Situation awareness amongst emergency care practitioners

The increase and changes in the demand for emergency care require pro-active responses from the designers and implementers of the emergency care system. The role of Emergency Care Practitioner (ECP) was introduced in England to improve the delivery of emergency care in the community. The role was evaluated using cost-benefit approach and compared with other existing emergency care roles. An analysis of the cognitive elements (situation awareness (SA) and naturalistic decision making (NDM)) of the ECP job was proposed considering the mental efforts involved. While the cost-benefit approach can justify further spending on developing the role, a cognitive approach can provide the evidence in ensuring the role is developed to fulfil its purpose. A series of studies were carried out to describe SA and NDM amongst ECPs in an ambulance service in England. A study examined decision-making process using Critical Decision Method interviews which revealed the main processes in making decision and how information was used to develop SA. Based on the findings, the subsequent studies focus on the non-clinical factors that influence SA and decision making. Data from a scoping study were used to develop a socio-technical systems framework based on existing models and frameworks. The framework was then used to guide further exploration of SA and NDM. Emergency calls that were assigned to ECPs over a period of 8 months were analysed. The analysis revealed system-related influences on the deployment of ECPs. Interviews with the ECPs enabled the identification of influences on their decision-making with respect to patient care. Goal-directed task analysis was used to identify the decision points and information requirements of the ECPs. The findings and the framework were then evaluated via a set of studies based on an ethnographic approach. Participant observations with 13 ECPs were carried out. Field notes provided further insight into the characteristics of jobs assigned to the ECPs. It was possible to map the actual information used by the ECP to their information needs. The sources of the information were classified according to system levels. A questionnaire based on factors influencing decision-making was tested with actual cases. It was found that the items in the questionnaire could reliably measure factors that influence decision-making. Overall, the studies identify factors that have direct and indirect influences on the ECP job. A coherent model for the whole emergency care systems can be developed to build safety into the care delivery process. Further development of the ECP role need to consider the support for cognitive tasks in light of the findings reported in this thesis

Measuring emotional intelligence in a Malaysian sample: an exploratory factor analysis

Schutte et al. (1998) developed a 33-item emotional intelligence scale which they claimed to be uni-dimensional. Petrides and Furnham (2006) conducted factor analysis on the same scale and found 4 factors underlying the scale. Studies on emotional intelligence had been conducted in Malaysia with scales that were adopted, adapted, and developed. The dimensionality of the scales needed to be clearly demonstrated to better put the findings within the local context. This study examined the factor structure of the bilingual version of the scale (Malay translation by Abd Hamid and Kimin, 2004) us-ing principal axis factoring with a varimax orthogonal rotation, in a Malaysian sample. The scale was administered to 187 Malaysian employees in a government agency and a college community. The analysis revealed four factors underlying the scale that matched Petrides and Furnham’s findings. Reliability was found to be good for three factors and unacceptable for one. The issues in the factor structure were discussed

Towards an integrated sociotechnical framework for situation awarenss and decision-making for emergency care

Emergency Care Practitioner (ECP) is a work role in the Ambulance Services in the UK that was introduced to provide an alternative emergency care within the community. In order to further understand the cognitive aspects of the work role, a study was carried out to identify factors influencing situation awareness and decision-making among ECPs in an Ambulance Service in England. Two ECPs participated in observations (40 hours of ride-outs) and semi-structured interviews. Analysis of the interview reveals factors that can be categorised into a number of systems-related levels of analysis (macro-micro). The outcomes from the study form the basis of an integrated sociotechnical system framework for emergency care with a focus on situation awareness and decision-making

System-related influences on assigning patients to emergency care practitioners

The deployment of advanced paramedics in ambulance services in the UK has been reviewed in the last few years. This study examined the role played by a computerised dispatch system (AMPDS – Advanced Medical Priority Dispatch System) which was reported to be not predictive in terms of selecting suitable patients to assign to emergency care practitioners (ECPs). The aim of this paper is to further examine the AMPDS data in order to understand influences on ECPs deployment and the resulting patient outcomes in an Ambulance Services NHS (National Health Service) Trust. AMPDS data for cases where ECPs were dispatched during a six-month period was extracted. The data was analysed using SPSS 12.0 to examine the number and types of cases across different time frames. In order to understand the factors related to ECP deployment and decisions to transport patients, semi-structured interviews were conducted with seventeen ECPs and three ambulance control room staff. The interviews were transcribed and analysed using emergent themes analysis with NVivo7. Results: There was an increase in the number of cases assigned to ECPs in the months covered by the data set. There are differences of the rate of patient transport among the Primary Care Trusts (PCT) within the Ambulance Services which are not due to fluctuations in workload across days of the week. The interviews help to explain the variations by identifying wider systemic influences. Themes derived from the interviews are patient’s social needs, geographical factor, technical factor, information factor, and connectivity to care pathways. Conclusions: The variations in the deployment of ECPs within the Ambulance Services can be partly attributed to wider systemic influences. Designing a paramedic role for pre-hospital care in the community should take into accounts the factors that influence their decisions regarding patient’s care pathway

System-related influences on assigning patients to emergency care practitioners

The deployment of advanced paramedics in ambulance services in the UK has been reviewed in the last few years. This study examined the role played by a computerised dispatch system (AMPDS – Advanced Medical Priority Dispatch System) which was reported to be not predictive in terms of selecting suitable patients to assign to emergency care practitioners (ECPs). The aim of this paper is to further examine the AMPDS data in order to understand influences on ECPs deployment and the resulting patient outcomes in an Ambulance Services NHS (National Health Service) Trust. AMPDS data for cases where ECPs were dispatched during a six-month period was extracted. The data was analysed using SPSS 12.0 to examine the number and types of cases across different time frames. In order to understand the factors related to ECP deployment and decisions to transport patients, semi-structured interviews were conducted with seventeen ECPs and three ambulance control room staff. The interviews were transcribed and analysed using emergent themes analysis with NVivo7. Results: There was an increase in the number of cases assigned to ECPs in the months covered by the data set. There are differences of the rate of patient transport among the Primary Care Trusts (PCT) within the Ambulance Services which are not due to fluctuations in workload across days of the week. The interviews help to explain the variations by identifying wider systemic influences. Themes derived from the interviews are patient’s social needs, geographical factor, technical factor, information factor, and connectivity to care pathways. Conclusions: The variations in the deployment of ECPs within the Ambulance Services can be partly attributed to wider systemic influences. Designing a paramedic role for pre-hospital care in the community should take into accounts the factors that influence their decisions regarding patient’s care pathway

Patient safety

Diseases and sickness are part of a normal life. It is also normal to seek treatment for afflictions. However, qUite surprisingly, it is also normal for people to be exposed to additional harms in the process of being treated. A study of British hospitals revealed that 10.8% of patients admitted to hospitals experienced unintended injuries caused by medical mismanagement (Vincent, Neale, & Woloshynowych, 2001). Patients experienced single or multiple injuries that led to mild impairments, permanent impairments, and even death. Shockingly, 48% of the unintended injuries, or adverse events, were preventable

Factor structure of the student engagement instrument among Malaysian undergraduates

Keterlibatan pelajar telah diketahui secara positif berkaitan dengan prestasi akademik, tetapi terdapat kekurangan kajian yang menyerlahkan fenomena ini di kalangan mahasiswa Malaysia. Kajian ini bertujuan untuk mengkaji struktur faktor Student Engagement Instrument (SEI) dengan sampel pelajar di Malaysia. Alat kajian telah ditadbirkan kepada 290 pelajar ijazah dari Fakulti Ilmu Wahyu dan Sains Kemanusiaan dan Fakulti Ekonomi dan Sains Pengurusan Universiti Islam Antarabangsa Malaysia. Ekstraksi principal axis factor dengan putaran Promax telah digunakan dalam analisis faktor penerokaan (Exploratory Factor Analysis) dan mendedahkan satu penyelesaian enam faktor yang konsisten dengan struktur faktor yang terdapat dalam kajian asal oleh Appleton et al. (2006). Faktor baru yang dinamakan kepunyaan tidak dibincangkan dalam kajian sebelum ini telah ditemui dan patut diterokai. Student engagement has been known to be positively associated with academic performance, but there has been a lack of studies that highlight this phenomenon among Malaysian undergraduates. This study seeks to examine the factor structure of the Student Engagement Instrument (SEI) in a Malaysian sample. The scale was administered to 290 undergraduate students from the Faculty of Islamic Revealed Knowledge and Human Sciences as well as the Faculty of Economics and Management Sciences of the International Islamic University of Malaysia. Principal axis factor with Promax rotation was used in exploratory factor analysis (EFA) and revealed a six-factor solution that was consistent with the factor structure found in the original study by Appleton et al. (2006). A new factor labelled belongingness which was not discussed in previous studies was also discovered, which is worth exploring

Factor structure of the student engagement instrument among Malaysian undergraduates

Keterlibatan pelajar telah diketahui secara positif berkaitan dengan prestasi akademik, tetapi terdapat kekurangan kajian yang menyerlahkan fenomena ini di kalangan mahasiswa Malaysia. Kajian ini bertujuan untuk mengkaji struktur faktor Student Engagement Instrument (SEI) dengan sampel pelajar di Malaysia. Alat kajian telah ditadbirkan kepada 290 pelajar ijazah dari Fakulti Ilmu Wahyu dan Sains Kemanusiaan dan Fakulti Ekonomi dan Sains Pengurusan Universiti Islam Antarabangsa Malaysia. Ekstraksi principal axis factor dengan putaran Promax telah digunakan dalam analisis faktor penerokaan (Exploratory Factor Analysis) dan mendedahkan satu penyelesaian enam faktor yang konsisten dengan struktur faktor yang terdapat dalam kajian asal oleh Appleton et al. (2006). Faktor baru yang dinamakan kepunyaan tidak dibincangkan dalam kajian sebelum ini telah ditemui dan patut diterokai. Student engagement has been known to be positively associated with academic performance, but there has been a lack of studies that highlight this phenomenon among Malaysian undergraduates. This study seeks to examine the factor structure of the Student Engagement Instrument (SEI) in a Malaysian sample. The scale was administered to 290 undergraduate students from the Faculty of Islamic Revealed Knowledge and Human Sciences as well as the Faculty of Economics and Management Sciences of the International Islamic University of Malaysia. Principal axis factor with Promax rotation was used in exploratory factor analysis (EFA) and revealed a six-factor solution that was consistent with the factor structure found in the original study by Appleton et al. (2006). A new factor labelled belongingness which was not discussed in previous studies was also discovered, which is worth exploring