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Challenges in prehospital emergency care: patient, spouse and personnel perspectives
Örebro University, Department of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Prehospital emergency care (PEC) with the emergency call to the Emergency Medical Dispatch (EMD) centre is an essential part of the health-care system. It is important to obtain knowledge about the links in the PEC chain from the perspectives of those providing the service and those receiving it. The overall aim of this thesis was to describe the challenges surrounding PEC based on the experiences of patients, spouses and personnel. A qualitative descriptive design was used in the five papers included. The data analysis methods were phenomenological-hermeneutics (I–III), qualitative content analysis (IV–V) and descriptive statistics (V).

Interviews with thirteen patients who had called the EMD-centre due to acute chest pain (I) revealed a general satisfaction with PEC. They were aware of the number to call in an emergency but were uncertain when to call. The potentially life threatening emergency situation was marked by vulnerability and dependency and was fraught with pain, fear and a sense of aloneness.

An overall theme of aloneness emerged from the interviews with nineteen spouses who had placed an emergency call for their husband or wife that was experiencing acute chest pain (II). The challenges in being a spouse to a person in need of PEC were associated with: “Being responsible and trying to preserve life” and “Being able to manage the uneasiness and feel trust in an uncertain situation”. The spouses were in an escalating spiral of aloneness, worry, uncertainty, stress, fear of loss and desperation.

Interviews with sixteen emergency operators dealt with situations they considered difficult to deal with and their reflections on how they managed such situations (III). Uncertainty, communication difficulties and insufficient resources characterized those situations. Skills, knowledge, experience, as well as personal qualities such as sensitivity, self-insight, empathy and intuition were regarded as important when handling them.

Interviews with four nurses and fifteen emergency operators related to their experiences of working together for two years at an EMD-centre were conducted after the nurses were added to the EMD-centre to increase medical and nursing competence (IV). Initial frustration and scepticism changed to positive experiences with improved cooperation and service. The nurses voiced difficulties dealing with the more medically urgent calls and the emergency operators with the more complicated and diffuse medical cases.

A total of 336 questionnaires related to alarms involving acute chest pain and given the highest priority by the emergency operator were collected in a study aimed at describing the ambulance personnel’s perceptions of the quality of the information received from the EMD-centre (V). The ambulance personnel perceived most of the information such as patient assessment, condition, history, preparedness and in particular pain status to be of high quality.

In summary: In PEC there is many interdependent complexities that present demands and challenges to the actors involved (I–V). In general those who received emergency assistance from PEC were satisfied, but the margins between success and failure are small. Risks for errors exist throughout the PEC chain and time poses a challenge. Understanding is crucial for all involved, and the same situation can be experienced differently. Challenges inherent in PEC are the communication problems, unpredictability and uniqueness along with daring to be in the acute situation and dealing with a sense of aloneness, uncertainty and dependency. The personnel that do not have the ability to see the person they are helping are even more challenged. Important attributes for PEC personnel are caring attitudes, personal skills, experiences and professional knowledge. PEC personnel have the authority and power to act and make decisions, in which responsibility, sensitivity, and human dignity must be addressed. Lives are saved with PEC despite all the challenges and possibilities for error, such as those that exist between the different actors. It is vital that the PEC chain is as strong as possible.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2007. , 74 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 16
Keyword [en]
challenge, prehospital, emergency, care, patient, spouse, personnel, chain, acute chest pain
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-1525ISBN: 978-91-7668-554-9 (print)OAI: oai:DiVA.org:oru-1525DiVA: diva2:135139
Public defence
2007-11-01, Wilandersalen, Universitetssjukhuset Örebro, Örebro, 13:00
Opponent
Supervisors
Available from: 2007-10-11 Created: 2007-10-11 Last updated: 2011-05-23Bibliographically approved
List of papers
1. Patients with acute chest pain: experiences of emergency calls and pre-hospital care
Open this publication in new window or tab >>Patients with acute chest pain: experiences of emergency calls and pre-hospital care
2005 (English)In: Journal of Telemedicine and Telecare, ISSN 1357-633X, Vol. 11, no 7, 361-367 p.Article in journal (Refereed) Published
Abstract [en]

Acute chest pain is a common reason why people call an emergency medical dispatch (EMD) centre. We examined how patients with acute chest pain experience the emergency call and their pre-hospital care. A qualitative design was used with a phenomenological-hermeneutic approach. Thirteen patients were interviewed, three women and 10 men. The patients were grateful that their lives had been saved and in general were satisfied with their pre-hospital contact. Sometimes they felt that it took too long for the emergency operators to answer and to understand the urgency. They were in a life-threatening situation and their feeling of vulnerability and dependency was great. Time seemed to stand still while they were waiting for help during their traumatic experience. The situation was fraught with pain, fear and an experience of loneliness. A sense of individualized care is important to strengthen trust and confidence between the patient and the pre-hospital personnel. Patients were aware of what number to call to reach the EMD centre, but were uncertain about when to call. More lives can be saved if people do not hesitate to call for help.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-5941 (URN)16238838 (PubMedID)
Available from: 2009-03-06 Created: 2009-03-06 Last updated: 2011-05-23Bibliographically approved
2. Acute chest pain: spouses' experiences of the alarm situation, emergency call and prehospital care
Open this publication in new window or tab >>Acute chest pain: spouses' experiences of the alarm situation, emergency call and prehospital care
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15655 (URN)
Available from: 2011-05-23 Created: 2011-05-23 Last updated: 2016-12-05Bibliographically approved
3. Operators' experiences of emergency calls
Open this publication in new window or tab >>Operators' experiences of emergency calls
2004 (English)In: Journal of Telemedicine and Telecare, ISSN 1357-633X, Vol. 10, no 5, 290-297 p.Article in journal (Refereed) Published
Abstract [en]

In Sweden, the operators at emergency dispatch centres are responsible for allocating resources (e.g. ambulances, fire brigade, police) in response to calls. We analysed situations that the emergency operators experienced as difficult and their reflections on how they managed them. Interviews were conducted with all 16 emergency operators at a centre that serves a population of 275,000 and receives about 700,000 emergency calls annually. A phenomenological-hermeneutic approach was used for the analysis. Situations that operators experienced as difficult were characterized by uncertainty, communication difficulties and insufficient resources. Skills, knowledge and experience were regarded as important in the management of these situations, as were personal qualities such as sensitivity, insight, empathy and intuition. The emergency operators stated that they needed more guidance, feedback and education in their work. This would lead to an increased sense of certainty, which would lead to decreased stress and a better outcome for those in need.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-5939 (URN)10.1258/1357633042026323 (DOI)
Available from: 2009-03-06 Created: 2009-03-06 Last updated: 2011-05-23Bibliographically approved
4. Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre
Open this publication in new window or tab >>Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre
2006 (English)In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, no 4, 230-236 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Prehospital care begins when the call is placed to the emergency medical dispatch (EMD) centre and ends when the patient is cared for at the emergency department. The highly technical and specialized character demands advanced medical competence. Communication problems, serious and unpredictable situations can often occur during the emergency calls. A two-year intervention study involved the addition of registered nurses to an EMD-centre team to increase medical competence. AIM: To describe registered nurses' and emergency-operators' experiences of working together at an EMD-centre after adding registered nurses to increase medical competence. METHODS: Qualitative content analysis was used to analyse the text from interviews with four registered nurses and 15 emergency-operators involved in the intervention. RESULTS: Initial frustration and scepticism changed to more positive experiences that resulted in improved cooperation and service. The registered nurses had difficulties dealing with the more urgently acute calls, while the emergency-operators had difficulties with the more complicated, somewhat diffuse cases. The two professions complemented each other. CONCLUSION: Combining the registered nurses' and emergency-operators' knowledge and experience at an EMD-centre can perhaps improve the prehospital care for those requiring emergency medical care.

National Category
Social Sciences Interdisciplinary Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-5943 (URN)10.1016/j.aaen.2006.06.006 (DOI)
Available from: 2009-03-06 Created: 2009-03-06 Last updated: 2011-05-23Bibliographically approved
5. Acute chest pain alarms: ambulance personnel's perceptions of the quality of the information received from the EMD-centre
Open this publication in new window or tab >>Acute chest pain alarms: ambulance personnel's perceptions of the quality of the information received from the EMD-centre
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15654 (URN)
Available from: 2011-05-23 Created: 2011-05-23 Last updated: 2016-12-05Bibliographically approved

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