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6.
Emerg Med J ; 36(10): 582-588, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31320333

RESUMO

OBJECTIVE: To characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit. METHODS: We performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018. RESULTS: The most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%). CONCLUSIONS: Emergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.


Assuntos
Barreiras de Comunicação , Serviço Hospitalar de Emergência/organização & administração , Relações Profissional-Paciente , Tradução , Adulto , Pessoal Técnico de Saúde/organização & administração , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Telefone , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
7.
Manchester; The National Institute for Health and Care Excellence (NICE); June 2019. 44 p.
Monografia em Inglês | BIGG - guias GRADE | ID: biblio-1014953

RESUMO

This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. Based on the stepped-care model, it aims to improve recognition and assessment and promote effective treatments for mild and moderate to severe depression.


Assuntos
Humanos , Criança , Adulto , Depressão/diagnóstico , Depressão/psicologia , Depressão/terapia , Saúde Mental , Pessoal Técnico de Saúde/organização & administração , Anamnese
8.
BMC Health Serv Res ; 19(1): 429, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248420

RESUMO

BACKGROUND: With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study. METHODS: Primary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use. RESULTS: More than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by "using gestures" (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified. CONCLUSION: Language barriers are relevant in primary care. Improved access to professional interpreters is warranted.


Assuntos
Barreiras de Comunicação , Comunicação , Atenção Primária à Saúde , Encaminhamento e Consulta/organização & administração , Migrantes , Tradução , Adulto , Pessoal Técnico de Saúde/organização & administração , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Suíça , Migrantes/estatística & dados numéricos
9.
BMC Health Serv Res ; 19(1): 241, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014334

RESUMO

BACKGROUND: Shortage of specialized healthcare volunteers is a major challenge during disasters and one solution could be pre-identified healthcare volunteers. This study aimed to develop a conceptual model of managing Iranian healthcare volunteers in disasters. METHODS: This mixed method study was designed in two phases. A qualitative study using semi-structured interviews was conducted with 22 health professionals and key informant. The interviews were analyzed by framework analysis. In the second phase, concepts derived from the first step were evaluated in a two round Delphi study by an expert panel comprised of 42 experts. RESULTS: Two themes and eight subthemes were identified based on the results of the first phase. The theme of background requirements included three sub-themes of laws and regulations, NGOs and socio-cultural factors. The second theme was called operational requirements which included six subthemes of preparedness, response, retention, relocation, terminating and follow-up. According to the results of the Delphi study, all of the concepts were confirmed. CONCLUSION: In addition to the need for supportive legal framework and building the culture of volunteering, it seems it is crucial to identify and prepare the health care volunteers in the preparedness phase and assign them appropriately in the response phase. Furthermore, the necessary measures should be prioritized to enhance volunteers' retention rate and motivation. Plans should also be implemented for volunteers' termination and volunteers' physical and mental health follow up after their mission.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Planejamento em Desastres/organização & administração , Desastres , Voluntários/educação , Adulto , Pessoal Técnico de Saúde/educação , Técnica Delfos , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
10.
PLoS Med ; 16(4): e1002785, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31013275

RESUMO

BACKGROUND: Schizophrenia is a leading cause of disability, and a shift from facility- to community-based care has been proposed to meet the resource challenges of mental healthcare in low- and middle-income countries. We hypothesized that the addition of mobile texting would improve schizophrenia care in a resource-poor community setting compared with a community-based free-medicine program alone. METHODS AND FINDINGS: In this 2-arm randomized controlled trial, 278 community-dwelling villagers (patient participants) were randomly selected from people with schizophrenia from 9 townships of Hunan, China, and were randomized 1:1 into 2 groups. The program participants were recruited between May 1, 2015, and August 31, 2015, and the intervention and follow-up took place between December 15, 2015, and July 1, 2016. Baseline characteristics of the 2 groups were similar. The patients were on average 46 years of age, had 7 years of education, had a duration of schizophrenia of 18 years with minimal to mild symptoms and nearly one-fifth loss of functioning, and were mostly living with family (95%) and had low incomes. Both the intervention and the control groups received a nationwide community-based mental health program that provided free antipsychotic medications. The patient participants in the intervention group also received LEAN (Lay health supporters, E-platform, Award, and iNtegration), a program that featured recruitment of a lay health supporter and text messages for medication reminders, health education, monitoring of early signs of relapses, and facilitated linkage to primary healthcare. The primary outcome was medication adherence (proportion of dosages taken) assessed by 2 unannounced home-based pill counts 30 days apart at the 6-month endpoint. The secondary and other outcomes included patient symptoms, functioning, relapses, re-hospitalizations, death for any reason, wandering away without notifying anyone, violence against others, damaging goods, and suicide. Intent-to-treat analysis was used. Missing data were handled with multiple imputations. In total, 271 out of 278 patient participants were successfully followed up for outcome assessment. Medication adherence was 0.48 in the control group and 0.61 in the intervention group (adjusted mean difference [AMD] 0.12 [95% CI 0.03 to 0.22]; p = 0.013; effect size 0.38). Among secondary and other outcomes we noted substantial reduction in the risk of relapse (26 [21.7%] of 120 interventional participants versus 40 [34.2%] of 117 controls; relative risk 0.63 [95% CI 0.42 to 0.97]; number needed to treat [NNT] 8.0) and re-hospitalization (9 [7.3%] of 123 interventional participants versus 25 [20.5%] of 122 controls; relative risk 0.36 [95% CI 0.17 to 0.73]; NNT 7.6). The program showed no statistical difference in all other outcomes. During the course of the program, 2 participants in the intervention group and 1 in the control group died. The limitations of the study include its lack of a full economic analysis, lack of individual tailoring of the text messages, the relatively short 6-month follow-up, and the generalizability constraint of the Chinese context. CONCLUSIONS: The addition of texting to patients and their lay health supporters in a resource-poor community setting was more effective than a free-medicine program alone in improving medication adherence and reducing relapses and re-hospitalizations. Future studies may test the effectiveness of customization of the texting to individual patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-ICR-15006053.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Adesão à Medicação , Sistemas de Apoio Psicossocial , Esquizofrenia/tratamento farmacológico , Esquizofrenia/fisiopatologia , Envio de Mensagens de Texto , Adulto , Telefone Celular , China , Feminino , Recursos em Saúde , Humanos , Vida Independente/psicologia , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Participação do Paciente , Desempenho Físico Funcional , Áreas de Pobreza , Sistemas de Alerta , População Rural , Esquizofrenia/patologia , Psicologia do Esquizofrênico
11.
BMJ Open ; 9(3): e023385, 2019 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-30833312

RESUMO

OBJECTIVES: To explore the impact of eye clinic liaison officers (ECLOs, also known as sight loss advisors) on the processes, functions and quality of ophthalmology clinics through the experiences of ophthalmology staff in the UK. DESIGN: Qualitative study. SETTING: UK hospital ophthalmology clinics. PARTICIPANTS: Health and social care professionals in the UK. RESULTS: ECLOs who had a presence in hospital ophthalmology clinics were seen as valuable in streamlining processes within the clinic, particularly in relation to the certification of visual impairment process, and providing continuity of care for patients when they were discharged from medical treatment. ECLOs also saved staff time in the clinic, as they were often responsible for providing emotional and practical support for patients living with sight loss. CONCLUSIONS: ECLOs are well placed in ophthalmology clinics. They can relieve pressure on clinical staff by taking on information giving and referring duties, allowing other staff to focus on their clinical responsibilities. The impact of ECLOs may depend on efficient communication with the clinical team, being trusted by other staff and having a good knowledge of local and national sight loss support services outside of the hospital setting. Further research could enhance our understanding of how much time and associated costs ECLOs substitute in the ophthalmology clinic.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Atitude do Pessoal de Saúde , Oftalmologia/organização & administração , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Reino Unido , Transtornos da Visão/terapia
12.
Rural Remote Health ; 19(1): 4888, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30704256

RESUMO

INTRODUCTION: Community paramedicine is one emerging model filling gaps in rural healthcare delivery. It can expand the reach of primary care and public health service provision in underserviced rural communities through proactive engagement of paramedics in preventative care and chronic disease management. This study addressed key research priorities identified at the National Agenda for Community Paramedicine Research conference in Atlanta, USA in 2012. The motivations, job satisfaction and challenges from the perspectives of community paramedics and their managers pioneering two independent programs in rural North America were identified. METHODS: An observational ethnographic approach was used to acquire qualitative data from participants, through informal discussions, semi-structured interviews, focus groups and direct observation of practice. During field trips over two summers, researchers purposively recruited participants from Ontario, Canada and Colorado, USA. These sites were selected on the basis of uncomplicated facilitation of ethics and institutional approval, the diversity of the programs and willingness of service managers to welcome researchers. Thematic analysis techniques were adopted for transcribing, de-identifying and coding data that allowed identification of common themes. RESULTS: This study highlighted that the innovative nature of the community paramedic role can leave practitioners feeling misunderstood and unsupported by their peers. Three themes emerged: the motivators driving participation, the transitional challenges facing practitioners and the characteristics of paramedics engaged in these roles. A major motivator is the growing use of ambulances for non-emergency calls and the associated need to develop strategies to combat this phenomenon. This has prompted paramedic service managers to engage stakeholders to explore ways they could be more proactive in health promotion and hospital avoidance. Community paramedicine programs are fostering collaborative partnerships between disciplines, while the positive outcomes for patients and health cost savings are tangible motivators for paramedic services and funders. Paramedics were motivated by a genuine desire to make a difference and attracted to the innovative nature of a role delivering preventative care options for patients. Transitional challenges included lack of self-regulation, navigating untraditional roles and managing role boundary tensions between disciplines. Community paramedics in this study were largely self-selected, genuinely interested in the concept and proactively engaged in the grassroots development of these programs. These paramedics were comfortable integrating and operating within multidisciplinary teams. CONCLUSIONS: Improved education and communication from paramedic service management with staff and external stakeholders might improve transitional processes and better support a culture of inclusivity for community paramedicine programs. Experienced and highly motivated paramedics with excellent communication and interpersonal skills should be considered for community paramedic roles. Practitioners who are proactive about community paramedicine and self-nominate for positions transition more easily into the role: they tend to see the 'bigger picture', have broader insight into public health issues and the benefits of integrative health care. They are more likely to achieve higher job satisfaction, remain in the role longer, and contribute to better long-term program outcomes. Paramedic services and policymakers can use these findings to incentivize career pathways in community paramedicine and understand those changes that might better support this innovative model.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Serviços Médicos de Emergência/organização & administração , Auxiliares de Emergência/organização & administração , Relações Interprofissionais , Serviços de Saúde Rural/organização & administração , Adulto , Pessoal Técnico de Saúde/educação , Colorado , Comportamento Cooperativo , Auxiliares de Emergência/educação , Feminino , Humanos , Masculino , Ontário , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Estados Unidos
13.
J Ment Health ; 28(1): 89-96, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30269628

RESUMO

BACKGROUND: Mental illness is a recognised global health issue and is a major burden of disease that health systems have failed to adequately address. National reforms in Australia to improve mental health service delivery propose building the knowledge and skills of service providers, such as paramedics, to ensure that they appropriately respond to the needs of people experiencing mental health issues. There is a paucity of literature on the role of paramedics in managing mental health presentations despite becoming an increasingly significant part of mental health care in the pre-hospital context. AIMS: This scoping review examined the available literature on the paramedic management of mental health related presentations. METHODS: The five stages of Arksey and O'Malley's methodological framework was used: (1) identifying the research question; (2) identifying relevant studies; (3) study section; (4) charting the data; and (5) collating, summarizing and reporting of results. Relevant databases were searched. RESULTS: Fourteen peer-reviewed articles met the inclusion criteria. Three themes were identified and structured the findings. These were education and training, organizational factors, and clinical decision making. CONCLUSION: The authors recommend that future research address these areas, as high quality evidence will support planning in this complex area of health care delivery.


Assuntos
Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/organização & administração , Serviços de Saúde Mental , Competência Clínica , Tomada de Decisão Clínica , Humanos , Lacunas da Prática Profissional
15.
BMJ Open ; 8(12): e019572, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552239

RESUMO

INTRODUCTION: Type 2 diabetes mellitus (T2DM) and its complications are more common among Maori and Pacific people compared with other ethnic groups in New Zealand. Comprehensive and sustained approaches that address social determinants of health are required to address this condition, including culturally specific interventions. Currently, New Zealand has no comprehensive T2DM management programme for Maori or Pacific people. METHODS AND ANALYSIS: The Mana Tu programme was developed by a Maori-led collaborative of primary healthcare workers and researchers, and codesigned with whanau (patients and their families) in order to address this gap. The programme is based in primary care and has three major components: a Network hub, Kai Manaaki (skilled case managers who work with whanau with poorly controlled diabetes) and a cross-sector network of services to whom whanau can be referred to address the wider determinants of health. The Network hub supports the delivery of the intervention through training of Kai Manaaki, referrals management, cross-sector network development and quality improvement of the programme. A two-arm cluster randomised controlled trial will be conducted to evaluate the effectiveness of the Mana Tu programme among Maori, Pacific people or those living in areas of high socioeconomic deprivation who also have poorly controlled diabetes (glycated haemoglobin, HbA1c, >65 mmol/mol (8%)), compared with being on a wait list for the programme. A total of 400 participants will be included from 10 general practices (5 practices per group, 40 participants per practice). The primary outcome is HbA1c at 12 months. Secondary outcomes include blood pressure, lipid levels, body mass index and smoking status at 12 months. This protocol outlines the proposed study design and analysis methods. ETHICS AND DISSEMINATION: Ethical approval for the trial has been obtained from the New Zealand Health and Disability Ethics Committee (17/NTB/249). Findings will be presented to practices and their patients at appropriate fora, and disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: ACTRN12617001276347; Pre-result.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Assistência Integral à Saúde/organização & administração , Diabetes Mellitus Tipo 2/etnologia , Serviços de Saúde do Indígena/organização & administração , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Feminino , Seguimentos , Hemoglobina A Glicada/metabolismo , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Planejamento de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Abandono do Hábito de Fumar , Resultado do Tratamento
16.
BMC Health Serv Res ; 18(1): 859, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30428869

RESUMO

BACKGROUND: Many asylum-seekers to Denmark come from war-torn countries where conflict and insufficient health care infrastructures disrupt vaccine programmes and result in very few children and their families presenting documentation of vaccinations on their arrival in asylum-centers. There is a need to explore how healthcare providers, in the absence of vaccine documentation, determine the vaccination needs of newly arrived refugee children. METHODS: To explore the tactics employed by healthcare professionals who screen and vaccinate asylum-seeking children in Denmark, we conducted semi-structured interviews between December 2015 and January 2016 with six healthcare professionals, including three doctors and three public health nurses. The interviews were digitally recorded, transcribed and subjected to a thematic network analysis. RESULTS: The analysis revealed that healthcare providers adopt a number of tactics to ascertain children's immunization needs. They ask into the children's vaccination history through the use of qualified interpreters; consult WHO lists of immunization programmes worldwide; draw on tacit knowledge about country vaccination programmes; consider the background of parents; err on the side of caution and revaccinate. CONCLUSIONS: This is one of the first studies to demonstrate the tactics employed by healthcare providers to ascertain the immunization needs of asylum-seeking children in a western receiving country. The findings suggest a need for clear guidance at a national level on how to determine the vaccination needs of asylum-seeking children, and an international effort to secure reliable immunization documentation for migrant populations, for example through virtual immunization records.


Assuntos
Pessoal de Saúde/organização & administração , Prática Profissional/organização & administração , Refugiados/estatística & dados numéricos , Vacinação , Adolescente , Idoso , Pessoal Técnico de Saúde/organização & administração , Criança , Pré-Escolar , Dinamarca , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pais , Pesquisa Qualitativa , Encaminhamento e Consulta , Vacinas
17.
Radiography (Lond) ; 24(4): 298-303, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30292497

RESUMO

INTRODUCTION: A study was proposed to examine the impact to patients and the Oncology review team, of extending the role of the Therapeutic Radiographer to undertake follow up review of prostate cancer patients who have completed a radical course of external beam radiotherapy treatment. METHOD: A total of 30 patients attending for routine radiotherapy follow up were included in an observational study. Patients were assigned for review with a Doctor or a Therapeutic Radiographer using 1:1 randomisation and a number of time points were recorded and analysed. RESULTS: Of the 44 patients screened, 30 patients were recruited. Average time from scheduled appointment time to departure from clinic was 36 min for both the doctor and Therapeutic Radiographer. The average length of Consultation was 19 min for the Therapeutic Radiographer and 10 min for the Doctor. Average length of wait for patients from scheduled appointment time to being taken for review was 17 min for the Therapeutic Radiographer and 25 min for the Doctor. Of the patients who completed questionnaires, 23/28 had no preference of reviewer, 2/28 declared a preference to be seen by a doctor, whilst 3/28 stated a preference for review with a Therapeutic Radiographer. CONCLUSION: The results of the study are encouraging and should be further investigated in an attempt of developing what would be a very rewarding aspect of the Therapeutic Radiographers role.


Assuntos
Assistência ao Convalescente/métodos , Pessoal Técnico de Saúde , Neoplasias da Próstata/radioterapia , Radiografia/métodos , Adulto , Pessoal Técnico de Saúde/organização & administração , Humanos , Masculino , Satisfação do Paciente , Papel Profissional , Estudos Prospectivos , Inquéritos e Questionários
18.
Implement Sci ; 13(1): 127, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261927

RESUMO

BACKGROUND: Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals. METHODS: A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals' use of research were eligible for inclusion. Studies were excluded if leadership could not be clearly attributed to someone in a management position. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. Narrative synthesis was conducted. RESULTS: The search yielded 7019 unique titles and abstracts after duplicates were removed. Three hundred five full-text articles were reviewed, and 31 studies reported in 34 articles were included. Methods used were qualitative (n = 19), cross-sectional survey (n = 9), and mixed methods (n = 3). All studies included nurses, and six also included allied health professionals. Twelve leadership behaviours were extracted from the data for point-of-care managers and ten for senior managers. Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented, relation-oriented and task-oriented behaviours. The most commonly described behavior was support for the change, which involved demonstrating conceptual and operational commitment to research-based practices. CONCLUSIONS: This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action. Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care. While findings explain how managers enact leadership for research use, we now require robust methodological studies to determine which behaviours are effective in enabling research use with nurses and allied health professionals for high-quality evidence-based care. TRIAL REGISTRATION: PROSPERO CRD42014007660.


Assuntos
Pessoal Técnico de Saúde/organização & administração , Liderança , Enfermagem/organização & administração , Cultura Organizacional , Pesquisa/organização & administração , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Ciência da Implementação , Disseminação de Informação , Pesquisa em Enfermagem
19.
CJEM ; 20(4): 518-522, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30033895

RESUMO

OBJECTIVE: The Collaborative Emergency Centre (CEC) model of care was implemented in Nova Scotia without an identifiable, directly comparable precedent. It features interprofessional teams working towards the goal of providing improved access to primary health care, and appropriate access to 24/7 emergency care. One important component of CEC functioning is overnight staffing by a paramedic and registered nurse (RN) team consulting with an off-site physician. Our objective was to ascertain the attitudes, feelings and experiences of paramedics working within Nova Scotia's CECs. METHODS: We conducted a qualitative study informed by the principles of grounded theory. Semi-structured telephone interviews were conducted with paramedics with experience working in a CEC. Analysis involved an inductive grounded approach using constant comparative analysis. Data collection and analysis continued until thematic saturation was reached. RESULTS: Fourteen paramedics participated in the study. The majority were male (n=10, 71%) with a mean age of 44 years and mean paramedic experience of 14 years. Four major themes were identified: 1) interprofessional relationships, 2) leadership support, 3) value to community and 4) paramedic identity. CONCLUSIONS: Paramedics report largely positive interprofessional relationships in Nova Scotia's CECs. They expressed enjoyment working in these centres and believe this work aligns with their professional identity. High levels of patient and community satisfaction were reported. Paramedics believe future expansion of the model would benefit from development of continuing education and improved communication between leadership and front-line workers.


Assuntos
Serviços Médicos de Emergência/organização & administração , Auxiliares de Emergência/organização & administração , Medicina de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Adulto , Pessoal Técnico de Saúde/organização & administração , Feminino , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Liderança , Masculino , Pessoa de Meia-Idade , Nova Escócia , Equipe de Assistência ao Paciente/organização & administração , Pesquisa Qualitativa
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