Caring approach for patients with chest pain – Swedish registered nurses’ lived experiences in Emergency Medical Services

Carnesten, Hillewi; Asp, Margareta; Holmberg, Mats

doi:10.1080/17482631.2021.1901449

Cited by 5 publications

(7 citation statements)

References 46 publications

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“…Fostering trust, care and patient empowerment were perceived as important by ambulance clinicians when managing adults suffering pain. It was found that “ Having a calm approach while encountering patients with chest pain is experienced as a prerequisite in obtaining the patient's trust .” Carnesten et al 29 [researcher quotation]. Creating conditions of participation and adapting to the patient's needs were methods identified to promote patient empowerment 40 …”

Section: Resultsmentioning

confidence: 99%

“…Regular re‐evaluation of pain was deemed important as well as allowing the patient to choose additional analgesic administration where needed 40 . Good verbal and nonverbal communication was found to engender well‐being, trust, confidence, and reassurance for patients 29 . Professional behavior and conduct were also a key aspect of care, as prioritization of the tasks over and above the patient were deemed to have a negative impact on the patient, creating a sense of loneliness 26 …”

Section: Resultsmentioning

confidence: 99%

“…40 Good verbal and nonverbal communication was found to engender well-being, trust, confidence, and reassurance for patients. 29 Professional behavior and conduct were also a key aspect of care, as prioritization of the tasks over and above the patient were deemed to have a negative impact on the patient, creating a sense of loneliness. 26 Fostering trust, care and patient empowerment were perceived as important by ambulance clinicians when managing adults suffering pain.…”

Section: The Clinician-patient Relationship Is Key To Enabling Good P...mentioning

confidence: 99%

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Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

et al. 2023

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Background We aimed to synthesize the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults and generate recommendations to improve the quality of care. Methods A systematic review was conducted following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines. We searched from inception to June 2021: MEDLINE, CINAHL Complete, PsycINFO and Web of Science (search alerts were screened up to December 2021). Articles were eligible for inclusion if they reported qualitative data and were published in the English language. The Critical Appraisal Skills Program for qualitative studies checklist was used to assess risk of bias, thematic synthesis was performed on included studies and recommendations for clinical practice improvement were generated. Results Twenty‐five articles were included in the review, representing over 464 patients, family members, and ambulance staff from 8 countries. Six analytical themes and several recommendations to improve clinical practice were generated. Strengthening the patient–clinician relationship by building trust, promoting patient empowerment, addressing patient needs and expectations, and providing a holistic approach to pain treatment is key to improving prehospital pain management in adults. Shared pain management guidelines and training across the prehospital and emergency department intersection should improve the patient journey. Conclusion Interventions and guidelines that strengthen the patient‐clinician relationship and span the prehospital and emergency department phase of care are likely to improve the quality of care for adults suffering acute pain in the prehospital setting.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: The Clinician-patient Relationship Is Key To Enabling Good P...mentioning

confidence: 99%

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Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

et al. 2023

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“…Older persons' dignity is also honoured when supported in making care decisions despite lowered decision-making ability [32]. However, ambulance personnel's decisions on-scene are influenced by the risk of being held liable in case of medical error [33], and the ability to provide qualitative safe care is similarly dependent on the collaboration within the ambulance team [34,35].…”

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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“…Ambulance personnel describe wanting available external dialogue with other healthcare professional during decision-making (159). Support is further experienced by ambulance personnel in external dialogue with colleagues during assessments and level-of-care decisions (114,159,307). Moreover, ambulance personnel seek acknowledgement of their decisions (23,168) through, for example dialogues with colleagues or other healthcare professionals during decision-making involving complex decisions.…”

Section: Healthcare Professionals' Experiences Of External Dialogue I...mentioning

confidence: 99%

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

Forsgärde¹

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Aim: The overall aim was to describe and compare pathways for older patients and the involved actors’ experiences of decision-making in acute situations in ambulatory care. Methods: The overall three-fold design, comprising exploratory, descriptive as well as comparative ones, was conducted inductively, including a mixed method with a convergent integrated approach to empirical data. The four involved studies were analysed using either quantitative or qualitative analysis methods. Results: Most older patients’ pathways when being assessed by ambulance personnel involved receiving care at hospitals. However, an increasing trend of non-conveyance to hospitals was identified during a five-year period (2014–2018), which means receiving care, for example, at home or primary healthcare (PHC) centres. Decision-making about the level-of-care for older patients was more or less uncertain for all involved actors, i.e. older patients, significant others and healthcare professionals such as ambulance personnel, registered nurses, specialists in general practice at PHC centres and community health nurses. To increase the level of certainty in the decision-making process, all actors was supported by both an individual and external dialogue. Individual dialogue gave support by using own experience and knowledge. For ambulance personnel and community health nurses, support was also partially gained from decision support tools but was regarded as insufficient when older patients had non-specific symptoms. External dialogue provided support through mutuality, and via collaboration, a common goal, trust and responsibility. Mutuality gave support through experience and knowledge being shared with all involved actors, which provided a common comprehensive understanding that facilitated consensus in the decision-making. Conclusion: The increasing level of non-conveyance to hospitals and uncertainty during decision-making highlights the need to develop and extend the availability of dialogue-based collaborations as support in ambulatory care. Dialogue-based support involves all actors contributing to the decision-making. Healthcare professionals need to be aware of the prerequisites and the support that mutuality in external dialogues brings. Healthcare organisations need to develop and extend dialogue-based collaboration in ambulatory care by combining different expertise and providing conditions to increase support in decisions adapted to older patients' needs.

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Caring approach for patients with chest pain – Swedish registered nurses’ lived experiences in Emergency Medical Services

Cited by 5 publications

References 46 publications

Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

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

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

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