Paramedics and dementia

Paramedic students are learning more about dementia care, but how many intend to work in the field? Joanne Brooke and Marlon Stiell’s study produced some worrying findings. Dementia requires a person-centred, holistic approach to care which considers the unique challenges faced by each individual. It is essential that health care professionals are competent in a range of skills to support and care for people with dementia as this will form a major part of their role in many cases (Clissett et al 2014). Care of people with dementia has been included in many undergraduate programmes for health care professionals such as nursing and medicine (Alushi et al 2015), but has only recently been acknowledged in paramedic science programmes (Ross 2012)

Evaluation of the accuracy of capillary hydroxybutyrate measurement compared with other measurements in the diagnosis of diabetic ketoacidosis: a systematic review

A complication of diabetes is diabetic ketoacidosis (DKA), which if left untreated is a life threatening condition. Prompt and accurate diagnosis of DKA is required for the commencement of life saving interventions. Measurements of ketone bodies in DKA have usually been through nitroprusside urine acetoacetate testing. The aim of this systematic review was to examine whether capillary β-hydroxybutyrate (β-OHB) testing is more accurate compared to other diagnostic methods of DKA. The following electronic databases were searched: EBSCO Host, MEDLINE, PSYCHInfo, CINAHL and Science Direct for publications from 1 January 2005 and up to and including 1 January 2016. Inclusion criteria were: Adults 18 years and over and known type 1 or type 2 diabetes. Retrospective and prospective observation studies were included. A total of nine studies met the inclusion criteria. Capillary β-OHB was found to have high sensitivity, specificity, positive predictive value and negative predictive value in identifying DKA compared to urinary ketone testing

Development of clinical and interpersonal skills to support people living with dementia

There is a lack of understanding on how paramedic students develop their knowledge, skills and attitudes to support people living with dementia and their families in the community. This qualitative study used focus groups to explore paramedic students’ perspectives. 1st and 3rd year paramedic students were recruited from two ambulance service providers in the South of England. Data were collected during 2017 and four themes emerged: 1) impact of dementia on all concerned 2) challenges of communicating with people with dementia 3) negative emotional response to dementia, and 4) lack of social care and pathways for people with dementia. A further two cross-cutting themes emerged: 1) Learning in the classroom and 2) Learning ‘on the road’. Paramedic students did not discuss person-centered approaches to supporting people with dementia; however they all acknowledged the impact of dementia as unique to each person, their family and situation

Paramedic students' beliefs, experiences, and development of clinical and interpersonal skills to support people living with dementia

There is a lack of understanding on how paramedic students develop their knowledge, skills and attitudes to support people living with dementia and their families. This original qualitative study applied focus groups to explore paramedic students’ perspectives. First and third year paramedic students were recruited from two ambulance service providers in the South of England. Data were collected during January and February 2017 and three themes emerged: 1) challenges of communication 2) students’ negative emotional response, and 3) lack of social care and pathways. Paramedic students did not discuss person-centred approaches to support people with dementia; however they all acknowledge the impact of dementia as unique to each person, their family and situation. Undergraduate paramedic education needs to support the development of students’ communication and interpersonal skills. Both university lecturers and placement educators need to provide consistent, clear, detailed information to enable students to support and care for people with dementia and their families

Nursing students' cultural beliefs and understanding of dementia: A phenomenological study across three continents

Background: Migrant nurses have reported difficulties adapting to their new culture and providing culturally sensitive care for people with dementia. However, to date no studies have explored the impact of student nurse's cultural heritage on their beliefs and understanding of dementia. Objectives: To explore the cultural beliefs of dementia of student nurses studying in England, Slovenia, Philippines and New Zealand. Design: An explorative hermeneutic phenomenology design. Settings: Higher Education Institutes delivering undergraduate nursing education in England (University of Greenwich and University of Essex), Slovenia (Angela Boškin Faculty of Health Care), New Zealand (University of Auckland), and the Philippines (University of Silliman). Participants: Student nurses studying nursing in England (n = 81), Slovenia (n = 41), Philippines (n = 53) and New Zealand (n = 6). Participants from England and New Zealand were from diverse cultural backgrounds. Student nurses at the beginning of their studies (n = 100) and towards the end of their studies (n = 81) participated. Methods: Completion of focus groups (n = 23), in England (n = 10), Slovenia (n = 6), Philippines (n = 6), and New Zealand (n = 1). All focus groups were audio recorded and transcribed verbatim. Data was analysed by applying an inductive theoretical approach of the Framework Method, which supports the generation of themes through open unhindered coding, pinpointing, examining, and recording patterns within the data. Results: Two major themes were identified in the data: familial piety and dementia discourse. Familial piety emerged from the importance of family and caring for family members with dementia, subthemes included: ‘my granddad’: familial experience, and ‘better to be with her’: familial home. Dementia discourse emerged from the terminology student nurses applied, such as: ‘preconceptions and misconceptions’ of aggression, and ‘considered crazy’ stigma of dementia due to a lack of awareness. Conclusions: The cultural heritage of student nurses impacted on their beliefs of dementia; however their understanding of the needs, care and support of a person with dementia changed and developed through clinical experience and education

A systematic scoping review and textual narrative synthesis of physical and mixed-reality simulation in pre-service teacher training

Background: Due to recent lockdown conditions, which restricted opportunities for face-to-face contact and the ability to be physically in schools, the need for novel, safe ways to train pre-service teachers emerged even more pressingly. Whilst virtual simulation has received some attention in pedagogy and its benefits have been demonstrated in many disciplines, there appears to be less synthesized evidence on the use of physical and/or mixed-reality simulation utilized in teacher training. Objectives: The goal of this systematic scoping review was to summarize and synthesize the literature on the use of physical and/or mixed-reality simulation in pre-service teacher training. Methods: A systematic scoping literature review combined with a textual narrative synthesis was undertaken. Ten reference databases were searched in May 2020:Academic search premier, CINAHL, Education Research Complete, Humanities Inter-national Complete, Psychology and Behavioural Sciences Collection, PsycInfo,Teacher Reference Center, Science Direct, Web of Science and Scopus. Results and Conclusions: Following inclusion/exclusion criteria assessment and screening, 13 articles were included for appraisal and synthesis. Seven papers examined physical simulations, while the remainder examined mixed-reality simulations. The evidence from this review suggests that simulation, including physical and mixed-reality types, could be used as a tool to increase confidence, self-efficacy, classroom management skills and communication. Implications: In comparison to other fields (e.g., nursing, medicine and aviation)simulation in education appears to be in its infancy—more large-scale research is needed. At the same time, this review indicates that mixed-reality simulation in particular has the potential for contributing to teacher education, because it offers the potential for learning in various contexts when compared to traditional didactic teaching practice

A systematic mapping literature review of ethics in healthcare simulation and its methodological feasibility

Both the ethics of simulation and how it may be used to explore, train and assess ethical issues in a clinical context have received growing interest in recent years. As ethical considerations permeate almost every element of simulation and clinical practice, the emerging literature in this field remains relatively fragmented, lacking a common vocabulary or standardized practice and methodology. Given this, the primary aim of this paper was to systematically map the literature related to ethics in healthcare simulation, guided by the research question of ‘how is ethics in healthcare simulation recorded in current literature?’. Our secondary aim was to explore the feasibility of conducting a systematic mapping review. One hundred four papers were included and analyzed. Results suggest that this is relatively small, but rapidly growing field. Most research was carried out in the US and with variety of research methods employed. Research involving samples of nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Keyword co-occurrence suggested that studies utilized simulation overwhelmingly in an educational context

A systematic mapping literature review of ethics in healthcare simulation and its feasibility

Both the ethics of simulation and how it may be used to explore, train and assess ethical issues in a clinical context have received growing interest in recent years. As ethical considerations permeate almost every element of simulation and clinical practice, the emerging literature in this field remains relatively fragmented, lacking a common vocabulary or standardised practice and methodology. Given this, the primary aim of this paper was to systematically map the literature related to ethics in healthcare simulation, guided by the research question of ‘how is ethics in healthcare simulation recorded in current literature?’. Our secondary aim was to explore the feasibility of conducting a systematic mapping review. One hundred and four papers were included and analysed. Results suggest that this is relatively small, but rapidly growing field. Most research was carried out in the US and with variety of research methods employed. Research involving samples of nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Keyword co-occurrence suggested that studies utilised simulation overwhelmingly in an educational context

Reporting on a systematic mapping literature review of ethics in healthcare simulation

Background There is a growing interest in ethics in simulation. The Ethical issues that are largely considered in simulation range from the vulnerability of standardised patients1 to debating the use of death in simulation2. This Systematic mapping review set out to systematically map the literature relating to ethics in healthcare simulation. Methods A search was carried out on Scopus, Medline, CINAHL and Psychinfo. The search terms were broad and reflected key concepts related to our research question. Bibliometric data was captured and papers were further coded. Results In total, 104 papers were included for review, 25% focused on the ethics of simulation, 73% focused on simulation as a means to explore/assess or train ethical issues related to healthcare. One paper focused on both issues. Just over half of the papers (n = 56; 54%) were coded as being empirical research. Of those, the majority focused on simulation as a means to explore/assess or train ethical issues (n = 49; 87.5%) as opposed to the ethics of simulation (n = 7; 12.5%). The majority of outputs came from the US. Studies were mainly conducted by nurse and medical doctors, with very few from other allied health professionals and limited co-authorship. Nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Conclusions This study identified that ethics in healthcare simulation is a small but rapidly growing field. However, there is little in the way of collaboration and multi-interdisciplinary approaches. The use of simulation for training of ethical dilemmas is greater than the ethics of simulation itself, however, this may be due to terminology used within healthcare simulation. Recommendations This study has identified that there is further need to explore and develop our understanding of the role of ethics in healthcare simulation itself, looking at higher quality collaborative approaches across disciplines to further the field