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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
Publications (10 of 92) Show all publications
Bremer, A. & Holmberg, M. (2019). Ambulance nurse students’ experiences of ethical problems in patient-relationships. In: : . Paper presented at NCCS/EACS Conference, Vaasa, Finland.
Open this publication in new window or tab >>Ambulance nurse students’ experiences of ethical problems in patient-relationships
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Ambulance nurse education in Sweden is a one-year master’s degree program for registered nurses leading to a postgraduate diploma in specialist nursing. Ambulance nurses face unpredictable and ethically challenging situations with multi-dimensional suffering, requiring the ability to provide medical care and simultaneously creating a trustful relationship. Students undergoing their specialist education face the same challenges. 

Aim: The aim was to describe ambulance nurse students’ (ANS) experiences of ethical problems in patient relationships during clinical studies. 

Method: Written exams (n=69) in ANS’ clinical placements studies were collected between 2014-2016 in three courses. In the exam the ANS were asked to describe and problematize a self-experienced ethical problem in the care relationship with a specific patient. The thematic analysis commenced with being familiarized with the text as a whole before condensation and coding. The exams were read and re-read several times. After coding followed further analysis, re-analysis and validation in several linear and circular steps to finally compile sub-themes and themes. 

Results: Ethical problems emerged as six themes; 1) Insecurity in considering patient autonomy, 2) Conflicting assessments of the patients best, 3) Inadequate access to patient narratives, 4) Absence of trustful relationships, 5) Disturbance of patient focus and 6) Limited possibility to provide proper care. 

Conclusions and implications: The result emphasizes ethical problem within patient-relationships in the ambulance care as multifaceted and strongly connected to patient’s autonomy. Outgoing from the results an intervention project regarding older patients’ autonomy in ambulance care started in January 2019.

National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-89493 (URN)
Conference
NCCS/EACS Conference, Vaasa, Finland
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-10-07
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 1477-7509, E-ISSN 1758-101X, 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.

Place, publisher, year, edition, pages
Sage Publications, 2019
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; Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-84648 (URN)10.1177/1477750919851050 (DOI)2-s2.0-85067664953 (Scopus ID)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-09-04Bibliographically approved
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)2-s2.0-85054421374 (Scopus ID)
Available from: 2018-09-25 Created: 2018-09-25 Last updated: 2019-08-29Bibliographically 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)2-s2.0-85055196911 (Scopus ID)
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2019-08-29Bibliographically 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)2-s2.0-85070204322 (Scopus ID)
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-08-29Bibliographically approved
Olander, A., Andersson, H., Sundler, A. J., Bremer, A., Ljungström, L. & Hagiwara, M. A. (2019). Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome. BMC Emergency Medicine, 19(1), 1-8, Article ID 43.
Open this publication in new window or tab >>Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome
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2019 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 19, no 1, p. 1-8, article id 43Article in journal (Refereed) Published
Abstract [en]

Background The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. Methods This was a retrospective observational study. The patients' electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. Results In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. Conclusions The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Emergency medical services, Characteristics, Prehospital, Sepsis, Symptoms, Vital signs
National Category
Other Clinical Medicine
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-88793 (URN)10.1186/s12873-019-0255-0 (DOI)000479221700001 ()31387528 (PubMedID)
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2019-08-28Bibliographically approved
Colldén Benneck, J. & Bremer, A. (2019). Registered nurses’ experiences of near misses in ambulance care – a critical incident technique study. International Emergency Nursing
Open this publication in new window or tab >>Registered nurses’ experiences of near misses in ambulance care – a critical incident technique study
2019 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background: In hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise.

Aim: To explore registered nurses’ experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized.

Methods: Based on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated.

Results: Seventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge.

Conclusions: Experiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Patient safety, Near misses, Ambulance care, Nurses, Emergency medical services, Critical incident technique
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-86937 (URN)10.1016/j.ienj.2019.05.002 (DOI)
Available from: 2019-07-20 Created: 2019-07-20 Last updated: 2019-09-06
Holmberg, M., Wallinvirta, E., Rantala, A. & Bremer, A. (2019). Suffering and Togetherness On-scene in Prehospital emergency care (STOP): A middle range theory. In: : . Paper presented at NCCS/EACS Conference, Vaasa, Finland.
Open this publication in new window or tab >>Suffering and Togetherness On-scene in Prehospital emergency care (STOP): A middle range theory
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Prehospital emergency care provides care for patients of all ages and life situations and with a variety of suffering, diseases and injuries. Different caring aspects are required in order to respond to the patients’ needs, in parallel with medical assessment and treatment. In order to manage care in these unpredictable and complex contexts, the contextual caring science perspective needs to be developed. 

Aim: To develop a middle-range theory aimed at prehospital emergency care within a caring science framework. 

Method: A deductive and inductive design was used to generate understanding of the central concepts; the suffering human being, the caring relationship and the caring environment within prehospital emergency care. 

Result: The STOP theory comprises the concepts; acute suffering (S), act of togetherness (T), on-scene caring space (O) within in the contextual framework of prehospital emergency care (P). Acute suffering affects us without a clear warning, becoming acute. It means recognizing and accepting that one’s own resources are insufficient and completely exhausted. The ambulance clinician and the patient are in an act of togetherness from different positions and understandings, being dependent on each other to create conditions for continued care. This represents for patients an alteration from being in an involuntary and lonely struggle, to be cared for in a shared struggle to alleviate suffering. The on-scene caring space in which the clinician and the patient are situated are both a prerequisite for care and caring in itself. The space is not static but constantly changing and thus dynamic and elusive. 

Conclusion and implications: The STOP theory is important for clinical care, education and research in the prehospital emergency care setting as the theory is developed with an understanding of suffering as a wider phenomenon than the narrower biomedical perspective.

National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-89492 (URN)
Conference
NCCS/EACS Conference, Vaasa, Finland
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-10-07
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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