“A call for a clear assignment” – A focus group study of the ambulance service in Sweden, as experienced by present and former employees
Section snippets
Background
A more or less universal definition of the Ambulance Service (AS) is an organization that provides advanced medical care to out-of-hospital patients [1], [2]. The rationale behind this study is that the Swedish context and legislation contain three somewhat poorly developed definitions; An ambulance is “a means of transportation designed and equipped for ambulance care and transport of sick and injured individuals/persons”, the AS delivers “Health care provided by health and medical personnel
Aim
The aim was to explore the ambulance service as experienced by present and former employees.
Design
The focus group method, in which data are generated by discussion among the participants, was used in this study. Group interaction during the interview is thus an important part of the method [17]. A focus group usually consists of 3–12 persons who represent the target group, a moderator who leads the discussion and an observer who takes notes. The environment in the focus group should encourage all participants to express their views and why they think in a certain way [18], [19].
Participants and setting
The
Results
The results are presented in five themes, which together constitute the AS. The themes are: “Poor guidance for practice”, “An unclear assignment”, “Being a gate keeper”, “From saving lives to self-care” and “Working in no man’s land”. The themes are illustrated by a selection of the participant’s discussions using fictitious names.
Reflection on the findings
The aim of this study was to explore what constitutes the AS in the eyes of present and former employees. We found that the participants experienced AS assignment as unclear and complex, i.e., caring for different age groups and diagnoses in a large variety of settings.
The lack of clarity about the assignment meant uncertainty about which patients were to be taken care of and who was entitled to call for an ambulance. The perception of the assignment differed between the ACs themselves and it
Conclusion
The participants described the AS as a complex, uncertain and rather ambiguous organization that lacks a clear definition of its mission. Furthermore, AC authorization, medical guidelines and the composition of the AS team vary within and between the counties of Sweden. As training focuses on emergency response, there is a problematic discrepancy between the anticipated type of assignments and the perceived working reality. According to the participants, there is an obvious need for
Ethical considerations
As the study did not involve patients, ethical approval was not required in accordance with the Swedish Law concerning Ethical Review or Research Involving Humans (SFS 2003:460). Ethical considerations on information, consent, confidentiality and utility were taken into account and are in line with the Declaration of Helsinki [20]. All participants received verbal and written information about the study aim and provided written informed consent.
Funding
This study received no grant from any funding agency in the public, commercial or non-profit sectors.
Author contributions
Study concept and design: HR, JP, AR and LB. Data collection: HR, JP, AR and LB. Analysis of the data: HR and LB. Drafting and revision of the manuscript: HR, JP, AR and LB.
Conflict of interest
The authors declare that there is no conflict of interest
Acknowledgement
We would like to thank all participants for their contribution to the study.
References (37)
- et al.
Medical emergency triage and treatment system (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine
J Emerg Med
(2011) - et al.
Reliability of a Swedish pre-hospital dispatch system in prioritizing patients
Int Emerg Nurs
(2013) - et al.
The meaning of being triaged to non-emergency ambulance care as experienced by patients
Int Emerg Nurs
(2016) - et al.
Pre-hospital assessment by a single-responder: the Swedish ambulance nurse in a new role: a pilot study
Int Emerg Nurs
(2016) - et al.
Prospective determination of medical necessity for ambulance transport by paramedics
Prehosp Emerg Care
(2003) - et al.
Factors influencing decision making among ambulance nurses in emergency care situations
Int Emerg Nurs
(2009) - et al.
The desired competence of the Swedish ambulance nurse according to the professionals – a delphi study
Int Emerg Nurs
(2014) - et al.
Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions
Int Emerg Nurs
(2011) - et al.
Reflective and collaborative skills enhances ambulance nurses' competence – a study based on qualitative analysis of professional experiences
Int Emerg Nurs
(2017) - et al.
Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service
Emerg Med J
(2014)
A qualitative study of decision-making and safety in ambulance service transitions
Health Serv Delivery Res
Rapid development of the new ambulances. From emergency transports to mobile emergency care
Lakartidningen
Introduction to the “space-control theory of paramedic scene management”
Emerg Med J
Work as a moral act: how emergency medical technicians understand their work
A new profession in the pre-hospital care field–the ambulance nurse
Nurs Crit Care
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