Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions

Sundström, Birgitta Wireklint; Dahlberg, Karin

doi:10.1016/j.ienj.2010.07.005

Cited by 65 publications

(58 citation statements)

References 27 publications

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“…How the elderly gain access to the world and live with their suffering is made apparent, that is, the life situation and feelings that come with illness and disease in old age are expressed through the elderly body. In agreement with Dahlberg (2011) and Wireklint Sundström and Dahlberg (2011), disease involves a subjective dimension of health and the importance of not reducing the patient to her/his symptoms or making her/him into an object is underlined.…”

Section: Discussionsupporting

confidence: 74%

“…Therefore, it is crucial that an interpersonal encounter develops, making it possible for patients to express their needs. According to Nyström et al (2002) and Wireklint Sundström and Dahlberg (2011), nursing practices need to account for patients’ contribution in care and decision-making processes. Consequently, and based on the present findings, we argue that healthcare must be lifeworld-centered with special carefulness toward vulnerable old people.…”

Section: Discussionmentioning

confidence: 99%

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Elderly patients’ participation in emergency medical services when offered an alternative care pathway

Vicente

Castrèn

Sjöstrand

et al. 2013

International Journal of Qualitative Studies on Health and Well

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As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient's medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as “There was a ray of hope about a caring encounter and about being treated like a unique human being”. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Elderly patients’ participation in emergency medical services when offered an alternative care pathway

Vicente

Castrèn

Sjöstrand

et al. 2013

International Journal of Qualitative Studies on Health and Well

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“…The result of this study shows SAN's perception of assessing patients exposed to severe trauma, which have not previously been studied. Studies have been carried out on ambulance personnel [1,18,19] and on the patient's experience [20] of the assessment situation, which our study complements with an additional dimension, SAN's experience and how this affects the assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Fast decisions are based on very little information, which is also stated by Wireklint [19]. In some cases the assessment resulted in actions that were not supported by the treatment guidelines.…”

Section: Discussionmentioning

confidence: 99%

The Prehospital assessment of severe trauma patients` performed by the specialist ambulance nurse in Sweden – a phenomenographic study

Abelsson

Lindwall

2012

Scand J Trauma Resusc Emerg Med

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BackgroundA common feature of prehospital emergency care is the short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made and the premise is the specialist ambulance nurse’s ability to capture the situation instantaneously. The assessment is therefore a pre-requisite for decisions about appropriate actions. However, the low exposure to severe trauma cases in Sweden leads to vulnerability for the specialist ambulance nurse, which makes the assessment more difficult. Our objective was to describe specialist ambulance nurses’ perceptions of assessing patients exposed to severe trauma.MethodsThis study had a phenomenographic approach and was performed in 2011 as an interview study. 15 specialist ambulance nurses with a minimum of 2.5 years of experience from praxis were included. The analysis of data was performed using phenomenography according to Marton.ResultsThe perceptions of assessing patients exposed to severe trauma were divided into: To be prepared for emergency situations, Confidence in one’s own leadership and Developing professional knowledge.ConclusionsThis study reveals that the specialist ambulance nurse, on the scene of accident, finds the task of assessment of severe trauma patients difficult and complicated. In some cases, even exceeding what they feel competent to accomplish. The specialist ambulance nurses feel that no trauma scenarios are alike and that more practical skills, more training, exercise and feedback are needed.

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“…This education was expected to deepen the ANs’ knowledge and increase their possibilities of relieving and treating chest pain and anxiety as well as providing cardiovascular treatment. A lifeworld approach (which refers to Edmund Husserl’s philosophy) [2] allowed caring and medicine to be applied simultaneously in a natural way [19]. The teaching strategies were based on the expectation that the patients would experience the inhibition of the anxiety accompanying their symptoms of pain and discomfort.…”

Section: Methodsmentioning

confidence: 99%

Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial

et al. 2016

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BackgroundCurrent research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses’ (ANs’) prehospital care of patients experiencing suspected ACS, related to pain intensity.MethodsThis is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.ResultsThe pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.ConclusionsAn educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.Trial registrationThe ClinicalTrials.gov Protocol Registration System (registration number NCT00792181).

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Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions

Cited by 65 publications

References 27 publications

Elderly patients’ participation in emergency medical services when offered an alternative care pathway

Elderly patients’ participation in emergency medical services when offered an alternative care pathway

The Prehospital assessment of severe trauma patients` performed by the specialist ambulance nurse in Sweden – a phenomenographic study

Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial

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