5 RESULTAT
7.1 Förslag på vidare forskning
Forskningsområdet kring prehospital smärtlindring är relativt sparsamt utforskat. Detta troligtvis för att i de flesta länder är det ej legitimerad personal som arbetar prehospitalt. Den stora majoriteten av forskningen inom prehospital smärtlindring är fokuserat på den
ospecificerade vuxna befolkningen samt den pediatriska populationen och hur faktorer påverkar den vården. Det finns ett större behov av forskning på den äldre befolkningen över 65 år, där forskningen inte enbart är riktat mot patienter med höftfrakturer. Det finns även en lucka i forskningen som undersöker dessa faktorer hos patienter med
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BILAGA A – ARTIKELMATRIS
Databas, tidskrift, år, land Titel, författare Syfte Metod, design, deltagare,
Etik Resultat
PubMed ,
Scandinavian Journal of Pain 817–22, 2015 Sweden Prehospital personnel’s attitudes to pain management Castrén, Lindström, Branzell, & Niemi- Murola,
the aim of this study was to survey the attitudes towards pain management among the prehospital personnel in the metropolitan areas of Helsinki, Finland, and Stockholm, Sweden. Qualative observational study. A questionnaire with 36 items was distributed to prehospital personnel working in Helsinki, Finland (n = 70) and to prehospital personnel working in Stockholm, Sweden (n = 634). Ethically approved The prehospital personnel from Sweden showed significantly more Hesitation to
administer pain relief compared to the Finnish personnel (mean 2.01 SD 0.539 vs. 1.67 SD 0.530, p < 0.001). Those who had received pain
education at their workplace showed significantly less Hesitation than those who had not
participated in education. There was a significant negative correlation (p < 0.01) between Hesitation and Side effects. There was also a statistically significant (p < 0.01) correlation between Perceptions and Hesitation, indicating that a stoic attitude towards pain was associated with indifference to
possible Side effects of pain medication (p < 0.05).
PubMed
American Journal of Emergency Medicine 37 2019
Sweden
The intensity of pain in the prehospital setting is most strongly reflected in the respiratory rate among physiological parameters Andersson, Salmir, Herlitz, Hjertonsson, & Axelsson. evaluate whether there is a clinically meaningful association between the patients’ estimated intensity of pain and vital para- meters (heart rate, systolic blood pressure and respiratory rate) and vegetative symptoms (cold sweat and paleness). retrospective, non- experimental, observational (reg- ister) study of 19,908 patients Ethically approved In all, 19,908 patients were studied (51% women). There were significant associa- tions between intensity of pain and the respiratory rate (r = 0.198; p < 0.0001), heart rate (r = 0.037; p < 0.0001), systolic blood pressure (r = 0.029; p < 0.0001), moist skin (r = 0.143; p < 0.0001) and pale- ness (r = 0.171; p < 0.0001). The strongest association was found with respiratory rate among patients aged 18–64 years (r = 0.258; p < 0.0001).
PubMed
International Emergency Nursing 46 2019
Sweden
Ambulance nurse’s experience to relieve pain in patients with addiction problems in Sweden
Bohm, Lund,
The aim of this study has been to describe PENs’ experiences of relieving pain in patients with addiction problems, qualitative approach with semistructured interviews. 8 interviews in total Ethically approved
The study's main finding is that the PENs wanted to give all patients equal care but often experienced uncertainty in the care of addicts. Many of the
Substance Abuse Syndrom (SAS).
created a doubt in what situations would be resolved. Lack of information and knowledge about addiction and their own feelings and values of addicts made it difficult to decide what was right or wrong treatment. The difficulty was further increased when the unclear guidelines and lack of support meant that the treatment still perceived to be different.
PubMed
International Emergency Nursing 43, 23–28 2019 Sweden Nurses’ experiences of prehospital care encounters with children in pain Holmström, Junehag, Velander, Lundberg, Ek & Häggström
The aim of this study was to describe nurses’ experiences in prehospital care encounters with children in pain and the specific related challenges.
qualitative, descriptive design and data was col- lected with focus group interviews and analysed with inductive quali- tative content analysis. 18 interviews in total
Ethically approved
The findings consist of a theme, “A challenge to shift focus and adjust to the child”, and three cate- gories describing prehospital care encounters with children in pain: “Being receptive and focusing on care,” “Developing a trusting relationship,” and “Providing
professional nursing care.” Caring for children in pain was
stressful for the nurses. The nurses described how they had to shift focus and used different
methods to build trust, such as playfulness, making eye contact, attracting curiosity, and using the parents to create trust. The also had to adjust to the child regarding dosages and materials.
PubMed
International Emergency Nursing 36, 39–45 2018
Sweden
Specialist nurses’ experiences when caring for preverbal children in pain in the prehospital context in Sweden
Gunnvall, Augustsson,
Lindström & Vicente
The aim of this study has been to examine PENs’ experiences of pain management during pre- hospital care of preverbal children, based on PENs’ given mission to alleviate patients’ suffering. 8 semi structured interviews with a qualitative approach Ethically approved
findings shows that a lifeworld perspective with a family- centred approach may support PENs in alleviating pain and suffering in preverbal children. What is required to meet children’s specific needs and security are customised
prehospital guidelines consisting of both medical and care guidelines;
collaboration within a multidisciplinary team; clinical skills and education
PubMed
International emergency nursing, Vol.23(3), p.244-249 2015 Sweden Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study.
Jakopovic, Falk & Lindström.
The purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture 22 Interviews with a A qualitative approach Ethically approved
The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to
individualize the pain relief for patients with a suspected hip fracture through a variety of interventions. PubMed Injury, Vol.43(9), p.1397-1402 2012 Netherlands Facilitators and barriers in pain management for trauma patients in the chain of emergency care.
Berben, Meijsb, van Grunsvenc,
Schoonhovend & Achterberg
The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. 10 Interviews with a A qualitative approach
This study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of
knowledge, attitude, professional communication, organisational aspects and ”patient input”, PubMed
International Journal of Orthopaedic and Trauma Nursing Volume 27, Pages 23-27
Ambulance personnel's
management of pain for patients with hip fractures; based on
the aim of this study was to describe ambulance personnel's assessments and A retrospective study of 722 patients Ethically approved
Most patients reported experiencing pain and 50% received pain medication.
2017 Sweden ambulance personnel's gender and years of experience
Alm Pfrunder, Falk & Lindström.
the pain relief they provide for patients with hip fractures, based on the ambulance personnel's gender and years of experience 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 give pain
medication more often compared to female personnel, but this tendency showed no significance. PubMed BMC Emergency Medicine., 2016. Sweden
Do male and female trauma patients receive the same prehospital care?: an observational follow- up study.
Rubenson Wahlin, Ponzer, Lövbrand, Skrivfars, Lossius & Castrén.
The aim of this study was to explore gender- related differences in prehospital trauma care of severely injured trauma patients, with a special focus on triage, transportation, and interventions.. etrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County, Sweden. A total of 383 trauma patients Ethically approved
Male patients had a 2.75 higher odds ratio (95 % CI, 1.2-6.2) for receiving the highest prehospital priority compared to females on controlling for injury mechanism and vital signs on scene. No significant difference between genders was detected regarding other aspects of the prehospital care provided..
PubMed Prehospital analgesia
using nasal
we describe the use of nasally Observational study of 9 case reports. Ethically approved VAS-score decreased from a median of 10
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine., 21. 2013 Sweden ketamine--a case series. Johansson, Sjöberg, Nordgren,
Sandström, Sjöberg & Zetterström. Ketamine in 9 cases. 10) to 3 (interquartile range 2-4). Nasally administered S- Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S- ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment
should be further studied. CINAHL Burns., Vol.42(4), p.777-782 2016 Netherlands Early management in children with burns: Cooling, wound care and pain
management Baartmans, de Jong, van Baar,
Beerthuizen, van Loey, Tibboel & Nieuwenhuis
The aim of this study was to evaluate the current practice in the Netherlands and factors related to early management in pediatric burns, i.e. cooling, wound covering and pain management. To study possible change and improvement over time, two study periods were compared.
Observational study over two periodes. Data were obtained from patient records, both retrospectively and prospectively of 323+299 cases Ethically approved A total of 323 and 299 children were included in periods 1 and 2, respectively. The vast majority of children in both study periods had been cooled before admission (>90%). Over time, wound covering increased significantly (from 64% to 89%) as well as pain treatment (from 68% to 79%). Predominantly paracetamol and morphine were used. Referral from ambulance services (OR = 41.4, 95%CI = 16.6–103.0) or general practitioners (OR = 59.7, 95%CI = 25.1–141.8) were strong independent predictors for not receiving pre-burn center pain medication. On the other hand, flame burns (OR = 0.2, 95%CI = 0.1–0.5) and
(TBSA 5–10%: OR = 0.4, 95%CI = −0.2 to 0.8; TBSA ≥ 10%: OR = 0.2, 95%CI = 0.1–0.4) were independent predictors of receiving pain medication. CINAHL
Journal Prehospital Emergency Care Volume 16, Issue 4, Pages 519-526 2012 USA Barriers to and Enablers for Prehospital Analgesia for Pediatric Patients Williams, Rindal, Cushman & Shah
To identify and investigate the barriers and enablers perceived by paramedics regarding the administration of analgesia to pediatric emergency medical services (EMS) patients.. qualitative study in which in-depth semistructured interviews of a purposively-sampled group of 16 paramedics Ethically approved Thirteen of 16 paramedics reported success with analgesia in children at least once in their careers. Provider anxiety, unfamiliarity and discomfort with pediatrics,
unfamiliarity with the protocol, insufficient didactic and clinical education, and concern for adverse effects from analgesic agents were perceived as barriers to pediatric pain management. The paramedics had differing beliefs about the importance of pain control, the role of parents in medical care for children, and the paramedic's ability to assess pediatric patients. Having a positive relationship
with online medical control and using commercially available assistive guides were