Mid Sweden University

Bakgrund: Barns rätt att delta i vården är fastslagen i lagstiftning och professionell etik. I den prehospitala vården utmanas denna rätt av tidspress, osäkerhet i att vårda barn och en miljö utformad för vuxna. Dessa faktorer kan skapa svårigheter i vården av barn, och tidigare forskning har visat att vårdinsatser ibland uteblir när patienten är ett barn. I flera regioner i Sverige finns särskilda barnombud inom ambulanssjukvården med uppdrag att främja barns rättigheter. Deras perspektiv ger viktig kunskap om hur barns delaktighet kan möjliggöras i akuta vårdmöten.

Syfte: Att utforska barnombuds uppfattningar om barns möjligheter till delaktighet i prehospital akutsjukvård.

Metod: En kvalitativ design med fenomenografisk ansats användes. Tio barnombud verksamma inom svensk ambulanssjukvård intervjuades under våren 2024. Intervjuerna analyserades induktivt för att identifiera variationer i hur barns delaktighet uppfattas och förstås.

Resultat: Barnombuden beskrev barns delaktighet som möjlig även under akuta förhållanden, men beroende av ambulanspersonalens attityd, erfarenhet och förmåga att skapa relation. Erfarenhet och trygghet i att vårda barn främjade kommunikation och empatiska möten, medan osäkerhet ofta ledde till ett mer uppgiftsfokuserat arbetssätt. Barns ålder, situationens allvar och föräldrars känslomässiga tillstånd påverkade hur mycket barnet kunde involveras, men även små handlingar, som att låta barnet välja färg på ett bandage, använda lek eller att väcka nyfikenhet, kunde minska rädsla och stärka delaktighet. Ambulansmiljön upplevdes som vuxencentrerad,men barnombuden betonade att kreativitet och vilja kunde omvandla även begränsade förutsättningar till delaktiga möten.

Slutsats:Barns delaktighet i prehospital vård formas i första hand av professionell vilja, snarare än av yttre begränsningar. För att barn ska kunna göras delaktiga krävs utbildning i barncentrerad kommunikation, strukturellt stöd och barnanpassade resurser. Delaktighet i ambulanssjukvård bör betraktas som en etisk och professionell kompetens, möjlig även i akutasituationer när vårdpersonal aktivt bekräftar barnet som del av vårdmötet.

Children have the right to express their views and to have those views considered respectfully in matters affecting them, as articulated in Article 12 of the United Nations Convention on the Rights of the Child. In emergency care, this right must be balanced with the child's best interests, particularly when illness, distress or developmental or cognitive factors limit a child's ability to participate directly (Article 3). Little is known about how this is implemented in prehospital emergency care. This study explores how children's participation occurs during ambulance care, as perceived by their parents, using Shier's ‘Pathways to Participation’ model. A qualitative study involving semi-structured interviews with 12 parents (nine mothers and three fathers) of 12 children (five females and seven males, aged 0–14) who received ambulance care in Sweden was conducted. A deductive content analysis was performed, guided by Shier's five-level participation model. Ethical approval was obtained. Participation was described at the first levels of Shier's model: children being listened to, supported in expressing their views and having their views considered. Parents described how emergency medical services clinicians used age-appropriate language, adjusted tone and body language and made meaningful adaptations. Preverbal children were included through non-verbal interaction and emotional presence. However, higher levels of participation were absent. Participation appeared relational and dependent on individual clinicians’ communication style. Participation was more likely when time allowed and less likely during urgent interventions. Children's participation in prehospital emergency care is not only feasible but already realised through relational and responsive clinical behaviours. However, participation is inconsistent and dependent on individual clinicians rather than embedded structures. To align practice with Article 12, clinicians should consider implementing training and clinical routines that facilitate child participation. These findings contribute to evidence that child-centred care is possible in fast-paced emergency contexts.

Background: Communication is central to implementing palliative care (PC) and effective interdisciplinary team functioning. Communication about existential issues is often urgent in PC, yet interdisciplinary teams frequently lack the time and education to meet these communication needs. Thus, more knowledge of existential conversations in different PC contexts is required. Aim: This study aimed to gain an in-depth understanding of healthcare professionals’ (HCPs) experiences of existential conversations with patients with PC needs and their next-of-kin by generating a theoretical model. Method: Seven focus-group interviews that included 26 HCPs who worked with PC patients in different care settings were carried out in 2020 and 2022. The grounded theory method was used to analyse and compare data from the interview transcripts. Results: The HCPs’ primary concern in daily work was establishing a trusting relationship, a prerequisite for enabling existential conversations with a person with PC needs and/or their next-of-kin. The main concern was characterised by the core category maintaining presence and four categories describing interdisciplinary strategies that the HCPs used to achieve a trusting relationship and enable existential conversations in the late phase of life. Several potential barriers also hindered existential conversations. The theoretical model ‘meaningful existential conversations in PC’ was constructed. Conclusions: The interdisciplinary strategies used to establish existential conversations, the potential barriers to these conversations and the model we present can be used as a basis for reflection in professional collaborative learning in PC, as a tool for teachers in educational PC programmes and as a guide for HCPs in PC. 

Introduction

Ambulance nurses’ (ANs) feel less confident treating children. According to the United Nations Convention on Child Rights, there is a provision to safeguard children’s rights. Child-Centered Care (CCC) strives to lift children’s voices in healthcare.

Aim

To describe ambulance nurses’ experiences of facilitating child-friendly care.MethodA qualitative approach with Reflexive Thematic Analysis was performed on seventeen individual semi-structured interviews.

Result

One overarching theme, caring with the child in center, and three themes were developed: adapting to follow the child’s lead, being reliable by balancing the trust, stepping back and supporting.

Discussion

The ANs’ communication with the children was honest and straightforward. Letting the child and the parents perform the care together reduced the child’s anxiety. Guided participation was used by ANs, expanding the child’s initiative.ConclusionThe ANs work according to CCC, but unknowingly. It is important and beneficial to elevate the CCC to a conscious level. The ANs could refer to CCC in training new colleagues, reflecting on cases, and incorporating the Child Act in their work.

Background: Care encounters with children are a challenging and important task, but opportunities for such encounters are rarely available. Therefore, ambulance nurses (ANs) face difficulties in gaining experience in properly handling children, which can lead to stress for the ANs. A deeper understanding of ANs’ emotions through the course of the care encounter is needed.

Aim: To describe how ambulance nurses’ feel and manage their emotions before, during and after a care encounter with a child.

Methods: A qualitative approach was adopted, with content analysis being performed on seventeen individual interviews.

Findings: Three themes were identified: Feeling worried and insecure, Emotional surge, and Mixed feelings of satisfaction and concern.

Conclusion: The ANs experienced a range of emotions during a care encounter with children as they had little experience with it. More training and education in paediatric care could benefit ANs. The ANs use professionalism during care encounters to create a calm and secure atmosphere for families. Their will to bring about a safe journey for the child and family through the care encounter supersedes their nervousness. Reflection after a care encounter could strengthen their confidence in their professional role and reduce emotional distress in future encounters. 

Background/Introduction: Ambulance nurses (ANs) experience a range of emotions in caring for children, feeling anxious and nervous if they lack experience or training (1). There is also an expectation for them to be respectful of the child´s autonomy, described in child-centered care (CCC) (2). ANs handle these challenges by stepping in to their professional role or pretending to be calm (1). Hence, it is important to research about how ANs create child friendliness. 

Objectives: To describe the experiences of ANs in creating child-friendly care encounters.

Methods: Seventeen individual semi-structured interviews with ANs were analyzed using the reflexive thematic analysis (3). 

Results: The themes (see figure 1) show the adaptation carried out by the ANs in caring for the child. They let the child set the pace in an encounter, employing sensitivity to the child´s signals. ANs were honest and direct, safeguarding the trust, allowing the participation of both child and parents in the care. Staying in the background when possible, letting the child and parents be close. ANs strived to maintain the child-centeredness of the care, prioritizing the child´s autonomy.

Conclusion: Although not aware, ANs work with a strong connection to CCC. The ANs’ care links to multiple key factors in CCC, such as child´s perspective and guided participation (2). This should be highlighted to strengthen the ANs perception of the care given and benefit the children by clearly define the importance of respecting their autonomy.

Figure 1. Overview of the overarching theme and themes

References 

1. Näsström M, Junehag L, Häggström M, Holmström-Rising M. An emotional journey when encountering children in prehospital care: Experiences from ambulance nurses. International Emergency Nursing 2023;66.

2. Coyne I, Hallstrom I, Soderback M. Reframing the focus from a family-centred to a child-centred care approach for children's healthcare. Journal of Child Health Care 2016;20(4):494-502.

3. Braun V, Clarke V. Thematic analysis : a practical guide. SAGE; 2022.

Background: Ambulance nurses (ANs) perform their work in situations which have not been planned. In such settings, the care of children can be extra challenging. Challenges might be pharmaceutical dosage, vital parameters that differ from adults, and the child's verbal development. Despite such challenges, the ANs must make the child participatory and listen to the child's voice. Such measures are described in child-centred care (CCC), which highlights the importance of care from the child's perspective.  

Aim: To describe ambulance nurses' experiences of facilitating child-friendly care encounters.  

Method: Seventeen individual semi-structured interviews were analysed with Reflexive Thematic Analysis.  

Result: The overarching theme, Caring with the child in centre, consists of three themes that describe the ANs' efforts to keep the child in the centre of care. The three themes constitute Adapting to follow the child's lead, describing how the ANs adapted themselves and the child's care, and constantly being sensitive to the child's signals. Being reliable by balancing the trust highlighting the honest and direct communication with the child, and describing the role of proxy when the child's condition was acute. Last, Stepping back and supporting showing the AN's role as a guide in the care, letting the child and parent perform as much as possible, however always with the AN present in the background.  

Discussion: The result indicates that the ANs work accordingly to CCC without it being expressed or aware. The importance of sensitivity to the child's perspective and autonomy is highlighted in CCC and is a typical work method for the ANs. Their communication with the child and the parents was direct and honest. That was considered imperative to safeguard the trust of the child. Earlier research describes the use of distractions to ease anxiety for the child. The present study suggests that the ANs instead use guided participation to make the child feel included and heard, thus reducing anxiety.  

Conclusion: It can be beneficial to make the ANs close link to CCC made aware, to make it conscious and deliberate. By doing so, CCC and its closeness to the Child Act can be used in the training and development of pediatric care within the ambulance service. In addition, it can be important for the ANs to learn of the high care level they give the children.

För framtidens specialistsjuksköterskor krävs professionskunskaper i kombination med yrkesskrivande och akademiskt skrivande, det vill säga ämnesintegrerad skrivdidaktik. Med inspiration från Skrivlyftet vid Mittuniversitetet har vi lärare inom tre specialistutbildningar utvecklat en kurs. En inventering våra specialistsjuksköterskeutbildningar genomfördes, den visade att det saknades uttalade lärandemål kring läsande och skrivande. Därför är syftet med presentationen att föra en fördjupad diskussion kring tillblivelsen av kursen ”Ämnesintegrerad skrivdidaktik inom specialistsjuksköterskeutbildning”. Kursen består av olika delmoment från formellt skrivande och konstruktiv respons till ett väl utvecklat yrkesskrivande och akademiskt skrivande. Under arbetet med kursen har utvecklats i vår lärarroll och dessutom skapat ett forum där vi kan inspireras och hämta kraft. Arbetssituationen har blivit mer begriplig, hanterbar och meningsfull och har resulterat i en ”känsla av sammanhang”. Kursen har inte fått den genomslagskraft som önskat och kommer i nuläget inte att genomföras. Förhoppningen är dock att våra erfarenheter kan bidra med inspiration och kunskaper inför andra utbildningars framtida kursutvecklingar kring ämnesintegrerad skrivdidaktik.

Referenser:

Borglin, G. (2012). Promoting critical thinking and academic writing skills in nurse education. Nurse Education Today, 32. 611–613.

Jefferies, D., McNally, S., Roberts, K., Wallace, A., Stunden, A., D’Souza, S., & Glew, P. (2018). The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: A systematic review. Nurse Education Today, 60. 84-91.

Mitchell, K., Blanchard, L., & Roberts, T. (2020). Seeking transformation: how students in nursing view their academic writing context – a qualitative systematic review. International Journal of Nursing Education Scholarship, (17). 1. 2–14.

Wingate, U. (2019). Achieving transformation through collaboration: the role of academic literacies. Journal of Learning Development in Higher Education, (15).

Introduktion Antalet larm som handlar om barn är få till antalet (1-3). Att vårda barn är en uppgift som kan väcka känslor av stress hos ambulanssjuksköterskorna (AS) (2).

Syfte Att beskriva ambulanssjuksköterskornas känslor och hanteringen av dessa, före, under och efter vårdmöten med barn.

Metod En kvalitativ design har använts relevant utifrån syftet (4). Sjutton individuella intervjuer genomfördes.

Resultat Innan larm kände sig AS osäkra kring vårdmöten med barn, det var svårare än larm om vuxna på grund av få larm och svårigheterna att få erfarenhet. På väg ut kände de anspänning, känslor av att inget får gå fel. Att åka med erfarna kollegor innebar känslor av trygghet och lugn. Teamet kunde ge lugn. På plats klev de in i den professionella rollen, för vissa innebärandes känslor av säkerhet och trygghet. För andra, att skärma av sig från egna känslor och sätta upp en lugn front. De kunde känna frustration när de inte kunde hjälpa barnet, ibland irritation då föräldrar störde deras interaktion med barnet. Vid avlämningen kände AS ansvar och beskyddande över barnet och ville ge en sömlös övergång till nästa vårdare. De kände ansvar över att förklara för barnet att deras resa var slut och kunde känna saknad om det avslutet uteblev. Efter avlämning kunde AS uppleva en mix av känslor, tillfredställelse av prestationen och bekymmer över det som inträffat. Teamet kunde reflektera över det som inträffat och känslorna kring det.  

Diskussion Utbildning i vård av barn kan minska stress, även visat av Nordén m fl (5). Tillit inom teamet kan påverka vårdmötet. En känsla av ansvar för varandra, likt Vicente m fl (6), fanns bland AS. Den professionella rollen är tvådelad men syftar båda till att ge barnet ett tryggt möte, likt Svensson m fl och Waldow (7, 8). Att reflektera enskilt och tillsammans kan stärka teamet och den enskilde i yrkesutövning genom att skapa en lärandeprocess, visat av Bohström m fl (9), och arbetsgivaren bör bereda tillfällen för detta.  

Referenser 

1. Harve H, Salmi H, Rahiala E, Pohjalainen P, Kuisma M. Out-of-hospital paediatric emergencies: a prospective, population-based study. Acta Anaesthesiologica Scandinavica 2016;60(3):360-9. 

2. Jeruzal JN, Boland LL, Frazer MS, Kamrud JW, Myers RN, Lick CJ, et al. Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study. Prehospital Emergency Care 2019;23(4):501-9. 

3. Jewkes F. Prehospital emergency care for children. Archives of Disease in Childhood 2001;84(2):103-5. 

4. Polit DF, Beck CT. Nursing Research : generating and assessing evidence for nursing practice. Eleventh edition. International edition uppl.; 2021. 

5. Nordén C, Hult K, Engström Å. Ambulance nurses’ experiences of nursing critically ill and injured children: A difficult aspect of ambulance nursing care. International Emergency Nursing 2014;22(2):75-80. 

6. Vicente V, Jansson J, Wikström M, Danehorn E, Rubenson Wahlin R. Prehospital Emergency Nurses' coping strategies associated to traumatic experiences. International Emergency Nursing 2021;59:N.PAG-N.PAG. 

7. Svensson C, Bremer A, Holmberg M. Ambulance nurses’ experiences of patient relationships in urgent and emergency situations: A qualitative exploration. Clinical Ethics 2019;14(2):70-9. 

8. Waldow VR. Collaborative care in health institutions: The nurse as integrator. Texto & Contexto Enfermagem 2014;23(4):1145-52. 

9. Bohström D, Carlström E, Sjöström N. Managing stress in prehospital care: Strategies used by ambulance nurses. International Emergency Nursing 2017;32:28-33.