What factors affect paramedics’ involvement of people with dementia in decisions about their care? A qualitative study

Choonara, Esme; Williams, Julia

doi:10.29045/14784726.2021.3.5.4.1

Cited by 6 publications

(17 citation statements)

References 23 publications

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“…An important pillar for creating a care relationship that promotes a person-centred perspective was trust between patients and ACs [25,26]. For trust, ACs' professional experience was considered important; possessing extensive medical knowledge and acting in a professional manner reduced stress in patients with acute illness and increased trust in the professionals [27].…”

Section: Creating Trustmentioning

confidence: 99%

“…Creating trust Participants unanimously tried to adjust their communication strategies to create greater trust and reduce distress, often by spending time engaging patients in broader conversations about their lives and their environment [26] Creating good communication…”

Section: A Good Care Relationshipmentioning

confidence: 99%

“…There was a variance in the weight given to the wishes of the person with dementia where they were found not to have capacity, with four participants concentrating on making the best interest decisions for the patient and three trying to involve the patient [26] Family member participation in decision-making When a patient's autonomy was reduced, relatives or others who were involved in the life and care of a patient became important participants in the decision-making process [25] Hindrances to practising personcentred care in ambulance care…”

Section: Decision-making Based On Patient Needsmentioning

confidence: 99%

“…The goal of decision-making concerning patient care and treatment was to make decisions together with patients [26,30,31,35]. ACs believed that strengthening patients' own ability to manage their own situation and treating patients as individuals by presenting different options before decisionmaking was important [26]. The power imbalance between patients and ACs was reduced by increasing patient participation through listening and asking questions [27].…”

Section: Patient Participation In Decision-makingmentioning

confidence: 99%

“…As patient capacity to participate in decision-making decreased, family members became important participants in the process [25]. Family members were considered more reliable than healthcare professionals to provide information and to support patients with cognitive impairment [26]. Family members of a patient could be an invaluable source of information of a patient's medical history, cultural traditions and personal preferences.…”

Section: Family Member Participation In Decision-makingmentioning

confidence: 99%

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Care relationship and interaction between patients and ambulance clinicians: A qualitative meta‐synthesis from a person‐centred perspective

Tikkanen,

Sundberg

2023

Scandinavian Caring Sciences

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BackgroundAmbulance care is characterised by disaster medicine, traumatology and care for acute illnesses and accidents. The focus of ambulance care is clearly on medical care, whereas interpersonal interaction between patients and ambulance clinicians appears less prioritised. A patient within ambulance care needs to be listened to, be taken seriously, be treated with empathy and be seen as a unique person. These are fundamental to delivering Person‐centred care.AimThe purpose is to describe how the care relationship and interaction between patients and ambulance clinicians in prehospital emergency care are described in the literature and how they can be interpreted from a person‐centred perspective.Data Sources and Review MethodsA qualitative meta‐synthesis was used. Data collection was carried out with PubMed, CINAHL Plus and Web of Science in September–October 2022 and in August–September 2023. The first article searching applied a timeline 1990–2022 and the second applied a timeline 2022–2023. A total of 13 studies employing a qualitative approach were evaluated and included in the interpretive analysis.ResultsThree themes were identified: A good care relationship, Decision‐making and Hindrances to practising person‐centred care in ambulance care. Trust, good communication and respect for patients' dignity were the most important parts of the good care relationship between patients and ambulance clinicians. Decision‐making regarding the examination of patients, medical treatment and transport to the receiving care unit was one of the tasks that ambulance clinicians do independently but in cooperation with patients and family members. Person‐centred care within ambulance care may be hindered due to environmental factors, attitudes and behaviour of ambulance clinicians and patient‐related factors.ConclusionMany ambulance clinicians have already adopted Person‐centred care, but several factors can hinder Person‐centred care in interactions with patients. Although the results build on a limited number of studies, they indicate that person‐centred care needs to be further developed and studied for high‐quality ambulance care.

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Section: Creating Trustmentioning

confidence: 99%

Section: A Good Care Relationshipmentioning

confidence: 99%

Section: Decision-making Based On Patient Needsmentioning

confidence: 99%

Section: Patient Participation In Decision-makingmentioning

confidence: 99%

Section: Family Member Participation In Decision-makingmentioning

confidence: 99%

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Care relationship and interaction between patients and ambulance clinicians: A qualitative meta‐synthesis from a person‐centred perspective

Tikkanen,

Sundberg

2023

Scandinavian Caring Sciences

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Out-of-hospital paramedic interactions with people living with dementia: a scoping review

Han,

Ross,

Hemingway

et al. 2024

Age and Ageing

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Background Dementia encompasses neurodegenerative disorders that account for a global estimated healthcare expenditure of 1.3 trillion US dollars. In Australia, one in 12 people aged ≥65 has a diagnosis of dementia and it is the second leading cause of death. Paramedics play a crucial role in person-centred dementia care, particularly in the community. While consensus has been established on paramedicine’s integration into interdisciplinary care teams, there remains a lack of clarity regarding the paramedic role in dementia care. Objective This study aimed to examine and report paramedic interactions with people living with dementia in the out-of-hospital setting. Design and Setting This was a scoping review study of paramedics and people living with dementia within the out-of-hospital setting. Methods This study was guided by the Joanna Briggs Institute (JBI) scoping review framework. Databases were searched without date limits, up to 4 April 2023. These encompassed OVID Medline, CINAHL, Scopus, APA PsycInfo and OVID Embase. Articles were included if they were primary, peer-reviewed studies in English and reporting on paramedic-specific interactions with people living with dementia in the out-of-hospital setting. Data extraction was performed based on study setting, design, population and key findings. Results Twenty-nine articles were included in the thematic analysis. Four themes emerged: need for training, patterns of attendances, patterns of documentation and the integrative potential of paramedicine. Paramedics reported feeling ill-equipped and unprepared in caring for patients living with dementia due to challenges in assessment and management of caregiver tensions. They were often called as a last resort due to poor service integration and a lack of alternative care pathways. Despite high conveyance rates, there was low incidence of paramedic interventions initiated. Underdocumentation of dementia and pain was found. Conclusion Emergency ambulance conveyance of people living with dementia is a surface reaction compounded by a lack of direction for paramedics in the provision of out-of-hospital care. There is a pressing need for establishment of research and educational priorities to improve paramedic training in dementia-specific skillsets.

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Comparison of prehospital stroke care at private homes and residential care settings

Finney,

McClelland,

Shaw

et al. 2023

Journal of Paramedic Practice

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Background: Suspected stroke is a common scenario among care home residents, who are typically older and have more complex health needs than the general population. Aims: The aim of this study was to describe the care of suspected stroke patients according to their residential status. Methods: Retrospective secondary analysis was carried out using a clinical record dataset from a UK ambulance service that described the care of patients labelled as having a suspected stroke between December 2021 and April 2022. Findings: Care home patients were older (median age 86 (interquartile range (IQR) 79–91) years) than those in their own homes (median age 75 (IQR 63–83) years; P≤0.001), with more comorbidities (median of five (IQR 3–6) versus median of three (IQR 2–5); P≤0.001) and taking more medications (median of six (IQR 4–9) versus median of four (IQR 1–7); P≤0.001). They were more likely to have difficulties completing the face, arms, speech, time test (17/170 (10%) versus 39/1305 (3%); P≤0.001) and present with facial droop (85/153 (55.6%) versus 506/1266 (40%); P≤0.001). Ambulance on-scene time was longer at care homes (median 41 (IQR 32–49.5) minutes versus median 35 (IQR 27–45) minutes; P≤0.001). Conclusion: Clinician awareness of characteristics associated with residential settings may be important for delivering emergency stroke care. Research is needed to optimise ambulance assessment for care home patients.

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What factors affect paramedics’ involvement of people with dementia in decisions about their care? A qualitative study

Cited by 6 publications

References 23 publications

Care relationship and interaction between patients and ambulance clinicians: A qualitative meta‐synthesis from a person‐centred perspective

Care relationship and interaction between patients and ambulance clinicians: A qualitative meta‐synthesis from a person‐centred perspective

Out-of-hospital paramedic interactions with people living with dementia: a scoping review

Comparison of prehospital stroke care at private homes and residential care settings

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