{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:25:56Z","timestamp":1771928756661,"version":"3.50.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008408","name":"Kristianstad University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008408","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The aging population has led to a growing number of frail older patients in prehospital emergency care. These patients often present with complex healthcare needs, posing significant challenges for prehospital emergency nurses (PENs) when assessing the appropriateness of providing self-care advice and recommending that patients remain at home. This study, therefore, aimed to explore the experiences of PENs in giving self-care advice and referring frail older patients to remain at home when this approach is considered the most appropriate course of action.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>An exploratory qualitative design was employed, which was based on individual semistructured interviews with ten PENs from an ambulance service organization in southwestern Sweden. The data were analysed via inductive qualitative content analysis, following the approach described by Elo and Kyng\u00e4s.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The analysis resulted in one main category: <jats:italic>Professional discretion and coordinated support for sustainable decision making<\/jats:italic>, along with three generic categories. The findings highlight key dilemmas faced by PENs: navigating uncertainty in frail older patients\u2019 cognitive and functional abilities, balancing patient autonomy and self-determination with safety concerns, and managing the ethical tension between respecting dignity and preventing harm. PENs also highlighted dilemmas in communication, where striving for clarity and trust was hampered by language barriers. They further experienced challenges in negotiating power and responsibility with frail older patients and relatives. Limited resources, unclear care structures, and insufficient collaboration with other healthcare providers created additional organizational dilemmas, constraining PENs\u2019 ability to make confident, ethically sustainable decisions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This study underscores the complexity of decision-making for PENs when giving self-care advice and referring frail older patients to remain at home. Ensuring safe and sustainable care requires thorough assessments, clear communication, clinical expertise, empathy, and interprofessional collaboration, while future research should also address patients\u2019 perspectives and the organizational factors influencing PENs\u2019 decisions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial registration<\/jats:title>\n            <jats:p>Not applicable.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12873-025-01355-0","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T14:31:34Z","timestamp":1758551494000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Balancing care needs - a qualitative study on prehospital emergency nurses\u2019 experiences of providing self-care advice and home referrals for frail older patients"],"prefix":"10.1186","volume":"25","author":[{"given":"Gabriella","family":"Norberg Boysen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elin","family":"Svensson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Heldtander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Herlitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes","family":"Olander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"1355_CR1","unstructured":"Statistics Sweden (SCB). After 60: a description of older people in Sweden. Demographic Reports 2022:2. https:\/\/www.scb.se. Accessed 4 June 2025."},{"key":"1355_CR2","unstructured":"World Health Organization, Ageing and health. (2024). Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/ageing-and-health. Accessed 4 June 2025."},{"key":"1355_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-020-00387-y","author":"A Hjalmarsson","year":"2020","unstructured":"Hjalmarsson A, Holmberg M, Asp M, \u00d6stlund G, Nilsson KW, Kerstis B. Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in sweden: a total population study. BMC Emerg Med. 2020. https:\/\/doi.org\/10.1186\/s12873-020-00387-y.","journal-title":"BMC Emerg Med"},{"key":"1355_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-023-00926-3","author":"T Coats","year":"2024","unstructured":"Coats T, Conroy S, de Groot B, Heeren P, Lim S, Lucke J, et al. Prevalence of frailty in European emergency departments (FEED): an international flash mob study. Eur Geriatr Med. 2024. https:\/\/doi.org\/10.1007\/s41999-023-00926-3.","journal-title":"Eur Geriatr Med"},{"key":"1355_CR5","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-020-00767-0","author":"R Ivic","year":"2020","unstructured":"Ivic R, Kurland L, Vicente V, Castr\u00e9n M, Bohm K. Serious conditions among patients with non-specific chief complaints in the pre-hospital setting: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2020. https:\/\/doi.org\/10.1186\/s13049-020-00767-0.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1355_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-022-00643-3","author":"C Magnusson","year":"2022","unstructured":"Magnusson C, Hagiwara MA, Norberg-Boysen G, Kauppi W, Herlitz J, Axelsson C, et al. Suboptimal prehospital decision- making for referral to alternative levels of care \u2013 frequency, measurement, acceptance rate and room for improvement. BMC Emerg Med. 2022. https:\/\/doi.org\/10.1186\/s12873-022-00643-3.","journal-title":"BMC Emerg Med"},{"key":"1355_CR7","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04545-2","author":"AS K\u00e4llberg","year":"2023","unstructured":"K\u00e4llberg AS, Berg LM, Skogli S, Bjurbo C, Muntlin \u00c5, Ehrenberg A. Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments. BMC Geriatr. 2023. https:\/\/doi.org\/10.1186\/s12877-023-04545-2.","journal-title":"BMC Geriatr"},{"key":"1355_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06960-w","author":"I De Brauwer","year":"2021","unstructured":"De Brauwer I, Cornette P, D\u2019Hoore W, Lorant V, Verschuren F, Thys F, et al. Factors to improve quality for older patients in the emergency department: a qualitative study of patient trajectory. BMC Health Serv Res. 2021. https:\/\/doi.org\/10.1186\/s12913-021-06960-w.","journal-title":"BMC Health Serv Res"},{"key":"1355_CR9","doi-asserted-by":"publisher","DOI":"10.5750\/ejpch.v4i","author":"G Norberg Boysen","year":"2016","unstructured":"Norberg Boysen G, Christensson L, Wireklint Sundstr\u00f6m B, Nystr\u00f6m M, Jutengren G. Use of the medical emergency services by patients with suspected acte primary healthcare problems: developing av questionnaire measure patient trust in healthcare. Eur J Person Centered Healthc. 2016. https:\/\/doi.org\/10.5750\/ejpch.v4i.","journal-title":"Eur J Person Centered Healthc"},{"key":"1355_CR10","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.14626","author":"E H\u00f6glund","year":"2019","unstructured":"H\u00f6glund E, Schr\u00f6der A, M\u00f6ller M, Andersson-Hagiwara M, Ohlsson-Nevo E. The ambulance nurse experiences of non-conveying patients. J Clin Nurs. 2019. https:\/\/doi.org\/10.1111\/jocn.14626.","journal-title":"J Clin Nurs"},{"key":"1355_CR11","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaf126","author":"J-N Krohn","year":"2025","unstructured":"Krohn J-N, Singler K. Frailty and prehospital emergency care: implications for paramedic education. Age Ageing. 2025. https:\/\/doi.org\/10.1093\/ageing\/afaf126.","journal-title":"Age Ageing"},{"key":"1355_CR12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x","author":"S Elo","year":"2008","unstructured":"Elo S, Kyng\u00e4s H. The qualitative content analysis process. J Adv Nurs. 2008. https:\/\/doi.org\/10.1111\/j.1365-2648.2007.04569.x.","journal-title":"J Adv Nurs"},{"key":"1355_CR13","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007. https:\/\/doi.org\/10.1093\/intqhc\/mzm042.","journal-title":"Int J Qual Health Care"},{"key":"1355_CR14","doi-asserted-by":"publisher","DOI":"10.11648\/j.ajtas.20160501.11","author":"I Etikan","year":"2016","unstructured":"Etikan I. Comparison of convenience sampling and purposive sampling. Am J Theoretical Appl Stat. 2016. https:\/\/doi.org\/10.11648\/j.ajtas.20160501.11.","journal-title":"Am J Theoretical Appl Stat"},{"key":"1355_CR15","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.255","author":"T Backman","year":"2019","unstructured":"Backman T, Juuso P, Borg R, Engstr\u00f6m \u00c5. Ambulance nurses\u2019 experiences of deciding a patient does not require ambulance care. Nurs Open. 2019. https:\/\/doi.org\/10.1002\/nop2.255.","journal-title":"Nurs Open"},{"key":"1355_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2025.02.002","author":"LB Schulson","year":"2025","unstructured":"Schulson LB, Rodriguez JA, Cruz R, Flynn D, Fernandez A. Patient safety event risk and language barriers: a scoping review. Joint Comm J Qual Patient Saf. 2025. https:\/\/doi.org\/10.1016\/j.jcjq.2025.02.002","journal-title":"Joint Comm J Qual Patient Saf"},{"key":"1355_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04053-3","author":"NL Hill","year":"2023","unstructured":"Hill NL, Bratlee-Whitaker E, Jang H, Bhargava S, Sillner AY, Do J, et al. Patient-provider communication about cognition and the role of memory concerns: a descriptive study. BMC Geriatr. 2023. https:\/\/doi.org\/10.1186\/s12877-023-04053-3.","journal-title":"BMC Geriatr"},{"issue":"1","key":"1355_CR18","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12912-020-00443-9","volume":"19","author":"EL Wanko Keutchafo","year":"2020","unstructured":"Wanko Keutchafo EL, Kerr J, Jarvis MA. Evidence of nonverbal communication between nurses and older adults: a scoping review. BMC Nurs. 2020;19(1):53.","journal-title":"BMC Nurs"},{"issue":"1","key":"1355_CR19","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12873-022-00659-9","volume":"22","author":"G Larsson","year":"2022","unstructured":"Larsson G, Dagerhem A, Wihlborg J, Rantala A. Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey. BMC Emerg Med. 2022;22(1):100.","journal-title":"BMC Emerg Med"},{"key":"1355_CR20","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-020-00443-9","author":"H Bruun","year":"2022","unstructured":"Bruun H, Milling L, Mikkelsen S, Huniche L. Ethical challenges experienced by prehospital emergency personnel: a practice-based model of analysis. BMC Med Ethics. 2022. https:\/\/doi.org\/10.1186\/s12912-020-00443-9.","journal-title":"BMC Med Ethics"},{"key":"1355_CR21","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12888","author":"V Vicente","year":"2014","unstructured":"Vicente V, Svensson L, Wireklint Sundstr\u00f6m B, Sj\u00f6strand F, Castren M. Randomized controlled trial of a prehospital decision system by emergency medical services to ensure optimal treatment for older adults in Sweden. J Am Geriatr Soc. 2014. https:\/\/doi.org\/10.1111\/jgs.12888.","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"1355_CR22","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1086\/JCE200920406","volume":"20","author":"EG Epstein","year":"2009","unstructured":"Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2009;20(4):330\u201342.","journal-title":"J Clin Ethics"},{"key":"1355_CR23","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2023207","author":"CH Rushton","year":"2023","unstructured":"Rushton CH. Transforming moral suffering by cultivating moral resilience and ethical practice. Am J Crit Care. 2023. https:\/\/doi.org\/10.4037\/ajcc2023207.","journal-title":"Am J Crit Care"},{"key":"1355_CR24","doi-asserted-by":"publisher","DOI":"10.1177\/09697330241291162","author":"J Wihlborg","year":"2025","unstructured":"Wihlborg J, Andersson U, Sterner A, Sandman L, K\u00e4ngstr\u00f6m A, Boysen GN. Stimulating ambulance specialist nurse students\u2019 ethical reflections by high-fidelity simulation. Nurs Ethics. 2025. https:\/\/doi.org\/10.1177\/09697330241291162.","journal-title":"Nurs Ethics"},{"key":"1355_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2013.10.004","author":"J Wihlborg","year":"2014","unstructured":"Wihlborg J, Edgren G, Johansson A, Sivberg B. The desired competence of the Swedish ambulance nurse according to the professionals - a Delphi study. Int Emerg Nurs. 2014. https:\/\/doi.org\/10.1016\/j.ienj.2013.10.004.","journal-title":"Int Emerg Nurs"},{"key":"1355_CR26","doi-asserted-by":"publisher","DOI":"10.1177\/0969733006069694","author":"L Sandman","year":"2006","unstructured":"Sandman L, Nordmark A. Ethical conflicts in prehospital emergency care. Nurs Ethics. 2006. https:\/\/doi.org\/10.1177\/0969733006069694.","journal-title":"Nurs Ethics"},{"key":"1355_CR27","doi-asserted-by":"publisher","DOI":"10.1111\/scs.12516","author":"A Rantala","year":"2018","unstructured":"Rantala A, Forsberg A, Ekwall A. Person-centred climate and psychometrical exploration of person-centredness and among patients not conveyed by the ambulance care service. Scand J Caring Sci. 2018. https:\/\/doi.org\/10.1111\/scs.12516.","journal-title":"Scand J Caring Sci"},{"key":"1355_CR28","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-007726","author":"MJ Booker","year":"2015","unstructured":"Booker MJ, Shaw ARG, Purdy S. Why do patients with \u2018primary care sensitive\u2019 problems access ambulance services? A systematic mapping review of the literature. BMJ Open. 2015. https:\/\/doi.org\/10.1136\/bmjopen-2015-007726","journal-title":"BMJ Open"},{"key":"1355_CR29","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-3056-x","author":"CD Jones","year":"2015","unstructured":"Jones CD, Vu MB, O\u2019Donnell CM, Anderson ME, Patel S, Wald HL, et al. A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations. J Gen Intern Med. 2015. https:\/\/doi.org\/10.1007\/s11606-014-3056-x.","journal-title":"J Gen Intern Med"},{"key":"1355_CR30","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2021.1970095","author":"ES Forsg\u00e4rde","year":"2021","unstructured":"Forsg\u00e4rde ES, Svensson A, R\u00f6\u00f6st M, Fridlund B, Elmqvist C. The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called. Int J Qual Stud Health Well-being. 2021. https:\/\/doi.org\/10.1080\/17482631.2021.1970095.","journal-title":"Int J Qual Stud Health Well-being"},{"key":"1355_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04331-0","author":"ES Forsg\u00e4rde","year":"2023","unstructured":"Forsg\u00e4rde ES, R\u00f6\u00f6st M, Svensson A, Fridlund B, Elmqvist C. Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study. BMC Geriatr. 2023. https:\/\/doi.org\/10.1186\/s12877-023-04331-0.","journal-title":"BMC Geriatr"},{"key":"1355_CR32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-006926","author":"S Wells","year":"2018","unstructured":"Wells S, Tamir O, Gray J, Naidoo D, Bekhit M, Goldmann D. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf. 2018. https:\/\/doi.org\/10.1136\/bmjqs-2017-006926.","journal-title":"BMJ Qual Saf"},{"key":"1355_CR33","unstructured":"Swedish Parliament. SFS 2003:460. Act concerning the ethical review of research involving humans. (2003). Accessed 4 June 2025. Available from: https:\/\/www.riksdagen.se\/sv\/dokument-lagar\/dokument\/svensk-forfattningssamling\/lag-2003460-om-etikprovning-av-forskning-som_sfs-2003-460"},{"key":"1355_CR34","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053","author":"World Medical Association Declaration","year":"2013","unstructured":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013. https:\/\/doi.org\/10.1001\/jama.2013.281053.","journal-title":"JAMA"}],"container-title":["BMC Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-025-01355-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12873-025-01355-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-025-01355-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T14:31:36Z","timestamp":1758551496000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcemergmed.biomedcentral.com\/articles\/10.1186\/s12873-025-01355-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1355"],"URL":"https:\/\/doi.org\/10.1186\/s12873-025-01355-0","relation":{},"ISSN":["1471-227X"],"issn-type":[{"value":"1471-227X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]},"assertion":[{"value":"23 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This type of study does not fall within the scope of the Swedish Act concerning the Ethical Review of Research Involving Humans (SFS 2003:460), which regulates all research involving humans in Sweden []. It was, however, conducted following the requirements of the Helsinki declaration []. This was done by ensuring that all participants were treated with respect to autonomy, beneficence, nonmaleficence, and justice. Written approval to conduct the interviews was obtained from the Head of Department responsible for the ambulance service organizations. Verbal and written information about the study was provided, and all participants gave written informed consent. The participating PENs were guaranteed confidentiality and their right to withdraw at any time without providing any reason.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication was obtained from all participants prior to data collection.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}