<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>

<p>The basic intention of this study is founded on an ambition to make </p><p>change within the competing activity at “Svenska Brukshundklubbens Halmstadavdelning” (SBK Halmstad). This is a local association for owners of working dogs, where I am one of the members. A problem in engage a larger number of voluntarily working members in the association has been established and discussed over several years. My premier aim was to make the members award of different perspectives of the problem. This was made by a presentation of made up assertions in focus groups. The interpretations that have been made from the result of the study are influenced from my former experiences from my membership of the association. From these interpretations I have made an analysis which mainly illustrates a need of reorganizing in tasks and improved communication among groups of the members. Eventually I have framed a plan of actions, which expresses my understanding of how the problem can be solved by an increased use of competence. Since I have learned a lot from my friends in SBK Halmstad, I hope this study will be significant in the future development of this association and others.</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.

The basic intention of this study is founded on an ambition to make change within the competing activity at “Svenska Brukshundklubbens Halmstadavdelning” (SBK Halmstad). This is a local association for owners of working dogs, where I am one of the members. A problem in engage a larger number of voluntarily working members in the association has been established and discussed over several years. My premier aim was to make the members award of different perspectives of the problem. This was made by a presentation of made up assertions in focus groups. The interpretations that have been made from the result of the study are influenced from my former experiences from my membership of the association. From these interpretations I have made an analysis which mainly illustrates a need of reorganizing in tasks and improved communication among groups of the members. Eventually I have framed a plan of actions, which expresses my understanding of how the problem can be solved by an increased use of competence. Since I have learned a lot from my friends in SBK Halmstad, I hope this study will be significant in the future development of this association and others.