Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care.  Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain.  Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II. Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain.  Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.

This study examines the Public Welfare Medical Transportation Program with particular focus on ambulance transportation. It addresses the problems Public Welfare has in funding and administrating the program, looks at the components of the larger emergency medical care system and its relationship to Public Welfare, studies who, how, and why this service is being delivered, and makes recommendations for policy revision in respect to the larger emergency medical care system.

Bakgrund: Ambulanssjukvården har genomgått en utveckling genom åren. Ambulanssjukvården anses idag vara ansvarig för kvalificerad akutsjukvård, med ökade möjligheter till avancerade undersökningar och behandlingsmetoder. Rollen som ambulanssjuksköterska har blivit alltmer betydelsefull med krav på kompetens. Den första tiden som ambulanssjuksköterska kan vara utmanande. Introduktionen till ambulansen är avgörande för att den nya sjuksköterskan ska kunna växa in i sin nya yrkesroll och utveckla kompetens och erfarenhet för att kunna hantera de utmaningar som kan uppstå. Syfte: Syftet med studien var att beskriva nyanställda sjuksköterskors upplevelser av att introduceras inom ambulanssjukvården. Metod: En kvalitativ intervjustudie genomfördes i form av tretton intervjuer inom en ambulansverksamhet. Intervjuerna genomfördes med en öppen intervjuguide. Datamaterialet analyserades med en kvalitativ innehållsanalys. Resultat: Studiens resultat visar att en strukturerad, stöttande och individanpassad introduktion är avgörande för att skapa en trygg och säker arbetsmiljö inom ambulansverksamheten. Det är viktigt att ha realistiska förväntningar, kontinuitet och stöd från kollegor och handledare för att underlätta introduktionsprocessen för nya medarbetare. Slutsats: Introduktion till ambulanssjukvården är en utmanande process som kräver individanpassning. Att introduceras avser inte bara den formella introduktionen utan är en process som pågår under en längre tid och det är viktigt med stöd och möjlighet till fortsatt lärande en lång tid efter introduktionens slut. / Introduction: The ambulance service has evolved over the years. Today, the ambulance service is responsible for providing advanced emergency care, with increased possibilities for advanced examinations and treatment methods. The role of the ambulance nurse has become increasingly important with demands for competency. The initial period as an ambulance nurse can be challenging. The introduction to the ambulance service is crucial for the new nurse to grow into their new professional role and develop competence and experience to handle the challenges that may arise. Aim: The aim of the study was to describe newly hired nurses' experiences of being introduced to the ambulance service. Methods: A qualitative interview study was conducted with thirteen interviews within an ambulance service. The interviews were conducted using an open interview guide. The data was analyzed using a qualitative content analysis. Results: The results of the study show that a structured, supportive, and individualized introduction is crucial for creating a safe and secure work environment within the ambulance service. It is important to have realistic expectations, continuity, and support from colleagues and mentors to facilitate the introduction process for new employees. Conclusion: Introduction to ambulance service is a challenging process that requires individualization. Introduction does not only refer to the formal introduction, but is a process that takes place over a longer period of time and it is important to have support and the opportunity for continued learning for a long time after the introduction has ended.

Ethical codes of non-medical health professions focusing on ambulance service workers ABSTRACT A sharp increase of number of the codes of ethics in all fields of human activity is the trend of current ethical education. The dissertation is oriented (focuses) on the question of the necessity or the suitability of codes of ethics for ambulance services (Emergency Ambulance Services and Non- emergency patient transport services). The introductory theoretical part defines the range of medical transport professions that are the subjects of research. There are introduce the theoretical bases of healthcare professions. The historical part of the dissertation is focused on the development of a medical transport with an emphasis on ethical principles in the work of emegency and nonemergency ambulance services. The theory that the direct precursors of code of ethics can be promises, oaths, orders, statutes, instructions, recommendations and similar written or unwritten documents containing ethical principles that include challenges to help others and the demands of collegiallity, respect, honesty or virtuous life was confirmed. In the work is also mentions some ethical problems and dilemmas in the work in the ambulance services. The content of the practical part of dissertation is research study on the question of...

Ethical codes of non-medical health professions focusing on ambulance service workers ABSTRACT A sharp increase of number of the codes of ethics in all fields of human activity is the trend of current ethical education. The dissertation is oriented (focuses) on the question of the necessity or the suitability of codes of ethics for ambulance services (Emergency Ambulance Services and Non- emergency patient transport services). The introductory theoretical part defines the range of medical transport professions that are the subjects of research. There are introduce the theoretical bases of healthcare professions. The historical part of the dissertation is focused on the development of a medical transport with an emphasis on ethical principles in the work of emegency and nonemergency ambulance services. The theory that the direct precursors of code of ethics can be promises, oaths, orders, statutes, instructions, recommendations and similar written or unwritten documents containing ethical principles that include challenges to help others and the demands of collegiallity, respect, honesty or virtuous life was confirmed. In the work is also mentions some ethical problems and dilemmas in the work in the ambulance services. The content of the practical part of dissertation is research study on the question of...

M.Cur. / With reference to the question whether the interhospital transport of ill neonates in South Africa and more specifically in the Transvaal is adequate, a study was done in which the quality of the interhospital transport of ill neonates on the Witwatersrand was investigated. Criteria for the interhospital transport of ill neonates were formulated according to a literature review and they were validated. The quality of interhospital transport of ill neonates on the Witwatersrand was researched according to the formulated criteria. The case study method was used and was applied to neonates who were transported to a selected private- and provincial hospital by private- and provincial ambulance services between May 1987 and June 1987. Through the results of the study the researcher came to the conclusion that the interhospital transport of ill neonates on the Witwatersrand is inadequate. Recommendations which may contribute to the improvement of the transport system were made.

The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria.

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.

This qualitative descriptive research study was conducted to understand nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. Examination of the literature revealed research on the importance of ambulatory care nurses, their bond with the communities they serve, and the need for ambulatory settings for underserved communities. The review also explored the fierce strike of the COVID-19 pandemic on these communities and the social justice implications of serving low-income and low-resource patients. No literature was found on this specific dissertation topic: ambulatory nurses’ experiences working in underprivileged communities during the COVID-19 pandemic. The sample used for this study consisted of 25 registered nurses who worked in ambulatory settings during the inception of the COVID-19 pandemic. In particular, the time period spanned February 2020 through the end of June 2020. The communities consisted of poorly resourced neighborhoods. The narrative description and accounts of nurses interviewed for this study will facilitate an understanding of nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. The researcher used a qualitative methodology, qualitative descriptive, to frame the stories. Qualitative content analysis methods, specifically thematic analysis, were used to understand the nurses’ reflections and experiences. Roy’s Adaptation Model (RAM) was the theoretical framework to guide the open-ended interview questions. The researcher developed questions based on the four modes of RAM: the physiologic mode, the self-concept mode, the role function mode, and the interdependence mode. Thematic analysis was used to identify themes from the interview transcripts. A thematic analysis strategy is an approach used to identify and analyze patterns of meaning from interview data (Braun & Clarke, 2006). A thorough overview was made of all the data, including initial notes. The notes were obtained by reading and rereading the transcripts and highlighting interesting phrases or statements called meaningful units. These units were then compiled into sub-themes, and ultimately themes were comprised after highlighting parts of the transcripts that generated similar content. Themes were developed by identifying patterns among meaningful units and data relevant to each theme. Themes were then reviewed to ensure they accurately represented the data after highlighting, constant review, and compounding them in meaningful units that identified and generated the final set of themes. The researcher developed and kept reflexive journal notes, which were reviewed constantly throughout the study to maintain best-practice qualitative methodology (Ortlipp, 2008). The thematic analysis revealed multiple themes. The themes discovered were crying, protector vs. moral distress, resilience vs. compassion fatigue, family vs. bereavement, and self-concept vs. self-care. An overarching theme of struggle was also manifested within this research.

Bakgrund: Vid en allvarlig händelse krävs det att ambulanssjukvården, räddningstjänsten och polisen samverkar för att nå bästa möjliga utfall vid arbetet i skadeområdet. Arbetet i skadeområdet styrs av tydliga föreskrifter och rutiner. Då allvarlig händelse inträffar relativt sällan kan ambulanspersonalen uppleva en osäkerhet att samverka på skadeområdet. Inom diskursetiken ges det goda argumentet företräde framför maktförhållanden och manipulation i syfte att nå enighet och rationell förståelse. Patientperspektivet ska genomsyra de beslut som fattas i skadeområdet vilket möjliggörs genom enighet mellan de samverkande organisationerna. Syfte: Att undersöka ambulanspersonalens erfarenhet att samverka med polis och räddningstjänst i skadeområde. Metod: Studien utfördes genom en integrativ litteraturstudie. Systematiska databassökningar genomfördes i databaserna PubMed, CINAHL och PsycINFO. Resultatet baseras på 15 vetenskapliga artiklar som bedöms vara av måttlig till hög kvalitet. Analysen genomfördes enligt Whittemore och Knafls (2005) metodbeskrivning. Resultat: Samverkan mellan organisationerna innebar utmaningar i att skapa balans mellan det egna och det gemensamma ansvaret. Ledarskapet hade i hög grad inverkan på arbetet i skadeområdet, men att iklä sig rollen som sjukvårdsledare förknippades ofta med osäkerhet hos ambulanspersonalen. Kunskap, kommunikation och en känsla av tillhörighet skapade förutsättningar för samverkan mellan organisationerna. Resultatet presenteras under fyra huvudteman: "Vi" och "dem", Härska utan att söndra, Konsten att kommunicera och Övning ger färdighet. Konklusion: Förmågan att kommunicera och att ha förståelse för varandra skapar förutsättningar för samverkan mellan ambulans, polis och räddningstjänst. Det finns ett behov av att utveckla ambulanspersonalens förmåga i radiokommunikation och att undersöka hur gemenskap kan befrämjas. / Bakgrund: Vid en större olycka är det nödvändigt att ambulansen, polisen och räddningstjänsten samarbetar för att uppnå bästa möjliga resultat när man arbetar i skadeområdet. Arbetet på olycksplatsen styrs av tydliga regler och rutiner. Eftersom större händelser inträffar relativt sällan kan ambulanspersonalen uppleva osäkerhet om samarbetet i skadeområdet. I diskursetiken har det goda argumentet företräde framför maktrelationer och manipulation för att nå enighet och rationell förståelse. Patientperspektivet ska genomsyra de beslut som fattas inom skadeområdet, vilket möjliggörs genom överenskommelse mellan de samverkande organisationerna. Syfte: Att beskriva ambulanspersonalens erfarenheter av samarbete med polis och räddningstjänst på olycksplatsen. Metod: Studien genomfördes genom en integrativ litteraturstudie. Systematiska databassökningar genomfördes i databaserna PubMed, CINAHL och PsycINFO. Resultaten är baserade på 15 vetenskapliga artiklar som anses vara av måttlig till hög kvalitet. Analysen utfördes enligt Whittmores och Knafls (2005) metodbeskrivning. Resultat: Samarbetet mellan organisationerna innebar utmaningar för att skapa en balans mellan det egna och det gemensamma ansvaret. Ledarskapet hade en stor inverkan på arbetet inom skadeområdet och tog på sig rollen som ambulanssjukvårdare, men var ofta förknippat med osäkerhet bland ambulanspersonalen. Kunskap, kommunikation och en känsla av tillhörighet skapade förutsättningar för samverkan mellan organisationerna. Resultatet presenteras under fyra huvudteman: "Vi" och "dem", Avgörande utan splittring, Konsten att kommunicera och öva gör perfekt. Slutsats: Förmågan att kommunicera och ha förståelse för varandra skapar goda förutsättningar för samverkan mellan ambulanssjukvården, polisen och räddningstjänsten. Det finns ett behov av att utveckla ambulanspersonalens förmåga inom radiokommunikation och att undersöka hur känslan av samhörighet kan främjas.