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Ethical challenges and action alternatives: Case reflections in ambulance care

Bennesved, Anna ; Bremer, Anders ; Svensson, Anders ; Rantala, Andreas LU orcid ; Holmberg, Mats and Björk, Joar (2025) In Nursing Ethics p.1-16
Abstract
Background
Ambulance clinicians regularly encounter medical, caring, existential and ethical challenges. Meeting patients with complex medical presentations underscore the need for holistic decision-making and actions as ambulance clinicians struggle to strike a balance between addressing medical and caring needs.
Aim
This study aimed to explore action alternatives considered and discussed during ethics case reflections in response to care-related challenges in ambulance services.
Research design
A qualitative descriptive study design was applied. Data were analyzed using conventional and summative content analysis.
Participants and research context
Ethics case reflections were performed with 14 groups... (More)
Background
Ambulance clinicians regularly encounter medical, caring, existential and ethical challenges. Meeting patients with complex medical presentations underscore the need for holistic decision-making and actions as ambulance clinicians struggle to strike a balance between addressing medical and caring needs.
Aim
This study aimed to explore action alternatives considered and discussed during ethics case reflections in response to care-related challenges in ambulance services.
Research design
A qualitative descriptive study design was applied. Data were analyzed using conventional and summative content analysis.
Participants and research context
Ethics case reflections were performed with 14 groups comprising a total of 78 ambulance clinicians. Prior to the reflections, a video depicting the encounter between two ambulance clinicians and an older patient and his spouse was viewed.
Ethical considerations
The principles of the Declaration of Helsinki were applied throughout the research process, and an advisory statement was obtained from the Swedish Ethical Review Authority (No. 2019-02127 and 2021-03490).
Findings
The ethics case reflections generated a variety and breadth of action alternatives to manage challenges in caring, suggesting that this format is suitable for discussing ethical issues in clinical cases that depart from standard medical emergencies. Furthermore, the breadth of the results reveals the wide professional discretion afforded to ambulance clinicians and suggest the presence of tacit competences embedded in professional practice.
Conclusions
Ethics case reflection has a potential to enhance ambulance clinicians’ ethical decision-making by deepening reflections about patient autonomy as well as highlighting the potential for a caring approach and promoting holistic care. By generating a breadth of specific action alternatives, many possible ways forward even in situations with complex care-related challenges are illustrated. Further investigation regarding the role of ethics case reflections to articulate implicit attitudes and tacit competencies is warranted. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Nursing Ethics
pages
1 - 16
publisher
SAGE Publications
ISSN
0969-7330
DOI
10.1177/096973302514031
language
English
LU publication?
yes
id
a1a4370e-2465-4966-aae1-43e460e454df
date added to LUP
2025-12-04 07:36:24
date last changed
2025-12-04 10:47:20
@article{a1a4370e-2465-4966-aae1-43e460e454df,
  abstract     = {{Background<br/>Ambulance clinicians regularly encounter medical, caring, existential and ethical challenges. Meeting patients with complex medical presentations underscore the need for holistic decision-making and actions as ambulance clinicians struggle to strike a balance between addressing medical and caring needs.<br/>Aim<br/>This study aimed to explore action alternatives considered and discussed during ethics case reflections in response to care-related challenges in ambulance services.<br/>Research design<br/>A qualitative descriptive study design was applied. Data were analyzed using conventional and summative content analysis.<br/>Participants and research context<br/>Ethics case reflections were performed with 14 groups comprising a total of 78 ambulance clinicians. Prior to the reflections, a video depicting the encounter between two ambulance clinicians and an older patient and his spouse was viewed.<br/>Ethical considerations<br/>The principles of the Declaration of Helsinki were applied throughout the research process, and an advisory statement was obtained from the Swedish Ethical Review Authority (No. 2019-02127 and 2021-03490).<br/>Findings<br/>The ethics case reflections generated a variety and breadth of action alternatives to manage challenges in caring, suggesting that this format is suitable for discussing ethical issues in clinical cases that depart from standard medical emergencies. Furthermore, the breadth of the results reveals the wide professional discretion afforded to ambulance clinicians and suggest the presence of tacit competences embedded in professional practice.<br/>Conclusions<br/>Ethics case reflection has a potential to enhance ambulance clinicians’ ethical decision-making by deepening reflections about patient autonomy as well as highlighting the potential for a caring approach and promoting holistic care. By generating a breadth of specific action alternatives, many possible ways forward even in situations with complex care-related challenges are illustrated. Further investigation regarding the role of ethics case reflections to articulate implicit attitudes and tacit competencies is warranted.}},
  author       = {{Bennesved, Anna and Bremer, Anders and Svensson, Anders and Rantala, Andreas and Holmberg, Mats and Björk, Joar}},
  issn         = {{0969-7330}},
  language     = {{eng}},
  month        = {{12}},
  pages        = {{1--16}},
  publisher    = {{SAGE Publications}},
  series       = {{Nursing Ethics}},
  title        = {{Ethical challenges and action alternatives: Case reflections in ambulance care}},
  url          = {{http://dx.doi.org/10.1177/096973302514031}},
  doi          = {{10.1177/096973302514031}},
  year         = {{2025}},
}