Australasian Journal of Paramedicine最新文献

{"title":"Resilience, posttraumatic growth and psychological wellbeing of paramedicine clinicians: An integrative review","authors":"Benjamin Coyte, Vasiliki Betihavas, Scott Devenish, Kim Foster","doi":"10.1177/27536386231206501","DOIUrl":"https://doi.org/10.1177/27536386231206501","url":null,"abstract":"Clinicians in paramedicine are exposed to stressful events at work that have potential to cause negative psychological outcomes. Posttraumatic growth (PTG), resilience and psychological wellbeing, however, are adaptive psychological states that can also occur following trauma and adversity. Synthesis of knowledge on these positive outcomes can provide insight into resources needed to support paramedicine clinicians. To examine and synthesise what is known of PTG, resilience and psychological wellbeing of paramedicine clinicians, including the experience of these phenomena and relationship between them. An integrative review of peer-reviewed empirical literature published in English from 2013 to 2022 was conducted, following Whittemore and Knafl’s method. CINAHL Complete, MEDLINE Complete, PsycINFO, Scopus and Embase databases were searched. Included articles were quality appraised, with data analysed using the constant comparison method. Thirteen articles were included, with results synthesised into four categories. Mean PTG scores were reportedly moderate, and resilience ranged from average to above average. PTG and resilience had positive and negative relationships with specific coping strategies including dysfunctional coping, active coping, planning, venting emotions, social and emotional support and mental and behavioural disengagement. PTG scores were significantly lower for clinicians with longer shift duration and paramedics compared to emergency medical technicians. Resilience scores were higher for clinicians working part-time. Wellbeing was reportedly moderate and associated with the psychosocial climate established by managers. Qualitative findings indicated that workplace culture was perceived as stoic and masculine, which served to undermine staff resilience and willingness to disclose emotions. To support PTG and resilience, organisations should work to reduce stressors in workplace culture, including management and clinical supervision style, and offer employment flexibility. Organisations can upskill clinicians’ capacity for positive adaptation to adversity with professional development targeting identified coping strategies. Future research could examine clinicians’ experiences of PTG, resilience and wellbeing, and the relationship between them.","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136032711","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":"Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – a systematic review","authors":"Maddison Jayne Poynter, Ashley Farrugia, Elisabeth Kelly, Paul M Simpson","doi":"10.1177/27536386231207055","DOIUrl":"https://doi.org/10.1177/27536386231207055","url":null,"abstract":"Sepsis is an increasingly common presentation to which ambulance resources are dispatched. Whilst early administration of antibiotics (AB) has been associated with improved outcomes, the impact of prehospital administration in an ambulance service context appears uncertain. This systematic review aimed to compare the effect of prehospital administration of antibiotics together with usual care (oxygen and intravenous fluids), to usual care alone, on mortality for patients with sepsis. A systematic review was conducted adherent to JBI methodology. Studies were eligible for inclusion if they were published after 2000; conducted in the prehospital setting; compared AB plus usual care to usual care alone in the prehospital phase; and reported an outcome of mortality at any time point. Systematic searches of Medline, CINAHL, EMBASE and Google Scholar were conducted, with included articles subjected to quality assessment using JBI appraisal tools. Each stage was completed by two authors, with a third engaged to resolve conflicts. A narrative synthesis was conducted and reported, and certainty of evidence was assessed. Of 587 studies identified from the searches, five satisfied the inclusion criteria and were included in the data synthesis. Two were randomized controlled trials, and three used observational comparative designs assessed as being at low-to-moderate risk of bias. Regarding the primary outcome of mortality, there was no evidence from high-quality studies with a low risk of bias that prehospital administration of ABs decreased mortality when measured at 28, 30 or 90 days. Regarding secondary outcomes, there was no evidence from high-quality studies with a low risk of bias that prehospital ABs reduce the length of stay in the hospital generally or the intensive care unit. The certainty of findings was low for mortality at 90 days, and very low for measurement at 28 and 30 days. There was insufficient evidence from high-quality studies with a low risk of bias indicating prehospital administration of ABs in addition to usual care, compared to usual care alone, reduces mortality at 28, 30 or 90 days, or length of stay in hospital or ICU, for adult patients with sepsis. There is insufficient evidence to enable the recommendation of routine administration of antibiotics to patients with sepsis presenting to ambulance service clinicians in the prehospital setting. Investigation of administration to more severe sepsis presentations in settings where prolonged prehospital intervals are inherent is warranted.","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136209261","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":"Corrigendum to “Barriers and enablers to paramedicine research in Australasia – A cross-sectional survey.”","authors":"","doi":"10.1177/27536386231205067","DOIUrl":"https://doi.org/10.1177/27536386231205067","url":null,"abstract":"","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135482568","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":"Corrigendum to “Rates of general practitioner attendance following paramedic-to-general practitioner referral in Victoria, Australia.”","authors":"","doi":"10.1177/27536386231205068","DOIUrl":"https://doi.org/10.1177/27536386231205068","url":null,"abstract":"","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135482840","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: An evolving identity","authors":"Kathryn Eastwood, Matthew Johnson, Julia Williams, Alan M Batt, Walter Tavares","doi":"10.1177/27536386231203401","DOIUrl":"https://doi.org/10.1177/27536386231203401","url":null,"abstract":"Paramedicine’s identity is evolving. As paramedicine strives for professional recognition, part of this process must involve defining and understanding the boundaries of the profession which will in turn inform its identity. ‘Boundary work’ – a concept used by sociologists – describes how professional bodies distinguish themselves from other professions by elucidating their field of practice. This process is an important part of establishing a group as a profession as it clarifies what resources are needed, from whom, and which should be prioritised for this group. There is a growing body of research attempting to explore what paramedicine is as a profession; however, this work may be somewhat futile while the industry expands into other healthcare domains without defining or considering its boundaries. This diversification of paramedicine into non-traditional roles has not been driven with an understanding of its professional boundaries and field of practice, but rather through a range of other drivers that are not coordinated and without clear goals about the future identity of paramedicine. As a result, there is an increasing lack of clarity about what it is that paramedics do. This confusion can be seen at governmental levels, within paramedicine education and within emergency medical services (EMSs) (otherwise known as ambulance services or paramedic/paramedicine services) themselves. A recent Canadian study identified a shift from paramedicine being considered a public safety service towards a public health service. A good example of this exists in Australia where some EMS systems operate under the governmental jurisdiction of the Department of Health and Human Services and are represented by a Health Minister, while others are part of the Department of Justice and are represented by an Emergency Services Minister. These differing identities directly impact resourcing. As part of the healthcare system, EMS, like other healthcare organisations, are expected to wade through the large workload and do their best to meet this demand. However, if operating within the boundaries of being an emergency service, it is likely there would be a greater focus on sufficient resourcing to ensure ambulances are available and able to respond to emergencies as they arise. The lack of clear boundaries also means we have not identified who should be delivering our education and what scope of practice should be covered. Whilst it is common now for paramedicine education to occur in tertiary institutions, the faculty or department in which paramedicine programs are situated and governed varies widely, and include paramedicine, nursing, biology, health and society, and even sport, health and engineering. Furthermore, much of the content of many paramedicine courses continues to revolve around the traditional model of emergency response to critically unwell patients, most if not all of whom require medical intervention in the prehospital setting. Beyond the pathoph","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136309064","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 advantages and challenges experienced with the implementation and delivery of community paramedicine programmes: A qualitative reflexive thematic analysis","authors":"Brenda N. Shannon, A. Batt, Georgette Eaton, Matthew Leyenaar, Peter O’Meara, Tomas Barry, C. Lanos, Gary Wingrove, Brett Williams, Michael Nolan, Ray Carney, J. Heffern, K. Bowles","doi":"10.1177/27536386231188595","DOIUrl":"https://doi.org/10.1177/27536386231188595","url":null,"abstract":"Objective This study aims to investigate the experiences of individuals involved in implementing and delivering community paramedicine programmes across several different regions internationally, in order to identify key themes that can inform ongoing development and introduction of community paramedicine programmes. Methods In this study, participants were enlisted through convenience sampling and a snowballing method. They responded to a custom survey emphasising open-ended responses. We employed a qualitative reflexive thematic analysis, utilising an inductive coding technique at the semantic/explicit level. This approach allowed us to discern themes from the participants’ accounts of the programme's implementation and delivery, along with their perceptions of its strengths and challenges. Results Data was collected from 29 participants engaged in the development or delivery of community paramedicine programmes spanning seven countries. Five themes were created: (1) community drives the need, which emphasises the importance of community engagement and flexible response to health needs; (2) working with others, which underscores the necessity of collaboration with stakeholders for integration and relationship maintenance; (3) promotion and communication, focusing on clarifying roles and countering misconceptions; (4) recruitment and support of community paramedics, highlighting the significance of experienced paramedic recruitment and providing support for staff retention; and (5) research and evaluation, stressing the importance of data sharing for patient care and programme evaluation. These themes demonstrate the significance of community-centred approaches, interprofessional practice, and programme evaluation in community paramedicine. Conclusion This study highlights the significance of community-centred approaches, interprofessional practice, and programme evaluation in community paramedicine. These findings can inform policymakers and practitioners in the development and implementation of community paramedicine programmes, ultimately improving the health and well-being of communities across different regions internationally.","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"40 1","pages":"181 - 197"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80692340","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":"Personality and vocational interest typologies associated with better coping and resilience in paramedicine: A review of two models","authors":"Rod Mason, John Roodenburg, Brett Williams","doi":"10.1177/27536386231199289","DOIUrl":"https://doi.org/10.1177/27536386231199289","url":null,"abstract":"Paramedics’ continued exposure to work-related stressors can negatively impact emotional wellbeing. Having or developing resilience contributes to better coping. Understanding differences in individual predispositions as they relate to resilience and coping can provide a needed understanding of why some people flourish while others are more at risk, with important implications for identifying and facilitating bespoke support for paramedics more at risk. The purpose of this article then is firstly to review two of the main well-validated models of innate dispositions in differential psychology, widely used in organisational and industrial psychology: personality and vocational interests. These are The Big-Five/Five-Factor Model and Holland's RIASEC. Then, we report which dispositions are an advantage for paramedic coping and resilience. Concerning personality, our findings from the literature suggest that for paramedics, lower levels of Neuroticism and Openness, and higher levels of Extraversion, Agreeableness and Conscientiousness are associated with higher resilience and better coping. RIASEC associations suggest person-environment congruence is also related to resilience and coping, this being for those with the profession's predominant Holland code of RSI (Realist, Social and Investigative inclinations). Paramedics approximating these preferences are, it appears, innately relatively less at risk of the negative effects associated with occupational stressors in paramedicine. Stressors typically include post-traumatic stress disorder, major depression and other psychological reactions that all can result in suicide. Importantly, such resilience does not mean an individual is instinctively protected from some form of emotional suffering. The implications of verifying the significance of predispositions implies the need to harness organisational psychology as part of training courses, and the need for involvement of psychologists in the field, both preventatively and in clinical care.","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85020935","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":"Peer review in Paramedicine: Owning imperfections and striving to optimise","authors":"P. Simpson, W. Tavares","doi":"10.1177/27536386231193540","DOIUrl":"https://doi.org/10.1177/27536386231193540","url":null,"abstract":"","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"44 1","pages":"128 - 131"},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87316070","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":"Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study","authors":"Ulf Andersson, Hanna Maurin Söderholm, Henrik Andersson, Birgitta Wireklint Sundström, M. Andersson Hagiwara, G. Puača","doi":"10.1177/27536386231189011","DOIUrl":"https://doi.org/10.1177/27536386231189011","url":null,"abstract":"Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR. Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources. The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates. The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77735046","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":"Advancing paramedicine: Error, accountability and patient safety","authors":"B. Meadley, Matthew Humar, Ross Salathiel, Tegwyn E McManamny","doi":"10.1177/27536386231189006","DOIUrl":"https://doi.org/10.1177/27536386231189006","url":null,"abstract":"The consequences of human error range from the benign to the catastrophic. Feedback and formal review of failures in human performance are essential for learning and avoidance of harm in the future. However, anecdotal evidence suggests that paramedicine may sustain a culture where formal review of error may be considered punitive, hampering enhancements in care and professional maturity. With enhanced transparency of adverse events, mature review processes and acceptance and translation of recommendations, we look to a shift in the culture. Clinicians and organisations must be accountable for their role in review and audit of near misses and adverse events. There is a path forward for paramedicine, where courageous individuals are empowered to identify clinical error and speak up, promoting growth. We must prevent individual feelings of shame and fear of consequences. Only then can we see a true patient-centric safety culture in paramedicine, one which supports clinicians’ development.","PeriodicalId":55865,"journal":{"name":"Australasian Journal of Paramedicine","volume":"56 1","pages":"214 - 218"},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76593160","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}