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Being first on the scene of an accident - experiences of 'doing' prehospital emergency care
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.ORCID iD: 0000-0002-3164-8681
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 266-273Article in journal (Refereed) Published
Abstract [en]

Prehospital emergency care includes the care and treatment of patients prior to them reaching hospital. This is generally a field for the ambulance services, but in many cases firemen or police can be the ones to provide the first responses. The aim of this study was to describe and understand experiences of being the first responder on the scene of an accident, as described by policemen, firemen and ambulance staff. A lifeworld perspective was used in four different traumatic situations from southern Sweden. The data consisted of 13 unstructured interviews with first responders. The phenomenological analysis showed that experiences of being the first responder on the scene of an accident is expectations of doing a systematic course of action, dressed in the role of a hero, and at the same time being genuine in an interpersonal encounter. This entails a continuous movement between ‘being’ and ‘doing’. It is not a question of either – or, instead everything is to be understood in relation to each other at the same time. Five constituents further described the variations of the phenomenon; a feeling of security in the uncertainty, a distanced closeness to the injured person, one moment in an eternity, cross-border cooperation within distinct borders and a need to make the implicit explicit. This finding highlights the importance of using policemen and firemen in doing life support measures while waiting for the ambulance staff, and would in turn increase the importance of the relationship between the different professionals on the scene of an accident.

Place, publisher, year, edition, pages
Wiley , 2010. Vol. 24, no 2, p. 266-273
Keywords [en]
phenomenology, prehospital emergency care, reversibility, team resources, trauma
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-10220DOI: 10.1111/j.1471-6712.2009.00716.xOAI: oai:DiVA.org:lnu-10220DiVA, id: diva2:389511
Available from: 2011-01-20 Created: 2011-01-19 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Akut omhändertagande: i mötet mellan patienter, närstående och olika professioner på skadeplats och på akutmottagning 
Open this publication in new window or tab >>Akut omhändertagande: i mötet mellan patienter, närstående och olika professioner på skadeplats och på akutmottagning 
2011 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim:  To describe and develop understanding of  the patient’s first encounter with the involved persons at the scene of an accident and at the emergency department; with a special focus on describing the meaning of emergency care of patients in these caring contexts. 

Method: The thesis uses a reflective lifeworld research (RLR) approach founded on phenomenological philosophy. The purpose with this approach is to describe the essential meaning and the variations of a phenomenon. Interviews with a lifeworld perspective were used for data collection and analyzed according to the RLR approach for searching for the essence of the phenomenon.  The four essences in the studies (I-IV) establish a general structure for the phenomenon.

Findings:  Emergency care is characterized by an organisation, whose goal and resources are focused on life-saving, and that encounters a human being with needs of emergency care as well as existential support. The responsibility in emergency care means an intertwining of doing and being.  The one who is in charge takes responsibility for performing or “doing” medical actions, and by “being” close and present in the situation the patient can at the same time feel an existential support. The responsibility for the injured or ill body is handed over to a chain of persons with more and more specialized competence and resources. This hand-over entails a relief for all involved but fails in one link in the chain, namely to explicitly hand back  the responsibility to the patient.  When the patient’s condition allows the distance to be larger the responsibility pales and the existential support decreases. A gap between doing and being arises where the patient is left to regain control and independence. The intertwining of doing and being, which appears as soon as the one in charge is close and present to the patient, facilitates the hand-over to the patient who in a natural way is able to receive the responsibility with possibilities to be able to conclude the encounter.

Conclusions: A new understanding of emergency care appears which entails more than just life support measures.  Emergency care includes different ways of communication in order to hand over the responsibility and complete the care chain back to the patient in a safe way. The results highlight the importance of empowering patients with a confirming, communicative contact throughout the whole caring process in order for them to retain their identity. There are also implications for educating students and personnel in inter-professional communication and work. In order to assist the intertwining between doing and being there are needs for the development of supportive structures for inter-professional reflection, which in turn would improve the interaction between patients and professionals in their encounter. 

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press, 2011. p. 79
Series
Linnaeus University Dissertations ; 57/2011
Keywords
Caring science, emergency care, emergency department, encounter, interpersonal communication, inter-professional work, lifeworld, lived experiences, patient perspective, phenomenology, pre hospital emergency care, scene of an accident
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-13643 (URN)978-91-86491-94-9 (ISBN)
Public defence
2011-08-26, Myrdal, Hus K, Växjö, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2011-08-09 Created: 2011-08-03 Last updated: 2012-01-30Bibliographically approved

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Elmqvist, CarinaBrunt, DavidFridlund, BengtEkebergh, Margaretha

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