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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.
    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.

  • 3. Barrientos, Christian
    et al.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    The care of patients assessed as not in need of emergency ambulance care: the perspective of registered nurses2019Conference paper (Refereed)
    Abstract [en]

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

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

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

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

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

  • 4.
    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 self-experienced ethical problem in the care relationship with a specific patient. The thematic analysis commenced with being familiarized with the text as a whole before condensation and coding. The exams were read and re-read several times. After coding followed further analysis, re-analysis and validation in several linear and circular steps to finally compile sub-themes and themes. 

    Results: Ethical problems emerged as six themes; 1) Insecurity in considering patient autonomy, 2) Conflicting assessments of the patients best, 3) Inadequate access to patient narratives, 4) Absence of trustful relationships, 5) Disturbance of patient focus and 6) Limited possibility to provide proper care. 

    Conclusions and implications: The result emphasizes ethical problem within patient-relationships in the ambulance care as multifaceted and strongly connected to patient’s autonomy. Outgoing from the results an intervention project regarding older patients’ autonomy in ambulance care started in January 2019.

  • 5.
    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.

  • 6.
    Holmberg, Mats
    Karolinska Institutet.
    Being secure in insecurity: Aspects of caring in the ambulance service2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Ambulance care focuses foremost on medical care and treatment. On the one hand the ambulance service encounters persons suffering acute and severe physical illness or injuries; conversely ambulance patients are described, as being vulnerable to more than just their illness or injury. Ambulance care is provided in an insecure environment and ambulance clinicians have to be prepared for the unexpected. The overall aim of this thesis was to gain understandings of relationships and knowledge in caring, within the ambulance service.Four studies have formed the foundation of this thesis. Three different methods were used; phenomenological hermeneutics (I-II) with individual interviews, qualitative content analysis (III) with focus group conversations and finally a Delphi method (IV). Study I aimed to elucidate the meaning of the relationship with ambulance clinicians as experienced by patients. This was to surrender in dependence of another, being secure in the hands of the ambulance clinician. The situation developed from being lonely before the arrival of the ambulance, to being cared for by the ambulance clinicians and finally being lonely again when transferred to the Emergency Department. Study II aimed to elucidate the meaning of the relationship with the ambulance clinician as experienced by significant others. This was to be lonely together and secure while sharing their lonely struggle for the affected person with the ambulance clinician. At the same time the ambulance clinician’s focus was on the affected person leaving the significant others deserted and lonely. Study III aimed to elucidate ambulance clinicians’ experiences of relationships with patients and significant others. This was encapsulated in the main category; ‘To be personal in a professional role’. Being both personal and professional were found to be intertwined aspects of the relationship. The ambulance clinicians focus on the patient and are involved in creating comfort, having a professional mission to handle their own and the patient’s safety as a priority of the care. Study IV aimed to identify and estimate desired knowledge among Swedish ambulance clinicians from the perspective of ambulance care managers. This embraced a wide spectrum, including both medical and caring knowledge. The highest ranked desirable knowledge areas were; ‘Knowledge to assess the patient’s situation from a holistic perspective’, ‘Medical knowledge to assess and care for different diseases’ and ‘Knowledge to able to care for critically ill patients’. In conclusion, the thesis unfolds a complex understanding of caring in the ambulance service, being secure in insecurity. The patients and significant others are secure in the ambulance clinicians’ presence, but insecure when lonely and powerless. Caring in the ambulance service focuses on the physical disorder, but is understood from the body’s inseparable connection to the lifeworld. Care is fixed in time and often short. The ambulance clinicians have to care for patients and significant others while simultaneously handling an insecure environment. This calls for ambulance clinicians to adopt a holistic approach to care for both patients and significant others, and to acknowledge the whole person.

  • 7.
    Holmberg, Mats
    Mälardalen University, Sweden.
    Hur vårdar man en trasig själ?2018In: Samverkan 112, ISSN 1650-7487, no 5-6, p. 8-8Article in journal (Other (popular science, discussion, etc.))
  • 8. Holmberg, Mats
    Möt din medmänniska2009In: Omvårdnadsmagasinet, ISSN 1652-0858, no 5, p. 39-39Article in journal (Other (popular science, discussion, etc.))
  • 9.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Patientens perspektiv på ambulanssjukvård - vad behöver vi veta?2019In: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019, 2019Conference paper (Other academic)
    Abstract [en]

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

  • 10.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    The EXPAND-model: a hermeneutical application of a lifeworld-led prehospital emergency care2019In: 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: Prehospital emergency care means to respond to patients’ life-threatening and critical medical conditions out of hospitals. Patients experience this as an existential suffering together with a physical suffering. Thus a need of combining the medical care and treatment with a caring science perspective in order to provide a lifeworld-led care is stated. 

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

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

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

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

  • 11.
    Holmberg, Mats
    University of Borås, Sweden.
    Vårdvetenskaplig analys2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 377-379Chapter in book (Other academic)
  • 12.
    Holmberg, Mats
    University of Borås, Sweden.
    Överlämnande till nästa vårdenhet2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 172-175Chapter in book (Other academic)
  • 13.
    Holmberg, Mats
    et al.
    Sörmland County Council, Sweden;Mälardalen University, Sweden;University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Winge, Karin
    South Älvsborgs Hospital, Sweden.
    Lundberg, Camilla
    South Älvsborgs Hospital, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome2018In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, p. 1-10, article id 216Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 14.
    Holmberg, Mats
    et al.
    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.
    Ambulance nurse students’ experiences of handling ethical problems in patient-relationship2019In: Presented at the 120th International Council of Nurses (ICN) congress, Singapore, June 27-July 1, 2019, 2019Conference paper (Refereed)
  • 15.
    Holmberg, Mats
    et al.
    Karolinska Institutet. Institutionen för neurobiologi, vårdvetenskap och samhälle.
    Fagerberg, Ingegerd
    Ersta Sköndal Brsäcke Högskola.
    The encounter with the unknown; Nurses lived experiences of their responsibility for the care of the patient in the Swedish Ambulance Service2011Conference paper (Refereed)
  • 16.
    Holmberg, Mats
    et al.
    Sömland County Council.
    Fagerberg, Ingegerd
    Ersta Sköndal University College.
    The encounter with the unknown: nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being.

  • 17.
    Holmberg, Mats
    et al.
    Mälardalen University, Sweden.
    Fagerberg, Ingegerd
    Ersta Sköndal Bräcke University College, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Sweden.
    Knowledge desired by EMS-managers of their ambulance clinicians2018In: 2nd European Emergency Medical Services (EMS2018), Copenhagen, Denmark, 2018Conference paper (Refereed)
  • 18.
    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.

  • 19.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Sweden;Uppsala University, Sweden.
    Forslund, Kerstin
    Örebro Universitet, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Sweden.
    Fagerberg, Ingegerd
    Karolinska institutet, Sweden;Ersta Sköndal Bräcke University College, Sweden.
    The relationship with the ambulance clinicians as experienced by significant others2016In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. e1-e8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Interpersonal relationships between clinicians and patients are important aspects of the ambulance care, requiring a balance between objectified acute medical treatment and a holistic care. Being a significant other (SO) in the ambulance care setting is described as being caught between hope and dread. Little research has focused on SOs' experiences of the relationship with the ambulance clinicians.

    AIM: To elucidate meanings of the relationship with the clinicians in the ambulance care setting as experienced by the patients' SOs.

    DESIGN: Qualitative lifeworld design.

    METHODS: Data was collected using open-ended interviews with nine SOs. The verbatim transcribed interviews were analysed with a phenomenological hermeneutic method.

    FINDINGS: The structural analysis resulted in one main theme: 'Being lonely together'. The main theme comprises three themes: 'Being in a shared struggle', 'To hand over the affected person in trust' and 'Being the second person in focus' and six subthemes. The main theme is for the SOs to share the struggles of the affected person with the ambulance clinicians and to be comforted while handing over the responsibility for the affected person. Hence the SO is excluded and lonely and on his/her own, while not the primary focus of the ambulance clinicians.

    CONCLUSIONS: The relationship with the ambulance clinicians from the perspective of the SOs can be understood as complex, involving both being lonely and together at the same time. The findings support a holistic approach towards the ambulance care involving SOs.

    RELEVANCE FOR CLINICAL PRACTICE: This study outlines the importance of an emergency ambulance care involving SOs as affected persons and supports a balance between emergency medical treatment to the patient and a holistic care, involving the SOs' suffering.

  • 20.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Sweden;Uppsala university, Sweden.
    Forslund, Kerstin
    Örebro University, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Sweden.
    Fagerberg, Ingegerd
    Karolinska Institutet, Sweden;Ersta Sköndal university college, Sweden.
    To surrender in dependence of another: The relationship with the ambulance clinicians as experienced by patients.2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 544-551Article in journal (Refereed)
    Abstract [en]

    Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care.

  • 21.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Institutionen för neurobiologi, vårdvetenskap och samhälle.
    Melby, Vidar
    University of Ulster, Londonderry, UK.
    McConnel, Donna
    University of Ulster, Jordanstown, UK.
    Personcenteredness in prehospital emergency care: A challenge to be mastered!2013Conference paper (Refereed)
  • 22.
    Holmberg, Mats
    et al.
    University of Borås, Sweden.
    Rantala, Andreas
    Bremer, Anders
    University of Borås, Sweden.
    Patient participation: A challenge within contemporary ambulance care?2016In: PreHospen Conference 2016: Where all care begins : 7th PreHospen Conference in Prehospital Emergency Care 10-11 March 2016, Högskolan i Borås, 2016, p. 82-82Conference paper (Refereed)
    Abstract [en]

    Background: Patient participation should be understood in relation to vulnerability, power and responsibility. Patients in ambulance care have urgent care needs and are vulnerable in an asymmetrical relationship with the clinicians. This places great responsibility on the clinicians to use their power for the benefit of the patient. An invitation to participate requires an informed consent and depends on the patient’s willingness and ability to participate. Hence, as- sessment of the patient’s decision-making ability is central together with a caring approach to enhance trust and confidence. Undoubtedly, patient partici- pation is a challenge within contemporary ambu- lance care – where failure is likely to cause suffering.

    Methods: Patient participation in ambulance care is discussed from philosophical, patient and person-centred perspectives in relation to empirical research of Bremer et al. (2012), Holmberg et al. (2014; 2015) and Rantala et al. (2015). 

    Results: Patients are comfortable in their surrender to ambulance clinicians, obeying commands and being important while involved in the care. However, pa- tients are powerless when they experience ambulan- ce clinicians’ care as excessive, having a strong desire of being acknowledged in their suffering. This can be achieved by seeing the patient as capable and in- volve the patient and significant others in the deci- sion-making. In addition ambulance clinicians have an ambition to be pliable to the patient’s wishes, inviting the patient in a shared decision-making.

    Conclusions: Patient participation in ambulance care can be understood as important for the patient’s wellbeing. However, unequal distribution of power within the ambulance clinician-patient relationship may challenge patient autonomy and interests. Is it pos- sible to achieve genuine patient participation in the context of ambulance care?

  • 23.
    Holmberg, Mats
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Rantala, Andreas
    Bremer, Anders
    University of Borås, Sweden.
    Patient participation: a challenge within contemporary ambulance care?2016In: Presented at the 7th PreHospen Conference in Prehospital Emergency Care, Borås, Sweden, March 10-11, 2016, 2016, p. 82-82Conference paper (Other academic)
    Abstract [en]

    Background

    Patient participation should be understood in relation to vulnerability, power and responsibility. Patients in ambulance care have urgent care needs and are vulnerable in an asymmetrical relationship with the clinicians. This places great responsibility on the clinicians to use their power for the benefit of the patient. An invitation to participate requires an informed consent and depends on the patient’s willingness and ability to participate. Hence, as- sessment of the patient’s decision-making ability is central together with a caring approach to enhance trust and confidence. Undoubtedly, patient partici- pation is a challenge within contemporary ambu- lance care – where failure is likely to cause suffering.

    Methods

    Patient participation in ambulance care is discussed from philosophical, patient and person-centred perspectives in relation to empirical research of Bremer et al. (2012), Holmberg et al. (2014; 2015) and Rantala et al. (2015). 

    Results

    Patients are comfortable in their surrender to ambulance clinicians, obeying commands and being important while involved in the care. However, pa- tients are powerless when they experience ambulan- ce clinicians’ care as excessive, having a strong desire of being acknowledged in their suffering. This can be achieved by seeing the patient as capable and in- volve the patient and significant others in the deci- sion-making. In addition ambulance clinicians have an ambition to be pliable to the patient’s wishes, inviting the patient in a shared decision-making.

    Conclusions

    Patient participation in ambulance care can be understood as important for the patient’s wellbeing. However, unequal distribution of power within the ambulance clinician-patient relationship may challenge patient autonomy and interests. Is it pos- sible to achieve genuine patient participation in the context of ambulance care? 

  • 24.
    Holmberg, Mats
    et al.
    Karolinska Institutet, Sweden;Uppsala University, Sweden.
    Wahlberg, Anna Carin
    Karolinska Institutet, Sweden.
    Fagerberg, Ingegerd
    Karolinska institutet, Sweden;Ersta Sköndal Bräcke University College, Sweden.
    Forslund, Kerstin
    Örebro University, Sweden.
    Ambulance clinicians' experiences of relationships with patients and significant others2016In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. e16-e23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambulance clinicians (ACs) have to provide advanced care and treatment to patients in a challenging and emotionally demanding environment, therefore they establish interpersonal relationships embracing both patients and significant others. Relationships in emergency care were earlier found to be short-lived and lacking a holistic understanding of the patient. In their relationship with the ambulance clinicians, it is for patients to surrender and become dependent, which may be interpreted as both a negative and a positive experience.

    AIM: The aim of this study was to elucidate ambulance clinicians' experiences of relationships with patients and significant others.

    METHODS: Data were collected from four focus group conversations, with a total of 18 participating ambulance clinicians. An inductive qualitative content analysis method was chosen.

    FINDINGS: The analysis resulted in one main category: 'To be personal in a professional role' and three generic categories: 'To be there for the affected person', 'To be personally involved' and 'To have a professional mission'. There were subsequently nine sub-categories. The main category was described as intertwining the experience of being both personal and professional. The ambulance clinicians adapt to a situation while having the affected person in focus. They involve themselves as persons but at the same time use the power of their professional role.

    CONCLUSION: The relationship with patients and significant others from the ambulance clinicians' perspective can be understood as embracing both personal and professional aspects.

    RELEVANCE TO CLINICAL PRACTICE: This study provides an understanding of the ambulance clinicians' professional role as embracing a personal perspective, which is important when developing an emergency ambulance service focusing on care that involves more than just emergency medical treatment.

  • 25.
    Holmberg, Mats
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wallinvirta, Eivor
    Arcada University of Applied Sciences, Finland.
    Rantala, Andreas
    Lund University, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Suffering and Togetherness On-scene in Prehospital emergency care (STOP): a middle range theory2019In: 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: Prehospital emergency care provides care for patients of all ages and life situations and with a variety of suffering, diseases and injuries. Different caring aspects are required in order to respond to the patients’ needs, in parallel with medical assessment and treatment. In order to manage care in these unpredictable and complex contexts, the contextual caring science perspective needs to be developed. 

    Aim: To develop a middle-range theory aimed at prehospital emergency care within a caring science framework. 

    Method: A deductive and inductive design was used to generate understanding of the central concepts; the suffering human being, the caring relationship and the caring environment within prehospital emergency care. 

    Result: The STOP theory comprises the concepts; acute suffering (S), act of togetherness (T), on-scene caring space (O) within in the contextual framework of prehospital emergency care (P). Acute suffering affects us without a clear warning, becoming acute. It means recognizing and accepting that one’s own resources are insufficient and completely exhausted. The ambulance clinician and the patient are in an act of togetherness from different positions and understandings, being dependent on each other to create conditions for continued care. This represents for patients an alteration from being in an involuntary and lonely struggle, to be cared for in a shared struggle to alleviate suffering. The on-scene caring space in which the clinician and the patient are situated are both a prerequisite for care and caring in itself. The space is not static but constantly changing and thus dynamic and elusive. 

    Conclusion and implications: The STOP theory is important for clinical care, education and research in the prehospital emergency care setting as the theory is developed with an understanding of suffering as a wider phenomenon than the narrower biomedical perspective.

  • 26.
    Svensson, Cecilia
    et al.
    South Älvsborg Hospital, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Holmberg, Mats
    Mälardalen University, Sweden;Region Sörmland, Sweden;Uppsala University, Sweden.
    Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: a qualitative exploration2019In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 14, no 2, p. 70-79Article in journal (Refereed)
    Abstract [en]

    Background

    The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations.

    Aim

    The aim of the study was to explore ambulance nurses’ experiences of relationships with patients in urgent and emergency situations.

    Methods

    Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis.

    Results

    Relationships with patients during urgent and emergency assignments emerged as three themes: “Ambiguous silence,” “Professional competence” and “Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship.

    Conclusions

    Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important.

    Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses.

  • 27.
    Wireklint-Sundström, Birgitta
    et al.
    University of Borås, Sweden.
    Holmberg, Mats
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1, article id 52Article in journal (Refereed)
    Abstract [en]

    Background:Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses' (ANs') prehospital care of patients experiencing suspected ACS, related to pain intensity.

    METHODS: 

    This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.

    RESULTS: 

    The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.

    CONCLUSIONS: 

    An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.

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