BACKGROUND: Non-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion of all patients seeking ambulance care. Scientific knowledge about patients' non-conveyance experiences is sparse. This study describes the lived experiences of non-conveyed patients in an ambulance care context.

METHODS: A reflective lifeworld research (RLR) approach founded on phenomenology is used. Data is derived from nine in-depth interviews with patients not conveyed by the ambulance service in a major Swedish region.

RESULTS: Patients' lived experiences of becoming acutely ill or injured and not conveyed by ambulance to a hospital are characterised by several dynamic movements: losing and regaining situational and bodily control, dependence and autonomy, external competence and inner knowledge, handing over and regaining responsibility, and fear and security.

CONCLUSIONS: Patients' lived experiences of non-conveyance are complex and versatile. Although non-conveyed patients initially experience strong fear and the loss of situational and bodily control, they gradually feel more secure when experiencing confirmation and trust, which evolves into insecurity and uncertainty. The non-conveyance situation's complexity from a patient's perspective implies the need for ambulance organisations to take measures to prevent further suffering. Non-conveyed patients must be taken seriously in their unique situations, requiring ambulance clinicians to reflect and act with a conscious ethical perspective before, during and after their visit.

BACKGROUND: One way of facilitating entrance into the Swedish health care system, for newly arrived physicians from outside the European Union/European Economic Area, could be to set up and offer a course aimed to enhance understanding of it. This course was offered to increase insight about clinical practices, interprofessional teamwork and topics such as, Swedish health care laws, culture, and ethics. Acceptance of, and a flexible attitude towards, interprofessional teamwork are important for maintaining both the physician's professional identity and a high quality of patient care. The aim of this study was to investigate newly arrived physicians', academic emotions, experience of stress and flow during a fourteen-week course, as well as attitudes to interprofessional collaboration, both before and after.

METHOD: A prospective study was conducted, with participants asked to respond on one questionnaire every course day, by using the Contextual Activity Sampling System methodology. The participants were asked to complete a questionnaire comprising ten questions about ongoing activity and in what way they experience, e.g., collaboration, interprofessional teamwork, academic emotions, flow, and stress. Furthermore, the participants were asked to score their attitude towards interprofessional teamwork by using the interdisciplinary education perception scale both before and after the course.

RESULTS: The total sample comprised 27 qualified physicians, from outside the European Union/European Economic Area. In the interdisciplinary education perception scale category, "perception of actual cooperation¨, the participants had significantly higher scores after the course. Flow and academic emotions were felt mostly during own periods of study, seminars, and lectures. The academic emotions were apathy, anxiety, and boredom. The most frequently experienced academic emotion was apathy. Course participants rated stress highest in connection with the examination.

CONCLUSION: The results show that the course had a positive impact on the participants perception of actual cooperation. It appears that participating in this kind of course was a positive experience for the participants, since they mostly experienced high levels of flow. Collaborating with others was experienced as positive, with participants reporting a high degree of flow in activities during collaboration.

BACKGROUND: Older adults (age ≥ 65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively.

METHODS: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18-64 and ≥ 65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses.

RESULTS: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level < 95% or systolic blood pressure > 160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients.

CONCLUSIONS: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex and variating presentation of symptoms and vital signs proved difficult for dispatch operators and ambulance clinicians to identify and assess, the identified risks raise questions on the patient safety of older adult non-conveyed patients. The results indicate a system failure that need to be managed within the ambulance service organisation to achieve higher levels of patient safety for older non-conveyed patients.

OBJECTIVES: Non-conveyed patients represent a significant proportion of all patients cared for by ambulance services in the western world. However, scientific knowledge on non-conveyance is sparse. Therefore, the aim of this study was to describe the prevalence of non-conveyance, investigate associations and compare patients' characteristics, drug administration, initial problems and vital signs between non-conveyed and conveyed patients.

DESIGN: A population-based retrospective cohort study.

SETTING: The study setting area, Stockholm, Sweden, has a population of 2.3 million inhabitants, with seven emergency hospitals. Annually, approximately 210 000 assignments are performed by 73 ambulances. All ambulance assignments performed from 1 January to 31 December 2015 were included.

RESULTS: In total, 23 603 ambulance assignments ended in non-conveyance-13.8% of all ambulance assignments performed in 2015. Compared with conveyed patients, non-conveyed patients were younger and more often female (median age 50.1 years for non-conveyed vs 61.7 years for conveyed; female=52 %, both p values <0.001). Approximately half of all ambulance assignments ending in non-conveyance were initially prioritised and dispatched as the highest priority. Non-conveyed patients were more often assessed by ambulance clinicians as presenting non-specific symptoms or symptoms related to psychiatric problems. Low blood glucose levels were highly associated with non-conveyance (adjusted OR (AOR): 15; 95 % CI 11.18 to 20.13), although non-conveyed patients presented abnormal vital signs across all categories of vital signs. Moreover, drugs were more often administered to younger non-conveyed patients. Older patients were more often conveyed and administered drugs once conveyed (AOR: 1.29; 95 % CI 1.07 to 1.56).

CONCLUSIONS: This study shows that non-conveyed patients represent a non-negligible proportion of all patients in contact with ambulance services. In general, most cases of non-conveyance occur at the highest dispatch level, to a large extent involve younger patients, and features problems assessed by ambulance clinicians as non-specific or related to psychiatric symptoms.

OBJECTIVES: To combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients' need for conveyance to hospital, and this is creating new and challenging demands for ACs. This study aimed to describe ACs' experiences of assessing non-conveyed patients.

DESIGN: A phenomenological interview study based on a reflective lifeworld research approach.

SETTING: The target area for the study was Stockholm, Sweden, which has a population of approximately 2.3 million inhabitants. In this area, 73 ambulances perform approximately just over 200 000 ambulance assignments annually, and approximately 25 000 patients are non-conveyed each year.

INFORMANTS: 11 ACs.

METHODS: In-depth open-ended interviews.

RESULTS: ACs experience uncertainty regarding the accuracy of their assessments of non-conveyed patients. In particular, they fear conducting erroneous assessments that could harm patients. Avoiding hasty decisions is important for conducting safe patient assessments. Several challenging paradoxes were identified that complicate the non-conveyance situation, namely; responsibility, education and feedback paradoxes. The core of the responsibility paradox is that the increased responsibility associated with non-conveyance assessments is not accompanied with appropriate organisational support. Thus, frustration is experienced. The education paradox involves limited and inadequate non-conveyance education. This, in combination with limited support from non-conveyance guidelines, causes the clinical reality to be perceived as challenging and problematic. Finally, the feedback paradox relates to the obstruction of professional development as a result of an absence of learning possibilities after assessments. Additionally, ACs also described loneliness during non-conveyance situations.

CONCLUSIONS: This study suggests that, for ACs, performing non-conveyance assessments means experiencing a paradoxical professional existence. Despite these aggravating paradoxes, however, complex non-conveyance assessments continue to be performed and accompanied with limited organisational support. To create more favourable circumstances and, hopefully, safer assessments, further studies that focus on these paradoxes and non-conveyance are needed.

Objective: The aim was to evaluate how family members of persons with chronic heart failure (CHF) experienced a group-based multi-professional educational programme.Methods: Family members who participated in an educational programme filled in an evaluation form directly after completing the programme (n = 53). One year after the completed programme family members (n = 11) who participated in 5-6 of six sessions were interviewed about their experience. The interviews were analysed by qualitative content analysis. Results: The evaluation form showed that most family members reported satisfaction with session structure and content, but a majority would have preferred to share the education together with the ill person. Interview findings are presented in three categories and eight subcategories identified through the analysis. Results showed that family members’ increased knowledge about heart failure and thereby attained a greater understanding of the ill person’s situation with an increased tolerance. Furthermore the family members acquired a better self-confidence and became a resource for the ill person and they described that they were more actively involved in the ill person’s self-care. Family members experienced it positive to meet others in the same situation. They also gained an insight into the importance of taking care of their own health. Conclusions: The educational programme produced valuable knowledge and understanding about heart failure among family members. With this newly acquired knowledge, family members had the possibility of working out appropriate support for the ill person. Being part of a group with others in the same situation was a positive experience.

Aim The aim of this study was to describe the experience of security and insecurity in patients with chronic heart failure who were treated by Advanced Home Care (AHC) in a city in Sweden.

Background It is common for patients with heart failure to have frequent readmissions to hospital due to deterioration. The patients have various symptoms such as breathing problems, oedema and fatigue. Being cared for by AHC has become more common for patients with heart failure to reduce deterioration of heart failure and prevent hospitalization.

Method A qualitative method with semi-structured interviews was used. Eight patients with heart failure participated in the study. The interviews were analysed by content analysis.

Findings Three categories were identified: ‘home care’, ‘the social network’ and ‘internal and external resources’.

Conclusion The experience was complex and depended on several factors both within and outside the health care situation. The need for access to a multidisciplinary team was great and it was important that the nursing staff had time to listen. It was important that the care had focus on the patient’s perspective to create security and avoid insecurity.

Aims and objectives.  To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background.  When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design.  Randomised controlled trial. Methods.  A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. Results.  There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R(2)  = 0·35) and depression (p = 0·021, R(2)  = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). Conclusion.  Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice.  Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

Background: Pain is one of the most common medical problems that occur in hospitals; in spite of its incidence, there are many patients who suffer with untreated pain. Unrelieved pain can negatively impact a person's quality of life, causing activity life disturbances like psychological distress; anxiety, depression and lack of sleep. Cardiovascular disorder is a significant global health problem, which accounts for the death of a third of people of the world. Chest pain is the most common symptom of heart attacks. However, some patients will present with pain in other areas like pain in arm, shoulder, neck, teeth, jaw and back pain. In literature there is little observational research to investigate actual pain assessment and management practices of critical care nurses in routine clinical practice for patients with myocardial infarction. Aim:The aim of this study was to explore nurses' perceptions regarding pain assessment and pain management for patients with Myocardial Infarction in a coronary care unit.

Methodology: The study was a qualitative design, using semi structured interviews. Ten critical care nurses who work in a coronary care unit were interviewed. The author used a qualitative content analysis approach to analyze the interviews by doing the manual analyzing and having different themes.Result: Three main themes were indentified in this study and each theme had different categories which are presented as the following: Dealing with patients who have myocardial infarction pain is challenging; there are different approaches in pain assessment including subjective and the third theme is Holistic approaches to pain management.

Conclusion: Critical care nurses need more skills and knowledge to practice good pain assessment and effective pain management when they deal with patients who have myocardial infarction pain. In this study patients who do not verbalized their pain lack the proper assessment of pain due to inability to communicate their pain. More research is needed in this area of pain assessment and management especially for patients with myocardial infarction.