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Skiftande vårdkvalité hotar patientsäkerheten inom ambulanssjukvården. Nu måste regeringen och Socialstyrelsen skapa nationella riktlinjer, skriver Nätverket för utbildning av ambulanssjuksköterskor.

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.

Background: Teamcare should, like all patient care, also contribute to evidence-based practice (EBP). Randomized controlled trials (RCTs) focusing on teamcare have been performed but no study has addressed its essentials. How far this EBP has progressed in different health aspects is generally established in systematic reviews of RCTs. Aim: The aim is to determine the essentials of teamcare including the nurse profession in RCTs of multi- or interdisciplinary interventions in somatic care focusing on the stated context, goals, strategies, content as well as effectiveness of quality of care. Methods: A systematic review was performed according to Cochrane review as- sumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligi- bility criteria. The PRISMA statement guided the data selection process of 27 articles from PubMed and CINAHL. Results: Eighty-five percent of RCTs in somatic care showed a positive effectiveness of teamcare interventions, of which interdisciplinary ones showed a greater effectiveness compared with the multidisciplinary approach (100% vs 76%). Also theory-based RCTs presented higher positive effectiveness (85%) compared with non-theory-based RCTs (79%). The RCTs with posi- tive effectiveness showed greater levels for professional-centered ambition in terms of goals and for team-directed initiatives in terms of strategy, and a significantly higher level for patient-team interaction plans in terms of content was shown. Conclusions: Teamcare RCTs are still grounded in the multidisciplinary approach having a professional-centered ambition while interdisciplinary

Background: Nursing practice has to contribute to evidence pointing out why there is a need for more nurse-designed randomized control trials (RCTs) focusing on evidence-based practice (EBP).How far this EBP has progressed in different health aspects is usually established by systematic reviews of RCTs. Nurse-led RCTs exist but no study has addressed the essentials of nursing care. Aim: The aim was therefore to determine the essentials of nurses’ interventions by means of nurse-led RCTs in somatic care focusing on the stated context, goals, content, strategies as well as the nurse’s role related to effectiveness. Methods: A systematic review was realized according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data extraction process (n = 55) from PubMed and CINAHL. Results: Of the RCTs in somatic care, 71% showed a positive effectiveness of nurse-led interventions, of which the nurse had a significant role with regard to being the main responsible in 67% of the studies. Also, 47% of the RCTs presented a theoretical standpoint related to the nurse-led interventions and most prominent were international evidence-based guidelines. Goals were found to have either a patient-centered or a professional-centered ambition. Strategies were based on patient-directed initiatives, nurse-patient-directed initiatives or nurse-directed initiatives, while contents were built upon either a patient-nurse interaction or a nursing management plan. Conclusions: This review underlines the necessity of a holistic view of a person, as nurse-led RCTs comprising a patient-centered ambition, patient-directed initiative and patient-nurse interaction plan showed beneficial nursing care effectiveness, particularly if theory-based. In a nurse-led RCT, a basic theoretical perspective is advantageous as well as to elucidate the role of the nurse in relation to the estimated effects.

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.

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. 

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.

One of several quality indicators that are relevant to study is patient’s satisfaction with health care in the ambulance services. Regular measurements of patient satisfaction in this field have not been carried out previously and a validated method of measurement is lacking.

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.

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.

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.

An entirely new type of blood gas analyser has made its way into the marketplace, to be used, for example, in emergency rooms, intensive care units, ambulances, and bedside with quarantined patients in infectious diseases units. The instruments reviewed here employ new miniaturised analysis circuitry, integrated into the cassette on which the blood sample is applied. These instruments are designed for use by care-givers without specific laboratory training. Four point-of-care blood gas analysers are tested: OPTI 1 (AVL), I-STAT (HP), IRMA (Infiniti) och ABL 70 (Radiometer).

The knowledge area of ambulance nurses’ competence represents a relatively new research area that cannot be regarded as having been fully explored and described by existing research. There is uncertainty regarding the required competence for ambulance nurses as well as the professional role of the ambulance nurse in ambulance care. It is also not clear if the ambulance nurse educational programmes reflect the demands placed on the professional requirements of ambulance nurses. The Swedish specialist education programmes for ambulance nurses could benefit from an adequateand up-to-date description of ambulance nurses’ professional competence, which can be used to develop all parts of the curriculum of the specialist nursing programme. The overall aim of this thesis was to explore ambulance nurses’ area of knowledge by describing aspects on competence and education in order to provide a comprehensive understanding of ambulance nurses’ competence as a basis for the development of the specialist nursing education curriculum.The results of this thesis are based on four studies. Several methods were used; the Delphi technique, the critical incident technique, the focus group method, facet theory analysis and qualitative content analysis. Data was collected using questionnaires, interviews and observations. The professional competence of ambulance nurses was found to be made up of multiple separate competences and can be described as complex and multidimensional. The professional demands placed on ambulance nurses’ competence are extensive andaspects of importance to their professional practice in the areas of cognitive, functional and personal competence are described. Formal education could be regarded as the foundation of competence development; however, we also found experienced-based learning in workplaces, including feedback and reflection on practice, to be of great importance to competence development. The ambulance nurse curriculum could be developed by including educational content designed in accordance with our findings concerning aspects on competence and through enhanced cooperation between universities and ambulance services. The results of this thesis can be used as a basis for systematic organisational measures for competence development in ambulance services and for curriculum development, as well as for the development of nationally agreed standards for ambulance nurses’ competence.

Background: The Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updateddescription of ambulance nurses’ competence, including the perspective of professional experiences, seems to be essential.Aim: The aim of this study was to elucidate ambulance nurses’ professional experiences and to describe aspects affecting their competence.Methods: For data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied.Results and conclusion: This study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences.The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development.

Nursing is evolving into new fields of health care including ambulance care, where a branch of specialist nursing is growing. Various views exist on the desired competence for the ambulance nurse and valid guidelines are lacking in Sweden. To increase knowledge of the field, professionals were asked to describe what competences an ambulance nurse should possess. The aim of this study was therefore to elucidate the desired professional competence of the specialist ambulance nurse, according to the professionals. A modified Delphi technique was used, where a panel of professional experts expressed their views on the desired competence of the ambulance nurse. This study reports, at a high level of agreement among the panel experts, that the desired competence of the specialist ambulance nurse consist of forty-four separate competences creating ten areas of competences: execute leadership, generic abilities, interpersonal communication, institutional collaboration, pedagogic skills, possession of relevant knowledge, professional judgement, professional skills, research activities, and technical skills. The high level of agreement among the professionals as well as the large number of competences reflects the high demands placed on the ambulance nurse by the professionals themselves.

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.

Clinical education is a significant part of nursing education on all levels of education. A lot of effort is made by educational providers to prepare the students for their clinical placement (Levett-Jones et al., 2015). At best, this is a shared enterprise, involving representatives from the profession in creating a useful clinical placement for the students. However, the strain on clinical nurses and health care services has led to a decreased communication between facultyand clinical representatives, leaving the universities almost solely responsible for forming clinical education. Some students report problems with clinical supervisorsÂŽ and other professionals’ lack of understanding of educational content and principles for teaching and learning. One way of addressing these problems could be to explore the clinicians ÂŽ views as a complement to the views of the students (Levett-Jones and Lathlean, 2009). The purpose ofthis study was to explore the cliniciansÂŽ views on teaching and learning to help teachers in planning of clinical education. A panel of 39 clinicians were invited to share their views on teaching and learning in a specialist nursing programme. Data was collected alongside a study of clinical competence (Wihlborg et al., 2013) using the Delphi method. A wide range of perceptions, covering all aspects of university education, were expressed and transformed into items for grading of importance. The grading of items provided us with challenges as well as possibilities. At the top end all informants agreed on the importance of clear learning outcomes and a research-based curriculum. Among the lowest graded items were distance education and role-play. The interpretation of these perceptions and their importance to the clinicians can beused in the planning of clinical education and have an impact on all aspects of an educational programme.

LEVETT-JONES, T. & LATHLEAN, J. 2009. ’Don’t rock the boat’: Nursing students’ experiences of conformity and compliance. Nurse Educ Today, 29, 342-9.

LEVETT-JONES, T., PITT, V., COURTNEY-PRATT, H., HARBROW, G. & ROSSITER, R. 2015. What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience? Nurse Educ Pract, 15, 304-9.

WIHLBORG, J., EDGREN, G., JOHANSSON, A. & SIVBERG, B. 2013. The desiredcompetence of the Swedish ambulance nurse according to the professionals - A Delphi study. International emergency nursing.Keywords: Clinical education, Curriculum planning, Perceptions of teaching

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.