Equal health-care services from a prehospital emergency care perspective

All health-care service should provide good health and care on equal terms for the entire population, regardless of their place of residence, age, sex, disability, education, social status, ethnic or religious affiliation or sexual orientation. The ambulance service is part of the prehospital chain of care which is primarily responsible for the assessment of urgent care and transport of patients. An ambulance team in Stockholm consists of one emergency care nurse and one emergency medical technician. Medical guidelines are used aiming to support the ambulance team to make the right decision concerning the health care management. However, little is known about equal care in the ambulance service and therefore the overall aim of this thesis was to explore the care of patients by the ambulance personnel from an equality perspective. In study I, the aim of the study was to describe, based on the ambulance personnel's gender and years of experience. A retrospective study of patients (>65 years) with hip fracture who, during 2011 (n=722), were transported by ambulance to hospital. Most patients reported experiencing pain and 50% received pain medication. Ambulance personnel with working experience of <10 years administered more pain medication compared to those with experience of >10 years. There was a tendency for male ambulance personnel to administer pain medication more often compared to female personnel, but this tendency showed no significance. The main finding of the study was that personnel with working experience of less than 10 years administer more pain relief, even though only half of the patients received pain medication during ambulance transportation.

In study II the aim was to explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish-English proficiency. A qualitative study design based on interviews was used and a purposeful sample and snowball technique was used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish-English proficiency. Eleven nurses were interviewed, and the main strategy they used was adapting to the patients' need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department since they had not found a secure way of assessing and caring for the patients in the ambulance.

In conclusion the nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker.

List of scientific papers

I. Alm Pfrunder A, Falk A-C & Lindström V. (2017). Ambulance personnel's management of pain for patient with hip fractures, based on ambulance personnel's gender and years of experience. International Journal of Orthopaedic and Trauma Nursing. 27:23-27.
https://doi.org/10.1016/j.ijotn.2017.06.001

II. Alm Pfrunder A, Falk A-C, Vicente V & Lindström V. (2018). Prehospital emergency care nurses' strategies while caring for patients with limited Swedish – English proficiency. Journal of Clinical Nursing. [Accepted]
https://doi.org/10.1111/jocn.14484