Smärta är en vanlig orsak att söka akutsjukvård, ambulanssjuksköterskan möter en stor variation av patienter i varierande miljöer och ska lindra lidande för patienter. Det saknas kunskap om hur ambulanssjuksköterskor upplever användning av farmakologisk smärtlindring. Syftet var att beskriva ambulanspersonalens erfarenheter av användning av farmakologisk smärtlindring. Metoden som valdes var en litteraturöversikt med systematisk sökning. Sex kategorier identifierades: Patientens fysiska behov, Livsstil och medicinsk historik, Uttryck och uppfattning, Oro för biverkan, Bristande utbildning skapar osäkerhet samt Tidigare erfarenheter. Konklusionen var att det är många faktorer som tas i beaktande vid smärtlindring prehospitalt, allt ifrån patientens livsbetingelser, kulturella preferenser och sjukdomshistorik till hur situationen ser ut på platsen och hur långt det är till sjukhuset. Det är en komplex uppgift att lösa på ett adekvat sätt, det behövs utbildning och erfarenhet för att lösa den uppgiften på ett personcentrerat och tillfredställande sätt. / Pain is a common cause for patients to seek emergency medical assistance, the specialized ambulance nurse meet a variety of patients in all kind of environment and is supposed to ease the suffering of the patients. There is a lack of knowledge of the experience of how specialized nurses experience the use of pharmacological pain management. The aim for this study was to describe the ambulance personnel’s experience of using pharmacological pain management. The opted method was a literature review with systematic search. Six categories were identified: Attention to the patients´ physical needs, Lifestyle and medical history, Expression and perception, Fear of adverse effects, Lack of training results in uncertainty, and Previous experiences. There are a lot of parameters to take into consideration when administrating pain medication prehospital, anything from the patient’s life conditions, cultural preferences and medical history to the status on site and how far away the hospital is located. It is a complex assignment to solve and to solve it in a satisfactory and patient centred manner, additional training and experience is required.

No / Ambulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors infl uencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life-threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated signifi cantly more life-threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing diffi culties (29% versus 14.5%) more commonly. Tackling inequality will require a whole-systems approach, effective leadership, and recognition of the benefi ts of understanding difference. A key relationship will entail engaging with seldom heard communities.

Redundant robotic systems, in terms of manipulators with one or twoarms, mobile manipulators, and multi-agent systems, have received an in-creasing amount of attention in recent years. In this thesis we describe severalways to improve robotic system performance by exploiting the redundancy. As the robot workspace becomes increasingly dynamic, it is common towork with imperfect geometric models of the robots or its workspace. Inorder to control the robot in a robust way in the presence of geometric uncer-tainties, we propose to assess the stability of our controller with respect to acertain task by deriving bounds on the geometric uncertainties. Preliminaryexperimental results support the fact that stability is ensured if the proposedbounds on the geometric uncertainties are fulfilled. As a non-contact measurement, computer vision could provide rich infor-mation for robot control. We introduce a two step method that transformsthe position-based visual servoing problem into a quadratic optimization prob-lem with linear constraints. This method is optimal in terms of minimizinggeodesic distance and allows us to integrate constraints, e.g. visibility con-straints, in a natural way. In the case of a single robot with redundant degrees of freedom, we canspecify a family of complex robotic tasks using constraint based programming(CBP). CBP allows us to represent robotic tasks with a set of equality andinequality constraints. Using these constraints we can formulate quadraticprogramming problems that exploit the redundancy of the robot and itera-tively resolve the trade-off between the different constraints. For example, wecould improve the velocity or force transmission ratios along a task-dependent direction using the priorities between different constraints in real time. Using the reactiveness of CBP, we formulated and implemented a dual-armpan cleaning task. If we mount a dual-arm robot on a mobile base, we proposeto use a virtual kinematic chain to specify the coordination between the mobilebase and two arms. Using the modularity of the CBP, we can integrate themobility and dual-arm manipulation by adding coordination constraints intoan optimization problem where dual-arm manipulation constraints are alreadyspecified. We also found that the reactiveness and modularity of the CBPapproach is important in the context of teleoperation. Inspired by the 3Ddesign community, we proposed a teleoperation interface control mode thatis identical to the ones being used to locally navigate the virtual viewpoint ofmost Computer Aided Design (CAD) softwares. In the case of multiple robots, we combine ideas from multi-agent coopera-tive coverage control, with problem formulations from the resource allocationfield, to create a distributed convergent approach to the resource positioningproblem. / <p>QC 20160224</p>

Anestesisjuksköterskan kan arbeta över flera områden där arbete vid en anestesiklinik är det vanligaste. I arbetet på en anestesiklinik ingår även uppgiften att medverka vid patienttransporter mellan sjukhus, interhospitala transporter. Tidigare studier har visat att många specialistsjuksköterskor är oroliga och bekymrade över dessa uppdrag. De upplevde otrygghet, osäkerhet och brist på tydliga riktlinjer. Ansvaret är stort och ibland är det långt mellan sjukhusen. Studiens syfte var att undersöka hur samtliga anestesisjuksköterskor på en anestesiklinik i sydvästra Sverige upplever att medverka vid patienttransporter mellan sjukhus. Studien genomfördes med en kvantitativ ansats och empirisk data samlades in med hjälp av ett frågeformulär. Deskriptiv statistik användes för att redovisa resultat. Resultatet av studien visar att anestesisjuksköterskornas erfarenheter av interhospitala patienttransporter är varierande. Flera svarade att de tyckte att det fanns svårigheter att utföra god omvårdnad under transporterna. Spridningen bland anestesisjuksköterskornas svar var stor på frågan om de kände sig stressade eller obekymrade över dessa uppdrag, de flesta befann sig kring mitten av skalan. Samarbetet med ambulanssjuksköterskorna var något som överlag fungerade mycket väl, och de hade stort förtroende för deras kompetens. Att helt avstå från att medverka vid interhospitala patienttransporter var något en fjärdedel av anestesisjuksköterskorna önskade. Behovet av mer forskning inom detta område är stort. / Nurse anesthetist work in several areas but working at an anesthetic clinic is the most common. Working at a clinic involves overseeing patients during interhospital patienttransports. Earlier studies have shown that many specialist nurses are worried and concerned over transporting patients. They experience feelings of insecurity, vulnerability, and a lack of clear guidelines. The responsibility is major and sometimes there are long distances between the hospitals. The aim of the study was to evaluate how the nurse anesthetists experience their participation during the transport of patients. The study was conducted using a quantitative approach and empirical data was collected using a questionair. Descriptive statistics were used to present the results. The results showed that the nurse anesthetists experiences of transporting patients varied greatly. Several responded that they found it difficult to give good care during the transport. There was also a large range of the answers to the question about whether they felt stressed or unconcerned during these assignments, but most were in the middle of the scale. Cooperation between the nurse anesthetists and the ambulance nurses generally worked well, they even had a strong confidence in their competence. One fourth of the nurse anesthetists reported they would prefer not to be involved in interhospital patienttransports. More research is needed in this area is great.

Bakgrund: Tidigare forskning visar att bemötandet och omvårdnaden av patienten under en ambulanstransport har stor betydelse för patientens upplevda lidande. Syfte: Syftet var att undersöka och dokumentera ambulanssjuksköterskors uppfattning av patientens upplevelse av bemötande och omvårdnad under ambulanssjukvård.  Metod: Semistrukturerade intervjuer som utfördes på ambulansstationen. Alla intervjuer genomfördes på ambulansstationen. Insamlade data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Denna studie visade att patienter överlag upplevs vara nöjda med bemötandet de får av ambulanssjuksköterskorna, detta på grund av den utsatta situationen och det totala fokus som kan ges till den enskilda patienten. Vidare framkom det i studien att patientens ålder kan ha inverkan på uttrycket och upplevelsen av lidandet, vilket framkom av att yngre personer oftare uttrycker lidandet verbalt och snabbare tillkallar ambulans medan de äldre generationerna oftare biter ihop och väntar med att tillkalla ambulans. Det framkom att omvårdnaden utvecklats inom flera områden med exempel som större möjligheter att bedöma och behandla på plats eller snabbspår för t ex. höftfrakturer. Detta bidrar till att minska patienters lidande. Slutsats: Ambulanssjuksköterskorna uppfattade det generellt som att majoriteten av patienterna upplevde bemötandet och omvårdnaden i ambulansen som mycket gott men att det försvåras av patientens tillstånd. Detta ställer höga krav på personalen vad gäller lyhörd, empati och respekt för individen. Utvecklingen upplevdes av samtliga ha gått framåt, med exempel som snabbspår, större egna mandat för bedömningar på plats och medicinska behandlingar.

MSc (Nursing), Faculty of health Sciences, University of the Witwatersrand / This quasi-experimental study assesses the value of simulation based learning for a medical flight crew within an air ambulance service based in Johannesburg, South Africa. The purpose of this study was to assess the value of simulation based learning for air medical crew in performing synchronized cardioversion efficiently, effectively and safely within the air medical environment. The objectives were to determine if there is a difference between the experimental group that had been exposed to a simulation-based learning experience versus a control group that had not, in respect of performing synchronized cardioversion and scene management pertaining to this skill. This was a qausi-experimental study in which stratified random sampling was done to divide the participants into the control and experimental groups using medical qualification as homogenous subsets. The outcome of the study showed that the control group was quicker to first shock than the participants in the experimental group. However, the participants in the experimental group performed the skill more effectively, with regard to doing / following the correct steps in performing the skill of synchronized cardioversion and were safer practitioners. None of the variants within the sample groups had a significant effect on performance of the skill. The conclusion is that within this specific air ambulance service, simulation- based learning improved the performance of synchronized cardioversion in comparison to the normal orientation / training provided in the service.

This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance.

<p>Syftet med studien var att beskriva ambulanspersonalens självskattning/upplevelse av smärta i rygg, leder och muskler samt sömn, vila och återhämtning. Ytterligare ett syfte var att undersöka om det finns några skillnader i nämnda besvär relaterat till kön och yrkeskategori. Data samlades in med enkäter och personal vid fyra ambulansstationer i Mellansverige deltog i studien. Sammanlagt delades 110 enkäter ut och 89 enkäter besvarades (svarsfrekvens 81 %). Resultatet avseende själskattad smärta visade att 53 personer (59,6 %) uppgav att de hade haft ländryggsbesvär de senaste 12 månaderna. Trettionio personer (43,6 %) uppgav nacksmärta de senaste12 månaderna. Tjugonio personer (32,6 %) uppgav skuldra/axelsmärta. Resultatet visade ingen statistisk signifikant skillnad mellan kön och yrkeskategorier. Resultatet avseende sömn visade att 72 personer (81 %) upplevde att de sov ganska bra till mycket bra. Cirka hälften av de 89 deltagarna 53 % uppgav att de kunde återhämta sig efter varje arbetspass och under lediga perioder uppgav 49 personer (55 %) att de kunde återhämta sig i stort sett varje period. Resultatet visade ingen statistisk signifikant skillnad mellan kön eller yrkeskategorier när det gällde smärt – och sömnbesvär.</p><p>Slutsats: För att förbättra arbetsmiljön för ambulanspersonal bör åtgärder inriktas mot belastningsergonomiska faktorer i arbetet.</p> / <p>The purpose of the study was to describe the ambulance personnel’s self-assessment/experiences of pain in the back, joints and muscles as well as sleep, rest and recovery. A further aim was to investigate whether there are any differences in the problems related to gender and profession. Data were collected with questionnaires, and personnel at four ambulance stations in central Sweden participated in the study. A total of 110 questionnaires were distributed, and the overall response rate was 81 %. The results for soul-rated pain showed that 53 persons (59, 6 %) reported low back pain in the last 12 months. Thirty-nine persons (43, 6 %) reported neck pain the past 12 months. Twenty-nine persons (32, 6 %) reported shoulder/shoulder pain. The results show no statistically significant difference between gender and occupational categories. The results showed that 72 persons (81 %) experience that they slept pretty good to very good. Approximately half of the 89 participants, 53 % reported they could recover after each session and during her free period reported 49 persons (55 %) experience that they could recover almost every period. The results show no statistically significant difference between gender or occupational categories regarding.</p><p>Conclusion: To improve the work environment for ambulance personnel, measures should be focused on load and strain ergonomic factors.</p>

Syftet med studien var att beskriva ambulanspersonalens självskattning/upplevelse av smärta i rygg, leder och muskler samt sömn, vila och återhämtning. Ytterligare ett syfte var att undersöka om det finns några skillnader i nämnda besvär relaterat till kön och yrkeskategori. Data samlades in med enkäter och personal vid fyra ambulansstationer i Mellansverige deltog i studien. Sammanlagt delades 110 enkäter ut och 89 enkäter besvarades (svarsfrekvens 81 %). Resultatet avseende själskattad smärta visade att 53 personer (59,6 %) uppgav att de hade haft ländryggsbesvär de senaste 12 månaderna. Trettionio personer (43,6 %) uppgav nacksmärta de senaste12 månaderna. Tjugonio personer (32,6 %) uppgav skuldra/axelsmärta. Resultatet visade ingen statistisk signifikant skillnad mellan kön och yrkeskategorier. Resultatet avseende sömn visade att 72 personer (81 %) upplevde att de sov ganska bra till mycket bra. Cirka hälften av de 89 deltagarna 53 % uppgav att de kunde återhämta sig efter varje arbetspass och under lediga perioder uppgav 49 personer (55 %) att de kunde återhämta sig i stort sett varje period. Resultatet visade ingen statistisk signifikant skillnad mellan kön eller yrkeskategorier när det gällde smärt – och sömnbesvär. Slutsats: För att förbättra arbetsmiljön för ambulanspersonal bör åtgärder inriktas mot belastningsergonomiska faktorer i arbetet. / The purpose of the study was to describe the ambulance personnel’s self-assessment/experiences of pain in the back, joints and muscles as well as sleep, rest and recovery. A further aim was to investigate whether there are any differences in the problems related to gender and profession. Data were collected with questionnaires, and personnel at four ambulance stations in central Sweden participated in the study. A total of 110 questionnaires were distributed, and the overall response rate was 81 %. The results for soul-rated pain showed that 53 persons (59, 6 %) reported low back pain in the last 12 months. Thirty-nine persons (43, 6 %) reported neck pain the past 12 months. Twenty-nine persons (32, 6 %) reported shoulder/shoulder pain. The results show no statistically significant difference between gender and occupational categories. The results showed that 72 persons (81 %) experience that they slept pretty good to very good. Approximately half of the 89 participants, 53 % reported they could recover after each session and during her free period reported 49 persons (55 %) experience that they could recover almost every period. The results show no statistically significant difference between gender or occupational categories regarding. Conclusion: To improve the work environment for ambulance personnel, measures should be focused on load and strain ergonomic factors.

ABSTRACT Background: As a nurse it is a part of your work description to precepting students. A good relationship between preceptor and student is important for a successful precepting witch can be rewarding for both parties. There are many studies on how nurses in hospital departments experience precepting students, however it is not as explored in the prehospital care. Objective: To describe ambulance nurses' experience of precepting nursing students in the third and final year of university-level nursing school. Method: A qualitative study was conducted. Nine respondents at two ambulance stations in central Sweden were selected with the help of strategic convenience sample. The informants were nurses with specialist education in ambulance/prehospital care who had experience of working in the ambulance unit for at least a year. Result: The majority of participants were positive to precepting students and the time seemed adequate. Primarily in emergency situations the nurses felt that there was not enough time. Despite this, the nurses felt that this wasn’t a problem since they usually had time afterwards to talk and reflect over the expired events. However, many felt that because of the short internship it was hard to get to know the students, which led to an uncertainty in letting the student take care of the patient in certain situations. Conclusion: The study shows new results regarding ambulance nurse's perception of the supervision process. The study also shows differences between supervision in emergency medical services and ward care. This shows that the results from studies of the tutorial are not directly transferable to the prehospital care. Larger studies with more variation among the participants would be able to raise additional aspects in the precepting area. Keywords: nurse, ambulance, student and precepting