The overall aim of this thesis was to explore nurses’ professional competence with a focus on scope of practice, content, utilization, and development within the ambulance service in Sweden.

Methods: Integrative review (I), qualitative (II, III) and quantitative methods (IV) were used. The integrative review was based on 25 studies. The qualitative studies were based on interviews with 13 (II) and 16 prehospital nurses (III), and data was analyzed using content analysis (II) and grounded theory (III). In the quantitative study (IV), 105 nurses answered a digital questionnaire and descriptive and analytical statistics were used in the analysis. 

Main findings: Advanced nurses’ and paramedics’ assessments, treatments, and referrals were safe and of high quality and were characterized by a high degree of autonomy. Patients were satisfied with the care provided, reduced waiting times, and the avoidance of unnecessary transportation to hospital (I). Broad medical and nursing competence was required, and personality traits and contextual awareness were emphasized as unique competences (II). Prehospital emergency nurses reported higher levels of professional competence compared to registered nurses or other specialist nurses. No differences were identified between nurses with master’s or bachelor’s degrees, and clinical experience was a predictor of nursing competence (IV). At the start of their careers, the ambulance service represented a developing environment for nurses. When focus, education, roles, responsibilities, and requirements remained the same, continued competence development risked stagnation (III).

Conclusions: Personality, clinical competence, prehospital experience, and contextual competence were emphasized. Academic competence was neglected and not demanded. This thesis provides new knowledge that can contribute to the continued development of the ambulance service and to a more efficient utilization of the full spectrum of nurses’ professional competence.  

Background: The Swedish ambulance service has undergone major changes in recent decades due to advancements being made in medical and technical resources, professional competence, and patient care. Registered and specialist nurses share the same role, accountabilities, and responsibilities in the ambulance service, and their professional competence has not yet been evaluated. Objectives: The aim of the study was to investigate and compare self-reported professional competence among nurses working in the ambulance service and to explore associations between potentially predictive background factors and self-reported professional competence. Method: A cross-sectional study with a digital questionnaire was used for collecting data from 34 registered nurses and 71 specialist nurses. The Ambulance Nurse Competence Scale and the Research Utilization Questionnaire were used for data collection. Results: Significant differences were found among the nursing categories in terms of age, gender, education, and work experience. Prehospital emergency nurses reported the highest professional competence. Nurses with a master's degree did not report significantly higher professional competence than nurses with a bachelor's degree. Conclusions: The findings indicated that there are differences in the professional competence of registered nurses and specialist nurses. Length of work experience in the ambulance service is an important factor associated with higher professional competence.

Aim To explore and present an overview of scope of practice among registered nurses and paramedics with an advanced level of education in pre-hospital and in-hospital emergency care. Design An integrative literature review. Method Studies published between 2006 and 2018 were retrieved by searching the databases CINAHL, PubMed, Scopus and Web of Science. Studies were selected by three independent researchers, and data were synthesized using thematic analysis. Results The 25 studies identified focused on in-hospital (n = 15) and pre-hospital emergency care (n = 10) and included 13 professional titles originated from seven countries. The thematic analysis disclosed four themes; "Versatile care," "Safe care based on precision and accuracy," "Autonomous performance within boundaries" and "Beneficial towards patients and society." Advanced paramedics' and advanced nurses' services are characterized as safe, of high quality and of public benefit. Their services are being used in everyday practice as well as directed to certain categories of patients.

Transportation with road ambulances is increasing because of a concentration of hospitals to larger units, with high quality in the acute care of the patients. The concentration implies longer distances to receiving units, which increases the transportation time. The purpose of the present study was to investigate the time difference in ambulance transportation with high speed emergency driving, compared to non-emergency driving in normal traffic pace. Data was collected from 30 emergency high speed ambulance transportations in urban and rural areas. These transportations were then repeated experimentally with an ambulance driving at normal traffic pace. The average speed and duration for the emergency transportations were shorter than for the experimental driving, both in urban and rural areas. The mean time saved was 2.9 min (urban areas) and 8.9 min (rural areas). Regardless of the patient's clinical status or need of care the emergency transportations were carried out in higher speed than the experimental driving. However, patients with life threatening conditions were not included in this study. Procedures and methods should be developed to identify the patients for which fast transportation has clinical relevance to the outcomes.

IntroductionHigh professional competence (Cheetham& Chivers, 1998) of personnel in ambulance services is something that patients, relatives, and the ambulance organizations themselves expect. Prehospital advanced trauma care requires high levels of professional and clinical competence, with high stakes decisions and judgements often being made with limited information or in less than ideal conditions (Wilson et al., 2015). The importance of trauma specific training is well established by the proliferation of trauma care education programs eg. BTLS, ATLS, PHTLS. The perceptions of prehospital providers regarding the competencies required to adequality care for trauma patients has been questioned ie. whether students learning is correctly focused on the competencies required in practice. It has been argued that student perceptions of self-efficacy and competence can positively influence learning, leading to greater effectiveness of competency based assessments (van Dinther et al., 2014).AimThe aim is to describe the perceptions of South African paramedic and Swedish prehospital emergency nurse students towards competence in prehospital trauma care and compare their alignment to the Global Rating Scale and Ambulance Nurse Competence Scale instruments commonly used for competency based assessments. MethodThe student will employ a cross sectional descriptive survey design with using an online questionnaire. Responses will be compared to validated instruments: the Global Rating Scale (Tavares et al, 2013) and the Ambulance Nurse Competence scale (Nilsson et al, 2022). The study populations consist of paramedic students from South Africa and prehospital emergency nurse students from Sweden. Analysis techniques will include descriptive and inferential methods.  ResultThe results may indicate that the differences between paramedics and nurses are not substantial, but they may also reveal specific distinctions. Furthermore, it can provide a greater understanding of students' perspectives on competency in the prehospital field, which both education programs can benefit from in terms of curriculum and didactic growth.