Health promotion in emergency care settings: investigating staff views and experiences.

BACKGROUND: Emergency departments (EDs) afford 'teachable moments' for health behaviour change, but staff may not see themselves as public health practitioners and it can be challenging to undertake health promotion activities in emergency care settings. Furthermore, the evidence on health promotion in these settings is limited. AIM: To investigate the views and experiences of emergency nurses and ambulance service paramedics regarding health promotion in emergency care settings. METHOD: A convenience sample of emergency nurses (n=3) and ambulance service paramedics (n=3) was recruited. An inductive and descriptive qualitative study design using semi-structured interviews and thematic analysis was employed. FINDINGS: The participants understood health promotion and were willing to have conversations about it with patients. However, they cited several barriers to health promotion, including understaffing, a lack of understanding of the relevance of health promotion among staff, a lack of training and information, and the sensitivity of topics such as body weight and sexual health. Lack of time was not cited as a barrier. CONCLUSION: There are opportunities for developing the health promotion aspect of practice in emergency care settings, where staff and patients would benefit from a more structured, system-wide approach to health promotion.

A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer.

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months.   Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.

Dominant versus non-dominant hand during simulated infant CPR using the two-finger technique: a randomised study.

AIMS: The aim of this randomised study was to compare the two-finger technique (TFT) performance using dominant hand (DH) and non-dominant hand (NH) during simulated infant CPR (iCPR). METHODS: 24 participants performed 3-min iCPR using TFT with DH or NH followed by 3-min iCPR with their other hand. Perceived fatigue was rated using visual analogue scale. Primary outcomes - (i) difference between DH and NH for compression depth (CCD), compression rate (CCR), residual leaning (RL) and duty cycle (DC); (ii) difference between first and last 30 s of iCPR performance with DH and NH. Secondary outcomes - (i) perception of fatigue between DH and NH; (ii) relationship between perception of fatigue and iCPR performance. RESULTS: No significant difference between DH and NH for any iCPR metric. CCR (DH: P = 0.02; NH: P = 0.004) and DC (DH: P = 0.04; NH: P < 0.001) were significantly different for the last 30 s for DH and NH. Perception of fatigue for NH (76.8 ± 13.4 mm) was significantly higher (t = -3.7, P < 0.001) compared to DH (62.8 ± 12.5 mm). No significant correlation between iCPR metrics and perception of fatigue for DH. However, a significant correlation was found for CCR (r = 0.43; P = 0.04) and RL (r = -0.48; P = 0.02) for NH. CONCLUSION: No difference in performance of iCPR with DH versus NH was determined. However, perception of fatigue is higher in NH and was related to CCR and RL, with no effect on quality of performance. Based on our results, individuals performing iCPR can offer similar quality of infant chest compressions regardless of the hand used or the perception of fatigue, under the conditions explored in this study.

Paramedic performance when managing patients experiencing mental health issues - Exploring paramedics' Presentation of Self.

INTRODUCTION: Mental health is a growing global concern with a significant rise in patients calling emergency services to respond to their needs. Paramedics in the UK are increasingly being asked to respond to this increase in demand. AIM: This study explores how paramedics perform in practice when managing patients experiencing mental health issues. METHODS: Qualitative observation over 240 h and interviews involving 21 paramedics and 20 patients with mental illness. RESULTS: Using Goffman's seminal text Presentation of Self to frame the analysis the findings of this study reveal that paramedics '"perform" on two stages: front stage and back stage. Their coping mechanisms, in the metaphorical sense, include props such as uniform and scripts filled with humour, stereotyping and nostalgia to aid in their management of this specialist patient group. CONCLUSIONS: Paramedics feel frustrated and unsupported when dealing with patients experiencing mental health issues. This study identifies the coping mechanisms paramedics use to manage this patient group but questions the longevity of these mechanisms and therefore recommends additional support for paramedics with further supportive education around mental health.