Archetypal meanings of being a paramedic: A hermeneutic review.

BACKGROUND: Interpretations of being a paramedic are normally unspoken in the literature and easily overlooked in the busyness of everyday work. The premise of this study was to explicate historical and cultural archetypes of the paramedic from within relevant literature. METHODS: A hermeneutic review was conducted to explore meanings associated with being a paramedic. This was a novel approach to exploring meanings of being and provided a rich depiction of the cultural and historical nuances inherent in paramedic work. RESULTS: Six paramedic archetypes were identified and related broadly to the principles of service, care and stoicism. These archetypes provided glimpses of how the paramedic is theorised both within and external to the profession, as well as gaps related to how the phenomenon of being a paramedic is experienced amid everyday practice situations. CONCLUSION: Historical archetypes of the paramedic need to be recognised by paramedics as important in shaping the inherited cultural meanings of the work they do. However, due to the limited ability of fixed archetypes to capture the dynamic meanings of being a paramedic further research is required to understand how paramedics experience their caring work as meaningful across diverse contexts.

What personality types dominate among nurses and paramedics: A scoping review?

BACKGROUND: Certain personality traits captured by the Big Five framework have been shown to play an important role in predicting burnout in response to stressors, with evidence they reflect a relationship to psychological resilience. Understanding such distributions can subsequently serve to facilitate identification and implementation of more specifically targeted preventative strategies. METHODS: Arksey and O'Malley's five stage scoping was used to review the literature. The research question that guided this scoping was: Big Five personality factor predominance's among nurses and paramedics, and any relationships with constructs critical for wellbeing. Five electronic databases were searched during November 2018: PsycINFO, Embase, Medline, ProQuest and Scopus. RESULTS: Eighteen articles met inclusion criteria. Two broad themes emerged: those specifically about personality traits of nurses and/or paramedics, and those concerned with various associations between one or other construct and personality trait(s). Low Neuroticism and higher Extraversion are considered desirable traits in nurses and paramedics as they have each been found to have a negative correlation with burnout. CONCLUSIONS: Nurses and paramedics with higher Neuroticism and lower Extraversion suggest being less suited to their profession, particularly when exposed to critical incidents.

Examining consensus for a standardised patient assessment in community paramedicine home visits: a RAND/UCLA-modified Delphi Study.

OBJECTIVE: Community paramedicine programme are often designed to address repeated and non-urgent use of paramedic services by providing patients with alternatives to the traditional 'treat and transport' ambulance model of care. We sought to investigate the level of consensus that could be found by a panel of experts regarding appropriate health, social and environmental domains that should be assessed in community paramedicine home visit programme. DESIGN: We applied the RAND/UCLA Appropriateness Method in a modified Delphi method to investigate the level of consensus on assessment domains for use in community paramedicine home visit programme. SETTING AND PARTICIPANTS: We included a multi-national panel of 17 experts on community paramedicine and in-home assessment from multiple settings (paramedicine, primary care, mental health, home and community care, geriatric care). MEASURES: A list of potential assessment categories was established after a targeted literature review and confirmed by panel members. Over multiple rounds, panel members scored the appropriateness of 48 assessment domains on a Likert scale from 0 (not appropriate) to 5 (very appropriate). Scores were then reviewed at an in-person meeting and a finalised list of assessment domains was generated. RESULTS: After the preliminary round of scoring, all 48 assessment domains had scores that demonstrated consensus. Nine assessment domains (18.8%) demonstrated a wider range of rated appropriateness. No domains were found to be not appropriate. Achieving consensus about the appropriateness of assessment domains on the first round of scoring negated the need for subsequent rounds of scoring. The in-person meeting resulted in re-grouping assessment domains and adding an additional domain about urinary continence. CONCLUSION: An international panel of experts with knowledge about in-home assessment by community paramedics demonstrated a high level of agreement on appropriate patient assessment domains for community paramedicine home visit programme. Community paramedicine home visit programme are likely to have similar patient populations. A standardised assessment instrument may be viable in multiple settings.

How soon do allied health professionals lose confidence to perform EBP activities? A cross-sectional study.

OBJECTIVE: To explore if there is a relationship between allied health professionals' confidence to perform a range of evidence-based practice (EBP) activities and the time since they graduated from their entry-level degree and the presence of postgraduate qualifications. DESIGN: Cross-sectional survey. SETTING: Allied health professionals from two Australian public metropolitan health services, including acute, subacute, and community settings. PARTICIPANTS: Sample of 288 (n = 288) allied health professionals from the disciplines of physiotherapy, occupational therapy, speech pathology, social work, dietetics/nutrition, and other. MAIN OUTCOME MEASURE: Cross-sectional survey including 12 questions measuring respondents' confidence to conduct a range of EBP activities. RESULTS: Allied health professionals begin to lose confidence related to EBP activities within the first 5 years of clinical practice, particularly for those activities involving critical analysis of published studies. Respondents with postgraduate qualifications were more likely to report greater confidence with EBP activities, suggesting that higher level qualifications protect against the effect of degradation of EBP skills and confidence over time. CONCLUSIONS: Allied health professionals' confidence to perform EBP activities degrades over time, particularly for those individuals with no postgraduate qualifications. Registration and accreditation bodies along with allied health professional employers should explore potential strategies to preserve and enhance EBP skills, confidence, and behaviours.

Allied health clinicians using translational research in action to develop a reliable stroke audit tool.

OBJECTIVE: To design and establish reliability of a local stroke audit tool by engaging allied health clinicians within a privately funded hospital. METHODS: Design: Two-stage study involving a modified Delphi process to inform stroke audit tool development and inter-tester reliability. PARTICIPANTS: Allied health clinicians. INTERVENTIONS: A modified Delphi process to select stroke guideline recommendations for inclusion in the audit tool. Reliability study: 1 allied health representative from each discipline audited 10 clinical records with sequential admissions to acute and rehabilitation services. MAIN OUTCOME MEASURES: Recommendations were admitted to the audit tool when 70% agreement was reached, with 50% set as the reserve agreement. Inter-tester reliability was determined using intra-class correlation coefficients (ICCs) across 10 clinical records. RESULTS: Twenty-two participants (92% female, 50% physiotherapists, 17% occupational therapists) completed the modified Delphi process. Across 6 voting rounds, 8 recommendations reached 70% agreement and 2 reached 50% agreement. Two recommendations (nutrition/hydration; goal setting) were added to ensure representation for all disciplines. Substantial consistency across raters was established for the audit tool applied in acute stroke (ICC .71; range .48 to .90) and rehabilitation (ICC.78; range .60 to .93) services. CONCLUSIONS: Allied health clinicians within a privately funded hospital generally agreed in an audit process to develop a reliable stroke audit tool. Allied health clinicians agreed on stroke guideline recommendations to inform a stroke audit tool. The stroke audit tool demonstrated substantial consistency supporting future use for service development. This process, which engages local clinicians, could be adopted by other facilities to design reliable audit tools to identify local service gaps to inform changes to clinical practice.

Characterizing the Mammography Technologist Workforce in North Carolina.

PURPOSE: Mammography technologists' level of training, years of experience, and feedback on technique may play an important role in the breast-cancer screening process. However, information on the mammography technologist workforce is scant. METHODS: In 2013, we conducted a survey mailed to 912 mammography technologists working in 224 facilities certified by the Mammography Quality Standards Act in North Carolina. Using standard survey methodology, we developed and implemented a questionnaire on the education and training, work experiences, and workplace interactions of mammography technologists. We aggregated responses using survey weights to account for nonresponse. We describe and compare lead (administrative responsibilities) and nonlead (supervised by another technologist) mammography technologist characteristics, testing for differences, using t-tests and χ(2) analysis. RESULTS: A total of 433 mammography technologists responded (survey response rate = 47.5%; 95% confidence interval [CI]: 44.2%-50.7%), including 128 lead and 305 nonlead technologists. Most mammography technologists were non-Hispanic, white women; their average age was 48 years. Approximately 93% of lead and nonlead technologists had mammography-specific training, but <4% had sonography certification, and 3% had MRI certification. Lead technologists reported more years of experience performing screening mammography (P = .02) and film mammography (P = .03), more administrative hours (P < .0001), and more workplace autonomy (P = .002) than nonlead technologists. Nonlead technologists were more likely to report performing diagnostic mammograms (P = .0004) or other breast imaging (P = .001), discuss image quality with a peer (P = .013), and have frequent face-to-face interaction with radiologists (P = .03). CONCLUSIONS: Our findings offer insights into mammography technologists' training and work experiences, highlighting variability in characteristics of lead versus nonlead technologists.

Who are they and what do they do? Profile of allied health professionals working with people with disabilities in rural and remote New South Wales.

OBJECTIVE: To explore the characteristics of allied health professionals (AHPs) working with people with disabilities in western New South Wales (NSW). DESIGN: A cross-sectional survey was conducted using an online questionnaire. SETTING: Rural western NSW. PARTICIPANTS: AHPs including physiotherapists, speech pathologists, occupational therapists and psychologists ('therapists') working with people with disabilities. MAIN OUTCOME MEASURE: AHPs characteristics. RESULTS: The majority of respondents were women (94%), with a mean age of 39 years; average time since qualification was 14 years; mean years in current position was 6. Most worked with people with a lifelong disability. Two thirds reported that family ties kept them in rural areas; 71% grew up in a rural/remote area. Most participants (94%) enjoyed the rural lifestyle, and 84% reported opportunities for social interaction as good or very good. Participants with dependent children were less likely to cease working in western NSW within 5 years than those without dependent children (P < 0.05). CONCLUSIONS: The characteristics of therapists working with people with disabilities in rural NSW were identified. Overall working, but also social conditions and community attachment were important for this group. Understanding the workforce will contribute to policy development to meet increasing demands for therapy services.

Regulamento para a mudanca de carreiras nas árias de regime geral e especifica no sector de saúde / Regulation for changing careers in the general and specific regime in the health sector

O estatuto geral dos funcionarios e a gente do estado, preve que os funcionários podem ser desevolver profissionalmente frequentando curcos ligados a sua ária de formação basica e tendo em conta as prioridades do sector onde prestam servicos.partindo deste principio e com o aumento de instituições de ensino superior no pais, um número significativo de profissionais da ária especifica de saúde concluiu/ frequenta curcos de nivel superior que nada tem a ver com a sua formação básica e/ou que não tem enquadramento no serviço nacional de saúde

Allied, scientific and complementary health professionals: a new model for Australian allied health.

There is no standard or agreed definition of "allied health" nationally or internationally. This paper reviews existing definitions of allied health, and considers aspects of allied health services and service delivery in order to produce a new model of allied health that will be flexible in a changing health service delivery workforce. We propose a comprehensive model of allied, scientific and complementary (ASC) health professionals. This model recognises tasks, training, organisation, health sectors and professional regulation. It incorporates traditional and new services which are congruent with allied health foci, allegiances, responsibilities and directions. Use of this model will allow individual organisations to describe their ASC health workforce, and plan for recruitment, staff training and remuneration.

Trends in the rehabilitation therapist workforce in underserved areas: 1980-2000.

CONTEXT: There is little information about how increases in the rehabilitation therapist workforce have been distributed over the nation. There is evidence that rural areas continue to face a shortage of trained rehabilitation providers. There has also been little attention to therapist distribution in non-rural settings where health professionals are in short supply. PURPOSE: To assess the change in the distribution of rehabilitation therapists in 1980, 1990, and 2000 across counties with different levels of health professional shortages and the difference between metropolitan and non-metropolitan counties. METHODS: A trend analysis of cross-sectional data of employment of physical therapists, occupational therapists, and speech-language pathologists from 1980 to 2000 by county, relative to population, was done. The groups were stratified by shortage area, partial shortage area, and non-shortage counties and metropolitan and non-metropolitan counties. FINDINGS: There is a maldistribution of rehabilitation therapists in the United States. Although the absolute differences have remained the same or, in most instances, have increased, the relative change was greatest in the shortage areas and non-metropolitan areas. If the trends in the relative changes continue, the absolute differences may begin to narrow. CONCLUSIONS: This study provides evidence that there are maldistributions of rehabilitation therapists in traditionally underserved areas. It is unclear if these maldistributions represent a shortage of rehabilitation therapists. Continued monitoring of the rehabilitation therapist workforce and the determination of the optimal supply should be undertaken in the future.

Workload capacity measures for estimating allied health staffing requirements.

Workforce planning methodologies for the allied health professions are acknowledged as rudimentary despite the increasing importance of these professions to health care across the spectrum of health services settings. The objectives of this study were to (i) identify workload capacity measures and methods for profiling allied health workforce requirements from a systematic review of the international literature; (ii) explore the use of these methods in planning workforce requirements; (iii) identify barriers to applying such methods; and (iv) recommend further action. Future approaches to workforce planning were explored through a systematic review of the literature, interviews with key stakeholders and focus group discussions with representatives from the different professional bodies and health agencies in Victoria. Results identified a range of methods used to calculate workload requirements or capacity. In order of increasing data demands and costliness to implement, workload capacity methods can be broadly classified into four groups: ratio-based, procedure-based, categories of care-based and diagnostic or casemix-based. Despite inherent limitations, the procedure-based measurement approach appears to be most widely accepted. Barriers to more rigorous workforce planning methods are discussed and future directions explored through an examination of the potential of casemix and mixed-method approaches.

Types, prevalence, and potential clinical significance of medication administration errors in assisted living.

OBJECTIVES: To describe the types and potential clinical significance of medication administration errors in assisted living (AL). DESIGN: Cross-sectional observational study. SETTING: This study was conducted in 12 AL settings in three states (Oregon, Washington, and New Jersey). PARTICIPANTS: Participants included 29 unlicensed assistive personnel and 510 AL residents. MEASUREMENTS: Medication administration observations, chart review, and determination of rates, types, and potential clinical significance of errors using standardized methodology. RESULTS: Of 4,866 observations, 1,373 errors were observed (28.2% error rate). Of these, 70.8% were wrong time, 12.9% wrong dose, 11.1% omitted dose, 3.5% extra dose, 1.5% unauthorized drug, and 0.2% wrong drug. Excluding wrong time, the overall error rate dropped to 8.2%. Of the 1,373 errors, three were rated as having potential clinical significance. CONCLUSION: A high number of daily medications are given in AL. Wrong time accounted for the majority of the errors. The bulk of the medications are low risk and routine; to promote optimal care delivery, clinicians need to focus on high-risk medications and residents with complex health problems.

Emergency Preparedness for Health Professionals in a Statewide AHEC Program: the first two years.

In 2003 through 2005, the California Statewide Area Health Education Centers (AHEC) Program developed an educational delivery system, through partnerships with six AHECs and state organizations concerned with emergency preparedness, to train for public health emergency preparedness the health professionals who practice primarily in the state's medically underserved areas. Four educational modules--General Emergency Preparedness, Bioterrorism, Chemical and Radiologic Agents, and Emerging Infections--were developed and delivered by a trained, multidisciplinary, community-based faculty. The authors discuss the organization, partnerships, curriculum, faculty, characteristics of trainees, outcomes of the program, effects for AHECs, and the evaluation used to commit the organization and program process to the intended program objectives during the two-year period. Over 9,000 health professionals attended one or more of the 462 educational presentations. Approximately one third of attendees were physicians, and 82% of the learners were from sites that typically care for the underserved. Important to the success of the program (which still continues in a revised form) were the types of partnerships, an orientation of the curriculum to all-hazards disaster preparedness, the delivery of educational sessions at clinical sites, and the increased capacities of community AHECs to facilitate continuing professional education. The challenges were the diminished role of a key partner organization, uncertainties within the funding agency, and the widespread geographic area to address.

Applying a theory of expertise in health social work administration and practice in Australia.

Social workers in health care have been urged to identify the nature of their expertise and to articulate profession specific roles (Peckuconis et al., 2003). This paper reports on the use of a theory of professional expertise (Fook, Ryan, & Hawkins, 2000) in management and clinical practice within two Australian hospital social work settings. This theory, directly applicable to social work, was applied within these hospitals to differentiate levels in social work industrial awards, in staff selection, in supervision and continuing professional development. Specific and broader implications for application of this theory are discussed.

The nonphysician provider in the gastroenterology practice.

Our nonphysician provider (NPP) experience has transformed the functioning and image of our practice. It allows the practice to care for poorly compensated or noncompensated patients and contains costs under managed care. NPPs enable our physicians to maintain reasonable workloads and focus their energy and skills on high-level diagnosis and treatment. This decreases the risk of physician burnout, and allows a diminishing supply of gastroenterologists to practice medicine until normal retirement age. NPPs greatly enhance physician productivity, revenue, and patient and physician satisfaction.

The public's perception of social work: is it what we think it is?

This article reports on the public's current perception of the social work profession as examined in a nationally representative, random digit telephone survey of 386 people. The survey asked respondents about their knowledge, beliefs, and attitudes regarding the profession and its practitioners and required respondents to make comparisons between social workers and other helping professionals such as psychiatrists, psychologists, counselors, nurses, and clergy. Results of the survey indicated that for the most part, a majority of the public understands the social work profession and in many ways recognizes its value.