A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services

Hjalmarsson, Anna; Östlund, Gunnel; Asp, Margareta; Kerstis, Birgitta; Holmberg, Mats

doi:10.1080/17482631.2022.2082062

Cited by 3 publications

(6 citation statements)

References 74 publications

(92 reference statements)

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“…Being multi-diseased, an older patient can follow all these trajectories at the same time, which may make their symptoms more difficult to assess. Therefore, it cannot be denied that many of them could benefit from being provided care in the ambulance, a space that has been described to possess advanced resources and competent staff who can provide the needed aid and safety in a vulnerable situation (31). Thus, ACs' tendency to leave older patients at home can be seen as an expression of ageism, signifying the discrimination against, and prejudicially stereotyping of, older people (32).…”

Section: Discussionmentioning

confidence: 99%

Caring for older patients with reduced decision-making capacity. A deductive exploratory study of ambulance clinicians’ ethical competence

Holmberg

Bennesved

Bremer

2023

Preprint

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Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patient. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack the acquired ethical knowledge regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values.

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Section: Discussionmentioning

confidence: 99%

Caring for older patients with reduced decision-making capacity. A deductive exploratory study of ambulance clinicians’ ethical competence

Holmberg

Bennesved

Bremer

2023

Preprint

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“…MCPs opposing ambulance personnel's assessments might face sanctions by conflict. Previous research describes how MCPs in recognition of the older person's vulnerable state act as representatives, and how they express frustration and anger when ambulance personnel display ignorance or disinterest [24]. Foucault [43] states that power and resistance always coexist.…”

Section: Trusting or Distrusting Abilitiesmentioning

confidence: 99%

“…A majority of ambulance assignments in Sweden involve older persons [22,23], and about 60% of assignments to people's homes involve persons aged 70 or older [22]. Swedish municipalities have no assigned responsibility to provide emergency care, and municipal care personnel face emergencies having insufficient knowledge and support [24]. South Korean research displays how panic might be experienced when faced with an older person's emergency, in addition to hardship in even recognising acute illness [25].…”

Section: Introductionmentioning

confidence: 99%

Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel

Hjalmarsson

Östlund

Asp

et al. 2023

Scandinavian Caring Sciences

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BackgroundPatient participation is considered to promote well‐being and is, therefore, central in care contexts. Care‐dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.AimTo illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.MethodA phenomenological hermeneutical method was used to analyse transcripts of narrative interviews with 11 ambulance personnel.ResultsThe ambulance personnel's lived experience of older persons' participation includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that empowers participation. The main theme ‘Balancing dignity in relation to manipulating the body’ included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well‐being and being guided by reactions. The main theme ‘Balancing influence in relation to perceived health risks’ included the themes Agreeing on a common perspective, Directing decision‐making mandate, and Sharing responsibility for well‐being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.ConclusionCare‐dependent older persons' participation in care from the perspective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balancing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve ambulance care to benefit older persons in critical life situations.

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“…Emergency care is the responsibility of the regional emergency medical service (EMS) and is provided by the ambulance services. Acute illness thus involves municipal and regional collaboration and transitional care [13].…”

Section: Introductionmentioning

confidence: 99%

“…Older persons with lowered decision-making ability also risk paternalistic ambulance care, which emphasises the ethical obligation to make decisions in the older person's best interest [17]. In situations involving older persons' acute illness, municipal care personnel are found to take on the role of the older person's representative in contact with EMS [13]. The involvement of both municipal and regional caregivers in emergencies can, however, both disturb and promote caring efforts [13,17].…”

Section: Introductionmentioning

confidence: 99%

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services

Hjalmarsson,

Östlund,

Asp

et al. 2023

Scandinavian Caring Sciences

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BackgroundParticipation in care is considered to promote safe and qualitative care. Care‐dependent older persons ageing in place have increased emergency care needs, which initiate inter‐organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.AimThis study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care‐dependent older persons experiencing acute illness at home.DesignThis study has a qualitative design with a lifeworld approach.MethodA phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care‐dependent persons aged 70–93 years.ResultsCare‐dependent older persons' participation in prehospital emergency care means ‘Entrusting life to professional caregivers’ when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.ConclusionCare‐dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well‐being and continued living.Implications for practicePrehospital emergency care from the perspective of care‐dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld‐led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

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A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services

Cited by 3 publications

References 74 publications

Caring for older patients with reduced decision-making capacity. A deductive exploratory study of ambulance clinicians’ ethical competence

Caring for older patients with reduced decision-making capacity. A deductive exploratory study of ambulance clinicians’ ethical competence

Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services

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