Paramedicine最新文献

{"title":"A scoping review of out-of-hospital research in Ireland from 2000 to 2022","authors":"K. Bowles, Niamh M. Cummins, Michelle O’Toole, Shane Knox, Liam Hemingway, Julia Williams, Emilia Ozioma Uzoukwu, Brett Williams, A. Batt","doi":"10.1177/27536386241263359","DOIUrl":"https://doi.org/10.1177/27536386241263359","url":null,"abstract":"A key component to the continued development of any profession is a strong research culture. For paramedicine, a research culture that acknowledges the uniqueness of the out-of-hospital setting allows clinical practice to develop. Recent international publications investigating paramedicine research outputs demonstrated that Ireland was not strongly represented in the production of paramedicine-based research. The aim of this scoping review was to identify and evaluate the quantity and quality of the research published to date in the Irish out-of-hospital literature, and to identify research gaps that may need to be addressed. A scoping review was conducted using the Joanna Briggs Institute guidance. All studies that reported on out-of-hospital care in the Republic of Ireland were included. MEDLINE, CINAHL, EMBASE, Cochrane Library, and grey literature sources were searched from 2000 until 2022 for relevant articles in March 2023. Key authors were contacted to identify missing articles and data were extracted to present the final publication yield. Scientific quality was assessed using Clarivate Average Journal Impact Factor Percentiles. Over 3200 research outputs were identified from the databases with a final yield of 294 research outputs included in this review. Research outputs were identified for most years included in the review period, with outputs published in a large range of journals. Research heavily focused on areas linked to the Clinical Practice Guidelines, and predominantly used quantitative data collection methods. Most authors identified in this review were named on only one output. However, diversification in research topics and methodologies, a concerted effort to ensure practitioners are leading research and support to ensure that conference presentations are continued to peer-reviewed publication would strengthen this resolve.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"25 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141800826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic educational interventions for out-of-hospital domestic and intimate partner violence cases: A scoping review","authors":"Wesley Craig, Natalie Hartnady, Navindhra Naidoo, Lorna J Martin, Lillian Artz","doi":"10.1177/27536386241265416","DOIUrl":"https://doi.org/10.1177/27536386241265416","url":null,"abstract":"Domestic and intimate partner violence are significant causes of mortality and morbidity worldwide. The act is usually serial in nature and tends to amplify in severity if not intervened. The first interaction a victim-survivor has with the healthcare system may be through a paramedic. Paramedics are opportunely placed for early violence intervention. Previous research sought to assess the impact of domestic and intimate partner violence education on healthcare professionals, primarily with in-hospital staff, however, there has been relatively minimal inquiry concerning paramedic education and practice. This study aimed to investigate evidence regarding domestic and intimate partner violence educational interventions for pre- and in-service paramedics. Additionally, we describe the nature and extent of interprofessional training and the relevant practice guidelines/policies for paramedic responses. A scoping review, utilising an a priori piloted search strategy (Medline via PubMed, Scopus, and EBSCOhost), was used to identify literature published from 2002 related to paramedic domestic and intimate partner violence interventions. Academic literature including research produced by organizations outside of conventional academic publishing were searched. A total of 1713 records were identified, and 36 were included for descriptive analysis. Major topic domains identified included teaching content and methods, professionalising best practices for public protection, intersectionality calls for interprofessional training, and the impact of educational interventions. With reports increasingly highlighting the potential role of the paramedic response to violence, there is a paucity of studies related to its improvement. Reported teaching strategies across multiple settings have some consistency. Though interventions may improve behaviour and actual/perceived knowledge and competence, there is no evidence suggesting an impact on victim-survivor experiences and outcomes. Interprofessional collaborations between out-of-hospital services, police, social workers, and in-hospital staff may be useful but remains underreported/underutilised. Future research should focus on domestic and intimate partner violence victim-survivor stakeholder engagement and intervention implementation.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"16 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141801544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of patient sex on pain management practices in Paramedicine: A rapid review","authors":"Sooaad Dahoud, Paul Simpson, Navindhra Naidoo","doi":"10.1177/27536386241240286","DOIUrl":"https://doi.org/10.1177/27536386241240286","url":null,"abstract":"Objective: Pain is a subjective multidimensional experience that impacts an individual's physical, emotional, and mental wellbeing. Paramedics are regularly contacted to alleviate pain, in both an emergency and non-emergency capacity. Patient presentation, assessment tools, and clinical judgement, together influence paramedic decision making, and therefore pain management practices will inevitably vary. This research aimed to identify the nature and description of sex-specific discrepancies in the literature in relation to paramedic pain management. Methods: Using the Cochrane rapid review methodology, a search of five electronic databases and nine paramedic-specific journals was conducted on 8 November 2023. Articles were included if they: investigated ambulance presentations of pain; analysed pharmacological analgesic management; compared management between the sexes; and reported on either medication type, dosage, time to administration, or pain score. Eligible articles were assessed for risk of bias and subjected to narrative synthesis. Results: A total of 2545 articles were identified during the systematic search, resulting in 13 studies eligible for inclusion. Seven studies indicated a sex disparity in the administration of analgesia after controlling for confounders, with females statistically less likely to receive analgesia, particularly opioids, compared to males. Five studies found that sex had no effect on analgesic administration. One study noted female paramedics provided better analgesia overall, while two studies found paramedic sex had no influence on analgesic decisions. Five studies indicated that the higher the pain score, the greater the likelihood of analgesic administration, with three studies highlighting that the analgesia provided was effective in reducing pain score. Conclusions: While some studies identified no sex-specific differences in relation to paramedic pain management, a greater number of studies indicated a gender-disparity, where females were found to have higher risk of oligo-analgesia. Ideal pain management practices were demonstrated in the literature, with higher pain scores correlating to increased rates of analgesia.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"312 9","pages":"168 - 180"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study on the relationship between leadership and clinical skills in paramedicine and the promotion of patient safety","authors":"Adrian Lockhart, Tony Walker, K. Bowles","doi":"10.1177/27536386241259739","DOIUrl":"https://doi.org/10.1177/27536386241259739","url":null,"abstract":"This study aims to investigate and describe the relationship between acquired leadership capability and clinical performance in the out-of-hospital environment (OOH) and to identify and explore those key themes that might influence a relationship between paramedic leadership aptitude and patient safety. This study employed a qualitative descriptive design using a combination of purposive and convenience sampling. Data collection occurred via semi-structured interviews conducted over teleconference. Qualitative thematic analysis was chosen with an inductive orientation, semantic focus of meaning, and experiential framework taken to coding and theme generation. This methodology facilitated the discovery and analysis of the participant's personal experiences with the interconnectedness of leadership and clinical skills and the associated implications to patient safety. Data was collected from seven registered paramedics, all of whom were working for public sector ambulance services as specialist, advanced care paramedics. Five primary themes emerged: (1) discovery of human factors, (2) knowledge growth is formal and informal, (3) working smarter, (4) leadership expectations and usefulness and (5) transparency of errors. These themes underpin the importance of, and provide constructive insights into, the relationship between leadership and clinical skills in paramedicine and the impact on patient safety. This research has identified that those non-technical skills (NTS) including that of leadership employed in paramedicine are inextricably linked and of equal importance to those technical clinical skills The assessment of a paramedic's NTS against a required standard in a similar way to a technical skill, is important when considering practice competency policies moving forward.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"40 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging collaboration to enhance quality in paramedicine research","authors":"Paul Simpson","doi":"10.1177/27536386241258040","DOIUrl":"https://doi.org/10.1177/27536386241258040","url":null,"abstract":"","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"57 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141108479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of patient sex on paramedic administration of analgesia for acute abdominal pain in an Australian ambulance service","authors":"Sooaad Dahoud, Paul Simpson, Navindhra Naidoo","doi":"10.1177/27536386241253145","DOIUrl":"https://doi.org/10.1177/27536386241253145","url":null,"abstract":"Objective: Pain is a subjective experience that encapsulates a physical, emotional, and mental response. An individual's sex is a factor that may influence how pain is experienced. It can be assumed that if females and males present with pain differently, then pain management may also differ. This research aimed to determine the influence of patients’ sex on paramedic administration of analgesia in cases of acute abdominal pain. Methods: A retrospective analytical cohort study included patients between the ages of 16 and 65 with a complaint of abdominal pain who were seen by paramedics employed by a jurisdictional ambulance service between July 2019 and June 2020. The data extracted included sex, age, pain score, type of analgesia administered, and analgesia dosage. The data were analysed using descriptive statistics, chi-square tests, and univariate and multivariate logistic regression. Results: The study sample comprised of 26,417 patients with 61.6% (n  =  16,271) females. Analgesia was administered to 65.9% (n  =  17,404) of patients, of whom 38.5% (n  =  10,177) received an opioid, with the most administered analgesia being morphine (n  =  8456; 32%). Chi-square testing identified significant associations between sex and analgesic administration (χ2(1, n  =  26,417)  =  7.32, p  =  .01, Φ = −0.02) and opioid administration (χ2(1, n  =  26,417)  =  25.51, p < .001, Φ = 0.03). Multivariate regression identified that sex had no influence on analgesic administration in general, however found that male sex was a statistically significant predictor of opioid administration. Adjusted for age and pain severity, females were at lower odds of opioid administration than males (adjusted odds ratio 0.86; 95% confidence interval 0.80–0.91; p < .001). Conclusions: Equity in pain management was demonstrated in relation to overall analgesic administration between the sexes. However, this research suggests that while females presented more commonly with abdominal pain, females had lower odds of being administered an opioid than their male counterparts. Further research is required on gender bias in relation to abdominal pain management practices by paramedics, to promote equitable access to analgesia.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"131 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141114920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedicine research with family and bystanders: A methodological review","authors":"Eillish Satchell, N. Anderson, Merryn Gott","doi":"10.1177/27536386241255387","DOIUrl":"https://doi.org/10.1177/27536386241255387","url":null,"abstract":"The evolving nature of paramedic care has resulted in a growing body of evidence considering service user experience, including the experiences of patients, family members and bystanders. As new areas of research enquiry emerge in paramedicine, it is important to review the methods, methodologies, and quality of evidence in these topic areas. A methodological review was conducted of peer-reviewed empirical studies reporting on family and bystander experiences where emergency ambulance services responded. Descriptive statistics were calculated to describe select study characteristics. Study quality was appraised using the Johanna Briggs Institute Checklist for Qualitative Research and the Mixed Method Appraisal Tool. Service user engagement was evaluated using a newly adapted tool, the Service User Engagement Ladder. After searching five databases, 37 studies of varying research designs were included in this review. While overall study quality was high, there was a notable absence of theoretical discussion, particularly regarding qualitative methodologies. In assessing service user engagement, family and bystanders had very low levels of engagement in the research process. Only one study in this review utilised methods where co-construction of research occurred. Current research is dominated by Western study locations and biomedical paradigms that privilege Westernised populations and ways of considering experience, ignoring the preferences and experiences of Indigenous people and people from minoritised ethnic groups. To further develop paramedicine research involving family and bystanders, transparent reporting around the theoretical underpinnings of research must be strengthened. There is a significant opportunity to increase service user engagement in the research process. Greater attention to cultural and ethnic diversity is needed in researching family and bystander experiences.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"31 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141120738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring undergraduate paramedic students’ understanding and experiences of person-centred care while on practice placement","authors":"Lorraine McAteer, Donna Brown","doi":"10.1177/27536386241251499","DOIUrl":"https://doi.org/10.1177/27536386241251499","url":null,"abstract":"To explore paramedic students’ understanding and experience of the perceived facilitators and barriers to implementing person-centred care in urgent and emergency practice-based placement situations. To explore paramedic students’ understanding of this concept and how it may be applied to clinical practice. A non-probability convenience sample of participants was drawn from a second-year undergraduate Bachelor of Science (Hons) programme in Paramedic Science, at a United Kingdom university. The programme was underpinned by the Person-centred Practice Framework. Undergraduate paramedic students participated in face-to-face, audio-recorded, semi-structured interviews. A qualitative reflexive thematic analysis was then conducted to identify themes arising from the data. Ten participants were interviewed. Four key themes emerged from the data: (1) realising person-centred prerequisites which have two sub-themes – curriculum and reality of practice, (2) challenge of high-acuity calls, (3) developing a rapport with vulnerable people and, (4) factors in the macro environment. Paramedic students witnessed moments of person-centred practice and were enabled to reflect on their learning experiences in positive ways, by working with paramedics/practice educators. However, their person-centred ideals were constantly challenged as students negotiated to work in complex, dynamic situations and in a health system under pressure.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"82 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an understanding of the embedded nature of everyday ethical reasoning in paramedic education and practice","authors":"Iain Campbell, Lawrence Hill, Joe Copson","doi":"10.1177/27536386241252856","DOIUrl":"https://doi.org/10.1177/27536386241252856","url":null,"abstract":"Paramedicine is increasingly complex in affective, behavioural, and cognitive domains of practice. The ability to navigate this complexity is essential for paramedics who are required to simultaneously practice assertively, dynamically, sensitively, and professionally. Although these may seem to be superficially incongruent ways of practising, through insightful and reflexive practice underpinned by appropriate ethical approaches, paramedics can navigate the complexity inherent in paramedic work whether care episodes are routine or extreme. In what follows, we discuss the potential of virtue ethics as a way of navigating complexity in paramedic practice and preparing clinicians for the varied work they manage as paramedics. We do this by first describing some of the issues faced by the modern paramedic, outlining ethical approaches to practice, then working through a vignette showing how a deeper understanding of ethics and utilising a virtue ethics approach may have helped the clinicians navigate a typical ethical dilemma found in practice.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"17 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Anglosphere comparison of paramedicine regulatory frameworks and the influence on curricula: A descriptive comparative review","authors":"Anthony Weber, Scott Devenish, Louisa Lam","doi":"10.1177/27536386241249177","DOIUrl":"https://doi.org/10.1177/27536386241249177","url":null,"abstract":"Paramedicine is a constantly evolving field, with paramedic education programmes needing to be adaptable to keep up with changes in the scope of practice. Regulatory frameworks are crucial in guiding university programmes, providing students with the knowledge, skills, and professional attributes necessary to be safe and competent practitioners. This study aimed to identify variations in regulatory structures, the factors that influence those variations, and how they influence curricula. A descriptive-comparative approach was taken to examine paramedic accreditation processes, curricula, and syllabi across five countries using a modified Brady's model and extending the Comparative Education model. The findings suggest that paramedic services, regulatory authorities, and tertiary institutions must adopt a multilateral approach to recognise paramedicine's evolving scope of practice. All three stakeholders are responsible for aligning regulatory frameworks with industry needs and providing curricula guidance to tertiary institutions. This approach will enable paramedic education programmes to remain relevant and adaptable to changes in the field, ensuring that graduates are safe and competent practitioners. In conclusion, this study highlights the need for a collaborative effort between paramedic services, regulatory authorities, and tertiary institutions to recognise paramedicine's evolving scope of practice. The need for recognition of this evolution in both regulatory frameworks and curricula is a significant concern, and a multilateral approach is required to address this issue. This study provides valuable insights into the factors that influence variations in regulatory structures and their influence on curricula.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"342 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}