Mapping simulation-based activities for health professionals in rural and remote contexts in high-income countries: a scoping review protocol.

OBJECTIVE: This scoping review will aim to map the existing academic literature on simulation-based activities that are designed with and delivered for health professionals in geographically rural and remote contexts in high-income countries. INTRODUCTION: Simulation-based health care activities are implemented in health services to increase patient safety because they allow health professionals to prepare, learn, practice, rehearse, and improve clinical performance and teamwork. Simulation-based activities are increasingly being used in rural and remote areas, where resources are limited compared with metropolitan areas. INCLUSION CRITERIA: This review will include all primary and peer-reviewed research articles and abstracts that report health simulation methodologies and activities that have been used in rural and remote health care contexts in high-income countries. METHODS: The proposed review will follow the JBI guidelines for scoping reviews and the PRISMA-ScR reporting guidelines. Databases to be searched will include Embase, Emcare, and MEDLINE (all searched via Ovid), Scopus, PubMed, and the Cochrane Database. The title and abstracts will be screened independently by 2 reviewers, followed by full-text screening. Data will be extracted and analyzed to address the review questions. DETAILS OF THIS REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK: https://doi.org/10.17605/OSF.IO/PU6GV.

Perceived and actual value of Student-led Objective Structured Clinical Examinations.

INTRODUCTION: Student-led Objective Structured Clinical Examinations (OSCEs) provide formative learning opportunities prior to Faculty-led OSCEs. It is important to undertake quality assurance measurements of peer-led assessments because, if they are found to be unreliable and invalid, they may have detrimental impacts. The objectives of this study were to explore and evaluate Student-led OSCEs hosted by fifth-year medical students. METHODS: Student-led OSCE results were analysed to examine reliability (Cronbach's alpha). The relationship between Student-led and Faculty-led OSCEs was evaluated using linear regression. Qualitative data were acquired by survey and semi-structured interviews and were analysed using an inductive content analysis approach. RESULTS: In total, 85 (94%) of 91 eligible students consented to study participation. Student-led OSCEs had a low-moderate reliability [Cronbach alpha = 0.47 (primary care) and 0.61 (human reproduction/paediatrics) (HRH)]. A statistically significant, positive relationship between Student-led and Faculty-led OSCE results was observed. Faculty-led OSCE grades increased by 0.49 (95% CI: 0.18, 0.80) to 1.09 (95% CI: 0.67, 1.52), for each percentage increase in Student-led OSCE result. Student-led OSCE participants highly valued the authentic peer-assessed experience. Reported benefits included a reduction of perceived stress and anxiety prior to Faculty-led OSCEs, recognition of learning gaps, contribution to overall clinical competency and facilitation of collaboration between peers. DISCUSSION: Student-led OSCEs are moderately reliable and can predict Faculty-led OSCE performance. This form of near-peer assessment encourages the metacognitive process of reflective practice and can be effectively implemented to direct further study. Faculties should collaborate with their student bodies to facilitate Student-led OSCEs and offer assistance to improve the quality, and benefits, of these endeavours.

Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services.

Patient journey mapping is an emerging field of research that uses various methods to map and report evidence relating to patient experiences and interactions with healthcare providers, services, and systems. This research often involves the development of visual, narrative, and descriptive maps or tables, which describe patient journeys and transitions into, through, and out of health services. This methods corner paper presents an overview of how patient journey mapping has been conducted within the health sector, providing cardiovascular examples. It introduces six key steps for conducting patient journey mapping and describes the opportunities and benefits of using patient journey mapping and future implications of using this approach.

Experiences of Simulated Patients Involved in Difficult Conversations With Undergraduate and Postgraduate Health Professionals.

INTRODUCTION: Simulated patients (SPs) are trained to simulate real patient scenarios for health professionals' education and training. The value of including SPs in simulated scenarios, particularly in relation to difficult and complex conversations, has been studied in various contexts, with a focus on learner experiences and outcomes. What has not been as extensively explored is the impact of difficult and complex conversations on the SPs. The aim of this study was to explore the perspectives, motivations, and experiences of SPs, particularly regarding difficult or complex conversations. METHODS: A qualitative approach was taken to gather and interpret SP experiences. Open-ended interviews were the primary means of obtaining data. Thematic analysis guided the interpretation of interview data to generate key themes that encapsulated the SP experience. RESULTS: Twelve participants shared their experiences of working as SPs in scenarios that involved difficult or complex conversations. From these data, 4 major themes were determined: Care for Students, Pedagogical Focus, Emotional Regulation, and Organizational Environment. The importance of empathy and safe design and support for simulations was apparent. CONCLUSIONS: This study presents insights into the experiences and perspectives of SPs regarding difficult and complex conversations. Participants highlighted the necessity of uniformity in standards of practice in simulation and the need for advocacy for awareness of simulation-based practices.

Insights into rural generalist therapeutic reasoning using a simulated multi-patient emergency scenario.

INTRODUCTION: Therapeutic reasoning focuses on the decisions related to patient disposition and management. This is in contrast to diagnostic reasoning, which is the focus of much of the current discourse in the medical literature. Few studies relate to therapeutic reasoning, and even fewer relate to the rural and remote context. This project sought to explore the therapeutic reasoning used by rural generalists working in a small rural hospital setting in Australia, caring for patients for whom it was unclear if escalation of care, including admission or interhospital transfer, was needed. METHODS: This study was conducted using an interpretivist approach. A simulation scenario was developed with rural generalists and experts in medical simulation to use as a test bed to explore the reasoning of the rural generalist participants. The simulation context was a small rural Australian hospital with resources and treatment options typical of those found in a similar real-life setting. A simulated patient and a registered nurse were embedded in the scenario. Participants needed to make decisions throughout the scenario regarding the simulated patient and two anticipated patients who were said to be coming to the department. The scenario was immediately followed by a semi-structured interview exploring participants' therapeutic reasoning when planning care for these three patients. An inductive content analysis approach was used to analyse the data, and a mental model was developed. The researchers then tested this mental model against the recordings of the participants' simulation scenarios. RESULTS: Eight rural generalists, with varying levels of experience, participated in this study. Through the semi-structured interviews, participants described five themes: assessing clinician capacity to manage patient needs; availability of local physical resources and team members; considering options for help when local management was not enough; patients' wishes and shared decision making; and anticipating future requirements. The mental model developed from these themes consisted of seven questions: 'What can I do for this patient locally and what are my limits?'; 'Who is in my team and who can I rely on?'; 'What are the advantages and disadvantages of local management vs transfer?'; 'Who else needs to be involved and what are their limits?;' 'How can we align the patient's wants with their needs?'; 'How do we adapt to the current and future situation?'; and 'How do I preserve the capacity of the health service to provide care?' CONCLUSION: This study explored the therapeutic reasoning of rural generalists using a simulated multi-patient emergency scenario. The mental model developed serves as a starting point when discussing therapeutic reasoning and is likely to be useful when providing education to medical students and junior doctors who are working in rural and remote contexts where resources and personnel may be limited.

Recommendations for embedding simulation in health services.

Aspirations to achieve quality and safety goals in health services through simulation have led to significant investments in simulation equipment, space and faculty. However, the optimal governance and operational models through which these resources are expertly applied in health services are not known. There is growing evidence supporting 'service' models for simulation. In these models, simulation activities are co-designed and delivered by a team of simulation experts in partnership with health service units, specifically targeting quality and safety goals. Embedded simulation specialist teams working within these programs offer benefits not fully captured by traditional models of health education or by traditional systems for quality and safety.In this article, we explore broad and specific recommendations for establishing a simulation consultancy service within an Australian metropolitan health service. We base these recommendations on a review of current Australian practice and healthcare simulation literature, and on a specific example within a large outer metropolitan health service. The broad domains discussed include (1) governance and leadership; (2) human resources; (3) principles and planning; (4) operationalise and evaluate and (5) look to the future.The recommendations recognise that healthcare simulation is moving beyond solely addressing individual learning outcomes. The value of simulation addressing organisation and system objectives through various simulation modalities is increasingly being explored and demonstrating value. There is a growing demand for translational simulation in these contexts, and a consequent requirement for organisations to consider how simulation services can be successfully operationalised. Recommendations included in this paper are discussed and described with the intent of facilitating a deeper appreciation of the complexities associated with, and opportunities afforded by, a well-integrated simulation service.

Reporting and conducting patient journey mapping research in healthcare: A scoping review.

AIM: To identify how patient journey mapping is being undertaken and reported. DESIGN: A scoping review of the literature was undertaken using JBI guidance. DATA SOURCES: Databases were searched in July 2021 (16th-21st), including Ovid's Medline, Embase, Emcare and PsycINFO; Scopus; Web of Science Core Collection, the Directory of Open Access Journals; Informit and; ProQuest Dissertations and Theses Global. REVIEW METHODS: Eligible articles included peer-reviewed literature documenting journey mapping methodologies and studies conducted in healthcare services. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles. A table was used to extract data and synthesize results. RESULTS: Eighty-one articles were included. An acceleration of patient journey mapping research was observed, with 76.5% (n = 62) of articles published since 2015. Diverse mapping approaches were identified. Reporting of studies was inconsistent and largely non-adherent with relevant, established reporting guidelines. CONCLUSION: Patient journey mapping is a relatively novel approach for understanding patient experiences and is increasingly being adopted. There is variation in process details reported. Considerations for improving reporting standards are provided. IMPACT: Patient journey mapping is a rapidly growing approach for better understanding how people enter, experience and exit health services. This type of methodology has significant potential to inform new, patient centred models of care and facilitate clinicians, patients and health professionals to better understand gaps and strategies in health services. The synthesised results of this review alert researchers to options available for journey mapping research and provide preliminary guidance for elevating reporting quality.

How social media data are being used to research the experience of mourning: A scoping review.

BACKGROUND: Increasingly, people are using social media (SM) to express grief, and researchers are using this data to investigate the phenomenon of mourning. As this research progresses, it is important to understand how studies are being conducted and how authors are approaching ethical challenges related to SM data. OBJECTIVE: The aim of this review was to explore how SM data are being used to research experiences of mourning through the following questions: a) 'Which topics related to mourning are being studied?'; b) 'What study designs have been used to analyse SM data'; c) 'What type of data (natural or generated) have been used?'; and d) 'How are ethical decisions being considered?'. METHODS: The JBI Scoping Review methodology guided this review. Eligibility criteria were determined using the PCC framework, and relevant key words and phrases derived from these criteria were used to search eight databases in September 2021 (CINAHL, Embase, LILACS, OpenGrey, ProQuest, PsycINFO, PubMed and Scopus). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were used to report the results of this review. RESULTS: Database searches resulted in 3418 records, of which, 89 met eligibility criteria. Four categories of grief and mourning were identified. Most records were qualitative in nature and used natural data. Only 20% of records reported ethics approval by an Institutional Review Board, with several including measures to protect participants, for example, using pseudonyms. CONCLUSIONS: This unique review mapped the diverse range of mourning-related topics that have been investigated using SM data and highlighted the variability in approaches to data analysis. Ethical concerns relating to SM data collection are identified and discussed. This is an emerging and rapidly changing field of research that offers new opportunities and challenges for exploring the phenomenon of mourning.

Reporting of patient journey mapping in current literature: a scoping review protocol.

OBJECTIVE: This scoping review will assess the literature that documents or utilizes patient journey mapping methodologies in health care settings. It will also examine the reporting processes of studies that use this methodology. INTRODUCTION: Health care systems are complex and can be challenging for patients to navigate. Using patient journey mapping as a research method promotes a deeper understanding of patient experiences when navigating these systems. Patient journey mapping provides valuable insights into where systems are working well, where gaps in care exist, and how the system could respond to these gaps. INCLUSION CRITERIA: This review will consider peer-reviewed articles and publicly available academic literature documenting patient journey mapping methodologies. The review will also consider studies providing guidance and recommendations on how to report patient journey mapping studies in health care services and systems. METHODS: The proposed review will follow JBI guidance for scoping reviews. The following databases will be searched: MEDLINE, Embase, Emcare, PsycINFO, Scopus, Web of Science Core Collection, the Directory of Open Access Journals, Informit, and ProQuest Dissertations and Theses Global. The search will not be limited to year of publication but will be limited to studies reported in English. The PRISMA-ScR extension will be used to document the literature search. Two reviewers will screen titles, abstracts, and full-text articles. An extraction table will be used to extract relevant data from all included articles and to facilitate data analysis.

Introducing the Needs in Recovery Assessment (NiRA) into clinical practice: protocol for a pilot study investigating the formal and systematic assessment of clinical and social needs experienced by service users at a tertiary, metropolitan mental health service.

BACKGROUND: The Needs in Recovery Assessment (NiRA) is a newly developed needs assessment tool, designed to identify the needs of people recovering from mental illness. This tool has been evaluated outside of the clinical context for validity and reliability. The aim of this study is to introduce the NiRA into clinical practice and to evaluate the value of the NiRA as an adjunct to service delivery from the perspectives of stakeholders and to evaluate the barriers and facilitators of embedding the NiRA in a mental health service. METHODS: The establishment of the NiRA in a tertiary mental health unit over a 6-month period will be evaluated using a multi-methods approach. Quantitative data will be collected using the NiRA itself and the Recovery Self-Assessment (RSA). Face-to-face interviews with service users and clinicians will be conducted following the initial completion of the NiRA, with a follow-up interview for service users on discharge from the service. Regular informal follow-up with clinicians throughout the study will support the introduction of the NiRA. Descriptive statistics will be used to analyse quantitative data, and descriptive qualitative methods will be used to analyse data from interviews. DISCUSSION: Aligning mental health services with recovery-oriented frameworks of care is imperative. The NiRA is a tool that has been designed in accordance with recovery principles and may assist services to be more recovery-oriented. If the NiRA is able to achieve the aims and objectives of this project, a larger implementation study will be conducted. Trial registration Australian and New Zealand Clinical Trial Registry (ANZCTR), ACTRN12621000316808.

Factors that influence the preceptor role: a comparative study of Saudi and expatriate nurses.

OBJECTIVES: The aim of this study was to compare expatriate and Saudi nursing staff's perceptions of factors that influence their role as preceptors of nursing students. METHODS: Descriptive comparative study using a self-administered survey was completed by a convenience sample of eligible nurses (n=285). It was conducted in five different hospitals within the Ministry of Health in the Kingdom of Saudi Arabia. RESULTS: Most preceptors were expatriate nurses (70.5%), while Saudi preceptors represented only 29.5%. The findings show that there is a difference between Saudi and expatriate nurses in their perception of the role, that cultural factors influence the role of expatriate preceptors and that organisational factors influence both groups. CONCLUSIONS: Expatriate preceptors felt that there were cultural obstacles that hindered their role. These findings will contribute to the development of a more contemporary and culturally sensitive preceptorship model.

Evaluating the Reliability of the Needs in Recovery Assessment (NiRA) with Simulated Patients.

INTRODUCTION: The Needs in Recovery Assessment (NiRA) is a tool designed to support recovery-oriented and person-centred approaches in mental health services through facilitating the identification and prioritisation of needs. The aim of this study was to evaluate the interrater reliability of the NiRA. Method: Ten mental health clinicians from various professional backgrounds used the NiRA to facilitate assessment interviews with Simulated Patients. Completed and semi-completed NiRA forms, questionnaires, and audio-visual recordings of assessment interviews were collected for analysis. The interrater reliability of the NiRA was calculated using percent agreement and Gwet's Agreement Coefficient (AC)1. Results: Percent agreement across all items of the finalised tool was 0.84 (item range: 0.55 to 1.0). Overall interrater reliability (Gwet's AC1) was 0.70 (95% CI 0.64-0.76) with items ranging from -0.08 to 1.0. Conclusion: The NiRA is a reliable tool and is ready to be trialled in a feasibility study in clinical settings. It is anticipated that the NiRA will facilitate a deeper understanding of service users' needs and a more targeted approach to meeting unmet needs.

Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics.

AIM: The aim of this study is to discuss the available methodological resources and best-practice guidelines for the development and completion of scoping reviews relevant to nursing and midwifery policy, practice, and research. DESIGN: Discussion Paper. DATA SOURCES: Scoping reviews that exemplify best practice are explored with reference to the recently updated JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR). IMPLICATIONS FOR NURSING AND MIDWIFERY: Scoping reviews are an increasingly common form of evidence synthesis. They are used to address broad research questions and to map evidence from a variety of sources. Scoping reviews are a useful form of evidence synthesis for those in nursing and midwifery and present opportunities for researchers to review a broad array of evidence and resources. However, scoping reviews still need to be conducted with rigour and transparency. CONCLUSION: This study provides guidance and advice for researchers and clinicians who are preparing to undertake an evidence synthesis and are considering a scoping review methodology in the field of nursing and midwifery. IMPACT: With the increasing popularity of scoping reviews, criticism of the rigour, transparency, and appropriateness of the methodology have been raised across multiple academic and clinical disciplines, including nursing and midwifery. This discussion paper provides a unique contribution by discussing each component of a scoping review, including: developing research questions and objectives; protocol development; developing eligibility criteria and the planned search approach; searching and selecting the evidence; extracting and analysing evidence; presenting results; and summarizing the evidence specifically for the fields of nursing and midwifery. Considerations for when to select this methodology and how to prepare a review for publication are also discussed. This approach is applied to the disciplines of nursing and midwifery to assist nursing and/or midwifery students, clinicians, researchers, and academics.

"Who Am I and Why Am I Here?" A Scoping Review Exploring the Templates and Protocols That Direct Actors in Their Roles as Simulated (Standardized) Patients.

SUMMARY STATEMENT: Simulated patients (SPs) are increasingly used in health education and research. The aim of this article was to investigate templates and protocols that enable SPs to accurately and consistently adopt these roles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guided the search strategy for articles that detailed such templates or protocols. Embase Classic + Embase, ProQuest ERIC, Ovid MEDLINE, Ovid EMCare, psycINFO, and Scopus were searched, and 17 articles were included in the review. The templates and protocols that were located differed in structure, length, and depth and were developed or used in medical, nursing, allied health, and veterinary medicine disciplines. The validity, reliability, and replicability of studies are explored, and the quality of reporting is evaluated using the Simulation Research Rubric. Recommendations for increasing the rigor of programs and the reporting of research where SPs are adopted are considered.

Development and validation of the Needs in Recovery Assessment (NiRA): A clinical tool for assessing the needs of individuals recovering from a first episode of mental illness.

Recovering from a first episode of mental illness entails unique challenges and often includes experiencing unmet needs. The availability of a formal, structured and valid means of assessing the needs of individuals recovering from a first episode of mental illness may improve mental health service delivery. This article describes the development of a new needs assessment tool, the Needs in Recovery Assessment (NiRA), and presents the results of processes used to validate the tool. The NiRA was developed using data collected in a previous literature review and focus groups with mental health service users. It contains three sections for the identification, prioritization, planning and re-evaluation of a broad array of needs. It was presented in two workshops, where mental health service users and clinicians evaluated its validity, acceptability and usability. Items of need and the format of the NiRA were evaluated using Likert-scale questions, open-ended short answer and closed questions. Each item of need was evaluated for its validity by a panel of experts via an online survey. Descriptive statistics were used to analyse data, including means, percentages and the Content Validity Index (CVI).Streiner and Kottner's scale development and testing guidelines were used in the reporting of this study. 48 items of need were evaluated as valid by mental health service users, clinicians and academics. Most items received an I-CVI of greater than .93. The scale CVI/Avg was .96. The NiRA is perceived as a valid and acceptable tool for assessing the needs of people recovering from a first episode of mental illness.

Needs of Individuals Recovering from a First-Episode of Mental Illness: A Qualitative Descriptive Analysis of Focus Group Discussions.

A broad array of needs often arise for individuals when significant physical or mental illness occurs. The aim of this study was to investigate the needs experienced by individuals recovering from a first-episode of mental illness, to explore how these needs have been assessed and to gauge the acceptability of participating in formal, systematic needs assessments in the future. Fifteen individuals who had presented to a tertiary mental health service within the previous 3 years, and who were considered to be recovering from a first-episode of mental illness discussed their current and previous needs in small focus groups. A qualitative descriptive methodology was adopted to analyse data. Three themes incorporating the broad range of inter-related and often complex needs were identified as being: the need for safety, stability and security; the need to be understood and to understand and; the need for support networks and services. Participants reported a lack of involvement in discussions with mental health clinicians regarding their needs, and were in favour of participating in formal, systematic needs assessments in the future.

The supportive care needs of individuals recovering from first episode psychosis: A scoping review.

BACKGROUND: First episode psychosis (FEP) can be a traumatic experience that may alter an individual's ability to meet their own needs. The Supportive Care Needs Framework (SCNF) could complement the recovery-oriented, person-centred approach that is the current foundation of mental health care. AIM: To identify the supportive care needs (SCNs) of individuals recovering from a FEP. METHODS: A scoping review of the literature was undertaken. Review questions were developed, and relevant studies were identified through database and hand searches of peer-reviewed journal articles. Data from selected articles were tabulated, and contextual meaning was given to the data through a process of collating, summarizing, and reporting. RESULTS: A total of 14 peer-reviewed journal articles met inclusion criteria. SCNs were identified at different stages of recovery, ranging from initial treatment to 7 years postdiagnosis. Emotional, informational, practical, psychological, and social needs were identified in over half of the included articles, while needs in the physical and spiritual domains were identified in less than five. CONCLUSIONS: Unmet needs in each of the seven domains of need of the SCNF were identified in this population. There are a number of gaps in the literature relating to the specific needs of this population and the timing for which individuals may require more supportive care in their recovery journey.

Needs of individuals recovering from a first episode of mental illness: A scoping review.

Central to the role of mental health clinicians is the assessment of needs. A number of assessment tools have been used to evaluate the needs of individuals diagnosed with a mental illness. These tools have largely been developed for people with a severe and persistent mental illness and may not be suitable for individuals who are recovering from a first episode of mental illness. The aims of this review were therefore to identify the needs experienced by individuals recovering from a first episode of mental illness; determine what tools have been used to evaluate these needs; and explore whether existing tools adequately reflect the needs described in the literature. Twenty-one articles were included, comprising articles which identified needs (n = 10), needs assessment tools (n = 1), or articles which identified both needs and a needs assessment tool (n = 10). Results indicate that individuals who have been admitted to a specialized mental health unit and are recovering from a first episode of mental illness may experience an extensive range of needs, spanning emotional, psychological, social, informational, functional, practical, and relationship needs. Four established needs assessment tools were found to have been used to evaluate these needs; however, these do not appear to represent all needs discovered in this review, were mostly developed for populations with a long-term mental illness, and may not be suitable for assessing the needs of individuals recovering from a first episode of mental illness following a presentation to a specialized mental health unit.

Improved culture conditions for the growth and detection of Borrelia from human serum.

In this report we present a method to cultivate Borrelia spirochetes from human serum samples with high efficiency. This method incorporates improved sample collection, optimization of culture media and use of matrix protein. The method was first optimized utilizing Borrelia laboratory strains, and later by demonstrating growth of Borrelia from sera from fifty seropositive Lyme disease patients followed by another cohort of 72 Lyme disease patients, all of whom satisfied the strict CDC surveillance case definition for Lyme disease. The procedure resulted in positive cultures in 47% at 6 days and 94% at week 16. Negative controls included 48 cases. The positive identification of Borrelia was performed by immunostaining, PCR, and direct DNA sequencing.

Public access defibrillation: psychological consequences in responders.

BACKGROUND: Adverse psychological reactions are relatively frequent in professional ambulance crews who attend traumatic events, yet appear unusual in lay persons who attempt resuscitation of victims of out of hospital cardiac arrest. AIM: To investigate the psychological profile of first responders to gain insight into possible factors that might protect them against such reactions. METHODS: Qualitative study of first responders in a community scheme in Barry, South Wales. In depth semi-structured interviews with six subjects were analysed using Interpretive Phenomenological Analysis (IPA). RESULTS: The study identified a resilience phenomenon in first responders accounted for by certain enabling core beliefs about their role, their capacity, and about the meaning of negative and positive outcomes for themselves. A realistic appreciation of their own limitations, confidence in their ability to perform as trained and being able to handle positive and negative outcomes were prominent features. The ability to act with emotional detachment appears a further protective mechanism. This mindset, loosely described as 'a philosophy', protects against the development of adverse reactions to stress or from becoming unduly concerned about negative outcomes. The responders had altruistic motives for undertaking the role yet were capable of operating with a high degree of naturally occurring resilience to stress or undermining anxiety. It is the combination of being motivated by altruism coupled with an inherent resilience that appears to be the crucial protective mechanism. CONCLUSIONS: The group demonstrated an apparently innate resilience to the adverse psychological effects of responding with an AED in a PAD scheme. This enables them to operate optimally in stressful situations without experiencing the negative psychological consequences that might otherwise arise. This information may be used to raise awareness about the psychological requirements for the role and to assist screening or selection processes.