The overall aim of the research was to deepen the understanding of learning through simulation in prehospital emergency care.

Method: In this research, qualitative and quantitative methods are used as well as integrative literature studies (I, II). Qualitative data from the interview studies (III, V) were analyzed by phenomenographic methodology. Quantitative data from the intervention study (IV) were analyzed using descriptive and analytical statistics.

Results: Research on simulation and learning within the prehospital trauma care context is relatively rare (I). Simulation of realistic scenarios where the caregivers are exposed to stress contributes to strengthen caregiver knowledge, skills and experience (II). Caregivers request simulation opportunities regarding critical and emergency situations (III). They describe that learning through regular simulation provides in-depth knowledge and skills in the care of a patient exposed to high-energy trauma (V). Interventions with repeated simulation opportunities related to the care of the patient exposed to high-energy trauma give some improvement in care provided at the site of the accident (IV).

Conclusion: Through simulation, the caregivers develop knowledge and skills and receive enhanced confidence in the care of an injured and sick patient. The research suggests several areas with potential for improvement with regard to the care of patients exposed to high-energy trauma. A model has been developed for systematic trauma simulation.

Introduction: Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. Aim: To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. Design: The study was designed as an observational study inspired by an ethnographic approach.MethodData was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis.Results: Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity.Conclusion: High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety.

BACKGROUND: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation.

OBJECTIVE: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care.

RESEARCH DESIGN: The study had a qualitative approach.

METHOD: Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis.

ETHICAL CONSIDERATIONS: The study followed the ethical principles in accordance with the Declaration of Helsinki.

FINDINGS: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient.

DISCUSSION: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human.

CONCLUSION: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

BACKGROUND: Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.

METHODS: An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.

RESULTS: It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.

CONCLUSION: Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.

Background:High energy trauma is rare and, as a result, training of prehospital care providers often takes placeduring the real situation, with the patient as the object for the learning process. Such training could instead becarried out in the context of simulation, out of danger for both patients and personnel. The aim of this study wasto provide an overview of the development and foci of research on simulation in prehospital care practice.Methods:An integrative literature review were used. Articles based on quantitative as well as qualitative researchmethods were included, resulting in a comprehensive overview of existing published research. For publishedarticles to be included in the review, the focus of the article had to be prehospital care providers, in prehospitalsettings. Furthermore, included articles must target interventions that were carried out in a simulation context.Results:The volume of published research is distributed between 1984- 2012 and across the regions North America,Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors,animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs),medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospitalcare providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage.Conclusion:Simulation were described as a positive training and education method for prehospital medical staff. Itprovides opportunities to train assessment, treatment and implementation of procedures and devices under realisticconditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care,CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integralrole in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staffregarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack ofknowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training andresearch, at both local and global levels