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Alzahrani A, Keyworth C, Alshahrani KM, Alkhelaifi R, Johnson J. Prevalence of anxiety, depression, and post-traumatic stress disorder among paramedic students: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02755-6. [PMID: 39264380 DOI: 10.1007/s00127-024-02755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 08/28/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally. METHODS A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data. RESULTS 1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8-21.6%), anxiety was 56.4% (95% CI 35,9-75%), and depression was at 34.7% (95% CI 23.4-48.1%). CONCLUSION This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.
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Affiliation(s)
- Adnan Alzahrani
- School of Psychology, University of Leeds, Leeds, LS29JT, UK.
- Department of Basic Science, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, 11466, Riyadh, Saudi Arabia.
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
| | - Khalid Mufleh Alshahrani
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
- Faculty of Arts and Humanity, Psychology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rayan Alkhelaifi
- Department of Aviation and Marines, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, 11466, Riyadh, Saudi Arabia
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Shriane AE, Vincent GE, Ferguson SA, Rebar A, Kolbe-Alexander T, Rigney G. Improving sleep health in paramedics through an app-based intervention: a randomised waitlist control pilot trial. BMC Public Health 2024; 24:2395. [PMID: 39227826 PMCID: PMC11373143 DOI: 10.1186/s12889-024-19823-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 08/16/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Due to work commitments, shiftworkers often obtain inadequate sleep, consequently experiencing negative health, wellbeing, and safety outcomes. Given shiftworkers may have limited control over their work commitments, lifestyle and environmental factors within their control may present an intervention opportunity. However, such interventions require tailoring to ensure applicability for this sleep-vulnerable population. METHODS A randomised waitlist control pilot trial investigated the effectiveness of mobile health application Sleepfit, which delivered a tailored sleep health intervention aimed at improving sleep health and sleep hygiene outcomes amongst paramedic shiftworkers. Outcome measures of self-reported sleep health (sleep need, duration, and quality, fatigue, Insomnia Severity Index, Fatigue Severity Scale, and Epworth Sleepiness Scale scores) and sleep hygiene (Sleep Hygiene Index score) were collected at baseline, post-intervention, and 3-month follow-up. RESULTS Fifty-eight paramedics (aged 33.4 ± 8.0 years; 50% male) were recruited, and trialed Sleepfit for a 14-day intervention period between August 2021-January 2022. For all participants, there was a significant reduction in Insomnia Severity Index and Sleep Hygiene index scores after intervention engagement. Regression models demonstrated no significant intervention effect on sleep health or sleep hygiene outcomes (intervention versus waitlist control group). A high study drop-out rate (91.4%) prevented assessment of outcomes at 3-month follow-up. CONCLUSIONS Pilot trial findings demonstrate that Sleepfit may elicit improvements in sleep health and sleep hygiene outcomes amongst paramedic shiftworkers. However, low enrolment and retention means that findings should be interpreted with caution, further highlighting potential engagement challenges, especially among paramedics who are particularly in need of support for improved sleep. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trial Registry 24/01/2020 (reference no. ACTRN12620000059965).
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Affiliation(s)
- Alexandra E Shriane
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, 44 Greenhill Road, Wayville, Adelaide, SA, 5034, Australia.
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, 44 Greenhill Road, Wayville, Adelaide, SA, 5034, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, 44 Greenhill Road, Wayville, Adelaide, SA, 5034, Australia
| | - Amanda Rebar
- Motivation of Health Behaviours Lab, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Tracy Kolbe-Alexander
- School of Health and Medical Sciences, and Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Research Unit for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gabrielle Rigney
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, 44 Greenhill Road, Wayville, Adelaide, SA, 5034, Australia
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Tunks Leach K, Demant D, Simpson P, Lewis J, Levett-Jones T. Chaplaincy and spiritual care in Australian ambulance services: an exploratory cross-sectional study. J Health Care Chaplain 2024; 30:202-225. [PMID: 38574262 DOI: 10.1080/08854726.2024.2323371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Ambulance staff wellbeing programs aim to support the bio-psycho-social and sometimes spiritual needs of paramedics. While evidence demonstrates strong connections between spirituality and/or religion to wellbeing outcomes, little is known about spiritual care in ambulance services or its impact. The aim of this study was to investigate paramedics' perspectives on the role and value of Australian ambulance chaplains. A cross-sectional online study of registered paramedics in Australia was conducted between November and December 2022. Analysis of the 150 responses identified that paramedics viewed the chaplain's role as one built on professional caring relationships that provided proactive and reactive care in paramedic workplaces. Chaplains were perceived to promote wellbeing by incorporating emotional, psychological, social and spiritual care, and assisting paramedics to access additional support. Perceived religiousness of chaplains and organisational factors were barriers to paramedics accessing chaplains, while pre-existing relationships and shared experiences positively influenced paramedics decision to seek chaplain support.
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Affiliation(s)
- Katie Tunks Leach
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Daniel Demant
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, OLD, Australia
| | - Paul Simpson
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Parsons C, Escobar C, Jasani A, Zhao D, Gliatto P, Blutinger E, Ornstein KA. Community paramedicine in dementia care. J Am Geriatr Soc 2024; 72:2167-2173. [PMID: 38485282 PMCID: PMC11226359 DOI: 10.1111/jgs.18872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/27/2024] [Accepted: 02/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Novel hospital diversion strategies are needed to support a growing number of patients with dementia living in the community. One promising model is community paramedicine (CP), which deploys paramedics to the home, who consult with a physician to coordinate treatment and assess disposition. While evidence suggests CP can manage many patients without escalation to the emergency department (ED), no studies have evaluated optimal CP utilization for patients with dementia. Therefore, we compare the use and outcomes of CP for homebound patients with and without dementia. METHODS This retrospective cohort study examines 251 homebound patients receiving home-based primary care, who utilized a physician-led CP service between March 2017 and May 2022. Linked electronic health record data included patient demographics, clinical characteristics, and CP encounter details. Dementia status and CP outcomes, including rates of ED transport, over-transport (i.e., transported, but not hospitalized), and under-transport (i.e., not transported, but ED visit within 3 days), were determined via chart review. Using logistic regression, we modeled the association of dementia status with over- and under-transport, adjusting for age, sex, and chief complaint. RESULTS Fifty-three percent of CP patients had dementia. Their most common chief complaints were dyspnea (24.3%), altered mental status (17.9%), and generalized weakness (9.8%). We found no significant difference in ED transport rates by dementia status (25.4 vs. 22.8%, p = 0.54). Dementia diagnosis was associated with lower rates of over-transport (OR = 0.21, p = 0.03, CI [0.05, 0.85]) and comparable rates of under-transport (OR = 0.70, p = 0.47, CI [0.27, 1.83]) in adjusted models. CONCLUSIONS CP has effectively managed a diverse population of homebound patients with dementia cared for via home-based primary care. Future work should examine potential cost savings and use of CP in dementia care across geographic and healthcare settings.
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Affiliation(s)
- Colby Parsons
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christian Escobar
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Jasani
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Duzhi Zhao
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Gliatto
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erik Blutinger
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA
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Zaphir JS, Murphy KA, MacQuarrie AJ, Stainer MJ. Understanding The Role of Cognitive Load In Paramedical Contexts: A Systematic Review. PREHOSP EMERG CARE 2024:1-23. [PMID: 38922409 DOI: 10.1080/10903127.2024.2370491] [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: 12/29/2023] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
Objectives: Cognitive load refers to the working memory resources required during a task. When the load is too high or too low this has implications for an individual's task performance. In the context of paramedicine and emergency medical services (EMS) broadly, high cognitive load could potentially put patient and personnel safety at risk. This systematic review aimed to determine the current understanding of the role of cognitive load in paramedical contexts.Methods: To do this, five databases were searched (Elsevier Embase, ProQuest Psychology, CINAHL, Ovid Medline, and Ovid PsychINFO) using synonyms of cognitive load and paramedical contexts. Included articles were full text, peer reviewed empirical research, with a focus on cognitive load and EMS work. Two reviewers screened titles, abstracts, and full text using a traffic light system against the inclusion and exclusion criteria. The quality of evidence was assessed using the GRADE framework. This study was registered on PROSPERO (CRD42022384246). No funding was received for this research.Results: The searches identified 73 unique articles and after title/abstract and full text screening, 25 articles were included in the final review. Synthesis of the research revealed 10 categories of findings in the area. These are clinical performance, cognitive processes, emotional responses, physical expenditure, physiological responses, equipment and ergonomics, expertise and experience, multiple loads, cognitive load measures, and task complexity.Conclusions: From these findings it was determined that there is agreement in terms of what factors influence cognitive load in paramedical contexts, such as cognitive processes, task complexity, physical expenditure, level of experience, multiple types of loads, and the use of equipment. Cognitive load influences clinical task performance and has a bi-directional relationship with emotion. However, the literature is mixed regarding physiological responses to cognitive load, and how they are best measured. These findings highlight potential intervention points where cognitive load can be managed or reduced to improve working conditions for EMS clinicians and safety for their patients.
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Affiliation(s)
- Jasmine S Zaphir
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
| | - Karen A Murphy
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
| | | | - Matthew J Stainer
- School of Applied Psychology, Griffith University, Queensland, Australia 4222
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Granlund L, Brännström I, Lindström V. Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study. BMC Nurs 2024; 23:271. [PMID: 38658953 PMCID: PMC11044363 DOI: 10.1186/s12912-024-01899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a notable variation in the percentage of non-conveyed patients within the ambulance service. Discharging patients at the scene includes a risk of adverse events, and both patients and ambulance clinicians experience the complexity of non-conveyance. Therefore, this study aimed to describe factors influencing the care encounter when care in the ambulance service concludes with non-conveyance. METHOD A qualitative study design employing the critical incident technique for data collection through individual interviews, and a qualitative analysis based on Fridlund et al. descriptions was utilized. The study conforms to the COREQ checklist for reporting qualitative research. RESULTS Fourteen Registered Nurses (RN) described 30 incidents and various factors were identified as influencing the care encounter. The factors included communication, sharing information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and an overall understanding of the patient's entire situation. These factors were integrated into the RNs' decision-making process for non-conveyance. CONCLUSION The decision-making process for non-conveyance by RNs is a multifaceted approach that incorporates several factors. Communication, sharing of information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and a comprehensive understanding of the patient's entire situation. These findings have the potential to contribute to the development of guidelines supporting the RNs working in the ambulance service in their decisions regarding non-conveyance. Further research is needed on the patient's and relatives' perspective on non-conveyance otherwise, patient participation and partnership in person-centered care are not possible to achieve.
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Affiliation(s)
- L Granlund
- Department of Ambulance Service, Region Västerbotten, Umeå, Sweden
| | - I Brännström
- Department of Ambulance Service, Region Västerbotten, Umeå, Sweden
| | - V Lindström
- Department of Nursing, Umeå University, Umeå, Sweden.
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Thomson M, Simpson P, Pap R, Munn Z. Clinical practice guidelines in prehospital pain management for paramedics: a systematic review protocol. JBI Evid Synth 2024; 22:461-471. [PMID: 38060196 DOI: 10.11124/jbies-23-00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVES The purpose of this review is to examine prehospital pain management clinical practice guidelines (CPGs) to identify recommendations that can be adopted or adapted into paramedic clinical practice. An additional aim is to consider the methodological quality of these CPGs and the recommendations within them. INTRODUCTION Quality, evidence-based CPGs support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, the evaluation of pain management CPGs, their quality, and whether their recommendations can be adopted or adapted into practice is required to increase understanding in this area. INCLUSION CRITERIA We will include CPGs for pain management intended for prehospital services in civilian communities. CPGs in English published from 2017, and containing clear recommendations addressing pain of any cause will be considered for inclusion. METHODS This review will combine methodologies, including the PICAR framework (population, intervention, comparison, attributes of eligible CPGs, recommendation characteristics) by Johnston et al. , and the JBI umbrella and scoping review methodologies. The search strategy will cover 12 databases, including PubMed, Embase, and specific CPG databases (eg, GIN Library). Additionally, Google Scholar and Google will be searched, and prehospital organizations without regular publications will be contacted. The AGREE II and AGREE-REX tools will be used to assess the methodological rigor and clinical credibility of the CPGs. The characteristics of both CPGs and the recommendations will be extracted and discussed in the review. REVIEW REGISTRATION PROSPERO CRD42022352951.
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Affiliation(s)
- Michelle Thomson
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Paul Simpson
- Western Sydney University, Sydney, NSW, Australia
| | - Robin Pap
- Western Sydney University, Sydney, NSW, Australia
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Hill L, Eaton G. Exploring paramedic professional identity. Br Paramed J 2023; 8:42-51. [PMID: 38046791 PMCID: PMC10690486 DOI: 10.29045/14784726.2023.12.8.3.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
The notion of a paramedic (as a title protected in law) has recently entered its third decade, but the history of the paramedic is considerably older than that. Who are we as a profession? What does it mean to be a paramedic? What makes us who we are? These intriguing and yet seldom asked philosophical questions are at the heart of this article, which is intended to provoke discussion and serve as a foundation for further inquiry into questions of identity and philosophy in paramedicine. Literature pertaining to paramedic professional identity was explored and contextualised within current paramedic practice. Although the overall picture is complex, four key areas for discussion emerged: the history of the paramedic profession; role diversity; the influence of ambulance work; and the education and training of paramedics. The influence of ambulance work permeates all areas, suggesting that it is central to the development of paramedic professional identity. This discussion article is an exploration of the unique contexts and experiences that are associated with the process of being and becoming for paramedics.
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Affiliation(s)
- Lawrence Hill
- University of East Anglia ORCID iD https://orcid.org/0000-0002-9147-0934
| | - Georgette Eaton
- University of Oxford; London Ambulance Service NHS Trust ORCID iD: http://orcid.org/0000-0001-9421-2845
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McDonald N, Little N, Kriellaars D, Doupe MB, Giesbrecht G, Pryce RT. Database quality assessment in research in paramedicine: a scoping review. Scand J Trauma Resusc Emerg Med 2023; 31:78. [PMID: 37951904 PMCID: PMC10638787 DOI: 10.1186/s13049-023-01145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Research in paramedicine faces challenges in developing research capacity, including access to high-quality data. A variety of unique factors in the paramedic work environment influence data quality. In other fields of healthcare, data quality assessment (DQA) frameworks provide common methods of quality assessment as well as standards of transparent reporting. No similar DQA frameworks exist for paramedicine, and practices related to DQA are sporadically reported. This scoping review aims to describe the range, extent, and nature of DQA practices within research in paramedicine. METHODS This review followed a registered and published protocol. In consultation with a professional librarian, a search strategy was developed and applied to MEDLINE (National Library of Medicine), EMBASE (Elsevier), Scopus (Elsevier), and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies that reported quantitative results of DQA using data that relate primarily to the paramedic practice environment were included. Protocols, commentaries, and similar study types were excluded. Title/abstract screening was conducted by two reviewers; full-text screening was conducted by two, with a third participating to resolve disagreements. Data were extracted using a piloted data-charting form. RESULTS Searching yielded 10,105 unique articles. After title and abstract screening, 199 remained for full-text review; 97 were included in the analysis. Included studies varied widely in many characteristics. Majorities were conducted in the United States (51%), assessed data containing between 100 and 9,999 records (61%), or assessed one of three topic areas: data, trauma, or out-of-hospital cardiac arrest (61%). All data-quality domains assessed could be grouped under 5 summary domains: completeness, linkage, accuracy, reliability, and representativeness. CONCLUSIONS There are few common standards in terms of variables, domains, methods, or quality thresholds for DQA in paramedic research. Terminology used to describe quality domains varied among included studies and frequently overlapped. The included studies showed no evidence of assessing some domains and emerging topics seen in other areas of healthcare. Research in paramedicine would benefit from a standardized framework for DQA that allows for local variation while establishing common methods, terminology, and reporting standards.
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Affiliation(s)
- Neil McDonald
- Winnipeg Fire Paramedic Service, EMS Training, 2546 McPhillips St, Winnipeg, MB, R2P 2T2, Canada.
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, S203 Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
- Applied Health Sciences, University of Manitoba, 202 Active Living Centre, Winnipeg, MB, R3T 2N2, Canada.
| | - Nicola Little
- Winnipeg Fire Paramedic Service, EMS Training, 2546 McPhillips St, Winnipeg, MB, R2P 2T2, Canada
| | - Dean Kriellaars
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Gordon Giesbrecht
- Faculty of Kinesiology and Recreation Management, University of Manitoba, 102-420 University Crescent, Winnipeg, MB, R3T 2N2, Canada
| | - Rob T Pryce
- Department of Kinesiology and Applied Health, Gupta Faculty of Kinesiology, University of Winnipeg, 400 Spence St, Winnipeg, MB, R3B 2E9, Canada
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Taplin JG, Bill L, Blanchard IE, Barnabe CM, Holroyd BR, Healy B, McLane P. Exploring paramedic care for First Nations in Alberta: a qualitative study. CMAJ Open 2023; 11:E1135-E1147. [PMID: 38086557 PMCID: PMC10721334 DOI: 10.9778/cmajo.20230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prior work has shown that a greater proportion of First Nations patients than non-First Nations patients arrive by ambulance to emergency departments in Alberta. The objective of this study was to understand First Nations perspectives on transitions in care involving paramedics, and paramedic perspectives on serving First Nations communities. METHODS Participants for this participatory qualitative study were selected by means of purposive sampling through author networks, established relationships and knowledge of the Alberta paramedicine system. First Nations research team members engaged First Nations community organizations to identify and invite First Nations participants. Four sharing circles were held virtually in July 2021 via Zoom by the Alberta First Nations Information Governance Centre. We analyzed the data from the sharing circles using a Western thematic approach. The data were reviewed by Indigenous researchers. RESULTS Forty-four participants attended the 4 sharing circles (8-14 participants per circle), which ranged from 68 to 88 minutes long. We identified 3 major themes: racism, system barriers and solutions. First Nations participants described being stereotyped as misusing paramedic systems and substance using, which led to racial discrimination by paramedics and emergency department staff. Discrimination and lack of options to return home after care sometimes led First Nations patients to avoid paramedic care, and lack of alternative care options drove patients to access paramedic care. First Nations providers described facing racism from colleagues and completing additional work to act as cultural mentors to non-First Nations providers. Paramedics expressed moral distress when called on to handle issues outside their scope of practice and when they observed discrimination that interfered with patient care. Proposed solutions included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models. INTERPRETATION First Nations people face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities, and First Nations should lead in the design of and priority setting for paramedic services in their communities.
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Affiliation(s)
- John G Taplin
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Lea Bill
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Ian E Blanchard
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Cheryl M Barnabe
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Brian R Holroyd
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Patrick McLane
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta.
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Phillips P, Trenoweth S. Crossing the 'flaky bridge' - the initial transitory experiences of qualifying as a paramedic: a mixed-methods study. Br Paramed J 2023; 8:18-27. [PMID: 37284606 PMCID: PMC10240861 DOI: 10.29045/14784726.2023.6.8.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Introduction Newly qualified paramedics (NQPs) may experience emotional turbulence as they transition to professional practice. This may negatively affect confidence and have an adverse effect on attrition. This study highlights the initial transitory experiences of NQPs. Methods The study utilised a mixed-methods convergent design. Qualitative and quantitative data were collected simultaneously and triangulated to more fully interpret participants' experiences. A convenience sample of 18 NQPs from one ambulance trust was used. The Connor-Davidson Resilience 25-point Scale questionnaire (CD-RISC25) was administered and analysed using descriptive statistics. Semi-structured interviews were conducted simultaneously and analysed using Charmaz's constructivist grounded theory approach. Data were collected from September to December 2018. Results There was a range of resilience scores, with a mean of 74.7/100 (standard deviation 9.6). Factors relating to social support were scored highly, and factors relating to determinism and spirituality were scored lower. Qualitative data constructed a process whereby participants were navigating a new identity across three spheres simultaneously: professional, social and personal identity. Attending a catalyst event such as a cardiac arrest was a trigger for starting to navigate this process. Participants had different pathways through this transitional period. Participants who found this process particularly turbulent seemed to have lower resilience scores. Conclusion The transition from student to NQP is an emotionally turbulent time. Navigating a changing identity seems to be at the centre of this turbulence, and this is triggered by a catalyst event such as attending a cardiac arrest. Interventions which support the NQP in navigating this change in identity, such as group supervision, may improve resilience and self-efficacy and reduce attrition.
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Affiliation(s)
- Peter Phillips
- Bournemouth University ORCID iD: http://orcid.org/0000-0002-9895-6945
| | - Steve Trenoweth
- Bournemouth University ORCID iD: http://orcid.org/0000-0001-8342-499X
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12
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Peters A, Lim D, Naidoo N. Down with falls! Paramedicine scope regarding falls amongst older adults in rural and remote communities: A scoping review. Aust J Rural Health 2023. [PMID: 37200405 DOI: 10.1111/ajr.12994] [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: 02/13/2023] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Australian rural and remote areas are faced with the double burden of an ageing population paired with inequitable access to health resources due to the paradigm of major city centred health care. This complicates fall management within this space. Paramedics are a registered health profession, which provides mobile, equitable health care. However, this resource is not being effectively utilised in rural and remote areas where primary care access barriers may cause patient needs to go unmet. OBJECTIVE To describe the existing literature and describe the international scope of current paramedicine practice in the out-of-hospital management of falls amongst older adults in rural and remote settings. DESIGN Joanna Briggs Institute scoping review methodology was employed. CINAHL (EBSCO), MEDLINE (Ovid), EMBASE (Ovid), SCOPUS (Elsevier), Google Scholar and These Global were searched and Australian, New Zealand and the UK ambulance service guidelines were sought. FINDINGS Two records met inclusion criteria. Currently, rural and remote paramedic fall management involves preventative health promotion through patient education, population-based screening and referrals. DISCUSSION The use of paramedics to screen at-risk populations and refer is vital, as many rural adults had screened positive to fall risks and other unmet needs. There is poor recollection of physically printed education material and low acceptance of further in-home assessments following paramedic departure. CONCLUSION This scoping review has highlighted a significant knowledge gap on this topic. Further research is needed to effectively utilise paramedicine within areas where access to primary care is not possible to achieve downstream, risk reducing care in the home.
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Affiliation(s)
- Aidan Peters
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Centre for Remote Health, Alice Springs, Northern Territory, Australia
| | - Navindhra Naidoo
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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13
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Alzahrani A, Keyworth C, Wilson C, Johnson J. Causes of stress and poor wellbeing among paramedic students in Saudi Arabia and the United Kingdom: a cross-cultural qualitative study. BMC Health Serv Res 2023; 23:444. [PMID: 37147658 PMCID: PMC10163716 DOI: 10.1186/s12913-023-09374-y] [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: 02/10/2023] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Paramedicine presents students with numerous challenges, including factors threatening their wellbeing. Over the last two decades studies have illustrated that paramedics and paramedic students are more likely to have mental disorders than the general population. These findings suggest that course-related factors could be important in contributing to poorer mental health. However, few studies have examined factors related to stress in paramedic students, and none of these have included paramedic students from cross-culture. To address this, the present study (1) explored paramedicine students' training experiences and other education-related factors that could affect their wellbeing, and (2) illustrated the possible differences and similarities between two cultures (Saudi Arabia and the UK) to determine whether the students' cultural environment influenced factors related to their wellbeing. METHODS A qualitative exploratory research design was used. Twenty semi-structured interviews were conducted with paramedicine students from the United Kingdom and Kingdom of Saudi Arabia (ten participants from each country). Reflexive thematic analysis was employed as the analytical approach in this study. RESULTS Four major themes were identified which captured the contributors to paramedic students' stress levels: (1) exposure to potentially traumatic events, (2) relationships and communication, illustrating the student's personal and professional experiences with others, (3) programme atmosphere, demonstrating the challenges and support students encounter during their coursework and training, and (4) career, elucidating the pressure of future career expectations and predictions. CONCLUSION The study revealed contributors to stress were similar in both countries. Better preparation can help to reduce the negative impacts of the possible traumatic events encountered on placements and supportive relationships, especially with proctors, can boost student wellbeing. Universities are able to address both these factors and help foster a positive environment for paramedicine students. As such, these results should help educators and policymakers when identifying and delivering interventions to support paramedic students.
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Affiliation(s)
- Adnan Alzahrani
- School of Psychology, University of Leeds, Leeds, LS29JT, UK.
- Department of Basic Science, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, 11466, Saudi Arabia.
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
| | - Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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14
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Cavanagh N, Blanchard IE, Weiss D, Tavares W. Looking back to inform the future: a review of published paramedicine research. BMC Health Serv Res 2023; 23:108. [PMID: 36732779 PMCID: PMC9893690 DOI: 10.1186/s12913-022-08893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. METHODS We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. RESULTS The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. CONCLUSIONS Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.
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Affiliation(s)
- N Cavanagh
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - I E Blanchard
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
| | - D Weiss
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada
| | - W Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
- York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario, Canada
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15
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Ross L, Semaan E, Gosling CM, Fisk B, Shannon B. Clinical reasoning in undergraduate paramedicine: utilisation of a script concordance test. BMC MEDICAL EDUCATION 2023; 23:39. [PMID: 36658560 PMCID: PMC9849838 DOI: 10.1186/s12909-023-04020-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Clinical reasoning is a complex cognitive and metacognitive process paramount to patient care in paramedic practice. While universally recognised as an essential component of practice, clinical reasoning has been historically difficult to assess in health care professions. Is the Script Concordance Test (SCT) an achievable and reliable option to test clinical reasoning in undergraduate paramedic students? METHODS This was a single institution observational cohort study designed to use the SCT to measure clinical reasoning in paramedic students. Clinical vignettes were constructed across a range of concepts with varying shades of clinical ambiguity. A reference panel mean scores of the test were compared to that of students. Test responses were graded with the aggregate scoring method with scores awarded for both partially and fully correct responses. RESULTS Eighty-three student paramedic participants (mean age: 21.8 (3.5) years, 54 (65%) female, 27 (33%) male and 2 (2%) non-binary) completed the SCT. The difference between the reference group mean score of 80 (5) and student mean of score of 65.6 (8.4) was statistically significant (p < 0.001). DISCUSSION Clinical reasoning skills are not easily acquired as they are a culmination of education, experience and the ability to apply this in the context to a specific patient. The SCT has shown to be reliable and effective in measuring clinical reasoning in undergraduate paramedics as it has in other health professions such as nursing and medicine. More investigation is required to establish effective pedogeological techniques to optimise clinical reasoning in student and novice paramedics who are devoid of experience.
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Affiliation(s)
- Linda Ross
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia.
| | - Eli Semaan
- Ambulance Victoria, Melbourne, Australia
| | - Cameron M Gosling
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia
| | - Benjamin Fisk
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia
- Ambulance Victoria, Melbourne, Australia
| | - Brendan Shannon
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia
- Ambulance Victoria, Melbourne, Australia
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16
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Bolster J, Pithia P, Batt AM. Emerging Concepts in the Paramedicine Literature to Inform the Revision of a Pan-Canadian Competency Framework for Paramedics: A Restricted Review. Cureus 2022; 14:e32864. [PMID: 36699791 PMCID: PMC9870303 DOI: 10.7759/cureus.32864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
The National Occupational Competency Profile (NOCP)-the competency framework for paramedics in Canada-is presently undergoing revision. Since the NOCP was published in 2011, paramedic practice, healthcare, and society have changed dramatically. To inform the revision, we sought to identify emerging concepts in the literature that would inform the development of competencies for paramedics. We conducted a restricted literature review and content analysis of all published and grey literature pertaining to or informing Canadian paramedicine from 2011 to 2022. Three authors performed a title, abstract, and full-text review to identify and label concepts informed by existing findings. A total of 302 articles were categorized into 11 emerging concepts related to competencies: inclusion, diversity, equity, and accessibility (IDEA) in paramedicine; social responsiveness, justice, equity, and access; anti-racism; healthy professionals; evidence-informed practice and systems; complex adaptive systems; learning environment; virtual care; clinical reasoning; adaptive expertise; and planetary health. This review identified emerging concepts to inform the development of the 2023 National Occupational Standard for Paramedics (NOSP). These concepts will inform data analysis, the development of group discussions, and competency identification.
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Affiliation(s)
- Jennifer Bolster
- Paramedicine, Monash University, Melbourne, AUS
- Clinical Governance and Professional Practice, British Columbia Emergency Health Services, Vancouver, CAN
- Centre for Research and Innovation, Fanshawe College, London, CAN
| | - Priya Pithia
- Centre for Research and Innovation, Fanshawe College, London, CAN
| | - Alan M Batt
- Paramedicine, Monash University, Melbourne, AUS
- Centre for Research and Innovation, Fanshawe College, London, CAN
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17
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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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Makrides T, Ross L, Gosling C, O’Meara P. A conceptual framework for the exploration of the relationship between systems of paramedicine and system performance. Australas Emerg Care 2022:S2588-994X(22)00083-5. [DOI: 10.1016/j.auec.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 03/08/2023]
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The Evolution of Clinician-Academics in Paramedicine: Completing the Picture of Professionalism. Prehosp Disaster Med 2022; 37:574-576. [PMID: 36059260 DOI: 10.1017/s1049023x22001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Paramedicine is an evolving and integral component of the health system, though the profession has historically relied on medicine and nursing to drive a research agenda. Now, with a well-established research presence, still lacking is the formalized role of the clinician-academic. In this opinion piece, the authors detail how paramedic clinician-academics can drive the profession forward, contribute to enhanced patient care, systems design, and staff well-being.
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Wilson C, Janes G, Williams J. Identity, positionality and reflexivity: relevance and application to research paramedics. Br Paramed J 2022; 7:43-49. [PMID: 36448000 PMCID: PMC9662153 DOI: 10.29045/14784726.2022.09.7.2.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
This article introduces the reader to the concepts of identity, positionality and reflexivity and outlines their relevance to research paramedics. We outline how a researcher's identity and positionality can influence all aspects of research, including the research question, study design, data collection and data analysis. We discuss that the 'insider' position of paramedics conducting research with other paramedics or within their specific clinical setting has considerable benefits to participant access, understanding of data and dissemination, while highlighting the difficulties of role duality and power dynamics. While positionality is concerned with the researcher clearly stating their assumptions relating to the research topic, the research design, context and process, as well as the research participants; reflexivity involves the researcher questioning their assumptions and finding strategies to address these. The researcher must reflect upon the way the research is carried out and explain to the reader how they moved through the research processes to reach certain conclusions, with the aim of producing a trustworthy and honest account of the research. Throughout this article, we provide examples of how these concepts have been considered and applied by a research paramedic while conducting their PhD research studies within a pre-hospital setting, to illustrate how they can be applied practically.
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Affiliation(s)
- Caitlin Wilson
- University of Leeds; North West Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-9854-4289
| | - Gillian Janes
- Manchester Metropolitan University ORCID iD: https://orcid.org/0000-0002-1609-5898
| | - Julia Williams
- South East Coast Ambulance Service NHS Foundation Trust; University of Hertfordshire ORCID iD: https://orcid.org/0000-0003-0796-5465
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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: 7] [Impact Index Per Article: 3.5] [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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22
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Out-of-hospital or pre-hospital: Is it time to reconsider the language used to describe and define paramedicine? Australas Emerg Care 2022; 25:177-178. [PMID: 35151617 DOI: 10.1016/j.auec.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/16/2022] [Accepted: 01/23/2022] [Indexed: 11/20/2022]
Abstract
The professionalisation of paramedicine in Australasia necessitates discussion about how the profession defines and describes itself in the literature and more broadly. This editorial discusses the descriptors pre-hospital care and out-of-hospital care, and the connotations, relevance and implications of their use to describe paramedic roles and practice.
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