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Wihlborg, Jonas, PhDORCID iD iconorcid.org/0000-0003-2171-7193
Publications (10 of 23) Show all publications
Jepsen, K., Lindström, V., Wihlborg, J. & Hörberg, A. (2024). Newly employed nurses’ transition into their new role in the ambulance service– a qualitative study. BMC Nursing, 23(1), Article ID 93.
Open this publication in new window or tab >>Newly employed nurses’ transition into their new role in the ambulance service– a qualitative study
2024 (English)In: BMC Nursing, E-ISSN 1472-6955, Vol. 23, no 1, article id 93Article in journal (Refereed) Published
Abstract [en]

Background Nurses are essential to ensure safe and high-quality care worldwide. The World Health Organization (WHO) forecasts a shortfall of 5.9 million nurses by the year 2030, and in the ambulance service, the turnover rate ranges between 20% and 30%. With this study, we seek to increase knowledge by exploring the transition of newly employed experienced nurses into their roles in the ambulance service using the Meleis theory of transition. Through understanding transition, support for newly employed nurses can be developed, turnover rates can decrease, and in the long term, patient safety may increase.

Design The study employed a qualitative approach.

Methods Eighteen newly employed experienced nurses were individually interviewed four times during their first six months of employment. Deductive qualitative content analysis was used to analyse the data. The reporting of this research adheres to the COREQ checklist.

Results The results show that the transition process for newly employed nurses in the ambulance service encompassed all five aspects of Meleis’ transition theory: Awareness, Engagement, Change and Difference, Time Span, and Critical Points. The transition period varied among the participants, and it was also observed that not all nurses went through a transition in line with Meleis’ theory. Additionally, there were findings that nurses highlighted the impact of the ambulance service culture on their transition.

Conclusions The findings provide a more profound insight into how newly employed nurses with previous experience as nurses navigate their roles and transition into a new profession in a new context. An ambulance service where the organisation is aware of the newly employed nurses’ transition processes and what the transition entails can develop and promote a supportive and permissive culture within the ambulance service. For newly employed nurses who are adequately supported, health transitions are more likely to occur, which may increase retention and in the long term increase patient safety. The insights gained from the study can empower ambulance organisations to improve their introduction programmes and offer enhanced support for newly employed experienced nurses entering the ambulance service.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Ambulance service; EMS; Introduction; Newly employed; Nurses; Transition
National Category
Nursing
Identifiers
urn:nbn:se:du-47975 (URN)10.1186/s12912-024-01745-y (DOI)001156282900001 ()38311770 (PubMedID)
Funder
Karolinska Institute
Available from: 2024-02-05 Created: 2024-02-05 Last updated: 2024-02-22Bibliographically approved
Heldring, S., Jirwe, M., Wihlborg, J., Berg, L. & Lindström, V. (2024). Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders – A Systematic Review of the Literature. Prehospital and Disaster Medicine, 39(1), 94-105
Open this publication in new window or tab >>Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders – A Systematic Review of the Literature
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2024 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 39, no 1, p. 94-105Article, review/survey (Refereed) Published
Abstract [en]

Introduction: First responders’ training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.

Methods: A systematic integrative literature review was used according to Whittemore and Knafl’s descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.

Results: Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.

Conclusions: This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.

Place, publisher, year, edition, pages
Cambridge University Press, 2024
Keywords
disaster medicine, Emergency Medical Services, high-fidelity simulation, mass-casualty incident, review. simulation training, situated cognition theory, virtual reality
National Category
Nursing
Identifiers
urn:nbn:se:du-48014 (URN)10.1017/s1049023x24000049 (DOI)001157480000001 ()38328887 (PubMedID)
Available from: 2024-02-12 Created: 2024-02-12 Last updated: 2024-02-26Bibliographically approved
Wihlborg, J., Svensson, A., Ivarsson, B. & Johansson, A. (2023). Ambulance nurses' experiences of pain management with Penthrox® in Swedish ambulance care: A mixed method study. International Emergency Nursing, 68, Article ID 101275.
Open this publication in new window or tab >>Ambulance nurses' experiences of pain management with Penthrox® in Swedish ambulance care: A mixed method study
2023 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 68, article id 101275Article in journal (Refereed) Published
Abstract [en]

Background: Methoxyflurane (MTX) is an inhalation agent that has several potential benefits for limiting various types of pain in ambulance care.

Aim: To elucidate how ambulance nurses experience the characteristics of MTX in an ambulance care setting.

Method: This cross-sectional study applied a mixed-methods approach, using a questionnaire together with complementary interviews. The questionnaire survey was analyzed using descriptive statistics (10-point Likert scale and question index values [Q-IV], range: 0-1.0). The interviews were analyzed using directed content analysis. Study results were reported following the STROBE statement.

Results: The ambulance nurses' overall general satisfaction with the MTX concept had a median of 7.0 (IQR 5-8), corresponding to a mean Q-IV of 0.84 (very good experience). The qualitative part was divided into three categories: sense of security, patient participation, and general usefulness. The results revealed varying experiences of usefulness, including pain-relieving effect and the possibility of patient participation. The perceived strong odor of MTX seemed to concern the ambulance nurses and their patients.

Conclusion: In general, MTX was experienced as a safe and effective analgesic. However, the experiences of the overall usefulness varied, particularly since the product had a perceived strong odor. Increasing knowledge of using MTX, could likely increase the overall usefulness.

Keywords
Ambulance care; Ambulance nurse; Methoxyflurane; Pain; Pain management; Patient safety; Penthrox; Work environment
National Category
Nursing
Identifiers
urn:nbn:se:du-45807 (URN)10.1016/j.ienj.2023.101275 (DOI)000967439900001 ()36989874 (PubMedID)2-s2.0-85151012645 (Scopus ID)
Available from: 2023-04-03 Created: 2023-04-03 Last updated: 2023-05-09Bibliographically approved
Hörberg, A., Wälivaara, B.-M. & Wihlborg, J. (2023). Taking or creating control: A qualitative study of uncertainty among novice nurses in ambulance care. International Emergency Nursing, 69, Article ID 101308.
Open this publication in new window or tab >>Taking or creating control: A qualitative study of uncertainty among novice nurses in ambulance care
2023 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 69, article id 101308Article in journal (Refereed) Published
Abstract [en]

Introduction: In emergency nursing situations, uncertainty may lead to delays, or block a decision which can have devastating consequences for a patient. The ambulance service is a complex clinical environment that often challenges the decision-making capabilities of the professionals, especially novice nurses. Novice nurses’ uncertainty may also lead to unhealthy transitions and turnover. To increase the understanding of how uncertainty affects novice nurses, this study explores novice nurses’ uncertainty during the first year of professional practice in the ambulance service.

Method: A qualitative descriptive design was applied using qualitative content analysis of thirteen individual face-to-face semi-structured deep interviews.

Result: From nine subcategories, three generic categories were derived: Reflections on contextual understanding, Strategies to create control, and Actions to take control. These were combined to form the main category Understanding what and dealing with how, while becoming a confident professional.

Conclusion: Uncertainty is exacerbated by situations that demand rapid decisions or actions. This is especially true of newcomers to a profession. Preparing novices through study programs and encouraging continuous reflection in professional practice may increase resilience and tolerance of uncertainty, as well as benefiting professional development. 

Keywords
Ambulance service, Emergency care, Novice Nurse, Professional development, Uncertainty
National Category
Nursing
Identifiers
urn:nbn:se:du-46258 (URN)10.1016/j.ienj.2023.101308 (DOI)001035437000001 ()37348240 (PubMedID)2-s2.0-85162242638 (Scopus ID)
Available from: 2023-06-20 Created: 2023-06-20 Last updated: 2023-09-01
Conte, H., Wihlborg, J. & Lindström, V. (2022). Developing new possibilities for interprofessional learning- students’ experience of learning together in the ambulance service. BMC Medical Education, 22(1), Article ID 192.
Open this publication in new window or tab >>Developing new possibilities for interprofessional learning- students’ experience of learning together in the ambulance service
2022 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 192Article in journal (Refereed) Published
Abstract [en]

Background: It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students’ experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL). Aim: The aim of this study was to explore undergraduate students’ experiences of collaboration and learning together during their clinical rotation in the ambulance service.Study design and method: A mixed convergent parallel design was used to describe nursing and medical students’ experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The groupdiscussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students’ self-assessed experiences and competencies in interprofessional collaboration. Results: In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care. Conclusion: The students’ experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students’ learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service.

Keywords
Interprofessional learning, Emergency medical services, Mixed method
National Category
Nursing
Identifiers
urn:nbn:se:du-40344 (URN)10.1186/s12909-022-03251-8 (DOI)000771625400001 ()35307011 (PubMedID)2-s2.0-85126799748 (Scopus ID)
Available from: 2022-03-22 Created: 2022-03-22 Last updated: 2023-04-14
Larsson, G., Dagerhem, A., Wihlborg, J. & Rantala, A. (2022). Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey. BMC Emergency Medicine, 22(1), Article ID 100.
Open this publication in new window or tab >>Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey
2022 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, no 1, article id 100Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The ambulance service is facing an increased number of calls and ambulance assignments. Between 12 and 42% of all assignments result in non-conveyance to the Accident and Emergency Department. However, there is limited knowledge regarding satisfaction among patients and significant others when patients are assessed as non-urgent and discharged at the scene. Therefore, the aim of the study was to explore and compare satisfaction with the ambulance service among patients and significant others when the patient was discharged at the scene.

METHODS: The present study was designed as a cross-sectional exploratory survey with a consecutive sample employing the Consumer Emergency Care Satisfaction Scale questionnaire on patients and significant others.

RESULTS: A total of 162 questionnaires were analysed, 87 patients and 75 significant others. Overall, satisfaction was high with no significant difference between patients and significant others, although 17-19% were dissatisfied with the discharge information.

CONCLUSIONS: Generally, patients and significant others are satisfied with the care provided by the Ambulance Service when discharged at the scene and thus not conveyed the Accident and Emergency Department. The participants were especially satisfied with Specialist Ambulance Nurses' interpersonal skills, e.g., making time and providing thorough information. Guidelines for assignments involving non-conveyance, as well as information, instructions and what to expect when discharged at the scene can be improved.

Keywords
Ambulance care, Ambulance services, Non-conveyance, Non-urgent, Nursing, Patient, Patient satisfaction, Pre-hospital emergency care, Significant others
National Category
Nursing
Identifiers
urn:nbn:se:du-41566 (URN)10.1186/s12873-022-00659-9 (DOI)000807486300001 ()35672702 (PubMedID)2-s2.0-85131481274 (Scopus ID)
Available from: 2022-06-08 Created: 2022-06-08 Last updated: 2023-03-17Bibliographically approved
Jacobsen, A., Bremer, A., Svensson, A., Rantala, A., Strömsöe, A., Hörberg, A., . . . Lindström, V. (2021). Ambulanssjukvården behöver genomgripande förändringar. Dagens medicin: oberoende nyhetstidning för hela sjukvården, Article ID 2021-06-23.
Open this publication in new window or tab >>Ambulanssjukvården behöver genomgripande förändringar
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2021 (Swedish)In: Dagens medicin: oberoende nyhetstidning för hela sjukvården, ISSN 1402-1943, article id 2021-06-23Article in journal, News item (Other (popular science, discussion, etc.)) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-37503 (URN)
Available from: 2021-06-23 Created: 2021-06-23 Last updated: 2023-04-14Bibliographically approved
Johansson, A., Svensson, A. & Wihlborg, J. (2021). Pain management with methoxyflurane (Penthrox®) in Swedish ambulance care: An observational pilot study. International Emergency Nursing, 59, Article ID 101076.
Open this publication in new window or tab >>Pain management with methoxyflurane (Penthrox®) in Swedish ambulance care: An observational pilot study
2021 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 59, article id 101076Article in journal (Refereed) Published
Abstract [en]

Background In ambulance care, patients are often classified as high-risk, particularly when they are in immediate need of pain relief. It has been shown that, after ambulance nurses administer intravenous analgesic drugs, patients delivered to the emergency department tend to complain of moderate to severe pain. Aims and objectives The present study aimed to evaluate the overall patient-perceived pain during treatment with methoxyflurane (MTX) in an ambulance-care setting. We also explored potential demographic variations. Methods This prospective observational study included 50 patients in need of ambulance care that perceived acute pain, defined as a Numeric Rating Scale (NRS) value ≥4 (scale range: 1–10). We monitored the vital parameters of patients and MTX treatment characteristics, including the total number of inhaled MTX breaths and the average number of treatment sequences. Results Among the 50 patients initially assessed, we excluded 8 patients (16%), due to MTX contraindications. We excluded 10 patients (24%), due to discontinued treatment. The remaining cohort (n = 32) that fulfilled the pain-relieving procedure, included equal numbers of men and women. The average time spent in ambulance care was 29 ± 15 min. The NRS scores for pain measured at the scene (median 8.0, interquartile range [IQR]: 7.25–10.0) were significantly higher than those measured at hospital admission (median 5.0, IQR: 4.0 7.0; p = .001). The median NRS scores measured at the hospital were different between sexes (men: 6.0, IQR: 5–7.25; women: 4.0, IQR: 3.76–6.0; p = .036). The average number of treatment sequences was 2. The overall average number of inhaled breaths was 17 ± 9. Conclusion This study demonstrates that MTX provided clinically significant lower pain scores among patients in ambulance care without significant effects on vital parameters. However, the pharmacological characteristics of MTX appeared to affect the potential of achieving standardized treatment objectives.

Keywords
Ambulance care, Emergency care, Pain, Pain management, Methoxyflurane, Penthrox
National Category
Nursing
Identifiers
urn:nbn:se:du-38273 (URN)10.1016/j.ienj.2021.101076 (DOI)000704343100005 ()34592606 (PubMedID)2-s2.0-85115972878 (Scopus ID)
Available from: 2021-09-27 Created: 2021-09-27 Last updated: 2023-04-14Bibliographically approved
Wihlborg, J., Edgren, G., Johansson, A., Sivberg, B. & Gummesson, C. (2019). Using the case method to explore characteristics of the clinical reasoning process among ambulance nurse students and professionals. Nurse Education in Practice, 35, 48-54
Open this publication in new window or tab >>Using the case method to explore characteristics of the clinical reasoning process among ambulance nurse students and professionals
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2019 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 35, p. 48-54Article in journal (Refereed) Published
Abstract [en]

Clinical reasoning is proposed to represent cognitive processes, skills and decision-making aspects of nursing practice and is important for quality care. It has been suggested that the reasoning processes should be practiced during education to develop decision-making competence among nurses. The aim of the study was to explore and describe clinical reasoning processes at different times during specialist ambulance nurse education and among specialist ambulance nurses. Nurses were invited to participate: at initiation of specialist education (n = 19) and during the final weeks of specialist education (n = 17). We also invited nurses employed in ambulance service (n = 13). At each session a written case was presented for small group discussions. Discussions were recorded and transcribed. A mapping sentence was used to analyse the meaning units of the text capturing different elements of clinical reasoning. For interpretation of data the results were then plotted in a three-dimensional diagram. Professional experiences and reflectivity seemed to influence both the content and the process of clinical reasoning. At initiation of specialist education, more analytical reasoning was used, while the specialist nurses mainly used a non-analytical approach. Specialist nurses incorporated a larger variety of content during their reasoning. Based on the findings here, the case-method might be useful for practicing various clinical reasoning skills and elaborating on decision-making processes.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Ambulance nurse, Case-method, Clinical reasoning, Facet theory, Nurse education
National Category
Nursing
Identifiers
urn:nbn:se:du-38266 (URN)10.1016/j.nepr.2019.01.001 (DOI)
Available from: 2021-09-27 Created: 2021-09-27 Last updated: 2021-09-28Bibliographically approved
Levett-Jones, T., Burdett, T., Leng Chow, Y., Jönsson, L., Mathews, L. R., McAllister, M., . . . Wihlborg, J. (2018). Case Studies of Interprofessional Education Initiatives From Five Countries. Journal of Nursing Scholarship, 50(3), 324-332
Open this publication in new window or tab >>Case Studies of Interprofessional Education Initiatives From Five Countries
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2018 (English)In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 50, no 3, p. 324-332Article in journal (Refereed) Published
Abstract [en]

Background: Although teamwork and interprofessional collaboration arecritical to patient safety, nursing, medical, and allied health graduates oftenfeel ill-prepared to confidently communicate and collaborate with other teammembers. While interprofessional education (IPE) has been advocated as a wayof addressing this issue, there are multiple barriers to its systematic and sustained integration in undergraduate healthcare programs. Despite these challenges, examples of effective IPE initiatives have emerged.Innovation: This article profiles seven case studies of innovative interprofessional education activities that have been successfully implemented across five countries, for a variety of learners, using different delivery modalities, and with evaluation results attesting to their success.Conclusions: The case studies demonstrate innovative ideas that have thepotential to overcome some of the barriers to IPE through the use of creativeand targeted approaches. This article provides a wealth of ideas for the successful design and implementation of IPE initiatives and will be of benefit toeducators wishing to expand their repertoire of teaching approaches.Clinical Relevance: A body of research attests to the relationship betweeninterprofessional communication, teamwork, and patient outcomes. IPE is imperative for facilitating the development of nursing graduates’ communicationand teamwork skills; however, innovative approaches are needed to overcomethe perceived and actual impediments to its implementation.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
Collaborative practice, communication, interprofessional education, nursing student, patient outcomes, teamwork
National Category
Nursing
Identifiers
urn:nbn:se:du-38250 (URN)10.1111/jnu.12384 (DOI)
Available from: 2021-09-27 Created: 2021-09-27 Last updated: 2021-09-28Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2171-7193

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