Paramedic attitudes and experiences working as a community paramedic: a qualitative survey.

BACKGROUND: Community paramedicine (CP) is an extension of the traditional paramedic role, where paramedics provide non-acute care to patients in non-emergent conditions. Due to its success in reducing burden on hospital systems and improving patient outcomes, this type of paramedic role is being increasingly implemented within communities and health systems across Ontario. Previous literature has focused on the patient experience with CP programs, but there is lack of research on the paramedic perspective in this role. This paper aims to understand the perspectives and experiences, both positive and negative, of paramedics working in a CP program towards the community paramedic role. METHODS: An online survey was distributed through multiple communication channels (e.g. professional organizations, paramedic services, social media) and convenience sampling was used. Five open-ended questions asked paramedics about their perceptions and experiences with the CP role; the survey also collected demographic data. While the full survey was open to all paramedics, only those who had experience in a CP role were included in the current study. The data was qualitatively analyzed using a comparative thematic analysis. RESULTS: Data was collected from 79 respondents who had worked in a CP program. Three overarching themes, with multiple sub-themes, were identified. The first theme was that CP programs fill important gaps in the healthcare system. The second was that they provide paramedics with an opportunity for lateral career movement in a role where they can have deeper patient connections. The third was that CP has created a paradigm shift within paramedicine, extending the traditional scope of the practice. While paramedics largely reported positive experiences, there were some negative perceptions regarding the slower pace of work and the "soft skills" required in the role that vary from the traditional paramedic identity. CONCLUSIONS: CP programs utilize paramedic skills to fill a gap in the healthcare system, can improve paramedic mental health, and also provide a new pathway for paramedic careers. As a new role, there are some challenges that CP program planners should take into consideration, such as additional training needs and the varying perceptions of CP.

Mentoring medical students as a means to increase healthcare assistant status: A qualitative study.

AIM: To offer a practical way in which the status of healthcare assistants (HCAs) can be increased by drawing on their experience, knowledge and skillset, whilst mentoring medical students during an HCA project. DESIGN: Qualitative, reflexive thematic analysis. METHODS: One-to-one semi-structured interviews were conducted between April and June 2019, with 13 participants. Participants included five healthcare assistants; three practice development nurses, two of whom were former HCAs; one registered general nurse and four clinical educators. RESULTS: Two themes were identified: HCAs as silent, invisible caregivers (theme 1) and the formation of an HCA identity through mentoring (theme 2). HCAs are often silent performers of complex patient care with limited opportunity to engage in the interprofessional team dialogue. Social perceptions of HCAs describe them as a marginalised, poorly understood, 'unqualified' group with 'lowly status'. Mentoring medical students allows HCAs to draw on their experience, knowledge and skillset by actively contributing to the learning and development of future doctors. CONCLUSION: The mentoring of medical students gave HCAs an active voice within the interprofessional team, instilling their confidence and self-worth. Mentoring allowed HCAs to move from a homogenous, group-based social identity to a role-based one that enabled HCAs to reveal the true extent of their work whilst negotiating their place and identity within the interprofessional team. IMPACT: Leaders in healthcare will see that a re-evaluation of HCAs as performers of basic, hands-on patient care is needed to breakdown ingrained beliefs, eliminating a 'us and them' mentality. Involving HCAs in the mentoring of medical students will impact on the personal development of both HCAs and medical students in the cultivation of a future, person-centred, inclusive and collaborative workforce. REPORTING METHOD: COREQ guidelines to enhance methodological rigour were strictly adhered to. PATIENT AND PUBLIC INVOLVEMENT: There is no patient or public involvement.

Conhecimento dos profissionais intra-hospitalares acerca do suporte básico de vida em uma parada cardiorrespiratória / In-hospital professionals' knowledge about basic life support in cardiac arrest / Conocimiento de los profesionales intrahospitalarios sobre el soporte vital básico en la parada cardíaca

Objetivo: avaliar o efeito da intervenção educativa no conhecimento da equipe de enfermagem sobre o suporte básico de vida para o atendimento à parada cardiorrespiratória de adultos no ambiente intra-hospitalar. Método: estudo transversal com abordagem quantitativa, realizado com 25 profissionais de enfermagem em dois hospitais de região oeste de Santa Catarina - Brasil. Avaliou-se por meio da aplicação de um pré-teste, intervenção educativa e pós-teste. Resultados: houve aumento significativo no conhecimento dos profissionais. O hospital A obteve a média de acertos de 7,23 no pré-teste, elevando para 11,33 no pós-teste, com valor de p ≤ 0,0001. Já o hospital B pontuou 6,07 no pré-teste, progredindo para 11,15 no pós-teste, valor de p ≤ 0,0006. Conclusão: a intervenção realizada demonstrou ser uma estratégia eficaz, visto que os resultados pré-teste demostravam déficit significativo de conhecimento, e após a intervenção educativa, mostraram melhoria na maioria dos itens avaliados em relação ao atendimento específico.

Objective: to evaluate the effect of an educational intervention on the nursing team's knowledge about basic life support for adult cardiac arrest care in the in-hospital environment. Method: cross-sectional study with a quantitative approach, carried out with 25 nursing professionals in two hospitals in the western region of Santa Catarina - Brazil. A pre-test, educational intervention and post-test were applied. Results: there was a significant increase in the professionals' knowledge. Hospital A had a mean score of 7.23 in the pre-test, increasing to 11.33 in the post-test, with p-value ≤ 0.0001. Hospital B scored 6.07 in the pre-test, increasing to 11.15 in the post-test, p-value ≤ 0.0006. Conclusion: the intervention proved to be an effective strategy, since the pre-test results showed significant knowledge deficit, and after the educational intervention, showed improvement in most of the items evaluated in relation to specific care.

Objetivos:evaluar el efecto de una intervención educativa en el conocimiento del equipo de enfermería sobre el soporte vital básico para la atención del paro cardíaco del adulto en el ambiente intrahospitalario. Método: estudio transversal con abordaje cuantitativo, realizado con 25 profesionales de enfermería en dos hospitales de la región oeste de Santa Catarina - Brasil. Se aplicó un pre-test, una intervención educativa y un post-test. Resultados: hubo un aumento significativo de los conocimientos de los profesionales. El Hospital A obtuvo una puntuación media de 7,23 en el pre-test, aumentando a 11,33 en el post-test, con valor p ≤ 0,0001. El Hospital B obtuvo una puntuación de 6,07 en el pre-test, aumentando a 11,15 en el post-test, con valor p ≤ 0,0006. Conclusión: una intervención realizada demostró ser una estrategia eficaz, visto que os resultados previos demostraron un déficit significativo de conhecimento, y después de una intervención educativa, mostraron una mejoría na maioria dos itens avaliados em relação ao atendimento específico.

Interprofessional peer assisted learning: Paramedic students learning falls assessments from Occupational Therapy students.

Peer-assisted learning (PAL) describes a program in which students learn from students from the same health discipline. This teaching method has gained significant momentum over the past decade as an effective learning strategy for undergraduate healthcare students. Paramedic programs are increasingly utilizing PAL, however there is a scarcity of literature about interprofessional PAL, particularly between Paramedics and allied health students. This project was an evaluation of a pilot educational intervention involving final year undergraduate paramedic students. Occupational Therapy (OT) peer instructors facilitated a session on falls' risk assessments during a scheduled undergraduate Paramedic practical class. The OT peer instructors discussed pertinent considerations for Paramedics attending to elderly patients who have fallen, and then provided direct feedback to the Paramedic students during a case simulation. At the conclusion of the session, Paramedic students completed a survey evaluating their reaction to and learning from the teaching session. Results indicated that interprofessional PAL can improve undergraduate paramedic students' knowledge and confidence in performing a new skill that is well understood by another allied health profession. This adds to the body of empirical research on interprofessional PAL and supports its inclusion as a teaching modality into undergraduate healthcare programs such as Paramedicine.

The Core Curriculum for Cardiovascular Nurses and Allied Professionals.

This 2023 update of the Core Curriculum in Cardiovascular Nursing (2015) embraces the formation of the Association of Cardiovascular Nursing and Allied Professionals and reflects the diverse professional backgrounds of our members, including nurses, allied health professionals, and healthcare scientists (in this document referred to collectively as Nurses and Allied Professionals).

Allied HealthWays - a clinical guidance website for allied health in an integrated health system.

Background and context The Canterbury health system adopted a whole-system approach towards integrated patient care. There was a need to optimise the use of allied health resources, across private and public settings. Assessment of the problem There was no common means for consensus and communication among allied health professions about consistent patient care, and barriers such as a lack of trust existed. This paper describes the implementation and monitoring of Allied Healthways, a website for allied health professionals, set up in 2017 using the HealthPathways approach. Results Over 100 pathways have been published on Allied Healthways, with >13 000 clinicians using the site in Canterbury. Targeted education sessions for allied health professionals, combined with newsletters, raised awareness of new pathways or changes in the system. A survey highlighted the usefulness of Allied Healthways, and the majority of respondents agreed that the site should be available nationwide. Strategies for improvement Development of pathways was found to be a useful mechanism for improving integration in the system. The workgroups and direct meetings engaged allied health professionals and helped achieve local consensus on pathways. They also enabled improvements to be designed and then communicated as a pathway. Lessons learnt Although the patient journey should be consistent, irrespective of their point of contact with the health system, guidance and processes need to be relevant to their target audience. It was essential to write pathways specifically for allied health professionals.

Can degrading information about patient symptoms in vignettes alter clinical reasoning in paramedics and paramedic students? An experimental application of fuzzy trace theory.

BACKGROUND: Research has shown paramedics form rapid intuitive impressions on first, meeting a patient and these impressions subsequently affected their clinical reasoning. We report an experiment where theory-based interventions are developed with the goal of reducing reliance on intuitive reasoning by paramedics and paramedic students in simulated patients. METHOD: Australian paramedics (n = 213; 49% female) and paramedicine students (n = 83; 55% female) attending paramedic conferences completed a 2 × 2 fully between participants experiment. They saw a written clinical vignette designed to be representative of Acute Coronary Syndrome (ACS) in which key clinical information was precise or degraded (stimulus), they then either chose the single most likely diagnosis from a list, or ranked competing diagnoses (response). Outcome variables were diagnostic rate and response time. RESULTS: There were no differences in the proportion of participants choosing ACS across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs, 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42) CONCLUSION: This is the first study attempting to experimentally examine clinical reasoning in paramedics using a theory-based intervention. Neither of the interventions tested succeeded in altering measures of clinical reasoning. Similar to previous research on physicians, paramedic reasoning appears robust to manipulation.

Video-Based (Livestream) and In-Person Continuing Professional Development: Participant and Course Features Associated With Choice.

PURPOSE: Information on factors influencing learner choice between in-person and video-based continuing professional development (CPD) would help course leaders with planning and implementation. This study aimed to investigate how registration patterns differ between in-person and video-based offerings for the same CPD course. METHOD: The authors obtained data from 55 CPD courses offered in-person (at various U.S. locations) and via livestreamed video, January 2020 to April 2022. Participants included physicians, advanced practice providers, allied health professionals, nurses, and pharmacists. Registration rates were compared by participant and course features including professional role, age, country of residence, distance to and perceived desirability of the in-person destination, and timing of registration. RESULTS: Analyses included 11,072 registrations, of which 4,336 (39.2%) were for video-based learning. There was significant heterogeneity in video-based registrations across courses, ranging 14.3% to 71.4%. Multivariable analysis showed higher video-based registrations for advanced practice providers (vs physicians; adjusted odds ratio [AOR] 1.80 [99% confidence interval, 1.55-2.10]), non-U.S. residents (AOR 3.26 [1.18-9.01]), longer distance (AOR 1.19 [1.16-1.23] for each doubling of distance), and courses in July-September 2021 (vs January-April 2022; AOR 1.59 [1.24-2.02]); video-based registrations were lower for current or former employees or trainees of our institution (AOR 0.53 [0.45-0.61]), destinations of moderate or high desirability (vs low; AOR 0.42 [0.34-0.51] and 0.44 [0.33-0.58], respectively), and early registration (AOR 0.67 [0.64-0.69] for each doubling of days between registration and course start). There was no significant difference by age (AOR 0.92 [0.82-1.05] for participants > 46 years old vs younger participants). The multivariable model correctly predicted actual registration 78.5% of the time. CONCLUSIONS: Video-based livestreamed CPD is popular (chosen by nearly 40% of participants), although choices varied widely by course. Professional role, institutional affiliation, distance traveled, location desirability, and registration timing have small but statistically significant associations with choice of video-based vs in-person CPD.

Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective.

PURPOSE: Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs' self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences. METHOD: This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options. RESULTS: Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel. CONCLUSIONS: Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload.

Integrated care in cardiovascular disease: a statement of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

In a rapidly changing health and care landscape, there is acknowledgement that the organization of care should be integrated with the patient placed at the centre. In reality, care systems are often fragmented, disjointed, and focused on the condition rather than the patient. The Science Committee of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology recognizes the need for a statement on integrated care to guide health professionals caring for people with cardiovascular disease. This statement outlines the evidence for integrated cardiovascular care, identifies challenges, and offers advice for practice, education, and research.

Paramedic training, experience, and confidence with out-of-hospital childbirth (OOHB) in Australia.

BACKGROUND: Out-of-hospital births (OOHBs) are rare representing ∼0.05% of prehospital callouts. OOHBs are at increased risk of complications including life-threatening conditions such as postpartum haemorrhage and neonate resuscitation. This research investigated Australian paramedics perceptions of' training, experience, and confidence with OOHBs. METHODS: Semi-structured qualitative interviews were undertaken in late 2021 via online conference or face-to-face. Sessions were audio-recorded and transcribed. Data was analysed and coded into over-arching themes using thematic analysis. RESULTS: Fourteen participants were interviewed from military, industrial, and jurisdictional ambulance services. Nine participants were female, and experience ranged from 1.5 to 20 years. Six Australian states were represented, incorporating rural and metropolitan regions. Participants reported sporadic or infrequent training. No participant had exposure to OOHBs during their undergraduate degree, with the most experienced paramedic only attending six births. Participants with little/no experience reported low confidence, and even more experienced participants reported anxiety when attending OOHBs, particularly if there were long distances to definitive care or potential complications. CONCLUSION: Many paramedics expressed low confidence and high anxiety regarding OOHBs, especially regarding complications. Many felt insufficient time was dedicated to OOHBs during education and training. This has the capacity to impact on patient care and outcomes.

Allied health professional's self-reported competences and confidence to deliver physical activity advice to cancer patients at a single Centre in England.

PURPOSE: Allied Health Professionals (AHPs) are well placed to deliver physical activity advice but this is currently not routine clinical practice. Increasing evidence demonstrates physical activity can improve quality-of-life for people affected by cancer, enable behaviour change, improve survival and reduce long-term treatment effects. We aimed to understand AHPs' current knowledge and practice in advising about physical activity. MATERIALS AND METHODS: AHPs' self-reported knowledge, competency and training needs in managing physical effects of cancer, and the merits of physical activity data were collected via an online survey. The survey link was cascaded electronically to all NHS and NHS-affiliated AHPs working across several generic and non-cancer-specific healthcare interfaces across one city in England. RESULTS: Eighty AHPs responded. Forty-one percent of AHPs had patients with current or past diagnoses of cancer. Overall, AHPs reported low confidence in giving physical activity advice, with physiotherapists the most confident. 60% of respondents identified training needs concerning the impact of cancer. CONCLUSIONS: Although the merits of physical activity for people affected by cancer is clearly evidenced, low levels of AHP confidence and competence in discussing this topic limit patients' awareness and access to services. Addressing this confidence and competence has potential to improve patient outcome.

People affected by cancer frequently experience disease and treatment-related impacts which can be detrimental to physical health and well-beingPhysical activity, can restore aspects of physical health and quality of life before, during and after cancer treatmentPeople affected by cancer have frequent points of contact with Allied Health Professionals throughout the cancer pathway and beyond via a variety of rehabilitation servicesWith increased confidence, Allied Health Professionals have the potential to "make every contact count" by providing physical activity advice and information to people affected by cancer across a variety of rehabilitation settingsTraining opportunities and bespoke learning and development offers may provide the platform for improving Allied Health Professional competences and confidence to deliver physical activity advice to people affected by cancerImproving Allied Health Professional skills, knowledge and confidence for people affected by cancer has the potential to influence patient outcomes.

Autonomia em demência avançada e estados vegetativos permanentes na iminência de morte / Autonomía en demencia avanzada y estados vegetativos permanentes al borde de la muerte / Autonomy in advanced dementia and permanent vegetative states in imminent death

RESUMO. A autonomia privada existencial, como expressão da dignidade da pessoa humana, representa para o indivíduo a possibilidade de agir em conformidade com valores e significados eleitos essenciais na elaboração do seu projeto de vida. Neste estudo, seus autores, dois terapeutas ocupacionais, dois advogados e uma psicóloga, somam saberes e dialogam com intuito de demarcar a relevância da autonomia privada existencial nas condições de demência avançada, nos estados vegetativos permanentes e na iminência de morte. Na tarefa a que se propõem, os autores ponderam sobre suas experimentações e interlocuções enquanto profissionais de formação acadêmica diversificada, inclinados a ofertar espaços para comunicar vida e acolher dores. São apresentadas e discutidas as bases jurídicas da autonomia privada, assim como os pressupostos da Logoterapia de Viktor Frankl em defesa da liberdade de vontade e da dignidade no final da vida.

RESUMEN La autonomía existencial privada, como expresión de la dignidad de la persona humana, representa para el individuo la posibilidad de actuar de acuerdo con valores y significados elegidos esenciales en la elaboración de su proyecto de vida. En este estudio, sus autores, dos terapeutas ocupacionales, dos abogados y un psicólogo suman conocimiento y diálogo con el fin de demarcar la relevancia de la autonomía privada existencial en condiciones de demencia avanzada, en estados vegetativos permanentes y muerte inminente. En la tarea que proponen, los autores reflexionan sobre sus vivencias e interlocuciones como profesionales con una formación académica diversificada, inclinados a ofrecer espacios para comunicar la vida y acoger el dolor. Se presentan y discuten las bases legales de la autonomía privada, así como los supuestos de la Logoterapia de Viktor Frankl en defensa de la libertad de voluntad y dignidad al final de la vida.

ABSTRACT. Existential private autonomy, as an expression of the dignity of the human person, represents for the individual the possibility of acting in accordance with essential values and meanings for elaboration of their life project. The authors of this study, two occupational therapists, two lawyers and a psychologist gather their knowledge and dialogue to demarcate the relevance of existential private autonomy in conditions of advanced dementia, in permanent vegetative states and imminent death. In the task proposed, the authors pondered over their experiences and dialogues as professionals with a diversified academic background, inclined to provide spaces to communicate life and welcome pain. The legal bases of private autonomy are presented and discussed, as well as the assumptions of Viktor Frankl's Logotherapy in defense of freedom of will and dignity at the end of life.

Understanding the roles and work of paramedics in primary care: a national cross-sectional survey.

OBJECTIVES: This research aimed to fill a current knowledge gap, namely the current scope of clinical role of paramedics in primary care, in relation to specific constructs such a level of education and clinical experience. SETTING: The survey was distributed to paramedics in primary care across the UK through the College of Paramedics. PARTICIPANTS: A total of 341 surveys were returned (male=215). 90% of responses were from paramedics in England, 1.7% from paramedics in Northern Ireland, 4.6% from paramedics in Scotland and 2.9% from paramedics in Wales. This represents approximately 33% of the primary care paramedic workforce in England and Wales. Estimates for percentages in Northern Ireland and Scotland are unavailable due to the lack of workforce datasets capturing paramedics in primary care. RESULTS: Considerable variation was found in job titles, level of education and provision of clinical supervision of paramedics in primary care. Differing levels of practice were noted, despite guidance documents that attempt to standardise the role. Statistical analysis of quantitative data highlighted that relationships exist between paramedic clinical exposure in primary care, level of education, and ability of independently prescribe medicines and the extent to which clinical presentations are seen and examinations performed. However, free-text responses indicated that challenges in relation to access to further education and clinical supervision to support clinical development resulted in frustration for paramedics who work in this setting. CONCLUSIONS: As well as offering an insight into the demographics of the primary care paramedic work force, there is indication of the clinical scope of role undertaken in this setting. Based on our findings, we recommend changes to education and support, governance and legislation to ensure paramedics employed in primary care can work to achieve the full extent of their professional capability.

The development of community paramedicine; a restricted review.

Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality.

Undergraduate paramedic students and interpersonal communication development: a scoping review.

The objective of this review is to examine the current literature related to interpersonal communication skill development within undergraduate paramedicine. Interpersonal communication is a vital paramedic skill, with evidence demonstrating it leads to improved patient outcomes and satisfaction and reduces medical errors. Interpersonal communication is a core capability set by paramedicine regulatory bodies, and it is the responsibility of accredited universities to ensure graduates are ready for industry and possess all required skills and attributes. In order to be included in this scoping review, all articles were required to meet a pre-determined 'population, concept, context' (PCC) framework. The population was undergraduate paramedic students within the context of their undergraduate paramedicine programs, and the concept was interpersonal communication education/teaching/training. In June 2021, a search was conducted using CINAHL, Medline, Emcare and ERIC. The articles had to be written in English and published between 2011 and 2021 and non-research sources were excluded. 176 articles were identified in this search and after screening for duplicates and relevancy, 15 articles were found to be eligible. The literature highlighted 4 key themes, including graduate perception of 'work readiness', and a variety of learning experiences including alternative work integrated learning (WIL), interactions with specific patient groups and professional learning experiences. The literature demonstrated that interpersonal communication skills are fostered through human interactions, WIL and simulation, within undergraduate paramedicine programs. Findings from the literature review indicate that practising communication through human interactions, afford an increase in confidence, awareness of ability and empathy, and an increased awareness of preconceived biases. Intraprofessional and interprofessional simulation teaching methods demonstrate the potential to build students confidence in communication and awareness of what is required to function well in a team.

Experiences of working as early career allied health professionals and doctors in rural and remote environments: a qualitative systematic review.

BACKGROUND: Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are  generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience. METHODS: Qualitative studies that include early career allied health professionals' or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach. RESULTS: Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors. CONCLUSIONS: Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021223187.

From stretcher bearer to practitioner: A brief narrative review of the history of the Anglo-American paramedic system.

BACKGROUND: This narrative review presents a brief chronological history of the Anglo-American paramedic system, combining decades of stories from across ambulance services in western, English-speaking developed countries METHODS: Databases, including Embase, MEDLINE, Web of Science, CINAHL and Google Scholar were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forwards and backwards searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Included studies were summarised using narrative synthesis structured around the exploration of the history of the Anglo-American paramedic system. RESULTS: The research team structured the narrative in chronological order and used metaphorical models based on philosophical underpinnings to describe in detail each era of paramedicine. The narrative explores several key milestones including, industrial orientation, scope of practice, innovation, education and training, regulation as well as significant clinical and technological advancements in the delivery of traditional and non-traditional paramedic care to patients. CONCLUSIONS: Paramedicine, like other allied health professions, has successfully navigated the pathway toward professionalisation in a considerably short period of time. From its noble beginnings as stretcher bearers in times of war, the profession has looked outwards to emulate the success of our healthcare colleagues in establishing its own unique body of knowledge supported by strong clinical governance, national registration, professional regulatory boards, self-regulation, and a move towards higher education supported by the development of entry-to-practice degrees. Whilst the profession has achieved many great milestones, their application across multiple jurisdictions within the Anglo-American paramedic system remains inconsistent, and more research is needed to explore why this is.

How do paramedics and student paramedics cope? A cross-sectional study.

Despite threats to wellbeing inherent in paramedicine, little is known about how paramedics cope. This study explored the breadth of healthy and unhealthy coping strategies used by paramedics and student paramedics. A convenience sample of 198 paramedics and student paramedics completed an online survey. Wellbeing was measured using WHO-5 and coping using the Coping Index. Primary outcomes were summarised using descriptive statistics. Most of the sample had wellbeing (68%); student paramedics had significantly better wellbeing than paramedics. There was no significant difference between paramedics and student paramedics on healthy or unhealthy coping. Participants with ill-being had significantly fewer healthy and more unhealthy coping strategies than those with wellbeing, and relatively few used professional support (28%). Internationally, few studies have reported coping strategies in paramedics. This study expands our understanding of healthy and unhealthy coping strategies used by paramedics and student paramedics. The results support research that shows paramedic work affects wellbeing, however not that paramedics are at greater risk of unhealthy coping than students or the general population. The results have implications for both the prevention of overwhelming distress in the workplace and the need to increase the use of professional support to prevent unhealthy coping, including suicidality.

Research training incorporating education and mentoring for rural and regional allied health professionals: An evaluation study.

INTRODUCTION AND OBJECTIVE: Building rural health workforce research capacity is critical to addressing rural health inequalities. Research training is a mainstay research capacity building strategy. This paper describes the delivery and evaluation of a research training program for rural and regional allied health professions (AHPs). DESIGN: A mentored research training program was delivered to AHPs employed public health services in rural and regional Victoria, Australia. The program was evaluated using the Evidence-Based Practice Knowledge Attitudes and Practice (EBP-KAP) tool at baseline and 3 months post-training. Semi-structured interviews undertaken at 3 and 16 months post-training explored participants' perspectives of the training, their development and application of EBP and research skills. Survey data were analysed descriptively, and interview data were analysed using a framework approach. FINDINGS: Thirty-four individuals from 14 organisations attended the first workshop and 31 attended the second. Thirty-one participants completed the survey at baseline and nine at 3 months post-training. Sixteen interviews were undertaken with 11 participants, five participating at both time points. Participants had positive EBP attitudes at both time points. Overall, participants' knowledge and incorporation of EBP into their practice, and retrieval of evidence was unchanged 3 months post-training. Themes identified in the interview data were as follows: (1) individual research capacity enhanced through supported practice, (2) organisational factors influence individuals' progression of research and (3) individual contributions towards research capacity within the organisation. CONCLUSION: A mentored rural research training program promoted the application of EBP skills at the individual level and contributed to organisational research capacity.