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The Transition from Clinician to Manager: The Paramedic Experience 从临床医生到管理者的转变:护理人员的经验
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.861
K. Stewart, Vicki Cope, Melanie Murray
Introduction Promotion from paramedic to manager is common in ambulance services, yet there is limited research concerning paramedics’ experience of this role transition. The purpose of this qualitative study was to explore the experiences of paramedics who have transitioned from clinician to manager. Methods A qualitative approach was used for this study. Through purposive sampling, semi-structured interviews were conducted with paramedics who had made the transition to manager. The participants were asked to describe how they felt and what their experiences were concerning this transition. Thematic analysis was undertaken identifying themes within participant responses. Results Six key themes emerged during the data analysis. Participants described feelings of isolation on moving from the frontline, a lack of feeling part of the team ‘in green’; however, they also reported that previously being a paramedic in some instances gave credibility in their new manager roles. Challenges reported concerned no formal training before transitioning into the role, and the lack of essential managerial experience. Conclusion This research provided insight into how paramedics feel and perceive the transition from clinician to management roles. A review of the organisational approach to role transition is of benefit to paramedics. Such a review may help identify what changes could be made in support of paramedics transitioning to management roles. Further research is required across other ambulance services to determine the efficacy of these results in the broader ambulance service environment.
从护理人员到管理者的晋升在救护车服务中很常见,但关于护理人员在这种角色转变中的经验的研究有限。本质性研究的目的是探讨从临床医师转变为管理人员的护理人员的经验。方法采用定性方法进行研究。通过有目的的抽样,半结构化的访谈进行了护理人员谁已经过渡到经理。参与者被要求描述他们对这种转变的感受和经历。进行了专题分析,确定与会者答复中的主题。结果在数据分析过程中出现了六个关键主题。参与者描述了离开前线时的孤立感,缺乏“绿色”团队的感觉;然而,他们也报告说,以前的护理人员在某些情况下给他们的新经理角色提供了可信度。所报告的挑战涉及在过渡到这一角色之前没有接受过正式培训,以及缺乏必要的管理经验。结论本研究揭示了护理人员如何感受和感知从临床医生到管理角色的转变。对角色转换的组织方法进行审查对护理人员有益。这样的审查可能有助于确定哪些变化可以支持护理人员过渡到管理角色。需要对其他救护车服务进行进一步的研究,以确定这些结果在更广泛的救护车服务环境中的有效性。
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引用次数: 1
Care in the Field: Adult Anaphylaxis for Paramedics 现场护理:护理人员的成人过敏反应
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.916
M. Wilkinson-Stokes, D. Rowland, Maddison Spencer, Sonja Maria, Marc Colbeck
This paper presents an overview of the definition, clinical features, epidemiology, classification, pathophysiology, evaluation and risk assessment and treatment pharmacodynamics of anaphylaxis from the perspective of Australasian paramedic practice.
本文从澳大利亚护理实践的角度,综述了过敏反应的定义、临床特征、流行病学、分类、病理生理学、评估和风险评估以及治疗药效学。
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引用次数: 0
A Comparison of Australasian Jurisdictional Ambulance Services’ Paramedic Clinical Practice Guidelines Series: Adult Sepsis 澳大利亚管辖救护车服务的护理人员临床实践指南系列的比较:成人败血症
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.932
M. Wilkinson-Stokes, Elena Ryan, Michael Williams, Maddison Spencer, Sonja Maria, Marc Colbeck
Introduction This article forms part of a series that seeks to identify interjurisdictional differences in the scope of paramedic practice and differences in patient treatment based upon which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS were accessed during June 2020, and updated in August 2021. Content was extracted and verified. Results Nine services provide antibiotics for meningococcal septicaemia, with dosage ranging from 1 – 4 grams. Five services provide antibiotics for non-meningococcal sepsis (three under doctor approval), with choice of antibiotic including Ceftriaxone, Benzylpenicillin, Amoxicillin, and Gentamicin. Three services provide antipyretics, one provides corticosteroids under doctor approval, and all provide fluids (with dosage ranging from 20 – 60 ml/kg). ICPs are allowed to provide adrenaline infusions in nine services, noradrenaline in three services (one requiring doctor approval), and metaraminol in three services. Two additional services restrict metaraminol to specialist paramedics, with one of these requiring doctor approval. Two services perform phlebotomy and one takes lactate. Paramedics perform unassisted intubation in one service, with nine restricting this to ICPs. Facilitated or Ketamine-only intubation is performed by ICPs in one service. Rapid or delayed sequence induction is performed by ICPs in six services, and restricted to specialists in two services. Conclusion The domestic jurisdictional ambulance services in Australasia have each created unique treatment clinical practice guidelines that are heterogeneous in their treatments and scopes of practice. A review of the evidence underlying each intervention is appropriate to determining best practice.
本文是系列文章的一部分,旨在确定护理人员实践范围的司法管辖区差异和患者治疗的差异,这些差异基于患者在投诉时地理位置所在的司法管辖区。方法于2020年6月获取各JAS现行cpg,并于2021年8月更新。内容被提取并验证。结果9个服务点提供脑膜炎球菌败血症抗生素,剂量从1 ~ 4克不等。五家服务机构提供治疗非脑膜炎球菌败血症的抗生素(其中三家经医生批准),可选择的抗生素包括头孢曲松、青霉素、阿莫西林和庆大霉素。三家诊所提供退烧药,一家诊所在医生批准下提供皮质类固醇,所有诊所都提供液体(剂量从20 - 60毫升/公斤不等)。ICPs被允许在九种服务中提供肾上腺素注射,在三种服务中提供去甲肾上腺素注射(一种需要医生批准),在三种服务中提供甲氨酚注射。另外两项服务将甲氨酚限制在专科护理人员使用,其中一项需要医生批准。有两处进行放血,一处服用乳酸。护理人员在一项服务中进行无辅助插管,其中九项限制为ICPs。辅助插管或仅氯胺酮插管由ICPs在一项服务中执行。快速或延迟序列诱导由ICPs在六个服务中执行,并且仅限于两个服务中的专家。结论国内管辖救护车服务在澳大拉西亚每个创建独特的治疗临床实践指南是异质的治疗和实践范围。对每项干预措施的证据进行审查是确定最佳做法的适当方法。
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引用次数: 0
Escape Rooms in Paramedic Education 急救教育中的密室逃生
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.935
S. Delport, A. Weber
Introduction Even with paramedicine's evolution, clinical decision-making will always be a crucial learning and teaching requirement. As part of their learning, paramedic students need to develop critical thinking and collaborative approaches with others. The aim was to review the literature around escape room activity as a pedagogical approach for paramedic education. The intent is to contribute to the discussion around authentic and engaging approaches to teaching clinical thinking and decision making in paramedicine. Methods A systematic review was undertaken to review existing literature on using this approach in higher education. EBSCO, Medline, CINAHL, ScienceDirect, ProQuest and PubMed were used to review paramedic and health education strategies using a list of keywords. Results There were 23 scholarly papers examining the use of escape rooms in an educational context found. There was no reference to using this teaching methodology in paramedicine, but some health contexts were identified for nursing, pharmacy, radiology and medicine. Conclusion With an instructional design that addresses logistical requirements, educational escape rooms can be used effectively in paramedic higher education. This review highlights a longitudinal study is needed to assess an educational escape room's implementation into the paramedic higher education curriculum. A longitudinal, multi-university study can further explore the feasibility of using a blended online/offline escape room activity in large enrolment paramedic programs.
即使随着辅助医学的发展,临床决策始终是一项重要的学习和教学要求。作为学习的一部分,护理学生需要培养批判性思维和与他人合作的方法。目的是回顾文献逃生室活动作为护理人员教育的教学方法。目的是促进围绕真实和引人入胜的方法来教学临床思维和决策的讨论。方法系统回顾现有的关于在高等教育中使用该方法的文献。EBSCO、Medline、CINAHL、ScienceDirect、ProQuest和PubMed使用关键词列表来审查护理人员和健康教育策略。结果共有23篇学术论文研究了密室密室在教育环境中的使用。没有提到在辅助医学中使用这种教学方法,但确定了护理、药学、放射学和医学的一些卫生背景。结论通过满足后勤要求的教学设计,教育密室可以有效地应用于护理高等教育。本综述强调需要进行纵向研究来评估教育密室在护理高等教育课程中的实施情况。一项纵向、多所大学的研究可以进一步探索在大型招生护理人员项目中使用混合在线/离线逃生室活动的可行性。
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引用次数: 1
Ethical Dilemmas with Little Time for Reflection: A Discussion of the Ethics of Out-of-Hospital Refusals 没有时间反思的伦理困境:院外拒绝的伦理讨论
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.909
Bryson Galozo, Blair Macdonald
In this article, we consider an approach for ethical decision-making for refusals in the out-of-hospital environment. Autonomy and beneficence are discussed as the two ethical principles central to guiding paramedic decision-making in this context. We describe some situations where the two principles may come into conflict and where the working paramedic may be faced with an ethical dilemma. These cases may involve temptations of medical paternalism, which we argue ought to be avoided if possible. A discussion on navigating between autonomy and beneficence will be presented in order to help paramedics sort through dilemmas when these principles conflict. We argue that when these principles are in conflict, autonomy should primarily be respected – however, we will examine situations where the principle of autonomy cannot be applied and the paramedic should either attempt to rectify the patient's capacity for autonomous decision-making, or, if not possible, proceed with the principle of beneficence.
在这篇文章中,我们考虑了医院外环境中拒绝的伦理决策方法。在这种情况下,自治和慈善作为指导护理人员决策的两个伦理原则进行了讨论。我们描述了一些情况下,这两个原则可能会发生冲突,其中工作护理人员可能面临道德困境。这些病例可能涉及医疗家长式作风的诱惑,我们认为应该尽可能避免。在自主和慈善之间导航的讨论将提出,以帮助护理人员通过困境排序,当这些原则冲突。我们认为,当这些原则发生冲突时,自主权应该首先得到尊重——然而,我们将检查自主性原则不能适用的情况,护理人员应该尝试纠正病人自主决策的能力,或者,如果不可能,继续行善原则。
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引用次数: 0
Uncharted Waters: The Effects of Covid-19 on Student Paramedics 未知的水域:Covid-19对学生护理人员的影响
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.921
S. Whitfield, A. Perkins, Sarah Kelly, Hannah Dumbleton
Introduction The effect of COVID-19 pandemic shutdowns on education has been discussed broadly in both the media and among academics, however its true effects on paramedicine students and their ability to attend in-person lectures, skill sessions and clinical placements has not been widely researched. This study aimed to investigate the impact of COVID-19 on a group of paramedicine students at an Australian university. Methods A cross-sectional study using a convenience sample of first and second year paramedicine students was undertaken to explore their perceived experiences of COVID-19 through both qualitative and quantitative responses. Results A total of 83 paramedicine students from Griffith University in Queensland participated in the survey, demonstrating an 84.7% response rate. Of the participants, 78.3% (n=65) disagreed that online workshop sessions were as valuable as face-to-face sessions. Similarly, the majority of participants (61.5%, n=51) disagreed that online lectures and tutorials were as beneficial as in-person equivalents. A further 61.4% (n=51) of students agreed that COVID-19-associated lockdowns had negatively impacted their ability to formulate strong personal relationships that are important for university, however 78.3% of students agreed that communication platforms assisted in maintaining some form of social interaction. Conclusion The results from this study demonstrate that the educational and social impacts of COVID-19 on paramedicine students were highly diverse, and were contingent on several factors including but not limited to: year of study, learning style, previously established social connections and extenuating life circumstances.
媒体和学术界广泛讨论了COVID-19大流行停工对教育的影响,但其对护理医学学生及其参加面对面讲座、技能课程和临床实习能力的真正影响尚未得到广泛研究。这项研究旨在调查COVID-19对澳大利亚一所大学的一组护理医学学生的影响。方法采用横断面研究方法,选取方便的一、二年级医学生为样本,通过定性和定量两方面的调查,探讨医学生对新冠肺炎的感知体验。结果来自昆士兰格里菲斯大学的83名医学生参与了调查,回复率为84.7%。在参与者中,78.3% (n=65)不认为在线研讨会与面对面会议一样有价值。同样,大多数参与者(61.5%,n=51)不认为在线讲座和教程与面对面的讲座和教程一样有益。另有61.4% (n=51)的学生认为,与covid -19相关的封锁对他们建立牢固的个人关系的能力产生了负面影响,而这对大学来说很重要,但78.3%的学生认为,通信平台有助于维持某种形式的社交互动。结论2019冠状病毒病对护理医学专业学生的教育和社会影响是高度多样化的,并取决于几个因素,包括但不限于:学习年份、学习方式、以前建立的社会关系和减轻的生活环境。
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引用次数: 2
Public Perceptions of the Cost of Paramedic Services in Saskatchewan, Canada 公众对加拿大萨斯喀彻温省护理服务成本的看法
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.889
Adeyemi O. Ogunade, F. Luhanga, Jacquie Messer-Lepage, Khan Md Rashed Al-Mamun
Introduction Despite the increasingly important role of paramedics in Canada's healthcare system, the Canadian Health Act does not cover paramedic services. Anecdotal evidence indicates that the cost of paramedic services prevents many people in need from accessing this care. This article explores public perceptions of the cost of paramedic services in Saskatchewan, Canada. Methods Using a qualitative research design, we collected data from 56 participants in focus group sessions and semi-structured interviews designed to explore perceptions of paramedic services in Saskatchewan. Results The data indicated that participants perceived the cost of paramedic services to be too high, and that this perception may limit the use of paramedic services during medical emergencies. The data also suggested a lack of understanding of how paramedic service costs are calculated. Overall, participants expected the government to do more to subsidise these costs. Conclusion The results revealed a disconnect between public perceptions about the cost of paramedic services and the initiatives designed by the provincial government to alleviate these costs. They also highlight the need for better public education about and access to government programs designed to alleviate the cost of paramedic services.
尽管护理人员在加拿大的医疗保健系统中扮演着越来越重要的角色,但《加拿大健康法》并未涵盖护理人员服务。轶事证据表明,护理服务的费用使许多有需要的人无法获得这种护理。本文探讨了公众对加拿大萨斯喀彻温省护理服务成本的看法。方法采用定性研究设计,我们从焦点小组会议和半结构化访谈中收集了56名参与者的数据,旨在探讨萨斯喀彻温省护理人员服务的看法。结果被调查者认为急救服务的费用过高,这可能会限制急救服务的使用。这些数据还表明,人们对护理服务费用的计算方式缺乏了解。总体而言,与会者期望政府采取更多措施补贴这些成本。结论:调查结果显示,公众对护理服务成本的看法与省政府为减轻这些成本而设计的举措之间存在脱节。他们还强调,有必要对公众进行更好的教育,让他们有机会参与旨在减轻护理服务成本的政府项目。
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引用次数: 0
State of the Evidence for Emergency Medical Services Care of Adult Patients with Sepsis: An Analysis of Research from the Prehospital Evidence-Based Practice Program 成人脓毒症患者急诊医疗服务的证据现状:院前循证实践项目的研究分析
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.851
J. Greene, J. Goldstein, D. Lane, J. Jensen, Yves Leroux, J. Swain, D. Fidgen, Ryan Brown, M. Simpson, Alix J. E. Carter
Introduction The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated emergency medical services evidence repository. This PEP summary describes the research evidence for the identification and management of adult patients with sepsis or septic shock. Methods A systematic search of the literature on sepsis or septic shock was conducted. Studies were scored by trained appraisers on a three-point level of evidence scale (based on study design and quality) and a three-point direction of evidence scale (supportive, neutral or opposing findings based on the studies’ primary outcome for each intervention). Results One hundred forty-three studies (80 existing and 63 new) were included for 16 interventions listed in PEP for adult patients with sepsis. The evidence matrix rank for supported interventions (n=16) were supportive-high quality (n=2, 12.5%) for crystalloid infusion and vasopressors, supportive-moderate quality (n=8, 50%) for identification tools, pre-notification, point-of-care lactate, titrated oxygen, temperature monitoring and balanced crystalloids. The benefit of pre-hospital antibiotics, colloids, Trendelenburg position and early goal-directed therapy remain inconclusive with a neutral direction of evidence. There is moderate level evidence opposing the use of high flow oxygen. Conclusion Several standard treatments are well supported by the evidence including fluid resuscitation, using balanced crystalloids, vasopressors and titrating oxygen. Tools for identifying and guiding treatment are also supported (eg. pre-notification, temperature monitoring and lactate). The evidence for antibiotic use is inconclusive. This PEP state of the evidence analysis can be used to guide selection of appropriate pre-hospital therapies during the development of pre-hospital protocols or clinical practice guidelines.
院前循证实践(PEP)计划是一个在线,免费访问,不断更新的紧急医疗服务证据库。本PEP摘要描述了成人脓毒症或感染性休克患者的识别和管理的研究证据。方法系统查阅有关脓毒症或感染性休克的文献。研究由训练有素的评估师根据证据量表的三点水平(基于研究设计和质量)和证据量表的三点方向(基于每项干预研究的主要结果的支持、中立或反对结果)对研究进行评分。结果针对成人脓毒症患者PEP中列出的16项干预措施,纳入了143项研究(现有80项,新63项)。支持干预措施(n=16)的证据矩阵等级为:支持-高质量(n=2, 12.5%)用于晶体输注和血管加压剂,支持-中等质量(n=8, 50%)用于鉴定工具、预先通知、护理点乳酸、滴定氧、温度监测和平衡晶体。院前抗生素、胶体、Trendelenburg位置和早期目标导向治疗的益处仍不确定,证据方向中立。有中等水平的证据反对使用高流量氧气。结论液体复苏、使用平衡晶体、血管加压药和滴定氧等标准治疗方法均有较好的证据支持。还支持用于识别和指导治疗的工具(例如。预先通知,温度监测和乳酸)。使用抗生素的证据尚无定论。证据分析的PEP状态可用于指导在制定院前协议或临床实践指南期间选择适当的院前治疗方法。
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引用次数: 1
Enhancing Professional Practice and Professionalism among Canadian Rural Paramedics 加强加拿大农村护理人员的专业实践和专业精神
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.926
Mathieu Grenier, Julia van Vuuren, E. Spelten
Introduction The scope of paramedic practice is being redefined and expanded. Professional development and clinical expertise are not only necessary for paramedics to perform their clinical functions and operational responsibilities, they are at the very core of their professionalisation. Professionalisation is a complex process, and the degree to which it can accomplished will impact society's perception of the profession – and its trust in it – for years to come. This study investigated ways to enhance professional practice, from the point of view of the main healthcare providers in a rural area of Ontario, Canada. Methods A qualitative analysis informed by action research methodology was used. The research design was staged and consisted of focus groups and a World Café. The data were coded and organised into themes, using thematic analysis, and were triangulated with the literature. Results Three key themes emerged from the World Café and focus group conversations including current enablers of professionalisation; system components that promote professionalism; and community of practice to support professional development and clinical expertise. Conclusion Paramedic practice is evolving. This should be reflected in clinical practice and education, and more paramedic-led research. Paramedic training may need to move from the college to the university environment to reflect equal standing with colleagues in the broader healthcare system. This study shows strong motivation among paramedics and management to enhance professional practice and professionalism. To achieve this, a culture of trust, developing engagement and communication strategies and establishing a community of practice are crucial.
护理实践的范围正在被重新定义和扩大。专业发展和临床专业知识不仅是护理人员履行其临床职能和业务职责所必需的,而且是其专业化的核心。职业化是一个复杂的过程,其完成的程度将在未来几年影响社会对该职业的看法以及对该职业的信任。本研究从加拿大安大略省农村地区主要医疗保健提供者的角度调查了加强专业实践的方法。方法采用行动研究方法进行定性分析。研究设计是分阶段进行的,由焦点小组和世界咖啡馆组成。这些数据被编码并组织成主题,使用主题分析,并与文献进行三角测量。结果:从世界咖啡馆和焦点小组对话中出现了三个关键主题,包括当前专业化的推动因素;促进专业的系统组件;和实践社区,以支持专业发展和临床专业知识。结论护理人员的实践在不断发展。这应该反映在临床实践和教育中,以及更多由护理人员主导的研究中。护理人员的培训可能需要从学院转移到大学环境,以反映在更广泛的医疗系统中与同事的平等地位。本研究显示护理人员和管理人员有强烈的动机加强专业实践和专业精神。为实现这一目标,建立信任文化、制定参与和沟通战略以及建立实践社区至关重要。
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引用次数: 0
Psychological and Social Wellbeing of Paramedics in Riyadh City during the Covid-19 Pandemic Covid-19大流行期间利雅得市护理人员的心理和社会福祉
Pub Date : 2021-01-01 DOI: 10.33151/ajp.18.895
A. Alqahtani, S. Alqahtani, Abdullah S Alhodaib, Amin Daoulah, Abdulmajeed Mobarad, S. Alhamid, R. Alhazmi
Introduction Our research sought to assess the psychological and social wellbeing of paramedics in Riyadh City in Saudi Arabia during the COVID 19 pandemic. It also aimed to assess the therapeutic assistance provided to pre-hospital care givers during the pandemic. Methods In this quantitative cross-sectional analysis an assessment of 106 paramedics was undertaken from data obtained from 28 September to 10 November 2020. The authenticity and durability of Pilot and the Cronbach have been added. Results Of the 106 paramedics surveyed, 60 (56.6%) were 30–39 years of age; 101 were male (95.3%). The mean average psychological wellbeing of the paramedics was 6.41 with the standard deviation of 2.42. Family and friends’ average social support score was 9.2 in norm 2.6 deviation. Conclusion Our study showed that during the COVID-19 pandemic paramedics suffered from social and psychological depression. Paramedics must be protected from the socioeconomic and psychological difficulties they face every day in order to combat the COVID-19 pandemic.
我们的研究旨在评估沙特阿拉伯利雅得市护理人员在2019冠状病毒病大流行期间的心理和社会福祉。它还旨在评估在大流行期间向院前护理人员提供的治疗援助。方法采用定量横断面分析方法,对2020年9月28日至11月10日获得的106名护理人员的数据进行评估。Pilot和Cronbach的真实性和耐久性已被添加。结果106名受访医护人员中,30 ~ 39岁60人(56.6%);男性101例(95.3%)。护理人员的平均心理幸福感为6.41,标准差为2.42。家庭和朋友的社会支持平均得分为9.2,标准差为2.6。结论新冠肺炎疫情期间,护理人员存在社会抑郁和心理抑郁。为了抗击COVID-19大流行,必须保护护理人员免受他们每天面临的社会经济和心理困难。
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引用次数: 4
期刊
Australian Journal of Paramedicine
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