Teve como objetivo estudar os riscos ocupacionais em profissionais da equipe do Atendimento Pré-Hospitalar móvel (APH) com ênfase nos acidentes com material potencialmente contaminado, desenvolvido em duas etapas. A primeira teve como objetivo identificar a exposição acidental a fatores de riscos ocupacionais em profissionais da equipe de saúde no APH móvel, no período de 2000 a 2005 e a segunda teve como objetivo analisar a exposição acidental a material biológico potencialmente contaminado (mbpc), em profissionais da equipe de saúde de APH móvel de uma empresa privada de APH móvel, do interior paulista, que realiza atendimento tanto na área urbana quanto nas rodovias. Na primeira etapa realizou-se pesquisa descritiva documental com dados obtidos de 4992 Fichas de Atendimento Rodoviário e das notificações dos Serviços Especializados em Engenharia de Segurança e Medicina do Trabalho - SEESMT, e na segunda realizou-se um estudo descritivo, exploratório, através de entrevista semi estruturada em 50 profissionais da equipe de APH móvel envolvendo bombeiros, enfermeiros, médicos, técnicos de enfermagem e motoristas de ambulância. O projeto obteve aprovação do Comitê de Ética em Pesquisa. Os dados foram analisados em Epi Info versão 3.4.3. Na primeira etapa foram detectadas 54 exposições aos riscos ocupacionais, dos quais apenas seis foram notificadas ao SEESMT. Entre os os riscos ocupacionais destacou-se o risco de acidente (64,8%), seguidos de situação não ergonômicas (16,7%) e riscos biológicos (9,2%). Na segunda etapa da pesquisa, de uma amostra de 50 profissionais da equipe de Atendimento Pré Hospitalar, a maioria (94,4%) apresentava faixa etária entre 20 e 50 anos; sexo masculino (84%); atuação na área de seis 06 a 60 meses (56%); apresentava esquema de vacinação contra HBV (92%). Dos profissionais entrevistados (56%) referiu exposição acidental ao material biológico potencialmente contaminado, perfazendo um total de 41 acidentes. Das exposições acidentais ao mbpc (70,7%) acometeu pele íntegra; (17,1%) o percutâneo; (7,3%) a mucosa; e (4,9%) a pele lesada. As áreas do corpo mais expostas ao mbpc foram antebraço (41,5%); braço (21,9%), e mão (21,9%). As exposições Andrea Alves Soerensen 9 acidentais com mbpc ocorreram em sua maioria ao realizar procedimentos de imobilização (39%), extricação (21,9%), exame físico (19,9%). O sangue foi o material biológico mais freqüente nas exposições (85%). Quanto a utilização do Equipamento de Proteção Individual no momento do acidente, a maioria fazia uso de macacão de brim (95%), botas de cano alto (90,2%) e luvas de procedimentos (63,4%). A conduta mais freqüente pós-exposição acidental foi a procura da consulta média (29,3%); realização de sorologias (17,1%). A maioria não registrou o acidente de Trabalho (78,1%). As situações favorecedoras que mais contribuíram para as exposições acidentais ao mbpc foram: emergência (46,4%); agitação do paciente (28,6%); operações de resgate (25%); distração (21,4%); estresse (17,9%) e presença de grande volume de material biológico potencialmente contaminado (14,3%). A maioria do entrevistados sugeriu medidas para prevenção de acidentes com mbpc. Os resultados do estudo, sugestões dos entrevistados e revisão de literatura subsidiaram propostas gerais aplicadas aos profissionais da saúde, e as específicas ao APH móvel, para prevençao e controle de acidentes com mbpc / This research aimed to study occupational risks in Mobile Prehospital Care (MPC) team professionals, emphasizing accidents with potentially contaminated material, and was developed in two phases. In the first, the goal was to identify accidental exposure to occupational risk factors in health team professionals working in MPC between 2000 and 2005. The second aimed to analyze accidental exposure to potentially contaminated biological material (pcbm) among health team professionals in MPC working for a private MPC company in the interior of São Paulo state, Brazil, which is active in the urban area and on highways. In the first phase, a descriptive documentary research was performed, using data obtained from 4992 Highway Care Records and notifications presented to Specialized Safety Engineering and Occupational Medicine Services SEESMT. In the second phase, a descriptive-exploratory study was carried out, using semi-structured interviews with 50 professionals from the MPC team, involving firefighters, nurses, physicians, nursing technicians and ambulance drivers. The project was approved by the Research Ethics Committee. Data were analyzed using Epi Info software, version 3.4.3. In the first phase, 54 cases of exposure to occupational risks were detected, only six of which were notified to the SEESMT. Among occupational risks, accident risks stood out (64.8%), followed by nonergonomic situations (16.7%) and biological risks (9.2%). In the second phase, in a sample of 50 MPC team professionals, a majority (94.4%) was between 20 and 50 years old; male (84%); active in the area between 06 and 60 months (56%); vaccinated against HBV (92%). Among the interviewees, (56%) indicated accidental exposure to pcbm, totaling 41 accidents. Of all cases of accidental exposure to pcbm, (70.7%) affected integral skin; (17.1%) percutaneous tissue; (7.3%) mucous tissue; and 4.9% injured skin. The body areas most exposed to the pbcm were forearm (41.5%); arm (21.9%) and hand (21.9%). Most cases of accidental exposure to pbcm occurred while performing immobilization (39%), extraction Andrea Alves Soerensen 11 (21.9%) and physical examination (19.9%) procedures. Blood was the most frequent biological material involved in exposures (85%). As to the use of Individual Protection Equipment at the moment of the accident, most professionals were wearing denim overalls (95%), long boots (90.2%) and procedure gloves (63.4%). The most frequent conduct after the accidental exposure was the search for a medical appointment (29.3%) and blood tests (17.1%). Most professionals did not file an Occupational Accident register (78.1%). The situations that most contributed to accidental exposure to pcbm were: emergency (46.4%); patients agitation (28.6%); rescue operations (25%); distraction (21.4%); stress (17.9%) and the presence of a large volume of potentially contaminated biological material (14.3%). Most interviewees suggested pcbm accident prevention measures. The study results, the interviewees suggestions and a literature review served as the base for general proposals applied to health professionals, as well as specific proposals for MPC, with a view to the prevention and control of pcbm accidents

Agriculture is a hazardous industry with high rates of occupational industry. Due to a variety of occupation-related factors, farmers may also be at risk for delays in reaching trauma services. Though the state of Iowa has a comprehensive trauma system implemented to provide an efficient response to traumatic injuries, it is unknown how farmers fare in this system. The aims of this study were to determine if the use of emergency medical services (EMS), the occurrence of interfacility transfers, the time to definitive care in severely injured patients, and the length of prehospital intervals for those using EMS differs between farmers and other workers. A population-based, retrospective observational study was performed using data from the Iowa State Trauma Registry for the years 2005-2011. Eligible entries included adults (≥15 year old) sustaining an occupational injury within the state of Iowa and treated in an Iowa trauma center. Multiple imputation was performed to replace values for missing covariates. Logistic regression modeling was performed to examine the use of EMS and the occurrence of interfacility transfers among farmers compared to non-farmers. Survival analysis was performed to determine the time to definitive care for severely injured farmers compared to severely injured non-farmers; similarly, a survival-based multi-state model was performed to compare the prehospital time intervals for farmers to non-farmers among EMS users. The study demonstrated that the likelihood of EMS use was dependent on injury severity. For lower severity injuries, farmers were less likely to use EMS, but there was no difference in EMS use for high severity injuries. The occurrence of interfacility transfers was also dependent on injury severity as well as rurality. Farmers tended to be less likely to receive an interfacility transfer in more rural areas; in large town and urban areas, farmers tended to be more likely to receive an interfacility transfer, particularly for moderate and severe injuries. These trends were slightly stronger for EMS non-users than EMS users; however, the results did not reach statistical significance for most levels. The median time to definitive care for farmers was nearly an hour longer for farmers compared to non-farmers (1h48m vs. 2h46m, respectively). In the survival analysis, time to definitive care for severely injured farmers compared to severely injured non-farmers was found to be time-dependent, and was only significant in the first hour after injury. When the prehospital time intervals for farmers using EMS (included all severities) were compared to non-farmers, farmers took longer to complete the discovery, response, and transport intervals; the scene interval was the only interval that did not reach statistical significance. The results obtained from this study provide useful information about the operation of the Iowa State Trauma System. While EMS use was lower for minor injuries, farmers with severe injuries had no significant difference in EMS use compared to non-farmers, suggesting comparable access. Likewise, the probability of transfer was only higher in specific instances when the patient did not use EMS. However, the fact that both time to definitive care and several prehospital intervals were longer suggest that occupation-specific factors may contribute to delay. Further research is needed to identify these barriers and develop new strategies to improve the response to traumatic agricultural injury.

Varje år genomför cirka 1100 personer i Sverige ett suicid. Varje suicid föregås av i genomsnitt 10 suicidförsök. Detta orsakar förutom kostnader i form av oerhörda summor pengar för samhället också otroligt mycket lidande för anhöriga. Ambulanssjuksköterskan är många gånger den första resursen i vårdkedjan som den suicidnära kommer i kontakt med. Detta ställer stora krav på bemötandet av patienten men också krav på kunskap om medicinska åtgärder för att rädda personen till livet. Detta arbete avser att studera ambulanssjuksköterskans bemötande och egna upplevelser av mötet med den suicidnära patienten genom att intervjua ambulanssjuksköterskor i Uppsala. Studien visar att få ambulanssjuksköterskor upplever sig ha tillräcklig kompetens för att bemöta den här typen av patienter. Vidare framgår att ambulanssjuksköterskan i mycket stor utsträckning känner en misstro till den vård som patienten erhåller från psykiatrin och att det förekommer stora skillnader i hur ambulanssjuksköterskan resonerar kring sin egen säkerhet i mötet med patienten. Studien visar också att de flesta av ambulanssjuksköterskorna bemöter patienterna enligt POSP-riktlinjerna (Prehospitalt Omhändertagande av Suicidnära Patienter). Patienten skriker ofta efter hjälp i samband med ett suicidförsök och vågar man identifiera syftet med handlingen så möts man ofta med tacksamhet. / Annually around 1100 individuals in Sweden end their lives by committing suicide. Prior to every completed suicide estimate shows that 10 attempts have been made. This results in both high costs for the society and unmeasurable suffering for their relatives. The nurses that are working in the Swedish ambulance system are often the first medical resources with whom the suicidal patient has contact. This means high demands are placed on the nurse both regarding the meeting itself with the patient but also with the medical knowledge that could prove to be lifesaving in an acute situation. This paper seeks to study the professional interaction and the strategies that the nurse uses to help the suicidal patients and their own experiences of the meeting by interviewing nurses working in the Uppsala ambulance service. This study shows that the nursing staff experiences a lack of knowledge in the meeting with the patients and a clear disbelief in the care that the patients receive at the psychiatric ward. Furthermore the study shows that most nurses in the study interact with the patients in accordance with the POSP-guidelines. The patient is often crying for help in connection to a suicide attempt and if the nurse has the courage to identify the purpose with the action one is most often met with gratitude.

SAMMANFATTNING Patienter som drabbas av höftfrakturer är en vårdkrävande och utsatt patientgrupp inom sjukvården. Riktlinjer för handläggning av misstänkta höftfrakturer har utformats för ett snabbare omhändertagande, så kallat snabbspår. Dessa används för att optimera och förkorta handläggningstiden, förbättra behandlingen samt minska risken för komplikationer. I Västernorrlands län tillämpas detta snabbspår, vilket medför att delar av den behandling som tidigare utfördes på akutmottagningen, nu utförs av ambulanssjuksköterskor redan i den prehospitala vården. Dessa medicinska och omvårdnadsmässiga åtgärder utförs i varierande och ibland svåra vårdmiljöer. Därför finns ett behov av att studera ambulanssjuksköterskornas upplevelser och erfarenheter av att vårda patienter med misstänkt höftfraktur. Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser och erfarenheter vid omhändertagande av patienter med misstänkt höftfraktur. Kvalitativ ansats användes och designen var semistrukturerade intervjuer som analyserades med kvalitativ manifest innehållsanalys. Studiepopulationen bestod av åtta ambulanssjuksköterskor stationerade i Ångermanland. I resultatet framkom att ambulanssjuksköterskorna innehar både positiva och negativa erfarenheter av att arbeta med misstänkta höftfrakturer. Äldre människor utgjorde den största patientgruppen och dessa patienter led ofta av demenssjukdomar samt andra sjukdomar och tillstånd som försvårade kommunikation och interaktion, vilket skapade svårigheter i handläggningen av dessa patienter. Vårdmiljön försvårade arbetet ytterligare för ambulanssjuksköterskorna och innebar ofta svåra förflyttningar och lyft. Positivt för både patienten och ambulanssjuksköterskorna var att det strukturerade omhändertagandet gav en snabbare vårdkedja och likvärdig vård för patienterna samt mer tid för omvårdnad. Andra aspekter som framkom var att ambulanssjuksköterskorna hade en del förutfattade meningar gällande patientgruppen och svårigheter att få patienten tillräckligt smärtlindrad. Själva omhändertagandet uppgavs vara alltför strukturerad, handläggningen tog lång tid och att det var svårt att få patienten tillräckligt smärtlindrad utan biverkningar. Slutsatsen var att ambulanssjuksköterskorna hade både positiva och negativa erfarenheter kring det strukturerade omhändertagandet, samt en del förutfattade meningar. Samtliga informanter ansåg att de hade mer tid för omvårdnaden och att de på så vis fick lära känna patienten bättre, därför kunde de enklare utvärdera behandlingsresultatet. De positiva erfarenheterna var att omhändertagandet gav en snabbare handläggning med bättre struktur och därigenom en likvärdig vård i hela länet gällande denna patientgrupp. Det accepterades att uppdragen tog längre tid och därför fick personalen även mer tid tillsammans med patienterna. Ambulanssjuksköterskorna kunde se ett konkret resultat av omhändertagandet. De negativa erfarenheterna innefattade att patientgruppen var svårbedömd på grund av eventuella tidigare sjukdomar och läkemedelsbehandlingar. Att anhöriga och vårdpersonal ibland trängde sig in i vårdrummet, med syfte att vara behjälplig, men flyttade istället fokus från patienten. / ABSTRACT Patients with hip fractures are a care-intensive and vulnerable patient population in health care. Guidelines for dealing with suspected hip fractures have been designed for a faster disposal, so-called fast track. These are used to optimize and shorten the processing time, improve treatment and reduce the risk of complications. Västernorrland county has applied a fast track, which means that parts of the processing previously performed in the emergency department, now is performed by ambulance nurses already in the prehospital care. These medical and nursing activities performed in varying and sometimes difficult healthcare environments. Therefore there was a need to study the ambulance nurses' experiences of caring for patients with suspected hip fracture. AIM: The aim of the study was to describe Ambulance nurses experiences of treatment of patients with suspected hip fracture. Qualitative approach was used and the design was semi-structured interviews were analyzed using qualitative manifest content analysis. The study population consisted of eight ambulance nurses stationed in Ångermanland, Sweden. The result showed that ambulance nurses possess both positive and negative experiences of working with suspected hip fracture. Older people represented the largest group of patients and these patients often suffered from dementia and other diseases and conditions that impeded communication and interaction, which created difficulties in dealing with these patients. The healthcare environment complicated the work further for the ambulance nurses and often includes difficult movements and lifting. Positive for both the patient and ambulance nurses was that it structured the care provided faster care chain and equivalent care for patients as well as more time for care. Other aspects that emerged were that the ambulance nurses have some preconceptions regarding the patient group and the difficulties in getting the patient adequate pain relief. The fast track was described to be too structured, the processing takes a long time and that it was difficult to get the patient enough pain relief without side effects. The conclusion was that it emerged that the ambulance nurses had both positive and negative experiences of the structured care, and had some preconceptions. All the respondents felt that they had more time for care, and that they got to know the patient better, because they could more easily evaluate the treatment outcome. The positive experience was that the fast track provided faster processing with better structure and thereby an equal treatment throughout the county regarding this population. It was accepted that missions took longer therefore the staff spent more time with the patients. The ambulance nurses could see concrete result of the fast track. The negative experiences included that the patient group was difficult to assess because of past illnesses and drug treatments. Relatives and caregivers are sometimes forced into the nursing room, with the aim to be helpful, but instead moved focus from the patient.

Objective: To investigate the experiences of ambulance nurses when using Boussignac CPAPcompared to their previous model, and their suggestions for possible improvements in the use of CPAP in the care of patients with pulmonary oedema. Method: A qualitative study with a descriptive and exploratory approach. Data was collected through ten semi-structured interviews with ambulance nurses, seven men and three women. The analysis was conducted using Lundman and Graneheim’s content analysis. Results: Three categories were identified: Usage, Treatment and Development. Boussignac CPAP is described as easy to use and with fewer elements than the previous model. With this model it is particularly appreciated to have the opportunity to be able to regulate the resistance without fixed settings. Boussignac CPAP is regarded as more convenient in the handover of the patient. The potential for increased use, with the possibility of adjustment without fixed settings of resistance for Boussignac CPAP, is not perceived to be fully realized. Conclusion: Boussignac CPAP is, by the ambulance nurses, perceived to have made the handling of equipment easier and increased quality of care. To make further use of the potential of Boussignac CPAP more training and changes in the guidelines may be needed. / Syfte: Att undersöka ambulanssjuksköterskors upplevelser av Boussignac CPAP jämfört med deras föregående modell, samt ambulanssjuksköterskors eventuella förslag till möjliga förbättringar vid användandet av CPAP i vården av patienter med lungödem. Metod: En kvalitativ studie med deskriptiv och utforskande ansats. Data utgörs av tio semistrukturerade intervjuer med ambulanssjuksköterskor, sju män och tre kvinnor. Materialet har analyserats med Lundman och Graneheims innehållsanalys. Resultat: Tre kategorier identifierades: Användning, Behandling samt Utveckling. Boussignac CPAP beskrivs som lättanvänd och med färre moment än föregående modell. Med modellen uppskattas särskilt möjligheten att steglöst reglera motståndet. Boussignac CPAP upplevs som lättare då masken eller dess delar inte behöver plockas av patienten vid överlämnandet från ambulansverksamheten. Förutsättningarna till ökat användningsområde, i och med möjligheten att steglöst ändra motståndet för Boussignac CPAP upplevs inteutnyttjas fullt ut. Slutsats: Boussignac CPAP upplevs av ambulanssjuksköterskorna ha underlättat hanteringen av utrustningen samt ökat vårdkvaliteten för patienten. För att vidare kunna utnyttja potentialen med Boussignac CPAP kan mer utbildning och förändringar i riktlinjer behövas.

Akut smärta är det vanligast förekommande symtom som den prehospitala akutsjukvården ställs inför. Behandlingsriktlinjerna presenterar intranasalt Fentanyl som ett alternativ för akut smärtlindring. Då det finns ett begränsat utbud av studier utförda på vuxna och inom prehospital akutsjukvård var syftet med studien att beskriva effekter av intranasal administrering av Fentanyl i prehospital akutsjukvård. Studien genomfördes med en kvantitativ metod och med en retrospektiv, deskriptiv design. Studien baserades på en granskning av 15 patientjournaler från Ambulanssjukvården i Region Halland och deras journalsystem Paratus. Journaler som inkluderades var de där Fentanyl administrerat. Resultatet visar att en majoritet av patienterna i studien drabbats av muskeloskeletal smärta. Resultatet visade på dokumentationsbrister i granskade patientjournaler. Vidare forskning av Fentanyl i den prehospitala akutsjukvården samt översyn av följsamhet till dokumentationsrutiner är nödvändig. / Acute pain is the most common symptom in the prehospital emergency care. The treatment guideline presents Fentanyl as an alternative for treating acute pain. As there is a limited range of studies conducted in adults and in prehospital emergency care the purpose of the study was to illustrate the effects of intranasal administration of Fentanyl in the prehospital emergency care. The study was conducted by a quantitative method and with a retrospective, descriptive design. The study was based on a review of patient records from the Ambulance Service in the Region of Halland and their record system Paratus. Fifteen patient records were Fentanyl was administrated were included in the study. The result showed that a majority of the patients included in the study suffered from musculoskeletal pain. The result showed a lack of documentation in the reviewed records. Further studies and an overview of the compliance of the routines for documentation as well are necessary.

Syfte: Syftet med denna studie var att beskriva ambulanssjuksköterskans upplevelser av hot och våld inom prehospital akutsjukvård, samt se vilka konsekvenser detta ledde till. Metod: 67 enkäter delades ut på ambulansstationer i Uppsala län. Av 67 tillfrågade var det 34 ambulanssjuksköterskor som svarade på enkäten. Insamlingen av data genomfördes med hjälp av enkäter som bestod av sex öppna frågor som sedan analyserades utifrån en kvalitativ innehållsanalys. Resultat: Resultatet som baseras på ambulanssjuksköterskornas svar visade att 97 % av respondenterna hade blivit utsatta för verbala hot och att mer än varannan utsatts för fysiskt våld på något arbetspass. Detta ledde till olika upplevelser hos ambulanssjuksköterskorna. Konsekvenserna upplevdes som större vid verbala hot än fysiskt våld. Genom analysen identifierades fyra kategorier; Omvårdnadssituationer med verbala hot och fysiskt våld, Privata- och yrkesrelaterade konsekvenser av fysiskt våld vid omvårdnadssituationer, Yrkesrelaterade konsekvenser av verbala hot vid omvårdnadssituationer samt Stöd för ambulanssjuksköterskor vid inträffade hot- och våldshändelser. Under dessa fyra kategorier tog ambulanssjuksköterskorna upp konsekvenser som både var yrkesrelaterade och privata. Slutsats: Studien visade att verbala hot och fysiskt våld mot ambulanssjuksköterskor är mycket vanligt förekommande. Detta resulterade i att majoriteten av ambulanssjuksköterskorna upplevde att omvårdnadssituationen blev obehaglig och de därför som en direkt konsekvens av detta reagerade med försiktighet, distanstagande från patienten eller direkt upphörde med patientvården. Studien visar att det uppstod större konsekvenser vid verbala hot än fysiskt våld. En fungerande handlingsplan fanns, men kunde bli bättre och tydligare. Detta tyder på att förbättringsåtgärder behöver göras när en hot- och/eller våldshändelse inträffar mot ambulanssjuksköterskor. Författarnas förhoppning är att studien ska fungera som underlag för förbättringar i prehospitala verksamheter. / Purpose: Aim of this study was to describe the experiences of threats and violence against ambulance nurses in prehospital emergency care, and see what consequences this entailed. Method: 67 questionnaires were distributed to ambulance stations in Uppsala County. Of the 67 asked ambulance nurses were there 34 that responded to the survey. The collected data was conducted using questionnaires that consisted six open-ended questions and then analyzed from a qualitative content analysis. Results: The results of the ambulance nurses responses revealed that 97% of respondents had been subjected to verbal threats and more than half experienced physical violence in any shift. This led to different experiences of ambulance nurse. The consequences were higher for verbal threats than physical violence. Through the analysis four categories were identified; Nursing Situations with verbal threats and physical violence, Private and occupational consequences of physical violence at nursing situations, Occupational consequences of verbal threats at nursing situations and Support for ambulance nurses to actual threats and incidents of violence. During these four categories, ambulance nurses brought up consequences that were both professional and private. Conclusion: The study showed that verbal threats and physical violence against ambulance nurses are very common. This resulted in that most ambulance nurses experienced that the nursing situation became uncomfortable and therefor, as a direct consequence they reacted with caution, distance itself from the patient or direct cessation of patient care. The study's findings showed that there were more consequences of verbal threats than of physical violence. A workable plan of action existed, but could be better and clearer. This suggests that improvements need to be made when a threat and/or violent incident occurs against ambulance nurse. The authors hope is that the study can become a basis for improvements in the pre-hospital operations.

The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

Väntetiden för patienter som ådragit sig höftfraktur till operation är ofta lång och kan uppgå till över ett dygn. I första delen av vårdkedjan är det ambulanssjuksköterskan som möter patienter som ådragit sig höftfraktur och omhändertagandet där smärtbehandling ingår genomförs med stöd av upprättade vårdriktlinjer. Ambulanssjuksköterskan har ett ansvar enligt svensk lag att den prehospitala akutsjukvården som genomförs ska vara evidensbaserad. Syftet med denna studie var att undersöka specialistutbildade ambulanssjuksköterskors uppfattningar om möjligheten att bedriva evidensbaserad vård vid prehospital smärtbehandling av patienter med höftfraktur. Detta är en kvalitativ studie med beskrivande design. Resultatet visade att den specialistutbildade ambulanssjuksköterskan uppfattade generellt att vårdriktlinjerna var tydliga och lätta att förhålla sig till. De uppfattade att smärtbehandling var väl fungerande och evidensbaserad. Vårdriktlinjerna var tydliga och lätta att förhålla sig till och informanterna uppfattade att smärtbehandlingen var väl fungerande och evidensbaserad. / The waiting time for patients that sustain hip fractures is often long and can be more than twenty-four hours. The Ambulance nurse provides the first care for those whom sustain a hip fracture.  These patients receive pain management care from the ambulance nurse as recommended by given guidelines.  The ambulance nurse has a responsibility by Swedish law to administer care in an evidence based care, prehospital in the emergency care. The intention of this study was to investigate the specialist educated ambulance nurses current opinions of the possibility to give evidence based care, during prehospital pain management to patients who have a hip fracture. This is a qualitative study with descriptive design. The outcome of this study shows that the specialist educated ambulance nurses believe that the guidelines are clear and easy to follow in general.  Their opinion was that the pain management was functional and evidence based. The guidelines were clear and easy to relate to and the informants experienced the pain management as evidence based.

Submitted by Jordan (jordanbiblio@gmail.com) on 2017-01-16T13:20:12Z No. of bitstreams: 1 DISS_2015_Wanessa Rezende Sousa.pdf: 1230691 bytes, checksum: 3574e5537b67f7f241c1c5a129159586 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-01-16T15:11:35Z (GMT) No. of bitstreams: 1 DISS_2015_Wanessa Rezende Sousa.pdf: 1230691 bytes, checksum: 3574e5537b67f7f241c1c5a129159586 (MD5) / Made available in DSpace on 2017-01-16T15:11:35Z (GMT). No. of bitstreams: 1 DISS_2015_Wanessa Rezende Sousa.pdf: 1230691 bytes, checksum: 3574e5537b67f7f241c1c5a129159586 (MD5) Previous issue date: 2015-03-11 / O presente estudo tem por objetivo conhecer a percepção de enfermeiros e acadêmicos de enfermagem sobre a formação acadêmica para atuar no serviço de urgência e emergência, especificamente no Atendimento Pré-Hospitalar – APH. Considerando os objetivos propostos optamos por realizar um estudo descritivo, com abordagem qualitativa, adotando como método o Estudo de Caso. Para tanto, desenvolvemos uma revisão bibliográfica que abordou o histórico do ensino da enfermagem, os marcos conceituais e regulatórios sobre o Atendimento Pré-Hospitalar, a formação do profissional em enfermagem e o papel do estágio nesta formação. O estudo empírico foi desenvolvido junto a Gerência de Enfermagem do Serviço de Atendimento Móvel de Urgência – SAMU da Secretaria de Estado de Saúde – SES, em Cuiabá, MT e Faculdade de Enfermagem da Universidade Federal de Mato Grosso – UFMT – campus Cuiabá. Os sujeitos da pesquisa foram os enfermeiros do SAMU e os acadêmicos do 9º semestre de graduação de enfermagem da UFMT – campus Cuiabá. Utilizamos como técnica de coleta de dados os seguintes instrumentos: uma entrevista semiestruturada, que foi destinada aos enfermeiros do SAMU, a partir de um roteiro contendo 16 (dezesseis) questões; dois questionários para os alunos da graduação, aplicados em 2 (dois) momentos distintos; a análise documental sobre as Diretrizes Curriculares do Curso de Enfermagem; Projetos Pedagógicos dos Cursos de Enfermagem da UFMT de 2010, Estrutura Curricular dos cursos datadas de 1976, 1983, 1990, 1996 e 2010, além das ementas das disciplinas que têm relação com o tema Urgência e Emergência. Para análise dos dados utilizamos a técnica de codificação dos dados proposta por Bogdan e Biklen (1994). Este sistema busca regularidades e padrões, visto que a repetição de respostas, palavras ou frases, identifica a forma como os sujeitos pensam. Na análise documental, no que tange às ementas todas abordam de forma ampla a assistência de enfermagem, não sendo possível identificar o aprofundamento do conteúdo a ser abordado no caso do APH. De maneira geral, enfermeiros e acadêmicos de enfermagem indicam a deficiência no ensino da graduação com relação a situações de, a falta de preparo do aluno para adentrar no campo de trabalho, sendo que esta lacuna poderia ser diminuída oportunizando aos acadêmicos o estágio nas unidades de emergência e em especial no atendimento pré-hospitalar. / This present study aims to understand the perception of nurses and nursing students on academic training to act in urgent and emergency service, specifically in Pre- Hospital Care - APH. Considering the proposed objectives, we decided to conduct a descriptive study with a qualitative approach, adopting the ‘Case Study’ as the method. We developed a literature review that addressed the history of nursing education, the conceptual and regulatory frameworks on Pre-hospital Care, the formation of nursing professional and the stage’s role in this formation. The empirical study was carried out in Nursing Management of Mobile Emergency Care Service - SAMU the State Health Department – SES, in Cuiabá, MT and Faculty of Nursing at the Federal University of Mato Grosso - UFMT - Cuiabá campus. The research subjects were the nurses of SAMU and students of the 9th semester of nursing graduation of UFMT - Cuiabá campus. We used as data collection technique the following instruments: A semi-structured interview, which was intended to SAMU nurses, from a script containing sixteen (16) questions; Two questionnaires for students of graduation, applied in two (2) different times; the documentary analysis on the Curriculum Guidelines of the Nursing Course; Pedagogical projects of the UFMT Nursing Courses of 2010, Curriculum Structure of courses dated 1976, 1983, 1990, 1996 and 2010, in addition to the menus of the disciplines that have relation with the theme Urgency and Emergency. For data analysis, we used data coding technique proposed by Bogdan and Biklen (1994). This system seeks regularity and standards, as the repetition of answers, words or phrases identifies how the subjects think. In the documentary analysis, as regards the menus all approach broadly nursing assistance, not being possible to identify the deepening of the content to be covered in the case of APH. In general, nurses and nursing students indicate the deficiency in the teaching undergraduate in relation to emergency situations, the lack of preparation of students to enter the labor field, since this gap could be decreased giving opportunities to academic stage in emergency units and especially in pre-hospital care.