Improving Paramedic Confidence with Paediatric Patients: A Scoping Review

Fowler, James B.; Beovich, Bronwyn; Williams, Brett

doi:10.33151/ajp.15.1.559

Cited by 15 publications

(12 citation statements)

References 38 publications

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“…While years of clinical experience cannot be replaced, we argue, based on our findings, there is a need for dedicated and ongoing resources targeting specialised paediatric sepsis education to enhance exposure; to supplement years of experience. These findings are supported in previous literature identifying that paediatric training and resources enhanced clinician’s exposure to and subsequent confidence in delivering care to critically unwell paediatrics [ 51 , 63 ].…”

Section: Discussionsupporting

confidence: 85%

“…Indeed, a recent university study concluded knowledge of paediatric sepsis was as low as 8% in graduating nurses in Queensland, Australia [ 64 ]. The importance of specified paediatric training, including post-graduate qualifications, facility mandated courses and certification, requires exploration in the future development of health services and education [ 55 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

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Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Harley

Schlapbach

Lister

et al. 2021

BMC Health Serv Res

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Background Several health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis Campaign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs. Methods This cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses’ perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables. Results In total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% (IQR = 46.7–66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score. Conclusion Translation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Harley

Schlapbach

Lister

et al. 2021

BMC Health Serv Res

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“…This may be reflective of the low level of exposure to research education in paramedic training programmes58 and provides an opportunity for intervention. Adults only being offered Treat and Referral is consistent with other findings 50.…”

supporting

confidence: 90%

“…This finding among PHECC practitioners was anticipated as research suggests that providing emergency care for paediatric patients can evoke anxiety and discomfort among pre-hospital practitioners. 50 'GPs shall be informed through e-mail following Treat and Referral for their patient' has little support from PHECC practitioners (48%) while EM consultants supported it by a large majority (89%). There is a highly statistical difference between PHECC practitioners and EM consultants on this statement (p < 0.001).…”

Section: These Two Statements Demonstrate Divergence Of Opinion On What Clinical Level Ismentioning

confidence: 99%

Stakeholder Opinion on the proposal to introduce ‘Treat and Referral’ into the Irish Emergency Medical Service.

Power¹,

Bury

Ryan

2019

Preprint

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Background: The Irish ambulance services have traditionally transported all patients following an emergency (112/999) call, regardless of acuity, to an ED. A proposal to introduce Treat and Referral, an established care pathway in some jurisdictions, is under active consideration in Ireland. This will present a significant change. Stakeholder engagement is recognised as an essential component of management of such change. This study has conducted a multicentre, cross-sectional survey exploring opinions on the introduction of Treat and Referral among key Irish stakeholders; consultants in emergency medicine, paramedics and advanced paramedics. Methods: Public-sector consultants in emergency medicine, registered paramedics and advanced paramedics, in Ireland at the time of the study, were invited to complete an on-line survey. Results: A significant finding was that 90% of both cohorts (EM consultants and PHECC practitioners) support written after-care instructions being given to referred patients, that > 83% agree that Treat and Referral will reduce unnecessary ambulance journeys and that 70% are in favour of their own family member being offered Treat and Referral. Consensus was reached between respondents that Treat and Referral would improve care and increase clinical judgement of practitioners. Differences were identified in relation to the increased availability of ambulances locally, that only adults should be included, and that research was required to extend Treat and Referral beyond the index conditions. There was no consensus on whether GPs should be directly informed. Conclusions: This study identified that the Irish healthcare practitioners surveyed are supportive of the introduction of Treat and Referral into Ireland. It also affords healthcare policymakers the opportunity to address the concerns raised, in particular the clinical level which will be targeted for inclusion in this extended scope of practice.

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“…Taking Healthcare To The Patient (Department of Health (DoH),2005), Transforming Ambulance services ( National Audit Office (NAO), 2011) and Taking Healthcare to the Patient 2 (Association of Ambulance Chief Executives (AACE), 2011) have all lent to positive transformation of the ambulance service model of care but within them there has been little mention specific to paediatric care. Fowler, Beovich and Williams (2017) scoping review of the literature surrounding paramedic confidence with paediatric patients revealed feelings of low confidence and efficacy. This was under pinned by anxiety and showed correlation with a potential of lower quality care for paediatric patients and reluctance to initiate treatment.…”

Section: Introductionmentioning

confidence: 99%

What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

Hetherington

Jones

2021

British Paramedic Journal

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Background: Children’s healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community.Aim: This study looked to understand the lived experiences of paramedics when attending to paediatric patients, and what factors influenced decision making.Methods: A qualitative study employing semi-structured interviews, to collect and describe the lived experiences of participants. Participants were paramedics working for an ambulance service responding to calls in the community. Participants varied in experience and registrant level of education. Interview data were transcribed verbatim and analysed utilising inductive thematic analysis.Results: <list id="list1" list-type="bullet"> <list-item>Education provoked the most discussion, with a desire for more knowledge and training to improve confidence when attending to patients with low acuity complaints.</list-item> <list-item>Confidence was found to be intrinsically linked to experience, with clinicians who were more exposed to paediatrics in their professional or personal life displaying more confidence when attending to this patient group.</list-item> <list-item>Emotion of clinicians and/or families contributes to the clinical decision-making process; coupled with a reliance on clinical guidelines, there is a high probability of a paediatric consultation resulting in conveyance to an emergency department.</list-item> <list-item>Provision of care was variable geographically, with largely negative experiences observed with attempts for community referrals.</list-item> </list>Conclusions: Providing a focus of education more reflective of paramedics’ experiences will address some of the factors discussed by participants. Introducing innovative solutions such as developing guidelines for lower acuity conditions and the introduction of specialist roles could contribute to mitigating the barriers paramedics faced while improving the quality of care provided to paediatric patients. Barriers to confidence existing due to lack of exposure may well still exist, as would options to refer to community services.

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Improving Paramedic Confidence with Paediatric Patients: A Scoping Review

Cited by 15 publications

References 38 publications

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

Stakeholder Opinion on the proposal to introduce ‘Treat and Referral’ into the Irish Emergency Medical Service.

What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

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