Clarke Alan
University of Wolverhampton.
Br Paramed J. 2019 Dec 1;4(3):1-7. doi: 10.29045/14784726.2019.12.4.3.1.
Little is known about paramedics who have left the ambulance service to work in emergency departments (EDs). This study sought to explore the lived experiences of paramedics working in specialist/advanced ED roles, focusing on role transition, influences on effective clinical practice and perceptions of role optimisation. A secondary aim of the study was to make recommendations on the future development of specialist/advanced ED roles for paramedics.
This was a qualitative study utilising descriptive phenomenology to collect and describe the lived experiences of participants via semi-structured interviews. The final sample comprised three emergency care practitioners (ECPs), three student ECPs and two advanced clinical practitioners (ACPs), all Health and Care Professions Council registered paramedics. Interview data were transcribed verbatim and analysed using inductive thematic analysis.
Transition to the ED involves significant adjustment to a new clinical environment, responsibilities and decision making.Pre-hospital physical assessment and history taking skills, and experience of autonomous working are pertinent enablers to effective practice within the ED.Difficulties in accessing medication in the ED emerged as a significant barrier to daily practice that could affect the patient experience and influence perceptions of sub-optimal working.Misconceptions by ED staff regarding paramedic competencies could lead to role confusion and make inter-professional working difficult.Opportunities exist for future role expansion into areas such as resus, majors and paediatrics within the ED environment.
While role transition to the ED represents a turbulent period for paramedics, elements of pre-hospital paramedic practice transfer directly into ED roles and contribute to effective practice. Participants found that they were accepted and supported to work in the ED setting and spoke positively of future role expansion. A lack of access to medicines presents a significant barrier to current clinical practice and a disparity in practice between paramedics and their nursing counterparts. The change in legislation to allow independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing arrangements to paramedics, improving the quality and safety of care they provide and ultimately the patient experience.
对于已离开急救服务部门转而在急诊科工作的护理人员，我们了解甚少。本研究旨在探索担任专科/高级急诊科职位的护理人员的生活经历，重点关注角色转变、对有效临床实践的影响以及对角色优化的看法。该研究的第二个目的是就护理人员专科/高级急诊科职位的未来发展提出建议。
这是一项定性研究，采用描述性现象学方法，通过半结构化访谈收集和描述参与者的生活经历。最终样本包括三名急救护理人员、三名急救护理专业学生和两名高级临床从业者，他们均为健康与护理专业委员会注册的护理人员。访谈数据逐字转录，并采用归纳主题分析法进行分析。
向急诊科的角色转变涉及对新临床环境、职责和决策的重大调整。院前身体评估和病史采集技能以及自主工作经验是在急诊科有效开展工作的相关促成因素。在急诊科获取药物困难成为日常实践的重大障碍，这可能影响患者体验并影响对工作不理想的看法。急诊科工作人员对护理人员能力的误解可能导致角色混乱，并使跨专业协作变得困难。在急诊科环境中，未来有机会将角色扩展到复苏、重症和儿科等领域。
虽然向急诊科的角色转变对护理人员来说是一个动荡时期，但院前护理人员实践的一些要素可直接转移到急诊科角色中，并有助于有效实践。参与者发现他们在急诊科工作得到认可和支持，并对未来角色扩展给予积极评价。获取药物困难是当前临床实践的重大障碍，护理人员与其护理同行之间存在实践差异。允许高级护理人员独立开处方的立法变化将解决其中一些问题，但需要进行临时改进，将现有安排扩展到护理人员，提高他们提供的护理质量和安全性，最终改善患者体验。
