Experiential learning in pre-hospital emergency care: a qualitative study

Defining capabilities in deployed UK military prehospital emergency care

The UK military prehospital emergency care (PHEC) operational clinical capability framework must be updated in order that it retains its use as a valid operational planning tool. Specific requirements include accurately defining the PHEC levels and the 'Medical Emergency Response Team' (MERT), while reinforcing PHEC as a specialist area of clinical practice that requires an assured set of competencies at all levels and mandatory clinical currency for vocational providers.A military PHEC review panel was convened by the Defence Consultant Advisor (DCA) for PHEC. Each PHEC level was reviewed and all issues which had, or could have arisen from the existing framework were discussed until agreement between the six members of this panel was established.An updated military PHEC framework has been produced by DCA PHEC, which defines the minimum requirements for each operational PHEC level. These definitions cover all PHEC providers, irrespective of professional background. The mandatory requirement for appropriate clinical exposure for vocational and specialist providers is emphasised. An updated definition of MERT has been agreed.This update provides clarity to the continually evolving domain of UK military PHEC. It sets out the PHEC provider requirements in order to be considered operationally deployable in a PHEC role. There are implications for training, manning and recruitment to meet these requirements, but the processes required to address these are already underway and well described elsewhere.

Digital feedback during clinical education in the emergency medical services: a qualitative study

BACKGROUND

Clinical education is essential for students' progress towards becoming registered nurses (RN) in Sweden. Assessment of caring skills in the Emergency Medical Services (EMS) is complex due to the ever-changing scenarios and the fact that multiple supervisors are involved in the student's education. Currently, assessments of student's skills are summative and occur twice during the six weeks of clinical education. A digitalized assessment tool (DAT) with an adaptation for formative assessment is a new approach to assessment of nursing skills in the EMS. Since new technologies and changes in procedures are likely to affect both students and supervisors, our aim in this study is to describe students' and clinical supervisors' experience of formative assessments using DAT in the EMS.

METHOD

This study is qualitative, using semi-structured group interviews (N = 2) with students and semi-structured individual telephone interviews (N = 13) with supervisors. The data was analysed according to Graneheim and Landman's method for content analysis. This analysis generated 221 codes organized into 10 categories within which three themes were identified. The students in this study were nursing students in their last semester and all supervisors were experienced RNs.

RESULTS

The results showed that students and supervisors had mainly positive views of the DAT and the formative assessment stating that the information they provided while using the DAT offered opportunities for reflection. The DAT supported the students' learning by visualizing strengths and areas of improvement, as well as displaying progress using a Likert scale. The application improved communication, but additional features linking the assessment tool with the university were requested. The application contributed to transparency in the assessments and was seen as preferable to the traditional 'pen and paper' method.

CONCLUSION

A digital system was described in a positive manner, and the assessment using the DAT facilitated reflection and formative assessment. The use of a Likert scale was considered positive in order to demonstrate progression which with advantage could be demonstrated visually.

Developing new possibilities for interprofessional learning- students' experience of learning together in the ambulance service

BACKGROUND

It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students' experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL).

AIM

The aim of this study was to explore undergraduate students' experiences of collaboration and learning together during their clinical rotation in the ambulance service.

STUDY DESIGN AND METHOD

A mixed convergent parallel design was used to describe nursing and medical students' experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The group discussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students' self-assessed experiences and competencies in interprofessional collaboration.

RESULTS

In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care.

CONCLUSION

The students' experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students' learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service.

ETHICAL APPROVAL

By the Swedish Ethical Review Authority. No: 2019-03595.

Experiential Learning for Psychomotor Skills Development of Emergency Medical Services (EMS) Students: An Action Research

Background

Experiential learning is useful for fostering the development of a wide range of clinical and practical skills. This study aimed to determine the usefulness of experiential learning for psychomotor skills development of emergency medical services (EMS) students.

Methods

An action research approach was used because it is useful for linking theory with action and practice. The Field Internship Student Data Acquisition Project (FISDAP) tool was used to assess and monitor students’ performance and competencies achievement in psychomotor skills. The study was conducted at Prince Sultan College for Emergency Medical Services (PSCEMS), King Saud University (KSU). Skills performance of 71 EMS students were analysed in the experiential learning implemented throughout the curriculum over 3 years.

Results

The finding indicates that the students’ skills performance falls below the minimum requirement during the clinical practicum and significantly improves during the time of internship period. The overall success rate ranges between 26.58% and 35.74% across all the psychomotor skills, whereas during the internship year student’s success rate ranges between 85.49% and 99.4% across all the psychomotor skills.

Conclusion

The findings of this study are promising and show that experiential learning is a useful and effective way to develop psychomotor skills and competencies in EMS students. Educators and policymakers can use the findings for strategizing policies for curriculum planning and development.

Use of the step-up action research model to improve trauma-related nursing educational practice

Background

A lack of authentic learning opportunities influence the quality of emergency training of nursing students. The purpose of this article is to describe how the step-up action research model was used to improve the quality of trauma-related educational practice of undergraduate nursing students.

Objectives

To reduce deaths caused by trauma, healthcare workers should be competent to provide emergency care and collaborate effectively with one another.

Method

A simulated mass casualty incident, structured to support the integration of theory into practice, became a more rigorous action research activity which focused on the quality improvement of the mass casualty incident.

Results

The results indicated improved student learning; partnership appreciation; improved student coping mechanisms, and increased student exposure. Quality emergency training thus results in better real-life collaboration in emergency contexts.

Conclusion

The step-up action research model proved to be a collaborative and flexible process. To improve the quality and rigour of educational programmes it is therefore recommended that the step-up action research model be routinely used in the execution of educational practices.

The encounter with the unknown: Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service

Registered nurses (RNs) have, according to the Swedish National Board of Health and Welfare, the overall responsibility for the medical care in the ambulance care setting. Bringing RNs into the ambulance service are judged, according to earlier studies, to lead to a degree of professionalism with a higher quality of medical care. Implicitly in earlier studies, the work in the ambulance service involves interpersonal skills. The aim of this study was to describe RNs' experiences of being responsible for the care of the patient in the Swedish ambulance service. A reflective lifeworld approach within the perspective of caring science was used. Five RNs with at least five years experience from care in the ambulance care setting were interviewed. The findings show that the essence of the phenomenon is to prepare and create conditions for care and to accomplish care close to the patient. Three meaning constituents emerged in the descriptions: prepare and create conditions for the nursing care, to be there for the patient and significant others and create comfort for the patient and significant others. The responsibility is a complex phenomenon, with a caring perspective, emerging from the encounter with the unique human being.

An investigation of theory-practice gap in undergraduate paramedic education

BACKGROUND

Bachelor of Emergency Health (Paramedic) (BEH) students at Monash University undertake clinical placements to assist with the transition from student to novice paramedic. Anecdotally, students report a lack of opportunity to practise their clinical skills whilst on placements. The barriers to participation and the theory-practice gap have not been previously documented in Australian paramedic literature. The purpose of this study was to investigate the theory-practice gap for paramedic students by linking education and skill level to case exposure and skills praxis during clinical placements.

METHODS

A cross-sectional retrospective study using a convenience sample of second and third year BEH undergraduate students. Ethics approval was granted.

RESULTS

Eighty four second and third year BEH students participated. 59.5% were female (n = 50), 40.5% were male (n = 34). Overall, students most commonly reported exposure to cardiac and respiratory cases and were satisfied with the number of cases encountered during placement. However, over half (n = 46) reported being exposed to < 50% of cases that allowed skills praxis. The most common barrier to participation (34.5%) was the opportunity to participate in patient care and 68% of student's were unsure if paramedics understood their role during clinical placements.

CONCLUSION

This study demonstrates that the majority of students were satisfied with their clinical placement experience; even though they were exposed to < 50% of cases that allowed skills practice. Identifying these educational barriers will assist in improving the quality and theory-practice gap of paramedic clinical education.

Research awareness: making learning relevant for pre-registration nursing students

This paper outlines efforts to improve the teaching and learning methods for research on a second year pre-registration nursing programme in one university in Wales, UK. This focussed on experiential approaches supported by electronic learning resources. A subsequent evaluation aimed to elicit participating students' and lecturers' perceptions of the success of the experiential approaches and the supporting resources. A questionnaire was distributed to 53 student nurses who participated in the experiential learning and this was supplemented with an informal qualitative 'graffiti board' evaluation with the cohort; and a group interview with 4 of the lecturers who had acted as group facilitators during the experiential research sessions. The findings revealed that similar issues were pertinent for both lecturers and students and these were contained within three distinct themes relating to the structure, process and outcomes of the teaching and learning approaches. The student-led approach to evaluation offers a fresh outlook which ensures that the emic perspective is included through the study. The study sheds light on the strengths and limitations of experiential approaches to research teaching and suggest that this is a challenging approach both for students and lecturers, which should not be entered into lightly.

Caring for older people in prehospital emergency care: can nurses make a difference?

AIMS AND OBJECTIVES

The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people.

BACKGROUND

There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role.

CONCLUSIONS

If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people.

RELEVANCE TO CLINICAL PRACTICE

The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.