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  • 1.
    Berg, Lena M.
    et al.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Ehrenberg, Anna
    Örebro universitet, Institutionen för hälsovetenskaper.
    Östergren, Jan
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Göransson, Katarina E.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
    Reasons for interrupting colleagues during emergency department work: A qualitative study2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, s. 21-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

    Method: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

    Results: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

    Conclusion: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

  • 2.
    Bohm, Katarina
    et al.
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Bartholdson, Sofia
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Castrèn, Maaret
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Descriptions and presentations of sepsis: A qualitative content analysis of emergency calls2015Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, nr 4, s. 294-298Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Sepsis is a serious condition which requires early treatment. We often fail to recognize sepsis patients in the chain of prehospital care. Knowledge of how sepsis is expressed in calls to the emergency medical communication centre (EMCC) is limited. An increased understanding could lead to earlier identification of patients with sepsis.

    OBJECTIVE: The aim of this study was to describe the descriptions of sepsis used during communication between the caller and the emergency medical dispatcher (EMD).

    METHODS: To achieve the aim of the study, an inductive approach of qualitative content analysis was used. In total, 29 consecutive patients, who arrived at the emergency department by ambulance and received a diagnosis of sepsis according to the International Classification of Diseases (ICD)-10, were included in the study. For each case, the corresponding emergency call recording from the EMCC was transcribed verbatim. Main categories and subcategories from the text were abstracted.

    RESULTS: From fifteen subcategories, three main categories were abstracted: "Deterioration", "Physical signs and symptoms" and "Difficulties establishing satisfactory contact with the patient." The way laymen and professionals expressed themselves seemed to differ.

    CONCLUSIONS: Sepsis was described in terms of the physical symptoms, changes of condition and communication abilities of the patient. This knowledge could lead to the identification of keywords which could be incorporated in the decision tool used by the EMD to increase sepsis identification, but further research is required.

  • 3.
    Ek, Bosse
    et al.
    Mid Sweden University, Östersund, Sweden.
    Edström, Pontus
    County Hospital, Östersund, Sweden.
    Toutin, Anders
    County Hospital, Östersund, Sweden.
    Svedlund, Marianne
    Mid Sweden University, Östersund, Sweden.
    Reliability of a Swedish pre-hospital dispatch system in prioritizing patients2013Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, nr 2, s. 143-149Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The need of emergency help often begins with a call to a dispatch center. The operator uses a medical index to prioritize dispatches. Since the resources of ambulances are limited, it is important that the priority grading decided by the operator at the dispatch center is as adequate as possible. In the county of Jamtland in Sweden, a system for triage named METTS-A (Medical Emergency Triage and Treatment System-A) has been in use since 2009, when the patient is coded according to priority level. The aim of this study was to analyse the sensitivity and specificity of the priority grading made by the dispatch center in comparison with the METTS-A priority assessed by the ambulance nurse. Statistics from a data-base in northern Sweden were analyzed. The material covered every ambulance that was dispatched, 6986 times during the period of data collecting. The results show a high sensitivity but low specificity in the dispatch system. The results also indicate that over prioritization exists since most of the patients with a high acute need of an ambulance are correctly identified, while many patients without that need are also given a high priority ambulance service. Therefore the conclusions were that both over- and under prioritizations were made.

  • 4.
    Frost, Elisabeth
    et al.
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden; Karolinska University Hospital, Solna, Sweden.
    Kihlgren, Annica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Jaensson, Maria
    Örebro universitet, Institutionen för hälsovetenskaper.
    Experience of physician and nurse specialists in Sweden undertaking long distance aeromedical transportation of critically ill patients: A qualitative study2018Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, s. 79-83Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Transportation of critically ill patients, intra- or inter-hospital, always involves risks when resources are limited. With aeromedical transports, additional risk factors are incurred. The physiological effects of altitude, when both pressure and density decline, can lead to hypobaric hypoxia and gases trapped in body cavities will expand and cause stress on biological tissue.

    AIM: The aim of this study was to explore the experiences of nurse and physician specialists in Sweden undertaking long distance aeromedical transport of critically ill patients, with a flight time of more than two hours.

    METHOD: A qualitative approach with a descriptive design. Thirteen recorded semi-structured interviews with physician and nurse specialists were analyzed using inductive qualitative content analysis.

    RESULTS: One overall theme emerged, To be one step ahead to ensure patient safety in the air; with three categories 1) With the patient in focus, 2) To be part of a team and concerned about patient safety and 3) To be in need of recovery.

    CONCLUSION: This study demonstrates the challenges with long distance aeromedical transport of critically ill patients. The healthcare personnel make decisions and actions to be one step ahead to ensure patient safety. This isolated work is improved with experience, education, training and good communication skills.

  • 5.
    Hugelius, Karin
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Karlskoga Hospital, Karlskoga, Sweden.
    Adolfsson, Annsofie
    Örebro universitet, Institutionen för hälsovetenskaper.
    The HOPE model for disaster nursing: A systematic literature review2019Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 45, s. 1-9Artikkel, forskningsoversikt (Fagfellevurdert)
  • 6.
    Hugelius, Karin
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Karlskoga Hospital, Karlskoga, Sweden.
    Gifford, Mervyn
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Örtenwall, Per
    Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Center for Woman’s, Family and Child Health, Faculty of Health Science, Buskerud & Vestfold University College, Kongsberg, Norway.
    "To silence the deafening silence": Survivor's needs and experiences of the impact of disaster radio for their recovery after a natural disaste2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 28, s. 8-13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the aftermath of the Haiyan typhoon, disaster radio was used to spread information and music to the affected population. The study described survivors' experiences of being in the immediate aftermath of a natural disaster and the impact disaster radio made on recovery from the perspective of the individuals affected. Twenty eight survivors were interviewed in focus groups and individual interviews analyzed with phenomenological-hermeneutic method. Being in disaster mode included physical and psychosocial dimensions of being in the immediate aftermath of the disaster. Several needs among the survivors were expressed. Disaster radio contributed to recovery by providing facts and information that helped the survivor to understand and adapt. The music played contributed to emotional endurance and reduced feelings of loneliness. To re-establish social contacts, other interventions are needed. Disaster radio is a positive contribution to the promotion of survivors' recovery after disasters involving a large number of affected people and severely damaged infrastructure. Further studies on the use and impact of disaster radio are needed.

  • 7.
    Källberg, Ann-Sofie
    et al.
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden; Department of Emergency Medicine, Falun Hospital, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Östergren, Jan
    Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Göransson, Katarina E.
    Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Physicians' and nurses' perceptions of patient safety risks in the emergency department2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, s. 14-19, artikkel-id S1755-599X(16)30114-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

    METHOD: Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.

    RESULTS: The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.

    CONCLUSION: The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

  • 8.
    Murphy, Jason P.
    et al.
    Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden.
    Rådestad, Monica
    Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Jirwe, Maria
    Sophiahemmet University, Stockholm, Sweden; Karolinska Institutet, Department of Neurobiology and Society, Sweden.
    Djalali, Ahmadreza
    Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Rüter, Anders
    Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden.
    Emergency department registered nurses' disaster medicine competencies: An exploratory study utilizing a modified Delphi technique2019Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, s. 84-91Artikkel i tidsskrift (Fagfellevurdert)
  • 9.
    Nilsson, Christina
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center.
    Bremer, Anders
    Department of Acute and Prehospital Care and Medical Technology and PreHospen – Centre for Prehospital Research Academy, University of Borås, Borås, Sweden; Division of Emergency Medical Services, Kalmar County Hospital, Kalmar, Sweden.
    Blomberg, Karin
    Örebro universitet, Institutionen för hälsovetenskaper.
    Svantesson, Mia
    Örebro universitet, Institutionen för hälsovetenskaper. Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
    Responsibility and compassion in prehospital support to survivors of suicide victim - Professionals' experiences2017Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 35, s. 37-42Artikkel i tidsskrift (Fagfellevurdert)
  • 10.
    Sjölin, Helena
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Lindström, Veronica
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Academic EMS, Stockholm, Sweden.
    Hult, Håkan
    Department of Behavioural Science and Learning, Linköpings University, Linköping, Sweden.
    Ringsted, Charlotte
    Department of Anesthesia and The Wilson Centre, University Health Network, Toronto, Canada; Department of Anesthesia and The Wilson Centre, University of Toronto, Toronto, Canada.
    Kurland, Lisa
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    What an ambulance nurse needs to know: a content analysis of curricula in the specialist nursing programme in prehospital emergency care2015Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, nr 2, s. 127-132Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution.

  • 11. Vatnoy, Torunn Kitty
    et al.
    Fossum, Mariann
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Smith, Nina
    Slettebo, Ashild
    Triage assessment of registered nurses in the emergency department2013Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, nr 2, s. 89-96Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Standardised triage systems have been implemented in emergency departments (EDs) to improve the efficacy of assessment strategies as performed by registered nurses (RNs). However, the exact effect the standardised triage systems have on the decision-making process remains unclear.

    Aim: To evaluate decision making in the triage setting before and after implementation of the Medical Emergency Triage and Treatment System Adult in one hospital's ED.

    Methods: A descriptive intervention design with a quantitative approach. A total of 655 patients before and 413 patients after the intervention were included. A questionnaire was used to evaluate how the RNs assessed the patients before intervention while the emergency patient records were used for data collection after intervention.

    Results: Before the intervention, a majority of the assessments were founded on signs and symptoms and medical diagnoses, whereas vital parameters were rarely used. After the intervention, nearly two thirds of the patients were assessed according to a triage system with vital parameters and standardised algorithm for symptoms and signs included in the assessment procedure.

    Conclusion: Implementing a standardised triage system, including vital parameters and standardised algorithms for signs and symptoms, increased the use of vital parameters and signs and symptoms for decision making and acuity assignment.

  • 12.
    Wennberg, Pär
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Center, Region Örebro, and School of Health Sciences, Örebro University, Sweden.
    Möller, Margareta
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center, Region Örebro.
    Sarenmalm, Elisabeth Kenne
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Institute of Health and Care Sciences and Centre for Person-Centred Care, and Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.
    Herlitz, Johan
    Prehospen-Centre of Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Sweden.
    Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures2020Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, artikkel-id 100825Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Pain management needs to be comprehensively investigated in patients with hip fractures, as it represents a fast-growing challenge to emergency care. The purpose of this study was to describe reported pain in patients with suspected hip fractures in a prehospital setting.

    METHODS: In this observational study, 1,426 patients with a suspected hip fracture were included. Dynamic and static pain were assessed on the arrival of the emergency medical services (EMS) and on hospital admission using the Numerical Rating Scale (NRS), if feasible, and the Behaviour Rating Scale (BRS), if not.

    RESULTS: On EMS arrival, the median dynamic NRS pain score was eight and 84% of the patients had severe or moderate dynamic pain according to the BRS. On admission to hospital, the median dynamic NRS pain score was reduced to five and 45% of the patients had reduced dynamic pain according to the BRS. Among all patients, the NRS was judged to be feasible and was therefore used in 36%. Furthermore, there was an association between the decrease in pain and the increase in the number of administered medications, as well as the duration of prehospital care.

    CONCLUSIONS: Patients with suspected hip fractures suffered substantial pain on EMS arrival. Only half experienced a reduction in pain on hospital admission and only 75% received pain-relieving medication.

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