Refereed) Published
Abstract [en]

Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care. Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data. Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons. Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented.

Place, publisher, year, edition, pages
Dove Medical Press, 2019
Keywords
manager, ethical responsibility, municipal, older person, thematic analysis
National Category
Medical Ethics
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-83662 (URN)10.2147/JHL.S199167 (DOI)000471092500001 ()31213938 (PubMedID)
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-07-15Bibliographically 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
Falchenberg, Å., Andersson, U., Bremer, A. & Andersson, H. (2018). Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care. In: : . Paper presented at 3rd Global Conference on Emergency Nursing and Trauma Care.
Open this publication in new window or tab >>Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Keywords
Evidence-based guidelines, comprehensive assessment, pre-hospital, hospital emergency care, AGREE II
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-80170 (URN)
Conference
3rd Global Conference on Emergency Nursing and Trauma Care
Available from: 2019-02-02 Created: 2019-02-02 Last updated: 2019-06-10
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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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