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Akut omhändertagande: i mötet mellan patienter, närstående och olika professioner på skadeplats och på akutmottagning 
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
2011 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim:  To describe and develop understanding of  the patient’s first encounter with the involved persons at the scene of an accident and at the emergency department; with a special focus on describing the meaning of emergency care of patients in these caring contexts. 

Method: The thesis uses a reflective lifeworld research (RLR) approach founded on phenomenological philosophy. The purpose with this approach is to describe the essential meaning and the variations of a phenomenon. Interviews with a lifeworld perspective were used for data collection and analyzed according to the RLR approach for searching for the essence of the phenomenon.  The four essences in the studies (I-IV) establish a general structure for the phenomenon.

Findings:  Emergency care is characterized by an organisation, whose goal and resources are focused on life-saving, and that encounters a human being with needs of emergency care as well as existential support. The responsibility in emergency care means an intertwining of doing and being.  The one who is in charge takes responsibility for performing or “doing” medical actions, and by “being” close and present in the situation the patient can at the same time feel an existential support. The responsibility for the injured or ill body is handed over to a chain of persons with more and more specialized competence and resources. This hand-over entails a relief for all involved but fails in one link in the chain, namely to explicitly hand back  the responsibility to the patient.  When the patient’s condition allows the distance to be larger the responsibility pales and the existential support decreases. A gap between doing and being arises where the patient is left to regain control and independence. The intertwining of doing and being, which appears as soon as the one in charge is close and present to the patient, facilitates the hand-over to the patient who in a natural way is able to receive the responsibility with possibilities to be able to conclude the encounter.

Conclusions: A new understanding of emergency care appears which entails more than just life support measures.  Emergency care includes different ways of communication in order to hand over the responsibility and complete the care chain back to the patient in a safe way. The results highlight the importance of empowering patients with a confirming, communicative contact throughout the whole caring process in order for them to retain their identity. There are also implications for educating students and personnel in inter-professional communication and work. In order to assist the intertwining between doing and being there are needs for the development of supportive structures for inter-professional reflection, which in turn would improve the interaction between patients and professionals in their encounter. 

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press , 2011. , 79 p.
Series
Linnaeus University Dissertations, 57/2011
Keyword [en]
Caring science, emergency care, emergency department, encounter, interpersonal communication, inter-professional work, lifeworld, lived experiences, patient perspective, phenomenology, pre hospital emergency care, scene of an accident
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-13643ISBN: 978-91-86491-94-9 (print)OAI: oai:DiVA.org:lnu-13643DiVA: diva2:432398
Public defence
2011-08-26, Myrdal, Hus K, Växjö, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2011-08-09 Created: 2011-08-03 Last updated: 2012-01-30Bibliographically approved
List of papers
1. More than medical treatment: The patient´s first encounter with prehospital emergency care
Open this publication in new window or tab >>More than medical treatment: The patient´s first encounter with prehospital emergency care
2008 (English)In: Journal of Emergency Nursing, ISSN 0099-1767, Vol. 16, no 3, 185-192 p.Article in journal (Refereed) Published
National Category
Nursing
Research subject
Caring Science
Identifiers
urn:nbn:se:vxu:diva-5478 (URN)
Available from: 2009-06-22 Created: 2009-06-22 Last updated: 2012-01-30Bibliographically approved
2. Being first on the scene of an accident - experiences of 'doing' prehospital emergency care
Open this publication in new window or tab >>Being first on the scene of an accident - experiences of 'doing' prehospital emergency care
2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, 266-273 p.Article in journal (Refereed) Published
Abstract [en]

Prehospital emergency care includes the care and treatment of patients prior to them reaching hospital. This is generally a field for the ambulance services, but in many cases firemen or police can be the ones to provide the first responses. The aim of this study was to describe and understand experiences of being the first responder on the scene of an accident, as described by policemen, firemen and ambulance staff. A lifeworld perspective was used in four different traumatic situations from southern Sweden. The data consisted of 13 unstructured interviews with first responders. The phenomenological analysis showed that experiences of being the first responder on the scene of an accident is expectations of doing a systematic course of action, dressed in the role of a hero, and at the same time being genuine in an interpersonal encounter. This entails a continuous movement between ‘being’ and ‘doing’. It is not a question of either – or, instead everything is to be understood in relation to each other at the same time. Five constituents further described the variations of the phenomenon; a feeling of security in the uncertainty, a distanced closeness to the injured person, one moment in an eternity, cross-border cooperation within distinct borders and a need to make the implicit explicit. This finding highlights the importance of using policemen and firemen in doing life support measures while waiting for the ambulance staff, and would in turn increase the importance of the relationship between the different professionals on the scene of an accident.

Place, publisher, year, edition, pages
Wiley, 2010
Keyword
phenomenology, prehospital emergency care, reversibility, team resources, trauma
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-10220 (URN)10.1111/j.1471-6712.2009.00716.x (DOI)
Available from: 2011-01-20 Created: 2011-01-19 Last updated: 2017-12-11Bibliographically approved
3. On a hidden game board: the patient’s first encounter with emergency care at the emergency department
Open this publication in new window or tab >>On a hidden game board: the patient’s first encounter with emergency care at the emergency department
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 17-18, 2609-2616 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives.  Describe and understand the patient’s first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions.

Background.  The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown.

Design.  A lifeworld research perspective was used in four different situations at the emergency department.

Methods.  The data consisted of 14 open-ended interviews with patients, next of kin and first providers.

Results.  The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, ‘courtesy encounters’, isolated in a timeless encounter, striving for meaning in the encounter.

Discussion.  Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter.

Relevance to clinical practice.  The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurse’s role as the patients’ advocate and for strengthening the effort for an emergency department to become more of a learning organisation.

Keyword
emergency care, emergency department, interpersonal communication, interprofessional care, lived experiences, patients' experience, phenomenology
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-17155 (URN)10.1111/j.1365-2702.2011.03929.x (DOI)000307546000023 ()2-s2.0-84865332356 (Scopus ID)
Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2017-12-08Bibliographically approved
4. Trapped between doing and being: First providers´ experience of “front line” work
Open this publication in new window or tab >>Trapped between doing and being: First providers´ experience of “front line” work
2012 (English)In: International emergency nursing, ISSN 1878-013X, Vol. 20, no 3, 113-119 p.Article in journal (Refereed) Published
Abstract [en]

A common focus in research studies within the Emergency Department (ED) is physician patient relations, experiences of the triage model and nurses´ experiences of caring. Little has, however, been written about different first providers´ experiences of working on the “front line” at the ED. The aim of this study was to describe and understand experiences of being the first provider on the “front line” at the ED, as expressed by nurse assistants, registered nurses and physicians. A reflective lifeworld research approach was used in four different caring situations. The data consisted of eight open-ended interviews with first providers. The analysis showed that being the first provider on the “front line” at the ED entails a continuous movement between providing and responding through performing “life-saving” actions and at the same time create a good relationship with the patient and the next of kin. Five constituents further described the variations of the phenomenon. The readiness to save lives creates a perceived stress of time pressure and the first providers adopt different strategies to cope with the work. Instead of leaving the first providers to find their own way to cope with the complex situation, there are needs for a redesigning of the internal work process within ED organizations.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-17162 (URN)10.1016/j.ienj.2011.07.007 (DOI)22726942 (PubMedID)2-s2.0-84862647647 (Scopus ID)
Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2015-03-05Bibliographically approved

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