Despite a growing awareness of the importance of interprofessional teamwork in relation to patient safety, many hospital units lack effective teamwork. The aim of this study was to explore if an interprofessional teamwork intervention in a surgical ward changed the healthcare personnel's perceptions of patient safety culture, perceptions of teamwork, and attitudes toward teamwork over 12 months. Healthcare personnel from surgical wards at two hospitals participated in a controlled quasi-experimental study. The intervention consisted of six hours of TeamSTEPPS team training and 12 months for the implementation of teamwork tools and strategies. The data collection was conducted among the healthcare personnel in the intervention group and the control group at baseline and at the end of the 12 month study period. The results within the intervention group showed that there were significantly improved scores in three of 12 patient safety culture dimensions and in three of five perceptions of teamwork dimensions after 12 months. When comparing between groups, significant differences were found in three patient safety culture measures in favor of the intervention group. The results of the study suggest that the teamwork intervention had a positive impact on patient safety culture and teamwork in the surgical ward.

Background: Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study. Methods: This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders' willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data. Results: After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions "Mutual Support" was associated with the Patient Safety Grade, after 12 months of intervention. Conclusion: These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.

Aim To translate "The Collaboration and Satisfaction About Care Decisions in Team" questionnaire (CSACD-T) into Norwegian and test it for psychometric properties. The further aim was to describe and compare healthcare personnel's collaboration and satisfaction about team decision-making (TDM) across hospital units. Design A cross-sectional study. Methods The questionnaire was translated into Norwegian. A total of 247 healthcare personnel at two hospitals responded to the questionnaire. An explorative factor analysis was performed to test the factor structure of the questionnaire, while a Cronbach's alpha analysis was used to test for internal consistency. A one-way ANOVA analysis and a Kruskal-Wallis test were applied to test for differences between hospital units. Results The results demonstrate that the Norwegian version of the CSACD-T has promising psychometric properties regarding construct validity and internal consistency. The mean score of the CSACD-T was significantly higher in the maternity ward group than in the emergency room group.

A linear optimization has been made to examine the economic viabilityof incorporating battery storage in a wind farm in Sweden. The studyexamines a future wind farm with 10 10 MW turbines. An orographicmapping with height differences and vegetation has been used incombination with measured wind data with IEC-rated anemometersand wind direction sensors between 1997 and 2017 to create asimulated production in the windPRO software. This effect, togetherwith hourly prices from 2021 from Nord pool in SE1, SE2, SE3, SE4and in Estonia, has been used in a linear optimization in Matlab to findthe battery capacity that generates the most revenue. 3 Scenarios areinvestigated where scenario 1 is a wind farm without battery storagewhere all electricity produced is sold directly at the current price.Scenario 2 also lacks battery storage and has a power limit of 75 MWat the transformer whilst the farm still produces 100 MW. Scenario 3has a power limit of 75 MW at the transformer and the possibility ofbattery storage.

CO2 is becoming increasingly important as a mediating fluid, and simulation studies are indispensable for corresponding developments. In this study, a simulation-based performance investigation of a solar water heating system using CO2 as a mediating fluid under sub-zero temperature condition is performed using the TRNSYS (R) software. The maximum performance is achieved at a solar savings fraction of 0.83 during July. The as lowest solar savingss fraction of 0.41 is obtained during December. The annual heat production of the proposed system under Fargo climate is estimated to be about 2545 kWh. An evacuated glass tube solar collector is designed, fabricated and tested for various climate conditions. Moreover, a detailed comparison of the system's performance at sub/supercritical and supercritical pressures shows that the annual heat transfer efficiency of the modeled system is 10% higher at supercritical pressure than at sub/supercritical pressures. This result can be attributd to the strong convection flow of CO2 caused by density inhomogeneities, especially in the near critical region. This condition resuls in high heat transfer rates.

Nowadays, there is a mobile application for almost every need, for instance, training, games, and news applications. Almost all the companies have also their own mobile applications that facilitate the daily communication between their employees and supervisors. In this thesis, the development process of an Android application for the company Askås is created, where the employees can for example send a Flex application or sick leave application, see their registered personal information and edit them. The final result of the project is almost what Askås asked for, An Android application that facilitates their employees’ daily needs. The development process, the results, and the encountered problems are also represented in a more detailed manner in the thesis. 

Cellular Internet of Things (CIoT) has emerged as a promising technology to support applications that generate infrequent data. One requirement on these applications, often battery-powered devices, is low energy consumption to enable extended battery life. Narrowband IoT (NB-IoT) is a promising technology for IoT due to its low power consumption, which is essential for devices that need to run on battery power for extended periods. However, the current battery life of NB-IoT devices is only a few years, which is insufficient for many applications. This thesis investigates the impact of energy-saving mechanisms standardized by 3GPP on battery life of NB-IoT devices. The main research objective is to classify and analyze existing energy-saving solutions for CIoT and examine their limitations, to study the impact of standardized energy-saving mechanisms on the battery life of NB-IoT devices, both in isolation and combined, and to provide guidelines on how to configure NB-IoT devices to reduce energy consumption efficiently. The research aims to provide a deeper understanding of the effect of energy-saving mechanisms and best practices to balance energy efficiency and performance of NB-IoT devices. Applying the proposed solutions makes it possible to achieve a battery life of 10~years or more for CIoT devices.

Cellular Internet of Things (CIoT) is a Low-Power Wide-Area Network (LPWAN) technology. It aims for cheap, lowcomplexity IoT devices that enable large-scale deployments and wide-area coverage. Moreover, to make large-scale deployments of CIoT devices in remote and hard-to-access locations possible, a long device battery life is one of the main objectives of these devices. To this end, 3GPP has defined several energysaving mechanisms for CIoT technologies, not least for the Narrow-Band Internet of Things (NB-IoT) technology, one of the major CIoT technologies. Examples of mechanisms defined include CONNECTED-mode DRX (cDRX), Release Assistance Indicator (RAI), and Power Saving Mode (PSM). This paper considers the impact of the essential energy-saving mechanisms on minimizing the energy consumption of NB-IoT devices, especially the cDRX and RAI mechanisms. The paper uses a purpose-built NB-IoT simulator that has been tested in terms of its built-in energy-saving mechanisms and validated with realworld NB-IoT measurements. The simulated results show that it is possible to save 70%-90% in energy consumption by enabling the cDRX and RAI. In fact, the results suggest that a battery life of 10 years is only achievable provided the cDRX, RAI, and PSM energy-saving mechanisms are correctly configured and used

This paper studies the impact of tunable parametersin the NB-IoT stack on the energy consumption of a user equipment(UE), e.g., a wireless sensor. NB-IoT is designed to enablemassive machine-type communications for UE while providing abattery lifetime of up to 10 years. To save battery power, most oftime the UE is in dormant state and unreachable. Still, duringthe CONNECTED and IDLE state, correct tuning of criticalparameters, like Discontinuous reception (DRX), and extendedDiscontinuous reception (eDRX), respectively, are essential to savebattery power. Moreover, the DRX and eDRX actions relate tovarious parameters which are needed to be tuned in order toachieve a required UE battery lifetime. The objective of thispaper is to observe the influence of an appropriate tuning ofthese parameters to reduce the risk of an early battery drainage

In this paper, we study the energy consumptionof Narrowband IoT devices. The paper suggests that key tosaving energy for NB-IoT devices is the usage of full Discontinuous Reception (DRX), including the use of connected-mode DRX (cDRX): In some cases, cDRX reduced the energy consumption over a 10-year period with as much as 50%. However, the paper also suggests that tunable parameters, such as the inactivity timer, do have a significant impact. On the basis of our findings, guidelines are provided on how to tune the NB-IoT device so that it meets the target of the 3GPP, i.e., a 5-Wh battery should last for at least 10 years. It is further evident from our results that the energy consumption is largely dependent on the intensity and burstiness of the traffic, and thus could be significantly reduced if data is sent in bursts with less intensity,irrespective of cDRX support.

The Cellular Internet of Things (CIoT), a new paradigm, paves the way for a large-scale deployment of IoT devices. CIoT promises enhanced coverage and massive deployment of low-cost IoT devices with an expected battery life of up to 10 years. However, such a long battery life can only be achieved provided the CIoT device is configured with energy efficiency in mind. This paper conducts a comprehensive survey on energy-saving solutions in 3GPP-based CIoT networks. In comparison to current studies, the contribution of this paper is the classification and an extensive analysis of existing energy-saving solutions for CIoT, e.g., the configuration of particular parameter values and software modifications of transport- or radio-layer protocols, while also stressing key parameters impacting the energy consumption such as the frequency of data reporting, discontinuous reception cycles (DRX), and Radio Resource Control (RRC) timers. In addition, we discuss shortcomings, limitations, and possible opportunities which can be investigated in the future to reduce the energy consumption of CIoT devices.

With the aim to improve road safety services in critical situations, vehicle trajectory and future location prediction are important tasks. An infinite set of possible future trajectories can exit depending on the current state of vehicle motion. In this paper, we present a multimodel-based Extended Kalman Filter (EKF), which is able to predict a set of possible scenarios for vehicle future location. Five different EKF models are proposed in which the current state of a vehicle exists, particularly, a vehicle at intersection or on a curve path. EKF with Interacting Multiple Model framework is explored combinedly for mathematical model creation and probability calculation for that model to be selected for prediction. Three different parameters are considered to create a state vector matrix, which includes vehicle position, velocity, and distance of the vehicle from the intersection. Future location of a vehicle is then used by the software-defined networking controller to further enhance the safety and packet delivery services by the process of flow rule installation intelligently to that specific area only. This way of flow rule installation keeps the controller away from irrelevant areas to install rules, hence, reduces the network overhead exponentially. Proposed models are created and tested in MATLAB with real-time global positioning system logs from Jeju, South Korea.

In Internet of Vehicles (IoV), numerous routing metrics have been used to assess the performance of routing protocols such as, packet delivery ratio, throughput, end-to-end delay and path duration. Path duration is an influential design parameter, among these routing metrics, that determines the performance of vehicular networks. For instance, in highly dynamic scenarios, it can be used to predict link life time in on-demand routing protocols. In this paper, we propose an infrastructure-assisted hybrid road-aware routing protocol which is capable of enhanced vehicle-to-vehicle and vehicle-to-infrastructure communication. A remarkable aspect of the proposed protocol is that it establishes a link between path duration and fundamental design parameters like vehicular velocity, density, hop count and transmission range. Although, a lot of research has been previously performed, a well defined analytical model for IoV is not available in the literature. Precisely, a relation between path duration and vehicular velocity has not been validated in the previous studies. Experimental results show that the increased packet delivery ratio with reduced end-to-end delay can be achieved by the prediction of path duration. Proposed model for path duration is validated by getting experimental results from network simulator 3 (NS3) and analytical results from MATLAB. In addition, SUMO simulator was used to generate real time traffic on the roads of Gangnam district, South Korea.

Proposing an optimal routing protocol for internet of vehicles with reduced overhead has endured to be a challenge owing to the incompetence of the current architecture to manage flexibility and scalability. The proposed architecture, therefore, consolidates an evolving network standard named as software defined networking in internet of vehicles. Which enables it to handle highly dynamic networks in an abstract way by dividing the data plane from the control plane. Firstly, road-aware routing strategy is introduced: a performance-enhanced routing protocol designed specifically for infrastructure-assisted vehicular networks. In which roads are divided into road segments, with road side units for multi-hop communication. A unique property of the proposed protocol is that it explores the cellular network to relay control messages to and from the controller with low latency. The concept of edge controller is introduced as an operational backbone of the vehicle grid in internet of vehicles, to have a real-time vehicle topology. Last but not least, a novel mathematical model is estimated which assists primary controller in a way to find not only a shortest but a durable path. The results illustrate the significant performance of the proposed protocol in terms of availability with limited routing overhead. In addition, we also found that edge controller contributes mainly to minimizes the path failure in the network.

The integration of commercial onshore large-scale wind farms into a national grid comes with several technical issues that predominately ensure power quality in accordance with respective grid codes. The resulting impacts are complemented with the absorption of larger amounts of reactive power by wind generators. In addition, seasonal variations and inter-farm wake effects further deteriorate the overall system performance and restrict the optimal use of available wind resources. This paper presented an assessment framework to address the power quality issues that have arisen after integrating large-scale wind farms into weak transmission grids, especially considering inter-farm wake effect, seasonal variations, reactive power depletion, and compensation with a variety of voltage-ampere reactive (Var) devices. Herein, we also proposed a recovery of significant active power deficits caused by the wake effect via increasing hub height of wind turbines. For large-scale wind energy penetration, a real case study was considered for three wind farms with a cumulative capacity of 154.4 MW integrated at a Nooriabad Grid in Pakistan to analyze their overall impacts. An actual test system was modeled in MATLAB Simulink for a composite analysis. Simulations were performed for various scenarios to consider wind intermittency, seasonal variations across four seasons, and wake effect. The capacitor banks and various flexible alternating current transmission systems (FACTS) devices were employed for a comparative analysis with and without considering the inter-farm wake effect. The power system parameters along with active and reactive power deficits were considered for comprehensive analysis. Unified power flow controller (UPFC) was found to be the best compensation device through comparative analysis, as it maintained voltage at nearly 1.002 pu, suppressed frequency transient in a range of 49.88-50.17 Hz, and avoided any resonance while maintaining power factors in an allowable range. Moreover, it also enhanced the power handling capability of the power system. The 20 m increase in hub height assisted the recovery of the active power deficit to 48%, which thus minimized the influence of the wake effect.

Due to its hemizygous inheritance and role in sex determination, the X-chromosome is expected to play an important role in the evolution of sexual dimorphism and to be enriched for sexually antagonistic genetic variation. By forcing the X-chromosome to only be expressed in males over >40 generations, we changed the selection pressures on the X to become similar to those experienced by the Y. This releases the X from any constraints arising from selection in females and should lead to specialization for male fitness, which could occur either via direct effects of X-linked loci or trans-regulation of autosomal loci by the X. We found evidence of masculinization via up-regulation of male-benefit sexually antagonistic genes and down-regulation of X-linked female-benefit genes. Potential artefacts of the experimental evolution protocol are discussed and cannot be wholly discounted, leading to several caveats. Interestingly, we could detect evidence of microevolutionary changes consistent with previously documented macroevolutionary patterns, such as changes in expression consistent with previously established patterns of sexual dimorphism, an increase in the expression of metabolic genes related to mito-nuclear conflict and evidence that dosage compensation effects can be rapidly altered. These results confirm the importance of the X in the evolution of sexual dimorphism and as a source for sexually antagonistic genetic variation and demonstrate that experimental evolution can be a fruitful method for testing theories of sex chromosome evolution.

Introduktion: En akutmottagning är avsedd för personer med akut sjukdom eller skada. Arbetet på en akutmottagning kan vara stressigt, ständigt omväxlande och oförutsägbart. Sjuksköterskans huvudansvar är omvårdnaden och förväntas göra snabba bedömningar samt ge adekvat vård. Arbetsrelaterad stress uppstår när kraven blir för höga jämfört med sjuksköterskans kompetens och förmåga. Långvarig arbetsrelaterad stress under en lång tid kan leda till problem med hälsan. Syfte: Syftet var att belysa vad som orsakar arbetsrelaterad stress hos sjuksköterskor på en akutmottagning. Metod: Litteraturstudien utfördes enligt Polit och Becks (2017) flödesschema i nio steg. Databassökningar i CINAHL, PsycINFO och PubMed utfördes där 12 artiklar var relevanta för litteraturstudiens syfte samt inklusion- och exklusionskriterierna. Sju var kvantitativa, fyra var kvalitativa och en mixad metod. Samtliga artiklar granskades med hjälp av granskningsmallar. Två huvudkategorier samt underkategorier identifierades under databearbetningen. Resultat: Orsakerna till arbetsrelaterad stress som belysts i den här litteraturstudien har presenterats i två huvudkategorier: Hög arbetsbelastning och påfrestande situationer samt underkategorier till hög arbetsbelastning: organisatoriska brister och tidsbrist. Slutsats: Sjuksköterskor på en akutmottagning träffar på en rad olika orsaker till arbetsrelaterad stress oavsett vilken akutmottagning. Överbeläggning och stort antal patienter bidrog till arbetsrelaterad stress hos sjuksköterskor. Resursen sjuksköterskor räcker inte till på akutmottagningen och orsakar en tidsbrist. Otillräckligt omhändertagande inom primärvården orsakar överbelastning på akutmottagningen.

Previous research had shown that students lacked knowledge in the multiplication tables. Automating the tables gives students good conditions to succeed in other areas of mathematics. The purpose of this study was to create knowledge about teacher’s perceptions of automating the multiplication tables and to examine how many of the pupils had automated the tables. The purpose was also to identify what methods teachers use to support students in multiplication table automation. The study was conducted with a survey and the results were followed up with focus group interviews. The results showed that many teachers value the automation of the multiplication tables because it prepares the students for other mathematics areas and it relieves the student’s working memory. The methods most teachers used in their teaching were digital teaching platforms and various worksheets such as drill training of the tables.

Background: Globally, there are a large and growing number of researchers using biotelemetry as a tool to studyaquatic animals. In Europe, this community lacks a formal network structure. The aim of this study is to review the useof acoustic telemetry in Europe and document the contribution of cross-boundary studies and inter-research groupcollaborations. Based on this, we explore the potential benefits and challenges of a network approach to identifyfuture priorities and best practices for aquatic biotelemetry research in Europe.

Results: Over the past decade, there was an approximately sevenfold increase in the number of acoustic telemetrystudies published on marine and diadromous species in Europe compared to a sixfold increase globally. Over 90%of these studies were conducted on fishes and undertaken in coastal areas, estuaries, or rivers. 75% of these studieswere conducted by researchers based in one of five nations (Norway, UK, France, Portugal, and Spain) and, eventhough 34% were based on collaborations between scientists from several countries, there was only one study withan acoustic receiver array that extended beyond the borders of a single country. In recent years, acoustic telemetryin European waters has evolved from studying behavioural aspects of animals (82.2%), into more holistic approachesaddressing management-related issues (10%), tagging methods and effects (5%), and technology and data analysisdevelopment (2.8%).

Conclusions: Despite the increasing number of publications and species tracked, there is a prominent lack ofplanned and structured acoustic telemetry collaborations in Europe. A formal pan-European network structure wouldpromote the development of (1) a research platform that could benefit the acoustic telemetry community throughcapacity building, (2) a centralized database, and (3) key deployment sites and studies on priority species requiringresearch in Europe. A network may increase efficiency, expand the scope of research that can be undertaken, promoteEuropean science integration, enhance the opportunities and success of acquiring research funding and, ultimately,foster regional and transatlantic collaborations. It may also help address research priorities such as the large-scalesocietal challenges arising from climate change impacts and assist the EU’s Marine Strategy Framework Directive viaidentification of good environmental status of endangered or commercially important species.

Introduktion/Bakgrund: Sjuksköterskor möter patienter som talar olika språk i sitt dagliga arbete.  Kommunikationen är en viktig del i sjuksköterskors arbete och är avgörande för att kunna skapa förståelse mellan sjuksköterskor och patienter. Tolk är det vanligaste hjälpmedlet att använda vid språkbarriärer. Språkbarriärer är en hindrande kommunikationssvårighet. World Health Organisation rapporterar att kommunikationssvårigheter är en bidragande orsak till att vårdskador kan uppstå i vården. Syfte: Syftet är att belysa sjuksköterskors erfarenheter av tolkanvändning vid språkbarriärer inom slutenvården. Metod: Studien har genomförts genom att tillämpa Polit och Becks (2017) nio steg med ett induktivt förhållningssätt. Sökningarna efter litteratur har skett systematiskt i databaserna Cinahl och PubMed. Sökningarna genererade tio kvalitativa artiklar. Artiklarna kvalitetsgranskades genom SBU:s granskningsmall för kvalitativa studier.  Resultat: Litteraturstudiens resultat genererade fyra teman: tidskrävande, oro och osäkerhet, begränsningar i kommunikationen och ett stöd i omvårdnadsarbetet. Slutsats: Sjuksköterskor erfar att tolken är det effektivaste hjälpmedlet vid språkbarriärer, dock är tolkanvändning inte problemfri. Tolkningstjänsterna har begränsningar och är tidskrävande, vilket skapar oro och osäkerhet hos sjuksköterskor.

The overall aim of the research was to deepen the understanding of learning through simulation in prehospital emergency care.

Method: In this research, qualitative and quantitative methods are used as well as integrative literature studies (I, II). Qualitative data from the interview studies (III, V) were analyzed by phenomenographic methodology. Quantitative data from the intervention study (IV) were analyzed using descriptive and analytical statistics.

Results: Research on simulation and learning within the prehospital trauma care context is relatively rare (I). Simulation of realistic scenarios where the caregivers are exposed to stress contributes to strengthen caregiver knowledge, skills and experience (II). Caregivers request simulation opportunities regarding critical and emergency situations (III). They describe that learning through regular simulation provides in-depth knowledge and skills in the care of a patient exposed to high-energy trauma (V). Interventions with repeated simulation opportunities related to the care of the patient exposed to high-energy trauma give some improvement in care provided at the site of the accident (IV).

Conclusion: Through simulation, the caregivers develop knowledge and skills and receive enhanced confidence in the care of an injured and sick patient. The research suggests several areas with potential for improvement with regard to the care of patients exposed to high-energy trauma. A model has been developed for systematic trauma simulation.

Introduction: Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. Aim: To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. Design: The study was designed as an observational study inspired by an ethnographic approach.MethodData was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis.Results: Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity.Conclusion: High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety.

BACKGROUND: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.

OBJECTIVE: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.

RESEARCH DESIGN: The study had a qualitative approach.

METHOD: Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.

ETHICAL CONSIDERATIONS: The study followed the ethical principles in accordance with the Declaration of Helsinki.

FINDINGS: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.

DISCUSSION: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.

CONCLUSION: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.