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  • 1.
    Agerström, Jens
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Andréll, Cecilia
    Lund University, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Strömberg, Anna
    Linköping University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    All else equal: Examining treatment bias and stereotypes based on patient ethnicity and socioeconomic status using in-hospital cardiac arrest clinical vignettes2024In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 63, p. 86-91Article in journal (Refereed)
    Abstract [en]

    BackgroundResearch on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination – whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed.ObjectiveThe primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals’ (HCP) stereotypical beliefs about these groups.MethodsHCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes).ResultsNo significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients.ConclusionsSwedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

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  • 2.
    Agerström, Jens
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Carlsson, Magnus
    Linnaeus University, School of Business and Economics, Department of Economics and Statistics.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden;University of Borås, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Discriminatory cardiac arrest care?: Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 8, p. 861-869Article in journal (Refereed)
    Abstract [en]

    Aims: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

    Methods and results: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

    Conclusion: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

  • 3.
    Agerström, Jens
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Carlsson, Magnus
    Linnaeus University, School of Business and Economics, Department of Economics and Statistics.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden;University of Borås, Sweden.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?2022In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 21, no 4, p. 341-347Article in journal (Refereed)
    Abstract [en]

    Aims 

    Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.

    Methods and results

    In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team’s reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).

    Conclusion

    Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

  • 4. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    University of Borås, Sweden.
    Strömsöe, Annelie
    Andersson, Henrik
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Prehospital suspicion and identification of adult septic patients: Experiences of a screening tool2016In: 2nd Global Conference on Emergency Nursing and Trauma Care, Melia Sitges, September 22-24, 2016, 2016Conference paper (Refereed)
    Abstract [en]

    Introduction: Sepsis is life threatening and requires urgent healthcare to reduce suffering and death. Therefore it is important that septic patients are identified early to enable treatment. Aim: To investigate to what extent EMS personnel identified patients with sepsis using the “BAS 90-30-90” model, and to describe assessments and medical procedures that were undertaken by the personnel.

    Methods: This was a retrospective study where 185 EMS medical records were reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

    Results: A physician assessed the patients in 74 of the EMS cases, which lead to exclusion of these records in regard to the EMS personnel’s ability to identify sepsis. The personnel documented suspicion of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion of patients ˃65 years of age was 73% (n=135) of which 37% (n=50) were over 80 years old. Thirty-nine percent (39%, n=72) were females. The personnel documented blood pressure in 91% (n=168), respiratory rate in 76% (n=140), saturation in 100% (n=185), temperature in 76% (n=141), and heart rate in 94% (n=174) of the records. Systolic blood pressure <90 mmHg was documented in 14,2% (n=24), respiratory rate ˃30 in 36% (n=50), saturation <90 in 49%  (n=91), temperature >38°C in 37.6% (n=53), and heart rate ˃90 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous lines (70%, n=130), intravenous fluids (10%, n=19) and administration of oxygen (72%, n=133).

    Conclusion: The EMS personnel identified only a few septic patients with the help of the BAS 90-30-90 model when all three criteria would be met for severe sepsis. Either advanced age (>65 years), fever (>38°C) or tachypnea (˃20 breaths/min) appeared to increase the personnel’s suspicion of sepsis. Oxygen, but not intravenous fluids, was given in an adequate way.

  • 5.
    Andersson, Henrik
    et al.
    University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Larsson, Anna
    South Älvsborg's Hospital, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Gellerstedt, Martin
    University West, Sweden.
    Bång, Angela
    University of Borås, Sweden;University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Sweden.
    The early chain of care in bacteraemia patients: early suspicion, treatment and survival in prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 36, no 12, p. 2211-2218Article in journal (Refereed)
    Abstract [en]

    Introduction

    Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome was assessed.

    Methods

    This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

    Results

    In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection” more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p < 0.0001).

    Conclusion

    This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

  • 6.
    Andersson, Henrik
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Svensson, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kronoberg, Sweden.
    Frank, Catharina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rantala, Andreas
    Lund University, Sweden;Helsingborg General Hospital, Sweden.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University, Sweden;Region Sörmland, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Ethics education to support ethical competence learning in healthcare: an integrative systematic review2022In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 23, article id 29Article, review/survey (Refereed)
    Abstract [en]

    Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethi- cal values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.

    Methods: In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 arti- cles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.

    Results: The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previ- ously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.

    Conclusions: The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.

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  • 7.
    Axelsson, Christer
    et al.
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Hagiwara, Magnus
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Nationella regler krävs för ambulanssjukvård2011In: Svenska Dagbladet, ISSN 1101-2412, no 2011-11-15Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    I Sverige är det upp till varje landsting att bestämma hur snabbt en ambulans ska vara på plats. I stället borde det finnas nationella riktlinjer kring hur tillgängligheten ska se ut, skriver flera ambulanssjuksköterskor.

  • 8.
    Axelsson, Christer
    et al.
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Karlsson, Anders
    Älvsborg Hospital, Sweden.
    Sjöberg, Henrik
    Älvsborg Hospital, Sweden.
    Jiménez-Herrera, Maria
    Universitat Rovira I Virgili, Spain.
    Bång, Angela
    University of Borås, Sweden.
    Jonsson, Anders
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Gellerstedt, Martin
    University West, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Sweden.
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 272-277Article in journal (Refereed)
    Abstract [en]

    There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

    All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

    In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.

    The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).

    Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.

  • 9.
    Bennesved, Anna
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kronoberg, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Svensson, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kronoberg, Sweden.
    Rantala, Andreas
    Lund University, Sweden;Region Skåne, Sweden.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University, Sweden;Region Sörmland, Sweden.
    Ambulance clinicians’ understanding of older patients’ self-determination: A vignette study2023In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.

    Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.

    Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.

    Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.

    Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.

    Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.

    Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.

  • 10.
    Berntsson, Tommy
    et al.
    Halmstad University, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Claesson, Andreas
    University of Borås, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Abelsson, Anna
    Karlstad University, Sweden.
    Johansson, Anders
    Karlstad University, Sweden.
    Svensson, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wallin, Kim
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Kågström, Christer
    Luleå University of Technology, Sweden.
    Rantala, Andreas
    Lund University, Sweden.
    Wihlborg, Jonas
    Lund University, Sweden.
    Ek, Bosse
    Mid Sweden University, Sweden.
    Styrwoldt, Eva
    Sophiahemmet University, Sweden.
    Aléx, Jonas
    Umeå University, Sweden.
    Gyllencreutz, Linda
    Umeå University, Sweden.
    Uppstu, Tom
    Umeå University, Sweden.
    Ekbom, Birgitta
    Uppsala University, Sweden.
    Lingsarve, Johan
    Uppsala University, Sweden.
    Adolfsson, Annsofie
    Örebro University, Sweden.
    Inget händer trots kända brister inom ambulanssjukvården2013In: Svenska Dagbladet, ISSN 1101-2412, Vol. 19 majArticle, book review (Other (popular science, discussion, etc.))
  • 11.
    Bertilsson, Emelie
    et al.
    Kalmar County Hospital, Sweden.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal (Refereed)
  • 12.
    Bertilsson, Emilie
    et al.
    Kalmar County Hospital, Sweden.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Do-not-attempt-to resuscitate-orders in a Swedish Community Hospital: does the wording of these orders point towards discrimination?2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 142, no s1, p. e5-e5Article in journal (Refereed)
  • 13.
    Bertilsson, Emilie
    et al.
    Kalmar County Hospital, Sweden.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Usage of do-not-attempt-to-resuscitate orders in a Swedish community hospital: patient involvement, documentation and compliance2020In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 21, no 1, p. 1-6, article id 67Article in journal (Refereed)
    Abstract [en]

    Background: To characterize patients dying in a community hospital with or without attempting cardiopulmonary resuscitation (CPR) and to describe patient involvement in, documentation of, and compliance with decisions on resuscitation (Do-not-attempt-to-resuscitate orders; DNAR).

    Methods: All patients who died in Kalmar County Hospital during January 1, 2016 until December 31, 2016 were included. All information from the patients’ electronic chart was analysed.

    Results: Of 660 patients (mean age 77.7 ± 12.1 years; range 21–101; median 79; 321 (48.6%) female), 30 (4.5%) were pronounced dead in the emergency department after out-of-hospital CPR. Of the remaining 630 patients a DNAR order had been documented in 558 patients (88.6%). Seventy had no DNAR order and 2 an explicit order to do CPR. In 43 of these 70 patients CPR was unsuccessfully attempted while the remaining 27 patients died without attempting CPR. In 2 of 558 (0.36%) patients CPR was attempted despite a DNAR order in place. In 412 patients (73.8%) the DNAR order had not been discussed with neither patient nor family/friends. Moreover, in 75 cases (13.4%) neither patient nor family/friends were even informed about the decision on code status.

    Conclusions: In general, a large percentage of patients in our study had a DNAR order in place (88.6%). However, 27 patients (4.3%) died without CPR attempt or DNAR order. DNAR orders had not been discussed with the patient/surrogate in almost three fourths of the patients. Further work has to be done to elucidate the barriers to discussions of CPR decisions with the patient.

  • 14.
    Bremer, Anders
    University of Borås.
    Ambulanssjukvård mellan liv och död: ett etiskt perspektiv2009In: Vårdvetenskapens dag, Växjö universitet, 2009Conference paper (Other academic)
    Abstract [en]

    Patienters hjärtstopp utanför sjukhus orsakar lidande och död. Det påverkar även närståendes fortsatta livssituation. Bakgrund: För ambulanspersonal kan det vara svårt ta etiskt riktiga beslut vid vård av patient med hjärtstopp. I balansen mellan nytta och risk med återuppliv-ning är det svårt att avgöra vad som är rätt eller fel och när det är meningslöst eller emot patientens vilja. De drabbades erfarenheter, och ett normativt per-spektiv, kan bidra med kunskap om vad etiskt god vård vid hjärtstopp kan vara. Syfte: Att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus re-spektive närvara vid närståendes hjärtstopp, samt belysa de etiska aspekter och problem som framträder. Metod: Kvalitativa intervjuer med fenomenologisk livsvärldsansats. Nio över-levande patienter och sju närstående intervjuades. Resultat: Överlevande patienter beskriver hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och för-lust av sammanhang. Efteråt, via andra människors berättelser och egna minnen, söker överlevande efter sammanhang så att händelsen och livssituationen kan ges mening och förklaring till tankar, känslor och upplevelser. I det fortsatta li-vet finns existentiell otrygghet där identiteten och meningen i livet omvärderas i takt med en växande insikt om hur kroppen påverkats. Där finns tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där det passerade livs-hotet införlivas i ett liv där nära relationer blivit viktigare. Närstående upplever patientens hjärtstopp som overkligt. Tiden tycks stanna upp. Samtidigt är verk-ligheten extremt påtaglig med ett överväldigande, ensamt ansvar med känsla av otillräcklighet. Ambulanspersonalens ankomst väcker närståendes hopp om att patienten ska överleva, samtidigt som allt är kaotiskt, ångestfyllt och omtumlan-de då närstående kastas mellan hopp och misströstan. Livets grundvalar skakas om. Efter händelsen finns frågor och oro. Närståendes ensamhet i sorg eller oro för den överlevandes framtid, riskerar att leda till uppoffringar av egna behov. Slutsats: I det akuta skedet är det svårt att avgöra om patienten kan räddas till ett fortsatt acceptabelt liv varför återupplivningsförsök bör göras vid behand-lingsbara hjärtstopp. Undantagsvis är det rätt att avstå från, eller avbryta, åter-upplivning och vid förekomst av giltigt förhandsdirektiv är det primära att främ-ja en värdig död. Ambulanssjuksköterskor kan antas kunna ta ett utökat etiskt ansvar när det gäller beslutsrätten att avstå/avbryta återupplivning vid hjärtstopp och i eftervården av överlevande patienter kan ambulanspersonal hjälpa till att återskapa förlorade sammanhang. Ett rimligt vårdansvar för närstående är att ge stöd i krissituationen, dels under pågående återupplivning och dels då patienten avlidit. Däremot är hjärtlungräddning utförd som en ritual för närstående skull inte att betrakta som ett gott akut vårdande.

  • 15.
    Bremer, Anders
    University of Borås, Sweden.
    Att vara patient inom ambulanssjukvården2012In: Akut vård ur ett patientperspektiv / [ed] Sofia Almerud Österberg, Lena Nordgren, Studentlitteratur AB, 2012, p. 29-49Chapter in book (Other academic)
  • 16.
    Bremer, Anders
    University of Borås.
    Att överleva hjärtstopp2007In: Inför bildandet av nytt forskningscentrum i VGR, Borås 2007-11-09, 2007Conference paper (Other academic)
  • 17.
    Bremer, Anders
    University of Borås, Sweden.
    Caring for families at sudden cardiac death: A balance between closeness and distance2012In: The 26th Conference of the European Society for Philosophy of Medicine and Health Care, 2012Conference paper (Refereed)
    Abstract [en]

    Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects more than half a million people in the United States and Europe each year. As resuscitation attempts are unsuccessful in most of the cases, ambulance professionals often face the needs of bereaved family members. Decisions to continue or terminate resuscitation attempts at OHCA are influenced by factors other than patient clinical characteristics, such as the personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. Research exploring how ambulance personnel are affected by family dynamics and the emotional context, and how they are able to provide care for bereaved family members is sparse. It is also a lack of research into why ambulance professionals sometimes administer physiologically futile cardiopulmonary resuscitation (CPR) to patients with cardiac arrest to benefit family members. This way of meeting families’ grief reactions implies ethical problems. Based on an empirical study of ambulance professional’s experiences of caring for families when patients suffer cardiac arrest and sudden death, and an ethical analysis exploring arguments for providing physiologically futile CPR, the issue of caring for bereaved family members in ethical good and bad ways is explored. The empirical study results show that ambulance personnel experience a concomitant responsibility, sometimes failing to prioritize between responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care imply a movement from well-structured guidance to a situational response where the personnel are forced to balance between interpretive reasoning and a more direct emotional response at their own discretion. With such affective response in decision-making, the personnel risk erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs is essential, and dependent on the ambulance personnel’s balance between closeness and distance, and on their courage to meet emotional expressions of the families, as well as the personnel’s own vulnerability. A need for ethical competence is invoked by the presence of family members, placing great demands on mobility in the decision-making process, between medical care of the patient and caring for family members. The conclusion is that the strategy of ambulance professionals in the care of bereaved family members should be to avoid additional suffering by focusing on the relevant care needs of the family members and provide support, arrange for a peaceful environment and administer acute grief counseling at the scene, which might call for a developed ethical caring competence. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Ambulance personnel also need training in awareness of the needs of families suffering sudden bereavement, as well as support and help to deal with personal discomfort.

  • 18.
    Bremer, Anders
    University of Borås, Sweden.
    Dagens ambulanssjukvård2016In: Prehospital akutsjukvård, Stockholm: Liber, 2016, 2, p. 48-64Chapter in book (Other academic)
  • 19.
    Bremer, Anders
    University of Borås, Sweden.
    Den mångfacetterade delaktigheten2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 65-71Chapter in book (Other academic)
  • 20.
    Bremer, Anders
    University of Borås, Sweden.
    "Ej HLR”: Rätten att få dö2013In: HLR 2013. Malmö 2013-10-22, 2013Conference paper (Refereed)
  • 21.
    Bremer, Anders
    University of Borås, Sweden.
    En andra chans2012In: Forskning för hälsa, ISSN 1653-9753, no 3, p. 18-19Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Överlevare av plötsligt hjärtstopp utanförsjukhus är en unik och växande patientgrupp.Men hur blir livet efteråt?Frågeställningen finns med i denforskning Anders Bremer bedriver och som tidigarei år utmynnade i en avhandling. I syfte att beskrivasamtliga inblandades erfarenheter vid plötsligthjärtstopp intervjuade han överlevare, närståendeoch ambulanspersonal, som inte sällan ställs införetiska frågeställningar vid hjärtstopp.

  • 22.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska aspekter vid HLR2012In: Hjärtstoppsymposium 2012, Stockholm, Sverige 24 April, 2012Conference paper (Other academic)
  • 23.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska frågeställningar vid drunkning2014In: HLR 2014 om drunkning: 3-4 juni, Tylösand, Sverige, 2014Conference paper (Refereed)
    Abstract [en]

    WHO uppskattar att 450 000 människor årligen avlider i världen till följd av drunkning, varav majoriteten är barn. Hjärtstopp och plötslig död som orsakas av drunkning är betydligt vanligare i låginkomstländer. Detta innebär att många liv går förlorade till följd av drunkningsolyckor, samtidigt som fattiga länder drabbas särskilt hårt. Mot bakgrund av detta framträder den etiska frågan: Hur kan fler liv räddas? Även rättviseprincipen blir viktig och bör rimligen föranleda åtgärder för att förhindra drunkning och rädda drunkningsoffer i särskilt utsatta delar av världen. Vilket ansvar har vi i Sverige för detta arbete? Etiker använder ofta drunkning som exempel för att tydliggöra den moraliska plikten att rädda liv. Vid ett drunkningstillbud kräver denna plikt specifika förmågor, mod och självuppoffring. Ett fullgörande av plikten kan å ena sidan riskera egna förluster och ytterst det egna livet, och å andra sidan ge belöning i form av självaktning och framför allt minskat lidande och död för andra. Plikten att göra allt för patientens bästa grundas i godhetsprincipen som innebär att främja nyttan för den drabbade, samtidigt som riskerna med fortsatta återupplivningsförsök övervägs i ett senare skede. Här framträder den etiska frågan: Hur kan liv räddas, samtidigt som överlevnad till ett ovärdigt liv minimeras?

  • 24.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska ställningstaganden vid hjärtstopp2013In: State of the Heart. Vårdprofessioner inom Cardiologi (VIC). Malmö 2013-11-13, 2013Conference paper (Other academic)
  • 25.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska värderingar inom spansk och svensk ambulanssjukvård2015In: Forskningssymposium om prehospital akutsjukvård: Torsdag 5 mars 2015, Högskolan i Borås, 2015Conference paper (Other academic)
  • 26.
    Bremer, Anders
    University of Borås, Sweden.
    Ett överväldigande ansvar: att vara närstående vid hjärtstopp2010In: PreHospenkonferensen. Träffsäker bedömning och god vård, 2010Conference paper (Other academic)
    Abstract [en]

    Denna fenomenologiska livsvärldsstudie beskriver sju närståendes erfarenheter av att en nära person drabbats av hjärtstopp i hemmet eller ute i samhället. Resultatet visade hur närstående plötsligt upplevde kontrollförlust och en känsla av overklighet. De upplevde sig ensamt ansvariga, otillräckliga och med svårigheter att möta ett överväldigande ansvar. I den ensamma och utsatta situationen blev allt kaotiskt, ångestfyllt och omtumlande. När ambulanspersonal anlände väcktes närståendes hopp. Beroende på vilken föreställning eller kunskap närstående hade om patientens tillstånd kastades de mellan förhoppningar om överlevnad och tvivel över det meningsfulla med livräddande åtgärder. Efter händelsen kände sig närstående ofta lämnade ensamma med oro och frågor inför framtiden. Oron motverkade välbefinnande och hotade viktiga värden i ett gott liv eftersom de riskerade att bli ensamma i sorg efter den döde, eller i oro för den överlevandes framtid. Närstående försummade egna och viktiga behov. Resultatet visar att ambulanspersonal har en prima facie plikt att stödja närstående i samband med en patients hjärtstopp och död. Detta förutsätter uppmärksamhet, känslighet och öppenhet inför närståendes outsagda eller uttryckliga frågor och behov. Vid dödsfall i hemmet bör ambulanspersonal finnas till hands så länge som det krävs för att hjälpa närstående i kris.

  • 27.
    Bremer, Anders
    University of Borås, Sweden.
    Hjärtstopp utanför sjukhus2012In: Medicinska Riksstämman, 28-30 nov 2012: Tema Framtidens hälsa, 2012Conference paper (Other academic)
  • 28.
    Bremer, Anders
    University of Borås.
    Mötet med närstående2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Liber, 2009, 1, p. 150-161Chapter in book (Other academic)
  • 29.
    Bremer, Anders
    University of Borås, Sweden.
    Mötet med närstående2016In: Prehospital akutsjukvård, Stockholm: Liber, 2016, 2, p. 211-227Chapter in book (Other academic)
  • 30.
    Bremer, Anders
    University of Borås, Sweden.
    Nytta mot risker: etiska riktlinjer för HLR2014In: Akutsjukvård – den äldre patienten : Omvårdnad - flöden - kompetens: Stockholm 3-4 september 2014, 2014Conference paper (Other academic)
    Abstract [en]

    När en person drabbas av plötsligt hjärtstopp gör sjukvårdspersonal i regel allt för att få igång hjärtat igen. Ibland kan det dock vara mer etiskt försvarbart att avstå från HLR. Här får vi inblick i Svenska Läkaresällskapet, Svensk sjuk-sköterskeförening och Svenska HLR-rådets etiska riktlinjer, som stöd till sjukvårdspersonalens ställningstagande om HLR ska påbörjas eller inte och skälen som kan motivera ett ställningstagande att avstå.

  • 31.
    Bremer, Anders
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    När livet skakas om: patienters och närståendes erfarenheter av hjärtstopp utanför sjukhus2008Licentiate thesis, comprehensive summary (Other academic)
    Abstract [sv]

    I Europa vårdar ambulanspersonal årligen cirka 300 000 människor med hjärtstopp. Ungefär en av tio överlever. Tidigare forskning har inte i någon större utsträckning berört hur överlevande patienter och närstående mår efteråt eller vilka etiska aspekter och problem som möter ambulanspersonal i dessa situationer. Med hjälp av en reflekterande livsvärldsansats är syftet med denna licentiatavhandling att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus respektive närvara vid en nära persons hjärtstopp. Med utgångspunkt i det empiriska resultatet är syftet att belysa och diskutera etiska aspekter och problem av betydelse för ambulanspersonals vårdande ur ett normativt perspektiv.

    Avhandlingens empiriska resultat visar hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och kontrollförlust genom den minneslucka som tillfogats. Att överleva innebär därför ett sökande efter sammanhang så att situationen kan ges mening och förklaring till tankar, känslor och upplevelser. Känslan av sammanhang nås via andra människors berättelser tillsammans med egna minnen. I det fortsatta livet finns existentiell rädsla och otrygghet där den egna identiteten och meningen i livet omvärderas i takt med en växande insikt om hur den egna kroppen påverkats av hjärtstoppet. Ibland upplevs kroppen som begränsad vilket skapar otrygghet och rädsla. I det fortsatta livet kan det finnas skuldkänslor för det inträffade likväl som att hjärtstoppet ses som en opåverkbar händelse. Men det finns även tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där vardagliga sysslor ger tillvaron en viss stadga. Det passerade livshotet införlivas i ett liv där mänskliga relationer blivit än viktigare värden i ett gott liv.

    Närvaro vid en nära persons hjärtstopp omkullkastar känslan av kontroll. Allt upplevs overkligt, tiden tycks stanna upp och samtidigt är verkligheten extremt påtaglig. Förvåning övergår snabbt till ett kaos av tankar och känslor där panik, chock och fruktan griper tag. Verkligheten innebär ett överväldigande och ensamt ansvar där närstående känner sig otillräckliga. Väntan på professionell hjälp känns lång och det är en befriande känsla då ambulanspersonal anländer och övertar ansvaret. Samtidigt väcks hopp om att patienten ska överleva. För närstående är allt kaotiskt, ångestfyllt och omtumlande då de kastas mellan hopp och misströstan för att slutligen få ett overkligt och ogripbart besked om den nära personens överlevnad eller död. Livets grundvalar skakas om och uppmärksammar livets skörhet och att inget kan tas för givet. Efter händelsen finns obesvarade frågor och oro som riskerar att leda till ensamhet i sorg eller i en oro för den överlevandes framtid. Oavsett vilket, riskerar ensamheten att leda till uppoffring av egna och viktiga behov.

    I ett gott beslut balanseras etiska normer att rädda liv, rätten till värdig/god död, autonomiprincipen samt att göra gott och inte skada. Den övergripande normen vid hjärtstopp är att rädda liv. Att i det akuta skedet avgöra om patienten räddas till ett acceptabelt liv är svårt. Det empiriska resultatet ger dock stöd för att återupplivning bör göras vid behandlingsbara hjärtstopp samtidigt som resultatet visar hur svårt det är att dra en gräns för vad ett acceptabelt liv är. Undantagsvis är det goda beslutet att avstå från eller avbryta återupplivning, exempelvis vid förekomst av ett giltigt förhandsdirektiv. En värdig/god död är då det primära. Ett utökat etiskt ansvar för ambulanssjuksköterskor kan vara att de ges beslutsrätt för avbrytande av återupplivning. Ett annat ansvar handlar om möjligheten att främja ett gott liv för överlevande genom att efteråt bidra med kunskap som kan skapa förlorade sammanhang. Ansvaret för närstående kan innebära att meningslös återupplivning inte görs ”för deras skull” utan att deras behov möts på bättre sätt.

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  • 32.
    Bremer, Anders
    University of Borås, Sweden.
    Specialistsjuksköterska med inriktning mot ambulanssjukvård2014In: Att bli specialistsjuksköterska eller barnmorska: utbildningar för framtiden, Studentlitteratur AB, 2014, p. 19-46Chapter in book (Other academic)
    Abstract [en]

    Behovet av specialistutbildade sjuksköterskor ökar. I den här boken presenteras tolv utbildningar som leder till en examen som specialistsjuksköterska eller barnmorska. Vidare ger boken en inblick i vad de olika yrkena innebär. Boken presenterar arbetsplatser och karriärvägar och ger också konkreta exempel på vad specialistsjuksköterskor eller barnmorskor kan komma att möta en vanlig dag på jobbet. Därutöver presenteras Högskoleverkets examensmål för respektive inriktning samt länkar till fastställda kompetensbeskrivningar. Kapitlet &quot;Specialistsjuksköterska med inriktning mot ambulanssjukvård&quot; beskriver professionen, utbildningen och utmaningar inför framtiden.

  • 33.
    Bremer, Anders
    University of Borås, Sweden.
    Vid existensens gräns: Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems.

    Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis.

    Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families.

    Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

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  • 34.
    Bremer, Anders
    University of Borås, Sweden.
    Vilka möjligheter finns att använda register för uppföljning?2013In: Skandinaviskt utbildningsmöte – Vård efter hjärtstopp: Prognosbedömning, uppföljning och rehabilitering. 30-31 maj, 2013. Skånes Unversitetssjukhus, Lund, Sverige, 2013Conference paper (Other academic)
    Abstract [en]

    Svenska Hjärt-lungräddningsregistret innehåller sedan länge beskrivande data med kontinuerliga variabler som ålder och tidsfördröjningar till påbörjande av behandling. Det innehåller också kategoriska variabler om defibrillerbar rytm, hjärtstoppets inträffande i hemmet, kardiell etiologi etc. Cerebral funktion registreras med CPC-score. Sedan 1 maj 2013 kompletterades registret med patientskattningar och mätningar av kvalitativa livskvalitetsvariabler. Den hälsorelaterade livskvaliteten kommer framledes att bedömas med det generiska instrumentet Euro Quality Life Scale (EQ-5D-5L) som mäter rörlighet, egenvård, vardagsaktiviteter, smärta-obehag och ängslan-depression. Dessutom används EQ-VAS för skattning av upplevd hälsa. Ängslan, oro och depression kommer mer detaljerat att bedömas med The Hospital Anxiety and Depression Scale (HADS). Utöver detta inhämtas data om kognitiv funktion och sysselsättning, totalt sju frågor med fasta svarsalternativ. Denna uppföljning av livskvaliteten hos överlevande efter hjärtstopp är en intensifiering av det rutinmässiga omhändertagandet av patientgruppen. Men framför allt innebär detta initiala och systematiska inhämtande av kvalitativa data från patienterna själva en möjlighet att tidigt upptäcka hur de mår och de behov av uppföljande vård och stöd som kan finnas. Genom registrets datainsamling ges även anhöriga en möjlighet att diskutera problem relaterade till den överlevandes situation. Med den utökade datainsamlingen kommer ny och viktig kunskap om patientgruppens cerebrala funktion och hälsorelaterade livskvalitet att genereras över tid, till gagn för patienter och anhöriga.

  • 35.
    Bremer, Anders
    University of Borås, Sweden.
    Vilken livskvalitet har patienter efter hjärtstopp?2013In: XV Svenska Kardiovaskulära Vårmötet: Svenska Hjärtförbundet. Göteborg 2013-04-17, 2013Conference paper (Other academic)
  • 36.
    Bremer, Anders
    Svenska läkaresällskapet.
    Vårdpersonal i ’dokusåpor’: är det etiskt försvarbart?2014In: Medicinska Riksstämman, Stockholm, 2014, 2014Conference paper (Other academic)
    Abstract [en]

    Att som vårdpersonal medverka i s.k. dokusåpor är förknippat med en rad etiska problem. Kan dessa problem lösas på ett etiskt försvarbart sätt, dvs. så att patienters och närståendes rätt till värdighet, integritet och autonomi säkerställs? Slutsatsen är att detta inte är möjligt. Risken att tillfoga skada är större än den potentiella nyttan.

  • 37.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Andersson Hagiwara, Magnus
    University of Borås, Sweden.
    Tavares, Walter
    University of Toronto, Canada;Regional Municipality of York, Canada.
    Paakkonen, Heikki
    Arcada University of Applied Sciences, Finland.
    Nyström, Patrik
    Arcada University of Applied Sciences, Finland.
    Andersson, Henrik
    University of Borås, Sweden.
    Translation and further validation of a global rating scale for the assessment of clinical competence in prehospital emergency care2020In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 47, no August, p. 1-8, article id 102841Article in journal (Refereed)
    Abstract [en]

    Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions. The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contribute validity evidence and instrument usefulness in training results and clinical competence assessments of students undergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The study included translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturally adapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated using eight experts. IRR tests were performed with five registered nurses working as university lecturers, and with six clinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment. Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI for items and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agree- ment in the group of clinicians. This study provides validity evidence for a Swedish version of the scale, sup- porting its use in measuring clinical competence among students undergoing training to become ambulance nurses and paramedics.

  • 38.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Axelsson, Åsa B.
    University of Gothenburg, Sweden.
    Vårdvetenskaplig analys: erfarenheter vid prehospitala hjärtstopp2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 345-349Chapter in book (Other academic)
  • 39.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Creutz, Tobias
    Region of Västra Götaland, Sweden.
    Pettersson Georgii, Johan
    Region of Västra Götaland, Sweden.
    Family members’ experiences of care provided by ambulance staff in out-of-hospital cardiac arrest situations2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 1 suppl, article id 268Article in journal (Refereed)
    Abstract [en]

    Purpose: Approximately 10 000 people in Sweden suffer from sudden cardiac arrest outside the hospital each year. Cardiopulmonary resuscitation (CPR) is started in about half of the cases. Treatment of patients with cardiac arrest in a pre-hospital context is complex and focus is placed first and foremost on the patient because of the acute and life-threatening condition. For relatives, it is a traumatic and upsetting experience to be present when a family member suffers from cardiac arrest. The purpose of this study was therefore to describe family members experiences of an out-of-hospital cardiac arrest (OHCA) situation and how the ambulance staff cared for them.

    Methods: This pilot study had a qualitative design, based on six individual interviews with family members who were present when the patient suffered OHCA. The interviews were conducted with an initial open-ended question and follow-up questions based on the responses. The data were analysed by qualitative content analysis with an inductive approach. The analysis generated subcategories, which were clustered into seven main categories.

    Results: The result describes the informants’ situation management, responsibility handover and their hope and hopelessness in the situation. The result also describes the staff’s care of family members by the categories closeness and distance, confirmation and exclusion, caring relationship and answered and unanswered questions. Family members described the OHCA situation as traumatic with feelings of panic, uncertainty, unreality, but also calm and rationality. Contentedness and gratitude for the ambulance staffs caring approach emerged. However, family members sometimes were not allowed to decide if they wanted to witness the resuscitation attempts or not, and a lack of information led to unnecessary frustration.

    Conclusions: Family members often have a need to talk to someone about their experiences of the OHCA situation, express their views on the care that was provided and receive feedback afterwards. Further research on family members’ situation at OHCAs is of great importance for the development of ambulance staff’s skills in caring approaches.

  • 40.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. University of Borås, Sweden.
    Dahlberg, Karin
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Sandman, Lars
    University of Borås, Sweden.
    Balancing Between Closeness and Distance: Emergency medical services personnel’s experiences of caring for families at out-of-hospital cardiac arrests and deaths2012In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 27, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem thataffects between 236,000 and 325,000 people in the United States each year. As resuscitationattempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services(EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced byfactors other than patient clinical characteristics, such as EMS personnel’s knowledge,attitudes, and beliefs regarding family emotional preparedness. However, there is littleresearch exploring how EMS personnel care for bereaved family members, or how theyare affected by family dynamics and the emotional contexts. The aim of this study is toanalyze EMS personnel’s experiences of caring for families when patients suffer cardiacarrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviewswere conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and familycare, and sometimes failed to prioritize these responsibilities as a result of their ownperceptions, feelings and reactions. Moving from patient care to family care implied amovement from well-structured guidance to a situational response, where the personnelwere forced to balance between interpretive reasoning and a more direct emotionalresponse, at their own discretion. With such affective responses in decision-making, thepersonnel risked erroneous conclusions and care relationships with elements of dishonesty,misguided benevolence and false hopes. The ability to recognize and respond to people’sexistential questions and needs was essential. It was dependent on the EMS personnel’sbalance between closeness and distance, and on their courage in facing the emotionalexpressions of the families, as well as the personnel’s own vulnerability. The presence offamily members placed great demands on mobility (moving from patient care to familycare) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family membersto avoid additional suffering. Opportunities to reflect on these situations within a frameworkof care ethics, continuous moral education, and clinical ethics training are needed.Support in dealing with personal discomfort and clear guidelines on family support couldbenefit EMS personnel.Bremer A, Dahlberg K, Sandman

  • 41.
    Bremer, Anders
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Borås.
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sandman, Lars
    University of Borås.
    Experiencing Out-of-Hospital Cardiac Arrest: Significant Others’ Lifeworld Perspective2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 10, p. 1407-1420Article in journal (Refereed)
    Abstract [en]

    When patients suffer out-of-hospital cardiac arrests (OHCA), significant others find themselves with no choice about being there. Afterwards they are often left with unanswered questions about the life-threatening circumstances, or the patient’s death, the emergency treatment and future needs. When it is unclear how the care, and the event itself will affect significant others’ well being, prehospital emergency personnel face ethical decisions. This study describes the experiences of significant others present at OHCA, focusing on ethical aspects and values. Using a lifeworld phenomenological approach, seven significant others were interviewed. The essence of the phenomenon of OHCA can be stated as: Unreality in the reality; Overwhelming responsibility; Inadequacy and limitation; Hope and hopelessness; Ethical considerations; Insecurity about the future; Trembling of life. These study findings show how significant others’ sense of unreality, inadequacy, and overwhelming responsibility at OHCA can threaten values deemed important for a good life.

     

  • 42.
    Bremer, Anders
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Borås, Sweden.
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sandman, Lars
    University of Borås, Sweden.
    To Survive Out-of-Hospital Cardiac Arrest: A Search for Meaning and Coherence2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 3, p. 323-338Article in journal (Refereed)
    Abstract [en]

    The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions, and actions should be based in the patient’s beliefs about health and well-being. In this article, we describe patients’ experiences of surviving OHCA. By using a phenomenological approach, we focus on how OHCA influences patients’ well-being over time. Nine survivors were interviewed. Out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding, as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. The study findings show survivors’ emotional needs and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.

     

  • 43.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Dahné, Tova
    Uppsala University, Sweden;Linköping University, Sweden.
    Stureson, Lovisa
    Linköping University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Thylén, Ingela
    Linköping University, Sweden.
    Lived experiences of surviving in‐hospital cardiac arrest2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 156-164Article in journal (Refereed)
    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.

  • 44.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Dahné, Tova
    Linköping University, Sweden.
    Stureson, Lovisa
    Linköping University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Thylén, Ingela
    Linköping University, Sweden.
    Lived experiences of surviving in-hospital cardiac arrest2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e122-e122Article in journal (Refereed)
  • 45.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ambulance nurse students’ experiences of ethical problems in patient-relationships2019In: Presented at the 3rd NCCS/EACS Conference: "Sustainable Caring for Health and Wellbeing", Vaasa, Finland, October 1-3, 2019, 2019Conference paper (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.

  • 46.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University, Sweden;Region Sörmland, Sweden.
    Ethical conflicts in patient relationships: experiences of ambulance nursing students2020In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 27, no 4, p. 946-959Article in journal (Refereed)
    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.

  • 47.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Jimenéz-Herrera, Maria
    Rovira i Virgili University, Spain.
    Axelsson, Christer
    University of Borås, Sweden.
    Burjalés Martí, D
    Rovira i Virgili University, Spain.
    Sandman, Lars
    University of Borås, Sweden.
    Casali, Luca
    Queensland University of Technology, Australia.
    Ethical values in emergency medical services: A pilot study2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 8, p. 928-942Article in journal (Refereed)
    Abstract [en]

    Background: Ambulance professionals often address conflicts between ethical values. As individuals’values represent basic convictions of what is right or good and motivate behaviour, research is neededto understand their value profiles.

    Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure thepresence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles inSpain and Sweden.

    Methods: The instrument was translated and culturally adapted. A content validity index was calculated.Pilot tests were carried out with 46 participants.

    Ethical considerations: This study conforms to the ethical principles for research involving humansubjects and adheres to national laws and regulations concerning informed consent and confidentiality.

    Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulanceorganizations. Both countries favoured utilitarianism least. Gender differences across countries showedthat males favoured rights. Spanish female professionals favoured justice most strongly of all.

    Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low onutilitarianism focusing on total population effect, preferring the opposite, individualized approach of therights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardizeambulance professionals’ moral right to make individual assessments based on the needs of the patientat hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justiceand rights perspectives portrayed in the survey mainly concern relationship to the organization and peerswithin the organization, this relationship might at worst be given priority over the equal treatment andmoral rights of the patient.

    Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and readyto act optimally – especially if these perspectives are used in patient care. Research is needed to clarify howjustice and rights are prioritized by ambulance services and whether or not these organization-related valuesare also implemented in patient care.

  • 48.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Jonasson, Lise-Lotte
    University of Borås, Sweden.
    Sandman, Lars
    Linköping University, Sweden;University of Borås, Sweden.
    Chefers etiska värderingar2016In: Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar / [ed] Lotta Dellve, Maria Wolmesjö, Borås: Högskolan i Borås, 2016, p. 43-56Chapter in book (Other academic)
    Abstract [en]

    Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

    Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

    Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

    De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

    Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbetsgivaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

    Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

  • 49.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Jonasson, Lise-Lotte
    University of Borås, Sweden.
    Sandman, Lars
    University of Borås, Sweden.
    Ethical values among managers in elderly care2015In: The Dilemmas for Human Services 2015: Organizing, Designing and Managing. 18th International Research Conference in Växjö, 2015Conference paper (Refereed)
  • 50.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden;University of Borås, Sweden.
    Kowalczyk, Emma
    Helsingborg County Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Emergency Medical Services physicians’ perceptions of ambulance nurses’ responsibility for referring patients to primary care and self-care - a Swedish national survey2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no Suppl 1, p. A6-A6Article in journal (Refereed)
    Abstract [en]

    Background: Based on guidelines developed by EMS physicians, registered nurses in the Swedish ambulance services sometimes by-pass the emergency department and refer non-urgent patients to primary care and self-care. However, these referrals are associated with problems that may jeopardize patient safety and patient participation.

    Aim: To identify the EMS physicians’ perceptions of ambulance nurses’ responsibilities and prerequisites to refer patients to primary care and self-care.

    Methods: A national survey of all EMS physicians (n=51) using study specific questions with close-ended and open response options, analysed with descriptive statistics and thematic analysis.

    Results: The response rate was 78% (n=40). The majority of the physicians (95%) perceived that nurses should be able to refer patients to primary care and self-care. One fourth (25%) perceived specialist nurses in ambulance care as the most appropriate professionals. The majority of the physicians (65%) perceived that referral to primary care maintain patient safety, whereas fewer (50%) assessed the referral as safe for the patient. All perceived that feedback should be given to nurses when the referral was incorrect. The majority perceived it important to extend the nurses’ authority to refer to primary care (63%) and self-care (55%).

    Conclusion: There is no consensus among the EMS physicians regarding responsibilities and conditions for nurses’ referral of patients. Registered nurses with basic education are expected to be able to refer, while there is varying opinion regarding requirements of specialist trained ambulance nurses to refer patients. Professional experience as a nurse is perceived more important than formal education.

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