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Stjerna Doohan I, Davidsson M, Danielsson M, Aléx J. Behind the scenes: a qualitative study on threats and violence in emergency medical services. BMC Emerg Med 2024; 24:172. [PMID: 39322957 PMCID: PMC11426083 DOI: 10.1186/s12873-024-01090-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 09/16/2024] [Indexed: 09/27/2024] Open
Abstract
The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospital emergency care, affecting both the safety and well-being of the clinicians involved. This study aimed to explore the experiences of Swedish ambulance clinicians when encountering threats and violence during their work. A qualitative approach was used, involving semi-structured interviews with 11 ambulance clinicians from various regions of Sweden. The participants were selected to ensure diversity in gender, age, and educational background. The data were collected over three weeks in 2021 and analyzed using qualitative content analysis. The analysis revealed three key categories related to the challenges faced by ambulance clinicians: Police cooperation challenges, Strategies for a safe care environment, and Impact during and relief after stressful events. These categories highlight the complexities of managing threats and violence in the field. This study sheds light on the multifaceted challenges that ambulance clinicians face due to threats and violence. It underscores the urgent need for comprehensive training, effective communication, and clear role allocation in complex situations. Furthermore, it emphasizes the importance of organized support systems to help clinicians cope with the aftermath of stressful events.
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Affiliation(s)
| | - Måns Davidsson
- Department of Nursing, Umeå University, Umeå, SE-901 87, Sweden
| | | | - Jonas Aléx
- Department of Nursing, Umeå University, Umeå, SE-901 87, Sweden.
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Sheikhi RA, Heidari M. The challenges of delivery in pre-hospital emergency medical services ambulances in Iran: a qualitative study. BMC Emerg Med 2024; 24:156. [PMID: 39218848 PMCID: PMC11368009 DOI: 10.1186/s12873-024-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Although unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emergency Medical Technicians (EMTs), midwives, and expectant mothers to examine the causes of giving birth in ambulances and the challenges EMTs, pregnant women, and midwives face during delivery. METHODS A qualitative study was conducted, and 28 EMTs, midwives, and pregnant women who had experience with pre-hospital births in the ambulance were interviewed. Data were analyzed using thematic content analysis. The MAXQDA/10 software was employed for data analysis and code extraction. RESULTS The analysis of the interviews revealed two main categories: factors that cause delivery in the ambulance and its challenges. The factors include cultural problems, weak management, and inaccessibility to facilities. The challenges consist of fear and anxiety, native culture, and lack of resources. CONCLUSIONS Several approaches should be implemented to reduce the number of births in ambulances and Pre-hospital Emergency Medical Services (PEMS). These include long-term community cultural activities, public education, awareness campaigns, education and follow-up for pregnant women, and improved accessibility to health facilities. Additionally, EMTS need to receive proper education and training for ambulance deliveries. Enhancing ambulance services and supporting EMTs in dealing with litigation claims are also critical.
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Affiliation(s)
- Rahim Ali Sheikhi
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Heidari
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Khazaei A, Afshari A, Salimi R, Fattahi A, Imani B, Torabi M. Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis. BMC Emerg Med 2024; 24:106. [PMID: 38926678 PMCID: PMC11209986 DOI: 10.1186/s12873-024-01024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers. METHODS This study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45-60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman's conventional content analysis approach. RESULTS The analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses. CONCLUSIONS The results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.
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Affiliation(s)
- Afshin Khazaei
- Department of Medical Emergencies, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Ali Afshari
- Nursing Department, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Rasoul Salimi
- Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Fattahi
- Department of Medical Library and Information Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Imani
- Department of Operating Room, School of Allied Medical Sciences, Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Torabi
- Department of Nursing, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
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Maple JL, Whiteside M, Smallwood N, Putland M, Baldwin P, Bismark M, Harrex W, Johnson D, Karimi L, Willis K. Culture, conditions and care support mental health of healthcare workers during crises. Occup Med (Lond) 2024; 74:211-217. [PMID: 38319824 DOI: 10.1093/occmed/kqae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers. AIMS This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis. METHODS Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations. RESULTS Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being). CONCLUSIONS Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.
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Affiliation(s)
- J L Maple
- Institute for Health and Sport, Victoria University, Footscray, Victoria 3011, Australia
| | - M Whiteside
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3000, Australia
| | - N Smallwood
- Department of Respiratory Medicine, The Alfred Hospital, Prahran, Victoria 3004, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria 3004, Australia
| | - M Putland
- Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
- Department of Critical Care, Faculty of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - P Baldwin
- Black Dog Institute, Randwick, New South Wales 2031, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - M Bismark
- Centre for Health Policy, University of Melbourne, Parkville, Victoria 3010, Australia
| | - W Harrex
- Australasian Faculty of Occupational and Medicine, Royal Australasian College of Physicians, Sydney, New South Wales 2000, Australia
| | - D Johnson
- Department of General Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - L Karimi
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia
| | - K Willis
- Institute of Health and Sport, Victoria University, Footscray, Victoria 3011, Australia
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Bäckström D, Alvinius A. Physicians' challenges when working in the prehospital environment - a qualitative study using grounded theory. Int J Emerg Med 2024; 17:28. [PMID: 38413854 PMCID: PMC10900586 DOI: 10.1186/s12245-024-00599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND In the rapid development in prehospital medicine the awareness of the many challenges in prehospital care is important as it highlights which areas need improvement and where special attention during education and training should be focused. The purpose of this study is to identify challenges that physicians face when working in the prehospital environment. The research question is thus; what challenges do physicians face when working in prehospital care? METHOD This is a qualitative study with an inductive approach and is based on individual interviews. The interviews were analyzed using the Classic Grounded Theory (GT) method as an approach. The interviews were conducted as semi-structured interviews via the digital platform Zoom during winter / early spring 2022. RESULTS Challenges for prehospital physicians can be understood as a process that involves a balancing act between different factors linked to the extreme environment in which they operate. This environment creates unique challenges not usually encountered in routine hospital practice, which results in trade-offs that they would not otherwise be faced with. Their individual situation needs to be balanced against organizational conditions, which means, among other things, that their medical decisions must be made based on limited information as a result of the constraints that exist in the prehospital environment. They must, both as individuals and as part of a team, manoeuvre in time and space for decision-making and practical tasks. This theory of balancing different entities is based on four themes; thus the theory is the relation between the four themes: leadership, environment, emotion management and organization. CONCLUSIONS With the help of previous studies and what we have found, it is reasonable to review what training is needed before starting to work prehospital as a physician. This should include components of the themes we have described: organization, environment, leadership and emotional management.
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Affiliation(s)
- Denise Bäckström
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden.
| | - Aida Alvinius
- Department of Leadership and Command & Control, Swedish Defence University, Våxnäsgatan 10, Karlstad, 651 80, Sweden
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Montero-Tejero DJ, Jiménez-Picón N, Gómez-Salgado J, Vidal-Tejero E, Fagundo-Rivera J. Factors Influencing Occupational Stress Perceived by Emergency Nurses During Prehospital Care: A Systematic Review. Psychol Res Behav Manag 2024; 17:501-528. [PMID: 38374938 PMCID: PMC10874882 DOI: 10.2147/prbm.s455224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
Objective To assess personal and work-related factors influencing the stress levels of nurses during prehospital care. Specifically, to identify associations between the level of perceived stress, the degree of professional experience, and the level of knowledge. Secondly, to examine the relationship between stress levels and violence in the work environment. And third, to investigate the main protective factors against work-related stress during prehospital care. Methods Systematic review in PubMed, WOS, Enfispo, Cochrane, and LILACS databases following the PRISMA methodology (last search 08/Aug/2023). Following the PECO framework, studies on occupational stress factors in ambulance emergency nurses were investigated. Studies in English or Spanish, from 2013 to 2023, and only research articles were admitted, thus excluding reviews, dissertations, and grey literature. Possible bias and level evidence were assessed using critical appraisal tools and GRADE. This protocol was registered in PROSPERO with code CRD42023446080. Results Fourteen articles were selected, and n=855 prehospital nurses were identified. One study was a clinical trial, and the others were observational and qualitative. The level of evidence was very low (n=7), low (n=6), and moderate (n=1); any study was excluded due to methodological bias. Five categories of stressors were extracted: the management of the health service (ie, workload organisation, and resources), patient care (mainly paediatric care), interpersonal stressors (relationship with peers), environmental factors (exposure to injuries), and personal factors (training, experience, and coping strategies). Violence at work is frequent for prehospital nurses, implying both verbal and physical aggressions. Support from peers was associated with positive results against stress. Conclusion Managing workload and improving resources in the work environment are essential to reduce fatigue and allow emotional processes to be addressed. Providing workers with coping skills also imposes on them the responsibility to cope with stress. Collective awareness is the main element in reducing the incidence of stress.
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Affiliation(s)
- Diego José Montero-Tejero
- Department of Emergency, Hospital Universitario Lucus Augusti, Galician Health Service, Lugo, Galicia, Spain
| | - Nerea Jiménez-Picón
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Andalusia, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Andalusia, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Elena Vidal-Tejero
- Department of Cardiology, Hospital Universitario Virgen Del Rocío, Andalusian Health Service, Sevilla, Andalusia, Spain
| | - Javier Fagundo-Rivera
- Centro Universitario de Enfermería Cruz Roja, University of Seville, Sevilla, Andalusia, Spain
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Wästerhed J, Ekenberg E, Hagiwara MA. Ambulance nurses' experiences as the sole caregiver with critical patients during long ambulance transports: an interview study. Scand J Trauma Resusc Emerg Med 2024; 32:6. [PMID: 38263118 PMCID: PMC10807097 DOI: 10.1186/s13049-024-01178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Working in rural areas involves tackling long distances and occasional lack of supportive resources. Ambulance nurses are faced with the responsibility of making immediate autonomous decisions and providing extended care to critically ill patients during prolonged ambulance transport to reach emergency medical facilities. This study aims to expose the experiences of ambulance nurses acting as primary caregivers for critically ill patients during lengthy ambulance transfers in rural regions. METHOD Fifteen nurses employed in an ambulance service within sparsely populated rural areas were subjected to semi-structured interviews. The collected data underwent qualitative content analysis. RESULT The analysis resulted in one overarching theme with two categories. The theme is 'Safety in the Professional Role,' and the two categories are 'Working in sparsely populated areas presents challenges' and 'Rare events: when routine cannot be established.' The findings suggest that working as an ambulance nurse in a rural setting poses various challenges that can be highly stressful. Delivering care to critically ill patients during extended ambulance transports requires the knowledge, experience, and careful planning of the healthcare provider in charge. CONCLUSIONS The findings underscore the necessity for thorough planning and adaptable thinking when attending to critically ill patients during extended transport scenarios. The absence of supporting resources can render the task demanding. Nevertheless, participants reported an inherent tranquility that aids them in maintaining focus amid their responsibilities.
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Affiliation(s)
- Jenny Wästerhed
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden
| | - Erika Ekenberg
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden.
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Gebhard J, Graf J, Abele H, Pauluschke-Fröhlich J. [Involvement and Handling of Paramedics in Unplanned Out-of-Hospital Births: An Online Survey]. DAS GESUNDHEITSWESEN 2024; 86:18-27. [PMID: 38081207 PMCID: PMC11248984 DOI: 10.1055/a-2183-5837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Unplanned out-of-hospital births are very rare in the ambulance service and there is evidence that emergency paramedics do not feel comfortable with this operational picture. At the same time, there is an increased of morbidity and mortality for both the mother and the newborn. The aims of the present cross-sectional study were to identify insecurities of emergency paramedics in connection with unplanned out-of-hospital births, to analyse the reasons for this and to derive possible support measures to be implemented. MATERIAL AND METHODS This study is a quantitative cross-sectional study examining management of unplanned out-of-hospital births by paramedics using a self-designed questionnaire. 65 participants took part in the online survey during the period from April 6, 2022 to April 30, 2022. SPSS was used for statistical data analysis. The central tendency of various influencing variables was examined with the help of the Mann-Whitney U test, the significance level was α<0.05. RESULTS On average, preparation Median (IQR): 2.0 (1.0) and safety with the measures to be performed 3.0 (01.0), as well as knowledge about unplanned out-of-hospital births 2.0 (1.0) were rated moderately well. The participating paramedics had particular difficulties with the documentation of the birth process 3.0 (1.0). There was a great deal of respect for out-of-hospital birth attendance among participants 1.0 (1.0). Participation in an interdisciplinary simulation session appeared to have had a positive influence on the handling and preparation for safety in the measures to be taken (p=0.016). CONCLUSION Insecurites as well as possible reasons for them could be identified. Possible suggestions for improvement for emergency paramedics in unplanned out-of-hospital births were developed. For example, specific birth protocols and participation in a simulation are good ways to help.
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Affiliation(s)
- Josina Gebhard
- Abteilung Hebammenwissenschaft, Eberhard Karls Universität
Tübingen, Tübingen, Germany
| | - Joachim Graf
- Abteilung Hebammenwissenschaft, Eberhard Karls Universität
Tübingen, Tübingen, Germany
| | - Harald Abele
- Abteilung Hebammenwissenschaft, Eberhard Karls Universität
Tübingen, Tübingen, Germany
- Department für Frauengesundheit, Universitätsklinikum
Tübingen, Tübingen, Germany
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Afshari A, Torabi M, Navkhasi S, Aslani M, Khazaei A. Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods. BMC Emerg Med 2023; 23:136. [PMID: 37968617 PMCID: PMC10648310 DOI: 10.1186/s12873-023-00906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. METHODS Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. RESULTS The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: "the overall impact of the stress crisis on technicians," "missing links in the communication network in incident management," "professional shortcomings in pre-hospital care," and "the complex and multifaceted context of stressful pre-hospital emergencies." Additionally, the study's theme was centered around "surveying the experiences of EMTs in stressful environments." CONCLUSION As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.
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Affiliation(s)
- Ali Afshari
- Department of Medical Surgical Nursing, Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Torabi
- Department of Nursing, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sasan Navkhasi
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Marzieh Aslani
- Instructor of Critical Care Nursing, Department of Nursing, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Afshin Khazaei
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran.
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Almeida M, Lobão C, Coelho A, Parola V. Emotional Management Strategies in Prehospital Nurses: A Scoping Review. NURSING REPORTS 2023; 13:1524-1538. [PMID: 37987407 PMCID: PMC10661275 DOI: 10.3390/nursrep13040128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Prehospital care is intricate and unpredictable. Nurses in this environment encounter psychologically challenging situations and traumatic experiences daily. Nurses respond variably when delivering care in this context. This study aims to map the emotional management strategies used by prehospital nurses. METHODS Research was conducted in MEDLINE, CINAHL Complete, and the Open Access Scientific Repository of Portugal (RCAAP). The inclusion criteria were studies with prehospital nurses in Portuguese, English, and Spanish languages, covering all study types. RESULTS From the initial 511 studies identified, four studies were deemed eligible after rigorous screening. The strategies used are individual (pre- and post-event) and collective, varying from formal to informal, with or without institutional support. Notable experiences included a lack of technical/scientific preparation, personal life association, treating acquaintances, pediatric-age patients, childbirth, cardiopulmonary arrests in young individuals, traffic accidents, and suicides. CONCLUSIONS Nurses need training in basic emotional management tools. This research provides an initial understanding of their emotional well-being's impact on personal and professional performance. This study was prospectively registered with the Open Science Framework (OSF) on 29 June 2023, with the registration number: z638t.
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Affiliation(s)
- Marisa Almeida
- Centro Hospitalar do Baixo Vouga, 3810-164 Aveiro, Portugal
| | - Catarina Lobão
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (A.C.); (V.P.)
| | - Adriana Coelho
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (A.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Vítor Parola
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (A.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
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Friberg M, Jonson CO, Jaeger V, Prytz E. The Effects of Stress on Tourniquet Application and CPR Performance in Layperson and Professional Civilian Populations. HUMAN FACTORS 2023; 65:495-507. [PMID: 34039045 PMCID: PMC10152217 DOI: 10.1177/00187208211021255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The purpose of this study was to compare laypeople's and professional first responders' ability to perform tourniquet application and cardiopulmonary resuscitation (CPR) during calm and stressful circumstances. BACKGROUND Life-threatening bleeding is a major cause of death that could be prevented by fast and appropriate first aid interventions. Therefore, laypeople are now being trained in bleeding control skills, transforming them from bystanders to immediate responders. However, critics have questioned whether laypeople are able to perform during more stressful conditions. METHOD Twenty-four laypersons and 31 professional first responders were tested in two conditions: a calm classroom scenario and a stressful scenario consisting of paintball fire and physical exertion. Stress and workload were assessed along with task performance. RESULTS The experimental manipulation was successful in terms of eliciting stress reactions. Tourniquet application performance did not decline in the stressful condition, but some aspects of CPR performance did for both groups. First responders experienced higher task engagement and lower distress, worry and workload than the laypeople in both the calm and stressful conditions. CONCLUSION Stress did not affect first responders and laypeople differently in terms of performance effects. Stress should therefore not be considered a major obstacle for teaching bleeding control skills to laypeople. APPLICATION Tourniquet application can be taught to laypeople in a short amount of time, and they can perform this skill during stress in controlled settings. Concerns about laypeople's ability to perform under stress should not exclude bleeding control skills from first aid courses for civilian laypeople.
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Owen CP, Djukic M, Whisenant M, Lobiondo-Wood G. Factors of maladaptive coping in emergency healthcare professionals: A systematic review. J Nurs Scholarsh 2023; 55:536-548. [PMID: 36419400 DOI: 10.1111/jnu.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/14/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergency healthcare professionals (EHPs) face significant occupational stressors requiring the skilled use of adaptive coping strategies. Some EHP resort to maladaptive coping (MC) strategies that negatively impact their mental health, yet MC strategies are not clearly defined in the literature. Examining factors that predispose EHP to MC can support interventions to improve coping and well-being. OBJECTIVE This systematic review examined MC among EHP working in pre-hospital and hospital-based settings. The primary aim was to identify factors associated with MC strategies used by EHP. METHODS Embase, Ovid, CINAHL Plus, PsychInfo, and the Cochrane Library were systematically searched for quantitative studies measuring MC use among EHP. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist was used to guide the review. Studies were included if they: (a) targeted licensed healthcare professionals providing patient care, (b) occurred in emergency department or pre-hospital emergency setting, and (c) examined provider coping. Studies were excluded if they: (a) did not include EHPs, (b) did not differentiate results in mixed samples, (c) did not clearly measure coping strategies, (d) failed to include MC strategies in the results, or (e) were not available in full text. Risk of bias and study quality was appraised using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Bandura's Social Cognitive Theory (SCT) guided the final synthesis, drawing conclusions from the evidence to identify factors associated with MC in EHP. RESULTS A total of 14 cross-sectional studies, published between 2003 and 2021, were included in the review. Included studies were conducted in either pre-hospital, hospital, or a combination of both settings. Most studies included mixed samples or emergency physicians. A variety of coping strategies were significantly correlated with poor mental health outcomes including venting, denial, disengagement, self-blame, and substance use. Among personal factors, EHPs who were female, older than 50, living alone, with personal trauma history were significantly more likely to use MC strategies. Additionally, EHP with children, work experience, higher life satisfaction, and resilience were negatively associated with MC. Environmental factors positively associated with MC included work stress, workload, and poor benefits. Trauma exposure had a positive, but non-significant relationship. CONCLUSIONS Emergency healthcare professionals use a variety of coping strategies, many of which are maladaptive and significantly related to poor mental health outcomes. Several personal and environmental factors contribute to behavior that reflect the use of MC strategies, but findings are sparse. Researchers should consider current limitations and challenges, particularly mental health stigma, when designing future studies. CLINICAL RELEVANCE The evidence in this review suggests that certain factors predispose EHP for use of MC strategies. This review highlights an important research gap necessitating more robust studies to identify MC risk factors among EHP in chronically high-stress environments.
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Affiliation(s)
- Christian Paige Owen
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
| | - Maja Djukic
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
| | - Meagan Whisenant
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
| | - Geri Lobiondo-Wood
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
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Breindahl N, Strange KF, Østergaard D, Collatz Christensen H. Evaluation of a critical incident management system on mental health in lifeguard organisations: a retrospective study. BMJ Open Sport Exerc Med 2023; 9:e001499. [PMID: 36704713 PMCID: PMC9872474 DOI: 10.1136/bmjsem-2022-001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Background Lifeguards may face many life-threatening situations during their careers and may be at increased risk of post-traumatic stress disorder (PTSD). Minimal evidence concerning critical incident management systems in lifeguard organisations exists. Objectives To develop, implement and evaluate an operational system for critical incident management in lifeguard organisations. Methods This retrospective study included data on occupational injury reports from 2013 to 2022 in TrygFonden Surf Lifesaving Denmark. All active lifeguards were invited to evaluate the system and the individual steps using an online questionnaire with three questions rated on a 5-point Likert scale. Primary outcome was a change in the frequency of psychological injury reports after system implementation in 2020. The secondary outcome was the lifeguards' satisfaction with the system. Results After implementation, the average annual number of psychological injury reports increased 6.5-fold from 2 (2013-2019) to 13 (2020-2022), without changes to the number of critical incidents attended by the lifeguards. Sixty-six (33.8%) active lifeguards answered the questionnaire and agreed that follow-up after critical incidents was very important (mean score 4.7/5). Satisfaction with steps 1-2 and 3 of critical incident management among involved lifeguards was high (mean score 4.4/5 and 4.6/5, respectively). The system included an operational workflow diagram and incident report template presented in this study. Conclusions The operational system for critical incident management may improve early recognition of symptoms for the prevention of PTSD. It may be used as a screening and decision tool for referral to a mental health professional.
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Affiliation(s)
- Niklas Breindahl
- Prehospital Center Region Zealand, Naestved Hospital, Naestved, Denmark,Department of Neonatal and Pediatric Intensive Care, Rigshospitalet, Copenhagen, Denmark,International Life Saving Federation, Leuven, Belgium,TrygFonden Surf Lifesaving Denmark, Hvidovre, Denmark
| | - Kirstine Friderichsen Strange
- TrygFonden Surf Lifesaving Denmark, Hvidovre, Denmark,Hammel Neurorehabilitation and Research Centre, Regional Hospital Hammel Neurocenter, Hammel, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Herlev, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Prehospital Center Region Zealand, Naestved Hospital, Naestved, Denmark,Copenhagen Emergency Medical Services, Region Hovedstaden, Ballerup, Denmark,Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark, Copenhagen, Denmark
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Herttuainen A, Nordquist H. Recent Paramedic Graduates' Chronic Stress Adds Intentions to Leave the Profession: A Pilot Study Utilizing a Web-Based Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231210706. [PMID: 38014634 PMCID: PMC10685760 DOI: 10.1177/00469580231210706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
Paramedics have mentally and physically demanding jobs, and chronic stress is not uncommon. Recently graduated paramedics, in particular, have been identified as needing support in their early careers. This pilot study examined chronic stress experienced by recent graduate paramedics and their intentions to leave the paramedic profession. Finnish paramedics encompass qualifications to work in various nursing sectors. This pilot study was a cross-sectional survey study among Finnish paramedics who graduated less than 3 years ago and who were currently working in prehospital EMS (n = 152). They evaluated chronic organizational and operational stressors on the Emergency Medical Services Chronic Stress Questionnaire with 20 statements. Two structured questions related to the intention to leave the paramedic profession. Three summary scales were formed. The differences in stress by the intention to leave were reported descriptively and the differences were tested with Mann-Whitney U test. The influence of potential predictors of the intention to leave prehospital EMS work or the nursing sector completely were explored with a forward stepwise logistic regression model. Those who intended to leave prehospital EMS work (25%, n = 35/152) or to leave the nursing sector completely (33%, n = 50/152) experienced higher levels of stress than those without such intentions. Stress related to organizational inequity and leadership challenges was the strongest and stress related to social, health, and personal impacts was the second strongest predictor of the intention to leave. Reducing chronic stress might be important in terms of paramedic retention. Several further study needs are addressed.
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Affiliation(s)
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
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15
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An emotional journey when encountering children in prehospital care: Experiences from ambulance nurses. Int Emerg Nurs 2023; 66:101239. [PMID: 36574740 DOI: 10.1016/j.ienj.2022.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Care encounters with children are a challenging and important task, but opportunities for such encounters are rarely available. Therefore, ambulance nurses (ANs) face difficulties in gaining experience in properly handling children, which can lead to stress for the ANs. A deeper understanding of ANs' emotions through the course of the care encounter is needed. AIM To describe how ambulance nurses' feel and manage their emotions before, during and after a care encounter with a child. METHODS A qualitative approach was adopted, with content analysis being performed on seventeen individual interviews. FINDINGS Three themes were identified: Feeling worried and insecure, Emotional surge, and Mixed feelings of satisfaction and concern. CONCLUSION The ANs experienced a range of emotions during a care encounter with children as they had little experience with it. More training and education in paediatric care could benefit ANs. The ANs use professionalism during care encounters to create a calm and secure atmosphere for families. Their will to bring about a safe journey for the child and family through the care encounter supersedes their nervousness. Reflection after a care encounter could strengthen their confidence in their professional role and reduce emotional distress in future encounters.
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Hjalmarsson A, Östlund G, Asp M, Kerstis B, Holmberg M. A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services. Int J Qual Stud Health Well-being 2022; 17:2082062. [PMID: 35703409 PMCID: PMC9225717 DOI: 10.1080/17482631.2022.2082062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. Methods An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. Results Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. Conclusions Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
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Affiliation(s)
- Anna Hjalmarsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Gunnel Östlund
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
- Faculty of Health and Life Sciences, Linneaus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Ambulance Services, Region Sörmland, Eskilstuna, Sweden
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17
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Maleczek M, Schebesta K, Hamp T, Burger AL, Pezawas T, Krammel M, Roessler B. ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial. Scand J Trauma Resusc Emerg Med 2022; 30:47. [PMID: 35841049 PMCID: PMC9288087 DOI: 10.1186/s13049-022-01033-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Aims Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field.
Methods In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. Results Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index. Conclusion ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2
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Affiliation(s)
- Mathias Maleczek
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Academic Simulation Center of Vienna, Vienna, Austria
| | - Karl Schebesta
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Academic Simulation Center of Vienna, Vienna, Austria.
| | - Thomas Hamp
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Achim Leo Burger
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Pezawas
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria.,PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Bernhard Roessler
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Academic Simulation Center of Vienna, Vienna, Austria
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Ulrich Hansen M, Vejzovic V, Zdravkovic S, Axelsson M. Ambulance nurses' experiences of using prehospital guidelines for patients with acute chest pain - A qualitative study. Int Emerg Nurs 2022; 63:101195. [PMID: 35802956 DOI: 10.1016/j.ienj.2022.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/29/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ambulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain. AIM To explore ambulance nurses' experiences of using prehospital guidelines for patients with acute coronary syndrome. METHOD A qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis. RESULTS Two main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines. CONCLUSIONS The ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.
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Affiliation(s)
- Michael Ulrich Hansen
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden.
| | - Vedrana Vejzovic
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Slobodan Zdravkovic
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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Morphometric analysis of middle and posterior cranial fossae foramina in 3D reconstructions of CT images: A midline asymmetry evaluation. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1061162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Mira JJ, Cobos-Vargas Á, Astier-Peña MP, Pérez-Pérez P, Carrillo I, Guilabert M, Pérez-Jover V, Fernández-Peris C, Vicente-Ripoll MA, Silvestre-Busto C, Lorenzo-Martínez S, Martin-Delgado J, Aibar C, Aranaz J. Addressing Acute Stress among Professionals Caring for COVID-19 Patients: Lessons Learned during the First Outbreak in Spain (March-April 2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12010. [PMID: 34831767 PMCID: PMC8624221 DOI: 10.3390/ijerph182212010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
Objectives: To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers' capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients' suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals' capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals); resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care); reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises.
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Affiliation(s)
- José Joaquín Mira
- Alicante-Sant Joan Health Department, 03013 Alacant, Spain
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain; (I.C.); (M.G.); (V.P.-J.); (C.F.-P.); (M.A.V.-R.)
| | - Ángel Cobos-Vargas
- Quality and Patient Management, San Cecilio Clinical University Hospital, 18016 Granada, Spain;
| | | | | | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain; (I.C.); (M.G.); (V.P.-J.); (C.F.-P.); (M.A.V.-R.)
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain; (I.C.); (M.G.); (V.P.-J.); (C.F.-P.); (M.A.V.-R.)
| | - Virtudes Pérez-Jover
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain; (I.C.); (M.G.); (V.P.-J.); (C.F.-P.); (M.A.V.-R.)
| | - Cesar Fernández-Peris
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain; (I.C.); (M.G.); (V.P.-J.); (C.F.-P.); (M.A.V.-R.)
| | - María Asunción Vicente-Ripoll
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain; (I.C.); (M.G.); (V.P.-J.); (C.F.-P.); (M.A.V.-R.)
| | | | - Susana Lorenzo-Martínez
- Quality and Patient Management Department, Alcorcon Foundation University Hospital, 28922 Alcorcon, Spain;
| | - Jimmy Martin-Delgado
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan D’ Alacant, Spain;
| | - Carlos Aibar
- Preventive Medicine Department, Lozano Blesa Clinical University Hospital, 50009 Zaragoza, Spain;
| | - Jesús Aranaz
- Preventive Medicine Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
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The Role of Health Literacy among Outpatient Caregivers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211743. [PMID: 34831499 PMCID: PMC8624592 DOI: 10.3390/ijerph182211743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
Health literacy became an important competence during the COVID-19 pandemic. Despite outpatient caregivers being a particularly vulnerable occupational group, their health literacy has hardly been examined yet, especially during the pandemic. Hence, this study aimed to explore this field and provide first empirical insights. Data were collected based on a cross-sectional online survey among 155 outpatient caregivers. In particular, health literacy (HLS-EU-Q16), diet and physical activity, pandemic-related worries, perceived information sufficiency and stress perception were examined. Descriptive and ordinal logistic regression analyses were run to test explorative assumptions. The majority of outpatient caregivers reported high values of health literacy (69% on a sufficient level). Although no significant associations between health literacy and health behaviours or perceived information sufficiency were found, perceived information sufficiency and perceived stress (OR = 3.194; 95% CI: 1.542-6.614), and pandemic-related worries (OR = 3.073; 95% CI: 1.471-6.421; OR = 4.243; 95% CI: 2.027-8.884) seem to be related. Therefore, dissemination of reliable information and resource-building measures to reduce worries may be important parameters for improving outpatient caregivers' health. Our results provide first explorative insights, representing a starting point for further research. Considering outpatient caregivers' mobile work setting, they need to be provided with adequate equipment and comprehensible information to ensure physically and mentally healthy working conditions.
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Hadian M, Jabbari A, Sheikhbardsiri H. Workplace violence and influencing factors among paramedic pre hospital paramedic personnel (city and road) in Iran: a quality content analysis. BMC Emerg Med 2021; 21:124. [PMID: 34715782 PMCID: PMC8555860 DOI: 10.1186/s12873-021-00520-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background The goal of every emergency department is to provide the highest quality services in the shortest time using limited resources. However, occupational violence is so prevalent among pre-hospital paramedic personnel that some experts claim that it is impossible to find pre-hospital personnel without an experience of violence in the workplace. Therefore, it seems necessary to investigate the causes of violence among this population group and find ways to control it. Aim The present study aimed to investigate the Violence and influencing factors among paramedic pre-hospital personnel. Method This qualitative study was conducted to explore the views of a group of pre-hospital paramedic personnel (n = 45) selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman’s conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. Results Based on the results of the analysis of data collected from prehospital paramedic personnel, three main categories including: human factors, organizational factors, and environmental factors and 20 subcategories were detected. Conclusion If authorities neglect violence in the workplace and do not take serious actions to prevent it, violence and, more importantly, “hostility” will gradually prevail in the workplace. It also increases the stress and anxiety of staff and consequently severely deteriorates their job performance. Hence, authorities are strongly recommended not to ignore this issue and, instead, take measures, for instance hold workshops, to train personnel about the techniques of anger and violence control.
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Affiliation(s)
- Marziye Hadian
- Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Jabbari
- Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hojjat Sheikhbardsiri
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Loef J, Vloet LCM, Vierhoven PH, van der Schans L, Neyman-Lubbers Y, de Vries-de Winter C, Ebben RHA. Starting ambulance care professionals and critical incidents: a qualitative study on experiences, consequences and coping strategies. BMC Emerg Med 2021; 21:110. [PMID: 34620095 PMCID: PMC8495434 DOI: 10.1186/s12873-021-00500-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ambulance care professionals are regularly confronted with critical incidents that increase risks for mental health disorders. To minimize these risks, it is important that ambulance care professionals adequately cope with critical incidents. Especially from the perspective of starting ambulance care professionals it is unknown which coping styles they use when experiencing a critical incident and how they are trained to cope with critical incidents. The aim of this study was to gain insight in (a) what starting ambulance care professionals describe as critical incidents, (b) how they experience these critical incidents and their consequences, (c) how they cope with these incidents, and (d) how they are trained and guided to cope with these incidents. METHODS A qualitative design with individual, semi-structured interviews was used. The data was analyzed by using inductive thematic analysis. RESULTS Twenty-two starting ambulance care professionals were interviewed of which, 11 were male. The age ranged from 23 to 31 years, with 11 participants being 27 years or younger. Three key-themes emerged that make an incident critical: (1) emotional connection versus emotional detachment, (2) feeling loss of control, and (3) incomprehension. All participants experienced several short to middle term physical, psychological and social consequences after encountering a critical incident. Starting ambulance care professionals applied different coping strategies during different phases of the ambulance care process: a mix of depersonification, focus on the medical task, support from colleagues and their own network, seeking confirmation, and distraction. Most starting ambulance care professionals don't actively remember they received education about coping with critical incidents during their initial educational program. During and after traineeships, the workplace preceptor has a crucial role for starting ambulance care professionals to learn them how to cope with critical incidents. CONCLUSIONS Three key-themes interact to make an incident more critical for starting ambulance care professionals. To cope with these critical incidents, starting ambulance care professionals use a variety of coping strategies. These results can be used to develop training and coaching for starting ambulance care professionals so they can adequately cope with critical incidents.
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Affiliation(s)
- Jorik Loef
- Emergency Medical Service Brabant Midden-West-Noord, 's Hertogenbosch, The Netherlands. .,Research Department of Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands.
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands.,IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Peter-Hans Vierhoven
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands.,, Dutch platform of Bachelor of Medical Health, Utrecht, The Netherlands
| | - Leonie van der Schans
- Dutch Society of Bachelor of Medical Health, Utrecht, The Netherlands.,Emergency Medical Service Amsterdam, Amsterdam, The Netherlands
| | - Yvonne Neyman-Lubbers
- Emergency Medical Service Brabant Midden-West-Noord, 's Hertogenbosch, The Netherlands
| | - Christine de Vries-de Winter
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands.,, Dutch platform of Bachelor of Medical Health, Utrecht, The Netherlands
| | - Remco H A Ebben
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands
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The Effect of Psychological Hotwash on Resilience of Emergency Medical Services Personnel. Emerg Med Int 2021; 2021:4392996. [PMID: 34462669 PMCID: PMC8403047 DOI: 10.1155/2021/4392996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/23/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency medical services (EMS) personnel are exposed to stress. Job stress in EMS personnel can reduce their resilience and have adverse effects on their clinical performance and mental health, thus reducing the quality of their work. The present research was performed to determine the effect of psychological hotwash on resilience of emergency medical services personnel. Methods This study was a quasiexperimental. Sixty-four EMS personnel were randomly divided into two groups of hotwash and control. The psychological hotwash program was performed in the intervention group for a month based on the protocol; however, the control group continued their usual work and received no intervention. A day and six weeks after the psychological hotwash in the intervention group, the resilience of the EMS personnel was remeasured in both groups. Results Before the intervention, the participants' mean resilience score was 138.37 ± 7.04 in the intervention group and 137.34 ± 8.48 in the control group. There was a statistically significant difference between the mean scores of resilience in the intervention and control groups a day after the intervention (P=0.003). There was no statistically significant difference between the mean scores of resilience in the intervention and control groups 6 weeks after the intervention (P=0.102). Conclusion The EMS personnel's attendance at psychological hotwash sessions could increase their resilience. Nevertheless, the sessions should not be interrupted because the 6-week interruption of the sessions caused the nonsignificant scores of resilience in the hotwash and control groups. Hence, it is recommended to continue the investigation of the effects of hotwash on resilience, stress reduction, and job burnout reduction in EMS personnel by other researchers in different settings.
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Vicente V, Bergqvist L, Kvist M, Rubenson Wahlin R, Sjölin H. Nurse's experiences of the caring encounter as single responder in prehospital emergency care. Int Emerg Nurs 2021; 58:101051. [PMID: 34411813 DOI: 10.1016/j.ienj.2021.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the Swedish emergency medical services, single responder and assessment units have been implemented to meet the increasing need for ambulance assessment and care. AIM To describe registered nurseś experiences of care encounters as single responders in the emergency medical services. METHOD The study design was descriptive with a qualitative approach. Semi-structured interviews with eight single responders were used together with inductive content analysis. RESULTS From the theme which showed the experiences of being a single responder in the caring encounter in the ambulance care "meeting unique human care needs with conscious caution", three categories emerged: Increased risk-awareness, Lack of resource support creates vulnerability and Professional experiences and personal qualities contribute to patient safety. CONCLUSION The single responders was aware of their vulnerability and a consistent theme was "caution". Risk assessments had evolved and were constantly present to maintain their own and the patient's safety. In critical patients, the experience of frustration and insufficiency dominated but at the same time there was a sense of meaningfulness. The main experience among all single responders was the feeling of getting close to the patient and responding to them in their own way.
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Affiliation(s)
- Veronica Vicente
- Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB], Stockholm, Sweden; Academic EMS, Stockholm, Sweden; Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Lenny Bergqvist
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Ambulance Service, Region Sörmland, Nyköping, Sweden
| | - Moa Kvist
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB], Stockholm, Sweden; Academic EMS, Stockholm, Sweden; Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Helena Sjölin
- Academic EMS, Stockholm, Sweden; Faculty of Medicine and Health, School of Health and Medical Sciences, Orebro University, Orebro, Sweden.
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de Graaf C, de Kruif AJTCM, Beesems SG, Koster RW. To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study. Resuscitation 2021; 164:84-92. [PMID: 34023427 DOI: 10.1016/j.resuscitation.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/09/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND If a patient in out-of-hospital cardiac arrest (OHCA) does not achieve return of spontaneous circulation (ROSC) despite advanced life support, emergency medical services can decide to either transport the patient with ongoing CPR or terminate resuscitation on scene. PURPOSE To determine differences between patients without ROSC to be transported vs. terminated on scene and explore medical and nonmedical factors that contribute to the decision-making of paramedics on scene. METHODS Mixed-methods approach combining quantitative and qualitative data. Quantitative data on all-cause OHCA patients without ROSC on scene, between January 1, 2012, and December 31, 2016, in the Amsterdam Resuscitation Study database, were analyzed to find factors associated with decision to transport. Qualitative data was collected by performing 16 semi-structured interviews with paramedics from the study region, transcribed and coded to identify themes regarding OHCA decision-making on the scene. RESULTS In the quantitative Utstein dataset, of 5870 OHCA patients, 3190 (54%) patients did not achieve ROSC on scene. In a multivariable model, age (OR 0.98), public location (OR 2.70), bystander witnessed (OR 1.65), EMS witnessed (OR 9.03), and first rhythm VF/VT (OR 11.22) or PEA (OR 2.34), were independently associated with transport with ongoing CPR. The proportion of variance explained by the model was only 0.36. With the qualitative method, four main themes were identified: patient-related factors, local circumstances, paramedic-related factors, and the structure of the organization. CONCLUSION In patients without ROSC on scene, besides known resuscitation characteristics, the decision to transport a patient is largely determined by non-protocollized factors.
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Affiliation(s)
- Corina de Graaf
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Anja J Th C M de Kruif
- Department of Epidemiology and Biostatistics, Amsterdam UMC location VUmc, Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Stefanie G Beesems
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rudolph W Koster
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Structured evaluation of stress triggers in prehospital emergency medical care : An analysis by questionnaire regarding the professional groups. Anaesthesist 2021; 71:291-298. [PMID: 33974115 PMCID: PMC8986693 DOI: 10.1007/s00101-021-00968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Emergency medical services work in the environment of high responsibility teams and have to act under unpredictable working conditions. Stress occurs and has potential of negative effects on tasks, teamwork, prioritization processes and cognitive control. Stress is not exclusively dictated by the situation-the individuals rate the situation of having the necessary skills that a particular situation demands. There are different occupational groups in the emergency medical services in Germany. Training, tasks and legal framework of these groups vary. OBJECTIVE The aim of this study was to identify professional group-specific stressors for emergency medical services. These stress situations can be used to design skills building tools to enable individuals to cope with these stressors. MATERIAL AND METHODS The participants were invited to the study via posters and social media. An expert group (minimum 6 months of experience) developed a set of items via a two-step online Delphi survey. The experts were recruited from all professional groups represented in the German emergency medical service. We evaluated the resulting parameters for relevance and validity in a larger collective. Lastly, we identified stress factors that could be grouped in relevant scales. In total 1017 participants (paramedics, physicians) took part in the final validation survey. RESULTS After validation, we identified a catalogue of stressors with 7 scales and 25 items for EMT (Emergency Medical Technician) paramedics (KMO [Kayser-Meyer-Olkin criterion] 0.81), 6 scales and 24 items for advanced paramedics (KMO 0.82) and 6 scales and 24 items for EMS (Emergency Medical Service) physicians (KMO 0.82). For the professional group of EMT basic, the quality parameters did not allow further processing of the items. Professional group-specific scales for EMT paramedics are "professional limitations", "organizational framework", "expectations" and "questions of meaning". For advanced paramedics "appreciation", "exceptional circumstances" and "legal certainty" were identified. The EMT physicians named "handling third parties", "tolerance to ambiguity", "task management" and "pressure to act". A scale that is representative for all professional groups is "teamwork". Organizational circumstances occur in all groups. The item "unnecessary missions" for EMT paramedics and "legal concerns with the application of methods" for advanced paramedics are examples. DISCUSSION Different stressors are relevant for the individual professional groups in the German emergency medical service. The developed catalogue can be used in the future to evaluate the subjective stress load of emergency service professionals. There are stressors that are inherent in the working environment (e.g. pressure to act) and others that can be improved through training (teamwork). We recommend training of general resistance as well as training of specific items (e.g., technical, nontechnical skills). All professionals mentioned items with respect to organizational factors. The responsible persons can identify potential for improvement based on the legal and organizational items. The EMT basic requires further subdivision according to task areas due to its variable applicability.
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Fonseca SM, Cunha S, Faria S, Campos R, Queirós C. Why are emergency medical technicians' coping strategies dysfunctional? Direct and indirect effects of resilience and perceived stress. Int Emerg Nurs 2021; 56:100995. [PMID: 33812197 DOI: 10.1016/j.ienj.2021.100995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/27/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency Medical Technicians (EMTs) are at high risk for traumatic disorders, and these disorders are more likely if they resort to dysfunctional coping. However, few studies have examined how dysfunctional coping can be decreased, specifically by comparing the impact of personal characteristics, such as resilience, and of occupational factors, such as stress. This study examines the contribution of resilience and perceived stress on EMTs' dysfunctional coping. METHODS A total of 502 EMTs (66% men), with a job experience of approximately 8 years (SD = 3.84), answered the Resilience Scale (Self and Life Acceptance; Personal Competence; Total score), Brief Cope, and Anxiety Depression Stress Scales. RESULTS EMTs reported high resilience, low stress and dysfunctional coping. Resilience dimensions, specifically self and life acceptance, and stress contributed to dysfunctional coping. Stress displayed the highest regression coefficient. The effect of self and life acceptance on dysfunctional coping was no longer significant when accounting for stress, revealing a full mediation effect. CONCLUSIONS How EMTs perceive stress can mitigate the protective role of acceptance on the use of dysfunctional coping. These findings suggest EMTs' occupational training may benefit from focusing on how to manage stressful and critical incidents, as well as on how to cope with stress.
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Affiliation(s)
- Sílvia M Fonseca
- Faculty of Psychology and Education Sciences, University of Porto, Portugal; FPCEUP - Rua Alfredo Allen, 4200-135 Porto, Portugal.
| | - Sónia Cunha
- National Institute of Medical Emergency, Portugal; Rua Dr. Alfredo Magalhães, 62 - 5° Andar, 4000-063 Porto, Portugal.
| | - Sara Faria
- Faculty of Psychology and Education Sciences, University of Porto, Portugal; FPCEUP - Rua Alfredo Allen, 4200-135 Porto, Portugal.
| | - Rui Campos
- National Institute of Medical Emergency, Portugal; Rua Dr. Alfredo Magalhães, 62 - 5° Andar, 4000-063 Porto, Portugal.
| | - Cristina Queirós
- Faculty of Psychology and Education Sciences, University of Porto, Portugal; FPCEUP - Rua Alfredo Allen, 4200-135 Porto, Portugal.
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Eriksson I, Wilhsson M, Blom T, Broo Wahlström C, Larsson M. Telephone nurses' strategies for managing difficult calls: A qualitative content analysis. Nurs Open 2020; 7:1671-1679. [PMID: 33072350 PMCID: PMC7544854 DOI: 10.1002/nop2.549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/02/2022] Open
Abstract
Aim To describe telenurses' strategies for managing difficult calls. Background Telenursing is a growing and complex area and places great demands on telenurses' knowledge and skills and on their ability to communicate and listen. To become emotionally concerned is central to telenurses' experiences of difficult calls. Design A descriptive qualitative study. Methods The data were collected during February 2017 through individual interviews with 19 telenurses at call centres and primary healthcare centres. Data were analysed with qualitative content analysis. Result The analysis revealed an essential strategy illustrated by the theme “to be calm and secure in themselves.” Further categories described telenurses' strategies to manage difficult calls, labelled as: “to show commitment and interest,” “to have structure in the call and use support systems,” “to pause the call” and “to reflect on difficult calls.” The results show that telenurses need multiple strategies to help them to navigate difficult calls.
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Affiliation(s)
- Irene Eriksson
- School of Health Sciences University of Skövde Skövde Sweden
| | - Marie Wilhsson
- School of Health Sciences University of Skövde Skövde Sweden
| | - Therese Blom
- Primary Child Health Service Care Falköping Sweden
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Tremblay M, Albert WJ, Fischer SL, Beairsto E, Johnson MJ. Physiological responses during paramedics' simulated driving tasks. Work 2020; 66:445-460. [PMID: 32568158 DOI: 10.3233/wor-203184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most ambulance collisions happen in emergency driving conditions and are caused by human factors. OBJECTIVE This study investigated the influence of human factors associated with time pressure, patient-care intervention, and health status on the physiological responses of simulated emergency driving tasks. METHODS A cohort of seventeen experienced paramedics performed a battery of three simulated diving tasks. The driving tasks were a non-urgent and two urgent driving simulations (one to the scene and one to the hospital). The second urgent driving task was preceded by a patient-care simulation (unstable cardiac patient with cardiopulmonary resuscitation). RESULTS The physiological responses between the three driving tasks were not significantly different due to time pressure and patient-care intervention. It is postulated that the physiological response of experienced paramedics was influenced by the fact that they are accustomed to handling stressful situations daily. Furthermore, it was observed that paramedics with health conditions were more physiologically aroused during the urgent driving scenarios (pre and post-intervention), suggesting they might have an elevated risk of collision when they drive with urgency. Paramedics with health conditions also had higher physiological responses for the post-intervention baseline, leading to a longer recovery time period, which might represent an elevated risk of developing chronic health problems or amplifying existing ones. CONCLUSIONS The findings of this research suggest that experienced paramedics manage the influence of time pressure and the impact of challenging patient-care well. Paramedics with health conditions represent an elevated risk of collision.
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Affiliation(s)
- Mathieu Tremblay
- Occupational Performance Lab, Faculty of Kinesiology, University of New Brunswick, Fredericton (NB), Canada.,Department of Health Sciences, Université du Québec à Rimouski, Rimouski (QC), Canada
| | - Wayne J Albert
- Occupational Performance Lab, Faculty of Kinesiology, University of New Brunswick, Fredericton (NB), Canada
| | - Steven L Fischer
- Department of Kinesiology, University of Waterloo, Waterloo (ON), Canada
| | - Eric Beairsto
- New Brunswick EMS, Medavie Health Services, Moncton (NB), Canada
| | - Michel J Johnson
- School of Kinesiology and Leisure, Université de Moncton, Moncton (NB), Canada
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Sjölin H, Lindström V, Vicente V, Hult H, Ringsted C, Kurland L. Prehospital emergency nurses' experiences of care in critical incidents. Int Emerg Nurs 2020; 51:100890. [PMID: 32502944 DOI: 10.1016/j.ienj.2020.100890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs' experiences of care in CIs. METHOD A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden. RESULTS PENs' experiences can be described as: "In a critical incident, personal ability based on experiential knowledge is central to patient care". Three generic categories underpinned the main category: "Clinical expertise", "Professional approach" and "Broad knowledge base". CONCLUSIONS The care given during a CI in the ambulance care setting depends on PENs' personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.
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Affiliation(s)
- Helena Sjölin
- Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Orebro, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Sweden.
| | - Veronica Lindström
- Academic EMS in Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
| | - Veronica Vicente
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Sweden; Academic EMS in Stockholm, Sweden.
| | - Håkan Hult
- Department of CLINTEC, Karolinska Institute, Stockholm, Sweden.
| | - Charlotte Ringsted
- Centre for Health Science Education, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Lisa Kurland
- Örebro University, Dept. of Medical Sciences, Örebro University Hospital, Dept. of Emergency Medicine, Sweden.
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Carvalho AELD, Frazão IDS, Silva DMRD, Andrade MS, Vasconcelos SC, Aquino JMD. Stress of nursing professionals working in pre-hospital care. Rev Bras Enferm 2020. [DOI: 10.1590/0034-7167-2018-0660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: To analyze the factors related to the occupational stress of a Mobile Emergency Care Service (Samu) nursing team. Methods: This is a descriptive study, with a quantitative approach, performed with nursing professionals from Samu service of a city of Pernambuco. A sociodemographic questionnaire and the Lipp’s Stress Symptom Inventory were used. Results: The participants presenting stress (24.6%) were classified in the phases: resistance (19.7%), exhaustion (4.4%) and near exhaustion (0.5%). It was also observed an association of stress level with the following factors: gender, sleep quality, professional autonomy restriction, emotional exhaustion with work performed and work in inadequate or unhealthy physical facilities. Conclusions: Although showing low occurrence of stress, this study pointed out the profile that presents the highest risk of developing occupational stress, through the factors significantly associated with stress in the studied population.
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Nord-Ljungquist H, Engström Å, Fridlund B, Elmqvist C. Lone and lonely in a double ambivalence situation as experienced by callers while waiting for the ambulance in a rural environment. Scand J Caring Sci 2019; 34:566-574. [PMID: 31614024 DOI: 10.1111/scs.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a rural environment where distances and access to ambulance resources in people's immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called 'While Waiting for the Ambulance' (WWFA). Knowledge is limited about the experience from a caller's perspective when a person has a life-threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved. AIM The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective. METHOD A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in-depth interviews with eight callers. RESULTS An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm. CONCLUSION A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.
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Affiliation(s)
- Helena Nord-Ljungquist
- Department of Health and Caring Science, Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency care (CICE), Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Vagle H, Haukeland GT, Dahl B, Aasheim V, Vik ES. Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study. Nurs Open 2019; 6:1542-1550. [PMID: 31660182 PMCID: PMC6805291 DOI: 10.1002/nop2.354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 01/23/2023] Open
Abstract
AIM To explore emergency medical technicians' experiences with unplanned births outside institutions. DESIGN A qualitative interview study. METHODS Individual semi-structured interviews with 12 emergency medical technicians in Norway. Systematic text condensation was used to analyse the data material. RESULTS Analysis showed that there is a mismatch between society's expectations about emergency medical technicians and the reality they encounter in out-of-hospital maternity care, that emergency medical technicians experience a general lack of training in caring for labouring women and that poor communication with other health professions challenges patient safety. The participants expressed how they do their best in caring for both mother and child, in spite of a lack of education, training and competence in assisting labouring women.
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Affiliation(s)
- Hanne Vagle
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Gunn Terese Haukeland
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Vigdis Aasheim
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Leonardsen AC, Ramsdal H, Olasveengen TM, Steen-Hansen JE, Westmark F, Hansen AE, Hardeland C. Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study. BMC Health Serv Res 2019; 19:545. [PMID: 31375098 PMCID: PMC6679546 DOI: 10.1186/s12913-019-4370-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 07/24/2019] [Indexed: 01/10/2023] Open
Abstract
Background Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers’ work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work? Methods The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis. Results Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) “Core technologies” and 2) “Environmental issues” . The theme “Core technologies” included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme “Environmental issues” included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service. Conclusion At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker’s ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system. Electronic supplementary material The online version of this article (10.1186/s12913-019-4370-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann-Chatrin Leonardsen
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757, Halden, Norway. .,Ostfold Hospital Trust, Surgical Ward, PB 300, NO-1714, Sarpsborg, Norway.
| | - Helge Ramsdal
- Department of Health and Social Studies, Ostfold University College, PB 700, NO-1757, Halden, Norway
| | - Theresa M Olasveengen
- Department of Anaesthesiology, Oslo University Hospital, PB 4956, NO-0424, Nydalen, Oslo, Norway
| | - Jon E Steen-Hansen
- Vestfold Hospital Trust, Prehospital Clinic, PB 2168, NO-3103, Tønsberg, Norway
| | - Fredrik Westmark
- Ostfold HF Hospital Trust, Prehospital Clinic, PB 300, NO-1714, Sarpsborg, Norway
| | - Andreas E Hansen
- Prehospital clinic, Oslo University Hospital, PB 4956, NO-0424, Nydalen, Oslo, Norway
| | - Camilla Hardeland
- Department of Health and Social Studies, Ostfold University College, PB 700, NO-1757, Halden, Norway
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Persson AC, Engström Å, Burström O, Juuso P. Specialist ambulance nurses' experiences of births before arrival. Int Emerg Nurs 2018; 43:45-49. [PMID: 30190223 DOI: 10.1016/j.ienj.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/11/2018] [Accepted: 08/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards. AIM This study describes the experiences of specialist ambulance nurses with BBA. METHOD A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis. FINDINGS The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education. CONCLUSION Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.
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Affiliation(s)
| | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Oskar Burström
- Resource Unit in Ambulance Care, Jämtland/Härjedalen, Sweden
| | - Päivi Juuso
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Anderson NE, Gott M, Slark J. Grey areas: New Zealand ambulance personnel’s experiences of challenging resuscitation decision-making. Int Emerg Nurs 2018; 39:62-67. [DOI: 10.1016/j.ienj.2017.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
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Hörberg A, Jirwe M, Kalén S, Vicente V, Lindström V. We need support! A Delphi study about desirable support during the first year in the emergency medical service. Scand J Trauma Resusc Emerg Med 2017; 25:89. [PMID: 28877728 PMCID: PMC5588605 DOI: 10.1186/s13049-017-0434-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/30/2017] [Indexed: 11/30/2022] Open
Abstract
Background New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS. Methods A purposeful sample and snowball technique was used and generated a panel of 32 registered nurses with 12–48 months of EMS experience. A Delphi technique in four rounds was used. Telephone interviews were undertaken in round one to identify what desirable support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded items which were developed into a questionnaire. The experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75%. Items which reached consensus were removed from questionnaires used in subsequent rounds. Results Desirable support was categorized into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organization and other support. The experts agree on the level of importance on 64 of a total of 70 items regarding desirable support. One item was considered not important, graded 1 or 2, 63 items were considered important, graded 4 or 5. Conclusion Even with extensive formal competence the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented.
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Affiliation(s)
- Anna Hörberg
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Academic EMS, Stockholm, Sweden.
| | - Maria Jirwe
- Department of Neurobiology Care Sciences and Society, Division of Nursing, Stockholm, Sweden
| | - Susanne Kalén
- Karolinska Institutet, Department of Clinical Sciences and Education, Södersjukhuset, Stockholm City Council, Stockholm, Sweden
| | - Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB) Sweden, Karolinska Institutet, Department of Clinical Sciences and Education, Södersjukhuset, Academic EMS, Stockholm, Sweden
| | - Veronica Lindström
- Department of Neurobiology Care Sciences and Society, Division of Nursing, Academic EMS, Stockholm, Sweden
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