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Rantala, Andreas
2017
Document Version:
Publisher's PDF, also known as Version of record
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Citation for published version (APA):
Rantala, A. (2017). Being taken seriously. Person-centredness and person-centred climate as experienced by
patients and significant others when the patient is assessed as non-urgent by the Swedish Ambulance Service.
Lund: Lund University: Faculty of Medicine.
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LUND UNIVERSITY
PO Box 117
221 00 Lund
+46 46-222 00 00
Being taken seriously
Person-centredness and person-centred
climate as experienced by patients and
significant others when the patient is assessed
as non-urgent by the Swedish
Ambulance Service
Andreas Rantala
1
© Andreas Rantala
Cover photo: Anton Ingoldsson
Faculty of Medicine, Department of Health Sciences
ISSN 1652-8220
ISBN 978-91-7619-490-4
Lund University, Faculty of Medicine Doctoral Dissertation Series 2017:108
Printed in Sweden by Media-Tryck, Lund University
Lund 2017
En del av Förpacknings- och
Tidningsinsamlingen (FTI)
2
Den tunna tråden mellan vitt och svart
Den tunna tråden mellan dag och natt
Den tunna tråden mellan att finnas eller ett stort ingenting
Peter Lemarc
3
4
Contents
Abstract 7
Original papers 9
Abreviations 10
Preface 1
Introduction 13
Perspectives and viewpoints 15
Epistemological asumptions 16
Background 19
The patient – A person with a perceived ilness 19
Significant others 20
Caring for patients in their own homes 22
The Swedish Ambulance Service 23
Emergency Medical Dispatch Centre (112) and Swedish
Healthcare Direct (1177) 24
The process of assessing and judging patients in Swedish
Ambulance Care 26
Ambulance clinicians 28
Framework 31
Person-centred climate 32
Person-centred care 32
Person-centrednes 33
Rationale 35
Aim 37
Methods 39
Seting 39
5
Papers I and I 40
Sample selection and Participants 40
Data colection 41
Data analysis 42
Papers I and IV 43
Sample selection and Participants 43
Data colection 43
Data analysis 46
Ethical considerations 48
Results 49
Being a non-urgent patient in ambulance care 49
Being a significant other in non-urgent ambulance care 52
The construct of person-centrednes 54
Experiences of the person-centred climate 55
Discusion 57
Methodological considerations 57
Trustworthines 57
Internal validity 62
External validity 63
Construct validity 65
General discusion of the results 67
Being a person in need of being taken seriously 67
Being a significant other in need of being de-burdened 70
Being the person taking the person seriously 73
The need for organisational adaptation 78
Conclusions and clinical implications 81
Future research 83
Summary in Swedish/ Svensk sammanfatning 85
Acknowledgements 89
References 93
Paper I-IV
Appendix
6
Abstract
Background
The experience of person-centeredness and person-centred climate is poorly
understood in the context of being assessed as non-urgent and, in many cases, left
at home by the Ambulance Service.
Aim
The overall objective of this thesis was to explore experiences of person-centredness
and the person-centred climate among patients and significant others when
patients were assessed as non-urgent by the Swedish Ambulance Service.
Methods
Both an inductive and deductive approach has been used in combination with
qualitative and quantitative research methods.
The study group consisted of I) 12 patients and II) 111 patients who were
considered non-urgent and thus recommended for triage and non-conveyance by
the Ambulance Service as well as III) 11 significant others and IV) 100 significant
others of patients considered non-urgent and therefore not conveyed to the
Accident and Emergency Department. Interviews were performed and analysed by
means of phenomenological hermeneutics developed by Lindseth and Norberg.
The instruments used for data collection were the Person-centred Climate
Questionnaire, Patient/Family version. In addition, questions from the inductive
studies were tested for construct validity.
Results
The meaning of person-centredness among the patients was a strong wish to be
taken seriously. The climate was perceived as highly person-centred. Being taken
seriously resulted in feelings of trust and being an active partner in the decision-
making process. In contrast, a sense of being rejected and insulted arose when not
taken seriously. Eight aspects of person-centredness were established psycho-
metrically with a one-factor solution covering 79.9 % of the variance. The patients
reported the climate as person-centred.
Significant others wished to be de-burdened from their caring responsibilities and
not abandoned in the present situation. The single most important factor for
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achieving this was ensuring that the patient was taken seriously. The significant
others reported that the psychosocial climate was person-centred.
Eight aspects of person-centredness and being de-burdened were established
psychometrically with a one-factor solution explaining 58.8 % of the variance.
Conclusion
It is possible to achieve a person-centred climate within in the Ambulance Service
irrespective of time and location, due to the fact that person-centredness mainly
concerns taking patients seriously and providing a moment of de-burdening for
significant others.
8
Original papers
This thesis is based on the following papers referred to in the text by their Roman
numerals:
I Rantala, Ekwall, A., & Forsberg, A. (2016), The meaning of being triaged
to non-emergency ambulance care as experienced by patients. International
Emergency Nursing. 25: 65-70
II Rantala, A., Forsberg, A. & Ekwall, A. (2017). Person–centred climate and
psychometrical exploration of person–centredness among patients not
conveyed by the Ambulance Care Service. Scandinavian Journal of Caring
Sciences. Accepted for publication August 7, 2017.
III Rantala, Ekwall, A., & Forsberg, A. (2016). The meaning of significant
others’ encounter with the ambulance clinicians in a non-emergency care
context. Nordic Journal of Nursing Research. 36(1): 51-58.
IV Rantala, A., Forsberg, A., & Ekwall, A. Person-centred climate and person-
centredness in a non-urgent Ambulance Service context, as experienced by
significant others. Submitted.
Reprints in this thesis are made with the permission of the publishers.
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