Patient perspective in focus for new professor

What is your research area about?

"The research area is for the most part emergency care with a focus on prehospital emergency care which includes the emergency chain of care when the patient in a vulnerable situation calls the emergency line."

"I mainly study patients with acute chest pain, suspected stroke or suspected hip fracture, as well as geriatric patients and patients in need of primary care. The research focuses on how the accuracy of assessments can increase both in the emergency telephone line and in ambulance care and how care and treatment can be developed using a patient perspective. The overall purpose of my research is to achieve improved evidence for prehospital emergency care and thus increased patient participation and patient safety."

Why is your research area important?

"Researching prehospital emergency care is important because it reflects society and people's living conditions. The caregivers in ambulance care come home to people and become messengers regarding how the patient, affected by an acute condition, lives their everyday life, for example if it is possible to come home again after any hospitalisations. The research is often of great benefit to society. This has been particularly evident in recent years with extensive cuts in the numbers of hospital beds. Put starkly, ambulance care is expected to solve the collaboration issues between different healthcare providers that is necessary, but which the caregivers do not succeed with on their own. Therefore, it is important that these conditions be explored."

"Particularly important is the human sciences' anchoring within emergency care, which naturally is characterised by emergency medical values and objectively rapid results. But the existential issues are always relevant in emergency care, as people's life situations have suddenly changed. Anxiety, worry and vulnerability are often what the research results show when patient experiences are described."

What are your most important results so far in your research work?

"Overall, my research increases the knowledge of the importance of the patient perspective in prehospital emergency care and the optimisation of assessment. Studies focussing on patients with suspected stroke identify improvement potential where the time factor is crucial, to enable more patients to be offered health, well-being and life-saving treatment. This research began in 2009 when the National Board of Health and Welfare introduced new guidelines for Swedish stroke care. In a plan for the development of stroke care in the West Götaland region, it became my job to coordinate the prehospital studies. The results show, for example, that about 60 per cent of patients are diagnosed with a stroke already in the ambulance. Only in a small proportion of the cases is the stroke care chain activated from ambulance care. This has been a wakeup call."

"On a more personal level, it feels very inspiring that my thesis ‘Prepared to be unprepared: A phenomenological study of caring assessment and its learning in ambulance care’ (2015) resulted in the concept of ‘caring assessment,’ that was introduced into ambulance care. The significance of the concept emphasises that the caregiver does not separate medical assessments and caring. Instead, it is important that the collected data are analysed in order to alleviate suffering and support the patient's health processes, while at the same time a decision-making process for diagnosing disease/injury is carried out. The dissertation has become classic and is very often referred to, both in scientific publications and in textbooks."

What do you see as challenges in your research area?

"Generally speaking, there is no evidence for all the treatment guidelines used in Swedish ambulance care. In the case of randomised studies, we have found that it is difficult to reach all carers who are involved and we have no reliable control over the data collection. The context is in itself demanding, disordered and unpredictable. In prehospital emergency care, it is difficult to request that the caregivers focus on ongoing studies and data collection. Thus, the extraordinary endurance of project managers is required, to inform and remind. In addition, data collection criteria must be simple and the data protocols clear. We have realised with the years that not everyone can be a data collector. Instead, it is important to find those who are interested in research and to select special people who can become project managers in the work."

What does it mean for you to have become a professor?

"Being a professor means leading the research group so that everyone makes progress and develops at their different individual levels, ranging from adjunct lecturers to associate professors. It is a fun task that gives me great satisfaction. When a doctoral student has had his first article published, everyone is pleased; it is an individual success after a very personal effort that strengthens the entire research group's sense of community."

What made you start your research journey?

"My research interest was triggered when the National Board of Health and Welfare decided in 2005 that all medicine handling would be carried out by authorised personnel. This meant that every ambulance had to be staffed with at least one licensed nurse. In order to achieve this national competence goal, the institutions of higher education were needed which could offer higher education preparatory courses for the ambulance care staff. In the West Götaland region, the then Department of Caring Science at the University of Borås in 1999 was commissioned to establish a knowledge centre for ambulance care. A knowledge centre that has grown and developed into PreHospen, a centre for prehospital research. Today, there is a successful research team, some twenty researchers and doctoral students, with a strong national and international reputation. It was in this context that my own education as a researcher began."

What is on the agenda right now?

"Most recent is Vinnova's call for Vision-Driven Health, where we collaborate with the Prehospital ICT Arena (PICTA) at Lindholmens Science Park and Ambulance Health Care Sahlgrenska University Hospital."

"I am also evaluating the conference Ambulans2019PreHospen, which we arranged in Stockholm in early April together with the Swedish National Association for Ambulance Nurses. We had nearly 1,000 visitors for two days and we presented very interesting research. The conference was a success, which promoted the University of Borås in an innovative way."

What do you want to achieve before retiring?

"Increase external funding for the research team and broaden collaboration with other researchers and healthcare developers. Another important task is that important research results are fed back to drive development in Swedish ambulance care. The ultimate goal of our interdisciplinary projects is to respond to society's most current requirements, especially the requirement that healthcare providers increase collaboration outside the hospital. With my health science perspective, I will in this context promote the patient perspective and patient participation. In addition, I would like to further anchor PreHospen's collaboration with the National Board of Health and Welfare and West Götaland Region's leadership regarding health care."

"I want people to remember how research in prehospital emergency care emerged with a focus on caring assessment. Implicitly, this means counteracting polarisation between different disciplines and emphasising the big picture for the welfare of the patient."



More about Birgitta Wireklint Sundström

What do you prefer to do when you have a day off?

"I have trouble taking it easy. Have always been like that. Free or not, three days a week begin with yoga; it gives me new energy, inside and out. Best of all is the headstand, the weightless state when the head is in the wrong direction, it is magical. It took me five years to achieve. It helps to be stubborn, and I am. In the winter, I like to do the KortVasan, 30 km on skis between Oxberg and Mora. I've done that for many years now. It is the same gang that goes so the social aspect is as important as the skiing itself. And I have to add that whiskey tasting is another interest. I am a member of Ladies' Whiskey Club Borås since the start in 2012.


"Husband, two children and their partners and three grandchildren. Everyone lives in Gothenburg."

What makes you laugh?

"Different things, can't point out anything special."

What makes you angry?

"What makes me angry is dishonesty and falsehood. Expect transparency in all relationships, both private and professional. I can suddenly get angry at small things but it passes equally quickly. I think I am perceived as a straightforward person and am usually quite happy actually."

What are you most proud of?

"I am very proud that I have been involved in one of the university's centres. I am also proud of the community that has emerged within the research group. Personally, I am extremely proud of my family. The fact that I am happy is largely due to the fact that my family is happy and that we stick together."

If you had not been a researcher, what would you have been then?

"I had probably been left as an anaesthetic nurse or something completely different. In school, the study counsellor suggested that I become an actor. It was then that my interest in theatre began, and continued with the Youth Red Cross in Lenhovda and student theatre in high school. For example, I have played Piglet in Nalle Puh. The little pink pig that always has bad things happen to it."

Text: Henrik Grönberg
Photo: Suss Wilén
Translation: Eva Medin