DOCSLIB.ORG

Predictors and Impacts on Paramedic Clinical Decision Making, Attitudes and Behaviours

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Predictors and Impacts on Paramedic Clinical Decision Making, Attitudes and Behaviours Predictors and impacts on paramedic clinical decision making, attitudes and behaviours Alexander Cardenas A thesis in fulfilment of the requirements for the degree of Doctor of Philosophy School of Public Health and Community Medicine Faculty of Medicine March 2017 THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: Cardenas First name: Alexander Other name/s: Daniel Abbreviation for degree as given in the University calendar: PhD School: School of Public Health and Faculty: Medicine Community Medicine Title: Predictors and impacts on paramedic clinical decision making, attitudes and behaviours. Abstract Paramedicine has transitioned rapidly from a trade to a modern, autonomous largely unsupervised health profession. The speed and extent of this development has resulted in its clinical governance, procedures and accreditation being largely untested, leading to a situation with immediate potential implications for patient care. This mixed methods study began with an examination of the evolution of paramedicine within the context of current best practice training and management of sudden cardiac arrest (SCA). It then utilised the findings to inform the design and testing of two new online platforms to assess and improve paramedic decision making in SCA. The first platform developed was the Online Cardiac Arrest Simulator (OCAS), which included both instructional videos and a simulated SCA. The second platform, the Online Clinical Decision Platform (OCDP), was then designed based on the results and recommendations of OCAS. All educational materials and platforms were designed by the PhD candidate and included point of view filming, realistic location shoots, high- fidelity simulation and clinically accurate scenarios; and were accessible by multiple media devices. The decisions made by participants were then analysed to examine if a paramedic’s age, gender, educational attainment, geographical posting or tenure had an impact on their clinical decisions. More than 1,200 paramedics across an ambulance service in Australia participated in this project. OCDP revealed significant variance in the management of SCA by paramedics of difference backgrounds and qualifications. Age was found to be a key predictor for paramedic compliance with best practice guidelines, with increased age associated with poorer compliance. Gender and geographical posting were also found correlate with certain paramedic attitudes, preferences and behaviours towards SCA education and management. The findings of these trials illustrate the opportunity to improve paramedic decision making through new clinical decision tools and clinical governance initiatives. The findings also demonstrate the potential of online simulation to assess and improve paramedic clinical decision making. This demonstrated effectiveness as well as paramedic support for these methods, supports their future use in educational programs to train and assess paramedics on SCA treatment protocols and procedures. Page ii of 417 Dedication This thesis is dedicated to my wife Dr Cassandra Brown. Only though her endless love, support and patience, has this been possible. Page iii of 417 Acknowledgements The thesis is completed with the support of NSW Ambulance in partnership with the University of NSW. NSW ambulance has supported the study through procurement of equipment, access to facilities, provision of study leave, and approval for over 1,200 staff to participate at various stages of this study. The commitment of NSW Ambulance to its staff, the development of knowledge in the field of paramedicine, and the use of evidence based decision making, is commendable and greatly appreciated by the researcher. The researcher also thanks the Council of Ambulance Authorities who in 2016 awarded the study second place for Excellence in Research and Education across Australia and New Zealand. Finally, the researcher would like to thank his Co-Supervisors Professor Joanne Travaglia and Professor Riana MacIntyre for their guidance, mentorship and support, throughout the candidature. Their passion and commitment to both paramedicine and the delivery of exceptional patient care continues to be an inspiration. The thesis has been professionally edited by Elite Editing, with editorial intervention restricted to Standards D and E of the Australian Standards for Editing Practice. Page iv of 417 Statement of Original Authorship Page v of 417 Copyright Statement Page vi of 417 Authenticity Statement Page vii of 417 Table of Contents Dedication ............................................................................................................... iii Acknowledgements ................................................................................................. iv Statement of Original Authorship ............................................................................. v Copyright Statement ................................................................................................ vi Authenticity Statement .......................................................................................... vii Table of Contents .................................................................................................. viii List of Figures ......................................................................................................... xv List of Tables .......................................................................................................... xix List of Abbreviations ............................................................................................... xx Glossary ............................................................................................................... xxii Chapter 1: Introduction .......................................................................................... 23 1.1 Context .................................................................................................................. 23 1.1.1 Evolution of Paramedicine ............................................................................. 23 1.1.2 Paramedicine as a Unique Profession Requiring Research ........................... 24 1.1.3 Variance in Paramedic Governance Standards and Potential Implications for Patient Care .............................................................................................. 25 1.1.4 Unknown Nature of Effectiveness of Paramedic Clinical Decision Making ... 26 1.1.5 Impact of Paramedic Clinical Decision Making on the Management of Sudden Cardiac Arrest as a Case Study ......................................................... 27 1.2 Problem Statement ............................................................................................... 27 1.3 Aim and Significance of the Study ......................................................................... 28 1.3.1 Aim ................................................................................................................. 28 1.3.2 Significance of the Study ................................................................................ 29 1.4 Overview of the Study ........................................................................................... 31 1.5 Research Questions and Aims ............................................................................... 32 1.5.1 Research Questions ........................................................................................ 32 1.5.2 Research Study Aims ...................................................................................... 33 1.6 Conclusion ............................................................................................................. 34 1.7 References ............................................................................................................. 35 Chapter 2: Situating the Study ................................................................................ 41 2.1 Introduction .......................................................................................................... 42 2.2 The Emergence of Paramedicine .......................................................................... 42 2.2.1 Ambulance Drives and Stretcher Bearers ...................................................... 43 2.2.2 Transition from Ambulance Driver to Ambulance Officer ............................. 43 2.2.3 Transition from Ambulance Officer to Paramedic ......................................... 44 2.2.4 Have Modern Paramedics Achieved Professional Status? ............................ 46 2.3 Role of a Paramedic .............................................................................................. 47 2.3.1 Paramedic Duties across Settings .................................................................. 47 2.3.2 Paramedic Acute Care Practice ...................................................................... 49 2.3.3 Paramedical Subacute Care ........................................................................... 50 Page viii of 417 2.3.4 Ambulance Special Operations and Retrieval Services .................................. 51 2.3.5 The Unique Culture and Organisational Context of Paramedicine................ 51 2.4 Paramedic Education ............................................................................................ 53 2.4.1 Paramedic Education in the United States of America .................................. 53 2.4.2 Paramedic Education in Australian Statutory Ambulance Services ............... 54 2.4.3 Paramedic Education in
Load more

Recommended publications
  • National Fire Protection Association Technical Committee On
    National Fire Protection Association Technical Committee on Emergency Medical Services National Stakeholders Meeting on Mobile Integrated Healthcare and Community Paramedicine Report National Fire Protection Association 1 Batterymarch Park, Quincy, Massachusetts 02169-9101 Telephone (617) 770-3000 ∙ Fax (617) 770-0700 ∙ www.nfpa.org Report on the NFPA Technical Committee on Emergency Medical Services National Stakeholder Meeting on Mobile Integrated Healthcare and Community Paramedicine April 2 & 3, 2014 MGM Grand Hotel Las Vegas, NV Background The NFPA Technical Committee on Emergency Medical Services (EMS-AAA) convened a national emergency medical services (EMS) stakeholders meeting to discuss the subject of Mobile Integrated Healthcare/Community Paramedicine (MIH/CP). Previously, the EMS Technical Committee had reviewed a new project request for a MIH/CP document, though that request was later administratively withdrawn. The entire EMS Technical Committee worked to develop that new project request which was submitted individually by Dr. David Tan, representing the National Association of EMS Physicians (NAEMSP) in late 2011. Since submittal of the proposal by Dr. Tan there 1 have been many changes to the delivery of healthcare, including the delivery of EMS. These reforms compelled the EMS Technical Committee to organize a meeting for stakeholders to garner input from a broad group of healthcare professionals and to discuss the possibility for a new request on MIH/CP. The meeting afforded the opportunity to not only learn the opinions of prominent national EMS and healthcare professionals, but also to discuss how the NFPA could assist the community of actors involved in MIH/CP. History The concept of MIH/CP has existed for quite some time, but more prevalent in other countries around the world than in the U.S.
    [Show full text]
  • Ambulance Service 2020
    Ambulance Service 2030: The Future of Paramedics Andy Newton Submitted to the University of Hertfordshire in partial fulfilment of the requirements of the degree of PhD November 2013 ________________________________________ Abstract ________________________________________ Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more i within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients.
    [Show full text]
  • 1 ORIGINAL RESEARCH the Exploration of Physical Fatigue
    Journal of Emergency Primary Health Care (JEPHC), Vol. 9, Issue 1, 2011 - Article 990435 ISSN 1447-4999 ORIGINAL RESEARCH The exploration of physical fatigue, sleep and depression in paramedics: a pilot study Sarah Sofianopoulos* Brett Williams* Professor Frank Archer* A/Professor Bruce Thompson** *Department of Community Emergency Health and Paramedic Practice Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Australia **Department of Allergy, Immunology and Respiratory Medicine The Alfred Hospital, Melbourne, Australia Abstract Ambulance paramedics are members of a discipline that forms a unique part of the emergency services. As pre-hospital providers they are constantly and increasing faced with heavy workloads that are physically, mentally and emotionally tiring. Fatigue and sleep disturbance are factors which can compromise the effectiveness of these workers, and as a result not only hamper patient safety but can have detrimental consequences on the paramedics‟ health and overall well-being. The objective of this study was to investigate the impact shift work on physical fatigue, sleep and psychological factors among paramedics in Australia. Methods A convenience sample of paramedics was asked to complete a number of self-reporting standardised questionnaires: The Epworth Sleepiness Scale (ESS) (8-items), Berlin Questionnaire (BQ) (10-items), Pittsburgh Sleep Quality Index (PSQI) (19-items) and the Beck Depression Inventory (BDI) (21-items). Ethics approval was granted. Results The study recruited 60 participants, the majority of which were male 77% (n=46), > 45 years of age 31% (n=19), and having worked shift work between 5-10 years 35% (n=21). Nine out of ten (92%, n=55) of paramedics reported having experienced fatigue in the last 6 months, with 88% (n=53) believing it had affected their performance at work.
    [Show full text]
  • Medecins Sans Frontieres Australia 2017 Highlights
    Médecins Sans Frontières Australia ANNUAL REPORT 2017 OUR CHARTER Médecins Sans Frontières is a private international association. The association is made up mainly of doctors and health sector workers and is also open to all other professions which might help in achieving its aims. All of its members agree to honour the following principals: Médecins Sans Frontières offers assistance to Médecins Sans Frontières volunteers undertake populations in distress, to victims of natural or to respect their professional code of ethics and to man-made disasters and to victims of armed maintain complete independence from all political, conflict, without discrimination and irrespective economic or religious powers. of race, religion, creed or political affiliation. As volunteers, members are aware of the risks and Médecins Sans Frontières observes neutrality and the dangers of the mission they undertake, and impartiality in the name of universal medical have no right to compensation for themselves or ethics and the right to humanitarian assistance their beneficiaries other than that which Médecins and demands full and unhindered freedom in the Sans Frontières is able to afford them. exercise of its functions. CONTENTS 3. Médecins Sans Frontières charter 4. Message from the President 6. 2017: Our Year in Review 8. Australian and New Zealand field staff 10. Message from the Medical Unit 12. Médecins Sans Frontières Australia 2017 highlights 14. Médecins Sans Frontières projects funded by Australian and New Zealand donors 56. Financial report Front cover: Australian doctor Roslyn Brooks assesses a young patient in Lankien, South Sudan, October 2017. © Kati Romics Left: Dr Andrew Dimitri (R) from Australia cares for a baby with pneumonia in Qayyarah hospital, Iraq.
    [Show full text]
  • Understanding the Role of the Paramedic in Primary Care: a Realist
    Eaton et al. BMC Medicine (2021) 19:145 https://doi.org/10.1186/s12916-021-02019-z RESEARCH ARTICLE Open Access Understanding the role of the paramedic in primary care: a realist review Georgette Eaton1* , Geoff Wong1, Stephanie Tierney1, Nia Roberts2, Veronika Williams3 and Kamal R. Mahtani1 Abstract Background: Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review. Methods: A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas—countries within which the paramedic role within primary care is well established. Results: Our searches resulted in 205 included documents, from which data were extracted to produce context- mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision.
    [Show full text]
  • Community Paramedicine
    The National EMS Advisory Council Final Advisory on Community Paramedicine Adopted on December 4, 2014 Adopted on December 4, 2014 1 The National EMS Advisory Council Table of Contents Background ...............................................................................................................................................................................4 The Patient Protection and Affordable Care Act ..................................................................................................... 4 Intended and Direct Consequences ......................................................................................................................... 4 Unintended and Indirect Consequences .............................................................................................................. 5 Unknown Consequences ............................................................................................................................................. 8 Problem Statement ...............................................................................................................................................................9 Resources and References ............................................................................................................................................ 10 Crosswalk with Other Standards Documents or Recommendations ..................................................... 11 Analysis ...................................................................................................................................................................................
    [Show full text]
  • Fluency and Confidence Predict Paramedic Diagnostic Intuition: an Experimental Study of Applied Dual-Process Theory
    Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory Toby Keene https://orcid.org/0000-0002-6030-5151 The Australian National University Kristen Pammer https://orcid.org/0000-0002-3183-5268 University of Newcastle Bill Lord https://orcid.org/0000-0001-8821-5353 Monash University Carol Shipp https://orcid.org/0000-0002-7586-3762 Australian Capital Territory Ambulance Service Author Note This research is supported by an Australian Government Research Training Program Scholarship. Correspondence concerning this article should be addressed to Toby Keene, Research School of Psychology, The Australian National University, Acton, ACT, Australia, 2600. Contact: [email protected] 1 Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory Abstract Introduction. Paramedics care for the sick and injured in a variety of settings and have been observed to form an impression of their patient prior to meeting them based on limited information. We report an experiment using Australian paramedics (n=64) and Australian paramedicine undergraduates (n=44), which considered the processes underlying the formation of an intuitive diagnostic impression. Previous research has signalled roles for objective likelihood of the disease, subjective typicality of the disease, and the ease with which the impression comes to mind (answer fluency) as important in impression formation. Method. Participants completed four brief written clinical vignettes under time pressure and with a concurrent navigation task to simulate conditions faced by paramedics prior to meeting a patient. The vignettes varied the objective likelihood of a diagnosis of Acute Coronary Syndrome (ACS), a condition often encountered by paramedics characterised by ambiguity and a need for accuracy.
    [Show full text]
  • Professionalism and Professionalisation in the Discipline of Paramedicine
    University of Wollongong Research Online Faculty of Science, Medicine and Health - Papers: Part B Faculty of Science, Medicine and Health 2019 Professionalism and professionalisation in the discipline of paramedicine Buck Reed University of Wollongong Leanne S. Cowin Universty of Western Sydney Peter O'Meara Monash University Ian G. Wilson University of Wollongong, [email protected] Follow this and additional works at: https://ro.uow.edu.au/smhpapers1 Publication Details Citation Reed, B., Cowin, L. S., O'Meara, P., & Wilson, I. G. (2019). Professionalism and professionalisation in the discipline of paramedicine. Faculty of Science, Medicine and Health - Papers: Part B. Retrieved from https://ro.uow.edu.au/smhpapers1/1067 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Professionalism and professionalisation in the discipline of paramedicine Abstract Background Professionalisation was cited as one of the key drivers for the recent addition of paramedics to the National Registration and Accreditation Scheme (NRAS) making paramedics the fifteenth health profession in the NRAS. Self-regulation inherently shifts the basis of establishing professional identity and the formal authority for determining professional standards. This has increased discussion of professionalism in paramedicine, however, professionalisation and professionalism are often poorly defined concepts wita myriad of interpretations. Method A scoping review was conducted to determine the available literature about professionalism and professionalisation in paramedicine. The review utilised 10 academic databases augmented with Google and Google Scholar to capture grey literature; 2740 results were refined ot 53 sources for review. Results Several works on paramedic professionalisation explore elements such as autonomy and occupational characteristics.
    [Show full text]
  • Pre- and Post-Home Visit Behaviors Using an After- Hours House Call (AHHC) Medical Services: a Questionnaire-Based Survey in Tokyo, Japan
    Pre- and Post-home Visit Behaviors using an after- hours House Call (AHHC) Medical Services: A Questionnaire-based Survey in Tokyo, Japan Ryota INOKUCHI ( [email protected] ) University of Tsukuba Kojiro MORITA University of Tsukuba Xueying JIN University of Tsukuba Masatoshi ISHIKAWA University of Tsukuba Nanako TAMIYA University of Tsukuba Research Article Keywords: After-hours primary care, Quality, Triage, Severity, AHHC, out-of-hour service, out-of-hours services, OOH, emergency department, ED Posted Date: March 1st, 2021 DOI: https://doi.org/10.21203/rs.3.rs-253637/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Background: To reduce the burden caused by emergency department (ED) visits and ambulance use, after-hours house call (AHHC) medical services have been implemented. Examining the pre-and post-home visit behaviors of those who use AHHC medical services, stratied by age and illness severity, may help determine the populations these services should target effectively to reduce ED visits and ambulance use. Methods: This questionnaire-based study used data from anonymized medical records and internet-based questionnaires completed by patients who used AHHC medical services in Tokyo, Japan, between January 1 and December 31, 2019. The questionnaire consisted of two questions: what action would the patient have taken in the absence of AHHC services, and what action was taken within three days following the use of the AHHC services. Results: Of the 15,787 patients who used AHHC medical services during the study period, 2,128 completed the questionnaire (13.5% response rate).
    [Show full text]
  • The Establishment of a National Registration System for Australian
    The Senate Legal and Constitutional Affairs References Committee Establishment of a national registration system for Australian paramedics to improve and ensure patient and community safety May 2016 Commonwealth of Australia 2016 ISBN 978-1-76010-422-1 This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Australia License. The details of this licence are available on the Creative Commons website: http://creativecommons.org/licenses/by-nc-nd/3.0/au/. This document was produced by the Senate Legal and Constitutional Affairs Committee secretariat and printed by the Senate Printing Unit, Department of the Senate, Parliament House, Canberra. ii Members of the committee Members Senator Glenn Lazarus (GLT, QLD) (Chair) Senator the Hon Ian Macdonald (LP, QLD) (Deputy Chair) Senator Catryna Bilyk (ALP, TAS) Senator Jacinta Collins (ALP, VIC) Senator the Hon Joe Ludwig (ALP, QLD) Senator Linda Reynolds (LP, WA) until 12.10.2015 Senator Dean Smith (LP, WA) from 12.10.2015 Substitute Member Senator Nova Peris (ALP, NT) substitute for Senator the Hon Joe Ludwig (ALP, QLD) on 20.04.2016 Participating Member Senator Sam Dastyari (ALP, NSW) Secretariat Ms Sophie Dunstone, Committee Secretary Dr Marcus Smith, Principal Research Officer Ms Jo-Anne Holmes, Administrative Officer Suite S1.61 Telephone: (02) 6277 3560 Parliament House Fax: (02) 6277 5794 CANBERRA ACT 2600 Email: [email protected] iii iv Table of contents Members of the committee ..............................................................................
    [Show full text]
  • The Role of Law in the Professionalisation of Paramedicine
    The Role of Law in the Professionalisation of Paramedicine in Australia Ruth Townsend LLB LLM A thesis submitted for the degree of Doctor of Philosophy of The Australian National University © Copyright by Ruth Townsend December 2017 All Rights Reserved ii Statement of Originality I certify that the thesis entitled, ‘The Role of the Law in the Professionalisation of Paramedicine in Australia,’ submitted for the degree of Doctor of Philosophy at the Australian National University is my own original work. Where reference is made to the work of others, due acknowledgement is given. I also certify that the material in this thesis has not previously been submitted for a degree or diploma at any university. Name: Ruth Townsend Signature: Date: December 2017 iii Acknowledgements I would not have been able to even think about undertaking this project if it wasn’t for the encouragement and support of some very special people. Thank you to my mum for giving me the gift of reading that has led to a lifelong love of learning, fostered my creativity and imagination, and allowed me to feel a sense of success and self-confidence in my abilities. Thanks dad for instilling in my a sense of social justice that has sparked a passion to try and make the world a better place even if it is in just a very small way. Thank you to my supervisors, Professor Tom Faunce, Associate Professor Michael Eburn, with whom I have worked closely on paramedic law matters for many years, and panel member Dr Dominique Dalla Pozza who have all offered me enormous support and shared their very limited and precious time, and great wisdom and intelligence with me so generously.
    [Show full text]
  • Mental Health and Paramedics
    mental health and paramedics Submission For Senate Inquiry into the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers June 2018 "At the root of this dilemma is the way we view mental health in this country. When it comes to mental health conditions, we often treat them differently from other diseases like cancer, diabetes or asthma. And that makes no sense. Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction." Michelle Obama Former First Lady of the USA ‘Change Direction’ Mental Health Summit, Newseum, Washington, 4 March 2015 1 1 Office of the First Lady, The White House, Remarks by The First lady at "Change Direction" Mental Health Event, Washington D.C., 4 March 2015 https://bit.ly/2pJBdTg accessed 01/06/2018 Senate Inquiry into Mental Health June 2018 - Bange Page 2 of 50 Table of Contents Page EXECUTIVE SUMMARY ..................................................................................................... 4 BACKGROUND ................................................................................................................. 5 THE WORK OF PARAMEDICS ............................................................................................ 6 THE EXTENT AND PROBABLE CAUSES OF PARAMEDIC DISTRESS ...................................... 8 THE CENTRAL IMPORTANCE OF ORGANISATIONAL CULTURE ........................................ 12 PROVIDER OVERSIGHT AND ACCREDITATION ...............................................................
    [Show full text]