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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
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Israelsson, J., Persson, C., Bremer, A., Strömberg, A. & Årestedt, K. (2020). Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor–partner interdependence model. European Journal of Cardiovascular Nursing, 19(4), 351-358
Open this publication in new window or tab >>Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor–partner interdependence model
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2020 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 19, no 4, p. 351-358Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each other’s health-related quality of life.

Aims: The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partner’s health-related quality of life.

Methods: This dyadic cross-sectional study used the actor–partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale).

Results: In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses.

Conclusions: Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Heart arrest, Survivor, Partner, Health, Quality of life, Dyads
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-90228 (URN)10.1177/1474515119890466 (DOI)000498130000001 ()31752502 (PubMedID)
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2020-05-07Bibliographically approved
Bremer, A. & Holmberg, M. (2020). Ethical conflicts in patient relationships: experiences of ambulance nursing students. Nursing Ethics, 1-14
Open this publication in new window or tab >>Ethical conflicts in patient relationships: experiences of ambulance nursing students
2020 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, p. 1-14Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts.

Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies.

Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses.

Participants: The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university.

Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study.

Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care.

Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation.

Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Ambulance service, Clinical studies, Ethical conflicts, Nursing students, Patient relationship, Thematic analysis
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-93311 (URN)10.1177/0969733020911077 (DOI)000527762800001 ()32253975 (PubMedID)
Funder
The Kamprad Family Foundation, 20180157
Available from: 2020-04-07 Created: 2020-04-07 Last updated: 2020-05-18
Djärv, T., Bremer, A., Herlitz, J., Israelsson, J., Cronberg, T., Lilja, G., . . . Årestedt, K. (2020). Health-related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: a Swedish population-based registry study. Resuscitation, 151(June), 77-84
Open this publication in new window or tab >>Health-related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: a Swedish population-based registry study
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2020 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 151, no June, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Background

Health-related quality of life (HRQoL) has been reported for out-hospital (OHCA) and in-hospital cardiac arrest (IHCA) separately, but potential differences between the two groups are unknown. The aim of this study is therefore to describe and compare HRQoL in patients surviving OHCA and IHCA.

Methods

Patients ≥18 years with Cerebral Performance Category 1–3 included in the Swedish Registry for Cardiopulmonary Resuscitation between 2014 and 2017 were included. A telephone interview was performed based on a questionnaire sent 3–6 months post cardiac arrest, including EQ-5D-5L and the Hospital Anxiety and Depression Scale. Mann–Whitney U test and multiple linear- and ordinal logistic regression analyses were used to describe and compare HRQoL in OHCA and IHCA survivors. Adjustments were made for sex, age and initial rhythm.

Results

In all, 1369 IHCA and 772 OHCA survivors were included. Most OHCA and IHCA survivors reported no symptoms of with anxiety (88% and 84%) or depression (87% and 85%). IHCA survivors reported significantly more problems in the health domains mobility, self-care, usual activities and pain/discomfort (p < 0.001 for all) and scored lower general health measured by EQ-VAS (median 70 vs. 80 respectively, p < 0.001) compared with the OHCA survivors.

Conclusion

Survivors of IHCA reported significantly worse HRQoL compared to survivors of OHCA. Consequently, research data gathered from one of these populations may not be generalizable to the other.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Health, Heart arrest, Psychological distress, Quality of life
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-94117 (URN)10.1016/j.resuscitation.2020.04.002 (DOI)
Available from: 2020-05-01 Created: 2020-05-01 Last updated: 2020-05-20Bibliographically approved
Wallin, K., Hörberg, U., Werkander Harstäde, C., Elmqvist, C. & Bremer, A. (2020). Preceptors’ experiences of student supervision in the emergency medical services: a qualitative interview study. Nurse Education Today, 84, 1-8, Article ID 104223.
Open this publication in new window or tab >>Preceptors’ experiences of student supervision in the emergency medical services: a qualitative interview study
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2020 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 84, p. 1-8, article id 104223Article in journal (Refereed) Published
Abstract [en]

Background

Clinical placements play a central part in the education of future emergency medical services (EMS) staff and their development of clinical skills and competence. A key aspect of students' integration of theory and praxis and development into an independent clinician is a supportive mentorship with the preceptor. However, students report barriers for learning within the EMS, while the preceptors' experiences of their role have received scant attention in research.

Objectives

To describe preceptors' experiences of student supervision in the EMS during clinical placements.

Design

A descriptive qualitative design was used.

Participants and setting

Twenty specialist nurses were recruited among EMS staff from all parts of Sweden.

Methods

Data were collected using individual interviews and analyzed with latent qualitative content analysis.

Findings

EMS preceptors develop a competence in combining caring and learning adapted to individual student needs when facing students with varying needs in an ever-changing healthcare setting. A trustful relationship between student and preceptor is fundamental when coping with a dual responsibility for student and patient needs. However, several aspects in the EMS setting hinders the preceptors' ability to support the development of the students' independence. Surrounding support structures are important if the preceptors are to feel safe and secure in their role as assessor, teacher and ambulance nurse.

Conclusions

Preceptors need to develop a didactic flexibility through preceptor courses adapted to the complex premises found in the EMS. Ambulance services and universities should recognize the importance of preceptors´ colleagues, student continuity, university support and cooperation for improving quality and clarity in supervision during clinical placements.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Ambulance nurse, Clinical placement, Emergency medical services, Learning environment, Preceptor, Specialist nurse, Supervision
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-89785 (URN)10.1016/j.nedt.2019.104223 (DOI)000501643800031 ()31726285 (PubMedID)
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2020-05-20Bibliographically 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 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
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
Bertilsson, E., Semark, B., Schildmeijer, K., Bremer, A. & Carlsson, J. (2019). Do-not-attempt-to resuscitate-orders in a Swedish Community Hospital: does the wording of these orders point towards discrimination?. Paper presented at The Congress of the European Resuscitation Council, Ljubljana, Slovenia, September 19-21, 2019. Resuscitation, 142(s1), e5-e5
Open this publication in new window or tab >>Do-not-attempt-to resuscitate-orders in a Swedish Community Hospital: does the wording of these orders point towards discrimination?
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 142, no s1, p. e5-e5Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Ethics, Patient involvement, Documentation, Do not attempt to resuscitate orders
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-89325 (URN)10.1016/j.resuscitation.2019.06.022 (DOI)
Conference
The Congress of the European Resuscitation Council, Ljubljana, Slovenia, September 19-21, 2019
Available from: 2019-09-26 Created: 2019-09-26 Last updated: 2020-05-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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