Unveiling the dynamics of older person care: a qualitative exploration of the intersection between formal and Informal Caregiving from the perspectives of registered nurses in Greece.

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses' experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers' experiences may contribute to quality care provision in systems rooted in familial caregiving traditions.

Lifeworld hermeneutics: An approach and a method for research on existential issues in caring science.

BACKGROUND AND AIM: The aim of the present article was to elaborate on a research approach and method called 'lifeworld hermeneutics'. Significant to lifeworld hermeneutics is that interpretation is the main methodological instrument for explaining and understanding existential research questions and lived experiences. From a caring science perspective, this often refers to research that aims to gain a deeper understanding of existential phenomena and issues, such as existential meaning of health, well-being, homelessness, lostness, suffering and ageing, as well as what it means to experience unhealthiness and illness, the need for care, and caring that responds to such needs. DESIGN: Theoretical paper. RESULT: The article briefly covers ontology and epistemology that clarifies the meaning and importance of a lifeworld hermeneutic attitude. This is followed by suggestions for how to perform a lifeworld hermeneutic study, expressed in relation to methodological principles for the interpretation, validation and structuring of interpretations. Thereafter, follow reflections on how to use theoretical or philosophical support to develop and deepen existential interpretations. The findings of lifeworld hermeneutic research consist of existential interpretations where the researcher, with an open and pliable attitude towards the phenomenon and the aim of the study, clarifies, explains and suggests new ways of understanding participants' lived experiences; the researcher should maintain such an attitude towards their understanding of the phenomenon as well. CONCLUSION: The lifeworld hermeneutical approach and method described in this article makes it possible to further deepen the understanding and knowledge about existential issues that is relevant for caring and caring science.

Meaning-oriented thematic analysis grounded in reflective lifeworld research-A holistic approach for caring science research.

BACKGROUND AND AIM: The aim of the present article is to describe meaning-oriented thematic analysis grounded in reflective lifeworld research and to illustrate how the thematic analysis can be integrated in the research process. The article is a methodological paper, including ontological and epistemological assumptions for lifeworld theory. Research based on lifeworld theory is directed towards lived experiences and meanings in everyday life. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and qualitative research can in particular contribute to existential knowledge needed to understand the world of the patient. DESIGN: Theoretical paper. RESULTS: Starting with a phenomenon of relevance for caring science, the article argues for lifeworld interviews as a data collection method that can contribute to depth and meaning, and then presents a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis. The research of lived experiences in caring science demands an approach that includes a reflective attitude during the methodological considerations. This article highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis. CONCLUSION: The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes.

Home care nurses lived experiences of caring relationships with older adults: A phenomenological study.

BACKGROUND: This paper describes registered nurses' lived experiences of caring relationships in the context of homecare provision for older adults living in Denmark. With the growing ageing population throughout Europe, more older adults will require complex care solutions within already overburdened care systems. This development places demands on the competencies and organisation of homecare nurses, as they become key players in healthcare systems. Fostering caring relationships in homecare is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. For a caring relationship to be truly caring, we must understand not only the subjective experience of such a relationship but also how it is experienced in relation to and shared with others. AIM: This study aimed to describe the essential meaning of the phenomenon of caring relationships in homecare for older adults based on the lived experiences of homecare nurses. APPROACH AND METHODS: Registered nurses working in homecare for older adults were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. FINDINGS: The essential meaning of the phenomenon is described as creating an existential and embodied space in which each patient's world is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of 'at-homeness' through trusting 'the other', experiencing continuity as caring and prioritising the time to care. CONCLUSION: Caring competence in homecare for older adults relies on a nurse's ability to intertwine physical and existential care needs and articulate them in their daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence.

Gender influences on caring, dignity and well-being in older person care: A systematic literature review and thematic synthesis.

Globally, healthcare has become dominated by women nurses. Gender is also known to impact the way people are cared for in various healthcare systems. Considering gender from the perspective of how lived bodies are positioned through the structural relations of institutions and processes, this systematic review aims to explore the meaning of gender in the caring relationship between the nurse and the older person through a synthesis of available empirical data published from 1993 to 2022. CINAHL, PUBMED, EMBASE and Web of Science were searched from the beginning of each database's temporal range, and PRISMA guidelines were used for the screening, reviewing and selection processes of available records. A thematic synthesis of the available data resulted in three analytical themes: (i) vulnerability of the gendered body, (ii) norms and values related to gender and sexuality and (iii) balancing closeness and distance in the nurse-patient relationship. These themes are intertwined and represent different aspects of gender meaning in the nurse-patient relationship. This research shows that gender, through its influence on the gendered body, its relationship with power dynamics in the caring process, and its intersection with dimensions of identity, has a significant meaning for the experienced vulnerability in the nurse-patient relationship. This has implications for the well-being and sense of dignity of the older person as well as the nurse.

Lived experiences of being cared for by ambulance clinicians when experiencing breathlessness-A phenomenological study.

BACKGROUND: Breathlessness is a serious and distressing symptom and a common reason why patients require prehospital care by ambulance clinicians. However, little is known about how patients experience this care when they are in a state of breathlessness. AIM: The aim of this study is to describe the lived experiences of being cared for by ambulance clinicians when experiencing breathlessness. METHODS: Fourteen lifeworld interviews were conducted with patients who experienced breathlessness and were cared for by ambulance clinicians. The interviews were analysed using a qualitative phenomenological approach. FINDINGS: The essential meaning of being cared for by ambulance clinicians when experiencing breathlessness is described in two ways: existential humanising care, in which the experience is that of being embraced by a genuine presence or existential dehumanising care, in which feeling exposed to an objectifying presence is the main experience. This meaning has four constituents: surrendering to and trusting in the care that will come; being exposed to an objectifying presence is violating; being embraced by a genuine presence is relieving; and knowing is dwelling. CONCLUSION: The findings reveal that the ability of ambulance clinicians to provide existential humanising and trustful care, which is the foundation of professional judgement, was essential in how patients responded to and handled the overall situation when breathlessness.

The Existential Breastfeeding Difficulty Scale's influences on the caring dialogue-Child healthcare nurses' lived experiences.

Breastfeeding is experienced as an existential journey, and breastfeeding difficulties put mothers in existentially vulnerable situations. For care to be caring, it must be based on the mother's breastfeeding story. Previous research show that healthcare professionals struggle to perform individualised breastfeeding care. The Existential Breastfeeding Difficulty Scale (ExBreastS) was developed to support an existential focus in caring dialogues and was introduced in child healthcare in Sweden. The aim of this study is to describe child healthcare nurses' lived experience of how the Existential Breastfeeding Difficulty Scale (ExBreastS) influences the caring dialogue. Seventeen child healthcare nurses with experience in using ExBreastS as a basis for caring dialogues with breastfeeding mothers were interviewed, in groups, pairs or individually. The interviews were analysed using a thematic analysis based on descriptive phenomenology. The results show that the caring dialogue becomes re-evaluated when using ExBreastS because existential aspects of breastfeeding is acknowledged. ExBreastS also visualises new perspectives of the mother's breastfeeding experiences. However, the use of ExBreastS also risks overshadowing the caring dialogue when the nurses focus too much on the instrument. The use of ExBreastS supports caring dialogues-and caring care-by highlighting the existential aspects of breastfeeding/breastfeeding difficulties and the uniqueness of every mothers' breastfeeding experience. However, the instrument sometimes evokes a vulnerability in the nurses that calls for support from the care organisation.

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study.

BACKGROUND: Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death. METHODS: A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the south-western part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique patients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using multiple logistic regression and multiple imputations. RESULTS: Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death. CONCLUSIONS: Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study.

BACKGROUND: Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN). METHODS: This retrospective observational study included patients aged > 16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the south-western part of Sweden by PENs during January and December, 2017. Of 7260 assignments (9% of all primary missions), 6354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis. RESULTS: The patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 h after symptom onset. CONCLUSIONS: Among patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.

Development and initial validation of an instrument to measure novice nurses' perceived ability to provide care in acute situations - PCAS.

BACKGROUND: Novice nurses need to be better prepared to provide care in acute situations. There is currently no validated scale specifically measuring nurses' perception of their ability to provide care in acute situations. The aim of this study was to develop and examine the psychometric properties of a scale that measures novice nurses self-reported perception of ability to provide care in acute situations. METHOD: Development and test of the psychometric properties of the Perception to Care in Acute Situations (PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an expert panel and cognitive interviews with the target group.Two hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct validity, item reduction and underlying dimensions between the measured variables and the latent construct. RESULT: The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic construct solution with no cross-loadings, high correlation for the total scale in both Cronbach's alfa 0.90 and ordinal alpha 0.92. CONCLUSIONS: The PCAS scale has proven to have acceptable validity. The factors," confidence in provision of care", "communication" and "patient perspective" are likely to be important aspects of providing care in acute situations. Additional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at improving novice nurses competence and suitable as a guide for reflection for novice nurses.

Mothers of preterm infants' experiences of breastfeeding support in the first 12 months after birth: A qualitative study.

BACKGROUND: Breastfeeding support is important for breastfeeding mothers; however, it is less clear how mothers of preterm infants (< 37 gestational weeks) experience breastfeeding support during the first year. Thus, the aim of this study was to describe how mothers of preterm infants in Sweden experience breastfeeding support during the first 12 months after birth. METHODS: This qualitative study used data from 151 mothers from questionnaires with open-ended questions and telephone interviews. The data were analyzed using an inductive thematic network analysis with a hermeneutical approach. RESULTS: The results exposed two organizing themes and one global theme. In the organizing theme "genuine support strengthens," the mothers described how they were strengthened by being listened to and met with respect, understanding, and knowledge. The support was individually adapted and included both practical and emotional support. In the organizing theme "inadequate support diminishes," the mothers described how health professionals who were controlling and intrusive diminished them and how the support they needed was not provided or was inappropriate. Thus, the global theme "being thrown into a lottery-dependent on the health professional who provided breastfeeding support" emerged, meaning that the support received was random in terms of knowledge and support style, depending on the individual health professionals who were available. CONCLUSION: Breastfeeding support to mothers of preterm infants was highly variable, either constructive or destructive depending on who provided support. This finding clearly shows major challenges for health care, which should make breastfeeding support more person-centered, equal, and supportive in accordance with individual needs.

Healthcare professionals' lived experiences of conversations with young adults expressing existential concerns.

INTRODUCTION: This paper describes first-line department healthcare professionals' experiences of conversations with young adults (16-25 years) who express existential concerns. Existential concerns encompass questions about the meaning of life and the choices people must make, and they are sometimes expressed during the period in which a child is becoming an adult. Sometimes the transition to adulthood can be difficult, and many young adults seek support from people in first-line departments, such as primary care providers, youth guidance centre personnel and student health service employees in high schools and universities. Conversations in which existential concerns are recognised may be important for preventing mental illness in the future. AIM: The study aimed to describe healthcare professionals' lived experiences of conversations with young adults who express existential concerns. APPROACH AND METHODS: This qualitative study utilises thematic meaning analysis. Interviews were conducted with healthcare professionals working in first-line departments, and data were analysed based on the principles of reflective lifeworld research. The study followed ethical codes of conduct and conformed to the ethical guidelines adopted by the Swedish Research Council. FINDINGS: The results are presented in three themes of meaning: searching for innermost thoughts requires being present, uncertainty about the unpredictable and awakening of one's own existential concerns. CONCLUSIONS AND IMPLICATIONS: Healthcare professionals are affected when young adults express their existential concerns, and they need more support to strengthen their ability to stay present and create inviting atmospheres.

Existential vulnerability can be evoked by severe difficulties with initial breastfeeding: a lifeworld hermeneutical single case study for research on complex breastfeeding phenomena.

Many mothers initiate breastfeeding, but some of these experience difficulties. This study has two aims in order to contribute to the development of optimal care for these mothers: firstly to explain and understand the existential meanings of one mother's severe initial breastfeeding difficulties and how these meanings affected her continued breastfeeding and secondly, to reflect on a method for applying lifeworld hermeneutics to research on complex breastfeeding phenomena. This is an approach that acknowledges and focuses on the concrete and lived existence and what it means for humans. Within this approach, humans are understood as whole human beings interacting in the world. The study was conducted using lifeworld interviews with Anna, focusing on meanings of her difficult lived experience of initial breastfeeding. The existential interpretation suggests that such an experience can evoke existential vulnerability, a vulnerability that becomes evident in shameful feelings, such as dislike of breastfeeding, aversion to the milk-producing body and anger towards the child. Anna continued breastfeeding as a way to rid herself of the shame, hoping to be confirmed as a good mother. Such an experience may have negative consequences for the mother-child relationship and it can create fear for future breastfeeding. This study concludes that carers should be aware of individual existential dimensions for breastfeeding mothers.

Lower limb prosthesis users' perceptions of everyday life-A phenomenographic study.

INTRODUCTION: A lack of understanding of personal experiences related to limb amputation and prosthetic use limits the extent to which clinicians involved in rehabilitation can support and advise their clients in a person-centered consultation. The objective of this qualitative study was to explore the personal experience of daily life as a lower limb prosthesis user. METHODS: Fifteen lower limb prosthesis users participated in individual semistructured interviews. Transcripts were analyzed using a phenomenographic approach. RESULTS: The extent to which prosthesis users were able to adjust to their impairment and move on with their life was influenced by social interactions with other prosthesis users, access to relevant information about prosthetic solutions that may benefit them, and finding a balance between desired activities and their physical and/or cognitive capacity. CONCLUSIONS: After a period of existential adjustment, prosthesis users described themselves as living active, fulfilling lives. This was facilitated to a large extent by social interactions with other prosthesis users and access to information they perceived as relevant. Social media plays a particularly important role in establishing connections with other prosthesis users and is perceived as a useful source of information.

Nulliparous women's lived experiences of the prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology.

INTRODUCTION: Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage. OBJECTIVE: To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women. METHODS: A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. RESULTS: The analysis resulted in four themes: "An unknown phase" that entailed remaining in a phase that the women lacked an awareness of. "Trust and mistrust in the body's ability" represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme "Loss of control" included experiences of frustration, fatigue, and having to deny bodily instincts. "Support through presence and involvement" signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence. CONCLUSIONS: The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

"A becoming in the meeting": the interpretations of competence in home care from the perspectives of older people and registered nurses - a meta-ethnography.

AIM: The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people's and registered nurses' interpretations of competence in home care. METHODS: The meta-ethnography followed the six phases developed by Noblit and Hare (1988). RESULTS: In Phase 6, the translation process of the included studies, three themes were identified: i) temporality-the feeling of being of value; ii) dignity-a person, not just a patient; and iii) mutuality of being-togetherness. A synthesis was developed, and the phrase "a becoming in the meeting" emerged. CONCLUSION: The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.

Balancing between familiarity and professionalism in caring for older persons: A phenomenological study from the perspective of nursing students.

AIM: To describe the meaning of caring for older persons based on the experiences of nursing students in Greece. BACKGROUND: The present study is conducted based on a caring science perspective derived from a holistic viewpoint of human beings, aiming to support the well-being of older persons. In Greece, informal caregivers play an important role in caring for older people; however, as the population ages, the need for registered nurses specialising in caring for older people is also increasing. Previous research in other countries has reported a relative lack of interest in this field, which is a threat to the quality of care. To ensure an adequate number of new-generation nurses caring for older people, nursing students' perceptions of the phenomenon of caring for older persons should be well understood and explored in a context where the number of long-term care beds and residential care facilities are low and where informal caregiving is common. DESIGN: Based on Descriptive Phenomenology, in line with the Reflective Lifeworld Research (RLR) approach. METHODS: A total of 12 nursing students at a university in Greece underwent in-depth lifeworld interviews online during June and July 2021 and March 2022; Interviews were transcribed verbatim and were analysed according to the principles of RLR that approaches the phenomena with openness and constant reflection. The participants were students in their fourth or fifth year of nursing education; they had previous experience in older person care and were not acquainted with the authors. RESULTS: The results show the essential structure of the meaning of caring for older persons, where otherness consists of intertwined demanding and rewarding elements. The essence is further conveyed by three constituents: otherness of the older person: witnessing someone's vulnerability; trustful caring: struggling with normative structures; and closeness and distance: balancing between familiarity and professionalism. CONCLUSION: To ensure quality of care for older persons in the future, an understanding of how nursing students describe their experiences of caring for older persons during education is important. Balancing between familiarity and professionalism highlights the need for further reflection on professionalism and dignity and identifying the norms and values helps to highlight particularities of the context and national healthcare system. Curricula focusing on cultivating students' preunderstanding, regarding caring for older persons are required to promote a higher quality of care in the future. Caring science can contribute to a focus on a holistic perspective in caring for older people. TWEETABLE ABSTRACT: There is an ever-increasing need for educated nurses in the field of caring for older people. With the lack of interest in this field of nursing, the overall quality of care is impacted. This study describes the meaning of caring for older persons based on the experiences of nursing students in the Greek health care system.

Finding an existential place to rest: enabling well-being in young adults.

What enables well-being when experiencing existential concerns as a young adult is an under-explored area of research. In order to address young adults' existential concerns and provide caring support that builds their resilience to meet life challenges, the purpose of the study is to describe the meaning of enabling well-being as experienced by young adults living with existential concerns. This phenomenological study is based on a reflective lifeworld research. Seventeen young adults, aged 17-27 years, were interviewed. The results is presented in an essential meaning and further explored with its variations and individual nuances of the phenomenon; enabling well-being. The essential meaning of enabling well-being, when experiencing existential concerns as a young adult, means finding a place to rest. Finding a place to rest means finding both movement and stillness in life to reflect upon one's life story in order to understand oneself. The results also show that young adults enable their own well-being in many ways when experiencing existential concerns. When their existential concerns feel overwhelming, they need support from healthcare professionals. When young adults seek professional support, the professionals must be open and focus on the young adults' life story to enable well-being.

Patients' lived experiences of breathlessness prior to prehospital care - A phenomenological study.

AIMS AND OBJECTIVES: The study aimed to describe how breathlessness is experienced by patients prior to prehospital care. DESIGN: A qualitative phenomenological design. METHODS: Lifeworld interviews were conducted with 14 participants. The analysis was carried out within the descriptive phenomenological framework. RESULTS: The essential meaning of the breathlessness phenomenon is described as an existential fear in terms of losing control over one's body and dying, which involves a battle to try to regain control. This is further described by four constituents: being in an unknown body, striving to handle the situation, the ambiguity of having loved ones close and reaching the utmost border. CONCLUSIONS: Patients describe a battling for survival. It is at the extreme limit of endurance that patients finally choose to call the emergency number. It is a challenge for the ambulance clinician (AC) to support these patients in the most optimal fashion.