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Fager C, Rantala A, Svensson A, Holmberg M, Bremer A. Nurses' use of an advisory decision support system in ambulance services: A qualitative study. J Adv Nurs 2024. [PMID: 38515226 DOI: 10.1111/jan.16165] [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: 10/13/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
AIM To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients. DESIGN Inductive and descriptive approaches. METHOD Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis. RESULTS The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations. CONCLUSION Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Cecilia Fager
- Department of Ambulance Service, Kalmar County, Kalmar, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Andreas Rantala
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Skåne, Helsingborg, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anders Svensson
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Växjö, Sweden
| | - Mats Holmberg
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anders Bremer
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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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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Pathfinder; alternative care pathways for older adults who phone the emergency medical services in North Dublin: a case study. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-12-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days.
Design/methodology/approach
This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days.
Findings
This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service.
Research limitations/implications
ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home.
Practical implications
The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care.
Originality/value
Patient feedback surveys confirm older adults want access to alternative care pathways.
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Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence. Scand J Trauma Resusc Emerg Med 2021; 29:4. [PMID: 33407771 PMCID: PMC7789540 DOI: 10.1186/s13049-020-00821-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.
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Hjalmarsson A, Holmberg M, Asp M, Östlund G, Nilsson KW, Kerstis B. Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study. BMC Emerg Med 2020; 20:94. [PMID: 33267796 PMCID: PMC7709262 DOI: 10.1186/s12873-020-00387-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18-69 years requiring emergency care at home in Sweden. METHODS A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017-2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns. RESULTS Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59-0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68-0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40-1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46-2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28-1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00-11:59 interval (p < 0.001, χ2 = 1224.08). CONCLUSION The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.
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Affiliation(s)
- Anna Hjalmarsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden.
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linneaus University, Växjö, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Ambulance Service, Region Sörmland, Eskilstuna, Sweden
| | - Margareta Asp
- 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
| | - Kent W Nilsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden.,Centre for Clinical Research Västerås, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
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Varg S, Vicente V, Castren M, Lindgren P, Rehnberg C. Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers. BMC Emerg Med 2020; 20:85. [PMID: 33126854 PMCID: PMC7602326 DOI: 10.1186/s12873-020-00380-5] [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: 06/10/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.
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Affiliation(s)
- Sofi Varg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. .,Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden.
| | - Veronica Vicente
- Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB], Stockholm, Sweden.,Academic Emergency Medical Services, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Maaret Castren
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,The Swedish Institute for Health Economics, Lund, Sweden
| | - Clas Rehnberg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
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Backman T, Juuso P, Borg R, Engström Å. Ambulance nurses' experiences of deciding a patient does not require ambulance care. Nurs Open 2019; 6:783-789. [PMID: 31367400 PMCID: PMC6650689 DOI: 10.1002/nop2.255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/29/2022] Open
Abstract
AIM To describe ambulance nurses' experience of deciding a patient does not require ambulance care. DESIGN An inductive, empirical study with a qualitative approach. METHODS Data collection was conducted through semi-structured interviews, and collected data were analysed with qualitative manifest content analysis. Data were collected during the spring 2017, and eight ambulance nurses participated. RESULTS The findings are presented in one main category, which is "Not very ill but a difficult decision" with totally three subcategories. The ambulance nurse's experience of making the assessment when the patient has no need for ambulance care is like walking the balance of slack line. This means that the assessment can be both easy and very difficult but something that definitely requires experience, knowledge and dedication.
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Affiliation(s)
| | - Päivi Juuso
- Division of Nursing, Department of Health ScienceLuleå University of TechnologyLuleåSweden
| | - Ronja Borg
- Västerås HospitalRegion of VästmanlandVästeråsSweden
| | - Åsa Engström
- Division of Nursing, Department of Health ScienceLuleå University of TechnologyLuleåSweden
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Holmqvist KL, James I. Patient participation in municipal elderly care from the perspective of nurses and occupational therapists. Nurs Open 2019; 6:1171-1179. [PMID: 31367443 PMCID: PMC6650693 DOI: 10.1002/nop2.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/01/2019] [Accepted: 05/07/2019] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of this study was to describe how nurses and occupational therapists in municipal care of older people define and implement patient participation in their daily work. DESIGN This study had a cross-sectional design. Data were collected using an online questionnaire. METHODS The questionnaire had both closed and open-ended questions. One-hundred and fourteen nurses and occupational therapists responded. Data were analysed with descriptive statistics and thematic analysis. RESULTS Two main themes were identified as follows: "The professionals' perspective at the centre - Patient participation to enhance compliance" and "The patients' perspective at the centre - Patient participation as an ongoing process." The themes covered a continuum. On one extreme, patient participation was equated with making the patient comply with what the professionals wanted to do. On the other extreme, all power was transferred to the patient. The first theme was restricted to the decision-making process. The second theme covered the entire care or, rehabilitation, process.
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Affiliation(s)
- Kajsa Lidström Holmqvist
- Faculty of Medicine and Health, University Health Care Research CenterÖrebro UniversityÖrebroSweden
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | - Inger James
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
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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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Offermann-van Heek J, Ziefle M. They Don't Care About Us! Care Personnel's Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study. JMIR Rehabil Assist Technol 2018; 5:e10424. [PMID: 30249592 PMCID: PMC6231777 DOI: 10.2196/10424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts. Objective The objective of our study was to investigate professional caregivers’ AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies. Methods A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people’s caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage. Results The care context significantly impacted the evaluations of AAL technologies (F14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F2,118=4.570; P=.01) and specific technologies (F2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F2,118=4.073, P=.02) that are allowed to be gathered. Conclusions AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional’s needs and concerns (“care about us”). The results contribute to a broader understanding of professional caregivers’ needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts.
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Affiliation(s)
| | - Martina Ziefle
- Human-Computer Interaction Center, RWTH Aachen University, Aachen, Germany
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Alm-Pfrunder AB, Falk AC, Vicente V, Lindström V. Prehospital emergency care nurses' strategies while caring for patients with limited Swedish-English proficiency. J Clin Nurs 2018; 27:3699-3705. [PMID: 29679408 DOI: 10.1111/jocn.14484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish-English proficiency. BACKGROUND Communication difficulties due to lack of mutual language is a challenge in healthcare systems around the world. Little is known about nurses' strategies while caring for patients with whom they do not share a mutual language in an unstructured, unplanned prehospital emergency environment, the ambulance service. DESIGN AND METHOD A qualitative study design based on interviews was used, and a purposeful sample and snowball technique were used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish-English proficiency. RESULTS Eleven nurses were interviewed, and the main strategy they used was adapting to the patients' need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department as they had not found a secure way of assessing and caring for the patients in the ambulance. CONCLUSION The nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker. RELEVANCE TO CLINICAL PRACTICE The nurses need to be prepared for how to assess and care for patients when there is a lack of mutual language; otherwise, there is a risk of increased unequal care in the ambulance service. To further explore and learn about this field of research, studies exploring the patients' perspective are needed.
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Affiliation(s)
- Annika B Alm-Pfrunder
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden
| | - Ann-Charlotte Falk
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden.,The Ambulance Medical Service in Stockholm (AISAB), Academic EMS, Stockholm, Sweden
| | - Veronica Lindström
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet & Academic EMS, Stockholm, Sweden
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Morales Erazo A, Cardona Arango D. [Prognostic factors of early 30-day mortality in elderly patients admitted to an emergency department]. Rev Esp Geriatr Gerontol 2017; 52:257-260. [PMID: 28666743 DOI: 10.1016/j.regg.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The main aim of this study was to identify the variables related to early mortality in the elderly at the time of admission to the emergency department. METHODOLOGY Using probability sampling, the study included patients 60 years old or older of both genders who were admitted for observation to the emergency department of the University Hospital of Nariño, ¿Colombia? in 2015. Using a questionnaire designed for this study, some multidimensional features that affect the health of the elderly were collected (demographic, clinical, psychological, functional, and social variables). The patients were then followed-up for 30 days in order to determine the mortality rate during this time. Univariate and multivariate logistic regressions and survival analysis were performed. RESULTS Data were collected from 246 patients, with a mean age of 75.27 years and the majority female. The 30-day mortality rate was 15%. The variables most associated with death were: being female, temperature problems, initial diagnosis of neoplasia, and unable to walk independently in the emergency department. CONCLUSION It is possible to determine the multidimensional factors present in the older patient admitted to an emergency department that could affect their 30-day mortality prognosis. and which should be intervened.
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Affiliation(s)
- Alexander Morales Erazo
- Internista Geriatra, Universidad de Caldas, Epidemiologia, Universidad CES, Hospital Universitario Departamental de Nariño, Pasto, Colombia.
| | - Doris Cardona Arango
- Docente investigadora, Grupo de Investigación Epidemiología y Bioestadística, Universidad CES, Medellín, Colombia
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Early prehospital assessment of non-urgent patients and outcomes at the appropriate level of care: A prospective exploratory study. Int Emerg Nurs 2017; 32:45-49. [PMID: 28291697 DOI: 10.1016/j.ienj.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/08/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. METHODS The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. RESULTS 394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. CONCLUSION This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.
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Abstract
BACKGROUND: The concept 'encounter' occurs in caring literature as a synonym for dialogue and relation describing deeper levels of interaction between patient and nurse. In nursing and caring research, the concept 'caring encounter' is often used without further reflection on the meaning of the concept. Encounters are, however, continuously taking place in the world of caring, which calls for a clarification of the concept. OBJECTIVES: This study is an analysis of the concept of caring encounter in nursing from the patients' and nurses' point of view. METHOD: Rodgers' evolutionary view guided the concept analysis within the theoretical perspective of caritative caring. DATA SOURCES: Peer-reviewed articles in English published between 1990 and 2014 were retrieved from the databases: CINAHL, PubMed, Web of Science, ScienceDirect (Elsevier), Springer Link, Primo Central (Ex Libris) and Academic Search Premier (EBSCO) using different combinations of encounter, caring and nursing as keywords. In all, 28 articles related to caring encounters were included in the analysis after applying inclusion and exclusion criteria. ETHICAL CONSIDERATIONS: This study was conducted according to good scientific practice. RESULTS: Four antecedents to the caring encounter are found in the nurse's way of being: a reflective way of being; openness, sensitivity, empathy and ability to communicate; confidence, courage and professionalism; and showing respect and supporting dignity. The attributes are as follows: being there, uniqueness and mutuality. As a consequence, the caring encounter influences both patient and nurse. DISCUSSION AND CONCLUSION: The caring encounter is an encounter between two equal persons where one is nurse and the other is patient. They encounter in mutuality, in true presence, and both have allowed themselves to be the person they are. The results clarify the conceptual differences between relationship and caring communion as the mutuality in the caring encounter differs from the dependence on the other pronounced in the relationship.
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Ahlenius M, Lindström V, Vicente V. Patients’ experience of being badly treated in the ambulance service: A qualitative study of deviation reports in Sweden. Int Emerg Nurs 2017; 30:25-30. [DOI: 10.1016/j.ienj.2016.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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Algilani S, James I, Kihlgren A. Experiencing Participation in Health Care: “Through the Eyes of Older Adults”. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.61007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vicente V, Svensson L, Wireklint Sundström B, Sjöstrand F, Castren M. Randomized Controlled Trial of a Prehospital Decision System by Emergency Medical Services to Ensure Optimal Treatment for Older Adults in Sweden. J Am Geriatr Soc 2014; 62:1281-7. [DOI: 10.1111/jgs.12888] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Veronica Vicente
- Department of Clinical Science and Education; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
- Section of Emergency Medicine; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
| | - Leif Svensson
- Department of Clinical Science and Education; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
- Section of Cardiology; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
| | - Birgitta Wireklint Sundström
- School of Health Sciences; Research Centre PreHospen; University of Borås; Prehospital Research Centre of Western Sweden; Borås Sweden
| | - Fredrik Sjöstrand
- Department of Clinical Science and Education; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
- Section of Emergency Medicine; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
- Nackageriatriken AB; Aleris AB; Nacka Hospital; Nacka Sweden
| | - Maaret Castren
- Department of Clinical Science and Education; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
- Section of Emergency Medicine; Karolinska Institutet; Södersjukhuset; Stockholm Sweden
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Aronsson K, Björkdahl I, Wireklint Sundström B. Prehospital emergency care for patients with suspected hip fractures after falling - older patients' experiences. J Clin Nurs 2014; 23:3115-23. [PMID: 24476341 DOI: 10.1111/jocn.12550] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe and explain older patients' lived experiences of prehospital emergency care in cases of suspected hip fractures after falling. BACKGROUND Falls among the elderly is an issue internationally and a public health problem that seems to be on the increase. In the emergency medical services, older people are frequent patients after having suffered a fall, but there is little information on how older patients experience prehospital emergency care in cases of suspected hip fractures after falling. DESIGN Qualitative interview study. METHODS Ten older patients were interviewed. These depth interviews were tape-recorded, transcribed verbatim and analysed for meanings. RESULTS The comprehensive understanding of the phenomenon is: 'Glad to have been rescued, despite bad experiences as well as good'. The older patient is offered care in an open and friendly atmosphere concurrently with feeling anxiety about the treatment. Intervention with streamlined care and treatment can thus simultaneously be beneficial as well as doing harm. Patients experience confusion and the need to ask questions about what really happened in the ambulance. Bad experiences remain unexplained. These findings are based on three themes with relevant subthemes: efficiency, concerned encounters and suffering from care. CONCLUSIONS Our study shows that prehospital emergency care when hip fracture is suspected - from patients' point of view - is insufficient and unsatisfying. Prehospital emergency care for these vulnerable patients could be improved through more compassion being shown towards older patients' existential needs and their increased participation. Furthermore, alternative methods of prehospital pain relief need to be developed. RELEVANCE TO CLINICAL PRACTICE Responsibility for patients' safety regarding pain relief is emphasised. Pain relief in the emergency medical services should be individualised. This development should focus on care that is already good and gradually eradicate compassionless care.
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Affiliation(s)
- Kenneth Aronsson
- Emergency Medical Service System at Södra Älvsborg Hospital, Borås, Sweden
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Vicente V, Castren M, Sjöstrand F, Sundström BW. Elderly patients' participation in emergency medical services when offered an alternative care pathway. Int J Qual Stud Health Well-being 2013; 8:20014. [PMID: 23445898 PMCID: PMC3584033 DOI: 10.3402/qhw.v8i0.20014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/14/2022] Open
Abstract
As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients' experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients' lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient's medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as "There was a ray of hope about a caring encounter and about being treated like a unique human being". Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.
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Affiliation(s)
- Veronica Vicente
- Section of Emergency Medicine, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Maaret Castren
- Section of Emergency Medicine, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Sjöstrand
- Section of Emergency Medicine, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Wireklint Sundström
- School of Health Sciences, Research Centre PreHospen, The Prehospital Research Centre of Western Sweden, University of Borås, Borås, Sweden
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