Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians
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 asse...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e030203.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850065945607798784 |
|---|---|
| author | Veronica Lindström Jakob Lederman Caroline Löfvenmark Therese Djärv Carina Elmqvist |
| author_facet | Veronica Lindström Jakob Lederman Caroline Löfvenmark Therese Djärv Carina Elmqvist |
| author_sort | Veronica Lindström |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-80ee81a5e7774e4cbdc5920a1ea9b17f |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-80ee81a5e7774e4cbdc5920a1ea9b17f2025-08-20T02:48:53ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-030203Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance cliniciansVeronica Lindström0Jakob Lederman1Caroline Löfvenmark2Therese Djärv3Carina Elmqvist4Samariten Ambulance, Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden3 Division of Cardiovascular Medicine, Danderyds Hospital, Karolinska Institutet, Stockholm, SwedenDepartment of Medicine Solna, Karolinska Institutet, Stockholm, SwedenCentre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, SwedenObjectives 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.https://bmjopen.bmj.com/content/9/9/e030203.full |
| spellingShingle | Veronica Lindström Jakob Lederman Caroline Löfvenmark Therese Djärv Carina Elmqvist Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians BMJ Open |
| title | Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians |
| title_full | Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians |
| title_fullStr | Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians |
| title_full_unstemmed | Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians |
| title_short | Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians |
| title_sort | assessing non conveyed patients in the ambulance service a phenomenological interview study with swedish ambulance clinicians |
| url | https://bmjopen.bmj.com/content/9/9/e030203.full |
| work_keys_str_mv | AT veronicalindstrom assessingnonconveyedpatientsintheambulanceserviceaphenomenologicalinterviewstudywithswedishambulanceclinicians AT jakoblederman assessingnonconveyedpatientsintheambulanceserviceaphenomenologicalinterviewstudywithswedishambulanceclinicians AT carolinelofvenmark assessingnonconveyedpatientsintheambulanceserviceaphenomenologicalinterviewstudywithswedishambulanceclinicians AT theresedjarv assessingnonconveyedpatientsintheambulanceserviceaphenomenologicalinterviewstudywithswedishambulanceclinicians AT carinaelmqvist assessingnonconveyedpatientsintheambulanceserviceaphenomenologicalinterviewstudywithswedishambulanceclinicians |