Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel.

ABSTRACT

BACKGROUND: Patient participation is considered to promote well-being and is, therefore, central in care contexts. Care-dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness. AIM: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel. METHOD: A phenomenological hermeneutical method was used to analyse transcripts of narrative interviews with 11 ambulance personnel. RESULTS: The ambulance personnel's lived experience of older persons' participation includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that empowers participation. The main theme 'Balancing dignity in relation to manipulating the body' included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well-being and being guided by reactions. The main theme 'Balancing influence in relation to perceived health risks' included the themes Agreeing on a common perspective, Directing decision-making mandate, and Sharing responsibility for well-being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel. CONCLUSION: Care-dependent older persons' participation in care from the perspective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balancing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve ambulance care to benefit older persons in critical life situations.