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Livsuppehållande åtgärder på bekostnad av den prehospitala sjuksköterskans säkerhet: En intervjustudie om prehospitala sjuksköterskors upplevelse av att ventilera patienter under pågående ambulanstransport
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
2020 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesisAlternative title
Life-sustaining measures at the expense of the prehospital nurse ́s safety : An interview study on the prehospital nurse ́s experience of ventilating patients during ambulance transportation (English)
Abstract [sv]

Bakgrund: Inom ambulanssjukvården krävs ingen specialistutbildning för att få anställning. Den prehospitala sjuksköterskan förväntas emellertid kunna utföra avancerade sjukvårdsinterventioner som ventilering oavsett tidigare erfarenheter. Patologiska tillstånd som kräver luftvägsinterventioner bedöms ofta som kritiska och transporteras under höga hastigheter till sjukhus. Detta innebär en risk, både för patient och ambulanspersonal. Syfte: Syftet med studien var att undersöka den prehospitala sjuksköterskans erfarenheter av att ventilera patienter under pågående ambulanstransport. Design: En kvalitativ intervjustudie användes. Metod: Studien genomfördes i Mellansverige med tolv prehospitala sjuksköterskor . Informanterna hade en varierad utbildningsnivå. Två specialistutbildningar representeras i studiens resultat: Anestesisjuksköterskor samt ambulanssjuksköterskor, men även allmänsjuksköterskor utan specialisering för att möjliggöra eventuell jämförelse mellan utbildningsnivåer avseende det aktuella området. Kvalitativ innehållsanalys användes för att analysera intervjuerna. Resultat: Informanterna upplevde att flera faktorer påverkade både ventileringen samt säkerheten under transporten. Ambulansens utformning skapade avstånd mellan vårdare och patient samt viktiga hjälpmedel som informanterna upplevde var nödvändiga vid luftvägshantering. Vårdrummet i rörelse var också en faktor som påverkade ventileringen. En konflikt kunde urskiljas mellan arbetsgivarens krav utifrån riktlinjer samt den realistiska och faktiska vårdmiljön, vilket påverkar vårdarnas personliga säkerhet. Informanternas utbildningsnivå är avgörande i deras känsla av trygghet avseende ventilering av patienter. Trots detta önskade samtliga informanter, oavsett tidigare klinisk erfarenhet mer klinisk utbildning med autentiska övningar. Konklusion: Resultatet av detta examensarbete indikerar att prehospitala sjuksköterskors säkerhet äventyras i samband med ventilering under pågående ambulanstransport. Arbetsgivarens krav på att prehospital personal ska sitta bältad under pågående transport är stundtals omöjliga att följa i relation till befintliga riktlinjer. Detta påverkar inte bara säkerheten för prehospital personal utan även patientsäkerheten. Resultatet påvisar även att prehospitala sjuksköterskor , oavsett utbildningsnivå önskar kontinuerliga och realistiska övningstillfällen gällande luftvägsinterventioner e.g. ventilering.

Abstract [en]

Background: In ambulance care, no specialist training is required to practice. However, a prehospital nurse is expected to be able to perform advanced health care interventions such as ventilation regardless of previous qualifications. Pathological conditions that require airway interventions are often considered critical and such patients are therefore transported to hospital at high speeds. This in itself poses a risk to the patient as well as ambulance personnel. Aim: The aim of the study was to investigate the prehospital nurse's experience of ventilating patients during an ambulance transport. Design: A qualitative interview study was used. Methods: The study was conducted in Central Sweden with twelve prehospital nurses. The nurses had varying levels of education. Two specialist training courses are represented in the study's results: Anesthesia nurses and ambulance nurses, but also general nurses without specialization to enable comparison of education levels with regards to the area in question. Qualitative content analysis was used to analyze the interviews. Results: The interviewees felt that several factors affected both ventilation and safety during transport. The design of the ambulance creates physical distance between caregiver, patient and the medical equipment utilised in airway management. The motion of the vehicle also affects the already difficult task of ventilation. A conflict was noted between the employer's requirements regarding seatbelts and the difficulty of following this guideline in the actual care environment, resulting in concerns regarding the personal safety of the caregivers. The nurses' level of education was found to have a direct correlation to their level of confidence regarding ventilation of patients. Despite this, all interviewees, regardless of education and previous clinical experience, wanted more clinical training with authentic exercises. Conclusion: The research results indicate that ventilating patients during ambulance transport may jeopardise the safety of prehospital nurses. Employer requirements regarding prehospital personnel wearing seatbelts at all times during transport, are sometimes impossible to comply with, due to the design of the ambulances. As the safety of the personnel is compromised, it naturally affects patient safety too. Our research shows that prehospital nurses, regardless of level of education, want continuing education programmes including realistic practical training in airway intervention techniques such as ventilation.

Place, publisher, year, edition, pages
2020. , p. 37
Keywords [en]
Prehospital, Airway management, Ambulance, Transport, Specialist nurse
Keywords [sv]
Prehospital, Luftvägshantering, Ambulans, Transport, Specialistsjuksköterska
National Category
Nursing
Identifiers
URN: urn:nbn:se:kau:diva-77126OAI: oai:DiVA.org:kau-77126DiVA, id: diva2:1410771
Subject / course
Emergency Care Specialist Nursing, Prehospital Nursing, Graduate Diploma*
Educational program
Study Programme for Specialist Nursing in Prehospital Nursing (60 ECTS credits)
Supervisors
Examiners
Available from: 2020-03-04 Created: 2020-03-01 Last updated: 2020-03-04Bibliographically approved

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