Malcolm Boyle

A pilot study of workplace violence towards paramedics

Background: International studies have shown that some 60% of paramedics have experienced physical violence in the workplace, and between 21–78% have experienced verbal abuse. To date, there is no Australian literature describing Australian paramedics’ experience of workplace violence. Objective: To identify the percentage of paramedics who had experienced six different forms of workplace violence. Methods: A questionnaire was developed to explore paramedics’ experience of workplace violence. Six forms of violence were included: verbal abuse, property damage or theft, intimidation, physical abuse, sexual harassment, and sexual assault. The questionnaire also included a series of demographic questions. The questionnaire was piloted using a reference group and changes made accordingly. The questionnaire was distributed to 500 rural Victorian paramedics and 430 metropolitan South Australian paramedics. Ethics approval was granted for this study. Results: The overall response rate was 28%, with 75% being male and 25% female. The median age of respondents was 40.7 years, range 21–62 years. The median number of years experience as a paramedic was 14.3 years, range 6 months to 39 years. There were 87.5% of paramedics exposed to workplace violence. Verbal abuse was the most prevalent form of workplace violence (82%), with intimidation (55%), physical abuse (38%), sexual harassment (17%), and sexual assault (4%). Conclusion: This study lays the foundation for further studies investigating paramedic experience of workplace violence. This study demonstrates that workplace violence is prevalent for paramedics and highlights the need for prevention and education within the profession.

Prevalence and predictors of occupational violence and aggression towards GPs: a cross-sectional study.

Occupational violence and aggression are common in general practice. This study examined occupational violence and aggression against GPs in terms of prevalence and predictive factors, such as sex of GP, and practice location. Over half of the GPs sampled had experienced at least one form of violence and aggression; more female than male GPs experienced sexual harassment; and there was no difference in the number of metropolitan and rural GPs who had experienced violence and aggression. Predictors emerged for verbal abuse, intimidation, physical abuse, and sexual harassment.

Levels of empathy in undergraduate nursing students

McKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L. International Journal of Nursing Practice 2012; 18: 246–251 Levels of empathy in undergraduate nursing students Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse–patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes.Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse-patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes.

Contemporary simulation education for undergraduate paramedic students

In recent years there has been an emphasis on the reduction of medical errors in patient management, especially in the hospital setting. There is no identified reporting structure for the prehospital setting like that used in some hospitals in Australia. The Australian Incident Monitoring Study (AIMS) has been developed and used predominantly by anaesthetists and in the intensive care unit to report actual management errors, near misses, and positive events.1 The main identifier of prehospital errors in Victoria has been the Consultative Committee on Road Traffic Fatalities (CCRTF). This group identified that 76 (84%) of prehospital problems (n = 90) in 2002/2003 contributed to the patient’s death, with 67 (75%) being actual patient management problems. It was noted that between the 1997/1998 and the 2002/2003 review there was a 20% increase in rural road traffic incidents and fatalities.2–7 With total Victorian road traffic fatalities decreasing by 28% over the last 5 years and a smaller decrease in other road traffic related injuries, including serious injuries, paramedics are being exposed to significantly less trauma, especially in rural and remote areas of the state.8 The Victorian prehospital data suggest that there is a need for simulation training, especially in trauma management, for undergraduate students before their employment in rural Victoria as their exposure to some trauma types will be infrequent. The Department of Community Emergency Health and Paramedic Practice (DCEH&PP) at Monash University, Australia, is one of the major providers of undergraduate paramedic education. To assist undergraduate students with authentic medical and trauma experiences we utilise two simulation centres. This paper about the simulation centres is intended to be descriptive; the efficacy, role and evaluation of simulation as an educational resource is beyond its scope. We describe how the indoor simulation centre and the outdoor road trauma simulation centre …

Numeracy skills of nursing students

Research has highlighted poor mathematical ability amongst qualified and student nurses. Three major classifications of errors: i)conceptual, ii)arithmetical and iii)computational have been identified. These errors involve being unable to formulate an equation from information given, unable to operate a given equation, or simple arithmetical errors respectively. The objective of this study was to determine if a sample of Australian second year undergraduate nursing students, from the state of Victoria, could accurately calculate drug dosages and perform some basic mathematical calculations that would be required in the workplace. A descriptive survey collecting demographical data, attitudes towards drug calculation performance and basic mathematical and drug calculation questions was administered to the 52 undergraduate nurses who participated in the study. The average score was 56.1%. Interestingly 63.5% of the students denied any drug calculations issues. On average those who completed a minimum of year 12 mathematics, or who had entered the course directly from secondary education achieved scores over 50%. Of all the errors that occurred 36.0% were conceptual, 38.9% were arithmetical and 25.1% were computational. Some Victorian nursing students currently have deficiencies in performing accurate calculations, with both arithmetical and conceptual errors, indicating fundamental flaws in their mathematical understanding and demonstrating an unacceptable level to practice safely.

Use of the Valsalva manoeuvre in the prehospital setting: a review of the literature.

Background: The Valsalva manoeuvre (VM) is used in the prehospital setting as a first-line treatment for managing haemodynamically stable supraventricular tachycardia (SVT) in the form of atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT). The hospital-based use of this technique is supported by a number of published studies, but the performance and efficacy of the VM in the prehospital setting has not been examined. Methods: A review of the literature via electronic databases was conducted. Six clinical studies examining the technique and efficacy of the VM in arrhythmia reversion were identified. No prehospital studies were identified. Significant variation in the practical application of the VM and its efficacy was noted. Results: The literature identified three primary elements of the technique which affected its efficacy in reversion of SVT: a pressure of 40 mm Hg, the supine position and duration of 15 s. The efficacy of the VM in reversion of SVT is difficult to quantify in some literature owing to variations in technique and clinical application. The VM appears to be more successful than carotid sinus massage and ice-to-face techniques, and is inherently safe across all age groups. Conclusion: This review has shown that a standard of performance of the VM technique is defined within the medical literature, but no evidence exists to determine its efficacy or use in the prehospital setting. A prehospital study is therefore required to affirm the VM as part of prehospital clinical practice guidelines for SVT.

An investigation of theory-practice gap in undergraduate paramedic education

BackgroundBachelor of Emergency Health (Paramedic) (BEH) students at Monash University undertake clinical placements to assist with the transition from student to novice paramedic. Anecdotally, students report a lack of opportunity to practise their clinical skills whilst on placements. The barriers to participation and the theory-practice gap have not been previously documented in Australian paramedic literature. The purpose of this study was to investigate the theory-practice gap for paramedic students by linking education and skill level to case exposure and skills praxis during clinical placements.MethodsA cross-sectional retrospective study using a convenience sample of second and third year BEH undergraduate students. Ethics approval was granted.ResultsEighty four second and third year BEH students participated. 59.5% were female (n = 50), 40.5% were male (n = 34). Overall, students most commonly reported exposure to cardiac and respiratory cases and were satisfied with the number of cases encountered during placement. However, over half (n = 46) reported being exposed to < 50% of cases that allowed skills praxis. The most common barrier to participation (34.5%) was the opportunity to participate in patient care and 68% of students were unsure if paramedics understood their role during clinical placements.ConclusionThis study demonstrates that the majority of students were satisfied with their clinical placement experience; even though they were exposed to < 50% of cases that allowed skills practice. Identifying these educational barriers will assist in improving the quality and theory-practice gap of paramedic clinical education.

Construct validation of the readiness for interprofessional learning scale: A Rasch and factor analysis

In order to improve efficiency and collaboration in healthcare service provision, it is recommended that students engage in interprofessional education; that is, learning with, from and about professions other than ones own profession. Such endeavors are often impeded by pre-existing attitudes; therefore, self-reporting scales such as the Readiness for Interprofessional Learning Scale (RIPLS) have often been used in studies to gauge perspectives. The original 19-item version of the RIPLS was completed by 418 undergraduate healthcare students from a large Australian University. A principal component analysis with a varimax rotation was first carried out followed by Rasch model analyses on the RIPLS data. A four-factor solution was produced by the initial factor analysis, which did not correspond to the original three-factor solution identified by the RIPLS authors. The subsequent Rasch analyses of the four-factor structure produced two misfitting items, and reconfirmed a four-factor solution. The 17-item four-factor RIPLS demonstrated a good fit to the Rasch model and exhibited good reliability and dimensionality. A four-factor RIPLS solution was identified and confirmed via two statistical approaches. Two items were found not to fit the new RIPLS four-factor structure and it is recommended that they be discarded. Further refinement of the RIPLS is recommended.

Trauma Incidents Attended by Emergency Medical Services in Victoria, Australia

INTRODUCTION International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service. PURPOSE The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS. METHODS A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained. RESULTS There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459). CONCLUSIONS This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.

Is mechanism of injury alone in the prehospital setting a predictor of major trauma – a review of the literature

BackgroundThe literature identifying mechanism of injury came to prominence in the mid to late 1980s. The current Victorian prehospital triage guidelines do not necessarily reflect the conditions within the Victorian population as the triage guidelines are based on studies undertaken and validated in the U.S.A. The objective of this study was to identify the mechanism of injury alone literature and the predictability of the mechanism criteria.MethodsA search of the prehospital related electronic databases was undertaken utilising the Ovid and EMASE systems available through the Monash University library. The Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, and EMBASE databases were searched from their beginning until the end of June 2006. Selected non-electronic listed prehospital journals were hand searched. References from articles gathered were reviewed.ResultsThe electronic database search located 203 articles for review. Three additional articles were identified from the reference lists. Of these articles 17 were considered relevant. After reviewing the articles only five provided sufficient information about mechanism of injury alone and its triage capability. None of the articles identified mechanism of injury criteria as a good predictor of major trauma.ConclusionThis study identified only five articles on the predictability of the mechanism of injury criteria alone. All studies stated that the mechanism of injury criteria alone are not good predictors of major trauma or the need for trauma team activation. This study was the precursor of a Victorian prehospital study to determine the predictability of the mechanism of injury alone criteria for trauma patients in the Australian context.