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

Abstract

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.

Caring science research in the ambulance services: an integrative systematic review

“…There are challenges for ambulance professionals associated with: (i) the assessment and triage of patients exposed to severe trauma and/or epilepsy seizures ; (ii) the referral of older people after falls ; (iii) religious and spiritual needs ; and (iv) differentiating frailty in older people . The extent of the challenges in emergency care situations was decisive for how decisions were made and demonstrated the challenges involved in getting to know individual patients .…”

“…The assessment of severe trauma patients was perceived as a way of developing professional knowledge. More learning by practical skills training and feedback was needed , such as communication skills with dying patients and their families ; nursing critically ill and injured children ; and pain management . Lack of training in paediatrics was found to be a problem .…”

Psychosocial Workload of Swedish Ambulance and Emergency Room Personnel with High Prevalence of Dying, Death and Grieving Relatives. A Descriptive and Comparison Study

“…Several studies have underlined the importance of feedback from the management and acknowledgment for a job good made (36). This was also frequently wished for by responders in our study.…”

Clinical decision-making described by Swedish prehospital emergency care nurse students – An exploratory study

“…To educate for the uncommon situations when there are few assignments during the clinical rotation is a complex task. It was reported that the PECNs were sometimes worried about specific emergencies as well as situations related to the environment where the illness or injury occurred (Abelsson and Lindwall, 2012;Svensson and Fridlund, 2008). The lack of opportunities to practice may cause this worry.…”

“…Emergency situations that arise in the prehospital context require quick assessment and a fast response to increase the survival of patients (Bang et al, 2008), and there is little margin for error or misjudgement. Previous studies have found that the RNs working in the ambulance services are sometimes worried about specific emergencies as well as situations related to the environment where the illness or injury has occurred (Abelsson and Lindwall, 2012;Svensson and Fridlund, 2008). Developing expertise in the prehospital emergency care practice requires both theoretical and empirical learning.…”