“A call for a clear assignment” – A focus group study of the ambulance service in Sweden, as experienced by present and former employees

doi:10.1016/j.ienj.2017.07.003

International Emergency Nursing

Volume 36, January 2018, Pages 1-6

https://doi.org/10.1016/j.ienj.2017.07.003 Get rights and content

Highlights

•
The AS was described as complex, including different patients and settings.
•
The participants perceived the ambulance mission statement as unclear.
•
There is a discrepancy between the anticipated assignments and the working reality.

Abstract

Aim

The aim was to explore the ambulance service as experienced by present and former employees.

Background

Over the last decade, the number of ambulance assignments has increased annually by about 10%, and as many as 50% of all ambulance assignments are considered non-urgent. This raises questions about which assignments the Ambulance Service (AS) is supposed to deal with.

Design/method

Data were collected from three focus group interviews with a total of 18 present and former employees of the Swedish AS. An inductive qualitative analysis method developed by Krueger was chosen.

Results

Five themes emerged in the analysis: “Poor guidance for practice”, “An unclear assignment”, “Being a gate keeper”, “From saving lives to self-care” and “Working in no man’s land”, which together constitute the AS.

Conclusion

Present and former employees of the AS in Sweden describe their mission as unclear and recognize the lack of consensus and a clearly developed mission statement. Furthermore, expectations and training mainly focus on emergency response, which is contrary to the reality of the ambulance clinicians’ everyday work.

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.

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View full text

“A call for a clear assignment” – A focus group study of the ambulance service in Sweden, as experienced by present and former employees

Highlights

Abstract

Aim

Background

Design/method

Results

Conclusion

Section snippets

Background

Aim

Design

Participants and setting

Results

Reflection on the findings

Conclusion

Ethical considerations

Funding

Author contributions

Conflict of interest

Acknowledgement

J Emerg Med

Int Emerg Nurs

Int Emerg Nurs

Int Emerg Nurs

Prehosp Emerg Care

Int Emerg Nurs

Int Emerg Nurs

Int Emerg Nurs

Int Emerg Nurs

Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

Emerg Med J

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