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Ambulance clinicians’ attitudes to older patients’ self-determination when the patient has impaired decision-making ability: A Delphi study

Svensson, Anders ; Bremer, Anders ; Rantala, Andreas LU orcid ; Andersson, Henrik ; Devenisch, Scott ; Williams, Julia and Holmberg, Mats (2022) In International journal of older people nursing 17(2).
Abstract

Objective
The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients’ self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care.
Materials and methods
An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N =... (More)

Objective
The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients’ self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care.
Materials and methods
An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale.
Results
Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus.
Conclusions
The findings highlight the complexity of ACs’ attitudes towards older patients’ self-determination. The respect of older patients’ self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs’ moral abilities within their professional practice.
Implications for practice
Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs’ abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International journal of older people nursing
volume
17
issue
2
publisher
Wiley-Blackwell
external identifiers
  • scopus:85114687386
  • pmid:34510764
ISSN
1748-3743
DOI
10.1111/opn.12423
language
English
LU publication?
yes
id
edced4ea-8b63-4db3-9ec4-df3f2be0c49b
date added to LUP
2021-09-13 11:08:55
date last changed
2024-01-20 12:09:47
@article{edced4ea-8b63-4db3-9ec4-df3f2be0c49b,
  abstract     = {{<br/>Objective<br/>The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients’ self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care.<br/>Materials and methods<br/>An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale.<br/>Results<br/>Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus.<br/>Conclusions<br/>The findings highlight the complexity of ACs’ attitudes towards older patients’ self-determination. The respect of older patients’ self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs’ moral abilities within their professional practice.<br/>Implications for practice<br/>Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs’ abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.<br/>}},
  author       = {{Svensson, Anders and Bremer, Anders and Rantala, Andreas and Andersson, Henrik and Devenisch, Scott and Williams, Julia and Holmberg, Mats}},
  issn         = {{1748-3743}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{International journal of older people nursing}},
  title        = {{Ambulance clinicians’ attitudes to older patients’ self-determination when the patient has impaired decision-making ability: A Delphi study}},
  url          = {{http://dx.doi.org/10.1111/opn.12423}},
  doi          = {{10.1111/opn.12423}},
  volume       = {{17}},
  year         = {{2022}},
}