This article takes its point of departure from the younger generation's problematic relationship with time and the future. A general sense of changeability and directionlessness in society compromises young people's confidence in themselves to make a difference as individuals in important global issues affecting their futures, such as climate change. Given recent aims and commitments of science education to promote sustainable development and student agency, this study explores how science teaching can help students imagine and face possible future scenarios and develop agency in the present to influence them. This article presents a science education approach to equip secondary school students with skills of futures thinking and agency that we call “future‐scaffolding skills.” It also shows the process of building an operational definition for recognizing those skills in students' discourse and actions. For this purpose, an empirical study was carried out in the context of a teaching–learning module on climate change, consisting of activities inspired by the field of futures studies. Essays, individual and group interviews, questionnaires, and video recordings of students' final projects were collected from 24 students (16–19‐years old) from three European countries. The results contribute to operationally defining “future‐scaffolding skills,” consisting of “structural skills” (the ability to recognize temporal, logical and causal relationships and build systemic views) and “dynamical skills” (the ability to navigate scenarios, relating local details to global views, past to present and future, and individual to collective actions).

Introduction: Pre-hospital pain management in children is poor, with very few children in pain receiving analgesia. Without effective pain treatment, children may suffer long-term changes in stress hormone responses and pain perception and are at risk of developing posttraumatic stress disorder. We aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting.Methods: A retrospective cross-sectional study using electronic clinical records from one large UK ambulance service between 1 October 2017 and 30 September 2018 was performed using multi-variable logistic regression. We included all children < 18 years suffering acute pain. Children with a Glasgow Coma Scale of < 15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥ 2 out of 10 using the numeric pain rating scale, Wong and Baker FACES® scale or Face, Legs, Activity, Crying and Consolability (FLACC) scale).Results: A total of 2312 patients were included for analysis. Median (IQR) age was 13 (9‐16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0‐5 years) compared to older (12‐17 years) (adjusted odds ratio (AOR) 1.57; 95% confidence interval (CI) 1.21‐2.03), administered analgesia (AOR 2.35; CI 1.94‐2.84), attended by a paramedic (AOR 1.39; CI 1.13‐1.70) or living in an area of medium deprivation (index of multiple deprivation (IMD) 4‐7) compared to children in an area of high deprivation (IMD 1‐3) (AOR 1.41; CI 1.10‐1.79). Child gender, type of pain, transport time and clinician experience were not significant.Conclusion: These predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.

Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and conducted semi-structured interviews. The data was analyzed in iterative cycles of inductive and deductive reasoning using Abductive Thematic Network Analysis. The analysis was informed by psychological theory, as well as models from the wider feedback effectiveness and feedback-seeking behavior literature. Results Participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Reported types of prehospital feedback included patient outcome feedback, patient-experience feedback, peer-to-peer feedback, performance feedback, feedforward: on-scene advice, debriefing and investigations and coroners’ reports. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was thought to improve patient care and staff wellbeing by supporting personal and professional development. Conclusions In line with previous research in this area, this study highlights EMS professionals’ strong desire for feedback. The study advances the literature by suggesting a typology of prehospital feedback and presenting a unique insight into the motives for feedback-seeking using psychological theory. A logic model for prehospital feedback interventions was developed to inform future research and development into prehospital feedback.

BackgroundExtensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development.MethodsA systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses.ResultsThe search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity.ConclusionThis review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS.PROSPERO registration numberCRD42020162600.