Bakgrund: Ambulanssjuksköterskans roll innebär bland annat att bedöma en patients tillstånd. I bakgrunden presenteras bedömningsprocessen ur ett psykiatriskt, prehospitalt och kombinationen prehospitalt/psykiatriskt perspektiv. Syfte: Syftet är att belysa på vilka grunder ambulanssjuksköterskor gör sina bedömningar i mötet med personer som kan antas lida av akut psykisk ohälsa. Metod: Studien grundar sig på en kvalitativ forskningsansats. Data har insamlats genom semistrukturerade intervjuer och har analyserats med hjälp av kvalitativa innehållsanalys som Granheim och Lundman beskriver den. Resultat: Utgörs av tre huvudkategorier; Patienten i fokus för bedömningen, Omgivningens roll samt Vårdarens tillvägagångssätt Diskussion: Resultatet har diskuterats utifrån andra studerade arbetssätt och tankeprocesser bakom en bedömning. Vidare lyfts reflektioner kring den teoretiska referensramens huvudbegrepp; Miljö, Hälsa, Människosyn och mötet med patienten. / Background: One of the ambulance nurses many responsibilities is assessing the patients’ current health situation. The background presents how this process may manifest itself in the nursing field of pre-hospital care, psychiatry and the combination of pre-hospital and psychiatry.  Aim: The present study aims to illuminate on what basis the ambulance nurse make their assessing decisions in the encounter with patients that might suffer from an acute psychiatric event Methods: Data was collected through semi-structured interviews and have been analysed using the qualitative content analysis as described by Graneheim and Lundman. Results: Three main categories emerged: Assessing the patient, The role of the environment and The nurses approach. Discussions: The results have been discussed comparing other known assessment situations and cognitive models. Reflections from the result, seen through the perspective of the theoretical frameworks, are also presented.

Bakgrund:Under de senaste decennierna har medvetenheten om barnmisshandel samt utvecklingen av förebyggande politik kring detta ökat. Ambulanssjuksköterskor har en unik möjlighet att upptäcka dessa barn som misstänks fara illa då de är först på plats vid ett akut sjukdomstillstånd och kan se tecken i hemmiljön som kan leda till en orosanmälan. Det kan leda till ett minskat lidande för barnen men för att det ska kunna ske bör en medvetenhet om vad en orosanmälan innebär finnas. Syfte:Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser av att göra en orosanmälan av barn som far illa.   Metod:En studie med tio stycken kvalitativa intervjuer gjordes. En öppen fråga med möjlighet till följdfrågor ställdes utifrån en intervjuguide. Materialet analyserades på en latent nivå utifrån Lundman och Hällgren Graneheims kvalitativa innehållsanalys.   Resultat:Resultatet redovisas utifrån tre huvudkategorier; Misstankar väcks, Påverkan på orosanmälansamt Samarbete och Öppenhet. Av dessa kategorier framkom sju underkategorier som beskrev informanternas upplevelser. Det framkom att brist på kunskap angående identifieringen av barn samt en okunskap kring vad ens egenansvar innebär, finns. Rädslan för repressalier kan ses som en anledning till att orosanmälan inte görs.   Slutsats:Utbildning i ämnet barn som far illa är av stor vikt för att kunna identifiera de utsatta barnen. En rädsla för repressalier kan vara anledningen till att orosanmälningar inte görs men skulle kunna öka om möjlighet till anonymitet i utförandet finns. Mer utbildning och stöttning i ämnet behövs. / Background: In recent decades, awareness of child abuse and the development of preventive policies has increased. Ambulance nurse have a unique opportunity to identify children who may be in a vulnerable situation as they are the first at the scene in the event of acute illness and can pick up signs in the home environment which could lead to suspicions of neglect being reported.This may result in less suffering for the children concerned, but in order for this to happen, it is important to be aware of the implications of making a report. Purpose:The purpose of the study was to describe the ambulance nurses’ experiences of reporting suspicions of child neglect. Method:The study is based on ten qualitative interviews. One open question with the possibility of follow-up questions were posed, based on an interview guide. The material was analyzed on a latent level based on Lundman and Hällgren Graneheim's qualitative content analysis Result: The results are reported based on three main categories: Suspicions arise, Impingement of reporting child neglect andCooperation and Transparency.Seven subcategories, that best described the informants experiences, were then selected. It was found that lack of knowledge regarding the identification of children as well as an ignorance of what one's own responsibility implies exists. The fear of reprisals can be seen as a reason for not reporting on suspicion of child neglect. Conclusion: Education in the subject child neglect are important for identifying the exposed children. A fear of reprisals may be the reason why no report on child neglect is made but could increase, if there is an opportunity for anonymity in the implementation. More education and support on the subject is needed.

This thesis deals with first aid knowledge among the general public. The theoretical part focuses on the basic aspects of first aid. The practical part is a survey of the results of the research, which are then evaluated and commented upon in the discussion. The research group consisted of people of working age. To obtain the data used quantitative research, carried out by polling, through a questionnaire. Based on its evaluation were confirmed or refuted in advance the hypothesis. These hypotheses were statistically verified. Research suggests that the level of knowledge of the general public is not sufficient.

Orientador: Maria Inês Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T12:45:49Z (GMT). No. of bitstreams: 1 Vegian_CamilaFernandaLourencon_M.pdf: 1716075 bytes, checksum: 4b20b61e4d945c73c30312b1ecf606c9 (MD5) Previous issue date: 2010 / Resumo: A assistência prestada pelo Serviço de Atendimento Pré-Hospitalar Móvel de Urgência pode ser definida como aquela realizada fora do ambiente hospitalar, com o objetivo de proporcionar ao usuário melhor resposta à sua solicitação. Para tal, o serviço possui diversos profissionais que atuam de modo a enfrentar situações diferenciadas e que exigem determinadas habilidades, as quais podem resultar em alterações na saúde dos trabalhadores. Este estudo epidemiológico transversal teve como objetivo avaliar a capacidade para o trabalho e os aspectos de saúde, estilo de vida e condições de trabalho entre os profissionais do Serviço de Atendimento Móvel de Urgência (SAMU) de Campinas, São Paulo. Para a coleta de dados foram utilizados quatro questionários e uma escala que permitiram a investigação de: dados sociodemográficos, estilo de vida e aspectos de saúde e trabalho; índice de capacidade para o trabalho (ICT); incivilidade e violência no trabalho; fadiga e sonolência. A taxa de resposta foi 86,6% e a amostra foi composta por 197 trabalhadores - enfermeiros, médicos, técnicos e auxiliares de enfermagem, motoristas e pessoal administrativo. Os resultados evidenciaram a prevalência do sexo masculino (61,4%), idade média de 39,1 anos (DP=8,3), residente na cidade de Campinas (80,7%); casados (63,5%), com filhos (76,7%) e com ensino médio completo (40,1%). Houve predomínio da categoria profissional de motoristas (30,5%), seguido pelos médicos (18,3%) e auxiliares de enfermagem (16,75%); além da atuação em turno diurno (54,3%). Destacou-se a porcentagem de possuir outro emprego (42,1%), realizar horas extras (48%) e trabalhar 70 horas ou mais na semana (25,3%). A maioria praticava atividade física (56,5%) e de lazer (96,5%) e tinha planos para o futuro (94,4%). A média de pontuação do ICT foi 41,8 (DP 5.4) pontos, isto é, boa capacidade para o trabalho: 41,1 entre profissionais de enfermagem; 41,5 entre os médicos; 42,9 entre os motoristas; 42,5 entre as telefonistas e 40,3 entre trabalhadores do setor administrativo. Diversas variáveis tiveram associação com a perda da capacidade do trabalho, sendo algumas delas: estado civil, filhos, atividade física, acidentes de trabalho, incivilidade no trabalho, fadiga, sonolência, estresse, satisfação com a vida e com o trabalho. Em síntese, faz-se necessária a utilização de abordagem multidimensional para a implementação de programas que visem à manutenção e promoção da saúde física e mental, em geral, assim como, específica para cada categoria profissional. Outro aspecto relevante é a educação da população usuária quanto ao uso correto do serviço. Este estudo está inserido na linha de pesquisa "Trabalho, saúde e educação". / Abstract: The assistance provided by the Pre hospital Emergency Care Mobile Unit can be defined as that performed outside the hospital, aiming to provide the user with better response to your request. To this end, the service has many professionals working in order to face different situations and require certain skills, which may result in changes in the health of workers. This epidemiological study aimed to evaluate the work ability and aspects of health, lifestyle and working conditions among professionals Pre hospital Emergency Care Mobile Unit (SAMU) in Campinas, São Paulo. To collect the data four questionnaires were used and a scale that allowed investigations: demographic data, lifestyle and health issues and work; work ability index (WAI), incivility and violence at work, fatigue and sleepiness. The response rate was 86.6% and the sample consisted of 197 workers - nurses, doctors, technicians and nursing assistants, drivers and administrative staff. The results showed the prevalence of males (61.4%), mean age 39.1 years (SD = 8.3), residing in the city of Campinas (80.7%), married (63.5%) with children (76.7%) and high school (40.1%). Predominated in the professional category of drivers (30.5%), followed by doctors (18.3%) and nursing assistants (16.75%) and performance on the day shift (54.3%). They noted the high percentage of having another job (42.1%), doing overtime (48%) and working 70 hours or more per week (25.3%). Most practiced physical activity (56.5%) and leisure (96.5%) and had plans for the future (94.4%). The average score of the WAI was 41.8 (SD 5.4) points, ie, good ability to work: 41.1 among nursing professionals, 41.5 among doctors, 42.9 among drivers; 42.5 between the telephone operators and 40.3 among workers in the administrative sector. Several variables were associated with loss of work ability, these include: marital status, children, physical activity, accidents, incivility at work, fatigue, sleepiness, stress, satisfaction with life and work. It is necessary to use muldimensional approach to the implementation of programs aimed at maintaining and promoting physical and mental health in general and, specific to each professional category. Another relevant aspect is the education of the user population about the correct use of the service. This study follows the line of research "Work, health and education." / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Sammanfattning Bakgrund: Antalet transporter mellan sjukhus, som kräver medföljande anestesipersonal, har ökat i region Jönköpings län från 135 stycken 2015 till 247 transporter 2016. Anestesisjuksköterskans arbetsuppgifter är bland annat att övervaka, observera, dokumentera och följa upp patientens ventilation, cirkulation, anestesidjup och temperatur. Att vårda patienter i ambulans är en stor utmaning eftersom situationen är komplex och oförutsägbar. Syfte: Syftet är att beskriva anestesisjuksköterskors erfarenheter och agerande i samband med kritisk händelse under ambulanstransport av svårt sjuk patient. Metod: Kvalitativ design med hjälp av intervjuer utfördes med Critical Incident Technique (CIT). En incident liknas vid en situation, ett dilemma eller enskild händelse som i efterhand betraktas som kritisk. Kritiska händelser definieras i  denna studie som händelser eller specifik situation med positiv eller negativ utgång. Resultat: Tre huvudområden söktes i resultatet, trygghet, kontroll och utsatthet. Anestesisjuksköterskorna upplevde att transportsituationen var en utsatt uppgift, trots flera år som anestesisjuksköterskor och mångårig yrkeserfarenhet utöver det. Det beskrevs som det värsta med jobbet och var inget som någon längtade efter. Slutsats: Anestesisjuksköterskor känner sig ofta otrygga, utsatta och har svårt att behålla kontrollen över situationen under ambulanstransporten.

Bakgrund: Att befinna sig i miljöer som kan uppfattas som hotfulla är ingen ovanlighet för ambulanssjuksköterskor. Att utsättas för hot i sitt arbete förekommer och uppfattas som ett problem av många inom ambulansverksamheten och är enligt såväl nationella som internationella studier ett växande problem. Att arbeta inom den prehospitala vården innebär att man ofta verkar inom en utsatt miljö. Då en hotfull situation påverkar vården är en viktig del av ambulanssjuksköterskans kompetensområde att skapa ett säkert vårdrum där patienten kan erhålla ett adekvat omhändertagande. Syfte: Syftet med studien var att beskriva ambulanssjuksköterskors uppfattningar av hot i samband med omhändertagande av sjuk eller skadad person. Metod: Kvalitativ intervjustudie med fenomenografisk ansats. Ett strategiskt urval användes vilket resulterade i tio intervjuer med ambulanssjuksköterskor på en ambulansstation i en mellanstor stad. Intervjuerna spelades in med ljud och transkriberades i efterhand. Resultat: De analyserade intervjuerna mynnade ut i fyra beskrivningskategorier om ambulanssjuksköterskors uppfattningar om hot i samband med omhändertagande av sjuk eller skadad person. De fyra beskrivningskategorierna var: Att det är en del av jobbet, Personliga förutsättningar och yrkeserfarenhet, Att hantera en hotfull situation och Att endast utföra det nödvändiga. Slutsats: Uppfattningarna kring hot varierar mycket, ett antal uppfattningar var extra förekommande. Bland annat att en könsdifferentierad ambulansbesättning uppfattades som positivt, också att en vårdrelation blir lidande och att bara den nödvändigaste vården utförs om situationen uppfattas vara hotfull. / Background: Being in environments that can be perceived as threatening is not unusual for ambulance nurses. Being exposed to threats in their work occurs and is perceived as a problem by many in the ambulance business and according to national as well as international studies, is a growing problem. Working in prehospital care means that you often work within an exposed environment. As a threatening situation affects healthcare, an important part of the ambulance nurse´s field of expertise is to create a safe care space where the patient can receive adequate care. Aim: The aim of the study was to describe ambulance nurse's perceptions of threats associated with the treatment of sick or injured persons. Method: Qualitative interview study with phenomenographic approach. A strategic selection was used which resulted in ten interviews with ambulance nurses at an ambulance station in a medium-sized city. The interviews were sound recorded and transcribed post the interviews. Results: The analyzed interviews appeared in four descriptive categories on the perception of ambulance nurses on threats associated with the treatment of sick or injured persons. The four description categories were: That it is part of the job, Personal circumstances and professional experience, Managing a threatening situation and To only perform the necessary. Conclusion: The perceptions regarding threats varies a lot, a number of different were more extra common. As example that a gender differentiated ambulance crew were perceived as something positive, also that the caring relationship suffers and that the only necessary care is given if a situation is regarded as being threatening.

Bakgrund: Den psykosociala arbetsmiljön är viktig för individen. Att skapa arbetsplatser med en tillfredsställande arbetsmiljö är både svårt och utmanande, men med kunskap och utbildad personal kan det skapas goda arbetsmiljöer och främja hälsan hos personalen. Syftet: Var att beskriva och jämföra hur ambulanspersonalen skattade sin psykosociala arbetsmiljö samt om det fanns skillnad i skattning mellan män och kvinnor inom ett verksamhetsområde i en region inom hälso-och sjukvården. Metod: En beskrivande och jämförande studie med kvantitativ ansats. Huvudresultat: Resultatet visade att faktorerna arbetskrav, låg kontroll i arbete, rollförväntningar, förutsägbarget i arbetet, social interaktion, ledarskap, kommunikation, organisationskultur/klimat, grupparbete, skicklighet i arbetet, arbetets centralitet och interaktion mellan arbete och privatliv/stress innefattade den påverkade psykosociala arbetsmiljön. Det fanns inga signifikanta skillnader mellan män och kvinnor av de beskrivna områdena arbetsnivå, social och organisationsnivå samt individnivå. Slutsatser: Distriktsjuksköterskans preventiva arbete kan förse arbetsplatser med hälsofrämjande kunskap angående den psykosociala arbetsmiljön. Att uppmärksamma och bibehålla faktorer på arbetsplatsen som gör den till en god och hälsosam arbetsplats är viktigt. Känslan av att känna ett sammanhang är betydelsefullt för både individen och gruppen. / Background: The psychosocial work environment is important for the individual. Creating workplaces with a satisfactory working environment is both difficult and challenging, but with knowledge and trained staff good working environments can be created and health promotion for the staff. Aim: To describe and compare how ambulance staff estimated their psychosocial work environment and whether there was a difference in estimation between men and women within an operation area in a healthcare region. Method: A descriptive and comparative study with quantitative approach. Main results: The result showed that factors such as work demands, control at work, role expectations, predictability, social interactions, leadership, communication, organization culture/climate, group work and skills at work, centrality of work, interactions between work and private life/stress were factors that included the affected psychosocial work environment. There were no significant differences between men and women in the described areas of work level, social and organizational level and individual level.    Conclusion: The district nurse´s preventive work can provide workplaces with health promotion knowledge regarding the psychosocial work environment. Attention and maintaining factors in the workplace that make it a good healthy workplace is important. The feeling of feeling a context is important for both individual and group.

Aim: The overall aim of the thesis is to investigate whether a new care-model can be introduced – in which patients with primary care needs and not in need of hospital emergency department care can be referred directly to a healthcare centre – and respond to the patient’s need of trust and patient safety.   Methods: The four sub studies employ different methods: three are quantitative with varying approaches and one is qualitative. Sub study I is a retrospective explorative register study aimed to identify characteristics and frequency. Sub study II is an instrument development study aimed to measure patient trust. Sub study III is a randomized controlled trial, which compared the level of patient trust and patient-safety among low-priority ambulance patients who were randomized into two groups: the experimental group (care at the healthcare centre) and the control group (traditional care at Emergency department). Finally, sub study IV is a hermeneutic lifeworld study based on interviews with patients who participated in the new care model.   Main results: Sixteen percent of the patients to whom an ambulance was allocated could have received care at a healthcare centre instead of an emergency department. They were slightly younger and healthier as regards their histories, but were found at all priority levels and with almost all symptom codes. Patient trust in care did not differ regardless of whether they were cared for at a healthcare centre or at the emergency department. However, 59 patients of 188 overall (31%) fulfilled one or more of the given criteria for potentially reduced patient safety. The phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of lifeworld” enables the patient to feel trust.  Conclusion: One in six patients allotted an ambulance may get taken to primary care instead of the hospital emergency department. These patients are found at all priority levels and in most of the symptom codes.  An instrument has been developed that measures patient trust in the prehospital chain of care (Study I). The instrument has proved to be useful in this patient group and is based on two dimensions: Credibility and Accessibility (Study II). Patients’ trust in the prehospital care chain proved to be high and bore no relation to where they received care. Patient safety, on the other hand, appeared to be limited in view of the fact that an excessive proportion of patients were exposed to potential patient safety risks (Study III). Communication that appeals to a patient's lifeworld increases the opportunities for understanding and participation. In all, lifeworld communication creates trust in care at the right level of care as well as in care relationships and the healthcare environment (Study IV).

Abstract Background: Maternal mortality is one of the most sensitive indicators of the health disparities between poorer and richer nations. It is also one of the most difficult health outcomes to measure reliably. In many settings, major challenges remain in terms of both measuring and reducing maternal mortality effectively. This thesis aims to quantify overall levels, identify specific causes, and evaluate local interventions in relation to efforts to reduce maternal mortality in Tigray Region, Northern Ethiopia, thereby providing a strong empirical basis for decision making by the Tigray Regional Health Bureau using methods that can be scaled at national level.   Methods: This study employed a combination of community-based study designs to investigate the level and determinants of maternal mortality in six randomly selected rural districts of Tigray Region. A census of all households in the six districts was conducted to identify all live births and all deaths to women of reproductive age occurring between May 2012 and September 2013. Pregnancy-related deaths were screened through verbal autopsy with the data processed using the InterVA-4 model, which was used to estimate Maternal Mortality Ratio. To identify independent determinants of maternal mortality, a case-control study using multiple logistic regression analysis was done, taking all pregnancy-related deaths as cases and a random sample of geographical and age matched mothers as controls. Uptake of ambulance services in the six districts was determined retrospectively from ambulance logbooks, and the trends in pregnancy-related death were analyzed against ambulance utilization, distance from nearest health center, and mobile network coverage at local area level. Lastly, implementation of the Family Folder paper health register, and its potential for accurately capturing demographic and health events, were evaluated using a capture-recapture assessment.   Results: A total of 181 deaths to women of reproductive age and 19,179 live births were documented from May 2012 to April2013. Of the deaths, 51 were pregnancy-related. The maternal mortality ratio for Tigray region was calculated at 266 deaths per 100,000 live births (95% CI 198-350), which is consistently lower than previous “top down” MMR estimates. District–level MMRs showed strong inverse correlation with population density (r2 = 0.86). Direct obstetric causes accounted for 61% of all pregnancy–related deaths, with hemorrhage accounting for 34%. Non-membership in the voluntary Women’s Development Army (AOR 2.07, 95% CI 1.04-4.11), low husband or partner involvement during pregnancy (AOR 2.19, 95% CI 1.14-4.18), pre-existing history of other illness (AOR 5.58, 95% CI 2.17-14.30), and never having used contraceptives (AOR 2.58, 95% CI 1.37-4.85) were associated with increased risk of maternal death in a multivariable regression model. In addition, utilization of free ambulance transportation service was strongly associated with reduced MMR at district level. Districts with above-average ambulance utilization had an MMR of 149 per 100,000 LB (95% CI: 77-260) compared with 350 per 100,000 (95% CI: 249-479) in districts with below average utilization. The Family Folder implementation assessment revealed some inconsistencies in the way Health Extension Workers utilize the Family Folders to record demographic and health events.   Conclusion: This work contributes to understanding the status of and factors affecting maternal mortality in Tigray Region. It introduces a locally feasible approach to MMR estimation and gives important insights in to the effectiveness of various interventions that have been targeted at reducing maternal mortality in recent years.

Bakgrund: En förutsättning för att ambulanssjuksköterskan ska kunna hänvisa patienter till primärvård på ett patientsäkert sätt är följsamhet mot lokala riktlinjer, triageringssystem, och en tydlig och strukturerad journalanteckning där det framgår vilka vårdhandlingar som utförts. Syfte: Syftet med studien var att göra en systematisk journalgranskning för att få en bild av hur ambulanssjuksköterskor dokumenterar hänvisningar av patienter till primärvård med fokus på patientsäkerhet. Hur följer ambulanssjuksköterskan triageringssystem och regionens lokala riktlinjer vid hänvisning till primärvård? Metod: Studien är en kvantitativ retrospektiv systematisk journalgranskning med en explorativ ansats. Resultat: Resultatet visar på hög följsamhet mot triageringssystem och lokala riktlinjer överlag. Samtidigt som vikten av identitetskontroll behöver diskuteras och förstås. Av den anledningen finns ett fortsatt behov av kontinuerlig utbildning för att följsamheten ska fortsätta vara hög. Slutsats: Resultatet är positivt och visar på att ambulanssjuksköterskor i regionen är följsamma mot lokala riktlinjer och triageringsverktyg. / Background: A prerequisite for the ambulance nurse with specialist competence to be able to refer patients to primary health care in manner that is patient safe is the compliance with local guidelines and triage systems. In order for the transfer to be as patient safe as possible. Aim: The aim of the study was to conduct a systematic journal review to understand how ambulance nurses with specialist competence document referrals of patients to primary care with focus on patient safety. How is the decision on referral of patients to primary health care documented? How compliant is the ambulance nurse with specialist competence with regard to triage systems and local guidelines when referring to primary health care? Method: The study is a quantitative retrospective systematic journal review with an explorative approach. Result: The result shows high compliance with triages system and local guidelines in general. There is a need for a discussion and understanding why identification control is important. There are also a need for continuous education so that the compliance will stay high. Conclusion: The result are positive and shows that ambulance nurses with specialist competence in the region are compliant with the guidelines and triage system.