The role of the nurse in Swedish prehospital emergency care

Background: Historically, the ambulance services have been considered mainly to be a transport function. Demands from the society and progress in medicine have transformed the services into an advanced form of emergency medical care for ill or injured persons. Therefore, a discussion has been going on as to the kind of competence that is needed in these services. Two major aims of the present study have been to describe both the development and the present status of the ongoing quality improvement process in prehospital emergency care in Sweden. Two other aims have been to describe the nurse s practical role in disasters, as well as the views of the involved professionals of both the nurse s and the ambulanceman s roles in the prehospital emergency care field in general. Methods: The study has included a questionnaire with open-ended questions for nursing students and semi-structured interviews along with questionnaires to ambulancemen, nurses and physicians, as well as a national questionnaire survey of all medical directors in Sweden. The data were processed using both qualitative and quantitative methods. Results: The findings indicate that nurses have an increasingly important function in prehospital emergency care, both at minor and major accidents, as well as in the care of the acutely ill patient. Both ambulancemen and physicians appreciate the nurse s broad competence and emphasise the need of special education and training for optimal functioning. The medical directors consider that progress in the field makes it necessary to have more highly competent personnel in order to maintain and develop the quality of care. They view the roles of nurses and ambulancemen as complements to one another. Nursing students receive basic knowledge in disaster nursing and learn how to use systematic approaches, which is a good basis for their advanced education and training in prehospital emergency care. Nurses with experience and education or training in prehospital emergency care function better then other nurses at an actual disaster site. They also have less negative experience from their work at such sites. The national survey indicates that quality improvement processes initiated by the Swedish authorities have resulted in considerable improvement of prehospital emergency care during the last few years. The competence level of ambulancemen has increased and more nurses have been employed. A majority of the medical directors reported that they have adapted the services to be in accordance with the regulations of the National Board of Health and Welfare (SOSFS 1995:8). All directors are, however, not satisfied with the present competence level of personnel, and mention in particular the lack of nurses in their local organisations. Conclusion: The progress and demands of quality improvement measures within prehospital emergency care have increased the need of a higher competence level of personnel. This has focused on nurses, and in particular, on emergency nurses. The regulations of the National Board of Health and Welfare have been a driving force in this matter. The study indicates that the specially trained nurse has come to the prehospital field to stay and that he or she has an important role in the continuing progress of prehospital emergency care both in routine prehospital work as well as in disaster situations