Bill Lord

Use of videos to support teaching and learning of clinical skills in nursing education: A review

Information and communications technology is influencing the delivery of education in tertiary institutions. In particular, the increased use of videos for teaching and learning clinical skills in nursing may be a promising direction to pursue, yet we need to better document the current research in this area of inquiry. The aim of this paper was to explore and document the current areas of research into the use of videos to support teaching and learning of clinical skills in nursing education. The four main areas of current and future research are effectiveness, efficiency, usage, and quality of videos as teaching and learning materials. While there is a clear need for additional research in the area, the use of videos seems to be a promising, relevant, and increasingly used instructional strategy that could enhance the quality of clinical skills education.

The Influence of Paramedic and Patient Gender on the Administration of Analgesics in the Out-of-Hospital Setting

Abstract Objective. To determine whether analgesic administration in the out-of-hospital setting is influenced by the gender of the patient or the gender of the paramedic. Methods. This retrospective cohort study of patient care records included adult patients (age > 15 years) with moderate to severe pain (verbal numerical rating score 4–10) treated by paramedics between January 1, 2008 and December 31, 2009. Data extracted included patient pain severity score, analgesia provided by paramedics, and gender of the treating paramedic. Data was analyzed by descriptive statistics, χ2 test, and logistic regression. The primary outcome measures were the effect of patient and paramedic gender on analgesic administration. Results. The study population comprised 42,051 patients, median age of 57 years (38–75); 50.4% were female and 51% were administered an analgesic agent. For the outcome of receiving any analgesia, neither patient gender nor paramedic gender was predictive (p = NS). In a multivariate model for the outcome of receiving any analgesia, patient gender, paramedic gender, and the interaction between patient and paramedic gender were all nonsignificant (p = NS). For the outcome of receiving opioid analgesia (i.e., morphine or fentanyl), male patients were at greater odds of receiving an opioid (OR 1.52, 95% CI 1.29–1.79, p < 0.0001). Paramedic gender was not predictive of whether an opioid was given (p = NS). Conclusions. The gender of the paramedic did not appear to influence the odds of analgesic administration. Female patients were less likely to receive opioids. Paramedic gender does not explain this finding.

Qualitative study of Queensland paramedics' perceived influences on their food and meal choices during shift work

Paramedics have higher rates of obesity, overweight and dyslipidaemia,compared to the general population. Studies investigating the nutri-tional health of other types of shift workers found their ability to achievea healthy diet appeared to be influenced by the nature of their work;however, these findings cannot be generalised to paramedics, who areambulance based and respond to emergencies over a wide geographicalarea. The research on paramedics’ eating behaviours and influences onfood choice is limited. This study aimed to explore paramedics’ per-ceived influences on their food choices specific to their unique workingenvironment. A qualitative study using individual semi-structured tel-ephone inter views was conducted on a purposive sample of 15 para-medics working on a rotating shift roster in Queensland. Transcribedinterviews were analysed manually using open coding inductive the-matic analysis. A conceptual model was developed that illustrated fourmajor themes of influences on food choices. These themes were physi-ological, psychosocial, the physical environment and the organisationalenvironment. Of significant influence on the participants’ food choice unique to their work, was the meal break structure and being ambu-lance based for the majority of their shift. These influences are createdby the environmental influences in which they work and result inextended periods of not eating or opportunistic eating. This has impli-cations on their ability to make healthy food choices. Further investi-gation into strategies to enable paramedics to improve food choicewithin their unique work environment is warranted in light of thenutrition-related diseases found within this group.

‘Popping nana back into bed’ - a qualitative exploration of paramedic decision making when caring for older people who have fallen

BackgroundOlder fallers constitute a large proportion of ambulance work, and as many as 25% are not transported to hospital following paramedic assessment. The objective of this study was to explore the decision making process used by paramedics when caring for older fallers.MethodsA qualitative study was conducted using constructivist grounded theory methodology. Purposive sampling was used to recruit paramedics to participate in semi-structured interviews and focus groups. Data analysis commenced with line-by-line coding, developing into formation of theoretical categories. Theoretical sampling was then used to clarify emerging theoretical concepts, with data collection and analysis continuing until theoretical saturation was achieved.ResultsA total of 33 paramedics participated in 13 interviews and 4 focus groups. When caring for older fallers, paramedic decision making is profoundly affected by ‘role perception’, in which the individual paramedic’s perception of what the role of a paramedic is determines the nature of the decision making process. Transport decisions are heavily influenced by a sense of ‘personal protection’, or their confidence in the ambulance service supporting their decisions. ‘Education and training’ impacts on decision making capacity, and the nature of that training subliminally contributes to role perception. Role perception influences the sense of legitimacy a paramedic attaches to cases involving older fallers, impacting on patient assessment routines and the quality of subsequent decisions.ConclusionsParamedic decision making processes when caring for older people who have fallen appear to be strongly influenced by their perception of what their role should be, and the perceived legitimacy of incidents involving older fallers as constituting ‘real’ paramedic work.

Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care

HIGHLIGHTSNoncompliance by Australian paramedics with recommended hand hygiene and gloving practices has been identified.The hands of paramedics have a potential role in the spread of health care–associated infection.Participants perceived that hand hygiene had been a minor aspect of their training.All participants wore gloves for every patient contact.Over half of the participants only changed their gloves post patient care.Improvements in both gloving practices and hand hygiene compliance among Australian paramedics are necessary. Background: Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care–associated infections and lead to poor patient outcomes. The aim of this study was to explore the self‐reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic‐led health care. Methods: A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia. Results: Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves. Conclusions: Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in‐field hand hygiene and the misuse of gloves during paramedic‐led health care.

The epidemiology of pain in children treated by paramedics

The present study aimed to describe paramedic assessment and management of pain in children in a large state‐wide ambulance service.

Clinically meaningful reduction in pain severity in children treated by paramedics: a retrospective cohort study

INTRODUCTION Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children. METHODS An analysis of electronic patient care records of all patients younger than 15 years presenting with pain to the emergency medical service of Victoria, Australia, over a 4-year period (2008-2011). Data were analyzed using descriptive statistics and multivariate regression to assess predictors of clinically meaningful pain reduction. Clinically meaningful pain reduction was defined as a reduction of 2 or more points on an 11-point scale. RESULTS A total of 92378 children were transported, of whom 15016 (16.3%) met the inclusion criteria. The median age was 11 (interquartile range, 9-13) years, and 59.2% were male. Patients older than 9 years were less likely (adjusted odds ratio [AOR], 0.5; 95% confidence interval [CI], 0.4-0.6) and boys were more likely (adjusted odds ratio, 1.1; 95% CI, 1.0-1.3) to have a clinically meaningful reduction in pain. Patients with pain classified as musculoskeletal were more likely to achieve a reduction in pain score of 2 or more when compared with pain due to other medical causes (AOR, 1.7; 95% CI, 1.5-1.9). CONCLUSIONS Factors other than the type of analgesia are important determinants of prehospital pain relief and are likely to impact on clinical care and research. Clinical audit and research projects should stratify patients according to patient as well as management factors to maximize service improvement.

Enhancing nursing and midwifery student learning through the use of QR codes

AbstractA recent teaching and learning innovation using new technologies involves the use of quick response codes, which are read by smartphones and tablets. Integrating this technology as a teaching and learning strategy in nursing and midwifery education has been embraced by academics and students at a regional university.

Challenges for environmental hygiene practices in Australian paramedic-led health care: A brief report

HighlightsParticipants reported noncompliance with recommended environmental hygiene practices.Participants reported working in ambulances often contaminated with body fluids.Participants had poor knowledge of how to manage blood or body substance spills.Participants had poor knowledge of how to clean shared medical equipment.Participants reported that environmental hygiene had been a minor aspect of their training. &NA; This study explored the self‐reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety.

Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Objective: We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation. Methods: We used a cross‐sectional design with a 7‐day retrospective sample of adults aged 18years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0–10 numerical verbal pain score [NVPS]). Results: We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff. Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p<0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75). Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P<0.01), attending patients aged 51 to 64years (OR 2.04, 95% CI 1.21 to 3.45, p=0.01), in moderate to severe (NVPS 4–10) compared with lower levels of pain for any clinical condition group compared with the reference condition. Conclusion: There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.