Thèse (de maîtrise)--Université Laval, 2007. / Bibliogr.: f. 69-70. Publié aussi en version électronique dans la Collection Mémoires et thèses électroniques.

<p>The prehospital management of patients with acute myocardial infarction (AMI)now includes 12-lead electrocardiogram transmission directly from the ambulance to hospital.If the ECG shows ST-elevated myocardial infarction the patient should be transported directlyto a hospital with capability for percutaneous coronary intervention (PCI).                                               Aim: The aim of this study was to describe how ambulance nurses experienced the prehospital management of patients with AMI who are transported by ambulance directly to hospital for PCI.                                                Method: Semi structured interviews were conducted with eight ambulance nurses. Data were analysed using qualitative content analysis. The categories that emerged were: Use ofcompetence, Responsibility and Insufficiency. Result: The result showed that the ambulance nurses felt secure when they cared for patients transported directly to PCI. The nurses assessed the patient and decided how he or she should be cared for. The contact with doctors was considered good. However the nurses discussed the noisy environment in ambulances and bad connection in the cellular phone network as a source of insecurity when prescriptions were given to them. They would like to have a written prescription as a text message from the doctor. The nurses also felt that they had the sole responsibility for the patient.                      Conclusions: The capability of working alone, ability to act in complex situations andspecialist knowledge in order to assess the patient correctly is important. Prescriptions should be verified with a text message to the ambulance from prescribing doctor.</p> / <p>Prehospital omvårdnad av patienter med akut hjärtinfarkt innefattar numera att 12-avledningsleds elektrokardiogram (EKG) sänds från ambulansen till sjukhus. Om EKG visar ST-höjningsinfarkt skall patienten transporteras direkt till sjukhus med möjlighet att utföra perkutan coronar intervention.          Syfte: Syftet med studien var att beskriva hur sjuksköterskor i ambulans upplever den prehospitala omvårdnaden av patienter med akut hjärtinfarkt som transporterats med ambulans direkt till sjukhus för perkutan coronar intervention (PCI).                                                                            Metod: Semistrukturerade intervjuer genomfördes med åtta sjuksköterskor inom ambulansverksamheten. Kvalitativ innehållsanalys valdes för att analysera data och utmynnade i tre kategorier: Kompetensnyttjande, Ansvarstagande och Otillräcklighet.                                                  Resultat: Resultatet visade att sjuksköterskorna upplevde trygghet i uppdraget att omhänderta patienter med hjärtinfarkt som transporteras direkt till PCI. Sjuksköterskorna bedömde patientens tillstånd och tog ställning till hur den fortsatta omvårdnaden skulle utformas. Kontakten med mottagande läkare upplevdes mycket bra. Något som upplevdes som mindre positivt var dels den bullriga miljö som förekom i några ambulansmodeller, samt när det var dålig mottagning i mobiltelefonnätet. Båda dessa störningsmoment upplevdes som en källa till osäkerhet när det gällde läkemedelsordinationer från mottagande läkare. Det fanns önskemålom att dessa ordinationer borde verifieras med ett textmeddelande till ambulansen. Vidare visade resultatet att sjuksköterskorna kunde uppleva ensamhet med omvårdnadsansvaret för patienten.    Slutsatser: Vikten av att kunna arbeta ensam, ha handlingsberedskap i komplexa situationer och specialistkunskaper för att kunna göra korrekta bedömningar är av stor betydelse. Läkemedelsordinationer till sjuksköterskan ska verifieras genom att ordinerande läkare skickar ordinationen skriftligt via textmeddelande till ambulansen.</p>

The prehospital management of patients with acute myocardial infarction (AMI)now includes 12-lead electrocardiogram transmission directly from the ambulance to hospital.If the ECG shows ST-elevated myocardial infarction the patient should be transported directlyto a hospital with capability for percutaneous coronary intervention (PCI).                                               Aim: The aim of this study was to describe how ambulance nurses experienced the prehospital management of patients with AMI who are transported by ambulance directly to hospital for PCI.                                                Method: Semi structured interviews were conducted with eight ambulance nurses. Data were analysed using qualitative content analysis. The categories that emerged were: Use ofcompetence, Responsibility and Insufficiency. Result: The result showed that the ambulance nurses felt secure when they cared for patients transported directly to PCI. The nurses assessed the patient and decided how he or she should be cared for. The contact with doctors was considered good. However the nurses discussed the noisy environment in ambulances and bad connection in the cellular phone network as a source of insecurity when prescriptions were given to them. They would like to have a written prescription as a text message from the doctor. The nurses also felt that they had the sole responsibility for the patient.                      Conclusions: The capability of working alone, ability to act in complex situations andspecialist knowledge in order to assess the patient correctly is important. Prescriptions should be verified with a text message to the ambulance from prescribing doctor. / Prehospital omvårdnad av patienter med akut hjärtinfarkt innefattar numera att 12-avledningsleds elektrokardiogram (EKG) sänds från ambulansen till sjukhus. Om EKG visar ST-höjningsinfarkt skall patienten transporteras direkt till sjukhus med möjlighet att utföra perkutan coronar intervention.          Syfte: Syftet med studien var att beskriva hur sjuksköterskor i ambulans upplever den prehospitala omvårdnaden av patienter med akut hjärtinfarkt som transporterats med ambulans direkt till sjukhus för perkutan coronar intervention (PCI).                                                                            Metod: Semistrukturerade intervjuer genomfördes med åtta sjuksköterskor inom ambulansverksamheten. Kvalitativ innehållsanalys valdes för att analysera data och utmynnade i tre kategorier: Kompetensnyttjande, Ansvarstagande och Otillräcklighet.                                                  Resultat: Resultatet visade att sjuksköterskorna upplevde trygghet i uppdraget att omhänderta patienter med hjärtinfarkt som transporteras direkt till PCI. Sjuksköterskorna bedömde patientens tillstånd och tog ställning till hur den fortsatta omvårdnaden skulle utformas. Kontakten med mottagande läkare upplevdes mycket bra. Något som upplevdes som mindre positivt var dels den bullriga miljö som förekom i några ambulansmodeller, samt när det var dålig mottagning i mobiltelefonnätet. Båda dessa störningsmoment upplevdes som en källa till osäkerhet när det gällde läkemedelsordinationer från mottagande läkare. Det fanns önskemålom att dessa ordinationer borde verifieras med ett textmeddelande till ambulansen. Vidare visade resultatet att sjuksköterskorna kunde uppleva ensamhet med omvårdnadsansvaret för patienten.    Slutsatser: Vikten av att kunna arbeta ensam, ha handlingsberedskap i komplexa situationer och specialistkunskaper för att kunna göra korrekta bedömningar är av stor betydelse. Läkemedelsordinationer till sjuksköterskan ska verifieras genom att ordinerande läkare skickar ordinationen skriftligt via textmeddelande till ambulansen.

Sepsis är ett tillstånd med livshotande organdysfunktion orsakat av ett stört systemiskt svar på infektion. Mortaliteten för sepsis beräknas vara två till tre gånger högre än vid akut hjärtinfarkt. Tidig identifiering och behandling av sepsis minskar patientens lidande och ökar patientens chanser till överlevnad. Syftet var att identifiera screeningverktyg som kan stödja ambulanssjuksköterskan att identifiera patienter med sepsis. Metod var litteraturöversikt med en systematisk ansats och en narrativ sammanställning av resultatet. Sökningarna genomfördes i databaserna PubMed och CINAHL. Sammanlagt inkluderades 18 kvantitativa vetenskapliga artiklar som alla kvalitetsgranskades före inkludering och analys. Resultatet presenteras under fem kategorier, där likheter och skillnader identifierades utifrån resultatet i inkluderade studier. I de lästa artiklarna identifierades tolv olika screeningverktyg. Dessa screeningverktyg var; BAS 90-30-90, Modified Early Warning Score, Modifierat Robson screening tool, National Early Warning Score, National Early Warning Score 2, Prehospital Earley Sepsis Detecetion, Predict Sepsis Screening tool 1,2 och 3, Prehospital Servere Sepsis score (PreSS), Rapid emergency triage and treatment system for adults, Sepsis Screening Tool, Systemic Inflammatory Response Syndrome och Quick Sequential Organ Failure Assesment. Tio stycken av de inkluderade artiklarna hade studerat användbarheten av screeningsverktyget Quick Sequential Organ Failure Assesment prehospitalt. Quick Sequential Organ Failure Assesment påvisade en låg känslighet för tidig identifiering av patienter med sepsis eller septisk chock. Slutsats från studien var att inget screeningverktyg kunde identifiera sepsis i tidigt skede. Screeningverktygen kunde i viss grad påvisa på ökad mortalitet eller intensivvårds inläggningar. Mer forskning krävs för att tidigt kunna identifiera patienter med sepsis och därmed minska patienternas lidande. / Sepsis is a condition of life-threatening organ dysfunction caused by an impaired systemic response to infection. The mortality rate for sepsis is estimated to be two to three times higher than for acute myocardial infarction. Early identification and treatment of sepsis reduces patient suffering and increases the patient's chances of survival. The objective was to identify screening tools that can support ambulance nurse to identify patients with sepsis. The methodology was a literature review using a systematic approach and a comparative compilation of the results. Searches were conducted in the PubMed and CINAHL databases. A total of 18 quantitative scientific articles were included, all of which were quality reviewedberfore inclusion and analysis. The results are presented in five categories, where similarities and differences were identified based on the findings.Twelve different screening tools were identified. These screening tools are; BAS 90-30-90, Modified Early Warning Score (MEWS), modified Robson screening tool, National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Predict Sepsis Screening tool 1, 2 and 3, Prehospital Early Sepsis Detection (PRESEP), Prehospital Servere Sepsis score (PreSS), Rapid Emergency Triage and Treatment System for Adults (RETTS-A), Sepsis Screening Tool, Systemic Inflammatory Response Syndrome (SIRS), and Quick Sequential Organ Failure Assessment (qSOFA). Ten of the included articles had studied the usefulness of Quick Sequential Organ Failure Assessment screening tool in pre-hospital emergency care. The Quick Sequential Organ Failure Assessment demonstrated a low sensitivity for early identification of patients with sepsis or septic shock. The conclusion of the study was that no screening tool could identify sepsis at an early stage. The screening tools were able to detect increased mortality or intensive care unit admissions to some extent. More research is needed to identify patients with sepsis early and thereby reduce patient suffering.

The increase and changes in the demand for emergency care require pro-active responses from the designers and implementers of the emergency care system. The role of Emergency Care Practitioner (ECP) was introduced in England to improve the delivery of emergency care in the community. The role was evaluated using cost-benefit approach and compared with other existing emergency care roles. An analysis of the cognitive elements (situation awareness (SA) and naturalistic decision making (NDM)) of the ECP job was proposed considering the mental efforts involved. While the cost-benefit approach can justify further spending on developing the role, a cognitive approach can provide the evidence in ensuring the role is developed to fulfil its purpose. A series of studies were carried out to describe SA and NDM amongst ECPs in an ambulance service in England. A study examined decision-making process using Critical Decision Method interviews which revealed the main processes in making decision and how information was used to develop SA. Based on the findings, the subsequent studies focus on the non-clinical factors that influence SA and decision making. Data from a scoping study were used to develop a socio-technical systems framework based on existing models and frameworks. The framework was then used to guide further exploration of SA and NDM. Emergency calls that were assigned to ECPs over a period of 8 months were analysed. The analysis revealed system-related influences on the deployment of ECPs. Interviews with the ECPs enabled the identification of influences on their decision-making with respect to patient care. Goal-directed task analysis was used to identify the decision points and information requirements of the ECPs. The findings and the framework were then evaluated via a set of studies based on an ethnographic approach. Participant observations with 13 ECPs were carried out. Field notes provided further insight into the characteristics of jobs assigned to the ECPs. It was possible to map the actual information used by the ECP to their information needs. The sources of the information were classified according to system levels. A questionnaire based on factors influencing decision-making was tested with actual cases. It was found that the items in the questionnaire could reliably measure factors that influence decision-making. Overall, the studies identify factors that have direct and indirect influences on the ECP job. A coherent model for the whole emergency care systems can be developed to build safety into the care delivery process. Further development of the ECP role need to consider the support for cognitive tasks in light of the findings reported in this thesis.

Bakgrund: Sepsis är en sjukdom där en infektion ger ett systemiskt inflammationssvar i kroppen. Symtombilden kan vara varierande och även ospecifik. Både incidensen och mortaliteten är hög i världen. Sjukdomen innebär stort lidande för patienterna både under den akuta sjukdomsfasen och i efterförloppet för de överlevande. Framtagna bedömningsinstrumenten grundar sig främst på patientens vitalparametrar, vilka nödvändigtvis inte är avvikande initialt. Genom en ökad kunskap om både subjektiva och objektiva värden har ambulanssjuksköterskan goda möjligheter att identifiera fler patienter med misstänkt sepsis prehospitalt. Syfte: Att beskriva kännetecken och symtom hos patienter med sepsis inom ambulanssjukvården.   Metod: En systematisk litteraturstudie gjord med en integrativ metod enligt Whittemore &amp; Knafl (2005) och en induktiv ansats. Resultatet baseras på 15 vetenskapliga artiklar med kvantitativ, kvalitativ och mixad metod.  Resultat: Resultatet visade att de subjektiva kännetecknen och de objektiva symtomen alla var viktiga delar som gav en helhetsbild av sepsis. Åtta subkategorier gav de två kategorierna En känsla av sjukdom och att inte vara sig själv och En kropp som sviker. De bildade sedan huvudkategorin Helhetsbilden av sepsis – kännetecken och symtom av betydelse.  Slutsats: Symtombilden vid sepsis kunde vara komplex och varierande. Patienterna beskrevs kunna ha kännetecken och symtom från alla kroppens organsystem. Patienterna var ofta mycket påverkade, hade ett stort lidande samt stor risk att avlida i sin sjukdom. / Background: Sepsis is a disease in which an infection produces a systemic inflammatory response in the body. The presentation of signs and symptoms can be varied and non-specific. Both the incidence and mortality are high in the world. The disease leads to great suffering for the patients both during the acute phase of the disease but also in the aftermath for the survivors. The assessment tools are mainly based on the patient's vital signs, which are not necessarily deviating initially. Through an increased knowledge of both subjective and objective parameters, the ambulance clinicians have good possibilities to identify more patients with suspected sepsis in the prehospital setting. Aim: To describe the signs and symptoms in patients with sepsis in the ambulance services. Method: A systematic literature review done with an integrative method according to Whittemore &amp; Knafl (2005) and an inductive approach. The result is based on 15 scientific papers with a variety of quantitative, qualitative and mixed methods. Results: The results showed that subjective signs and objective symptoms were important pieces of the overall picture of sepsis. 8 subcategories formed two categories A feeling of illness and not being oneself and A body that fails. These shaped the main category The overall picture of sepsis – signs and symptoms of significance. Conclusion: The presentation of sepsis could be complex and varied. Patients were described as having signs and symptoms from all the body's organ systems. The patients were often very affected, had a great deal of suffering and a high risk of dying from their disease.

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...