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Carnicelli A, Williams AMM, Edwards DG. Paramedic Education and Training for the Management of Patients Presenting with Low-Acuity Clinical Conditions: A Scoping Review. Healthcare (Basel) 2024; 12:176. [PMID: 38255066 PMCID: PMC10815047 DOI: 10.3390/healthcare12020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/03/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Ambulance services around the world are increasingly attending to calls for non-emergency conditions. These lower-acuity conditions do not always require patients to be transported to the emergency department. Consequently, over the past two decades, ambulance services have implemented strategies to support paramedics in diverting non-urgent patients to alternative care pathways. However, assessing and managing low-acuity conditions can be challenging for paramedics, especially when education and training has traditionally focussed on emergency care. This scoping review explores the education and training provided to paramedics on low-acuity clinical conditions and the use of alternative care pathways. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. The databases searched included Scopus, CINAHL, Embase, Emcare, and MEDLINE (PubMed). The search identified one-hundred sixty-six records, with a total of nine articles reviewed after the removal of duplicates and the screening process. The articles were diverse, with education and training ranging from university degrees for extended care practitioners to short in-service-based training for a suite of protocols or assessment tools. However, the literature addressing education and training on low-acuity conditions and alternative care pathways is limited, with the type and length of education programs appearing to influence practice. There is a need for further research to establish a low acuity education model.
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Affiliation(s)
- Anthony Carnicelli
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.-M.M.W.); (D.G.E.)
| | - Anne-Marie M. Williams
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.-M.M.W.); (D.G.E.)
| | - Dale G. Edwards
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.-M.M.W.); (D.G.E.)
- Clinical Services, Ambulance Tasmania, Cambridge, TAS 7170, Australia
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Shannon B, Eaton G, Lanos C, Leyenaar M, Nolan M, Bowles K, Williams B, O'Meara P, Wingrove G, Heffern JD, Batt A. The development of community paramedicine; a restricted review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3547-e3561. [PMID: 36065522 PMCID: PMC10087318 DOI: 10.1111/hsc.13985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 08/13/2022] [Indexed: 05/22/2023]
Abstract
Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality.
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Affiliation(s)
- Brendan Shannon
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Georgette Eaton
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Matthew Leyenaar
- Department of Health and Wellness, Emergency Health ServicesGovernment of Prince Edward IslandPrince Edward IslandCanada
| | - Mike Nolan
- County of Renfrew Paramedic ServicePembrokeCanada
| | - Kelly‐Ann Bowles
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Brett Williams
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Peter O'Meara
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
| | - Gary Wingrove
- International Roundtable on Community ParamedicineDuluthMNUSA
| | - JD Heffern
- Indigenous Services Canada, Government of CanadaOttawaOntarioCanada
| | - Alan Batt
- Department of ParamedicineMonash UniversityFrankstonVictoriaAustralia
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Allana A, Tavares W, Pinto AD, Kuluski K. Designing and Governing Responsive Local Care Systems - Insights from a Scoping Review of Paramedics in Integrated Models of Care. Int J Integr Care 2022; 22:5. [PMID: 35509960 PMCID: PMC9009364 DOI: 10.5334/ijic.6418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods A study was conducted following Arksey and O'Malley's method for scoping reviews, using Valentijn's Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.
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Affiliation(s)
- Amir Allana
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
| | - Walter Tavares
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- McNally Project for Paramedicine Research, CA
- The Wilson Centre and Temerty Faculty of Medicine, University of Toronto|University Health Network, CA
- York Region Paramedic Services, Community and Health Services Department, The Regional Municipality of York, CA
| | - Andrew D. Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, CA
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, CA
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Institute for Better Health, Trillium Health Partners, CA
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Koivulahti O, Tommila M, Haavisto E. The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study. Scand J Trauma Resusc Emerg Med 2020; 28:70. [PMID: 32703267 PMCID: PMC7376915 DOI: 10.1186/s13049-020-00761-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient’s outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis. Methods A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic’s preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital’s patient records. Logistic regression analysis and a binomial test were used to test the statistical significance. Results The agreement between the paramedics’ preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0,000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelor-degree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis. Conclusions Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.
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Affiliation(s)
- Outi Koivulahti
- Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland.
| | - Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, University of Turku and Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
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Community paramedicine: A systematic review of program descriptions and training. CAN J EMERG MED 2019; 21:749-761. [DOI: 10.1017/cem.2019.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjectivesThe aim of this study is to identify the types of community paramedicine programs and the training for each.MethodsA systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).ResultsFrom 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.ConclusionCommunity paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.
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Oosterwold J, Sagel D, Berben S, Roodbol P, Broekhuis M. Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review. BMJ Open 2018; 8:e021732. [PMID: 30166299 PMCID: PMC6119414 DOI: 10.1136/bmjopen-2018-021732] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The decision over whether to convey after emergency ambulance attendance plays a vital role in preventing avoidable admissions to a hospital's emergency department (ED). This is especially important with the elderly, for whom the likelihood and frequency of adverse events are greatest. OBJECTIVE To provide a structured overview of factors influencing the conveyance decision of elderly people to the ED after emergency ambulance attendance, and the outcomes of these decisions. DATA SOURCES A mixed studies review of empirical studies was performed based on systematic searches, without date restrictions, in PubMed, CINAHL and Embase (April 2018). Twenty-nine studies were included. STUDY ELIGIBILITY CRITERIA Only studies with evidence gathered after an emergency medical service (EMS) response in a prehospital setting that focused on factors that influence the decision whether to convey an elderly patient were included. SETTING Prehospital, EMS setting; participants to include EMS staff and/or elderly patients after emergency ambulance attendance. STUDY APPRAISAL AND SYNTHESIS METHODS The Mixed Methods Appraisal Tool was used in appraising the included articles. Data were assessed using a 'best fit' framework synthesis approach. RESULTS ED referral by EMS staff is determined by many factors, and not only the acuteness of the medical emergency. Factors that increase the likelihood of non-conveyance are: non-conveyance guidelines, use of feedback loop, the experience, confidence, educational background and composition (male-female) of the EMS staff attending and consulting a physician, EMS colleague or other healthcare provider. Factors that boost the likelihood of conveyance are: being held liable, a lack of organisational support, of confidence and/or of baseline health information, and situational circumstances. Findings are presented in an overarching framework that includes the impact of these factors on the decision's outcomes. CONCLUSION Many non-medical factors influence the ED conveyance decision after emergency ambulance attendance, and this makes it a complex issue to manage.
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Affiliation(s)
- Johan Oosterwold
- Department of Health Sciences - Nursing Research, UMC Groningen, Groningen, The Netherlands
- NHL Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
| | - Dennis Sagel
- Ambulance Department, University Medical Center Groningen, Roden, The Netherlands
| | - Sivera Berben
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, The Netherlands
- Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petrie Roodbol
- Department of Health Sciences - Nursing Research, UMC Groningen, Groningen, The Netherlands
| | - Manda Broekhuis
- Operations Department, Faculty of Economics and Business, Groningen, The Netherlands
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Mikkola R, Paavilainen E, Salminen-Tuomaala M, Leikkola P. Out-of-hospital emergency care providers' work and challenges in a changing care environment. Scand J Caring Sci 2017; 32:253-260. [PMID: 28524371 DOI: 10.1111/scs.12456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Abstract
Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training.
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Affiliation(s)
- Riitta Mikkola
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Eija Paavilainen
- School of Health Sciences, University of Tampere, Finland/ Hospital District of South Ostrobothnia, Finland
| | - Mari Salminen-Tuomaala
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Päivi Leikkola
- School of Health Sciences, University of Tampere, Tampere, Finland.,The Hospital District of South Ostrobothnia, Seinäjoki, Finland
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Simpson P, Thomas R, Bendall J, Lord B, Lord S, Close J. 'Popping nana back into bed' - a qualitative exploration of paramedic decision making when caring for older people who have fallen. BMC Health Serv Res 2017; 17:299. [PMID: 28431536 PMCID: PMC5399835 DOI: 10.1186/s12913-017-2243-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older fallers constitute a large proportion of ambulance work, and as many as 25% are not transported to hospital following paramedic assessment. The objective of this study was to explore the decision making process used by paramedics when caring for older fallers. METHODS A qualitative study was conducted using constructivist grounded theory methodology. Purposive sampling was used to recruit paramedics to participate in semi-structured interviews and focus groups. Data analysis commenced with line-by-line coding, developing into formation of theoretical categories. Theoretical sampling was then used to clarify emerging theoretical concepts, with data collection and analysis continuing until theoretical saturation was achieved. RESULTS A total of 33 paramedics participated in 13 interviews and 4 focus groups. When caring for older fallers, paramedic decision making is profoundly affected by 'role perception', in which the individual paramedic's perception of what the role of a paramedic is determines the nature of the decision making process. Transport decisions are heavily influenced by a sense of 'personal protection', or their confidence in the ambulance service supporting their decisions. 'Education and training' impacts on decision making capacity, and the nature of that training subliminally contributes to role perception. Role perception influences the sense of legitimacy a paramedic attaches to cases involving older fallers, impacting on patient assessment routines and the quality of subsequent decisions. CONCLUSIONS Paramedic decision making processes when caring for older people who have fallen appear to be strongly influenced by their perception of what their role should be, and the perceived legitimacy of incidents involving older fallers as constituting 'real' paramedic work.
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Affiliation(s)
- Paul Simpson
- Western Sydney University, Locked Bag 1797, Penrith, 2750 NSW Australia
| | - Ric Thomas
- Western Sydney University, Locked Bag 1797, Penrith, 2750 NSW Australia
| | | | - Bill Lord
- University of Sunshine Coast, Queensland, Australia
| | - Stephen Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW Australia
- Department of Geriatric Medicine, Prince of Wales Clinical School, Sydney, Australia
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Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Peconi J, Phillips C, Phillips J, Porter A, Siriwardena AN, Smith G, Toghill A, Wani M, Watkins A, Whitfield R, Wilson L, Russell IT. Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate. Health Technol Assess 2017; 21:1-218. [PMID: 28397649 PMCID: PMC5402213 DOI: 10.3310/hta21130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. OBJECTIVES To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use. DESIGN Cluster randomised controlled trial. PARTICIPANTS Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas. INTERVENTIONS Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal. OUTCOMES The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation. RESULTS Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied with assessments carried out by paramedics. Paramedics reported that the intervention had increased their confidence to leave patients at home, but barriers to referral included patients' social situations and autonomy. CONCLUSIONS Findings indicate that this new pathway may be introduced by ambulance services at modest cost, without risk of harm and with some reductions in further emergency calls. However, we did not find evidence of improved health outcomes or reductions in overall NHS emergency workload. Further research is necessary to understand issues in implementation, the costs and benefits of e-trials and the performance of the modified Falls Efficacy Scale. TRIAL REGISTRATION Current Controlled Trials ISRCTN60481756 and PROSPERO CRD42013006418. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen A Snooks
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Rebecca Anthony
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachael Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Sarah Gaze
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Mary Halter
- Faculty of Health and Social Care Sciences, St George's University Hospital, London, UK
| | - Ioan Humphreys
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Marina Koniotou
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Phillipa Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Ronan Lyons
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julie Peconi
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Judith Phillips
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Alison Porter
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | | | | | | | - Mushtaq Wani
- Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, UK
| | - Alan Watkins
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Richard Whitfield
- Pre-hospital Emergency Research Unit (PERU), Welsh Ambulance Services NHS Trust, Cardiff, UK
| | - Lynsey Wilson
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
| | - Ian T Russell
- Patient and Population Health and Informatics, Swansea University Medical School, Swansea, UK
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Tohira H, Fatovich D, Williams TA, Bremner AP, Arendts G, Rogers IR, Celenza A, Mountain D, Cameron P, Sprivulis P, Ahern T, Finn J. Is it Appropriate for Patients to be Discharged at the Scene by Paramedics? PREHOSP EMERG CARE 2016; 20:539-49. [DOI: 10.3109/10903127.2015.1128028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brooks IA, Cooke M, Spencer C, Archer F. A review of key national reports to describe the development of paramedic education in England (1966–2014). Emerg Med J 2015; 33:876-881. [DOI: 10.1136/emermed-2015-205062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/31/2015] [Accepted: 10/31/2015] [Indexed: 11/03/2022]
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Williams B, Webb V. A national study of paramedic and nursing students' readiness for interprofessional learning (IPL): Results from nine universities. NURSE EDUCATION TODAY 2015; 35:e31-e37. [PMID: 26047600 DOI: 10.1016/j.nedt.2015.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The development of successful and functional interprofessional practice is best achieved through interprofessional learning (IPL). Given that many paramedic programmes still take an isolative uni-professional educational approach to their undergraduate courses, it is unclear on their preparedness for students' IPL. Therefore, the objective of this study was to assess the attitudes of undergraduate paramedic and nursing/paramedic students from nine Australian universities towards IPL over a two year period. METHODS Using a convenience sample of paramedic and nursing/paramedic students-attitudes towards IPL was measured using the Readiness for Interprofessional Learning Scale (RIPLS) 5-point Likert-scale (1=strongly disagree and 5=strongly agree). RESULTS A total of 1264 students participated (n=303 in 2011 and n=961 in 2012) in this study, consistent with a 43% response rate. Surveyed students were predominantly first year n=506 (40.03%), female n=748 (59.2%) and undertaking single paramedic degrees n=948 (75.0%). Nursing/paramedic students demonstrated significantly lower Negative Professional Identity (M=6.26, p=0.004) and Roles and Responsibilities means (M=6.87, p<0.0001) and higher Positive Professional Identity means (M=15.68, p=0.011) compared with paramedic students. CONCLUSIONS The impact of nursing/paramedic education was shown to significantly enhance student attitudes towards interprofessionalism and the individual universities involved in this study generated students at varying stages of IPL preparedness. Students' year level appeared to influence IPL readiness, yet there are compelling paradoxical arguments for both earlier and later inclusion of IPL within curricula.
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Affiliation(s)
- Brett Williams
- Department of Community Emergency Health & Paramedic Practice, Monash University, Frankston, Australia.
| | - Vanessa Webb
- Department of Community Emergency Health & Paramedic Practice, Monash University, Frankston, Australia
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Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes. CAN J EMERG MED 2015; 17:532-50. [DOI: 10.1017/cem.2014.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesEmergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs.Data SourceBroad systematized bibliographic and grey literature searches were conducted.Study SelectionInclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure.Data ExtractionThe reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described.Data SynthesisThe bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n=44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n=4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported.ConclusionsNumerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs.
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Tohira H, Williams TA, Jacobs I, Bremner A, Finn J. The impact of new prehospital practitioners on ambulance transportation to the emergency department: a systematic review and meta-analysis. Emerg Med J 2013; 31:e88-94. [PMID: 24243486 DOI: 10.1136/emermed-2013-202976] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to examine the impact of new prehospital practitioners (NPPs), including emergency care practitioners (EmCPs), paramedic practitioners and extended care paramedics (ECPs), on ambulance transportation to the emergency department (ED). METHODS We searched MEDLINE, Embase, CINAHL and AUSTHealth databases, and hand searched emergency medicine journals and journal reference lists for relevant papers. To be included, studies were required to target one type of NPP and compare outcomes such as the frequencies of conveyance to the ED, discharge at scene, subsequent ED attendance and/or appropriateness of care between NPPs and conventional ambulance crews. Three investigators independently selected relevant studies. The risk of bias in individual studies was assessed using a validated checklist. We conducted meta-analyses for comparisons which had acceptable heterogeneity (I(2)<75%) and reported pooled estimates of ORs with 95% CIs. RESULTS 13 studies were identified from 16 584 citation reports. EmCPs were most frequently studied. The majority of studies (77%) did not fully report important potential confounders. NPPs were less likely to convey patients to the ED and more likely to discharge patients at the scene than conventional ambulance crews. Pooled ORs for conveyance to the ED and discharge at the scene by ECPs were 0.09 (95% CI 0.04 to 0.18) and 10.5 (95% CI 5.8 to 19), respectively. The evidence for subsequent ED attendance and appropriateness of care was equivocal. CONCLUSIONS The NPP schemes reduced transport to the ED; however, the appropriateness of the decision of the NPPs and the safety of patients were not well supported by the reported studies.
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Affiliation(s)
- Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia St John Ambulance, Belmont, Western Australia, Australia
| | - Ian Jacobs
- Prehospital, Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia St John Ambulance, Belmont, Western Australia, Australia
| | - Alexandra Bremner
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia St John Ambulance, Belmont, Western Australia, Australia School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hill H, McMeekin P, Price C. A systematic review of the activity and impact of emergency care practitioners in the NHS. Emerg Med J 2013; 31:853-60. [PMID: 23851036 DOI: 10.1136/emermed-2013-202660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The NHS has seen a great expansion in the number of emergency care practitioners (ECPs) working in prehospital, primary and acute care settings since the role was introduced in 2003. This paper updates and expands on two previous reviews of ECP roles by identifying and discussing all empirical studies to date that examined the impact of ECP services in the NHS. OBJECTIVES To summarise the national evidence-based literature on the impact of ECPs on healthcare delivery, effectiveness of practice and related health service resource use. METHODS Searches in MEDLINE, EMBASE and CINAHL databases, and two internet search engines (Google and Google Scholar). Identified publications were screened for relevance and quality before a description and synthesis of their findings. No statistical comparison was undertaken. RESULTS Studies from the peer-reviewed literature (n=15) and project reports (n=6) were included. Overall, there was evidence that investment in ECP roles is beneficial for the quality of care reported by patients and cost efficiency savings. There was clear support from staff and patients for ECP services, and a number of studies of high methodological quality described care processes (diagnosis, investigations instigated and treatment initiated) provided by ECPs to be equivalent to or better to that provided by practitioners with traditional roles. Prehospital ECPs provided 'added value' by treating more patients at the scene thereby reducing unnecessary referral to emergency departments. It was often unclear whether the ECP intervention was part of a larger service change and/or new investment. CONCLUSIONS Successful implementation of the ECP role has been described. Further evaluations should consider whether the beneficial impact of the role transfers equally across all operational settings and patient groups, and is not just a reflection of new investment in clinical services.
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Affiliation(s)
- Harry Hill
- Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - Peter McMeekin
- Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - Christopher Price
- Institute for Ageing and Health, Institute of Health and Society, University of Newcastle, Newcastle, UK
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Bigham BL, Kennedy SM, Drennan I, Morrison LJ. Expanding Paramedic Scope of Practice in the Community: A Systematic Review of the Literature. PREHOSP EMERG CARE 2013; 17:361-72. [DOI: 10.3109/10903127.2013.792890] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Blair L. Bigham
- From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, ID, LJM), Toronto, Ontario, Canada; York Region Emergency Medical Services (BLB, ID), York Region, Ontario, Canada; the School of Health and Wellness, Centennial College (BLB), Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine (SMK), Toronto, Ontario, Canada; the Institute of Medical Science, University of Toronto (ID, LJM), Toronto, Ontario, Canada; the Division of Emergency Medicine,
| | - Sioban M. Kennedy
- From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, ID, LJM), Toronto, Ontario, Canada; York Region Emergency Medical Services (BLB, ID), York Region, Ontario, Canada; the School of Health and Wellness, Centennial College (BLB), Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine (SMK), Toronto, Ontario, Canada; the Institute of Medical Science, University of Toronto (ID, LJM), Toronto, Ontario, Canada; the Division of Emergency Medicine,
| | - Ian Drennan
- From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, ID, LJM), Toronto, Ontario, Canada; York Region Emergency Medical Services (BLB, ID), York Region, Ontario, Canada; the School of Health and Wellness, Centennial College (BLB), Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine (SMK), Toronto, Ontario, Canada; the Institute of Medical Science, University of Toronto (ID, LJM), Toronto, Ontario, Canada; the Division of Emergency Medicine,
| | - Laurie J. Morrison
- From Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (BLB, ID, LJM), Toronto, Ontario, Canada; York Region Emergency Medical Services (BLB, ID), York Region, Ontario, Canada; the School of Health and Wellness, Centennial College (BLB), Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine (SMK), Toronto, Ontario, Canada; the Institute of Medical Science, University of Toronto (ID, LJM), Toronto, Ontario, Canada; the Division of Emergency Medicine,
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Abstract
Aims This paper compares the results of two studies conducted by the same researcher into the attributes and characteristics of clinical leaders. Background The two studies used an almost identical questionnaire; however, they were conducted 6 years apart, in different counties, with different health care staff (nurses and paramedics), made up of very different gender ratios. The initial study was larger and focused on more than describing clinical leader attributes; however, this was the principle focus of the second study. Findings The findings from both studies offer very similar results and describe clear insights into the attributes health professionals seek in clinical leaders. The research findings are remarkably similar given the differences in professional group, gender variations, country differences and time span. Conclusions Leaders are followed because there is a match between the leaders values and beliefs and their actions. People identify with the leaders values and follow them if they are reflected in the leaders’ actions. Clinical leader characteristics are approachability, clinical competence, being supportive, acting as mentors or role models, being visible in practice, directing and helping people, inspiring confidence, having effective communication skills and behaving with integrity. Vision and creativity were less evidently sought or identified as a clinical leader characteristic.
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Affiliation(s)
- David Stanley
- Associate Professor, Nursing, University of Western Australia, Australia
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Walsh B, Cone DC, Meyer EM, Larkin GL. Paramedic attitudes regarding prehospital analgesia. PREHOSP EMERG CARE 2012; 17:78-87. [PMID: 22971168 DOI: 10.3109/10903127.2012.717167] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although pain is a major reason why patients summon emergency medical services (EMS), prehospital medical providers administer analgesic agents at inappropriately low rates. One possible reason is the role of EMS provider attitudes. OBJECTIVE This study was conducted to elicit attitudes that may act as impediments or deterrents to administering analgesia in the prehospital environment. METHODS A qualitative methodology was employed. We recruited experienced paramedics, with at least one year of full-time fieldwork, from a variety of agencies in New England. We sought to include a balance of rural and urban as well as both private and hospital-based agencies. Participants at each site were selected through purposive sampling. A semistructured discussion guide was designed to elicit the paramedics' past experiences with administering analgesia, as well as reflections on their role in the care of patients in pain. Both interviews and focus groups were conducted. These sessions were recorded and transcribed verbatim. The transcripts were topic-analyzed and iteratively coded by two independent investigators utilizing the constant comparative method of Glaser and Strauss' Grounded Theory; coding ambiguities were resolved by consensus. Through a series of conceptual mapping and iterative code refinement, themes and domains were generated. RESULTS Fifteen paramedics from five EMS agencies in three New England states were recruited. Major themes were: 1) a reluctance to administer opioids to patients without significant objective signs (e.g., deformity, hypertension); 2) a preoccupation with potential malingering; 3) ambivalence about the degree of pain control to target or to expect (e.g., aiming to "take the edge off"); 4) a fear of masking diagnostic symptoms; and 5) an aversion to aggressive dosing of opioids (e.g., initial doses of morphine did not exceed 5 mg). CONCLUSIONS A number of potentially modifiable attitudinal barriers to appropriate pain management were revealed.
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Affiliation(s)
- Brooks Walsh
- Yale-New Haven Medical Center Emergency Medicine Residency Program, Yale University School of Medicine, New Haven, CT 06519,
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Simpson PM, McCabe B, Bendall JC, Cone DC, Middleton PM. Paramedic-Performed Digital Nerve Block To Facilitate Field Reduction Of A Dislocated Finger. PREHOSP EMERG CARE 2012; 16:415-7. [DOI: 10.3109/10903127.2012.670690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Snooks H, Anthony R, Chatters R, Cheung WY, Dale J, Donohoe R, Gaze S, Halter M, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Phillips C, Phillips J, Russell I, Siriwardena AN, Wani M, Watkins A, Whitfield R, Wilson L. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care. BMJ Open 2012; 2:bmjopen-2012-002169. [PMID: 23148348 PMCID: PMC3533098 DOI: 10.1136/bmjopen-2012-002169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. DESIGN Pragmatic cluster randomised trial. METHODS AND ANALYSIS We randomly allocated 25 participating ambulance stations (clusters) in three services to intervention or control group. Intervention paramedics received training and clinical protocols for assessing and referring older people who have fallen to community-based falls services when appropriate, while control paramedics deliver care as usual. Patients are eligible for the trial if they are aged 65 or over; resident in a participating falls service catchment area; and attended by a trial paramedic following an emergency call coded as a fall without priority symptoms. The principal outcome is the rate of further emergency contacts (or death), for any cause and for falls. Secondary outcomes include further falls, health-related quality of life, 'fear of falling', patient satisfaction reported by participants through postal questionnaires at 1 and 6 months, and quality and pathways of care at the index incident. We shall compare National Health Service (NHS) and patient/carer costs between intervention and control groups and estimate quality-adjusted life years (QALYs) gained from the intervention and thus incremental cost per QALY. We shall estimate wider system effects on key-performance indicators. We shall interview 60 intervention patients, and conduct focus groups with contributing NHS staff to explore their experiences of the assessment and referral service. We shall analyse quantitative trial data by 'treatment allocated'; and qualitative data using content analysis. ETHICS AND DISSEMINATION The Research Ethics Committee for Wales gave ethical approval and each participating centre gave NHS Research and Development approval. We shall disseminate study findings through peer-reviewed publications and conference presentations. TRIAL REGISTRATION ISRCTN 60481756.
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Affiliation(s)
- Helen Snooks
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Rebecca Anthony
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Wai-Yee Cheung
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachael Donohoe
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Sarah Gaze
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Mary Halter
- Faculty of Health and Social Services, St Georges University Hospital, London, UK
| | - Marina Koniotou
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Phillippa Logan
- Community Health Sciences, The University of Nottingham, Nottingham, UK
| | - Ronan Lyons
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
| | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Judith Phillips
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Ian Russell
- West Wales Organisation for Rigorous Trials in Health, College of Medicine, Swansea, UK
| | | | - Mushtaq Wani
- Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, UK
| | - Alan Watkins
- School of Business and Economics, Swansea University, Swansea, UK
| | - Richard Whitfield
- Pre-hospital Emergency Research Unit (PERU), Welsh Ambulance Services NHS Trust, Cardiff, UK
| | - Lynsey Wilson
- Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
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Cooper S, Grant J. New and emerging roles in out of hospital emergency care: a review of the international literature. Int Emerg Nurs 2009; 17:90-8. [PMID: 19341994 DOI: 10.1016/j.ienj.2008.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/20/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
Abstract
AIMS The aim of the literature review was to identify new and emerging out of hospital emergency care roles and to describe their activity and impact. BACKGROUND Demographic changes, increased demands for health services, altered working practices, and health system economic pressures have led to the development of a disparate set of new health care roles. DATA SOURCES MEDLINE, EMBASE and CINAHL databases, and the two search engines Google and Google Scholar were searched for contemporary studies in the identified study area. REVIEW METHODS All publications identified through the search were assessed for relevance. Those that discussed new roles were included (n=34) and empirical studies (n=14) analysed in detail. RESULTS Emergency care and paramedic practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the conveyance rate to hospital, improved inter-professional working, immediacy of treatment and referral, and high patient satisfaction. Limited economic data suggests savings of between pound31 (USD 55) and pound37 (USD 65) per case when ECPs replace standard ambulance responders. Concerns have been expressed about patient safety, recruitment and training levels, regulatory and role implementation issues. CONCLUSION Further work is required to fully understand the patient safety, clinical practice, professional role and financial implications of these new roles.
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Affiliation(s)
- Simon Cooper
- School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill, Vic 3842, Australia.
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Emergency care practitioners (ECP): Practice and performance in the UK West country – A case study. Int Emerg Nurs 2008; 16:180-4. [DOI: 10.1016/j.ienj.2008.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 04/12/2008] [Indexed: 11/18/2022]
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Cooper S, Endacott R. Generic qualitative research: a design for qualitative research in emergency care? Emerg Med J 2008; 24:816-9. [PMID: 18029510 DOI: 10.1136/emj.2007.050641] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The frequency of qualitative studies in the Emergency Medicine Journal, while still low, has increased over the last few years. All take a generic approach and rarely conform to established qualitative approaches such as phenomenology, ethnography and grounded theory. This generic approach is no doubt selected for pragmatic reasons but can be weakened by a lack of rigor and understanding of qualitative research. This paper explores qualitative approaches and then focuses on "best practice" for generic qualitative research.
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Affiliation(s)
- S Cooper
- Faculty of Health and Social Work, C501 Portland Square, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.
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Abstract
Evidence suggests a positive effect, but future programmes need rigorous assessment before being expanded
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Cooper S, O'Carroll J, Jenkin A, Badger B. Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner--qualitative and summative findings. Emerg Med J 2007; 24:625-9. [PMID: 17711937 PMCID: PMC2464628 DOI: 10.1136/emj.2006.043943] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify collaborative instances and hindrances and to produce a model of collaborative practice. METHODS A 12-month (2005-2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi-professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients RESULTS Using a generic qualitative approach, observational records and interviews showed that ECPs' numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, "restricted transport codes" of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi-professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a "crew room" blue collar view of inter-professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs' role. The quantitative findings are reported elsewhere. CONCLUSIONS The final model of collaborative practice suggests that ECPs are having an impact on patient care, but that improvements can be made. We recommend the appointment of ECP clinical leads, degree level clinically focussed multi-professional education, communication skills training, clinical supervision and multi-professional ECP appointments.
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Affiliation(s)
- Simon Cooper
- Faculty of Health and Social Work, C501 Portland Square, University of Plymouth, Plymouth, Devon PL4 8AA, UK.
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Cooper S, O'Carroll J, Jenkin A, Badger B. Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner--quantitative findings. Emerg Med J 2007; 24:630-3. [PMID: 17711938 PMCID: PMC2464656 DOI: 10.1136/emj.2007.048058] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify collaborative instances and hindrances and to produce a model of collaborative practice. METHODS A 12 month (2005-6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. RESULTS Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p < or = 0.001) and teamwork (p < or = 0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. CONCLUSIONS The collaborative performance of ECPs varies, but the ECPs' role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere.
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Affiliation(s)
- Simon Cooper
- Faculty of Health and Social Work, C503 Portland Square, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.
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Abstract
OBJECTIVE To explore nurses' views and to identify the perceived advantages and disadvantages of the "4-hour target." METHODS The study was based in one emergency department (ED) in the UK and took a generic qualitative approach. A stratified sample of nine experienced ED nurses were recruited for semi-structured interviews. Data was analysed using the framework analysis approach. RESULTS The 4-hour target was considered an overall success in reducing waiting times and increasing patient satisfaction. However, staff expressed concerns over the imposed nature of the target, workload pressures, quality of care, and the level of support from secondary and primary care. CONCLUSION Although deemed an overall success, there were reservations as to the target's sustainability. Recommendations are made for improved communication between primary and secondary care and establishing the target as a shared goal within the hospital environment.
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Affiliation(s)
- Andy Mortimore
- Emergency Department, Torbay Hospital, Lawes Bridge, Torquay, Devon, TQ2 7AA, UK.
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Snooks HA, Halter M, Close JCT, Cheung WY, Moore F, Roberts SE. Emergency care of older people who fall: a missed opportunity. Qual Saf Health Care 2006; 15:390-2. [PMID: 17142584 PMCID: PMC2464894 DOI: 10.1136/qshc.2006.018697] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2006] [Indexed: 11/03/2022]
Abstract
INTRODUCTION A high number of emergency (999) calls are made for older people who fall, with many patients not subsequently conveyed to hospital. Ambulance crews do not generally have protocols or training to leave people at home, and systems for referral are rare. The quality and safety of current practice is explored in this study, in which for the first time, the short-term outcomes of older people left at home by emergency ambulance crews after a fall are described. Results will inform the development of care for this population. METHODS Emergency ambulance data in London were analysed for patterns of attendance and call outcomes in 2003-4. All older people who were attended by emergency ambulance staff after a fall in September and October 2003, within three London areas, were identified. Those who were not conveyed to hospital were followed up; healthcare contacts and deaths within the following 2 weeks were identified. RESULTS During 2003-4, 8% of all 999 calls in London were for older people who had fallen (n = 60 064), with 40% not then conveyed to hospital. Of 2151 emergency calls attended in the study areas during September and October 2003, 534 were for people aged >or=65 who had fallen. Of these, 194 (36.3%) were left at home. 86 (49%) people made healthcare contacts within the 2-week follow-up period, with 83 (47%) people calling 999 again at least once. There was an increased risk of death (standard mortality ratio 5.4) and of hospital admission (4.7) compared with the general population of the same age in London. COMMENT The rate of subsequent emergency healthcare contacts and increased risk of death and hospitalisation for older people who fall and who are left at home after a 999 call are alarming. Further research is needed to explore appropriate models for delivery of care for this vulnerable group.
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Affiliation(s)
- Helen A Snooks
- Centre for Health Information Research and Evaluation (CHIRAL), School of Medicine, Swansea University, Swansea, UK.
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Williamson GR, Webb C, Abelson-Mitchell N, Cooper S. Change on the horizon: issues and concerns of neophyte advanced healthcare practitioners. J Clin Nurs 2006; 15:1091-8. [PMID: 16911049 DOI: 10.1111/j.1365-2702.2005.01462.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim was to interview new entrants to a Master's level programme of educational preparation for advanced healthcare practice roles. The objectives were to gain an understanding of their issues and concerns as they looked ahead to their future development and to illuminate issues concerning their experiences as students and as employees. BACKGROUND As advanced practice roles become more widespread in the United Kingdom and abroad, nurses and other healthcare professionals are becoming more involved in innovation and service development and experiencing greater autonomy in many areas, particularly in regard to clinical examination and diagnosis. DESIGN A qualitative design was employed to illuminate issues and concerns of new students on a Master's degree programme of educational preparation for advanced healthcare practitioners. METHODS Two focus group interviews were conducted in 2004. Sixteen students from two programme cohorts participated in the two groups. FINDINGS Two main themes were outlined. These were: 'opportunities for development' and 'time pressures'. Subcategories within these two themes are also discussed. CONCLUSIONS Students undertaking Master's level preparation for advanced healthcare practitioner roles perceive personal and professional benefits and opportunities to develop innovative services to improve patient care as accruing from the programme. These opportunities and benefits were related to the United Kingdom national health policy agenda. Some role difficulties were experienced. The additional burdens that the programme of study provided were an issue for some, but these were perceived as a temporary problem, worth undergoing for the likely long-term benefits. RELEVANCE TO CLINICAL PRACTICE Students undertaking educational preparation for advanced practice roles see themselves as innovators, specifically aiming to develop and improve aspects of service provision. Education for advanced practice roles should not be undertaken lightly, but can equip students with various skills, particularly regarding clinical assessment, and these skills should underpin practitioners' autonomy.
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Affiliation(s)
- Graham R Williamson
- Adult Nursing, Faculty of Health and Social Work, University of Plymouth, Devon, UK.
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Mason S. Emergency care practitioners should not be compared with paramedics. Emerg Med J 2006; 23:325-6; author reply 326. [PMID: 16549589 PMCID: PMC2579521 DOI: 10.1136/emj.2005.032243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cooper S. Contemporary UK paramedical training and education. How do we train? How should we educate? Emerg Med J 2005; 22:375-9. [PMID: 15843714 PMCID: PMC1726764 DOI: 10.1136/emj.2004.019208] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop an understanding of the current system and future development of training and education within a large UK ambulance trust, based upon the experiences, beliefs, and opinions of stakeholders. METHODS This was a qualitative naturalistic inquiry using an interpretative constructivist approach for 44 interviews with a range of ambulance staff. Stakeholder views on training and education were analysed and compared using the constant comparison method. RESULTS Key emergent themes included: issues around prescribed programme entry levels and methods; the desire for a higher education curriculum with a balance between theory and practice; valid and reliable assessment methods; development of a supportive mentorship framework; an emphasis on self directed professional development with a focus on deskilling issues; and development of interprofessional collaborative links. CONCLUSION This thematic review suggests that this UK ambulance service is in a transition stage, with significant organisational, professional, and cultural challenges. The dichotomies, boundaries, and development issues are part of the development of an emerging profession for which it is essential that the educational agenda is addressed.
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Affiliation(s)
- S Cooper
- Faculty of Health and Social Work, C403, Portland Square, University of Plymouth, Plymouth, Devon PL4 8AA, UK.
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