Impact of online learning on sense of belonging among first year clinical health students during COVID-19: student and academic perspectives.

BACKGROUND: The need to belong is a fundamental human desire that provides the basis for relationships and community; it provides a sense of security that enables growth and development. This sense of belonging is pivotal to new University students, indeed, without it, students are at greater risk of failing or withdrawing from their studies. Yet developing a sense of belonging within a new cohort is complex and multi-faceted and further complicated by a sudden shift away from in-person to online learning. Using the situated-learning framework, our study explores first year clinical health students' sense of belonging in the context of the rapid transition to online learning because of the COVID-19 pandemic. METHODS: We utilised a current mixed-method approach including a survey incorporating previously validated tools, demographic and open-ended qualitative questions. Data was also gathered from three focus groups: two dedicated student groups and one academic focus group. Qualitative data was subjected to thematic analysis whilst descriptive statistics were used to describe the quantitative data. RESULTS: 179 first year students complete the survey and four students, and five academics were involved in the focus groups. All participants were from clinical health science courses at an Australian university. Our qualitative results indicated a global theme of: Navigating belonging during the COVID-19 crisis: a shared responsibility; with four organising themes describing (1) dimensions of belonging, (2) individual experiences and challenges, (3) reconceptualising teaching and learning, and (4) relationships are central to belonging. CONCLUSION: While the rapid transition to online learning did not greatly impact knowledge acquisition of first-year students in this cohort, the lack of sense of belonging highlights the need for further research into development of this essential aspect of learning in the online domain. Although contextualised in the COVID-19 pandemic, it became clear that the findings will remain relevant beyond the current situation, as a student's need to belong will always be present in the face of challenges or change.

The Impact of a Novel Operational Readiness Response Model on the Environmental Cleanliness of Emergency Ambulances.

Objectives: Environmental cleanliness of emergency ambulances may be associated with increased risk of healthcare acquired infection (HAI). Surface cleanliness, measured using adenosine triphosphate (ATP) testing, has been demonstrated to correlate with potentially harmful levels of microbial pathogens. In most ambulance services, environmental cleanliness of ambulances and the equipment within them is the responsibility of paramedics. In 2016 NSW Ambulance introduced the Make Ready Model (MRM), in which ambulances are systematically cleaned by non-clinical support staff at the end of each shift. This prospective study aimed to 1) provide a baseline level of ambulance cleanliness; and 2) compare the MRM to a standard cleaning model (SCM). Methods: A prospective comparative study was conducted comparing cleanliness of ambulances in the SCM to those in the MRM. Adenosine-triphosphate (ATP) bioluminescence testing was performed in a pseudo-randomised sample of ambulances. Six 'high touch' areas within each ambulance were systematically sampled. Testing occurred without warning to operational staff. The primary outcome was 'overall bioburden' (OB)' measured in radiant light units ('RLU'). Non-parametric tests were used to assess differences in RLU values between each of the test points, while Poisson multivariate regression was used to compare median overall bioburden between the two groups, adjusting for the confounder variable of 14-day ambulance workload. Results: Sixty-eight ambulances were sampled, 32 from the SCM and 36 from the MRM. Median surface bioburden was significantly lower in the MRM for four of the six test points (preparation table, mobile data terminal, stretcher handles and steering wheel). For the primary outcome of overall bioburden, the unadjusted MRM OB was 35% lower than for the SCM group (RR 0.65 (0.64-0.66; p < 0.01)). After adjusting for the significant confounding variable of 14-day workload, the OB was 38% lower for the MRM group (ARR 0.68 (0.61-0.63; p < 0.001)). Conclusion: The innovative MRM cleaning system was associated with significantly improved cleanliness in frontline emergency ambulances. The magnitude of improvement in cleanliness suggests this cleaning model has the potential to make a major contribution to infection control strategies in paramedicine. Future research should focus on cost effectiveness of the MRM and its applicability to regional and remote ambulance service operations.

Review article: Prevalence of burnout in paramedics: A systematic review of prevalence studies.

Paramedic wellness is an increasing priority within the profession. Burnout has been described as having areas of 'emotional exhaustion, depersonalisation and reduced personal accomplishment'. Prevalence of burnout is unclear, hampering evaluation of protective initiatives. The aim of this systematic review was to identify prevalence and predictors of burnout in paramedic populations. A systematic review was registered via PROSPERO and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO and PsycARTICLES were searched from 2000 to present. Abstract screening and selection of articles was undertaken with good agreement. Quality assessment of included articles used Hoy's validated quality assessment tool, with excellent inter-rater agreement (K = 0.9). Qualitative synthesis of included studies was performed. Each step of the process was performed independently by two authors, with a third arbitrating disputes as required. Five studies met inclusion criteria; two were from the USA, and one each from Australia, South Africa and Israel. Burnout measurement varied; three used Copenhagen Burnout Inventory (CBI), one Maslach's Burnout Inventory (MBI), and one General Burnout Measure (GBM). Prevalence of burnout ranged between 16% and 56%. Higher prevalence was reported in CBI studies (30%, 38% and 56%), while lower prevalence was seen with other tools (MBI 18%, GBM 16%). Included studies were of low to moderate quality. The prevalence of burnout in paramedics varies from 16% to 56%. Existing evidence describing burnout in paramedics is weak; research of good methodological rigour is needed to quantify prevalence of burnout, providing a reliable baseline against which protective interventions could be measured.

A Comparison of Venous versus Capillary Blood Samples when Measuring Blood Glucose Using a Point-of-Care, Capillary-Based Glucometer.

BACKGROUND: Blood glucose level (BGL) is routinely assessed by paramedics in the out-of-hospital setting. Most commonly, BGL is measured using a blood sample of capillary origin analyzed by a hand-held, point-of-care glucometer. In some clinical circumstances, the capillary sample may be replaced by blood of venous origin. Given most point-of-care glucometers are engineered to analyze capillary blood samples, the use of venous blood instead of capillary may lead to inaccurate or misleading measurements. HYPOTHESIS/PROBLEM: The aim of this prospective study was to compare mean difference in BGL between venous and capillary blood from healthy volunteers when measured using a capillary-based, hand-held, point-of-care glucometer. METHODS: Using a prospective observational comparison design, 36 healthy participants provided paired samples of blood, one venous and the other capillary, taken near simultaneously. The BGL values were similar between the two groups. The capillary group had a range of 4.3mmol/l, with the lowest value being 4.4mmol/l and 8.7mmol/l the highest. The venous group had a range of 2.7mmol/l, with the lowest value being 4.1mmol/l and 7.0mmol/l the highest.For the primary research question, the mean BGL for the venous sample group was 5.3mmol/l (SD = 0.6), compared to 5.6mmol/l (SD = 0.8) for the capillary group. This represented a statistically significant difference of 0.3mmol/l (P = .04), but it did not reach the a priori established point of clinical significance (1.0mmol/l). Pearson's correlation coefficient for capillary versus venous indicated moderate correlation (r = 0.42). CONCLUSION: In healthy, non-fasted people in a non-clinical setting, a statistically significant, but not clinically significant, difference was found between venous- and capillary-derived BGL when measured using a point-of-care, capillary-based glucometer. Correlation between the two was moderate. In this context, using venous samples in a capillary-based glucometer is reasonable providing the venous sample can be gathered without exposure of the clinician to risk of needle-stick injury. In clinical settings where physiological derangement or acute illness is present, capillary sampling would remain the optimal approach.