No description available.

Psykiska störningar är tillstånd som kan drabba alla oss människor. Krav om kompetens på hälso- och sjukvården har ställts för att kunna erbjuda patienter med psykisk störning ett effektivt omhändertagande. Syftet med detta examensarbete är att beskriva ambulanssjuksköterskans erfarenheter av att vårda patienter med psykiska störningar. Metoden är av deskriptiv kvalitativ design och semi-strukturerade intervjuer utgör grunden för den kvalitativa innehållsanalysen med manifest utgångspunkt som genomförts. Resultatet omfattar tre huvudkategorier såsom följer, ’svåra möten skapar rädsla och frustration och försvårar interaktion’, ’svårt bedöma tillstånd och lämpliga åtgärder’ och ’vård byggd med autonomi, erfarenhet och uppfinningsrikedom’. Slutsatsen är att interaktionen mellan patienter och sjuksköterskor byggs av omvårdnadsevidens, att det i sjuksköterskornas bedömningar av tillstånd saknas evidens och att den vård som oftast ges strävas att utgöras av evidensbaserad vård men att det saknas direkta sätt att komma i kontakt med en sådan specialistsjukvård. Det har därmed visats att det finns områden att förbättra och utveckla för att kunna erbjuda patienter med psykisk störning ett effektivt omhändertagande. / Psychiatric disorders are conditions which may afflict every one of us humans. Requirements of competence have been set for the healthcare service to be able to offer an effective emergency care to patients with psychiatric disorder. The aim is to describe the ambulance nurse’s experience by caring for patients with psychiatric disorders. The method is of a descriptive qualitative design and semi-structured interviews constitute the material for the qualitative content analysis, which has been carried out with a manifest basis. The result consist of three main categories as follows, ‘difficult encounters create fear and frustration and complicates interaction’, ‘difficult assessing conditions and appropriate measurements’ and ‘care build with autonomy, experience and inventiveness’. The conclusion is how the interaction between patients and nurses is built by evidence-based nursing, how it is in nurses’ assessments of conditions to be a lack of evidence and how the care most often provided is being strived to constitute of evidence-based healthcare while how it is lacking direct ways to come in contact with such a specialised healthcare. Thus has it been shown that it exist areas for amelioration and evolvement to be able to offer an effective emergency care for patients with a psychiatric disorder.

The material in current emergency medical services (EMS) curricula is insufficient to prepare prehospital emergency medical care personnel recognize the signs and symptoms of post-traumatic stress disorder (PTSD) within their workforce. Prehospital emergency textbooks focus on treating patients affected with PTSD, but there is very little included about how EMS professionals may also be affected. Moreover, supervisors and managers of EMS agencies receive very little education on workforce PTSD in their personnel. The purpose of this study was to understand the educational preparation of EMS supervisors in order to develop a PTSD-awareness course. The research question investigated the educational preparation that EMS supervisors receive. The conceptual framework of the study was Conti-O’Hare’s wounded healer theory. EMS professionals are wounded healers from frequent critical incident exposure. A qualitative approach featuring a case study design was used. The study included 9 participants. A focus group was used that consisted of three paramedics and three emergency medical technicians (EMTs). Separate interviews were conducted with three EMS supervisors. Data gained from the focus group and individual interviews were analyzed through coding with the goal of investigating the education received by EMS supervisors on PTSD. The themes that emerged were EMS supervisors do not receive enough education on workforce PTSD and a course specifically targeted on this subject is needed. Positive social change may be achieved through this study by enabling EMS managers to help paramedics and EMTs cope with a critical incident (CI) improving prehospital healthcare.

Demand for the emergency medical technician (EMT) is 2 times greater than that of all other occupations. Sustainability of ambulance services (AS) personnel is dependent upon the recruitment of EMTs into the industry. The purpose of this multiple case study was the exploration of the recruiting strategies that AS administrators used to increase the number of EMTs. Herzberg's 2-€factor theory of motivation was the conceptual framework for this study. The data collection instrument included semistructured interviews with 6 AS company executives in southeastern New Mexico and southwestern Texas. Secondary data and document from each state's emergency medical services personnel and websites related to EMTs were reviewed. Data were analyzed using thematic analysis alignment between the recruiting strategies and the conceptual framework. Two key themes emerged: AS administrators have minimal data-€driven recruitment tracking mechanisms and recruiting strategies for EMTs must align with the motivational aspects of growth, advancement, recognition, and responsibility in the AS business to entice people into the industry. The implications of this study for social change include the potential for AS executives to identify recruiting strategies they might use to increase the recruitment of EMTs to meet patient and community needs for medical transport while reducing the demand for EMTs nationwide.

Bakgrund: Sjuksköterskor som arbetar prehospitalt ska kunna bedöma om en patient är kritiskt sjuk samt kunna påbörja en adekvat behandling. Det är sällsynt med komplikationer vid luftvägshantering men det kan i stället ha allvarliga konsekvenser. Tidigare forskning presenterar att det visar en brist på utbildning vid luftvägshantering inom de prehospitala verksamheterna, där utbildning saknas för att bibehålla en viss kompetens hos sjuksköterskorna. Syfte: Syftet var att undersöka hur utbildning påverkar sjuksköterskans hantering av en ofri luftväg prehospitalt.  Metod: En litteraturstudie med kvantitativ ansats med elva vetenskapliga studier. Datainsamlingen hämtades i databaserna PubMed och Cinahl. Resultat: Genom utbildning ökade kunskap och självkänslan hos sjuksköterskor som arbetar prehospitalt. Utbildningen bör hållas frekvent för att bibehålla kompetensen hos de prehospitala sjuksköterskorna. Efter utbildning av supraglottiska enheter för luftvägshantering, insåg personalen som arbetar prehospitalt att den är både lättare att hantera och går snabbare att använda jämfört med endotrakeal intubation.  Konklusion: Det är nödvändigt med en fortsatt kontinuerlig forskning i den prehospitala vården för att kunna ge och upprätthålla en säker vård till patienterna. / Background: The pre-hospital nurses must be able to assess if a patient is critically ill, as well as start adequate treatment for the patient. Complications in respiratory management are rare but can have serious consequences. Previous research indicate that airway management is worsening in pre-hospital settings, where there is a lack of training to maintain a certain level of competence within the nurse staff. Aim: The aim of the study was to investigate how training affects the nurse’s management of an airway obstruction in a pre-hospital setting. Method: A literature review based on eleven scientific studies. The data collection was collected from the databases PubMed and Cinahl. Results: The training increased the knowledge and self-esteem of the pre-hospital nurses and should be offered regularly to maintain the competence of the staff. After the training period with supraglottic airway management devices, the pre-hospital nurses realized that the devices were easier to manage and faster to use compared to endotracheal intubation. Conclusion: Continuous research in prehospital care is necessary in order to provide and maintain safe care to patients.

The expression ``motivation`` describes the fact that the human psyche is affected by internal driving forces, both conscious and subconscious. Holland´s vocational personality typology presents six basic types, namely Realistic, Investigative, Artistic, Social, Enterprising and Conventional. This thesis is aimed at finding and evaluating motivation factors which influence prospective emergency medical technicians in their professional choice. To get the research data, the combination of quantitative and qualitative techniques was used. The research was conducted among emergency medical technician students at the college and university and, as a supportive research material, among Czech and Scottish Emergency Medical Service professionals. The students´ primary motivating factor influencing their vocational choice to become an emergency medical technician is their interest in this field, sometimes supported by a healthcare worker in the family. Over 80% respondents prefer working in the field which they study. An emergency medical technician belongs to the most popular positions while an emergency dispatcher to the less popular ones. The fact that women respondents like working positions connected with driving a car was a surprising discovery of the research. Corresponding to the recent professional literature, the most frequent career types among professionals and students are Realistic and Social types. This thesis can contribute to further research into this topic (working position preferences, career types). Component findings can be introduced into personnel and human resources management of the Emergency Medical Service, especially searching for Investigative and Conventional career types of workers and their subsequent engagement in pedagogical and administrative work. The research can also be helpful in other issues, e.g. how to make a position of an emergency dispatcher more popular.

Problématique : Le rôle des paramédics se transforme partout dans le monde. Les besoins des aînés et des malades chroniques entraînent une forte proportion d’interventions préhospitalières non urgentes. La confrontation entre la perception et l’expérience du rôle peut entraîner un conflit correspondant à un stress organisationnel modéré et chronique chez ces travailleurs. Pour y faire face, différentes stratégies d’adaptation peuvent être adoptées. Objectifs : Cette étude vise à dépeindre la réalité des interventions préhospitalières non urgentes des paramédics québécois et à explorer son influence sur leur perception du rôle et les manifestations de cynisme et de désengagement. Méthode : Les données qualitatives obtenues en entrevues semi-structurées ont été codifiées et analysées à partir d’un modèle adapté des théories en psychosociologie du travail et d’administration de la santé (n=13, 3 régions, intervenants de - de 3 à + de 20 ans de carrière). Résultats : Les paramédics reconnaissent vivre un conflit de rôle alors que la formation et la définition de leur pratique se rapportent exclusivement à l’urgence, au contraire de leur expérience. Ils manifestent des attitudes de cynisme et de désengagement affectant la qualité des services, précisant qu’il s’agit d’une réalité inhérente à leur expérience professionnelle intimement reliée à l’épuisement professionnel, plus qu’à un manque fondamental de professionnalisme. Conclusion : Les paramédics décrivent différents mécanismes à instaurer qui visent à reconnaître la dualité conflictuelle de leur pratique dont, la mise en valeur de leur aptitude clinique à intervenir en première ligne dans un cadre préhospitalier non urgent ainsi que l’ajustement et le rehaussement des programmes de formation. / Problem: The paramedic’s role has been steadily evolving internationally. Elderly and chronically ill user’s demands have lead to an increase in prehospital non urgent interventions. Confronting the conflict between the perceived role of a paramedic and the shifting reality toward non urgent care may result in a role conflict that manifests as chronic-moderate organizational stress. Mechanisms of coping related to this stress may be adopted. Objectives: The objectives of this study are to depict the Quebec paramedic’s experience related to non urgent interventions and explore their role perception and resulting attitudes of cynicism and disengagement. Method: Qualitative data from semi-structured interviews have been codified and analyzed based on a model adapted from the literature on works in socio-psychology and health administration theories. (n=13, 3 administrative regions, less than 3 years to more than 20 years of career) Results: Paramedics acknowledge experiencing role conflict as they explain the formation of their work and field of practice as being exclusively oriented toward emergency response, contrary to their pervasive work reality. They demonstrate cynicism and disengagement, and specify it as being inherent to the professional experience and intimately linked with burnout, affecting quality of care despite fundamental professional intentions. Conclusion: Paramedics described different professional coping mechanisms aimed at acknowledging the conflicting duality of their practice, amongst them, showcasing their clinical capability to play an active role in primary health care in the prehospital, non urgent setting and adjusting and enhancing the training programs.

Problématique : Le rôle des paramédics se transforme partout dans le monde. Les besoins des aînés et des malades chroniques entraînent une forte proportion d’interventions préhospitalières non urgentes. La confrontation entre la perception et l’expérience du rôle peut entraîner un conflit correspondant à un stress organisationnel modéré et chronique chez ces travailleurs. Pour y faire face, différentes stratégies d’adaptation peuvent être adoptées. Objectifs : Cette étude vise à dépeindre la réalité des interventions préhospitalières non urgentes des paramédics québécois et à explorer son influence sur leur perception du rôle et les manifestations de cynisme et de désengagement. Méthode : Les données qualitatives obtenues en entrevues semi-structurées ont été codifiées et analysées à partir d’un modèle adapté des théories en psychosociologie du travail et d’administration de la santé (n=13, 3 régions, intervenants de - de 3 à + de 20 ans de carrière). Résultats : Les paramédics reconnaissent vivre un conflit de rôle alors que la formation et la définition de leur pratique se rapportent exclusivement à l’urgence, au contraire de leur expérience. Ils manifestent des attitudes de cynisme et de désengagement affectant la qualité des services, précisant qu’il s’agit d’une réalité inhérente à leur expérience professionnelle intimement reliée à l’épuisement professionnel, plus qu’à un manque fondamental de professionnalisme. Conclusion : Les paramédics décrivent différents mécanismes à instaurer qui visent à reconnaître la dualité conflictuelle de leur pratique dont, la mise en valeur de leur aptitude clinique à intervenir en première ligne dans un cadre préhospitalier non urgent ainsi que l’ajustement et le rehaussement des programmes de formation. / Problem: The paramedic’s role has been steadily evolving internationally. Elderly and chronically ill user’s demands have lead to an increase in prehospital non urgent interventions. Confronting the conflict between the perceived role of a paramedic and the shifting reality toward non urgent care may result in a role conflict that manifests as chronic-moderate organizational stress. Mechanisms of coping related to this stress may be adopted. Objectives: The objectives of this study are to depict the Quebec paramedic’s experience related to non urgent interventions and explore their role perception and resulting attitudes of cynicism and disengagement. Method: Qualitative data from semi-structured interviews have been codified and analyzed based on a model adapted from the literature on works in socio-psychology and health administration theories. (n=13, 3 administrative regions, less than 3 years to more than 20 years of career) Results: Paramedics acknowledge experiencing role conflict as they explain the formation of their work and field of practice as being exclusively oriented toward emergency response, contrary to their pervasive work reality. They demonstrate cynicism and disengagement, and specify it as being inherent to the professional experience and intimately linked with burnout, affecting quality of care despite fundamental professional intentions. Conclusion: Paramedics described different professional coping mechanisms aimed at acknowledging the conflicting duality of their practice, amongst them, showcasing their clinical capability to play an active role in primary health care in the prehospital, non urgent setting and adjusting and enhancing the training programs.

緊急醫療救護法自從民國84年8月9日公布迄今，已歷經四次修正，最後ㄧ次修正為民國96年7月。公布後迄今的十多年間，緊急醫療救護之環境丕變，從原本消防局救護人員擔任從家裡送到醫院，單純的「運送」角色，然後轉交於醫院醫護人員為急診醫療處置的情況，驟然變成了由指導醫師教育、訓練、督導、考核之下，得由救護技術員於現場實行不等的醫療救護行為，有問題時得詢問線上醫療指導醫師。除此之外，在需救護車送到醫院情況下，民眾現在得自由選擇民間救護車機構或是消防局救護車。換句話說，緊急救護場景即從原本的三角當事人關係，演變成了複雜五角甚至六角當事人關係。當事人間的權利義務關係為何？查詢最近的論文，多為醫師與病患間醫療行為的刑事與民事關係，卻鮮少論及到院前救護時，地方政府、救護技術員、醫療指導醫師與緊急傷病患間之權利義務關係。 本論文之研究目的，就在於了解並釐清緊急救護系統內各當事人間之權利義務，待損害發生時可得適當之救濟途徑；並嘗試藉由美國與我國已有之到院前救護相關爭訟判決，來了解未來我國到院前救護可能發生之紛爭，進而提出改善建議，來達到預防爭訟之效果。本研究之範圍將限於緊急醫療系統中之到院前救護階段，著重於緊急傷病患之現場緊急救護及醫療處理，與送醫途中之緊急救護。而大量傷病患、重大傷病患或離島、偏遠地區難以診治之傷病患之轉診與醫療機構內之緊急醫療，以及災難醫療救護部分則不在本論文之討論範圍內。 本文共分五章，分別為第一章緒論、第二章我國緊急醫療系統的介紹與現狀、第三章派遣與反應階段損害賠償責任之成立、第四章現場救護與送往醫院階段損害賠償責任之成立、第五章結論。 第一章為緒論，在於闡述本研究之動機與目的，與進行本研究之範圍及研究方法，最後作架構性的介紹與各章節的簡介，祈能使讀者對本論文架構有一初步的認識。 第二章首先對於緊急醫療救護的定義與目的作一概要之介紹，再來介紹我國現行到院前緊急救護系統中各個當事人於現行法規規定下所扮演的身分、角色與工作內容。之後對於我國到院前緊急醫療系統資源現況、缺失與運作流程作一清楚之描述。 第三章首先介紹到院前救護損害賠償責任之態樣，分「國家賠償責任」與「民法損害賠償責任」兩種為說明。本文認為「救災救護指揮中心啟動之到院前救護」為具公法性質之行政事實行為，因而如該當國家賠償之要件時，自有國家賠償請求權。而「非救災救護指揮中心啟動之到院前救護」則為民法之範疇，並將之類型化可分為「民眾直接聯絡民間救護車營業機構」、「負保護義務之人聯絡簽約之救護車設置機構」及「救護車設置機構自行啟動」三種類型，並對其中當事人間之法律關係作一描述與釐清相對之權利義務。 再來論及緊急救護中借名醫療院所的連帶責任，並搜集學說與實務判決以了解目前通說與實務之見解。隨後介紹派遣與反應階段可能發生的問題，及美國與我國之實務判決。 第四章介紹現場救護階段與送往醫院階段所可能發生的法律問題。首先釐清救護技術員執行緊急醫療救護是否違反醫師法之密醫罪。接著探討現場救護人員之注意義務標準與共同侵權責任判定之實務見解。再來討論線上醫療指導制度所可能引發之問題與解決方案。另外亦分析如非緊急醫療系統的醫師於救護現場時可能發生的情況與相關問題。之後對於現場救護時所可能遭遇的說明義務履行困境及相關建議。本章的最後，則再探討送往醫院的路程中可能發生的問題，包括送往醫院的決定者為誰，與救護車發生車禍時，對於緊急情況判定的法院見解與本文建議。 第五章為結論。