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Holmberg, Mats, Med.Dr.ORCID iD iconorcid.org/0000-0003-1878-0992
Publications (10 of 24) Show all publications
Bremer, A. & Holmberg, M. (2019). Ambulance nurse students’ experiences of ethical problems in patient-relationships. In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019: . Paper presented at 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
Open this publication in new window or tab >>Ambulance nurse students’ experiences of ethical problems in patient-relationships
2019 (English)In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Conference 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
3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-11-19Bibliographically approved
Bremer, A. & Holmberg, M. (2019). Ambulance nurse students’ experiences of ethical problems in patient-relationships. In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019: . Paper presented at 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
Open this publication in new window or tab >>Ambulance nurse students’ experiences of ethical problems in patient-relationships
2019 (English)In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Conference 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 selfexperienced 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.

Keywords
Ethics; ambulance nurse students; experiences; patient-relationships
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-89469 (URN)
Conference
3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-11-19Bibliographically approved
Holmberg, M. & Bremer, A. (2019). Ambulance nurse students’ experiences of handling ethical problems in patient-relationship. In: Presented at the 120th International Council of Nurses (ICN) congress, Singapore, June 27-July 1, 2019: . Paper presented at 120th International Council of Nurses (ICN) congress, Singapore, June 27-July 1, 2019.
Open this publication in new window or tab >>Ambulance nurse students’ experiences of handling ethical problems in patient-relationship
2019 (English)In: Presented at the 120th International Council of Nurses (ICN) congress, Singapore, June 27-July 1, 2019, 2019Conference 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
120th International Council of Nurses (ICN) congress, Singapore, June 27-July 1, 2019
Available from: 2019-07-02 Created: 2019-07-02 Last updated: 2019-11-19Bibliographically approved
Holmberg, M. (2019). Patientens perspektiv på ambulanssjukvård - vad behöver vi veta?. In: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019: . Paper presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019.
Open this publication in new window or tab >>Patientens perspektiv på ambulanssjukvård - vad behöver vi veta?
2019 (Swedish)In: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019, 2019Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Ambulance clinicians encounter different kinds of illness/injury in all different ages and life-situations, requiring their ability to provide a multidimensional care. Being in need of ambulance care is to be vulnerable and exposed in a dramatic life-event, and refers to an existential suffering. The care of this suffering is often described as being based on common sense diminishing the advanced, complex and professional competence this requires. This is not exclusively rooted in a biomedical perspective on the patient’s illness, but in an understanding of an existential wellbeing. Those two perspectives have to be equal in a contemporary ambulance care. The starting point for this has to be the patient’s subjective experience of his/her illness/injury. To develop this the French philosopher Paul Ricoeur’s theory about explanationand understandingis used. Ricoeur suggests a dialectic differentiation between those concepts, giving them an intimate relationship. Explanationcorresponds to the structural study of an object as a reality in itself, such as a biomedical explanation of the patient’s illness. Understandingon the other hand is to interpret an object as a part of a greater reality and generated by a subjective interpretation, such as understanding the illness from the perspective of the patient’s unique experience. Those concepts have to be intertwined and given equal priority in the ambulance care. Thus, the ambulance clinicians have to both understand and explain the patient and his/her situation, in order to properly assess and provide care based on the patient’s perspective. 

National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-83183 (URN)
Conference
Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-09-09Bibliographically approved
Holmberg, M., Wallinvirta, E., Rantala, A. & Bremer, A. (2019). Suffering and Togetherness On-scene in Prehospital emergency care (STOP): a middle range theory. In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019: . Paper presented at 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
Open this publication in new window or tab >>Suffering and Togetherness On-scene in Prehospital emergency care (STOP): a middle range theory
2019 (English)In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Conference 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
3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-11-19Bibliographically approved
Barrientos, C. & Holmberg, M. (2019). The care of patients assessed as not in need of emergency ambulance care: the perspective of registered nurses. In: : . Paper presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019.
Open this publication in new window or tab >>The care of patients assessed as not in need of emergency ambulance care: the perspective of registered nurses
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Non-emergency patients are described as vulnerable and in need of being taken seriously in the ambulance care. Ambulance care has a natural and obvious focus onemergency medical care. Research has found patients as being dependent of the RegisteredNurse (RN) in the ambulance care. This is experienced as putting the life into the hands of the RN. RNs in the ambulance care encounter those patients on daily basis, and there is a need ofdeepened knowledge based on their experiences.

Aim: The aim was to describe the care of patients assessed as not in need of emergencyambulance care, from RNs' lived experiences.

Methods: The study had a qualitative design. A reflective lifeworld research method was usedand five RNs in the ambulance service were individually interviewed.

Results:The general structure of the phenomenon is described in the essence together with thedescription of the meaning constituents.The essence of the phenomenon is a desire to providegood care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged; 'Being in a struggle between different expectations', 'Being in aquestioned professional role', and 'Being in lack of support and formal directives'.

Conclusion: RNs' care for patients assessed as not in need of emergency ambulance care, is alonely struggle between different expectations and related to the encounter between thepatient's and the RN's lifeworld. This study calls for developing care-strategies and interventionsin order strengthen and support RNs in this care.

National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-83184 (URN)
Conference
Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-09-09Bibliographically approved
Holmberg, M. (2019). The EXPAND-model: a hermeneutical application of a lifeworld-led prehospital emergency care. In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019: . Paper presented at 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019.
Open this publication in new window or tab >>The EXPAND-model: a hermeneutical application of a lifeworld-led prehospital emergency care
2019 (English)In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Prehospital emergency care means to respond to patients’ life-threatening and critical medical conditions out of hospitals. Patients experience this as an existential suffering together with a physical suffering. Thus a need of combining the medical care and treatment with a caring science perspective in order to provide a lifeworld-led care is stated. 

Aim: The aim was to develop a model for application of a lifeworld-led prehospital emergency care. 

Method: The model was developed using Paul Ricoeur’s hermeneutical philosophy, bringing together the concepts explanation (EXP) and understanding (AND)

Results: The EXPAND-model comprises the three phases; 1) primary understanding, 2) structural explanation and 3) secondary understanding that together integrate medical care with a lifeworld perspective on the patient’s illness/injury. The primary understanding refers to the intuition and first impression of the patient as a person and his/her multifaceted needs, adapting to the patient and his/her surroundings. The structural explanation belongs to the emergency medical assessment and care using different structural systems. This aims to quickly identify and provide care for life-threating conditions. In the secondary understanding the primary understanding and the structural assessment are brought together into a whole, creating a comprehensive understanding of the patient’s lifeworld as intertwined with his/her illness/injury. 

Conclusion and implications: In the EXPAND-model the three phases cooperate in order to expand the assessment and care of the patient, based on a lifeworld perspective. The implication of this is two folded. Firstly, this is of importance in order to develop a lifeworld-led prehospital emergency care, which goes beyond fixed medical diagnosis. Secondly, the model may structure the training of professionals to unfold the uniqueness of a person’s experience of illness/injury in relation to a complex world and the existential aspects of being human.

National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-89467 (URN)
Conference
3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-11-19Bibliographically approved
Holmberg, M., Andersson, H., Winge, K., Lundberg, C., Karlsson, T., Herlitz, J. & Wireklint Sundström, B. (2018). Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome. BMC Cardiovascular Disorders, 18, 1-10, Article ID 216.
Open this publication in new window or tab >>Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome
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2018 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, p. 1-10, article id 216Article in journal (Refereed) Published
Abstract [en]

Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. 

Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain 4 on the visual analogue scale. 

Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. 

Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Acute coronary syndrome, Ambulance care, Ambulance nurse, Assessment, Chest pain, Patients ́ experiences
National Category
Cardiac and Cardiovascular Systems
Research subject
Care Sciences
Identifiers
urn:nbn:se:lnu:diva-79554 (URN)10.1186/s12872-018-0957-3 (DOI)000451531300001 ()30486789 (PubMedID)2-s2.0-85057532229 (Scopus ID)
Available from: 2019-01-16 Created: 2019-01-16 Last updated: 2019-08-28Bibliographically approved
Holmberg, M. (2018). Hur vårdar man en trasig själ?. Samverkan 112 (5-6), pp. 8-8
Open this publication in new window or tab >>Hur vårdar man en trasig själ?
2018 (Swedish)In: Samverkan 112, ISSN 1650-7487, no 5-6, p. 8-8Article in journal, News item (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
On Road Communications, 2018
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-79621 (URN)
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-05-13Bibliographically approved
Holmberg, M., Fagerberg, I. & Wahlberg, A. C. (2018). Knowledge desired by EMS-managers of their ambulance clinicians. In: 2nd European Emergency Medical Services (EMS2018), Copenhagen, Denmark: . Paper presented at 2nd European Emergency Medical Services (EMS2018), Copenhagen, Denmark.
Open this publication in new window or tab >>Knowledge desired by EMS-managers of their ambulance clinicians
2018 (English)In: 2nd European Emergency Medical Services (EMS2018), Copenhagen, Denmark, 2018Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-79583 (URN)
Conference
2nd European Emergency Medical Services (EMS2018), Copenhagen, Denmark
Note

Ej belagd 191206

Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-12-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1878-0992

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