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Charlton K, Bate A. Factors that influence paramedic decision-making about resuscitation for treatment of out of hospital cardiac arrest: Results of a discrete choice experiment in National Health Service ambulance trusts in England and Wales. Resusc Plus 2024; 17:100580. [PMID: 38380418 PMCID: PMC10877159 DOI: 10.1016/j.resplu.2024.100580] [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] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
Background During out of hospital cardiac arrest (OHCA) paramedics must make decisions to commence, continue, terminate or withhold resuscitation. These decisions are known to be complex, subject to variability and often dependent on provider preference. This study aimed to understand paramedic decision-making regarding the commencement of resuscitation using a discrete choice experiment. Methods A discrete choice experiment between October-December 2022 surveying paramedics from ten National Health Service ambulance trusts in England and Wales. Respondents were presented with fourteen vignettes, each comprising thirteen attributes, and asked to decide if they would provide resuscitation or not. Results Eight hundred and sixty-four paramedics completed the survey (61.8% male, median age 36 years (IQR 17.1)) and half had < 5 years clinical experience (n = 443 (51.2%). Respondents expressed a general preference to offer resuscitation (p = <0.01). All attributes except patient gender were statistically significant and important regarding an offer of resuscitation. Cut-offs where an offer of resuscitation was less likely were patient age of 73 years (p=>0.05), mild dementia (p = >0.05) and moderate frailty (p = <0.01). Paramedic characteristics of female gender, longest (>10 years) and shortest (<5 years) period qualified, lower academic qualification, lower skill level and attending fewer OHCA's were more likely to result in an offer of resuscitation. Conclusion During OHCA paramedics use objective and non-objective factors to make pragmatic decisions regarding an offer of resuscitation. Future research should focus on how best to support paramedics to make decisions during OHCA, how variability in decision-making impacts patient outcomes and how this relates to patient and public expectations.
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Affiliation(s)
- Karl Charlton
- Research Paramedic, North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne, NE15 8NY, UK
| | - Angela Bate
- Associate Professor of Health Economics, Northumbria University, Sutherland Building, Northumberland Road, Newcastle upon Tyne, NE1 8ST, UK
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Wilson C, Janes G, Lawton R, Benn J. Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. BMJ Qual Saf 2023; 32:573-588. [PMID: 37028937 PMCID: PMC10512001 DOI: 10.1136/bmjqs-2022-015634] [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: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Extensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development. METHODS A systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses. RESULTS The search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2 value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity. CONCLUSION This review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS. PROSPERO REGISTRATION NUMBER CRD42020162600.
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Affiliation(s)
- Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, UK
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Gillian Janes
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Jonathan Benn
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
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3
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Milling L, Kjær J, Binderup LG, de Muckadell CS, Havshøj U, Christensen HC, Christensen EF, Lassen AT, Mikkelsen S, Nielsen D. Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review. Scand J Trauma Resusc Emerg Med 2022; 30:24. [PMID: 35346307 PMCID: PMC8962561 DOI: 10.1186/s13049-022-01004-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Aim This systematic review explored how non-medical factors influence the prehospital resuscitation providers’ decisions whether or not to resuscitate adult patients with cardiac arrest. Methods We conducted a mixed-methods systematic review with a narrative synthesis and searched for original quantitative, qualitative, and mixed-methods studies on non-medical factors influencing resuscitation of out-of-hospital cardiac arrest. Mixed-method reviews combine qualitative, quantitative, and mixed-method studies to answer complex multidisciplinary questions. Our inclusion criteria were peer-reviewed empirical-based studies concerning decision-making in prehospital resuscitation of adults > 18 years combined with non-medical factors. We excluded commentaries, case reports, editorials, and systematic reviews. After screening and full-text review, we undertook a sequential exploratory synthesis of the included studies, where qualitative data were synthesised first followed by a synthesis of the quantitative findings. Results We screened 15,693 studies, reviewed 163 full-text studies, and included 27 papers (12 qualitative, two mixed-method, and 13 quantitative papers). We identified five main themes and 13 subthemes related to decision-making in prehospital resuscitation. Especially the patient’s characteristics and the ethical aspects were included in decisions concerning resuscitation. The wishes and emotions of bystanders further influenced the decision-making. The prehospital resuscitation providers’ characteristics, experiences, emotions, values, and team interactions affected decision-making, as did external factors such as the emergency medical service system and the work environment, the legislation, and the cardiac arrest setting. Lastly, prehospital resuscitation providers’ had to navigate conflicts between jurisdiction and guidelines, and conflicting values and interests.
Conclusions Our findings underline the complexity in prehospital resuscitation decision-making and highlight the need for further research on non-medical factors in out-of-hospital cardiac arrest. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01004-6.
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Affiliation(s)
- Louise Milling
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Kildemosevej 15, 5000, Odense C, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jeannett Kjær
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Kildemosevej 15, 5000, Odense C, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lars Grassmé Binderup
- Philosophy, Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | | | - Ulrik Havshøj
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Kildemosevej 15, 5000, Odense C, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Aalborg, Denmark.,Emergency Medical Services, Region North Denmark, Aalborg, Denmark
| | | | - Søren Mikkelsen
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Kildemosevej 15, 5000, Odense C, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Nielsen
- Department of Infectious Diseases, Sub-Department of Immigrant Medicine, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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Nord-Ljungquist H, Bohm K, Fridlund B, Elmqvist C, Engström Å. "Time that save lives" while waiting for ambulance in rural environments. Int Emerg Nurs 2021; 59:101100. [PMID: 34781156 DOI: 10.1016/j.ienj.2021.101100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
AIM Firefighters perform first aid before the ambulance arrives in areas with a long response time in Sweden; this is called 'While Waiting for the Ambulance' (WWFA). The aim was to describe WWFA assignments in rural environments, focusing on frequency, event time, actions and survival >30 days after cardiopulmonary resuscitation (CPR) was performed. METHODS Retrospective descriptive and comparative design. RESULTS Firefighters in the northern part of Sweden were involved in 518 WWFA assignments between 2012 and 2016. From alarm call until ambulance dispatch, median time was 2:20 min; for firefighters, nearly four minutes. Median dispatch time at out-of-hospital cardiac arrests (OHCA) (n = 52) was 1:40 min for ambulance and three minutes for firefighters. Maximal dispatch time was nearly 10 min for ambulance and 44 min for firefighters. Firefighters arrived first at the scene, after 17 min' median, for 95 % of assignments, while the ambulance took nearly twice the amount of time. In OHCA situations, time for firefighters was over 19 min versus ambulance at nearly twice the time. CPR was terminated by ambulance staff at 83% (n = 43) of 52 when firefighters performed prolonged CPR. Return to spontaneous circulation after OHCA was 17%, and 9% were alive after >30 days. CONCLUSION The efficiency of incident time and utilisation rate for WWFA assignments can be increased for the benefit of affected persons, especially in OHCA.
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Affiliation(s)
- Helena Nord-Ljungquist
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Division of Nursing and Medical Technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
| | - Katarina Bohm
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, 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), Linnaeus University, Växjö, Sweden; Head of Research in County Council Kronoberg and Research Manager for the Centre of Interprofessional Collaboration within Emergency Care (CICE) at the Department of Health and Caring Science, Linnaeus University, Sweden.
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Olsson A, Sjöberg F, Salzmann-Erikson M. Follow the protocol and kickstart the heart-Intensive care nurses' reflections on being part of rescue situations in interdisciplinary teams. Nurs Open 2021; 8:3325-3333. [PMID: 34431610 PMCID: PMC8510712 DOI: 10.1002/nop2.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/20/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022] Open
Abstract
Aim To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in‐hospital cardiopulmonary resuscitation. Design A qualitative descriptive design. Methods: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis. Results The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation—referred as before, during and after the CPR situation. Conclusions The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non‐familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.
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Affiliation(s)
- Annakarin Olsson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Fredric Sjöberg
- Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Salzmann-Erikson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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6
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Milling L, Binderup LG, de Muckadell CS, Christensen EF, Lassen A, Christensen HC, Nielsen DS, Mikkelsen S. Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests. BMC Med Ethics 2021; 22:82. [PMID: 34193147 PMCID: PMC8247191 DOI: 10.1186/s12910-021-00654-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 01/04/2023] Open
Abstract
Background Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation. Methods This was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice.
Results Of 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making.
Conclusions There is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00654-y.
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Affiliation(s)
- Louise Milling
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Kildemosevej 15, 5000, Odense C, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Grassmé Binderup
- Philosophy, Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | | | | | - Annmarie Lassen
- Emergency Medicine Research Unit, Odense University Hospital, Odense, Denmark
| | | | - Dorthe Susanne Nielsen
- Department of Infectious Diseases, Sub-department of Immigrant Medicine, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Søren Mikkelsen
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Kildemosevej 15, 5000, Odense C, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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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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Hasselqvist-Ax I, Nordberg P, Svensson L, Hollenberg J, Joelsson-Alm E. Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study. BMJ Open 2019; 9:e030895. [PMID: 31753873 PMCID: PMC6887046 DOI: 10.1136/bmjopen-2019-030895] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The objective of this study was to explore firefighters' and police officers' experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme. DESIGN A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants' narratives. The interviews where transcribed verbatim and analysed with inductive content analysis. SETTING The County of Stockholm, Sweden. PARTICIPANTS Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin. RESULTS Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted. CONCLUSIONS Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.
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Affiliation(s)
- Ingela Hasselqvist-Ax
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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9
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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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10
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Wireklint Sundström B, Bremer A, Lindström V, Vicente V. Caring science research in the ambulance services: an integrative systematic review. Scand J Caring Sci 2019; 33:3-33. [PMID: 30252151 PMCID: PMC7432173 DOI: 10.1111/scs.12607] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings. AIM This integrative systematic review aims to describe caring science research content and scope in the ambulance services. DATA SOURCES Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156. REVIEW METHODS The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five-stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3-level scale, and data relevance was evaluated on a 2-level scale. RESULTS After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision-making; Public environment and patient safety; Life-changing situations; and Ethics and values. CONCLUSION Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional-patient relation, with special focus on value conflicts in emergency situations.
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Affiliation(s)
- Birgitta Wireklint Sundström
- PreHospen – Centre for Prehospital ResearchUniversity of BoråsBoråsSweden
- Faculty of Caring Science, Work Life and Social WelfareUniversity of BoråsBoråsSweden
| | - Anders Bremer
- PreHospen – Centre for Prehospital ResearchUniversity of BoråsBoråsSweden
- Faculty of Caring Science, Work Life and Social WelfareUniversity of BoråsBoråsSweden
- Faculty of Health and Life SciencesLinnaeus UniversityVäxjöSweden
- Division of Emergency Medical ServicesKalmar County HospitalKalmarSweden
| | - Veronica Lindström
- Division of NursingDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Academic EMSStockholmSweden
| | - Veronica Vicente
- Academic EMSStockholmSweden
- The Ambulance Medical Service in Stockholm (AISAB)StockholmSweden
- Department of Clinical Science and EducationKarolinska InstitutetSödersjukhusetStockholmSweden
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11
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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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Lee MR, Cha C. Emergency department nurses' experience of performing CPR in South Korea. Int Emerg Nurs 2017; 38:29-33. [PMID: 29050836 DOI: 10.1016/j.ienj.2017.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/16/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emergency Department (ED) nurses often confront unexpected cardiopulmonary resuscitation (CPR) with little information about the patients. METHODS This qualitative study explored the experience of performing CPR among ED nurses. Data collection took place between May and June 2016 using an online advertisement to recruit 17 ED nurses. Each participant was interviewed for 40-90min. Interviews were recorded and transcribed verbatim. Data analysis was conducted using a conventional content-analysis method. RESULTS Four themes emerged: Pressure from the urgency of the CPR, becoming sharp tempered in addressing personnel during CPR, keeping psychological conflicts of CPR patient care to oneself, and growing as an ED nurse through CPR. CONCLUSION ED nurses had anxiety about CPR, regardless of their ability to perform CPR. They also suffered psychologically afterward. ED nurses could benefit from education that promotes their competencies for CPR and support systems to alleviate their psychological distress.
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Karlsson M, Karlsson N, Hilli Y. Ethical dilemmas during cardiac arrest incidents in the patient's home. Nurs Ethics 2017; 26:625-637. [PMID: 28558489 DOI: 10.1177/0969733017709337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. AIM: The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. METHODS: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. ETHICAL CONSIDERATIONS: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. FINDINGS: Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. CONCLUSION: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.
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Assarroudi A, Heshmati Nabavi F, Ebadi A, Esmaily H. Professional Rescuers' experiences of motivation for cardiopulmonary resuscitation: A qualitative study. Nurs Health Sci 2017; 19:237-243. [PMID: 28247467 DOI: 10.1111/nhs.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/25/2016] [Accepted: 12/31/2016] [Indexed: 11/29/2022]
Abstract
Rescuers' psychological competence, particularly their motivation, can improve the cardiopulmonary resuscitation outcomes. Data were collected using semistructured interviews with 24 cardiopulmonary resuscitation team members and analyzed through deductive content analysis based on Vroom's expectancy theory. Nine generic categories were developed: (i) estimation of the chance of survival; (ii) estimation of self-efficacy; (iii) looking for a sign of effectiveness; (iv) supportive organizational structure; (v) revival; (vi) acquisition of external incentives; (vii) individual drives; (viii) commitment to personal values; and (ix) avoiding undesirable social outcomes. When professional rescuers were called to perform cardiopulmonary resuscitation, they subjectively evaluated the patient's chance of survival, the likelihood of achieving of the desired outcome, and the ability to perform cardiopulmonary resuscitation interventions. If their evaluations were positive, and the consequences of cardiopulmonary resuscitation were considered favorable, they were strongly motivated to perform it. Beyond the scientific aspects, the motivation to perform cardiopulmonary resuscitation was influenced by intuitive, emotional, and spiritual aspects.
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Affiliation(s)
- Abdolghader Assarroudi
- Department of Medical Surgical Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Heshmati Nabavi
- Department of Nursing Management, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Habibollah Esmaily
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death. ENFERMERIA INTENSIVA 2017; 28:57-63. [PMID: 28094116 DOI: 10.1016/j.enfi.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. METHOD An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. MAIN RESULTS After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. CONCLUSIONS Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals.
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Sjöberg F, Schönning E, Salzmann-Erikson M. Nurses' experiences of performing cardiopulmonary resuscitation in intensive care units: a qualitative study. J Clin Nurs 2015; 24:2522-8. [DOI: 10.1111/jocn.12844] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Fredric Sjöberg
- Faculty of Health and Occupational Studies; University of Gävle; Gävle Sweden
| | - Emil Schönning
- Faculty of Health and Occupational Studies; University of Gävle; Gävle Sweden
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