Foerster Christopher R, Tavares Walter, Virkkunen Ilkka, Kämäräinen Antti
*Lambton EMS,Lambton County,ON.
†Paramedic Program,Centennial College,Toronto,ON.
CJEM. 2018 Mar;20(2):238-246. doi: 10.1017/cem.2017.36. Epub 2017 Jun 7.
Paramedicine is often dependent on physician medical directors and their associated programs for direction and oversight. A positive relationship between paramedics and their oversight physicians promotes safety and quality care while a strained or ineffective one may threaten these goals. The objective of this study was to explore and understand the professional relationship between paramedics and physician medical oversight as viewed by front-line paramedics.
All active front-line paramedics from four municipal paramedic services involving three medical oversight groups in Ontario were invited to complete an online survey.
Five hundred and four paramedics were invited to participate in the study, with 242 completing the survey (48% response rate); 66% male, 76% primary care paramedics with an average of 13 (SD=9) years of experience. Paramedics had neutral or positive perceptions regarding their autonomy, opportunities to interact with their medical director, and medical director understanding of the prehospital setting. Paramedics perceived medical directives as rigid and ambiguous. A significant amount of respondents reported a perception of having provided suboptimal patient care due to fear of legal or disciplinary consequences. Issues of a lack of support for critical thinking and a lack of trust between paramedics and medical oversight groups were often raised.
Paramedic perceptions of physician medical oversight were mixed. Concerning areas identified were perceptions of ambiguous written directives and concerns related to the level of trust and support for critical thinking. These perceptions may have implications for the system of care and should be explored further.
护理急救往往依赖于医师医疗主任及其相关项目来提供指导和监督。护理急救人员与其监督医师之间的积极关系可促进安全和优质护理，而紧张或无效的关系可能会威胁到这些目标。本研究的目的是探讨和理解一线护理急救人员所认为的护理急救人员与医师医疗监督之间的专业关系。
邀请安大略省四个城市护理急救服务机构中涉及三个医疗监督小组的所有在职一线护理急救人员完成一项在线调查。
邀请了504名护理急救人员参与研究，其中242人完成了调查（回复率为48%）；男性占66%，初级护理急救人员占76%，平均工作经验为13年（标准差=9）。护理急救人员对其自主性、与医疗主任互动的机会以及医疗主任对院前环境的理解持中立或积极看法。护理急救人员认为医疗指令既严格又模糊。大量受访者表示，由于担心法律或纪律后果，他们认为自己提供的患者护理不够理想。护理急救人员经常提出缺乏批判性思维支持以及与医疗监督小组缺乏信任的问题。
护理急救人员对医师医疗监督的看法不一。已确定的令人担忧的领域包括对书面指令模糊性的看法以及与批判性思维的信任和支持水平相关的问题。这些看法可能会对护理系统产生影响，应进一步探讨。
