Licentiatavhandlingens resultat pekar på att doktorsavhandlingens fortsatta inriktning bör fokusera på hur ambulanspersonal kan uppleva etiska aspekter och problem vid vård av patient med hjärtstopp samt omhändertagande av närstående i kris. Utifrån forskningens tre empiriska studier av fenomenet ”att erfara hjärtstopp utanför sjukhus” bör en fjärde studie i form av teoretisk fördjupning kunna belysa centrala etiska aspekter och problem av betydelse för vårdandet.
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STUDIE I
Acknowledgements
This project has been generously supported by the ‘Etik i vården’ program, which is sponsored by the Swedish research foundations Barncancerfonden, Hjärt-Lungfonden, Vårdalstiftelsen and the Swedish Research Council. We are grateful to all the participants in this study for willingly sharing their experiences and lifeworlds. We also want to thank Anna Maria Hipkiss and professor Nancy Drew for their very helpful comments on the linguistic perspective of our research.
To Survive Out-of-Hospital Cardiac Arrest: A Search for Meaning and Coherence
Anders Bremer
University College of Borås, Sweden Växjö University, Sweden
Karin Dahlberg Växjö University, Sweden
Lars Sandman
University College of Borås, Sweden Mr. Anders Bremer
Corresponding author
Address: University College of Borås, School of Health Sciences, SE-501 90 Borås, Sweden. Phone numbers: + 46 33 435 5995, +46 33 435 4446 (fax)
E-mail address: anders.bremer@hb.se Professor Karin Dahlberg
Address: Växjö University, School of Health Sciences and Social Work, Georg Lückligs väg 8, SE-351 95 Växjö, Sweden.
Phone numbers: +46 470 70 83 09, +46 470 363 10 (fax) E-mail address: karin.dahlberg@vxu.se
PhD. Lars Sandman
Address: University College of Borås, School of Health Sciences, SE-501 90 Borås, Sweden. Phone numbers: + 46 33 435 4793, +46 33 435 4010 (fax)
E-mail address: lars.sandman@hb.se
ABSTRACT
The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions and actions should be based in the patient’s beliefs about health and well-being. This study aims to describe patients’ experiences of surviving OHCA. By using a phenomenological approach, the study focuses on how OHCA influences patients’ well-being over time. Nine survivors were interviewed. Of out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. These study findings show survivors’ emotional need and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.
Keywords: emergency medical services; heart health; illness and disease, acute; quality of life; phenomenology
The number of people in Europe who experience out-of-hospital cardiac arrest (OHCA) treated by the Emergency Medical Services are estimated to approximately 275,000 of which 29,000 survive to hospital discharge (Atwood, Eisenberg, Herlitz & Rea, 2005). Resuscitation attempts are unsuccessful in 70% to 95% of the cases (Baskett, Steen & Bossaert, 2005). For example, the one-month survival in Sweden is estimated to 7,3 % (Herlitz, Eriksson, Svensson, Kongstad & Silferstolpe, 2006).
The primary objective at OHCA is the patient’s life. Other concerns are the patient’s future quality of life or a dignified death for the patient. Ideally, in situations with central values at stake and out of respect for patient autonomy, the patient’s perspective should be consulted and the patient should be involved in decision-making around treatment. From a caring science perspective, an important responsibility is to provide care that ethically matches the patient’s world, supports the patient’s participation in health and care processes, and ensures that the patient’s perspective is considered (Dahlberg, Segesten, Nyström, Suserud & Fagerberg, 2003).