title: How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective.
abstract: OBJECTIVE
  Ambulance emergency care is multifaceted with extraordinary challenges to implement accurate assessment and care. A clinical learning environment providing opportunities for mastering these essential skills is a key component in ensuring that prehospital emergency nurse (PEN) students acquire the necessary clinical competence.
  
  
  OBJECTIVE
  The aim is to understand how PEN students experience their clinically based training, focusing on their learning process.
  
  
  METHODS
  We applied content analysis with its qualitative method to our material that consisted of three reflections each by 28 PEN students over their learning process during their 8 weeks of clinical ambulance practice. The research was carried out at the Center for Prehospital Care, University of Borås, Sweden.
  
  
  RESULTS
  The broad spectrum of ambulance assignments seems to awaken great uncertainty and excessive respect in the students. Student vulnerability appears to decrease when the clinical supervisor behaves calmly, knowledgeably, confidently and reflectively. Early traumatic incidents on the other hand may increase the students' anxiety. Each student is offered a unique opportunity to learn how to approach patients and relatives in their own environments, and likewise an opportunity to gather information for assessment. Infrequency of missions seems to make PEN students less active in their student role, thereby preventing them from availing themselves of potential learning situations. Fatigue and hunger due to lack of breaks or long periods of transportation also inhibit learning mode.
  
  
  CONCLUSIONS
  Our findings suggest the need for appraisal of the significance of the clinical supervisor, the ambulance environment, and student vulnerability. The broad spectrum of conditions in combination with infrequent assignments make simulation necessary. However, the unique possibilities provided for meeting patients and relatives in their own environments offer the PEN student excellent opportunities for learning how to make assessments.
authors.affiliation: Faculty of Caring Science, Working Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden. Electronic address: christer.axelsson@hb.se.
authors.forename: Christer
authors.initials: C
authors.lastname: Axelsson
authors.affiliation: Nursing Department, Universitat Rovira I Virgili, Campus Catalunya despatx 0.22, Av. Catalunya, 35, 43002 Tarragona, Spain. Electronic address: maria.jimenez@urv.cat.
authors.forename: Maria Jimenez
authors.initials: MJ
authors.lastname: Herrera
authors.affiliation: Faculty of Caring Science, Working Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden. Electronic address: angela.bang@hb.se.
authors.forename: Angela
authors.initials: A
authors.lastname: Bång
mesh_terms: D000552:Ambulances; D002983:Clinical Competence; D004511:Education, Nursing, Graduate; D004632:Emergency Medical Services; D016529:Emergency Nursing / Q000193:education*; D006801:Humans; D007858:Learning; D009730:Nursing Assessment / Q000379:methods; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology; D013548:Sweden
keywords: Ambulances; Clinical competence; Emergency medical service; Learning; Nursing; Students