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  • 1. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    University of Borås, Sweden.
    Strömsöe, Annelie
    Andersson, Henrik
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Prehospital suspicion and identification of adult septic patients: Experiences of a screening tool2016In: 2nd Global Conference on Emergency Nursing and Trauma Care, Melia Sitges, September 22-24, 2016, 2016Conference paper (Refereed)
    Abstract [en]

    Introduction: Sepsis is life threatening and requires urgent healthcare to reduce suffering and death. Therefore it is important that septic patients are identified early to enable treatment. Aim: To investigate to what extent EMS personnel identified patients with sepsis using the “BAS 90-30-90” model, and to describe assessments and medical procedures that were undertaken by the personnel.

    Methods: This was a retrospective study where 185 EMS medical records were reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

    Results: A physician assessed the patients in 74 of the EMS cases, which lead to exclusion of these records in regard to the EMS personnel’s ability to identify sepsis. The personnel documented suspicion of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion of patients ˃65 years of age was 73% (n=135) of which 37% (n=50) were over 80 years old. Thirty-nine percent (39%, n=72) were females. The personnel documented blood pressure in 91% (n=168), respiratory rate in 76% (n=140), saturation in 100% (n=185), temperature in 76% (n=141), and heart rate in 94% (n=174) of the records. Systolic blood pressure <90 mmHg was documented in 14,2% (n=24), respiratory rate ˃30 in 36% (n=50), saturation <90 in 49%  (n=91), temperature >38°C in 37.6% (n=53), and heart rate ˃90 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous lines (70%, n=130), intravenous fluids (10%, n=19) and administration of oxygen (72%, n=133).

    Conclusion: The EMS personnel identified only a few septic patients with the help of the BAS 90-30-90 model when all three criteria would be met for severe sepsis. Either advanced age (>65 years), fever (>38°C) or tachypnea (˃20 breaths/min) appeared to increase the personnel’s suspicion of sepsis. Oxygen, but not intravenous fluids, was given in an adequate way.

  • 2.
    Andersson, Henrik
    et al.
    University of Borås, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Larsson, Anna
    South Älvsborg's Hospital, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås, Sweden.
    Gellerstedt, Martin
    University West, Sweden.
    Bång, Angela
    University of Borås, Sweden;University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Sweden.
    The early chain of care in bacteraemia patients: early suspicion, treatment and survival in prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 36, no 12, p. 2211-2218Article in journal (Refereed)
    Abstract [en]

    Introduction

    Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome was assessed.

    Methods

    This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

    Results

    In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection” more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p < 0.0001).

    Conclusion

    This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

  • 3.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Larsson, Anna
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    Bång, Angela
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ljungström, Lars
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed)
    Abstract [en]

    Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

    Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

    Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

    Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

  • 4.
    Andersson, Ulf
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Falchenberg, Åsa
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Evidence-based guidelines for comprehensive assessment in pre-hospital and hospital emergency care2018In: 3rd Global Conference on Emergency Nursing & Trauma Care, Noordwijkerhout, October 4-6, 2018, 2018Conference paper (Other academic)
  • 5.
    Axelsson, Christer
    et al.
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Hagiwara, Magnus
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Nationella regler krävs för ambulanssjukvård2011In: Svenska Dagbladet, ISSN 1101-2412, no 2011-11-15Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    I Sverige är det upp till varje landsting att bestämma hur snabbt en ambulans ska vara på plats. I stället borde det finnas nationella riktlinjer kring hur tillgängligheten ska se ut, skriver flera ambulanssjuksköterskor.

  • 6.
    Axelsson, Christer
    et al.
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Karlsson, Anders
    Älvsborg Hospital, Sweden.
    Sjöberg, Henrik
    Älvsborg Hospital, Sweden.
    Jiménez-Herrera, Maria
    Universitat Rovira I Virgili, Spain.
    Bång, Angela
    University of Borås, Sweden.
    Jonsson, Anders
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Gellerstedt, Martin
    University West, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Sweden.
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 272-277Article in journal (Refereed)
    Abstract [en]

    There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

    All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

    In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.

    The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).

    Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.

  • 7.
    Berntsson, Tommy
    et al.
    Halmstad University, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Claesson, Andreas
    University of Borås, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Abelsson, Anna
    Karlstad University, Sweden.
    Johansson, Anders
    Karlstad University, Sweden.
    Svensson, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wallin, Kim
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Kågström, Christer
    Luleå University of Technology, Sweden.
    Rantala, Andreas
    Lund University, Sweden.
    Wihlborg, Jonas
    Lund University, Sweden.
    Ek, Bosse
    Mid Sweden University, Sweden.
    Styrwoldt, Eva
    Sophiahemmet University, Sweden.
    Aléx, Jonas
    Umeå University, Sweden.
    Gyllencreutz, Linda
    Umeå University, Sweden.
    Uppstu, Tom
    Umeå University, Sweden.
    Ekbom, Birgitta
    Uppsala University, Sweden.
    Lingsarve, Johan
    Uppsala University, Sweden.
    Adolfsson, Annsofie
    Örebro University, Sweden.
    Inget händer trots kända brister inom ambulanssjukvården2013In: Svenska Dagbladet, ISSN 1101-2412, Vol. 19 majArticle, book review (Other (popular science, discussion, etc.))
  • 8.
    Bertilsson, Emelie
    et al.
    Kalmar County Hospital.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal (Refereed)
  • 9. Bertilsson, Emilie
    et al.
    Semark, Birgitta
    Schildmeijer, Kristina
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Do-not-attempt-to resuscitate-orders in a Swedish Community Hospital – does the wording of these orders point towards discrimination?2019Conference paper (Refereed)
  • 10.
    Bremer, Anders
    University of Borås.
    Ambulanssjukvård mellan liv och död: ett etiskt perspektiv2009In: Vårdvetenskapens dag, Växjö universitet, 2009Conference paper (Other academic)
    Abstract [en]

    Patienters hjärtstopp utanför sjukhus orsakar lidande och död. Det påverkar även närståendes fortsatta livssituation. Bakgrund: För ambulanspersonal kan det vara svårt ta etiskt riktiga beslut vid vård av patient med hjärtstopp. I balansen mellan nytta och risk med återuppliv-ning är det svårt att avgöra vad som är rätt eller fel och när det är meningslöst eller emot patientens vilja. De drabbades erfarenheter, och ett normativt per-spektiv, kan bidra med kunskap om vad etiskt god vård vid hjärtstopp kan vara. Syfte: Att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus re-spektive närvara vid närståendes hjärtstopp, samt belysa de etiska aspekter och problem som framträder. Metod: Kvalitativa intervjuer med fenomenologisk livsvärldsansats. Nio över-levande patienter och sju närstående intervjuades. Resultat: Överlevande patienter beskriver hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och för-lust av sammanhang. Efteråt, via andra människors berättelser och egna minnen, söker överlevande efter sammanhang så att händelsen och livssituationen kan ges mening och förklaring till tankar, känslor och upplevelser. I det fortsatta li-vet finns existentiell otrygghet där identiteten och meningen i livet omvärderas i takt med en växande insikt om hur kroppen påverkats. Där finns tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där det passerade livs-hotet införlivas i ett liv där nära relationer blivit viktigare. Närstående upplever patientens hjärtstopp som overkligt. Tiden tycks stanna upp. Samtidigt är verk-ligheten extremt påtaglig med ett överväldigande, ensamt ansvar med känsla av otillräcklighet. Ambulanspersonalens ankomst väcker närståendes hopp om att patienten ska överleva, samtidigt som allt är kaotiskt, ångestfyllt och omtumlan-de då närstående kastas mellan hopp och misströstan. Livets grundvalar skakas om. Efter händelsen finns frågor och oro. Närståendes ensamhet i sorg eller oro för den överlevandes framtid, riskerar att leda till uppoffringar av egna behov. Slutsats: I det akuta skedet är det svårt att avgöra om patienten kan räddas till ett fortsatt acceptabelt liv varför återupplivningsförsök bör göras vid behand-lingsbara hjärtstopp. Undantagsvis är det rätt att avstå från, eller avbryta, åter-upplivning och vid förekomst av giltigt förhandsdirektiv är det primära att främ-ja en värdig död. Ambulanssjuksköterskor kan antas kunna ta ett utökat etiskt ansvar när det gäller beslutsrätten att avstå/avbryta återupplivning vid hjärtstopp och i eftervården av överlevande patienter kan ambulanspersonal hjälpa till att återskapa förlorade sammanhang. Ett rimligt vårdansvar för närstående är att ge stöd i krissituationen, dels under pågående återupplivning och dels då patienten avlidit. Däremot är hjärtlungräddning utförd som en ritual för närstående skull inte att betrakta som ett gott akut vårdande.

  • 11.
    Bremer, Anders
    University of Borås, Sweden.
    Att vara patient inom ambulanssjukvården2012In: Akut vård ur ett patientperspektiv / [ed] Sofia Almerud Österberg, Lena Nordgren, Studentlitteratur AB, 2012, p. 29-49Chapter in book (Other academic)
  • 12.
    Bremer, Anders
    University of Borås.
    Att överleva hjärtstopp2007In: Inför bildandet av nytt forskningscentrum i VGR, Borås 2007-11-09, 2007Conference paper (Other academic)
  • 13.
    Bremer, Anders
    University of Borås, Sweden.
    Caring for families at sudden cardiac death: A balance between closeness and distance2012In: The 26th Conference of the European Society for Philosophy of Medicine and Health Care, 2012Conference paper (Refereed)
    Abstract [en]

    Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects more than half a million people in the United States and Europe each year. As resuscitation attempts are unsuccessful in most of the cases, ambulance professionals often face the needs of bereaved family members. Decisions to continue or terminate resuscitation attempts at OHCA are influenced by factors other than patient clinical characteristics, such as the personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. Research exploring how ambulance personnel are affected by family dynamics and the emotional context, and how they are able to provide care for bereaved family members is sparse. It is also a lack of research into why ambulance professionals sometimes administer physiologically futile cardiopulmonary resuscitation (CPR) to patients with cardiac arrest to benefit family members. This way of meeting families’ grief reactions implies ethical problems. Based on an empirical study of ambulance professional’s experiences of caring for families when patients suffer cardiac arrest and sudden death, and an ethical analysis exploring arguments for providing physiologically futile CPR, the issue of caring for bereaved family members in ethical good and bad ways is explored. The empirical study results show that ambulance personnel experience a concomitant responsibility, sometimes failing to prioritize between responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care imply a movement from well-structured guidance to a situational response where the personnel are forced to balance between interpretive reasoning and a more direct emotional response at their own discretion. With such affective response in decision-making, the personnel risk erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs is essential, and dependent on the ambulance personnel’s balance between closeness and distance, and on their courage to meet emotional expressions of the families, as well as the personnel’s own vulnerability. A need for ethical competence is invoked by the presence of family members, placing great demands on mobility in the decision-making process, between medical care of the patient and caring for family members. The conclusion is that the strategy of ambulance professionals in the care of bereaved family members should be to avoid additional suffering by focusing on the relevant care needs of the family members and provide support, arrange for a peaceful environment and administer acute grief counseling at the scene, which might call for a developed ethical caring competence. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Ambulance personnel also need training in awareness of the needs of families suffering sudden bereavement, as well as support and help to deal with personal discomfort.

  • 14.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dagens ambulanssjukvård2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber, 2016, 2, p. 48-64Chapter in book (Other academic)
  • 15.
    Bremer, Anders
    University of Borås, Sweden.
    Dagens ambulanssjukvård2016In: Prehospital akutsjukvård, Stockholm: Liber, 2016, 2, p. 48-64Chapter in book (Other academic)
  • 16.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Den mångfacetterade delaktigheten2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 65-71Chapter in book (Other academic)
  • 17.
    Bremer, Anders
    University of Borås, Sweden.
    Den mångfacetterade delaktigheten2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 65-71Chapter in book (Other academic)
  • 18.
    Bremer, Anders
    University of Borås, Sweden.
    "Ej HLR”: Rätten att få dö2013In: HLR 2013. Malmö 2013-10-22, 2013Conference paper (Refereed)
  • 19.
    Bremer, Anders
    University of Borås, Sweden.
    En andra chans2012In: Forskning för hälsa, ISSN 1653-9753, no 3, p. 18-19Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Överlevare av plötsligt hjärtstopp utanförsjukhus är en unik och växande patientgrupp.Men hur blir livet efteråt?Frågeställningen finns med i denforskning Anders Bremer bedriver och som tidigarei år utmynnade i en avhandling. I syfte att beskrivasamtliga inblandades erfarenheter vid plötsligthjärtstopp intervjuade han överlevare, närståendeoch ambulanspersonal, som inte sällan ställs införetiska frågeställningar vid hjärtstopp.

  • 20.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska aspekter vid HLR2012In: Hjärtstoppsymposium 2012, Stockholm, Sverige 24 April, 2012Conference paper (Other academic)
  • 21.
    Bremer, Anders
    University of Borås, School of Health Science. University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Etiska frågeställningar vid drunkning2014Conference paper (Other academic)
    Abstract [sv]

    WHO uppskattar att 450 000 människor årligen avlider i världen till följd av drunkning, varav majoriteten är barn. Hjärtstopp och plötslig död som orsakas av drunkning är betydligt vanligare i låginkomstländer. Detta innebär att många liv går förlorade till följd av drunkningsolyckor, samtidigt som fattiga länder drabbas särskilt hårt. Mot bakgrund av detta framträder den etiska frågan: Hur kan fler liv räddas? Även rättviseprincipen blir viktig och bör rimligen föranleda åtgärder för att förhindra drunkning och rädda drunkningsoffer i särskilt utsatta delar av världen. Vilket ansvar har vi i Sverige för detta arbete?

    Etiker använder ofta drunkning som exempel för att tydliggöra den moraliska plikten att rädda liv. Vid ett drunkningstillbud kräver denna plikt specifika förmågor, mod och självuppoffring. Ett fullgörande av plikten kan å ena sidan riskera egna förluster och ytterst det egna livet, och å andra sidan ge belöning i form av självaktning och framför allt minskat lidande och död för andra. Plikten att göra allt för patientens bästa grundas i godhetsprincipen som innebär att främja nyttan för den drabbade, samtidigt som riskerna med fortsatta återupplivningsförsök övervägs i ett senare skede. Här framträder den etiska frågan: Hur kan liv räddas, samtidigt som överlevnad till ett ovärdigt liv minimeras?

  • 22.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska frågeställningar vid drunkning2014In: HLR 2014 om drunkning: 3-4 juni, Tylösand, Sverige, 2014Conference paper (Refereed)
    Abstract [en]

    WHO uppskattar att 450 000 människor årligen avlider i världen till följd av drunkning, varav majoriteten är barn. Hjärtstopp och plötslig död som orsakas av drunkning är betydligt vanligare i låginkomstländer. Detta innebär att många liv går förlorade till följd av drunkningsolyckor, samtidigt som fattiga länder drabbas särskilt hårt. Mot bakgrund av detta framträder den etiska frågan: Hur kan fler liv räddas? Även rättviseprincipen blir viktig och bör rimligen föranleda åtgärder för att förhindra drunkning och rädda drunkningsoffer i särskilt utsatta delar av världen. Vilket ansvar har vi i Sverige för detta arbete? Etiker använder ofta drunkning som exempel för att tydliggöra den moraliska plikten att rädda liv. Vid ett drunkningstillbud kräver denna plikt specifika förmågor, mod och självuppoffring. Ett fullgörande av plikten kan å ena sidan riskera egna förluster och ytterst det egna livet, och å andra sidan ge belöning i form av självaktning och framför allt minskat lidande och död för andra. Plikten att göra allt för patientens bästa grundas i godhetsprincipen som innebär att främja nyttan för den drabbade, samtidigt som riskerna med fortsatta återupplivningsförsök övervägs i ett senare skede. Här framträder den etiska frågan: Hur kan liv räddas, samtidigt som överlevnad till ett ovärdigt liv minimeras?

  • 23.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska ställningstaganden vid hjärtstopp2013In: State of the Heart. Vårdprofessioner inom Cardiologi (VIC). Malmö 2013-11-13, 2013Conference paper (Other academic)
  • 24.
    Bremer, Anders
    University of Borås, Sweden.
    Etiska värderingar inom spansk och svensk ambulanssjukvård2015In: Forskningssymposium om prehospital akutsjukvård: Torsdag 5 mars 2015, Högskolan i Borås, 2015Conference paper (Other academic)
  • 25.
    Bremer, Anders
    University of Borås, Sweden.
    Ett överväldigande ansvar: att vara närstående vid hjärtstopp2010In: PreHospenkonferensen. Träffsäker bedömning och god vård, 2010Conference paper (Other academic)
    Abstract [en]

    Denna fenomenologiska livsvärldsstudie beskriver sju närståendes erfarenheter av att en nära person drabbats av hjärtstopp i hemmet eller ute i samhället. Resultatet visade hur närstående plötsligt upplevde kontrollförlust och en känsla av overklighet. De upplevde sig ensamt ansvariga, otillräckliga och med svårigheter att möta ett överväldigande ansvar. I den ensamma och utsatta situationen blev allt kaotiskt, ångestfyllt och omtumlande. När ambulanspersonal anlände väcktes närståendes hopp. Beroende på vilken föreställning eller kunskap närstående hade om patientens tillstånd kastades de mellan förhoppningar om överlevnad och tvivel över det meningsfulla med livräddande åtgärder. Efter händelsen kände sig närstående ofta lämnade ensamma med oro och frågor inför framtiden. Oron motverkade välbefinnande och hotade viktiga värden i ett gott liv eftersom de riskerade att bli ensamma i sorg efter den döde, eller i oro för den överlevandes framtid. Närstående försummade egna och viktiga behov. Resultatet visar att ambulanspersonal har en prima facie plikt att stödja närstående i samband med en patients hjärtstopp och död. Detta förutsätter uppmärksamhet, känslighet och öppenhet inför närståendes outsagda eller uttryckliga frågor och behov. Vid dödsfall i hemmet bör ambulanspersonal finnas till hands så länge som det krävs för att hjälpa närstående i kris.

  • 26.
    Bremer, Anders
    University of Borås, Sweden.
    Hjärtstopp utanför sjukhus2012In: Medicinska Riksstämman, 28-30 nov 2012: Tema Framtidens hälsa, 2012Conference paper (Other academic)
  • 27.
    Bremer, Anders
    University of Borås.
    Mötet med närstående2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Liber, 2009, 1, p. 150-161Chapter in book (Other academic)
  • 28.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Mötet med närstående2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 211-227Chapter in book (Other academic)
  • 29.
    Bremer, Anders
    University of Borås, Sweden.
    Mötet med närstående2016In: Prehospital akutsjukvård, Stockholm: Liber, 2016, 2, p. 211-227Chapter in book (Other academic)
  • 30.
    Bremer, Anders
    University of Borås, Sweden.
    Nytta mot risker: etiska riktlinjer för HLR2014In: Akutsjukvård – den äldre patienten : Omvårdnad - flöden - kompetens: Stockholm 3-4 september 2014, 2014Conference paper (Other academic)
    Abstract [en]

    När en person drabbas av plötsligt hjärtstopp gör sjukvårdspersonal i regel allt för att få igång hjärtat igen. Ibland kan det dock vara mer etiskt försvarbart att avstå från HLR. Här får vi inblick i Svenska Läkaresällskapet, Svensk sjuk-sköterskeförening och Svenska HLR-rådets etiska riktlinjer, som stöd till sjukvårdspersonalens ställningstagande om HLR ska påbörjas eller inte och skälen som kan motivera ett ställningstagande att avstå.

  • 31.
    Bremer, Anders
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    När livet skakas om: patienters och närståendes erfarenheter av hjärtstopp utanför sjukhus2008Licentiate thesis, comprehensive summary (Other academic)
    Abstract [sv]

    I Europa vårdar ambulanspersonal årligen cirka 300 000 människor med hjärtstopp. Ungefär en av tio överlever. Tidigare forskning har inte i någon större utsträckning berört hur överlevande patienter och närstående mår efteråt eller vilka etiska aspekter och problem som möter ambulanspersonal i dessa situationer. Med hjälp av en reflekterande livsvärldsansats är syftet med denna licentiatavhandling att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus respektive närvara vid en nära persons hjärtstopp. Med utgångspunkt i det empiriska resultatet är syftet att belysa och diskutera etiska aspekter och problem av betydelse för ambulanspersonals vårdande ur ett normativt perspektiv.

    Avhandlingens empiriska resultat visar hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och kontrollförlust genom den minneslucka som tillfogats. Att överleva innebär därför ett sökande efter sammanhang så att situationen kan ges mening och förklaring till tankar, känslor och upplevelser. Känslan av sammanhang nås via andra människors berättelser tillsammans med egna minnen. I det fortsatta livet finns existentiell rädsla och otrygghet där den egna identiteten och meningen i livet omvärderas i takt med en växande insikt om hur den egna kroppen påverkats av hjärtstoppet. Ibland upplevs kroppen som begränsad vilket skapar otrygghet och rädsla. I det fortsatta livet kan det finnas skuldkänslor för det inträffade likväl som att hjärtstoppet ses som en opåverkbar händelse. Men det finns även tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där vardagliga sysslor ger tillvaron en viss stadga. Det passerade livshotet införlivas i ett liv där mänskliga relationer blivit än viktigare värden i ett gott liv.

    Närvaro vid en nära persons hjärtstopp omkullkastar känslan av kontroll. Allt upplevs overkligt, tiden tycks stanna upp och samtidigt är verkligheten extremt påtaglig. Förvåning övergår snabbt till ett kaos av tankar och känslor där panik, chock och fruktan griper tag. Verkligheten innebär ett överväldigande och ensamt ansvar där närstående känner sig otillräckliga. Väntan på professionell hjälp känns lång och det är en befriande känsla då ambulanspersonal anländer och övertar ansvaret. Samtidigt väcks hopp om att patienten ska överleva. För närstående är allt kaotiskt, ångestfyllt och omtumlande då de kastas mellan hopp och misströstan för att slutligen få ett overkligt och ogripbart besked om den nära personens överlevnad eller död. Livets grundvalar skakas om och uppmärksammar livets skörhet och att inget kan tas för givet. Efter händelsen finns obesvarade frågor och oro som riskerar att leda till ensamhet i sorg eller i en oro för den överlevandes framtid. Oavsett vilket, riskerar ensamheten att leda till uppoffring av egna och viktiga behov.

    I ett gott beslut balanseras etiska normer att rädda liv, rätten till värdig/god död, autonomiprincipen samt att göra gott och inte skada. Den övergripande normen vid hjärtstopp är att rädda liv. Att i det akuta skedet avgöra om patienten räddas till ett acceptabelt liv är svårt. Det empiriska resultatet ger dock stöd för att återupplivning bör göras vid behandlingsbara hjärtstopp samtidigt som resultatet visar hur svårt det är att dra en gräns för vad ett acceptabelt liv är. Undantagsvis är det goda beslutet att avstå från eller avbryta återupplivning, exempelvis vid förekomst av ett giltigt förhandsdirektiv. En värdig/god död är då det primära. Ett utökat etiskt ansvar för ambulanssjuksköterskor kan vara att de ges beslutsrätt för avbrytande av återupplivning. Ett annat ansvar handlar om möjligheten att främja ett gott liv för överlevande genom att efteråt bidra med kunskap som kan skapa förlorade sammanhang. Ansvaret för närstående kan innebära att meningslös återupplivning inte görs ”för deras skull” utan att deras behov möts på bättre sätt.

  • 32.
    Bremer, Anders
    University of Borås, Sweden.
    Specialistsjuksköterska med inriktning mot ambulanssjukvård2014In: Att bli specialistsjuksköterska eller barnmorska: utbildningar för framtiden, Studentlitteratur AB, 2014, p. 19-46Chapter in book (Other academic)
    Abstract [en]

    Behovet av specialistutbildade sjuksköterskor ökar. I den här boken presenteras tolv utbildningar som leder till en examen som specialistsjuksköterska eller barnmorska. Vidare ger boken en inblick i vad de olika yrkena innebär. Boken presenterar arbetsplatser och karriärvägar och ger också konkreta exempel på vad specialistsjuksköterskor eller barnmorskor kan komma att möta en vanlig dag på jobbet. Därutöver presenteras Högskoleverkets examensmål för respektive inriktning samt länkar till fastställda kompetensbeskrivningar. Kapitlet &quot;Specialistsjuksköterska med inriktning mot ambulanssjukvård&quot; beskriver professionen, utbildningen och utmaningar inför framtiden.

  • 33.
    Bremer, Anders
    University of Borås, Sweden.
    Vid existensens gräns: Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems.

    Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis.

    Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families.

    Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

  • 34.
    Bremer, Anders
    University of Borås, Sweden.
    Vilka möjligheter finns att använda register för uppföljning?2013In: Skandinaviskt utbildningsmöte – Vård efter hjärtstopp: Prognosbedömning, uppföljning och rehabilitering. 30-31 maj, 2013. Skånes Unversitetssjukhus, Lund, Sverige, 2013Conference paper (Other academic)
    Abstract [en]

    Svenska Hjärt-lungräddningsregistret innehåller sedan länge beskrivande data med kontinuerliga variabler som ålder och tidsfördröjningar till påbörjande av behandling. Det innehåller också kategoriska variabler om defibrillerbar rytm, hjärtstoppets inträffande i hemmet, kardiell etiologi etc. Cerebral funktion registreras med CPC-score. Sedan 1 maj 2013 kompletterades registret med patientskattningar och mätningar av kvalitativa livskvalitetsvariabler. Den hälsorelaterade livskvaliteten kommer framledes att bedömas med det generiska instrumentet Euro Quality Life Scale (EQ-5D-5L) som mäter rörlighet, egenvård, vardagsaktiviteter, smärta-obehag och ängslan-depression. Dessutom används EQ-VAS för skattning av upplevd hälsa. Ängslan, oro och depression kommer mer detaljerat att bedömas med The Hospital Anxiety and Depression Scale (HADS). Utöver detta inhämtas data om kognitiv funktion och sysselsättning, totalt sju frågor med fasta svarsalternativ. Denna uppföljning av livskvaliteten hos överlevande efter hjärtstopp är en intensifiering av det rutinmässiga omhändertagandet av patientgruppen. Men framför allt innebär detta initiala och systematiska inhämtande av kvalitativa data från patienterna själva en möjlighet att tidigt upptäcka hur de mår och de behov av uppföljande vård och stöd som kan finnas. Genom registrets datainsamling ges även anhöriga en möjlighet att diskutera problem relaterade till den överlevandes situation. Med den utökade datainsamlingen kommer ny och viktig kunskap om patientgruppens cerebrala funktion och hälsorelaterade livskvalitet att genereras över tid, till gagn för patienter och anhöriga.

  • 35.
    Bremer, Anders
    University of Borås, Sweden.
    Vilken livskvalitet har patienter efter hjärtstopp?2013In: XV Svenska Kardiovaskulära Vårmötet: Svenska Hjärtförbundet. Göteborg 2013-04-17, 2013Conference paper (Other academic)
  • 36.
    Bremer, Anders
    Svenska läkaresällskapet.
    Vårdpersonal i ’dokusåpor’: är det etiskt försvarbart?2014In: Medicinska Riksstämman, Stockholm, 2014, 2014Conference paper (Other academic)
    Abstract [en]

    Att som vårdpersonal medverka i s.k. dokusåpor är förknippat med en rad etiska problem. Kan dessa problem lösas på ett etiskt försvarbart sätt, dvs. så att patienters och närståendes rätt till värdighet, integritet och autonomi säkerställs? Slutsatsen är att detta inte är möjligt. Risken att tillfoga skada är större än den potentiella nyttan.

  • 37.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Åsa B
    Vårdvetenskaplig analys – erfarenheter vid prehospitala hjärtstopp2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 345-349Chapter in book (Other academic)
  • 38.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Axelsson, Åsa B.
    University of Gothenburg, Sweden.
    Vårdvetenskaplig analys: erfarenheter vid prehospitala hjärtstopp2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 345-349Chapter in book (Other academic)
  • 39.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Vårdvetenskaplig analys2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 318-321Chapter in book (Other academic)
  • 40.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Vårdvetenskaplig analys2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 318-321Chapter in book (Other academic)
  • 41.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Creutz, Tobias
    Region of Västra Götaland, Sweden.
    Pettersson Georgii, Johan
    Region of Västra Götaland, Sweden.
    Family members’ experiences of care provided by ambulance staff in out-of-hospital cardiac arrest situations2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 1 suppl, article id 268Article in journal (Refereed)
    Abstract [en]

    Purpose: Approximately 10 000 people in Sweden suffer from sudden cardiac arrest outside the hospital each year. Cardiopulmonary resuscitation (CPR) is started in about half of the cases. Treatment of patients with cardiac arrest in a pre-hospital context is complex and focus is placed first and foremost on the patient because of the acute and life-threatening condition. For relatives, it is a traumatic and upsetting experience to be present when a family member suffers from cardiac arrest. The purpose of this study was therefore to describe family members experiences of an out-of-hospital cardiac arrest (OHCA) situation and how the ambulance staff cared for them.

    Methods: This pilot study had a qualitative design, based on six individual interviews with family members who were present when the patient suffered OHCA. The interviews were conducted with an initial open-ended question and follow-up questions based on the responses. The data were analysed by qualitative content analysis with an inductive approach. The analysis generated subcategories, which were clustered into seven main categories.

    Results: The result describes the informants’ situation management, responsibility handover and their hope and hopelessness in the situation. The result also describes the staff’s care of family members by the categories closeness and distance, confirmation and exclusion, caring relationship and answered and unanswered questions. Family members described the OHCA situation as traumatic with feelings of panic, uncertainty, unreality, but also calm and rationality. Contentedness and gratitude for the ambulance staffs caring approach emerged. However, family members sometimes were not allowed to decide if they wanted to witness the resuscitation attempts or not, and a lack of information led to unnecessary frustration.

    Conclusions: Family members often have a need to talk to someone about their experiences of the OHCA situation, express their views on the care that was provided and receive feedback afterwards. Further research on family members’ situation at OHCAs is of great importance for the development of ambulance staff’s skills in caring approaches.

  • 42.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Dahlberg, Karin
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Sandman, Lars
    University of Borås, Sweden.
    Balancing Between Closeness and Distance: Emergency medical services personnel’s experiences of caring for families at out-of-hospital cardiac arrests and deaths2012In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 27, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem thataffects between 236,000 and 325,000 people in the United States each year. As resuscitationattempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services(EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced byfactors other than patient clinical characteristics, such as EMS personnel’s knowledge,attitudes, and beliefs regarding family emotional preparedness. However, there is littleresearch exploring how EMS personnel care for bereaved family members, or how theyare affected by family dynamics and the emotional contexts. The aim of this study is toanalyze EMS personnel’s experiences of caring for families when patients suffer cardiacarrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviewswere conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and familycare, and sometimes failed to prioritize these responsibilities as a result of their ownperceptions, feelings and reactions. Moving from patient care to family care implied amovement from well-structured guidance to a situational response, where the personnelwere forced to balance between interpretive reasoning and a more direct emotionalresponse, at their own discretion. With such affective responses in decision-making, thepersonnel risked erroneous conclusions and care relationships with elements of dishonesty,misguided benevolence and false hopes. The ability to recognize and respond to people’sexistential questions and needs was essential. It was dependent on the EMS personnel’sbalance between closeness and distance, and on their courage in facing the emotionalexpressions of the families, as well as the personnel’s own vulnerability. The presence offamily members placed great demands on mobility (moving from patient care to familycare) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family membersto avoid additional suffering. Opportunities to reflect on these situations within a frameworkof care ethics, continuous moral education, and clinical ethics training are needed.Support in dealing with personal discomfort and clear guidelines on family support couldbenefit EMS personnel.Bremer A, Dahlberg K, Sandman

  • 43.
    Bremer, Anders
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Borås.
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sandman, Lars
    University of Borås.
    Experiencing Out-of-Hospital Cardiac Arrest: Significant Others’ Lifeworld Perspective2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 10, p. 1407-1420Article in journal (Refereed)
    Abstract [en]

    When patients suffer out-of-hospital cardiac arrests (OHCA), significant others find themselves with no choice about being there. Afterwards they are often left with unanswered questions about the life-threatening circumstances, or the patient’s death, the emergency treatment and future needs. When it is unclear how the care, and the event itself will affect significant others’ well being, prehospital emergency personnel face ethical decisions. This study describes the experiences of significant others present at OHCA, focusing on ethical aspects and values. Using a lifeworld phenomenological approach, seven significant others were interviewed. The essence of the phenomenon of OHCA can be stated as: Unreality in the reality; Overwhelming responsibility; Inadequacy and limitation; Hope and hopelessness; Ethical considerations; Insecurity about the future; Trembling of life. These study findings show how significant others’ sense of unreality, inadequacy, and overwhelming responsibility at OHCA can threaten values deemed important for a good life.

     

  • 44.
    Bremer, Anders
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work. University of Borås, Sweden.
    Dahlberg, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Sandman, Lars
    University of Borås, Sweden.
    To Survive Out-of-Hospital Cardiac Arrest: A Search for Meaning and Coherence2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 3, p. 323-338Article in journal (Refereed)
    Abstract [en]

    The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions, and actions should be based in the patient’s beliefs about health and well-being. In this article, we describe patients’ experiences of surviving OHCA. By using a phenomenological approach, we focus on how OHCA influences patients’ well-being over time. Nine survivors were interviewed. Out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding, as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. The study findings show survivors’ emotional needs and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.

     

  • 45.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Dahné, Tova
    Linköping University.
    Stureson, Lovisa
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council.
    Thylén, Ingela
    Linköping University.
    Lived experiences of surviving in-hospital cardiac arrest2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e122-e122Article in journal (Refereed)
  • 46.
    Bremer, Anders
    et al.
    Linnaeus Univ, Fac Hlth & Life Sci, Kalmar Vaxjo, Sweden;Kalmar Cty Council, Div Emergency Med Serv, Kalmar, Sweden.
    Dahné, Tova
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Stureson, Lovisa
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden;Linkoping Univ, Dept Anaesthesiol & Intens Care, Linkoping, Sweden.
    Årestedt, Kristofer
    Linnaeus Univ, Fac Hlth & Life Sci, Kalmar Vaxjo, Sweden;Kalmar Cty Council, Res Sect, Kalmar, Sweden.
    Thylén, Ingela
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden;Linkoping Univ, Dept Cardiol, Linkoping, Sweden.
    Lived experiences of surviving in-hospital cardiac arrest2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 156-164Article in journal (Refereed)
    Abstract [en]

    Background: Out-of-hospital cardiac arrest survivors suffer from psychological distress and cognitive impairments. They experience existential insecurity and vulnerability and are striving to return to a life in which well-being and the meaning of life have partly changed. However, research highlighting the experiences of in-hospital cardiac arrest survivors is lacking. This means that evidence for postresuscitation care has largely been extrapolated from studies on out-of-hospital cardiac arrest survivors, without considering potential group differences. Studies investigating survivors' experiences of an in-hospital cardiac arrest are therefore needed.

    Aim: To illuminate meanings of people's lived experiences of surviving an in-hospital cardiac arrest.

    Design: An explorative, phenomenological hermeneutic method to illuminate meanings of lived experiences.

    Method: Participants were identified through the Swedish national register of cardiopulmonary resuscitation and recruited from two hospitals. A purposive sample of eight participants, 53-99 years old, who survived an in-hospital cardiac arrest 1-3 years earlier, was interviewed.

    Findings: The survivors were striving to live in everyday life and striving for security. The struggle to reach a new identity meant an existence between restlessness and a peace of mind, searching for emotional well-being and bodily abilities. The search for existential wholeness meant a quest for understanding and explanation of the fragmented cardiac arrest event and its existential consequences. The transition from hospital to home meant a transition from care and protection to uncertainty and vulnerability with feelings of abandonment, which called for a search for security and belonging, away from isolation and loneliness.

    Conclusion: Surviving an in-hospital cardiac arrest can be further understood by means of the concept of hospital-to-home transition. Following hospital discharge, patients felt vulnerable and abandoned when pending between denial and acceptance of the 'new' life. Hence, the healthcare system should play a significant role when it comes to facilitate cardiac arrest survivors' security during hospital-to-home transition.

  • 47.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Dahné, Tova
    Uppsala University, Sweden;Linköping University, Sweden.
    Stureson, Lovisa
    Linköping University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Thylén, Ingela
    Linköping University, Sweden.
    Lived experiences of surviving in‐hospital cardiac arrest2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 156-164Article in journal (Refereed)
    Abstract [en]

    Background

    Out‐of‐hospital cardiac arrest survivors suffer from psychological distress and cognitive impairments. They experience existential insecurity and vulnerability and are striving to return to a life in which well‐being and the meaning of life have partly changed. However, research highlighting the experiences of in‐hospital cardiac arrest survivors is lacking. This means that evidence for postresuscitation care has largely been extrapolated from studies on out‐of‐hospital cardiac arrest survivors, without considering potential group differences. Studies investigating survivors’ experiences of an in‐hospital cardiac arrest are therefore needed.

    Aim

    To illuminate meanings of people's lived experiences of surviving an in‐hospital cardiac arrest.

    Design

    An explorative, phenomenological hermeneutic method to illuminate meanings of lived experiences.

    Method

    Participants were identified through the Swedish national register of cardiopulmonary resuscitation and recruited from two hospitals. A purposive sample of eight participants, 53–99 years old, who survived an in‐hospital cardiac arrest 1–3 years earlier, was interviewed.

    Findings

    The survivors were striving to live in everyday life and striving for security. The struggle to reach a new identity meant an existence between restlessness and a peace of mind, searching for emotional well‐being and bodily abilities. The search for existential wholeness meant a quest for understanding and explanation of the fragmented cardiac arrest event and its existential consequences. The transition from hospital to home meant a transition from care and protection to uncertainty and vulnerability with feelings of abandonment, which called for a search for security and belonging, away from isolation and loneliness.

    Conclusion

    Surviving an in‐hospital cardiac arrest can be further understood by means of the concept of hospital‐to‐home transition. Following hospital discharge, patients felt vulnerable and abandoned when pending between denial and acceptance of the ‘new’ life. Hence, the healthcare system should play a significant role when it comes to facilitate cardiac arrest survivors’ security during hospital‐to‐home transition.

  • 48.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Holmberg, Mats
    Ambulance nurse students’ experiences of ethical problems in patient-relationships2019Conference paper (Refereed)
    Abstract [en]

    Background: Ambulance nurse education in Sweden is a one-year master’s degree program for registered nurses leading to a postgraduate diploma in specialist nursing. Ambulance nurses face unpredictable and ethically challenging situations with multi-dimensional suffering, requiring the ability to provide medical care and simultaneously creating a trustful relationship. Students undergoing their specialist education face the same challenges.

    Aim: The aim was to describe ambulance nurse students’ (ANS) experiences of ethical problems in patient relationships during clinical studies.

    Method: Written exams (n=69) in ANS’ clinical placements studies were collected between 2014- 2016 in three courses. In the exam the ANS were asked to describe and problematize a selfexperienced ethical problem in the care relationship with a specific patient. The thematic analysis commenced with being familiarized with the text as a whole before condensation and coding. The exams were read and re-read several times. After coding followed further analysis, re-analysis and validation in several linear and circular steps to finally compile sub-themes and themes.

    Results: Ethical problems emerged as six themes; 1) Insecurity in considering patient autonomy, 2) Conflicting assessments of the patients best, 3) Inadequate access to patient narratives, 4) Absence of trustful relationships, 5) Disturbance of patient focus and 6) Limited possibility to provide proper care.

    Conclusions and implications: The result emphasizes ethical problem within patient-relationships in the ambulance care as multifaceted and strongly connected to patient’s autonomy. Outgoing from the results an intervention project regarding older patients’ autonomy in ambulance care started in January 2019.

  • 49.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Holmberg, Mats
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ambulance nurse students’ experiences of ethical problems in patient-relationships2019Conference paper (Refereed)
    Abstract [en]

    Background: Ambulance nurse education in Sweden is a one-year master’s degree program for registered nurses leading to a postgraduate diploma in specialist nursing. Ambulance nurses face unpredictable and ethically challenging situations with multi-dimensional suffering, requiring the ability to provide medical care and simultaneously creating a trustful relationship. Students undergoing their specialist education face the same challenges. 

    Aim: The aim was to describe ambulance nurse students’ (ANS) experiences of ethical problems in patient relationships during clinical studies. 

    Method: Written exams (n=69) in ANS’ clinical placements studies were collected between 2014-2016 in three courses. In the exam the ANS were asked to describe and problematize a self-experienced ethical problem in the care relationship with a specific patient. The thematic analysis commenced with being familiarized with the text as a whole before condensation and coding. The exams were read and re-read several times. After coding followed further analysis, re-analysis and validation in several linear and circular steps to finally compile sub-themes and themes. 

    Results: Ethical problems emerged as six themes; 1) Insecurity in considering patient autonomy, 2) Conflicting assessments of the patients best, 3) Inadequate access to patient narratives, 4) Absence of trustful relationships, 5) Disturbance of patient focus and 6) Limited possibility to provide proper care. 

    Conclusions and implications: The result emphasizes ethical problem within patient-relationships in the ambulance care as multifaceted and strongly connected to patient’s autonomy. Outgoing from the results an intervention project regarding older patients’ autonomy in ambulance care started in January 2019.

  • 50.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Jimenéz-Herrera, Maria
    Rovira i Virgili University, Spain.
    Axelsson, Christer
    University of Borås, Sweden.
    Burjalés Martí, D
    Rovira i Virgili University, Spain.
    Sandman, Lars
    University of Borås, Sweden.
    Casali, Luca
    Queensland University of Technology, Australia.
    Ethical values in emergency medical services: A pilot study2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 8, p. 928-942Article in journal (Refereed)
    Abstract [en]

    Background: Ambulance professionals often address conflicts between ethical values. As individuals’values represent basic convictions of what is right or good and motivate behaviour, research is neededto understand their value profiles.

    Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure thepresence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles inSpain and Sweden.

    Methods: The instrument was translated and culturally adapted. A content validity index was calculated.Pilot tests were carried out with 46 participants.

    Ethical considerations: This study conforms to the ethical principles for research involving humansubjects and adheres to national laws and regulations concerning informed consent and confidentiality.

    Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulanceorganizations. Both countries favoured utilitarianism least. Gender differences across countries showedthat males favoured rights. Spanish female professionals favoured justice most strongly of all.

    Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low onutilitarianism focusing on total population effect, preferring the opposite, individualized approach of therights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardizeambulance professionals’ moral right to make individual assessments based on the needs of the patientat hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justiceand rights perspectives portrayed in the survey mainly concern relationship to the organization and peerswithin the organization, this relationship might at worst be given priority over the equal treatment andmoral rights of the patient.

    Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and readyto act optimally – especially if these perspectives are used in patient care. Research is needed to clarify howjustice and rights are prioritized by ambulance services and whether or not these organization-related valuesare also implemented in patient care.

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