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  • 1.
    Andersson, Annika
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik.
    Boundaries as mechanisms for learning in emergency exercises with students from emergency service organisations2016Inngår i: Journal of Vocational Education and Training, ISSN 1363-6820, E-ISSN 1747-5090, Vol. 68, nr 2, s. 245-262Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To prepare emergency response organisations for collaborative work in unpredictable and dynamic situations, various types of exercises are widely used. Still, our knowledge of collaboration exercises with emergency response students is limited. This study aimed to contribute to this field by exploring boundaries that emerged between collaborating organisations in exercise activities and how these boundaries could be understood for learning. Drawing on the Akkerman and Bakker framework of boundaries as learning mechanisms, this study explored an exercise, including full-scale scenarios and seminars with students from the police, ambulance and rescue services education in Sweden. Thematic analysis of interviews and observations illustrated boundaries that emerged regarding vocabulary, prioritisation, roles, knowledge gaps and overlapping responsibilities across organisations. Rather than dissolving boundaries, this article suggests that boundaries can be utilised in exercises to support the students to contextualise their knowledge in relation to the demands of collaborative work. The concepts boundary work and boundary awareness were suggested to capture more generally the dynamics of learning in exercise contexts.

  • 2.
    Andersson, Annika
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik.
    Boundary work and boundary awareness: a case study of an emergency exercise with blue light students2015Inngår i: Proceedings of the ISCRAM 2015 Conference - Kristiansand, May 24-27 / [ed] Palen, Büscher, Comes & Huges, 2015Konferansepaper (Fagfellevurdert)
  • 3.
    Andersson, Annika
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik.
    In case of emergency: Collaboration exercises at the boundaries between emergency service organizations2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Due to the emergent and dynamic nature of incidents, the complexity of emergency work is often referred to as a challenge for learning. Another recurrent challenge in emergency work is that of collaboration at and across established organizational boundaries involving actors with specific types of expertise who are operating under different regulations and responsibilities. In addition, training emergency service organizations in collaboration remains a challenge. In light of the difficulties and shortcomings that have been identified in major incident responses, the need for exercises for developing and maintaining collaborative response effectiveness prior to the next incident is often highlighted. The overall aim of this thesis is to understand how full-scale exercises can provide conditions for developing inter-organizational collaboration between the police, ambulance and rescue services at the incident site. Learning activities that carry the potential to support and develop collaborative capacity, and how the alignment of distributed expertise can be trained for, were of particular interest. Interviews with participants in eight full-scale exercises with professionals and interviews and observations of one exercise with senior-level students in Sweden served as the empirical base.Central concepts from Cultural-Historical Activity Theory (CHAT) provided theoretical tools to explore the exercises and understand boundaries between organizations with a wider, systemic approach. The empirical studies show that the participants understood full-scale exercises to be valuable opportunities for becoming involved in response work, making decisions, and acting and interacting in uncertain situations and realistic environments. As in real-life responses, exercises are characterized by the stabilization and confirmation of everyday routines on the one hand, and by improvisation and change on the other hand. The studies also show that exercises tend to focus on specific scenarios,intra-organizational routines, and leadership positions. Infrequent exercises inwhich the participants were only trained in a limited role were perceived to be in adequate for developing preparedness and collaboration. However, the analysis suggested that the way in which exercises were organized and performed had implications for how participants were trained in collaboration.Realizing the potential of boundaries as resources for learning in exercises depends on how boundaries are explicated and approached. Thus, rather than striving to ignore or eliminate boundaries in exercises, the studies illustrated the learning value of explicitly reflecting on the multiple understandings around boundaries. The studies demonstrated that much of the work at an incident site takes place around negotiations. Collaboration at the incident site was not only aquestion about boundary crossing; operational tasks may not always be aligned and have to be prioritized and sequenced. The exercises comprised work situations in which no single motive could explain or determine the collaboration,due to different types of expertise, primary responsibilities and needs forinformation. These factors were understood in terms of the concepts of boundarywork and boundary awareness. These concepts point at a more divergent understanding of collaboration that reaches beyond striving to create mutual understanding between organizations in learning activities. Differences between organizations, such as in terminology, time horizons, priorities, leadership structures, understandings of safety and how intra-organizational decisions and actions could impact the collaborating organizations' work, were central triggers for discussion and negotiation. These differences required explanations in order to make the actions and decisions of one organization understandable and justifiable to another, based on organizational mandates and types of expertise.Giving emergency services the opportunity to work together, to develop an awareness of their expectations of each other in various situations, to use and interpret their own and others' terminologies, and to identify internal hierarchies and motives for prioritizations was essential dimensions of exercises

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  • 4.
    Andersson, Annika
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik.
    Carlström, Eric D.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur. Sahlgrenska Academy at University of Gothenburg.
    Åhgren, Bengt
    Nordic School of Public Health, Göteborg, Sweden.
    Berlin, Johan
    Högskolan Väst, Institutionen för individ och samhälle, Avd för socialpedagogik och sociologi.
    Managing boundaries at the accident scene: a qualitative study of collaboration exercises2014Inngår i: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 3, nr 1, s. 77-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose The purpose of this study is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.

    Design/methodology/approach Interviews with 23 participants from four exercises in Sweden were carried out during autumn 2011. Interview data were subjected to qualitative content analysis.

    Findings Findings indicate that the exercises tend to focus on intra-organisational routines and skills, rather than developing collaboration capacities. What the participants practiced depended on roles and order of arrival at the exercise. Exercises contributed to practicing leadership roles, which was considered essential since crises are unpredictable and require inter-organisational decision-making.

    Originality/value The results of this study indicate that the ability to identify boundary objects, such as injured/patients, was found to be important in order for collaboration to occur. Furthermore, lessons learned from exercises could benefit from inter-organisational evaluation. By introducing and reinforcing certain elements and distinct aims of the exercise, the proactive function of collaboration exercises can be clarified.

  • 5.
    Andersson, Annika
    et al.
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Lindström, Berner
    Högskolan Väst, Institutionen för individ och samhälle, Avd för utbildningsvetenskap och språk.
    Making collaboration work: Developing boundary work and boundary awareness in emergency exercises2017Inngår i: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 29, nr 4, s. 286-303Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Collaboration in emergency work is challenging on many levels. The unforeseen and temporary nature of incidents presents basic challenges. Another important challenge is boundaries between specialized and autonomous emergency service organizations. We need to know more about how exercises are performed to increase the individuals and organizations preparedness for future joint response work. The aim of this study was to explore how boundary work is carried out at the incident site during exercises, and how boundary awareness is developed based on this boundary work. The analytic focus was on how boundaries were identified, negotiated and managed in the participants work. Empirically, full-scale exercises involving police, ambulance and rescue services and with repetition of practical scenarios and joint-reflection seminars are studied. Much of the work in the exercises was performed within distinct areas of expertise, in accordance with concrete routines, skills and responsibilities. Boundary work was often organized in the form of distribution of labour or creating chains of actions. The exercises shed light on challenges related to other aspects of emergency response,such as a lack of resources, diverging primary responsibilities, time-criticality and hazardous environments. The design allowed participants to explicate boundaries, test and discuss alternative solutions, and to visualize the effects of different solutions as the scenarios were repeated. The boundaries that were identified were often of institutional character, and were also related to the specific scenarios and to the actions taken in the activities. By integrating real-life experiences of collaborative work in the exercise, the exercise gained a certain meaning that was essential for the participants to develop boundary awareness.

  • 6.
    Detlín, Maria
    et al.
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen for hälsopromotion och vårdvetenskap.
    Lindberg-Nyman, Viola
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå. University of Gothenburg, Gothenburg (SWE); NU-hospital Group, Trollhättan (SWE).
    Eklund, Annika
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Nilsson, Maria Skyvell
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    The experience of new nurses’ early working life: learning in a hospital care context – An interview study2022Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 65, artikkel-id 103506Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To explore how nurses during their early working life learn to provide high-quality care in relation to organisational prerequisites in a hospital setting.BackgroundWhen nurses enter employment in contemporary hospital settings, they face multiple learning challenges. Organisational prerequisites that have been identified to affect their ability to learn to provide high-quality care are related to staffing turnovers, large patient groups and a lack of experienced staff to support their learning.

    Design: Qualitative.

    Methods: The study was conducted between 2018 and 2019 at a medium-sized hospital in Sweden. Data from interviews with 10 nurses with fewer than two years’ work experience were subjected to qualitative content analysis.

    Results: The results describe the nurses’ learning during their early working life in two categories: Performing tasks in relation to organisational prerequisites and Making use of clinical experiences to grasp the complexity of nursing care. The first theme reflected a learning process that was initially characterised by seeking confirmation and instructions from colleagues of how to act safely and by balancing the demands of time efficiency and sustaining patient safety. The second theme reflected that, after addressing organisational prerequisites, the nurses tried to understand and make use of clinical experiences to grasp the complexity of nursing care by encountering and processing clinical patient situations.

    Conclusions: The results of this study revealed that nurses’ learning during early working life seemed to be primarily directed towards handling tasks, with sometimes limited opportunities to grasp the complexity of nursing care. Their learning depended largely on their own initiative and motivation and was strongly influenced by organisational prerequisites. The limited availability of experienced nurse colleagues and lack of time devoted for reflection needs to be dealt with to support nurses’ learning.

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  • 7.
    Eklund, Annika
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik. Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Can we be prepared for the next accident or catastrophe?: Potential contributions of emergency collaboration exercises2013Inngår i: Proceedings of  The 8th International Conference in Critical Management Studies; 10 Jul 2013-12 Jul 2013; The University of Manchester. Manchester, United Kingdom: The University of Manchester Library; 2013., Manchester: University of Manchester Library , 2013, s. 1-12Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Catastrophes and accidents (natural,technological, or man-made) have been subjected to scientific research from different disciplines and perspectives for a long time. Examples of these perspectives include community risk and vulnerability, human behaviour during crisis, fire behaviour and eco-system management, decision-making, communication, and collaboration issues. This paper deals with different perspectives of preparation and prevention in terms of accidents and catastrophes. The overall aim is to present an overview of different aspects on the possibility for organisations and societies to be prepared for the next incident and to highlight emergency exercises as a part of crisis management. In the second part of the paper the project “Collaboration exercises—from parallelto synchronous”, is introduced. The project is carried out in Sweden, and aims to explore how collaboration between police, ambulance and rescue services is practiced and developed during exercises. Of particular interest is inter-organisational collaboration and learning during exercises. To develop an understanding of these processes, a range of different types of emergency collaboration exercises was observed and participants were interviewed about their experiences. Tentative findings from the studies so far are briefly introduced. Some challenges of using exercises to increase the preparedness for managing the uncertainty and the unexpected are further discussed.

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  • 8.
    Eklund, Annika
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi. Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Introduktionsprogram i sjukhusvården för nyutexaminerade sjuksköterskor: en internationell utblick samt forskning om och utvärdering av Kliniskt basår i Västra Götalandsregionen2023Rapport (Annet vitenskapelig)
    Fulltekst (pdf)
    fulltext
  • 9.
    Eklund, Annika
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Redo att lära, oförberedd på jobbet: sex år med introduktionsprogram för nyutexaminerade sjuksköterskor2023Inngår i: Abstracts för Decemberkonferensen, Trollhättan: Högskolan Väst , 2023, s. 1-1Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

    I presentationen berättar jag lite om hur vi arbetat med VGR:s regionala grupp för Kliniskt basår, och lite kort om våra studieresultat i kontexten att skapa förutsättningar för nyutexaminerade.

  • 10.
    Eklund, Annika
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Samverkan som fenomen och i praktiken2023Inngår i: Samverkan i vården: från system till praktik / [ed] Annika Eklund & Christian Gadolin, Stockholm: Liber, 2023, 1., s. 12-33Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    Boken beskriver samverkan i hälso- och sjukvård ur olika perspektiv och ger verksamhetsnära exempel. Svensk hälso- och sjukvård har jämförelsevis goda resultat men brister i exempelvis kontinuitet och koordinering. Till följd av vårdens ökade specialisering behövs förmågan att samverka för en säker vård och ett effektivt utnyttjande av resurser.

  • 11.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Billett, Stephen
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    A bridge over troubled water?: Exploring learning processes in a transition program with newly graduated nurses2021Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 3, nr 51, artikkel-id 102982Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Successful preparation of newly graduated nurses (NGN) is a critical concern for the healthcare sector. This study explores the learning processes enacted in a transition program with NGNs implemented in hospitals in western Sweden. Group interviews with NGNs and ward managers were conducted, with the data analyzed using qualitative thematic analysis. The following themes were identified as the learning processes secured through the program: Recognizing the NGNs' role as novice practitioners, Emphasizing newly graduated nurses as learners, and Progressing towards a comprehensive nursing role. To support these learning processes, the program should provide opportunies to consolidate and reconcile NGNs' experiences as novices in healthcare environments where effective performance is crucial. If NGNs are supported in these ways, the program can make salient contributions to develop the knowledge bases of their occupational expertise. 

    Fulltekst (pdf)
    fulltext
  • 12.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik. Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Carlström, Eric
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på avancerad nivå. Göteborgs universitet, Sahlgrenska Akademin, Institutionen för vårdvetenskap och hälsa .
    Berlin, Johan
    Högskolan Väst, Institutionen för individ och samhälle, Avd för socialpedagogik och sociologi.
    Organisering av en fingerad verklighet: Om övningar mellan blåljusorganisationer2013Inngår i: Nordiske organisasjonsstudier, ISSN 1501-8237, Vol. 15, nr 3, s. 34-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study aimed to elucidate exercise participants’ understanding of critical aspects of organizing and implementation of collaboration exercises with police, fire department and ambulance services. The focus is critical aspects in exercises that have, or are expected to have, bearing on the participants’ ability to learn. Collaboration exercises are used as a tool to reinforce and develop the preparedness for future incidents. The need for such exercises was usually advocated after critique to actions during largescale real-life incidents. The study had a qualitative approach and is based on phenomenographic analysis of interviews with participants from four exercises with different scenarios. The identified critical aspects of exercises were related to realism, acceptance for mistakes, exercise extent and aims and opportunities for joint discussions. The management of an accident can be described to a large extent depend on the organizations’ joint ability to adapt to the prevailing situation and to collaborate. For exercises to contribute to these abilities, they could benefit from shifting the focus to how to organize exercises that allow participants to test different decisions and actions, with less emphasis on the choice of scenario.

  • 13.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Gadolin, ChristianHögskolan Väst, Institutionen för ekonomi och it, Avd för företagsekonomi.
    Samverkan i vården: från system till praktik2023Collection/Antologi (Annet vitenskapelig)
    Abstract [sv]

    Boken beskriver samverkan i hälso- och sjukvård ur olika perspektiv och ger verksamhetsnära exempel. Svensk hälso- och sjukvård har jämförelsevis goda resultat men brister i exempelvis kontinuitet och koordinering. Till följd av vårdens ökade specialisering behövs förmågan att samverka för en säker vård och ett effektivt utnyttjande av resurser...[Bokinfo] 

  • 14.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Gadolin, Christian
    Högskolan Väst, Institutionen för ekonomi och it, Avd för företagsekonomi.
    Samverkanskompetens2023Inngår i: Samverkan i vården: från system till praktik / [ed] Annika Eklund & Christian Gadolin, Liber, 2023, s. 196-208Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 15.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå. Department of Surgical and Perioperative Sciences, Centre for Disaster Medicine, Umeå University, Umeåm (SWE).
    Karlsson, Sofia
    Department of Surgical and Perioperative Sciences, Centre for Disaster Medicine, Umeå University, Umeå (SWE).
    Gyllencreutz, Lina
    Department of Surgical and Perioperative Sciences, Centre for Disaster Medicine, Umeå University, Umeå (SWE).
    Building “common knowledge” when responding to major road tunnel incidents: an inter-organisational focus group study2022Inngår i: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 12, nr 2, s. 145-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose – Major incidents in tunnel environment will pose several challenges for the emergency service organisations in terms of heat, visibility and lack of experiences from working in confined environments. These aspects, in turn, could pose challenges to establish collaboration. This study aims to contribute to the field of collaborative tunnel responses by exploring how “common knowledge” (Edwards, 2011) is built by the emergency services organisations, that is, what the organisations consider important while working on a potentially common problem, and their motives for the interpretations and actions if a major tunnel incident occurs.

    Design/methodology/approach – Participants from the road traffic control centre, emergency dispatch centre, emergency medical service, rescue service and police were included in the study. Data from four focus group sessions was analysed using thematic analysis.

    Findings – The study revealed that the tunnel environment presents specific aspects of how common knowledge was produced related to lifesaving and safety. The themes structuring mechanisms to reduce uncertainty, managing information for initial priorities, aligning responsibilities without hampering eachother’s work and adjusting actions to manage distance, illustrated how common knowledge was producedas crucial aspects to a collaborative response. Organising management sites, grasping and communicating risks, accessing the injury victims, was challenged by the confined environment, physical distances and imbalance in access to information and preparedness activities in tunnel environments.

    Originality/value – This study offers new insights of common knowledge, by illustrating a motive perspective on collaborative responses in tunnel incidents. Creating interoperability calls not just for readiness for action and tunnel safety, but also training activities acknowledging different interpretations and motives to further develop tunnel responses.

    Fulltekst (pdf)
    Fulltext
  • 16.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi. Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, Umeå (SWE).
    Karlsson, Sofia
    Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, Umeå (SWE).
    Hylander, Johan
    Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, Umeå (SWE).
    Östlund, Henrik
    F.E, Bricon AB (SWE).
    Gyllencreutz, Lina
    Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University,Umeå,(SWE); Department of Nursing, Umeå University, Umeå (SWE).
    Exploring focus group discussions for building knowledge across emergency services organisations: a foundation for road tunnel incidents responses and future research?2022Inngår i: International Conference on Work Integrated Learning: Abstract Book, Trollhättan: University West , 2022, s. 65-67Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction and aim

    Road tunnels are important parts of today’s infrastructure and society, but also with potential for many injured in case of an incident and a challenging work environment for emergency services organisations. If a mass-casualty incident (MCI) occurs in a road tunnel, specific challenges in terms of safety, heat, smoke, long distances to the injured and lack of and contradictory information will impact the response and how collaboration is established (Holgersson et al., 2020; Lockey et al., 2005). In addition, sharing information during responses is, however, often limited due to the lack of knowledge and understanding of each other’s work processes at an individual and organisational level (Sederholm et al., 2021). A key for collaboration here is a good understanding of how their own, and collaborative organisations interpret and operate in a potentially shared task (Edwards, 2012; Wolbers et al., 2017). Thus, the road tunnel environment is one area where research has pointed to the need for a shared understanding of incidents across the organisations (Casse & Caroly, 2019) and for arenas facilitating exchange of experiences and reflections upon work procedures to develop collaboration (Njå & Svela, 2018; Hylander et al., 2022). This calls for activities that could stimulate work-integrated learning. While exercises and simulations are valuable in enhancing response preparedness, the perceived effects have been reported to vary in terms of learning and usefulness (see e.g., Roud et al., 2021). In addition, exercises and simulations are expensive and time consuming, calling for alternative but still effective learning activities for developing collaboration. This abstract aim to present and critically explore an innovative learning activity for development of joint knowledge to improve MCI response in road tunnel environments.

    Design and participants 

    The learning activity analysed for this abstract was a series of four focus groups á 4 to 4,5 hours, conducted online in a region of Sweden. The overall aim of the series was to share experiences and develop joint knowledge across emergency organisations in tunnel environments. The participants in the focus groups represented the organisations that typically respond to tunnel incidents, i.e., ambulance service (EMS), police service, rescue service, Swedish Transport Administration (RTCC, Trafikverket) and emergency dispatch center (EDC, SOS Alarm) (Table 1). The study participants had extensive work experience within their organisations and are expected to have a tactical or operational management function in a major response.

    Table 1 not included in this abstract

    The researchers designed the focus group series with the intention to alternate experiences, with procedural, conceptual and practical elements. The study used a partly participatory design. For this study, rather than being co-interpreters of the results, the participants were involved to shape the sessions content and questions to be discussed in ways they found valuable (Baum et al., 2005). The researchers built the following session from what the participants had asked for, discussed, or found challenging in the prior sessions. One week in advance, the overarching theme, goal, and suggestions for discussion questions for the session, and a summary of bullet points from the previous session, was sent out to the participants. Session I was set out to be an open discussion to familiarize themselves with each other’s ways of working, and to discern the participants’ understandings of specific challenges and needs for responses in tunnels, but also to illuminate the impact of internal decisions and actions for saving lives safely. The first approximate 20 minutes was discussed as crucial for establishing a tunnel response, which is why this phase was focused on during Session II: a best-practice discussion based on the initial 20 minutes of a full-scaled exercise where several of the participants had been involved. Information gathering and sharing was highlighted as both crucial and challenging, which lead to the research group introducing and participants discussing practical implications of concepts of “situational awareness” in Session III. Session IV was a ‘digital exercise’ based on a crash and vehicle fire in a tunnel, aiming to wrap up the identified challenges and practicing information sharing and management during the initial 20 minutes of the response.The analysis was conducted as critical discussions in the research group, in-between the sessions and when the full series was conducted, set out to identify potential strengths and weaknesses/challenges of the design and content for knowledge development. The results will present the preliminary findings and contributions.

    Results 

    The analysis performed for this abstract found that the focus groups series ha s strengths and weaknesses/challenges to build knowledge across organisations regarding potential MCI road tunnel responses. 

    First, the opportunity to discuss the same questions from four “basis”/perspectives, including presenting the organisations own perspectives and exercise experiences, a theoretical concept, and a practical moment was a strength. However, rather than a progression of learning (such as becoming more effective in information sharing), the design primarily allowed analysis of a deeper and more complex understanding of the overall question of joint and timely responses. 

    Second, the iterative and participatory design was a strength in terms of that the sessions could to some extent focus on the issues the participants highlighted. By using this method, the participants also had the possibility to reflect upon prior and upcoming sessions (Baum et al., 2006). This could, however, be a limitation for comparing results across different groups if the issues of concern diverge too much.

    Third, the focus groups could contribute to the organisations’ knowledge development across practices, such as identifying specifically critical moments when establishing a response or sharing thoughts about safety. Using this design could be a complement to the typical focus on actions in exercises and training (Roud et al., 2021). In addition, the nature of focus group data provides opportunities to analyse interactions (Wilkinson, 2021). Still, how the knowledge developed could be further implemented in and across the organisations remains unknown and needs further consideration in research and practice.

    Fourth, the focus groups were effective for researchers to explore how knowledge is shared and possible contradictions in interpretations and actions. This approach is valuable for developing knowledge in cross-practice collaborations (Edwards, 2012). Including materials from a full-scale exercise and a practical digital exercise was valuable due to the obvious connection to their work tasks and potential challenges, and to contextualize their learning. Further, the amount and various types of data obtained from each session, such as discussing a theoretical concept and a practical exercise moment, could pose challenges for analysis. However, including both structured discussions and practical exercises as stimuli could strengthen the internal validity of the findings (e.g., reduce the discrepancies between what they say they do and what they actually do).

    Fifth, using online meetings was time-effective (and safe during the COVID-19 pandemic), allowing participants and researchers to work from where they choose. However, the online setting produced primarily a dialogue between moderator and participants, with less initiatives for dialogues between participants. It co uld be valuable to further evaluate the design in physical meetings. Moreover, it was easier to drop out or pop out, to simultaneously manage other work tasks, from online meetings compared to physical meetings.

    Conclusion

    In conclusion, we would here argue that using inter-organisational focus groups, that acknowledge participants needs for learning and providing various stimuli to engage in a shared problem, can contribute to knowledge development for future tunnel responses. Research and practice should further explore how various interpretations and actions can be used to improve strategies, communication and organizational changes. Further research could 67 also explore how discussion-based learning activities can be used as a platform to develop and main tain collaborative learning networks, and as a complement to exercises and simulations.

  • 17.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Saveman, Britt-Inger
    Department of Surgery and Perioperative Sciences, Section for Surgery, Umeå University, 901 87 Umeå, Sweden Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
    Gyllencreutz, Lina
    Department of Surgery and Perioperative Sciences, Section for Surgery, Umeå University, 901 87 Umeå, Sweden Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
    Situational awareness during a full-scale exercise in an underground mine: A qualitative single-case study of the ambulance incident commander2021Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 54, nr January, artikkel-id 100950Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    IntroductionUnderground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care.

    AimThis study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise.

    MethodsData consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents.

    ResultsThe results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process.

    ConclusionThe AIC’s situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises.

  • 18.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Kliniskt basår för nyutexaminerade sjuksköterskor inom Västra Götalandsregionen: en utvärderingsrapport2018Rapport (Annet vitenskapelig)
    Abstract [sv]

    Newly graduate nurses (NGN) transition between basic education and work in a complex health care practice, as well as their intention of leaving the profession during the first year of work and how this can be prevented, is a global concern. NGN experience difficulties integrating workplace environment, expectations, and educational experiences. This is an evaluation study of a one-year transition program, which was implemented as a project during 2016-17, at six hospitals in Sweden.

    An explorative research design was used and data consist of focus group and individual interviews with NGNs, interviews with first-line managers, observations of simulation training, and survey material from the hospitals. Data was analyzed using thematic analysis. Results show an overarching structure for all hospitals in the region, the NGNs are engaged in the following learning activities; introduction at the ward and a senior RN as preceptor, lectures and/or simulations, change of ward, process-oriented reflection seminars and mentorship.

    The different learning activities contribute to the overall learning in different ways. Continuous supervision and structured reflection are central to NGNs professional learning. Organizational conditions create prerequisites for learning during the transition program and a change of ward is a particular challenge to get organized. The results, also provides a deeper understanding of the foundational components in NGNs early development of expertise, security as professionals, and essential knowledge for bridging the practices of the first cycle program and healthcare practice at hospitals.

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  • 19.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Program coordinators’ perspectives on implementing a transition program for newly graduated nurses: a qualitative interview study2024Inngår i: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 38, nr 9, s. 143-156Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose

    While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.

    Design/methodology/approach 

    An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

    Findings

    The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

    Originality/value 

    This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

    Fulltekst (pdf)
    fulltext
  • 20.
    Eklund, Annika
    et al.
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi. Department of Individual and Behavioral studies, University West, Trollhättan, Sweden.
    Sterner, Anders
    Department of Work Life and Social Welfare, Faculty of Caring Sciences, University of Borås, Borås (SWE).
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Larsman, Pernilla
    Department of Psychology, University of Gothenburg, Gothenburg (SWE).
    The impact of transition programs on well-being, experiences of work environment and turnover intention among early career hospital nurses2024Inngår i: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, s. 1-10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups.

    OBJECTIVE:

    To explore the long-term impact of having attended a transition program on the nurses’ experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables.

    METHODS:

    A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups.

    RESULTS:

    The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small.

    CONCLUSION:

    Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

  • 21.
    Holgersson, Annelie
    et al.
    Department of Nursing, Umeå University (SWE).
    Eklund, Annika
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå. Department of Nursing, Umeå University (SWE).
    Gyllencreutz, Lina
    Department of Nursing, Umeå University (SWE).
    Saveman, Britt-Inger
    Department of Nursing, Umeå University (SWE).
    Emergency Medical Response in Mass Casualty Tunnel Incidents: with Emphasis on Prehospital Care2020Inngår i: Journal of Human Security, E-ISSN 1835-3800, Vol. 16, nr 1, s. 3-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Responding to mass casualty incidents in a tunnel environment is problematic not least from a prehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorize preconditions for emergency response in tunnel environments based on Haddon's matrix and 2) identify specific EMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected for further analysis. Firstly, sorting the data from each included article was done according to Haddon's matrix. The result covers human factors, technical factors, physical environmental factors and socioeconomic environmental factors all related to preconditions for emergency response. To describe the EMS's knowledge the data was also sorted according to command and safety, communication, assessment, and triage treatment and transport, also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regarding emergency response to tunnel incidents and those that do, often have a main focus on management by the rescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue service in action, the subsequent EMS response issues that have taken place appear to have been given limited attention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective work environment for the emergency services, there is a need to explore the event phase.

  • 22.
    Karlsson, Sofia
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 87 Umeå, (SWE).
    Gyllencreutz, Lina
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 87 Umeå,(SWE); Department of Nursing, Umeå University, 901 87 Umeå (SWE).
    Hylander, Johan
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 87 Umeå (SWE).
    Eklund, Annika
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Tactical leaders’ and collaborative organizations’ non-technical skills during major road tunnel incidents – An iterative focus group study2023Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 71, artikkel-id 101357Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Leadership during major incidents has been described as challenging and dependent on the non-technical skills of leaders. The complex tunnel environment contributes to an even more challenging incident response. Hence, this study aims to identify elements of non-technical skills when leading collaborative road-tunnel incident responses.

    Methods: The study was conducted using four focus group discussions with tactical leaders from the rescue services, emergency medical services, police, and collaborative organizations from the emergency dispatch center and road-traffic control center. The data was analyzed using a non-technical skills taxonomy.

    Results: Twelve non-technical skill elements emerged. Abilities to gather, sort, and proactively share relevant information and dispatch the correct resources were described. Additionally, abilities to prioritize actions and cooperate to establish a shared operational picture were found. Abilities to adjust leadership to the tunnel environment and conditions and assess the severity of the incident to make decisions were also described.

    Conclusion: When managing a road-tunnel incident response, tactical leaders utilizes a range of non-technical skills. The elements of these skills were found to be specific both to the tunnel environment and the collaborative nature of the response. Further studies into and development of these skills are needed to facilitate a timely response and minimize potential risks to personnel or evacuees in future tunnel incident responses.  

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    fulltext
  • 23.
    Karlsson, Sofia
    et al.
    Umeå University, Department of Surgical and Perioperative Sciences, Surgery, Umeå, 901 87, Sweden.
    Saveman, Britt-Inger
    Umeå University, Department of Surgical and Perioperative Sciences, Surgery, Umeå, 901 87, Sweden.
    Hultin, Magnus
    Umeå University, Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå, 901 87, Sweden.
    Eklund, Annika
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Gyllencreutz, Linda
    Umeå University, Department of Surgical and Perioperative Sciences, Surgery, Umeå, 901 87, Sweden.
    Expansive learning process of exercise organizers: The case of major fire incident exercises in underground mines2020Inngår i: Applied Sciences, E-ISSN 2076-3417, Vol. 12, nr 14, artikkel-id 5790Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A major fire incident in a Swedish underground mine made the personnel from the mining company and the rescue service realize their limited preparedness. It was the beginning of a collaboration project that included the development of a new exercise model for a more effective joint rescue operation practice. The aim of this study was to explore the collaborative learning process of exercise organizers from the rescue service, mining companies, the emergency medical service, a training company, and academia. The analysis was performed through the application of the theory cycle of expansive learning to the material consisting of documents from 16 collaboration meetings and 11 full-scale exercises. The learning process started by the participants questioning the present practice of the rescue operation and analyzing it by creating a flow chart. An essential part of the process was to model new tools in order to increase the potential for collaboration. The tools were examined and tested during collaboration meetings and implemented during full-scale exercises. The exercise organizers reflected that the process led to organizational development and a better understanding of the other organizations’ perspectives. Consequently, a tentative model for developing the learning process of exercise organizers was developed. © 2020 by the authors.

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    fulltext
  • 24.
    Sterner, Anders
    et al.
    Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås (SWE).
    Eklund, Annika
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Prepared to learn but unprepared for work: A cross sectional survey study exploring the preparedness, challenges, and needs of newly graduated nurses entering a hospital-based transition program2023Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 72, artikkel-id 103782Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.

    Background: Previous research has raised questions about new graduate nurses’ (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs’ expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.

    Design: A cross-sectional survey design was used. Method: NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.

    Results: Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit.

    The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses’ readiness for clinical work, the challenges they perceive, and their needs for learning and supp

    Fulltekst (pdf)
    fulltext
  • 25.
    Sterner, Anders
    et al.
    Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås (SWE).
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Eklund, Annika
    Högskolan Väst, Institutionen för individ och samhälle, Avdelningen för psykologi, pedagogik och sociologi.
    The value of simulation-based education in developing preparedness for acute care situations: An interview study of new graduate nurses’ perspectives2023Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 67, s. 1-7, artikkel-id 103549Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim

    This study aimed to explore how new graduated nurses experience a one-day simulation based education, contributing to providing care in acute situations two months after completion.

    Background

    Simulation-based education is often offered to new graduated nurses as part of important workplace learning. Simulation-based education is a valid learning and teaching strategy and is suggested as a measure to improve nurses’ ability in acute situations. However, studies are often conducted as pre-post evaluations immediately after completion of a simulation. Thus, knowledge of the clinical impact of simulation-based education on actual acute care situations could benefit both research and practice.

    Design/method

    During the winter of 2021–2022, 14 semi-structured interviews were conducted with newly graduated nurses two months after they completed the simulation-based education and the interviews were analyzed using thematic analysis.

    Results

    The results are presented in three themes: a structured and shared strategy to handle acute situations, a developed role in acute situations and a more comprehensive understanding of acute situations. The results revealed that simulation-based education can contribute to the ability to care in acute situations in terms of action readiness and broad contextual understanding.

    Conclusion

    Simulation-based education can help develop the ability to care for patients in acute situations. However, differences in participant experiences must be acknowledged and processed in order for the implementation and outcome to be successful.

    Fulltekst (pdf)
    fulltext
  • 26.
    Sterner, Anders
    et al.
    University of Borås (SWE).
    Skyvell Nilsson, Maria
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Jacobsson, Madelene
    Sahlgrenska University Hospital, Regional simulation center, Gothenburg (SWE).
    Eklund, Annika
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Ability to Care in Acute Situations: The Influence of Simulation-Based Education on New Graduate Nurses2022Inngår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 48, nr 5, s. 515-524Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction:

    Simulation-based education is frequently used in transition programs for new graduate nurses. Simulation-based education is implemented as a measure to practice nursing skills, gain experience, and prepare nurses for caring in challenging situations, such as acute situations. However, concerns about the data supporting the use of simulation are obtained from small studies that do not use validated measurement scales.

    Objective:

    This study aimed to explore the influence of simulation-based education on new graduate nurses’ perceivedability to provide care in acute situations.

    Methods:

    A total of 102 new graduate nurses participated in simulation-based education as a mandatory part of an introductory program. They completed a premeasurement and a postmeasurement using the Perception to Care in Acute Situations scale. The Wilcoxon signed-rank test and the paired samples ttest were used to test the statistical significance of outcomes for the simulation-based education, with the alpha set at 0.05.Cohen’s d formula was used to calculate the effect size.

    Results:

    The Wilcoxon signed-rank test on the total scale score showed that simulation-based education resulted in a statistically significant change in the nurses’ perceptions of their abilityt o care in acute situations (N ¼ 99; Z ¼ 7877; P < .001). The paired samples

    t test showed that the mean posteducation scorewas significantly higher (P < .001) in the total score. Cohen’sd formula (-1.24) indicated a large effect size on the total score.

    Discussion:

    Simulation-based education can provide an effective means of improving new graduate nurses’ perceivedability to provide care in acute situations. 

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