Carina Elmqvist

Powerlessness: Dissatisfied patients' and relatives' experience of their emergency department visit

AIM The aim of this study was to disclose the meaning of patients and relatives lived experience of dissatisfaction when visiting an emergency department. INTRODUCTION Even though most patients are pleased with the emergency department care, there are areas that dissatisfy them, for example lack of communication and unoccupied wait time. However, there are few studies that describe both patients and relatives experience of dissatisfaction. METHODS This explorative study uses a phenomenological hermeneutic approach where patients and relatives were interviewed. RESULTS Patients and relatives meaning of dissatisfaction mainly contain powerlessness, struggling for control over the situation, lacking knowledge and information, receiving and providing support. CONCLUSIONS The results showed that the experiences of dissatisfaction were similar among patients and relatives. They suffer in the same way when being treated like objects during their visits. Nursing rounds are one way to decrease dissatisfaction by making patients and relatives participating in the care continually updated with information.

Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire - family version

BACKGROUND In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed. SETTING Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden. METHOD The Person-centred Climate Questionnaire-Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality--three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P. AIM The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context. RESULTS The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbachs Alpha was >0.7 and item-total correlations were >0.3 and <0.7. CONCLUSION In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.

A nursing student-run health clinic – an innovative project based on reflective lifeworld-led care and education

Nursing students need support in order to be able to intertwine caring science theory with practice through reflection. In this theoretical paper a nursing student-run health clinic based on lifeworld led learning and caring is described and propounded as providing such support. The student nurses are offered possibilities for integrating theoretical and practical knowledge by the re-location of parts of the theoretical courses to this innovative learning environment. In applying a phenomenological attitude, both in the learning situation and in the caring situation, the natural (unreflective) attitude is challenged in order for the student nurses to gain a deeper and broader understanding of caring science within their caring practice and vice versa. This means that the nursing students can develop a reflective caring approach that is important in order to become both sensitive and sensible nurses. This paper can be supportive for nurse educators in developing nursing education to meet the needs of the modern society. Our perspective on health, well-being and reflective learning can also inspire persons who work in clinical practice and with health promotion.

Home healthcare nurses’ experiences of being on stand by as a first responder in a ‘While Waiting For the Ambulance’ assignment

The aim of the study is to describe experiences of the ‘While Waiting for the Ambulance’ (WWFA) assignment, as described by home healthcare nurses (HHCNs). Since the early 1990s, municipal resources in Sweden, preferably firefighters, have been dispatched on WWFA. In order to further assist the local residents on an island in the southwest of Sweden, HHCNs have recently begun accompanying firefighters on WWFA. A reflective lifeworld approach was used for data analysis including in-depth interviews with eight HHCNs. When WWFA was established, the HHCNs experienced lack of clarity in where their responsibilities start and end. A split role is described, and there is a paradox in that the responders are meant to collaborate toward saving lives, when the assignment itself has a lack of collaborative structure. Ethical dilemmas and inner emotional worries led to the nurses expressing a need for support before, during and after WWFA.

Using 360-degrees interactive videos in patient trauma treatment education: design, development and evaluation aspects

Extremely catastrophic situations are rare in Sweden, which makes training opportunities important to ensure competence among emergency personnel who should be actively involved during such situations. There is a requirement to conceptualize, design, and implement an interactive learning environment that allows the education, training and assessment of these catastrophic situations more often, and in different environments, conditions and places. Therefore, to address these challenges, a prototype system has been designed and developed, containing immersive, interactive 360-degrees videos that are available via a web browser. The content of these videos includes situations such as simulated learning scenes of a trauma team working at the hospital emergency department. Various forms of interactive mechanisms are integrated within the videos, to which learners should respond and act upon. The prototype was tested during the fall term of 2017 with 17 students (working in groups), from a specialist nursing program, and four experts. The video recordings of these study sessions were analyzed and the outcomes are presented in this paper. Different group interaction patterns with the proposed tool were identified. Furthermore, new requirements for refining the 360-degrees interactive video, and the technical challenges associated with the production of this content, have been found during the study. The results of our evaluation indicate that the system can provide the students with novel interaction mechanisms, to improve their skills, and it can be used as a complementary tool for the teaching and learning methods currently used in their education process.

Firefighters as First Incident Persons : breaking the chain of events and becoming a new link in the chain of survival

Purpose In order to shorten the response time, two part-time fire departments (FDs) in Sweden initialize a first incident person (FIP) assignment. This is done by alarming the crew manager as an FIP, responding in a separate emergency vehicle, and by arriving at the scene before rest of the crew. The purpose of this paper is to explore and describe experiences of the FIP assignment within an FD. Design/methodology/approach A multimethod design was used, influenced by Creswell and Plano Clark’s (2011) explanatory sequential mixed method design including emergency reports, a questionnaire and interviews. Findings The results show that the FIP assignment was a function that secured an early presence at the scene of an accident or emergency situations, which is beneficial for society in the form of a safety factor, for the firefighters in the form of early prior information on what to expect at the scene and for the patient in the form of early existential support and increased chances of survival. Originality/value In order to prevent full scenarios to happen and get the chance to save lives, an early response must be ensured. Hence, studies must be made in different settings, based on its unique conditions. This study indicates that by implementing FIP in FDs placed in a rural area, the FIP can break the chain of events and becoming a new link in the chain of survival.

Meanings of Chronic Pain in Patient Interactions with Health Services

Chronic pain causes suffering for patients and managing chronic pain is one of the most common assignments in the health service. Health care professionals can profoundly influence the meaning patients and their families attribute to pain experience. Patients with chronic pain may feel discredited and called into question by skeptical medical professionals. Patients may have to fight to receive entitled care and to suggest suitable treatments. To contribute to medical decision-making and improved patient outcomes, health care professionals should integrate phenomenological narratives and stories about pain into health care in parallel with consulting the medical evidence. Professional care structures should not make health care professionals feel torn between meeting patient needs for existential support and the demand of meeting high clinical work-loads. Narratives and stories can provide shared structures that allow patients and medical professionals to make decisions that feel meaningful, accurate, and clear. Many patients use psychological strategies in their everyday lives in order to live meaningfully with persistent pain; but, this is not enough. Healthcare professionals need “dare to open up and accept personal and deep conversations with patients” about their pain experiences and the lived consequences of persistent pain.