Paramedic Practice – Knowledge Invested in Action

Abstract

<jats:p>The ability of expert practitioners to make sound judgments when faced with non-routine situations calls on a form of tacit knowing that has been loosely branded as ‘intuition’, a ‘sixth sense’, or ‘gut feeling’. The development of tacit knowledge is associated with nonformal learning that occurs in the context of the workplace; however, the elusive nature of this phenomenon has served to hamper research efforts. The focus has therefore shifted away from tacit knowledge toward the more observable concept of ‘judgment’. Paramedics are called to make clinical judgments as part of their everyday practice, often unaware of the basis behind these judgments. This case study examines the source of knowledge drawn on by experienced paramedics when making judgments, especially when faced with situations they have not previously encountered, and proposes how new knowledge and meaning is constructed through such involvements. A better understanding of the relationship between knowing and judgment, and how they are developed, will have future implications for the provision of ongoing education and training programs for paramedics.</jats:p>

Paramedic Judgement, Decision-Making and Cognitive Processing: A Review of the Literature

“…After removal of duplicates, a total of 362 abstracts and titles were reviewed and from that, the full text of 59 articles were further assessed resulting in six articles included in the final summary. One article (47) was quantitative using a Likert scale survey, while four articles utilised a qualitative approach (48)(49)(50)(51) with the remaining article mixed-methods (52). Of the qualitative articles a mixture of data collection was used including interviews (48)(49)(50)52), clinical scenarios (18,49), case study (51), questionnaire survey (47,52) and real-life observation (50).…”

“…These were based on theoretical knowledge, ie. explicit knowledge that is evidence-based and sourced from articles and books (50,51). Participants in Jones et al (48) impressed performing slower more thorough assessments including acquiring more accurate measurements, when time permitted and once initial interventions had been undertaken and was reportedly used to verify what had already subjectively and intuitively been determined.…”

Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: Constructivist metasynthesis of the qualitative literature

“…Paramedic care for people who self-harm often involves on the spot decisions in emergency situations and is clearly challenging. Wyatt [41] explored professional judgments made by paramedics faced with such unique and non-routine situations, finding decision making to be associated with development of tacit knowledge. The relationship of tacit knowledge with judgments made as part of expert practice was considered, finding that paramedics utilised multiple sources of information when making judgments, and a rich interplay of factors was revealed contributing to the development of judgment making, including experience within a particular context, along with reversion to tried and trusted rules or guidelines, and the capacity to play a hunch and trust in judgment.…”

The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents

“…While the novice will rely on formula and procedure to reach a conclusion, the expert will use a range of cognitive skills to process information. To assist with the clinical decision making process, an expert practitioner uses an element of flexibility and openness combined with knowledge, experience and an ability to consider multiple approaches to a single clinical presentation 8 9. Factors such as clinical experience, domain specific knowledge, the collection and evaluation of clinical data from the incident, and the synthesis of this information underpin clinical decision making 10…”