目标:探索一线决策,适应,在不断发展的COVID-19大流行期间,在救护车护理中学习。
方法:描述性和解释性定性研究。
方法:来自瑞典救护车服务的28名注册护士通过自由文本问卷描述了COVID-19大流行期间的56起重大事件。使用临界入射技术和解释性描述通过潜在的弹性性能透镜来分析材料。
结果:研究结果被综合为四个主题:\'在永无止境的压力下航行未知水域',\'平衡在深渊的边缘\',“牺牲少数人拯救许多人”和“为下一波做好准备”。大流行期间的前线决策导致道德困境,同时需要困难的优先次序来适应和应对有限的资源。与不适应相比,学习通过有效的信息共享和成功适应的识别来体现。
结论:在大流行期间或在其他极端条件下,必须迅速做出决定,即使在新兴的混乱中,由于最初缺乏知识和准则,可能需要使用未经测试的方法和临时解决方案。在救护车护理中,充满活力的领导势在必行,将自主一线决策与管理层支持相结合。加强道德能力和培养道德话语可以增强决策信心,特别是在道德上具有挑战性的情况下。
结论:极端条件下的表现会提高决策和不良后果的风险,老年人尤其脆弱。因此,需要有针对性的决策支持和干预措施。在这种情况下,提高救护车护理中的患者安全性需要管理层的积极参与和治理,以及决策支持和指导方针。管理层和一线专业人员之间的垂直沟通和协作对于确保关键信息、指导方针,资源得到有效传播和实施。需要进一步研究救护车护理的管理和领导,以及极端条件下前线决策的道德挑战。
■根据报告定性研究的综合标准(COREQ)报告调查结果。
■没有患者或公共捐款。
OBJECTIVE: To explore frontline decision-making, adaptation, and learning in ambulance care during the evolving COVID-19 pandemic.
METHODS: Descriptive and interpretative qualitative study.
METHODS: Twenty-eight registered nurses from the Swedish ambulance services described 56 critical incidents during the COVID-19 pandemic through free-text questionnaires. The material was analysed using the Critical Incident Technique and Interpretive Description through the lens of potential for resilient performance.
RESULTS: The findings were synthesized into four themes: \'Navigating uncharted waters under never-ending pressure\', \'Balancing on the brink of an abyss\', \'Sacrificing the few to save the many\' and \'Bracing for the next wave\'. Frontline decision-making during a pandemic contribute to ethical dilemmas while necessitating difficult prioritizations to adapt and respond to limited resources. Learning was manifested through effective information sharing and the identification of successful adaptations as compared to maladaptations.
CONCLUSIONS: During pandemics or under other extreme conditions, decisions must be made promptly, even amidst emerging chaos, potentially necessitating the use of untested methods and ad-hoc solutions due to initial lack of knowledge and guidelines. Within ambulance care, dynamic leadership becomes imperative, combining autonomous frontline decision-making with support from management. Strengthening ethical competence and fostering ethical discourse may enhance confidence in decision-making, particularly under ethically challenging circumstances.
CONCLUSIONS: Performance under extreme conditions can elevate the risk of suboptimal decision-making and adverse outcomes, with older adults being especially vulnerable. Thus, requiring targeted decision support and interventions. Enhancing patient safety in ambulance care during such conditions demands active participation and governance from management, along with decision support and guidelines. Vertical communication and collaboration between management and frontline professionals are essential to ensure that critical information, guidelines, and resources are effectively disseminated and implemented. Further research is needed into management and leadership in ambulance care, alongside the ethical challenges in frontline decision-making under extreme conditions.
UNASSIGNED: Findings are reported per consolidated criteria for reporting qualitative research (COREQ).
UNASSIGNED: No Patient or Public Contribution.