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  • 1.
    Andersson, Henrik
    et al.
    University of Borås, Sweden.
    Ullgren, Andreas
    University of Borås, Sweden;Skaraborg Hospital, Sweden.
    Holmberg, Mats
    University of Borås, Sweden;Mälardalen university, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care.2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 43-47Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome.

    METHODS: This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010.

    RESULTS: In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI).

    CONCLUSION: This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.

  • 2.
    Andersson, Sten-Ove
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Armed Forces, Sweden.
    Lundberg, Lars
    Swedish Armed Forces, Sweden;University of Borås, Sweden.
    Jonsson, Anders
    Swedish Armed Forces, Sweden;University of Borås, Sweden.
    Tingström, Pia
    Linköping University, Sweden.
    Dahlgren, Madeleine Abrandt
    Linköping University, Sweden.
    Doctors' and nurses' perceptions of military pre-hospital emergency care - When training becomes reality2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 32, p. 70-77Article, review/survey (Refereed)
    Abstract [en]

    The aim of this study was to identify physicians' and nurses' perceptions of military pre-hospital emergency care before and after an international mission. A qualitative empirical study with a phenomeno-graphic approach was used. The results after pre-deployment training can be categorised as (1) learning about military medicine and (2) taking care of the casualty. The results after an international mission can be categorised as (1) collaborating with others, (2) providing general health care and (3) improving competence in military medicine. These results indicate that the training should be developed in order to optimise pre-deployment training for physicians and nurses. This may result in increased safety for the provider of care, while at the same time minimising suffering and enhancing the possibility of survival of the injured. (C) 2017 Elsevier Ltd. All rights reserved.

  • 3.
    Barrientos, Christian
    et al.
    Norrtälje Hospital, Sweden.
    Holmberg, Mats
    Mälardalen University, Sweden;Sörmland County Council, Sweden .
    The care of patients assessed as not in need of emergency ambulance care: registered nurses' lived experiences2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 38, p. 10-14Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe the care of patients assessed as not in need of emergency ambulance care, from Registered Nurse's lived experiences.

    Background: Non-emergency patients in need of ambulance care are described as vulnerable and patients in ambulance care have earlier been found to be dependent on the Registered Nurse. However, little is known about the care of non-emergency patients in the ambulance setting, from the perspective of Registered Nurses.

    Methods: A reflective lifeworld research design was chosen. Five Registered Nurses with experience of ambulance care were individually interviewed.

    Results: The result reveals the essence of the phenomenon as a desire to provide good care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged in the description; Being in a struggle between different expectations, Being in a questioned professional role, and Being in lack of support and formal directives.

    Conclusion: Registered Nurses' care for patients assessed as not in need of emergency ambulance care, is a complex struggle between different expectations. This may be related to the encounter between the nurse's and the patient's lifeworld.

  • 4.
    Colldén Benneck, Jessica
    et al.
    Uppsala University Hospital, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Registered nurses’ experiences of near misses in ambulance care: a critical incident technique study2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 47, no November, article id 100776Article in journal (Refereed)
    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.

  • 5.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Emergency care in the encounter between patients, next of kin and different professionals at the scene of an accident and at the emergency department2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 273-273Article in journal (Other academic)
  • 6.
    Emmamally, W.
    et al.
    Univ KwaZulu Natal, South Africa.
    Erlingsson, Christen
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Brysiewicz, P.
    Univ KwaZulu Natal, South Africa.
    Partnering with families: Is the ED ready?2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 42, p. 1-1Article in journal (Other academic)
  • 7.
    Forsgärde, Elin-Sofie
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    From Attebring, Mona
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Powerlessness: dissatisfied patients' and relatives' experiences of their emergency department visit2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 25, no March 2016, p. 32-36Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to disclose the meaning of patients and relatives lived experience of dissatisfaction when visiting an emergency department.

    Introduction

    Even though most patients are pleased with the emergency department care, there are areas that dissatisfy them, for example lack of communication and unoccupied wait time. However, there are few studies that describe both patients and relatives experience of dissatisfaction.

    Methods

    This explorative study uses a phenomenological hermeneutic approach where patients and relatives were interviewed.

    Results

    Patients and relatives meaning of dissatisfaction mainly contain powerlessness, struggling for control over the situation, lacking knowledge and information, receiving and providing support.

    Conclusions

    The results showed that the experiences of dissatisfaction were similar among patients and relatives. They suffer in the same way when being treated like objects during their visits. Nursing rounds are one way to decrease dissatisfaction by making patients and relatives participating in the care continually updated with information.

  • 8.
    Frank, Catharina
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Asp, Margareta
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Patient participation in emergency care: A phenomenographic study based on patients lived experience2009In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 17, no 1, p. 15-22Article in journal (Refereed)
  • 9.
    Göransson, K.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Parenti, N.
    Imola Hosp, Imola, Italy.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wirekllint, S. C.
    Comparison of a four and a five-point triage party reliability (Italy vs Sweden)2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 289-289Article in journal (Other academic)
  • 10.
    Holmberg, Mats
    et al.
    Mälardalen university;Uppsala University;Karolinska Institutet.
    Fagerberg, Ingegerd
    Ersta Sköndal Bräcke University College.
    Wahlberg, Anna Carin
    Karolinska Institutet.
    The knowledge desired by emergency medical service managers of their ambulance clinicians - A modified Delphi study2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 34, p. 23-28Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians.

    BACKGROUND: Emergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers' approach to this knowledge.

    DESIGN: A modified Delphi method in three rounds.

    METHODS: In total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round.

    RESULTS: Five categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category 'Knowledge to assess the patient's situation from a holistic perspective' was the highest ranked, followed by 'Medical knowledge to assess and care for different diseases' and 'Knowledge to be able to care for critically ill patients'.

    CONCLUSIONS: Taken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge.

  • 11.
    Lederman, Jakob
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Södersjukhuset;Karolinska Institutet.
    Svensson, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rantala, Andreas
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Lund University;Helsingborg Gen Hospital.
    Absence of evidence-based and person-centred guidelines in the Swedish Emergency Medical Services - a patient safety issue?2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 38, p. 56-58Article in journal (Refereed)
  • 12.
    Lindahl, Jeanette
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Thulesius, Hans
    Region Kronoberg.
    Edvardsson, D.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Caring Optimized Physical Environment (COPE) at an emergency department in Sweden2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 287-288Article in journal (Other academic)
  • 13.
    Magnusson, Carl
    et al.
    Sahlgrenska University Hospital, Sweden.
    Källenius, Christofer
    Kungälv Ambulance Service, Sweden.
    Knutsson, Susanne
    Jönköping University, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Axelsson, Christer
    Sahlgrenska University Hospital, Sweden.
    Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 26, p. 32-37Article in journal (Refereed)
    Abstract [en]

    When a person with vague symptoms calls 112, the dispatchers often have difficulty prioritising the severity of the call. Their only alternative has been to send an ambulance. In Gothenburg, Sweden, a nurse-manned single responder (SR) was initiated to assess this patient group. The study aims to describe patient characteristics and assessment level made by the SR nurse among patients assessed by the dispatcher as low priority and/or vague symptoms. A consecutive journal review was conducted. During six months, 529 patients were assessed; 329 (62%) attended the emergency department (ED) or inpatient care (IC). Of these, 85 patients (26%) were assessed as high priority. Only 108 were assessed as being in need of ambulance transport. ED/IC patients were significantly older. Two hundred (38%) stayed at the scene (SS) (n = 142) or were referred to primary care (PC) (n  = 58). Of the 200 SS/PC patients, 38 (19%) attended the ED within 72 hrs with residual symptoms, 20 of whom were admitted to a ward. Nine patients (4% of 200 SS/PC patients) required inpatient treatment and 11 patients stayed overnight for observation. These results suggest a relatively high level of patient safety and the usefulness of an SR among patients assessed by the dispatcher as low priority.

  • 14.
    Nilsson, Christina
    et al.
    Örebro University, Sweden.
    Bremer, Anders
    University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Blomberg, Karin
    Örebro University, Sweden.
    Svantesson, Mia
    Örebro University, Sweden;University of Warwick, UK.
    Responsibility and compassion in prehospital support to survivors of suicide victim: professionals’ experiences2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 35, no November, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Highlights

    • Feelings of inadequacy as personal faced the survivors’ emotional storm and despair.
    • Personal made attempts to shield themselves and also the survivors.
    • Personal decision to focus on the survivors to give time and to be accessible.
    • They were uncertainty about responsibility and felling torn in the professional role.
    • The professionals need organisational guidelines and ethical support.
  • 15.
    Rahmqvist Linnarsson, Josefin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Erlingsson, Christen
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Challenges of caring for victims of violence and their family members in the emergency department2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 42, p. 2-6Article in journal (Refereed)
    Abstract [en]

    Introduction

    Interpersonal violence causes illness and suffering for victims and their family members. Emergency nurses are often given responsibility for forensic patients and their family members, but there is limited knowledge of their experiences regarding this task. This study aimed to describe nurses' experiences when caring for victims of violence and their family members in the emergency department.

    Methods

    Individual interviews were conducted with twelve nurses from seven emergency departments. Data were analyzed using qualitative content analysis.

    Results

    The analysis resulted in the theme: a challenge to create a caring encounter. Hindering factors comprising this challenge are described under four categories: struggling to intervene and talk about violence; contradictions when caring for family members; being helped by forensic guidelines but needing more knowledge; and dealing with one’s own strong emotions towards violence.

    Discussion

    Creating a caring encounter is perceived as a prerequisite to providing forensic care. Nurses often felt hindered to act and forensic issues were left unaddressed. Family members are offered little or no support in the aftermath of violence. The hindering factors must be overcome to ensure forensic care for victims of all types of violence.

  • 16.
    Svensson, Anders
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Fridlund, Bengt
    Växjö Central Hospital, Sweden.
    Experiences of and actions towards worries among ambulance nurses in their professional life: a critical incident study2008In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 16, no 1, p. 35-42Article in journal (Refereed)
    Abstract [en]

    Nurses working in the ambulance service are frequently exposed to situations in which they have to take sole responsibility for sick or injured patients, many of which can be emotionally trying. The purpose of this study was therefore to describe critical incidents in which ambulance nurses experience worry in their professional life and the actions they take in order to prevent and cope with it. The sample consisted of 13 male and 12 female nurses working in ambulance services in three small to medium-sized counties in the south of Sweden. The data were collected by means of interviews and analysed according to Critical Incident Technique (CIT). The result showed that nurses worried about specific emergency situations as well as situations related to their working environment. Worry was alleviated by their own actions or with help from others. It was also shown that, with increasing experience, came a responsibility to be able to cope with all kinds of situations. This responsibility was experienced as worrying. However, if the nurse felt confident in their colleague, the worry could ease. It was concluded that the worry experienced by ambulance nurses in specific emergency situations requires flexibility on the part of the ambulance service. Nurses must be given the opportunity to address their worries in the way that is most appropriate for each individual.

  • 17.
    Wallin, Kim
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Thorén, Ann-Britt
    University of Borås, Sweden.
    Prehospital Emergency Nursing students’ experiences of learning during prehospital clinical placements2013In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 3, p. 197-203Article in journal (Refereed)
    Abstract [en]

    Clinical placements play an important role in learning a new profession, but students report about poor placement experiences. Standards have been laid down for improvements within clinical training in Prehospital Emergency Nursing programmes in Sweden, but no studies have been carried out in this field in a Swedish context. The purpose of this study was thus to describe the experiences of Prehospital Emergency Nursing (PEN) students of their clinical placement and the effect on their learning process. Data were collected in 28 individual interviews and analyzed in accordance with Flanagan’s Critical Incident Technique. Three main areas emerged: the professional clinical supervisor, the clinical placement setting and the learning strategy. All these areas played a significant role in the PEN students’ learning progress and development into a new professional role. The choice of clinical supervisor (CS) and clinical placement is important if PEN students’ learning is to be an effective and positive experience. The prehospital environment is unique and can have positive and negative effects on student learning depending on the support and structure given during their clinical placement. A learning strategy based on reflective dialogue, CS continuity and a learning structure based on the prehospital environment is presented.

  • 18.
    Wireklint, Sara
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kronoberg.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Parenti, Nicola
    University of Modena, Italy.
    Göransson, Katarina E.
    Karolinska Institutet.
    A descriptive study of registered nurses’ application of the triage scale RETTS©: a Swedish reliability study2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 38, p. 21-28Article in journal (Refereed)
    Abstract [en]

    Background

    From a patient safety perspective, it is of great importance that decision support systems such as triage scales are evidence based. In the most recent national survey, the majority of Swedish Emergency Departments (EDs) apply the Swedish triage scale known as the Medical Emergency Triage Treatment Scale (METTS), subsequently renamed the Rapid Emergency Triage Treatment Scale (RETTS©). Despite national widespread implementation, there has been limited research on METTS/RETTS©.

    Aim

    To determine the reliability of application by registered nurses of the RETTS© triage scale in two Swedish emergency departments.

    Methods

    In this prospective, cross-sectional study at two EDs, 46 written patient scenarios were triaged by 28 registered nurses (RNs). Data were analysed with descriptive statistics and Fleiss kappa (κ).

    Results

    The RNs allocated 1281 final triage levels. There was concordance in seven (15%) of the scenarios, and dispersion over two or more triage levels in 39 (85%). Dispersion across the stable/unstable patient boundary was found in 21 (46%) scenarios. Fleiss κ was 0.562, i.e. moderate agreement.

    Conclusion

    The inability of the triage scale to distinguish between stable/unstable patients can lead to serious consequences from a patient safety perspective. No general pattern regarding concordance or dispersion was found.

  • 19.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Sweden.
    Dahlberg, Karin
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions2011In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 19, no 3, p. 113-119Article in journal (Refereed)
    Abstract [en]

    This study has a health care science approach and explores pre-hospital emergency care with emphasis on assessment. Health care science is focused on the patient with the general aim to describe care that strengthens and supports health. Assessment in the ambulance services has not been explored earlier from this perspective, despite the emphasis on ‘coming close’ to the acute suffering patient. The aim of the study is to describe and analyse assessment in caring situations. Data was collected by participant observations. The major findings point out the importance of professional carers’ recognition of the patient’s lifeworld as an essential part of assessment. The carers’ openness to the situation and to the patient’s suffering and needs vary from being of minor interest to complete focus of the assessment. It seems that assessments that focus solely on a patient’s medical condition can be an obstacle to a full understanding of the individual, and thereby the illness per se. A caring assessment based on an encounter and a dialogue between patient and carer, characterised by inviting the patient to participate, adds further dimensions to the objective data. Therefore, the inclusion of the patient perspective relieves suffering and enables more safe decisions.

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