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Militär akutsjukvård i fält: när den övade verkligheten blir verklig
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: Governing for the Armed Forces health care is respect for human dignity and the view of each individual as irreplaceable. The quality of the military care will be at a level equivalent to that of today's civil peace healthcare, which requires that the training is of high quality. Casualty care in the military environment is a complex, challenging and dangerous task. Today there is a lack of knowledge about how to learn these skills. The purpose of the research was to identify the knowledge area pre-hospital care in the military environment by examining what doctors, nurses, paramedics and officers learn about military health care during preparation and exercise.

Method: A phenomenographic approach was used in all sub-studies, and empirical data were collected by means of semi-structured interviews. Study I‐III are cross-sectional studies and study IV is a longitudinal study. Twelve registered nurses who had served in Bosnia were interviewed for study I, and 24 conscript paramedics were interviewed for study II. Study III included 20 officers in their pre-deployment training for service in Afghanistan and Liberia, and Study IV included 7 doctors and twenty nurses who previously had served in Afghanistan, Bosnia, Kosovo and Liberia.

Results: Learning military health care by training and gaining experience can be seen as different abilities; interaction, action and reflection. In-depth analysis at a meta--‐level revealed that the integration between the military and military medical fields of knowledge was missing. The results indicate that participants' understanding of their respective fields of knowledge is inadequate and needs to be integrated in education in a clearer way.

Implications: To create opportunities for better education and integration in these fields of knowledge are proposed (1) that the findings of the thesis could be utilised to develop the design of the curriculum (2) the inter-professional learning is introduced as a part of creating a safer and more effective pre-hospital care, (3) the clinical competence becomes part of the development of pre-hospital emergency care in the field, and (4) that the training is built according to the principle of "train as you fight" with emphasis on the requirements in the combat zone.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. , 76 inkl. 3 bilagor p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1411
National Category
Pedagogy
Identifiers
URN: urn:nbn:se:liu:diva-111670DOI: 10.3384/diss.diva-111670ISBN: 978-91-7519-284-0 (print)OAI: oai:DiVA.org:liu-111670DiVA: diva2:758878
Public defence
2014-11-24, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-10-28 Created: 2014-10-28 Last updated: 2014-10-31Bibliographically approved
List of papers
1. The criteria nurses use in assessing acute trauma in military emergency care
Open this publication in new window or tab >>The criteria nurses use in assessing acute trauma in military emergency care
2007 (English)In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 15, no 3, 148-156 p.Article in journal (Refereed) Published
Abstract [en]

Emergency medical care for seriously injured patients in war or warlike situations is highly important when it comes to soldiers' survival and morale. The Swedish Armed Forces sends nurses, who have limited experience of caring for injured personnel in the field, on a variety of international missions. The aim of this investigation was to identify the kind of criteria nurses rely on when assessing acute trauma and what factors are affecting the emergency care of injured soldiers. A phenomenographic research approach based on interviews was used. The database for the study consists of twelve nurses who served in Bosnia in 1994-1996. The criteria nurses rely on, when assessing acute trauma in emergency care, could be described in terms of domain-specific criteria such as a physiological, an anatomical, a causal and a holistic approach as well as contextual criteria such as being able to communicate, having a sense of belonging, the military environment, the conscript medical orderly and familiarity with health-caring activity. The present study shows that the specific contextual factors affecting emergency care in the field must also be practised before the nurse faces military emergency care situations. This calls for realistic exercises and training programs, where experience from civilian emergency care is interwoven with the knowledge specific to military medical care. © 2007 Elsevier Ltd. All rights reserved.

Keyword
International mission, Military emergency care, Military nursing, Qualitative method
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-49199 (URN)10.1016/j.aaen.2007.05.002 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
2. Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces
Open this publication in new window or tab >>Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces
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2013 (English)In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, no 8, 861-866 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how leaming is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. Interaction during the period of education is important for learning. Action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. Reflection, leaming to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

Place, publisher, year, edition, pages
AMSUS, 2013
National Category
Medical and Health Sciences Social Sciences
Identifiers
urn:nbn:se:liu:diva-106000 (URN)10.7205/MILMED-D-13-00048 (DOI)
Available from: 2014-04-16 Created: 2014-04-16 Last updated: 2017-12-05Bibliographically approved
3. Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield
Open this publication in new window or tab >>Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield
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2015 (English)In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, no 2, 224-229 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify tactical officers’ views of pre-hospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat oriented including being able to do one’s specialist task, being able to talk with local people and being able to give first aid, (2) combat oriented including soldiers’ skills and roles in the unit, being able to act in the unit and being able to lead the care of  injured These findings are important for officers’ preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

Place, publisher, year, edition, pages
Association of Military Surgeons Us, 2015
National Category
Social Sciences Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-111668 (URN)10.7205/MILMED-D-13-00558 (DOI)000349101900016 ()25643391 (PubMedID)
Note

Funding Agencies|Swedish Armed Forces; Centre for Defence Medicine; VastraFrolunda; Department of Medical and Health Sciences, University of Linkoping

Available from: 2014-10-28 Created: 2014-10-28 Last updated: 2017-12-05Bibliographically approved
4. Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care
Open this publication in new window or tab >>Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to identify physicians’ and nurses’ perceptions of military prehospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The aim is to identify the area of knowledge, pre-hospital care in a military environment, in terms of expressions from doctors and nurses focussing on the variation in how learning of pre-hospital care is perceived. The result of the study is a set of descriptive categories on a collective level, showing the variation in how doctors and nurses perceived the phenomenon of military pre-hospital emergency care. The results after predeployment training can be categorized as (1) to learn military medicine, (2) to take care of the casualty and (3) to have safety awareness. The results after an international mission can be categorized as (1) to collaborate with others, (2) to deliver general health care, and (3) to improve competence in military medicine. Possible implications of the results from the present study are the following; (I) better conditions for doctors and nurses to provide appropriate military medical care by clarification and better understanding of professions in the mission area (doctors, nurses, officers), since they may have different goals for their actions, (II) to pay attention to all aspects of military health care during predeployment training, including general health care in the mission area, (III) to implement new knowledge in military medicine in the predeployment training, and (IV) to train for the reality all doctors and nurses are about to meet. These results indicate  that the training should be developed in order to optimize the prepare physicians and nurses for international assignments. This may result in increased safety for the provider of care, while at the same time minimizing suffering and enhancing the possibility of survival of the injured.

National Category
Medical and Health Sciences Social Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-111669 (URN)
Available from: 2014-10-28 Created: 2014-10-28 Last updated: 2014-10-28Bibliographically approved

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Andersson, Sten-Ove

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