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  • 51.
    Colldén Benneck, Jessica
    et al.
    Uppsala University Hospital, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Registered nurses’ experiences of near misses in ambulance care: a critical incident technique study2019In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 47, no November, p. 1-6, article id 100776Article in journal (Refereed)
    Abstract [en]

    Background: In hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise.

    Aim: To explore registered nurses’ experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized.

    Methods: Based on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated.

    Results: Seventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge.

    Conclusions: Experiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm.

  • 52.
    Dellve, Lotta
    et al.
    University of Borås, Sweden.
    Wolmesjö, Maria
    University of Borås, Sweden;Linköping University, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Chefers stödresurser och ledarutbildning2016In: Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar, Borås: Högskolan i Borås, 2016, p. 69-76Chapter in book (Other academic)
  • 53.
    Djärv, Therese
    et al.
    Karolinska Institutet, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    University of Gothenburg, Sweden.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Årestedt, Kristofer
    Region Kalmar County, Sweden.
    Health related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: a national population-based Swedish cohort study2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 142, no s1, p. e27-e27Article in journal (Refereed)
  • 54.
    Falchenberg, Åsa
    et al.
    University of Borås, Sweden.
    Andersson, Ulf
    University of Borås, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Andersson, Henrik
    University of Borås, Sweden.
    Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care2018In: Presented at the 3rd Global Conference on Emergency Nursing and Trauma Care, Noordwijkerhout, Netherlands, October 4-6, 2018, 2018Conference paper (Refereed)
  • 55.
    Heidenreich, Kaja
    et al.
    Örebro University, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Materstvedt, Lars Johan
    Norwegian University of Science and Technology, Norway;University of Glasgow, UK.
    Tidefelt, Ulf
    Örebro University, Sweden.
    Svantesson, Mia
    Örebro University, Sweden.
    Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD)2018In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 21, no 4, p. 467-477Article in journal (Refereed)
    Abstract [en]

    In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

  • 56.
    Heidenreich, Kaja
    et al.
    Örebro University, Sweden.
    Slowther, Anne
    University of Warwick, UK.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Griffiths, Frances
    University of Warwick, UK.
    Svantesson-Sandberg, Mia
    Örebro University, Sweden.
    The complex decision-making process of referring patients to intensive care – meanings of senior doctor’s experiences2019In: Presented at the EACME Annual Conference 2019: Rethinking Ethics in 21st Century Europe, Oxford, UK, September 12-14, 2019, 2019Conference paper (Refereed)
    Abstract [en]

    Background: The decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these ethical questions in practice.

    Objectives: To illuminate the meaning of senior referring doctors´ lived experiences of decision-making about whether to initiate intensive care treatment. 

    Methods: Analysis, using a phenomenological hermeneutical method, of interviews with 27 senior doctors from departments regularly referring patients to intensive care in six British hospitals. The interviews were conducted as part of the larger research project ‘Understanding and improving the decision-making process surrounding admission to the intensive care unit’, funded by the National Institute of Health Research, UK.

    Results: Senior doctors struggle with the complex decision-making process when they are in doubt whether escalation to intensive care for the critically ill patient would be beneficial. A trusted process requires senior, mutual responsiveness between the referring doctor and the intensivist. Within the professional vulnerability created by the burdensome uncertainty of not being sure what is good and right for the patient, moral responsibility is secured through clinical proximity, and confidence is gained through responsive interaction.

    Conclusions: Decision-making requires a reliable process based on mutual responsiveness and proximity. To promote this, an organizational structure and culture is needed where mutual recognition and support between decision-makers are valued.

  • 57.
    Herlitz, Johan
    et al.
    University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Hagiwara, Magnus
    University of Borås, Sweden.
    Englund, Lotta
    University of Borås, Sweden.
    Så skapas världens bästa ambulanssjukvård2011In: Göteborgsposten, ISSN 1103-9345, no 2011-05-14Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Tiden från larm till dess att ambulans kommer har ökat dramatiskt de senaste tio åren i Västra Götaland. Samtidigt bedöms allt fler i behov av snabb utryckning. Kompetens finns att råda bot på detta – om den tillåts styra utvecklingen, skriver bland andra professor Johan Herlitz.

  • 58.
    Herlitz, Johan
    et al.
    University of Borås, Sweden;Sahlgrenska University Hospital, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Wireklint-Sundström, Birgitta
    University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Hagiwara, Magnus
    University of Borås, Sweden.
    Jonsson, Anders
    University of Borås, Sweden.
    Lundberg, Lars
    University of Borås, Sweden.
    Suserud, Björn-Ove
    University of Borås, Sweden.
    Ljungström, Lars
    Skövde Central Hospital, Sweden.
    Suspicion and treatment of severe sepsis: An overview of the prehospital chain of care2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 42Article in journal (Refereed)
    Abstract [en]

    Background

    Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis.

    Aim

    To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis.

    Methods

    A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.

    Results

    In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis.Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT.There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers.

    Conclusion

    Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  • 59.
    Herlitz, Johan
    et al.
    University of Borås, Sweden;Västra Götalandsregionen, Sweden.
    Ravn-Fischer, Annica
    Sahlgrenska universitetssjukhuset, Sweden.
    Svensson, Leif
    Karolinska institutetet, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Circulation: Bröstsmärtor2016In: Prehospital Akutsjukvård, Liber, 2016, 2, p. 308-321Chapter in book (Other academic)
  • 60. Herrera Jiménez, María
    et al.
    Bremer, Anders
    University of Borås, Sweden.
    Ethical profiles in the Spanish and Swedish Emergency Medical Services2013In: Prehospital vård för att värma om patientens hälsa: PreHospen-konferens : Borås 2013-04-2, 2013Conference paper (Refereed)
    Abstract [en]

    The ambulance crew faces in their daily work different kinds of ethical problems, such as conflicts between ethical values and standards that are critical for the health care. This gives a complexity of the situations and becomes a constant challenge in the care practice for these professionals. Sandman and Nordmark (2006) describe that decision-making in this area of care often creates high pressure and discomfort among the ambulance personnel. Adams, Arnold, Siminoff and Wolfson (1992) identified ethical conflicts in 14.4% of the alerts made by the ambulance crews. In Sweden, Sandman and Nordmark (2006) found ethical conflicts in out-of-hospital care regarding the care relationship, the patient’s autonomy, the patient’s best interest, professional ideals, the professional role and self-identity, family members and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. In Spain, Jiménez (2009) presented some ethical problems that arouse during CPR, pain relief, death and in situations when the right to autonomy was at stake. None of these studies are presenting tools for mapping or help for understand the different situation. The ethical value profile is a help to create tools for mapping and understanding. The first part of this project aims to translate, adapt and test a previous used instrument to map the ethical profile among ambulance crew in Spain and Sweden and in a pilot compare ethical values among the professionals. Result: The Managerial Value Profile (MVP) was translated from English to Swedish and Spanish. The translation was made forward and backward and then subjected to a psychometric test. To adapt the questions in regard to cultural aspects a pilot study was made in both countries (Sweden n=26, Spain n=20). In the pilot we found that ambulance personnel in Sweden and Spain tended to stress the value of individual rights and partly social justice while an utilitaristic approach was regarded as less important. On three items we found a huge difference between the two groups. In those items the Spanish professionals tended to consider social justice more often than the Swedish ambulance personnel that considered individual rights.

  • 61.
    Hjelm, Carina
    et al.
    Linköping University.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Broström, Anders
    Jönköping University ; Linköping University Hospital.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Exploring sleep disturbances in cardiac arrest survivors: a phenomenographic interview study from registered nurses’ perspective2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e129-e129Article in journal (Refereed)
  • 62.
    Hollenberg, Jacob
    et al.
    Södersjukhuset ; Karolinska institutet.
    Engdahl, Johan
    Hallands sjukhus.
    Axelsson, Åsa B.
    University of Gothenburg.
    Bremer, Anders
    University of Borås.
    Hjärtstopp2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Liber, 2009, 1, p. 295-304Chapter in book (Other academic)
  • 63.
    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)
  • 64.
    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?

  • 65.
    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? 

  • 66.
    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.

  • 67.
    Israelsson, Johan
    et al.
    Kalmar County Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Axelsson, Åsa
    University of Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Djärv, Therese
    Karolinska Institutet, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Sweden.
    Larsson, Ing-Marie
    Uppsala University, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Sunnerhagen, Katarina S
    University of Gothenburg, Sweden.
    Wallin, Ewa
    Uppsala University, Sweden.
    Ågren, Susanna
    Linköping University, Sweden.
    Åkerman, Eva
    Skåne University Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Neurologic outcome, health-related quality of life, anxiety and symptoms of depression among in-hospital cardiac arrest survivors2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no S1, p. 101-101Article in journal (Refereed)
    Abstract [en]

    Purpose: Most cardiac arrest research has focused on survival in an out-of-hospital context. The knowledge of health and quality of life is sparse, especially regarding in-hospital cardiac arrest (IHCA) survivors. The aim of the current study was therefore to describe neurologic outcome, health-related quality of life (HRQoL), anxiety and symptoms of depression among IHCA survivors.

    Materials and methods: This study has a cross-sectional design. Data from the Swedish Register of Cardiopulmonary Resuscitation was used. In the register, data is collected 3–6 months after resuscitation by using a questionnaire including two questions about activities in daily life and mental/intellectual recovery, the EQ-5D-5L and the Hospital Anxiety and Depression Scale (HADS). In addition, Cerebral Performance Category (CPC)-scoring is performed.

    Results: Between the 11th of June 2013 and the 7th of May 2015, 488 IHCA survivors with a mean age of 69 ± 13 were included. A majority were men (62%), had a cerebral function of CPC 1 (87%) and no need of assistance from other people in daily life (71%). A large proportion had not made a complete mental/intellectual recovery (27%). Pain/discomfort was the dimension in EQ-5D-5L where most survivors reported problems (64%), while least problems were reported in the dimension self-care (24%). The individual variations of present health state (EQ-VAS) were substantial (range 0–100), with a mean value of 66 ± 22. Anxiety and symptoms of depression were reported by 16% and 15% respectively.

    Conclusions: Although the majority of the IHCA survivors reported good neurologic outcome, satisfactory HRQoL, no anxiety or symptoms of depression, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of structured post resuscitation care and follow-up, in order to identify and support those in need.

  • 68.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Bremer, Anders
    University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Axelsson, Åsa B.
    University of Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Djärv, Therese
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Sweden;Uppsala University, Sweden.
    Larsson, Ing-Marie
    Uppsala University, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Sunnerhagen, Katharina S.
    University of Gothenburg, Sweden.
    Wallin, Ewa
    Uppsala University, Sweden.
    Ågren, Susanna
    Linköping University, Sweden;County Council of Östergötland, Sweden.
    Åkerman, Eva
    Skåne University Hospital, Sweden;Karolinska Institutet, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Ersta Sköndal Bräcke University College, Sweden;Kalmar County Hospital, Sweden.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 69.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    Bremer, Anders
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex2016In: Presented at EuroHeart, Dubrovnik, Croatia, June 14-15, 2015, 2016, Vol. 134Conference paper (Refereed)
    Abstract [en]

    Introduction: Previous studies have demonstrated differences in characteristics and outcome between men and women in cardiac arrest (CA) populations. However, most studies have focused only on survival outcome. Knowledge about patient reported health and psychological distress among CA survivors is sparse, in particular among those suffering in-hospital cardiac arrest (IHCA). The aim was to describe health status and psychological distress among IHCA survivors in relation to sex. Methods: This national register study presents follow-up data of IHCA survivors from 64% of the eligible hospitals in Sweden. A questionnaire was sent to the survivors, 3-6 months post CA, including measures of health status (EQ-5D) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included. Women reported more problems in all dimensions of EQ-5D, except for Self-care. They also had worse health status (EQ-index) (0.75 vs 0.79, p<0.001). The median value for EQ-VAS was 70 (q1-q3=50-80), significantly lower for women compared to men (65 vs 75, p<0.001). A majority reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (median 3 vs 2, p<0.001) and symptoms of depression (median 3 vs 2, p<0.001) compared to men. Being women was significantly associated with lower health status and more psychological distress in the regression models. No interaction effects for sex and age were found. Conclusions: Although the majority of the survivors reported acceptable health status and no psychological distress, a substantial group reported serious problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. All IHCA survivors should be screened for health problems during the post cardiac arrest follow-up, and offered support when needed.

  • 70.
    Israelsson, Johan
    et al.
    Kalmar County Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health-related quality of life among in-hospital cardiacarrest survivors2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 1 suppl, article id 174Article in journal (Refereed)
    Abstract [en]

    Purpose: A cardiac arrest can cause brain injury with cognitive dysfunctions, emotional reactions and negative effects on activities in daily life. However, most research has focused on survival and the knowledge about health-related quality of life (HRQoL) among survivors is limited. In addition, almost all studies are performed in an out-of-hospital context. The aim of the current study was therefore to describe HRQoL among in-hospital cardiac arrest (IHCA) survivors.

    Methods: This study has a cross-sectional design. In collaboration with the Swedish national register for cardiopulmonary resuscitation, data was collected 3-6 months after resuscitation by using a questionnaire including EuroQol-5 dimension (EQ-5D), the Hospital Anxiety and Depression Scale (HADS) and single questions on activities in daily life and mental/intellectual recovery. In addition, the Cerebral Performance Category (CPC) was scored.

    Results: In total, 286 IHCA survivors with a mean age of 67±12 were included. A majority of the survivors were men (65%), had a cerebral function of CPC 1 (88%) and had no need of assistance from other people in daily life (70%). A large proportion of the survivors had not made a complete mental and/or intellectual recovery (34%), causing problems in daily life for 65% of them. Pain was the dimension in EQ-5D where most survivors reported problems of some degree (64%). Problems within the dimensions anxiety/depression and mobility were reported by more than half of the survivors (53% vs. 51%). In the dimensions personal care and activities in daily life problems were reported by less than half of the survivors (24% vs. 49%). The individual variations of present health measured by the EQ-VAS were substantial (range 0-100), with a mean value of 67±22. Symptoms of anxiety and depression (measured by HADS) were reported by 15% and 16% respectively.

    Conclusions: Although the majority of the IHCA survivors reported satisfactory HRQoL, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of assessing HRQoL among IHCA survivors and the need of follow-up and structured post cardiac arrest care.

  • 71.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Lilja, Gisela
    Lund University, Sweden;Skåne University Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Stevenson-Ågren, Jean
    Linnaeus University, Faculty of Arts and Humanities, Department of Languages. University of Sheffield, UK.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University, Sweden.
    Post cardiac arrest care and follow-up in Sweden: a national web-survey2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Recent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden.

    Methods: An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis.

    Results: Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up.

    Conclusions: Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.

  • 72.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Persson, Carina
    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. Region Kalmar County, Sweden.
    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.
    Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor–partner interdependence model2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, p. 1-8Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 73.
    Israelsson, Johan
    et al.
    Linköping University.
    Thylén, Ingela
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Factors associated with health status and psychological distress among cardiac arrest (CA) survivors living with an implantable cardioverter-defibrillator (ICD)2017Conference paper (Refereed)
    Abstract [en]

    Background: The aim was to explore factors associated with health status and psychological distress among ICD-implanted CA survivors.  

    Materials and methods: This cross-sectional study included all eligible adult ICD-implanted CA survivors in the Swedish ICD and Pacemaker Registry, 2011-2012. Health status and psychological distress were measured with the EQ-5D-5L (EQ index & EQ VAS) and the Hospital Anxiety and Depression Scale (HADS) respectively. Linear regression analyses were used to explore associations between explanatory- and outcome variables.

    Results: In total, 990 patients (22% women) with a median age of 68 (q1-q3=60-74) were included. Time since the CA varied between 6 months to 23 years. The median values for EQ index and EQ VAS were 0.85 (q1-q3=0.73-1.00) and 80 (q1-q3=69-90) respectively. Gender, comorbidity, receiving ICD-shock/-s, perceived control and personality were independently associated with health status. The final models explained 25% (EQ index) and 30% (EQ VAS) of the total variance (according to the R2 values). The median values for HADS Anxiety and HADS Depression were 3 (q1-q3=1-6) and 2 (q1-q3=1-4) respectively. Age, gender, comorbidity, living alone, ICD-related concerns, perceived control and personality were independently associated with psychological distress. The final models explained 51% (HADS Anxiety) and 44% (HADS Depression) of the total variance.

    Conclusion: Age, gender, living alone, comorbidity, receiving ICD-shock/-s, ICD-related concerns, perceived control and personality were associated with health status and/or psychological distress. These results contribute to a better understanding of the life situation among CA survivors, and may be important to develop individualized post CA care. 

  • 74.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Department of Cardiology, Kalmar County Council, Kalmar ; Linköping University.
    Thylén, Ingela
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Division of Emergency Medical Services, Kalmar County Council, Kalmar.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. The Research Section, Kalmar County Council, Kalmar.
    Factors associated with health status and psychological distress among cardiac arrest survivors treated with an implantable cardioverter-defibrillator2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e85-Article in journal (Refereed)
  • 75.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Council;Linköping university.
    Thylén, Ingela
    Linköping university.
    Strömberg, Anna
    Linköping university.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 78-84Article in journal (Refereed)
    Abstract [en]

    Aim

    To explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population.

    Methods

    This cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personality (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL.

    Results

    The CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p < 0.001). In contrast, they reported more problems in mobility and usual activities (p < 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personality. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models.

    Conclusions

    This extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions.

  • 76.
    Johansson Sundler, Annelie
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Skövde.
    Berglund, Mia
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Skövde.
    Summer Meranius, Martina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. Mälardalen University.
    Thurang, Anna
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. Beroendecentrum, Stockholm .
    Rusner, Marie
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. Södra Älvsborg Hospital ; University of Borås.
    Nilsson, Christina
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. Sahlgrenska University Hospital ; University of Borås.
    Karlsson, Ann-Christin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. Blekinge Institute of Technology.
    Pettersson, Bengt-Olof
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Bremer, Anders
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Borås.
    Varför vårdvetenskap?2008In: Vårdvetenskapliga vägskäl / [ed] Maria Berglund, Annelie Johansson Sundler & Åsa Roxberg, Växjö: Institutionen för vårdvetenskap och socialt arbete , 2008, p. 49-59Chapter in book (Other academic)
  • 77.
    Jonasson, Lise-Lotte
    et al.
    University of Borås, Sweden.
    Sandman, Lars
    University of Borås, Sweden;Linköping university, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training2019In: Journal of Healthcare Leadership, ISSN 1179-3201, E-ISSN 1179-3201, Vol. 11, p. 63-74Article in journal (Refereed)
    Abstract [en]

    Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care. Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data. Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons. Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented.

  • 78. Jonsson, Annica
    Ambulanspersonalen måste ha utrymme för de närstående2012In: Vårdfokus, ISSN 2000-5717, no 3, p. 48-48Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Samtidigt som ambulanspersonalen försöker återuppliva en person med hjärtstopp, ska de vara lyhörda för anhörigas behov. Men beslutet att avbryta hjärt-lungräddning är alltid personalens.

  • 79.
    Nilsson, Christina
    et al.
    Örebro University, Sweden.
    Bremer, Anders
    University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Blomberg, Karin
    Örebro University, Sweden.
    Svantesson, Mia
    Örebro University, Sweden;University of Warwick, UK.
    Responsibility and compassion in prehospital support to survivors of suicide victim: professionals’ experiences2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 35, no November, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Highlights

    • Feelings of inadequacy as personal faced the survivors’ emotional storm and despair.
    • Personal made attempts to shield themselves and also the survivors.
    • Personal decision to focus on the survivors to give time and to be accessible.
    • They were uncertainty about responsibility and felling torn in the professional role.
    • The professionals need organisational guidelines and ethical support.
  • 80.
    Nord, Anette
    et al.
    Linköping University, Sweden.
    Lundgren, Johan
    Bremer, Anders
    University of Borås, Sweden.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linköping University, Sweden.
    Apropå! – HLR och rätten till en värdig död2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 20, article id 113:DZEHArticle in journal (Other (popular science, discussion, etc.))
  • 81.
    Olander, Agnes
    et al.
    University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Sundler, Annelie J.
    University of Borås, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Ljungström, Lars
    University of Gothenburg, Sweden;Skaraborg Hospital, Sweden.
    Hagiwara, Magnus Andersson
    University of Borås, Sweden.
    Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome2019In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 19, no 1, p. 1-8, article id 43Article in journal (Refereed)
    Abstract [en]

    Background The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. Methods This was a retrospective observational study. The patients' electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. Results In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. Conclusions The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

  • 82.
    Olander, Agnes
    et al.
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Ljungström, Lars
    Skaraborg hospital, Sweden.
    Gellerstedt, Martin
    University West, Sweden.
    Fridlund, Bengt
    Jönköping University, Sweden.
    Bång, Angela
    University of Gothenburg, Sweden.
    Identify the septic patient in the prehospital care2017In: Abstractbook: Advances in Health Care Sciences Conference 2017, Doctoral School in Health Care Sciences, Stockholm, November 15 & 16, 2017, p. 63-63Conference paper (Refereed)
    Abstract [en]

    AIM

    The aim was to determine the sensitivity of the new symptom based index test Altered Signs and Symptoms Emerge Sudden in Sepsis (ASSESS) in order to identify sepsis and compare it with four established index tests in the prehospital care.

    METHOD

    This is a quantitative study were the researchers collected data from medical records, and tested whether a new symptom based index test ASSESS was significantly better to identify sepsis compared to Rapid Emergency Triage and Treatment System (RETTS-ESS 47), BAS 90-30-90, Quick Sequential [Sepsis-related] (qSOFA) and The prehospital severe sepsis screening tool (PSSST). According to the Standards for Reporting of Diagnostic Accuracy (STARD-concept), a retrospective diagnostic accuracy and cohort study was conducted. The participants were 380 consecutive adult patients (age >18 years) who activated the Prehospital care-system and were transported to Skaraborgs County Hospital in west of Sweden , and subsequently discharged with an ICD-10-code consistent with sepsis, during a three-month period between January through April, 2012.

    RESULTS

    Of 380 patients 180 (47%) were female and 200 (53%) were male and with a mean age of 74±15 years. The ASSESS had a higher sensitivity to all four established index tests. Of the included symptoms in ASSESS the most common were sudden fever (63,9%), sudden breathing difficulties (60%), sudden muscle weakness (23,9%) and sudden gastrointestinal symptoms (20,2%).

    CONCLUSION

    ASSESS showed a higher sensitivity compared to the other four index test, which could in turn enable an earlier identification of sepsis patients in the prehospital care. Symptom presentation is included in the ASSESS index test as compared to the other four index tests which focus in major on vital signs alone. An inclusion of symptom presentation in a prehospital screening tool may thus increase the identification of sepsis. However, evidence on clinical benefit of the ASSESS index test need to be prospectively validated. 

  • 83.
    Sandlund, Mikael
    et al.
    Umeå University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ågård, Anders
    Sahlgrenska University Hospital.
    Engström, Ingemar
    Universitetssjukvårdens forskningscentrum, Örebro.
    Sallin, Karl
    Uppsala University.
    Kontinuitet främjar personligt och professionellt ansvarstagade2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 42, p. 1-2, article id ETHIArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Att utröna medicinska behov, fatta beslut och se dem genomförda är läkarens ansvar.

    För att få veta den enskilde patientens värderingar och önskemål krävs en förtroendefull relation med vårdgivaren. Kontinuitet förenklar skapandet av en sådan relation.  

    Trots att kontinuitet är centralt är det inte ett mål i sig, utan bör betraktas som ett medel för att uppnå andra mål som följer av läkarens yrkesetik och lagstiftning.

  • 84.
    Sandman, Lars
    et al.
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Etik inom ambulanssjukvården2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 26-39Chapter in book (Other academic)
  • 85.
    Steel, Karin
    et al.
    Linköping University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Gunnarsson, Lise-Lotte
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Strömberg, Anna
    Linköping University.
    Hjelm, Carina
    Linköping University.
    Nurses’ perceptions of cognitive function in survivors after cardiac arrest: a qualitative study2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e128-e128Article in journal (Refereed)
  • 86.
    Strandmark, Rasmus
    et al.
    Sahlgrenska University Hospital, Sweden.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden;University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Claesson, Andreas
    Karolinska Institutet, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Jimenez-Herrera, Maria
    Universitat Rovira i Virgili, Spain.
    Ravn-Fischer, Annica
    Sahlgrenska University Hospital, Sweden.
    Determinants of pre-hospital pharmacological intervention and its association with outcome in acute myocardial infarction2015In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 105Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was a) To identify predictors of the use of aspirin in the pre-hospital setting in acute myocardial infarction (AMI) and b) To analyze whether the use of any of the recommended medications was associated with outcome.

    Methods: All patients with a final diagnosis of AMI, transported by the Emergency Medical Services (EMS) and admitted to the coronary care unit at Sahlgrenska University Hospital in Gothenburg, Sweden, in 2009–2011, were included.

    Results: 1,726 patients were included. 58 % received aspirin by the EMS. Ischemic heart disease (IHD) was suspected in 84 %. Among patients who did not receive aspirin IHD was still suspected in 67 %. Among patients in whom IHD was suspected, and who were not on chronic treatment with aspirin the following predicted its pre-hospital use: a) age (odds ratio 0.98; 95 % confidence interval (CI) 0.96–0.99); b) a history of myocardial infarction (2.21; 1.21–4.04); c) priority given by EMS (8.07; 5.42–12.02); d) ST-elevation on ECG on admission to hospital (2.22; 1.50–3.29); e) oxygen saturation > 90 % (3.37; 1.81–6.27). After adjusting for confounders among patients who were not on chronic aspirin, only nitroglycerin of the recommended medications was associated with a reduced risk of death within 1 year (hazard ratio 0.40; 95 % CI 0.23–0.70).

    Conclusions: Less than six out of ten patients with AMI received pre-hospital aspirin. Five clinical factors were independently associated with the pre-hospital administration of aspirin. This suggests that the decision to treat is multifactorial, and it highlights the lack of accurate diagnostic tools in the pre-hospital environment. Nitroglycerin was independently associated with a reduced risk of death, suggesting that we select the use for a low-risk cohort.

  • 87.
    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.

  • 88.
    Svensson, Leif
    et al.
    University of Borås.
    Herlitz, Johan
    University of Borås.
    Bång, Angela
    University of Borås.
    Bremer, Anders
    University of Borås.
    Bröstsmärtor2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Liber, 2009, 1, p. 264-278Chapter in book (Other academic)
  • 89.
    Wallin, Kim
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hörberg, Ulrica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Werkander Harstäde, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Enablers and barriers in ambulance clinical placements – a mentor perspective2019In: Presented at Ambulans2019PreHospen: Ambulanssjukvårdens roll i morgondagens akutsjukvård, Stockholm, Sweden, April 2-3, 2019, 2019Conference paper (Refereed)
    Abstract [en]

    Background: The importance of clinical placements for nursing students to be able to integrate theory and practice and develop clinical competence are described in literature. Recent research in the Swedish prehospital context has shown that there possibly are differences in the preparations among ambulance nursing students before entering their clinical placements in accordance with studies in other countries. Studies have also highlighted difficulties in creating a good learning environment in the context of prehospital emergency care. The role of the mentor in supporting these students during clinical placements via an individualized mentorship model has proven to be of most importance. At the same time the role of the mentor is described as demanding, undefined and lacking support from both universities and ambulance services. In the Swedish educational system, the voice of the mentor is missing in research in order to develop and enhance the learning environment during clinical placements.

    Purpose: To describe mentors ‘experiences of enablers and barriers for supervision during ambulance clinical placements.

    Methods: Individual interviews were conducted with 20 mentors from 10 ambulance districts from all parts of Sweden. The interviews were analysed according to qualitative content analysis.

    Results/Conclusions: Preliminary findings indicates that the mentors need specific competence, further education and improved support from universities and ambulances services to feel competent and safe. They are forced to adjust their learning strategies to the unique context of prehospital emergency care and are constantly drawn between responsibilities towards the patient and the student. The role and the assignment are unclear and they are in need of support and structure. The competence and attitudes of the team colleague are of high importance for the mentors’ perceived support.

  • 90.
    Wallin, Kim
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hörberg, Ulrica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Werkander Harstäde, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Preceptors’ experiences of student supervision in the emergency medical services: a qualitative interview study2020In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 84, p. 1-8, article id 104223Article in journal (Refereed)
    Abstract [en]

    Background

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

    Objectives

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

    Design

    A descriptive qualitative design was used.

    Participants and setting

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

    Methods

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

    Findings

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

    Conclusions

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

  • 91.
    Wallin, Kim
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hörberg, Ulrica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Werkander Harstäde, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Elmqvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Prehospital emergency nurses' experiences as clinical supervisors2018In: Presented at the 3rd Global Conference on Emergency Nursing and Trauma Care, Noordwijkerhout, Netherlands, October 4-6, 2018, 2018Conference paper (Refereed)
  • 92.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Sweden.
    Abelsson, Anna
    Karlstad University, Sweden.
    Jakopovic, Denis
    Karolinska Institutet, Sweden.
    Wallin, Kim
    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.
    Rantala, Andreas
    Lund University, Sweden.
    Kågström, Christer
    Luleå University of Technology, Sweden.
    Ek, Bosse
    Mid Sweden University, Sweden.
    Lingsarve, Johan
    Uppsala University, Sweden.
    Tegelberg, Alexander
    Uppsala University, Sweden.
    Aléx, Jonas
    Umeå University, Sweden.
    Gyllencreutz, Lina
    Umeå University, Sweden.
    Uppstu, Tom
    Umeå University, Sweden.
    Lammgård, Tomas
    Örebro University, Sweden.
    Adolfsson, Annsofie
    Örebro University, Sweden.
    "Förödande att sänka kraven på ambulanspersonal"2017In: Svenska Dagbladet, ISSN 1101-2412, no 2017-06-08Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tidig och avancerad bedömning krävs när patienter möter personal inom ambulanssjukvården. Hur är det möjligt att frågan om sänkta kompetenskrav inom svensk ambulanssjukvård överhuvudtaget har väckts? undrar Nät­verket för ut­bildning av ambulanssjuksköterskor.

  • 93.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Lindström, Veronica
    Karolinska Institutet, Sweden;Academic EMS, Sweden.
    Vicente, Veronica
    Academic EMS, Sweden;The Ambulance Medical Service in Stockholm (AISAB), Sweden;Karolinska Institutet, Sweden.
    Caring science research in the ambulance services: an integrative systematic review2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 3-33Article, review/survey (Refereed)
    Abstract [en]

    Background

    The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.

    Aim

    This integrative systematic review aims to describe caring science research content and scope in the ambulance services.

    Data sources

    Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.

    Review methods

    The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five‐stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3‐level scale, and data relevance was evaluated on a 2‐level scale.

    Results

    After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision‐making; Public environment and patient safety; Life‐changing situations; and Ethics and values.

    Conclusion

    Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional–patient relation, with special focus on value conflicts in emergency situations.

  • 94.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, Sweden.
    Hagiwara, Magnus
    University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Abelsson, Anna
    Karlstad University, Sweden.
    Jakopovic, Denis
    Karolinska Institutet, Sweden.
    Wallin, Kim
    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.
    Kågström, Christer
    Luleå University of Technology, Sweden.
    Ek, Bosse
    Mid Sweden University, Sweden.
    Lingsarve, Johan
    Uppsala University, Sweden.
    Tegelberg, Alexander
    Uppsala University, Sweden.
    Hellman, Per
    Uppsala University, Sweden.
    Aléx, Jonas
    Umeå University, Sweden.
    Gyllencreutz, Lina
    Umeå University, Sweden.
    Uppstu, Tom
    Umeå University, Sweden.
    Lammgård, Tomas
    Örebro University, Sweden.
    Adolfsson, Annsofie
    Örebro University, Sweden.
    Ek, Tony
    Riksföreningen för ambulanssjuksköterskor, Sweden.
    Hommel, Ami
    Svensk sjuksköterskeförening, Sweden.
    Ribeiro, Sineva
    Vårdförbundet, Sweden.
    ”Nationella riktlinjer behövs för ambulanspersonal”2017In: Svenska Dagbladet, ISSN 1101-2412, no 2017-06-29Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Det är förödande att sänka kraven på ambulanspersonal. Därför efterlyser vi nationella riktlinjer och beslut som tydligt anger en lägsta utbildningsnivå för anställning inom ambulanssjukvården, skriver Nät­verket för ut­bildning av ambulanssjuksköterskor i en slutreplik.

  • 95.
    Ågård, Anders
    et al.
    Sahlgrenska University Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Sallin, Karl
    Uppsala University, Sweden.
    Engström, Ingemar
    Örebro University, Sweden.
    Ethical controversies in the process of formulating new national guidelines on cardiopulmonary resuscitation in Sweden2017In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 4, p. 174-179Article in journal (Refereed)
    Abstract [en]

    The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

  • 96.
    Årestedt, Kristofer
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Allert, Camilla
    Blekinge Institute of Technology, Sweden.
    Djukanovic, Ingrid
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Council, Sweden.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Agerström, Jens
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Herlitz, Johan
    University of Borås, Sweden.
    Årestedt, Liselott
    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. Kalmar County Council, Sweden.
    Health-related quality of life among in-hospital cardiac arrest survivors in working age2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, article id e18Article in journal (Refereed)
  • 97.
    Årestedt, Kristofer
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Psychometric properties of the Hospital Anxiety and Depressionscale in sudden cardiac arrest survivors2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl 1, p. 141-141Article in journal (Refereed)
    Abstract [en]

    Purpose: Emotional distress, in terms of anxiety and depression, is common among patients who survive a sudden cardiac arrest (SCA). The Hospital Anxiety and Depression scale (HAD) is one of the most used instruments to assess emotional distress in SCA survivors. However, it has not to our knowledge been psychometrically tested in this group of patients. The aim was therefore to evaluate the measurement properties of the HAD in SCA survivors.

    Materials and methods: Data from the Swedish Register of Cardiopulmonary Resuscitation was used. In the register, data is collected 3–6 months after resuscitation by using a questionnaire including HAD. Data quality was evaluated according to the distribution of item and scale score and missing data patterns. A principal component factor analysis was conducted to explore the factor structure. Internal consistency was evaluated with Cronbach's alpha.

    Results: The sample consisted of 498 in-hospital survivors with a mean age of 69.3 ± 12.6 years. All items demonstrated problems with floor effects. The scale scores for both anxiety and depression deviated significantly from a normal distribution (p < 0.001). The factor analysis reproduced the hypothesized two-factor structure, which explained 59% of the total variance. The factor loadings varied between 0.547 and 0.778 for anxiety and between 0.651 and 0.780 for depression. Cronbach's alpha was 0.874 and 0.875 for anxiety and depression respectively.

    Conclusions: The HAD demonstrated good measurement properties among SCA survivors. Despite problems with floor effects, the two HAD scales, anxiety and depression, seem to be uni-dimensional measures with good internal consistency. Therefore, the HAD can be recommended to assess emotional distress among SCA survivors.

  • 98.
    Årestedt, Kristofer
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sawatsky, Richard
    Trinity Western University, Canada.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Psychometric properties of the Hospital Anxiety and Depression scale in cardiac arrest survivors2017Conference paper (Refereed)
    Abstract [en]

    Background: The Hospital Anxiety and Depression scale (HAD) is commonly used to assess emotional distress in different group of patients. Despite emotional distress is common in sudden cardiac arrest survivors (SCA), HAD have not to our best knowledge been psychometrically evaluated in this patient group.

    Purpose: The aim was to evaluate the psychometric properties of the HAD, with focus on factor structure, internal consistency and differential item functioning (DIF) for sex and age, in SCA survivors.

    Methods: Data from the national Swedish Register of Cardiopulmonary Resuscitation were used, including HAD ratings from in-hospital cardiac arrest survivors, collected 3-12 months after resuscitation. Confirmatory factor analysis (CFA) was used to evaluate the hypothesized two factor structure for Anxiety and Depression, respectively. Ordinal version of Cronbach’s alpha was calculated to evaluate internal consistency reliability of the two factors. Multiple indicator multiple causes CFA models (MIMIC) were used to detect presence of DIF.

    Results: The sample consisted of 604 in-hospital cardiac arrest survivors (mean age 69.4±12.6), 384 men and 220 women. The suggested two-factor model was confirmed after item 7 was allowed to cross-load on Depression. The internal consistency was satisfactory for both Anxiety (.92) and Depression (.91). No DIF for sex and age was demonstrated.

    Conclusion: This study shows that the HAD Anxiety and Depression subscales are unidimensional. Both scales can also be used to make invariant comparisons between groups of different sex and age. Therefore, HAD can be used to assess psychological distress (anxiety and depression) in SCA survivors.

  • 99.
    Årestedt, Kristofer
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sawatzky, R.
    Trinity Western Univ, Canada.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Herlitz, J.
    University of Borås, Sweden.
    Lilja, G.
    Lund University, Sweden.
    Cronberg, T.
    Lund University, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Psychometric properties of the Hospital Anxiety and Depression scale in cardiac arrest survivors2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, p. S2-S3Article in journal (Other academic)
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