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  • 1. Conte, Helen
    et al.
    Wihlborg, Jonas
    Lindström, Veronica
    Sophiahemmet University.
    Developing new possibilities for interprofessional learning: Students' experience of learning together in the ambulance service2022In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 192Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students' experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL).

    AIM: The aim of this study was to explore undergraduate students' experiences of collaboration and learning together during their clinical rotation in the ambulance service.

    STUDY DESIGN AND METHOD: A mixed convergent parallel design was used to describe nursing and medical students' experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The group discussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students' self-assessed experiences and competencies in interprofessional collaboration.

    RESULTS: In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care.

    CONCLUSION: The students' experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students' learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service.

    ETHICAL APPROVAL: By the Swedish Ethical Review Authority. No: 2019-03595.

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  • 2. Ericsson, Christoffer R
    et al.
    Lindström, Veronica
    Sophiahemmet University.
    Rudman, Ann
    Nordquist, Hilla
    Paramedics' perceptions of job demands and resources in Finnish emergency medical services: A qualitative study2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, p. 1469-, article id 1469Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Paramedics' fatigue is rising. Stress factors show increased risk for burnout, fatigue, leaving the profession, decreased performance and risk for patient safety. Meanwhile, paramedics' strong community of practice, autonomy and a sense of professional respect are important factors in forming psychological resilience. We aimed to explore Finnish paramedics' perceptions of job demands and resources.

    METHODS: Our study design was descriptive, inductive with a constructivist approach. Using reflexive thematic analysis, we analyse open-ended questions, from a web-based survey and essays written by Finnish paramedic masters-degree students. The study followed the SRQR checklist.

    RESULTS: We identified paramedics' job demands as stress from a high workload, environmental factors and emotional burden. Performance expectations and a sense of inadequacy were further noted, as well as an organizational culture of hardiness, presenting lack of support and sense of inequality. Paramedics' job resources were pressure management strategies, which were expressed as positive coping mechanisms, agency to affect workload and professional self-actualization, expressed as psychologically safe work community, professional pride and internal drive to professional development.

    CONCLUSIONS: Finnish paramedics exhibit resources and demands related to uncertainty and emotional burden as well as cultural hardiness and psychological safety in communities.

    PATIENT OR PUBLIC CONTRIBUTION: This study was done based on survey data collected and analysed by the authors. No patient or public contribution was utilized for this study.

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  • 3. Falk, Ann-Charlotte
    et al.
    Lindström, Veronica
    Sophiahemmet University.
    Self-reported clinical competence before entering advanced level training in acute and prehospital emergency care among registered nurses in Sweden2022In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 61, article id 101146Article in journal (Refereed)
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  • 4. Göransson, Katarina
    et al.
    Kanstrup, Marie
    Singh, Laura
    Dahl, Oili
    Lindström, Veronica
    Sophiahemmet University.
    Falk, Ann-Charlotte
    Rudman, Ann
    Holmes, Emily
    Enkel Kognitiv Uppgift efter Trauma under COVID-19 - sjukvårdspersonal ’EKUT-P’: En randomiserad kontrollerad studie2020Conference paper (Other academic)
  • 5.
    Heldring, Sara
    et al.
    Sophiahemmet University.
    Lindström, Veronica
    Sophiahemmet University.
    Jirwe, Maria
    Wihlborg, Jonas
    Ambulance clinicians simulating mass casualty incident with virtual reality2022Conference paper (Other academic)
  • 6.
    Lindström, Veronica
    et al.
    Sophiahemmet University.
    Falk, Ann-Charlotte
    Emergency care nurses' self-reported clinical competence before and after postgraduate education: A cross-sectional study2023In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 70, p. 101320-, article id 101320Article in journal (Refereed)
    Abstract [en]

    Changing prerequisites in healthcare leads to the increased complexity of nursing. Since there are no regulations on re-validation of competencies for emergency nurses in Sweden there is sparse knowledge on how nurses develop competencies after registration as nurses (RN).

    AIM: To describe self-reported professional competence after postgraduate education among RNs in emergency care settings.

    METHOD: A cross-sectional design and STROBE guidelines were used. The short version of the Nurse Professional Competence Scale was used for data collection and the data were collected before and after postgraduate education, descriptive and comparative statistic was used for analysis.

    RESULTS: 62 (71%) students participated in the first data collection and an independent group of 31 (48%) students participated in the second data collection. The results showed generally good competencies before entering education and significantly improved competencies after education were found in areas of working independently and reviewing literature for evidence-based nursing Conclusion: The competencies were assessed as very good after education. Evaluating nurses' competencies supports educators in developing education to ensure the need for knowledge in emergency care. To ensure required competencies among emergency care nurses there is a need to regulate additional training and re-validation of emergency nurses' competencies.

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  • 7. Nilsson, Tomas
    et al.
    Masiello, I
    Broberger, E
    Lindström, Veronica
    Sophiahemmet University.
    Digital feedback during clinical education in the emergency medical services: A qualitative study2023In: BMC Medical Education, E-ISSN 1472-6920, Vol. 23, article id 156Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical education is essential for students' progress towards becoming registered nurses (RN) in Sweden. Assessment of caring skills in the Emergency Medical Services (EMS) is complex due to the ever-changing scenarios and the fact that multiple supervisors are involved in the student's education. Currently, assessments of student's skills are summative and occur twice during the six weeks of clinical education. A digitalized assessment tool (DAT) with an adaptation for formative assessment is a new approach to assessment of nursing skills in the EMS. Since new technologies and changes in procedures are likely to affect both students and supervisors, our aim in this study is to describe students' and clinical supervisors' experience of formative assessments using DAT in the EMS.

    METHOD: This study is qualitative, using semi-structured group interviews (N = 2) with students and semi-structured individual telephone interviews (N = 13) with supervisors. The data was analysed according to Graneheim and Landman's method for content analysis. This analysis generated 221 codes organized into 10 categories within which three themes were identified. The students in this study were nursing students in their last semester and all supervisors were experienced RNs.

    RESULTS: The results showed that students and supervisors had mainly positive views of the DAT and the formative assessment stating that the information they provided while using the DAT offered opportunities for reflection. The DAT supported the students' learning by visualizing strengths and areas of improvement, as well as displaying progress using a Likert scale. The application improved communication, but additional features linking the assessment tool with the university were requested. The application contributed to transparency in the assessments and was seen as preferable to the traditional 'pen and paper' method.

    CONCLUSION: A digital system was described in a positive manner, and the assessment using the DAT facilitated reflection and formative assessment. The use of a Likert scale was considered positive in order to demonstrate progression which with advantage could be demonstrated visually.

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  • 8. Olsson, H
    et al.
    Olsson, S
    Sturesson, L
    Lindström, Veronica
    Sophiahemmet University.
    Do we need a pandemic to improve hygiene routines in the ambulance service?: A cross-sectional study2022In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 62, article id 101171Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We know that ambulance staff may have sparse knowledge on how to comply with care approaches that ensure appropriate hygiene in the ambulance, but we do not know if and how the COVID-19 pandemic has affected ambulance staff's perceived compliance with hygiene routines.

    AIM: To investigate ambulance staff's self-reported hand hygiene (HH) perceptions and compliance; and to explore if and how the COVID-19 pandemic has affected ambulance staff's perceived compliance with hygiene routines.

    METHODS: A cross-sectional study design using the WHO-validated Perception Survey for Healthcare Workers regarding hygiene. Thematic analysis and descriptive statistics were used for analysis.

    RESULTS: 204 surveys were analysed, 92% of participants stated that their hygiene routine compliance had improved during the COVID-19 pandemic, and some participants also described that their colleagues' practice had improved. These improvements were reportedly driven by the need to acquire new knowledge to deal with the pandemic and sometimes with fear.

    CONCLUSIONS: Experience acquired during the pandemic needs to be sustainable if we are to increase HH and hygiene routine compliance in ambulance services. Interventions aimed at changing ambulance staff's perceived behaviour are warranted, and stakeholders should try and identify the personal motivations that lead these staff to seek self-betterment regarding HH and hygiene routine compliance. Otherwise, the risk of patients suffering from healthcare-associated infection may not decrease as wished.

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  • 9. Singh, Laura
    et al.
    Kanstrup, Marie
    Depa, Katherine
    Falk, Ann-Charlotte
    Lindström, Veronica
    Sophiahemmet University.
    Dahl, Oili
    Göransson, Katarina E
    Rudman, Ann
    Holmes, Emily A
    Digitalizing a brief intervention to reduce intrusive memories of psychological trauma for health care staff working during COVID-19: Exploratory pilot study with nurses2021In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 5, no 5, article id e27473Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19-related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach.

    OBJECTIVE: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection.

    METHODS: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis.

    RESULTS: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure.

    CONCLUSIONS: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.

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  • 10. Singh, Laura
    et al.
    Kanstrup, Marie
    Gamble, Beau
    Geranmayeh, Anahita
    Göransson, Katarina E
    Rudman, Ann
    Dahl, Oili
    Lindström, Veronica
    Sophiahemmet University.
    Hörberg, Anna
    Holmes, Emily A
    Moulds, Michelle L
    A first remotely-delivered guided brief intervention to reduce intrusive memories of psychological trauma for healthcare staff working during the ongoing COVID-19 pandemic: Study protocol for a randomised controlled trial2022In: Contemporary Clinical Trials Communications, E-ISSN 2451-8654, Vol. 26, article id 100884Article in journal (Refereed)
    Abstract [en]

    Addressing the mental health needs of healthcare staff exposed to psychologically traumatic events at work during the COVID-19 pandemic is a pressing global priority. We need to swiftly develop interventions to target the psychological consequences (e.g., persistent intrusive memories of trauma). Interventions for healthcare staff must be brief, flexible, fitted around the reality and demands of working life under the pandemic, and repeatable during ongoing/further trauma exposure. Intervention delivery during the pandemic should be remote to mitigate risk of infection; e.g., here using a blend of digitalized self-administered materials (e.g., video instructions) and guided (remote) support from a researcher. This parallel groups, two-arm, randomised controlled trial (RCT) with healthcare staff working during the COVID-19 pandemic is the first evaluation of whether a digitalized form of a brief cognitive task intervention, which is remotely-delivered (guided), reduces intrusive memories. Healthcare staff who experience intrusive memories of work-related traumatic event(s) during the COVID-19 pandemic (≥2 in the week before inclusion) will be randomly allocated (1:1) to receive either the cognitive task intervention or an active (attention placebo) control, and followed up at 1-week, 1-month, 3-months, and 6-months post-intervention. The primary outcome will be the number of intrusive memories reported during Week 5; secondary and other outcomes include the number of intrusive memories reported during Week 1, and other intrusive symptoms. Findings will inform further development and dissemination of a brief cognitive task intervention to target intrusive memories.

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  • 11. Venesoja, Anu
    et al.
    Lindström, Veronica
    Sophiahemmet University.
    Aronen, Pasi
    Castrén, Maaret
    Tella, Susanna
    Exploring safety culture in the Finnish ambulance service with Emergency Medical Services Safety Attitudes Questionnaire2021In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 29, no 1, article id 148Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency Medical Services (EMS) is, by its nature, a challenging context that may create risks for both patients and employees. It is also known that an organisation's safety culture has an influence on both patient and employee safety. Finnish EMS organisations lack knowledge of how their safety culture is perceived by their employees.

    AIM: This study aims to test the psychometric properties of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) in a Finnish EMS setting. We also explore the connections between individual- and organisation-based characteristics and safety attitudes in the Finnish EMS.

    METHODS: A cross-sectional survey study design was used. The EMS-SAQ was used to collect data via social media. The instrument measures six domains of workplace safety culture: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions and stress recognition. The 5-point Likert scale was converted to a 100-point scale and mean ≥ 75 was dichotomized as a positive. Confirmatory factor analysis (CFA) was carried out to validate the EMS-SAQ in a Finnish setting. Other results were analysed by using non-parametric tests.

    RESULTS: 327 responses were included in the analysis. CFA showed that the total EMS-SAQ model had acceptable goodness-of-fit values in the Finnish EMS setting. Total mean scores for each safety culture domain were identified non-positively (mean score < 75); safety climate 60.12, teamwork climate 60.92, perceptions of management 56.31, stress recognition 64.55, working conditions 53.43 and job satisfaction 70.36. Higher education was connected to lower job satisfaction and the teamwork climate within the individual characteristics. All organisation-based characteristics caused at least one significant variation in the safety culture domain scores. Working area significantly affected (p < 0.05) five out of the six safety culture domain scores.

    CONCLUSIONS: The EMS-SAQ is a valid tool to evaluate safety culture among the Finnish EMS organisations; it offers a novel method to evaluate safety and patient safety within the Finnish EMS organisations. According to the findings, the organisation-based characteristics more likely had an impact on safety attitudes than did the individual-based characteristics. Therefore, it is suggested that the Finnish EMS organisations undertake safety culture development at the organisational level.

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  • 12. Venesoja, Anu
    et al.
    Lindström, Veronica
    Sophiahemmet University.
    Castrén, Maaret
    Tella, Susanna
    Prehospital nursing students' experiences of patient safety culture in emergency medical services: A qualitative study2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 5-6, p. 847-858Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship.

    BACKGROUND: Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills.

    DESIGN: The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions.

    METHODS: Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study.

    RESULTS: Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork.

    CONCLUSIONS: This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services.

    RELEVANCE TO CLINICAL PRACTICE: Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.

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  • 13. Venesoja, Anu
    et al.
    Tella, Susanna
    Castrén, Maaret
    Lindström, Veronica
    Sophiahemmet University.
    Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: A qualitative study2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 4, p. e067754-, article id e067754Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aimed to describe emergency medical services (EMS) managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues in the EMS.

    DESIGN: The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study.

    SETTING: EMS organisations from Finland's five healthcare districts.

    PARTICIPANTS: EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used.

    RESULTS: Two main themes, 'Patient safety considered an organisational responsibility' and 'EMS patients' opportunities and obstacles to speaking up', were generated from the data. Under the main theme, 'Patient safety considered an organisational responsibility', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management's ability to find a balance when using patients' feedback for patient safety development. Under the other main theme were four subthemes: 'social and feedback skills of EMS personnel and management', 'managements' assumptions of patients' reasons for not speaking up', 'EMS organisations' different but unsystematic ways of collecting feedback' and 'management's openness to develop patient participation'.

    CONCLUSIONS: The nature of the EMS organisations and EMS assignments could affect a patient's participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management's collaborating with patients.

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