Förberedd på att vara oförberedd : En fenomenologisk studie av vårdande bedömning och dess lärande i ambulanssjukvård

Sammanfattning: A focal point in this dissertation is that there is knowledge in the ambulance service that is experience-based, which has not always been made explicit, and that provides the foundation for the caregivers' assessment of the patients and their needs for care. The first aim of the study was to describe and analyse the ambulance services with a focus on the phenomenon of assessment from the lifeworld perspective in the caring sciences. The second aim of the study was of an educational nature where the object was to be able to draw conclusions about the learning process in the ambulance service in the light of the knowledge generated by the empirical findings. Thus the aim was to create a synthesis consisting of didactic ideas that are based on the caring sciences and describing how assessment can be learnt and can support future caregivers in the ambulance services.Assessment in the ambulance service entails, on an overall level, having a natural caring attitude that includes striving in two directions at the same time. These are that on the one hand the caregivers strive to bring order to that which is disordered as soon as possible, to structure the unstructured, and in short define the indefinite in order to provide medical assistance. There is a need to quickly assess the patient's condition and which measures are necessary. On the other hand the caregivers strive to let the indefinite wait a while in order to be able to meet the patient's suffering. There is thus a desire to listen attentively to the individual patient.The essential meaning of assessment of patients in the ambulance services is that thereare conflicting demands on assessment and care, which entails that the caregiver adapts him/herself to the prevailing care situation in a way that means being flexible and adaptable to the patient's medical condition. The caregivers also have a flexibility and adaptability in relation to their colleague, which leads to a mutual interplay in the assessment. Assessment in the ambulance services also means that the caregivers are paradoxically prepared at the same time as being unprepared, i.e. they are prepared for the unprepared. The assessment thus starts before the caregivers have reached the patient and the actual situation. Even if they "know" what awaits them, they do not really "know". It becomes a dynamic struggle between on the one side the expectancy that feels certain and on the other the unknown in every new situation. The struggle contains a desire for control and effectiveness in a care practice full of surprises.