AIM:To explore how patients and their relatives perceive and experience emergency care delivered at home by Mobile Emergency Teams (METs). DESIGN:An exploratory qualitative design was used to explore how patients and relatives experienced the care encounter. This approach was appropriate given the exploratory nature of the study. ETHICAL CONSIDERATIONS:The study was approved by the Swedish Ethical Review Authority (No: 2023-02186-01) and conducted in accordance with the Declaration of Helsinki. Participants provided informed consent, were assured of confidentiality, and were informed of their right to withdraw at any time. METHODS:The study was conducted in southwestern Sweden and included 20 semi-structured interviews with patients (n = 11), relatives (n = 4), and joint patient-relative interviews (n = 5) who had recently received care from METs. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's six-phase thematic analysis. RESULTS:The analysis generated two overarching themes: Embraced by a calming environment and A sense of safety and security. Participants described METs' arrival as a turning point that brought calm and clarity to emotionally intense situations. The teams' respectful approach, clear communication and structured assessments contributed to emotional reassurance. Receiving care at home, in a familiar environment and in the presence of loved ones, supported participants' sense of dignity, autonomy and control. However, some participants expressed uncertainty about what would happen after METs' departure, indicating a need for improved follow-up and continuity of care. LIMITATIONS:Findings are shaped by a specific Swedish context, joint interviews and purposive sampling, which may limit transferability. CONCLUSION:Emergency care at home was experienced as emotionally supportive and clinically competent. Attentiveness, clarity and a respectful presence were central to participants' sense of being thoroughly and considerately cared for.

Emergency care faces increasing pressure, with extended waiting times and strained resources. Medical Emergency Teams (METs) combine expertise from emergency departments and ambulance services to deliver coordinated emergency care in patients’ homes. This study explores nurses’ and physicians’ experiences and actions when providing such care. This qualitative study used the Critical Incident Technique with an inductive approach. Seventeen individual interviews were conducted with nurses and physicians from two METs in southwestern Sweden. All 22 clinicians were eligible and invited to participate, and no exclusion criteria were applied. Data were collected between November 2023 and January 2024 and analyzed using content analysis. Participants reported that collaboration within MET was sometimes insufficient, limiting the full use of team skills. However, in time-critical situations, teamwork became more cohesive. Actions included understanding patients situations and preferences and fostering collaboration with other care providers. Experience over time helped clinicians identify which patients could safely remain at home. Delivering emergency care at home allows clinicians to gain deeper insight into patients’ everyday lives and provide more comprehensive care. This shift may reduce care fragmentation and help identify contextual risks often overlooked in hospital-based settings.

Simulation-based education is commonly used in undergraduate training but has gained increased utilization in postgraduate education. Ambulance nursing programs struggle to provide suitable simulations, as ambulance care can involve any possible situation. Simulation-based education in ambulance nursing programs commonly includes basic assessment and treatment of various conditions. However, there seems to be a lack of knowledge regarding students' experience of simulating pediatric emergency care in an ambulance care setting. Thus, the aim of this study was to explore specialist nursing students' experiences of simulating pediatric emergency care in an ambulance care setting. A qualitative design was deployed, utilizing field notes, individual and group interviews to capture the students' experiences. The results show that students immerse themselves in the simulations when the environment and facilitators support this. The simulation can elicit both emotional and physical responses among the students. Students gain insights into their knowledge deficit regarding certain topics, such as pediatric emergency care, as well as the rules and regulations governing what they are allowed to do for a child's safety and well-being. During simulation, students understand the importance of using adequate communication and recognize that there might be several aspects influencing this. Finally, the students gain insight into their emotional and behavioral responses when encountering patients and relatives in situations that conflict with their own views. In conclusion, simulation-based education can be a useful pedagogical tool if barriers to immersion are reduced. It can provide students with insights into their emotional and behavioral responses when encountering unexpected events. If properly discussed in debriefing sessions, these matters lead to increased learning that students can carry with them into their future careers. However, more research is needed on the feasibility of this kind of simulation in the ambulance nurse education setting.

This article illustrates how clinical decision support systems (CDSS) are integrated into clinical reasoning and affect decision-making processes in emergency medical services (EMS). CDSS aims to assist clinical reasoning with relevant patient information and medical knowledge, facilitating decision-making. As CDSS become increasingly significant in Swedish healthcare, understanding their implementation is critical, particularly as technological innovations may reshape clinical reasoning and professionals’ decision-making. The study draws on empirical data from observations and interviews with registered nurses (RNs) in a simulation project. Findings illustrate how clinical reasoning is a collective process among colleagues and how emotions and tacit knowledge are central to professional judgment. Although RNs express confidence in technical systems assisting clinical reasoning, they remain skeptical in situations requiring compromises to their judgment based on CDSS outputs. Finally, the article problematizes the effects on RNs when working with unsynchronized or insufficiently functioning technical systems.

Introduction Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR. Methods Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources. Results The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates. Conclusion The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.

The growing global instability has increased the demand for healthcare and disaster response skills among registered nurses (RNs). However, research shows that RNs are not sufficiently prepared for disaster situations. Although RNs are responsible for managing injuries during armed conflicts in accordance with International Humanitarian Law (IHL), nursing education lacks specific training in this area. A national survey revealed that only two universities in Sweden offer IHL-related education for nursing students. These findings highlight the urgent need to revise nursing education in Sweden to better prepare RNs for the challenges posed by global crises, including armed conflicts.

Introduction Healthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exacerbate crowding and boarding problems in the ED, negatively impacting patient safety and the work environment. In Sweden a hybrid of prehospital and intrahospital emergency care has been established, referred to in this article as Medical Emergency Team (MET), to meet the increasing demand for emergency care. MET, consisting of physicians and nurses, moving emergency care from EDs to patients' home. Physicians and nurses may encounter challenges in their healthcare work, such as limited resources for example medical equipment, sampling and examination, in unfamiliar varying home environments. There is a lack of knowledge about how these challenges can influence patient care. Therefore, the aim of this study was to explore the healthcare work of the METs when addressing patients' emergency care needs in their homes, with a focus on the METs reasoning and actions. Methods Using a qualitative multiple case study design, two METs in southwestern Sweden were explored. Data were collected from September 2023 - January 2024 and consist of field notes from participant observations, short interviews and written reflections. A qualitative manifest content analysis with an inductive approach was used as the analysis method. Result The result of this study indicates that physicians and nurses face several challenges in their daily work, such as recurring interruptions, miscommunication and faltering teamwork. Some of these problems may arise because physicians and nurses are not accustomed to working together as a team in a different care context. These challenges can lead to stress, which ultimately can expose patients to unnecessary risks. Conclusion When launching a new service like METs, which is a hybrid of prehospital and intrahospital emergency care, it is essential to plan and prepare thoroughly to effectively address the challenges and obstacles that may arise. One way to prepare is through team training. Team training can help reduce hierarchical structures by enabling physicians and nurses to feel that they can contribute, collaborate, and take responsibility, leading to a more dynamic and efficient work environment.

Introduction: Ethical competence in professional practice can be considered essential among nurses and nurses in ambulance care encounter ethical dilemmas frequently. To enhance ethical competence among students in the ambulance specialist nursing program, high-fidelity simulation scenarios including ethical dilemmas were introduced as a learning activity. Research aim: The research aim was to investigate the usefulness of high-fidelity simulation in ambulance specialist nurse education to teach ethical reasoning when caring for children. Research design: This study was conducted as a qualitative interview study, complemented with observations and using field notes and qualitative interviews for data collection. Data was analysed using deductive qualitative content analysis based on a care ethical model. Participants and research context: Participants ( n = 35) were recruited from an ambulance nurse educational program at a Swedish university. Data was collected after the students took part in two high-fidelity simulations involving children in an ambulance care setting. Ethical considerations: The study has been vetted and approved by the ethical council at the University of Borås, Sweden. The study follows the Helsinki Declaration’s advice on ethical principles. Results: The results showed that most of the students expressed some form of ethical reasoning during the simulation sessions, which were elaborated and reflected upon during the debriefing part of the sessions. The simulation design seemed to have a great impact on the outcome of the student’s ethical reasoning, where increased immersion led to deeper emotional engagement among the students which increased awareness of their personal preconceptions. Conclusions: This study aimed to investigate whether high-fidelity simulations could be useful to stimulate ethical reflections and contribute to increased ethical competence among students. In conclusion, a well-designed high-fidelity simulation can be useful as an educational tool to learn and enhance ethical competence among specialist ambulance nursing students.

Registered nurses play a critical role in disaster response and patient care during crises. Recent global events underscore the importance of preparedness for disaster response. However, the readiness of registered nurses and their educational preparation vary. In Sweden, this prompted the National Board of Health and Welfare to introduce a new national curriculum for disaster response. This study aimed to assess how education for undergraduate and specialist registered nurses aligns with this curriculum. A descriptive cross-sectional study was conducted among universities and university colleges in Sweden offering undergraduate and specialist nursing programs. Surveys were sent to all 25 higher education institutions providing nursing education in November 2023, comprising 29 questions related to the new curriculum. Findings revealed that half of the respondents had discussed the new curriculum, with 15 reporting some form of learning activities. Traditional lectures were the most commonly used format, and 11 respondents had designated teachers for the subject. Reasons for lacking disaster response education included prioritizing other acute care areas or a limited perspective at the academy. In conclusion, this study suggests that nursing education may not sufficiently prepare registered nurses for disaster response and armed conflicts. Education tends to focus more on acute care rather than taking a broader perspective. As a result, registered nurses may lack the competence and readiness required to effectively respond to disasters.

Background Medicine is facing a global shortage of nurses, including those with postgraduate education. One suggested educational method for undergraduate and postgraduate education, such as specialist ambulance nurse education, is simulation-based education (SBE). The implementation of SBE is motivated, in part, by the desire to attract and retain students, but also to contribute to student learning. Consequently, the use of SBE is increasing in specialist ambulance nurse education. The aim of this study was to explore how specialist ambulance nursing students experience SBE. Methods This qualitative survey study involved the collection of study data using a purposefully designed, paper-based survey comprising five open-ended questions that required participant free-text answers. The answers were analysed using inductive content analysis and searching for descriptions of the participants’ experiences. The survey was presented to 35 specialist ambulance nursing students. Results The results are presented in two themes: SBE as learning and SBE as an educational method . Participating in SBE during the programme provides students with a realistic understanding of their future profession and its expected demands. The learning experience disregards prior work experience in ambulance services. Conclusions Based on the findings, conclusions are that SBE is an appreciated educational method among nursing students, regardless of their prior experience in the field of prehospital care. To some extent, this differs from previous research findings related to this subject. Furthermore, SBE contributes to the provision of field work insights, preparing the ambulance nurse specialist students.

Situation awareness is knowing what is going on in the situation. Clinicians working in the emergency medical services (EMS) encounter numerous situations in various conditions, and to be able to provide efficient and patient safe care they need to understand what is going on and possible projections of the current situation. The design of this study encompassed a Goal-Directed Task analysis where situation awareness information requirements were mapped in relation to goals related to various aspects of the EMS mission. A group of 30 EMS subject matter experts were recruited and answered a web-based survey in three rounds related to what they though themselves or a colleague might need to achieve situation awareness related to the specific goals of various situations. The answers were analysed using content analysis and descriptive statistics. Answers reached consensus at a predetermined level of 75%. Those who reached consensus were entered into the final goal-directed task analysis protocol. The findings presented that EMS clinicians must rely on their own, or their colleagues prior experience or knowledge to achieve situation awareness. This suggests that individual expertise plays a crucial role in developing situation awareness. There also seems to be limited support for situation awareness from organizational guidelines. Furthermore, achieving situation awareness also involves collaborative efforts from the individuals involved in the situation. These findings could add to the foundation for further investigation in this area which could contribute to the development of strategies and tools to enhance situation awareness among EMS clinicians, ultimately improving patient care and safety.

In emergency medical services (EMS), the clinical reasoning (CR) of registered nurses (RNs) working in ambulance care plays an important role in providing care and treatment that is timely, accurate, appropriate and safe. However, limited existing knowledge about how CR is formed and influenced by the EMS mission hinders the development of service provision and decision support tools for RNs that would further enhance patient safety. To explore the nature of CR and influencing factors in this context, an inductive case study examined 34 observed patient–RN encounters in an EMS setting focusing on ambulance care. The results reveal a fragmented CR approach involving several parallel decision-making processes grounded in and led by patients’ narratives. The findings indicate that RNs are not always aware of their own CR and associated influences until they actively reflect on the process, and additional research is needed to clarify this complex phenomenon.

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

Background Clinical practice guidelines (CPGs) provide guidance for emergency care clinicians to perform patient assessments. Neglecting CPGs may lead to incomplete or fragmented assessments and cause ad-verse events. However, it is important for CPGs to be evidence based, and patient assessments must be conducted in such a manner that high levels of patient safety can be achieved. The aim of this study was to explore and evaluate the quality of emergency medical services (EMS) and emer-gency departments (EDs) CPGs for comprehensive patient assessments. Methods A national cross-sectional design was used, and the listed managers from 97 organizations (25 EMS and 72 EDs) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were ap-praised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Results The results revealed that none of the CPGs outlined a comprehensive patient assessment. The main characteristic of the CPGs was their focus on the medical assessment of patients with life-threatening conditions, mostly based on initial assessment and the A-E principle (airway, breathing, circulation, disability, and exposure). According to the AGREE II analysis, the overall quality of the guidelines was poor. CPGs lacked scientific support, underlying evidence, descriptions of how that evidence was collected, and explanations of the criteria used for CPG development. Conclusions This research indicated that there were no Swedish CPGs with comprehensive patient assessments in emergency care and that the foundation for evidence-based CPGs for comprehensive patient assessments was weak.

Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review. Data was collected through searches in electronic databases, networking among research teams, colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding - namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes. This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives. Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.

Larmrapporterna duggar tatt inom flera delar av samhallet idag och en turbulent omvarld gor sig standigt pamind. I en tid dar den som hors och syns mest oftast ar den som far fram sitt budskap syftar Larmar och gor sig till till att ge diverse effektfulla och kansloknutna utsagor om var samtid lite empiriskt tuggmotstand. Larmar och gor sig till ar den sjuttionde forskarantologin fran SOM-institutet. Boken innehaller 40 kapitel och baseras i huvudsak pa 2016 ars nationella SOM-undersokning, i kombination med SOM-institutets trettioariga tidsserier.

Sammanfattning/abstrakt Problemomrade Syftet med arbetet ar att synliggora hur barn framstalls muntligt och verbalt inom en forskoleverksamhet. I studien vill vi undersoka om samma barnsyn kan sparas i det skrivna och det verbala spraket. Ur ett specialpedagogiskt perspektiv kan det vara av nytta att se vilka olika satt att betrakta barn som det kan finnas inom en verksamhet, samt hur man som specialpedagog kan arbeta med det. Vidare kommer studien att berora hur barn och vardnadshavare blir paverkade av denna barnsyn. Sa vart problemomrade blir: - Hur framstalls barn inom en forskoleverksamhet? Syfte Vi vill med detta arbete synliggora hur barn beskrivs inom en forskoleverksamhet. I denna studie vill vi undersoka om samma barnsyn genomsyrar det skrivna, samt det verbala spraket. Ur ett specialpedagogiskt perspektiv kan det vara av nytta att se vilka olika roster om barn som lyfts inom en verksamhet och hur man som specialpedagog kan arbeta med det. Fragestallningar • Hur ser olika pedagoger pa relationen mellan individ och dokumentation? • Hur framtrader barns och vardnadshavares delaktighet? • Hur gors bedomningar av barn och vilka olika synsatt framtrader? Teoretiska utgangspunkter Den teoretiska utgangspunkten ar en ansats till kritisk pragmatism. Inom kritisk pragmatism utgar man ifran helheten och all verksamhet, samt hur konsekvenserna av verksamheten ska forstas ur ett helhetsperspektiv. Den kritiska pragmatismen tillsammans med diskursanalysen har gett oss mojligheten att se detta helhetsperspektiv i verksamheten som studien har utforts i. Aven Foucaults maktteorier har hjalpt oss att se balansen mellan de olika aktorerna som verkar inom verksamheten. Metod Studien har en kvalitativ och hermeneutisk ansats och hermeneutiken har hjalpt oss att tolka det empiriska materialet, bade utvecklingsplanerna samt att skapa en forstaelse kring informanternas utsagor vid intervjutillfallena. Vara intervjuer har varit semistrukturerade, intervjuerna har transkriberats och med hjalp av diskursanalys har monster hittats. Studien har genomforts i en forskoleverksamhet och sammanlagt har fem forskollarare och tva specialpedagoger intervjuats. Sammanfattning av resultatet Resultatet i var studie visar att det finns tva olika satt att se pa barn i verksamheten dar den ena ar en verbal barnsyn och den andra ar en skriftlig barnsyn. Den verbala barnsynen lutar sig overlag mot en sociokulturell utgangspunkt medan den skriftliga har inslag av konstruktivismen. Verbalt visade pedagogerna en medvetenhet om att verksamheten ska utga ifran det kompetenta barnet, medan detta synsatt inte lyftes lika tydligt i den skriftliga dokumentationen. Anledningen till att det kan ha uppstatt tva olika satt att beskriva barn anser vi kan bero pa att idag ska det sociokulturella perspektivet genomsyra forskolans verksamhet, men samtidigt finns en utvecklingspsykologisk tradition som lever kvar. Den sociokulturella medvetenheten finns med i det verbala spraket och en generell slutsats till varfor det sociokulturella inte lyser igenom utvecklingsplanen kan vara att pedagogerna inte ar nojda med utvecklingsplanens utformning. Vi kan i studien se maktens betydelse bland de olika aktorerna inom verksamheten. Pedagogerna gav uttryck for en stravan mot en jamnare maktfordelning dar barn och vardnadshavare ska fa okat inflytande. Samtidigt finns en ojamn maktfordelning som kan vara svar att bryta, da pedagoger besitter en legitim kunskap via sin yrkesprofession. Aven specialpedagogerna beskriver tva olika satt att se pa barn i de verksamheter som de besoker. Specialpedagogerna lyfter fram att de stravar efter att maktfordelningen ska bli jamnare mellan alla aktorer inom verksamheten. Nyckelord Barnsyn, Diskursanalys, Dokumentation, Forskola, Kritisk pragmatism, Makt