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)

Brooke, Joanne

Stiell, Marlon

Greenwich Academic Literature Archive

Paramedics and dementiaDementia requires a person-centred,holistic approach to care whichconsiders the unique challengesfaced by each individual. It is essential thathealth care professionals are competent in arange of skills to support and care forpeople with dementia as this will form amajor part of their role in many cases(Clissett et al 2014).  Care of people withdementia has been included in manyundergraduate programmes for health careprofessionals such as nursing and medicine(Alushi et al 2015), but has only recentlybeen acknowledged in paramedic scienceprogrammes (Ross 2012).  Historically, the ambulance service has ofcourse been responsible for taking acutelyunwell adults and children to local hospitalA&E departments (Craggs & Blaber 2012).But the increasing complexity of patients’needs, including the growing prevalence ofdementia, has placed additional demandson ambulance services (King’s Fund 2016).Therefore, the scope of paramedic practicemust be widened to include thedevelopment of psychosocial skills(Gaisford 2014), which can help preventpeople living with dementia in their ownhome from being unnecessarily transferredto hospital (Tavares et al 2016).Dementia care objectives for practisingparamedics have been introduced by theAssociation of Ambulance Chief Executives(2017), such as delivering person-centredcare, recognising early signs of dementia,and developing inter-professional workingpartnerships to improve health and healthoutcomes for people with dementia.Paramedics can choose to specialise incomplex older persons’ care. But the requirement to gain knowledgeand skills in dementia care can runcontrary to the expectations of newparamedic students. They often see the roleof a paramedic as involving advancedtechnical clinical skills and may join theambulance service because they “want tosave lives”, seek a “high stress dangerouswork environment”, or want theopportunity to develop clinical practice(O’Meara et al 2012). A recent study explored how paramedicstudents developed their knowledge andskills to support people with dementia andtheir families during a crisis (Brooke &Stiell 2017). This study highlighted how asmall number of students were surprisedthat they had regular calls to people withdementia and it acknowledged the need todevelop undergraduate education with aview to strengthening students’ knowledgeand advanced communication skills. InEngland, there is now a move toreconfigure paramedic education at thislevel to ensure that care of older people is aprominent component (Ham 2017). A balanced understanding of the impactof dementia is required, one approachbeing “Time for Dementia” (Banerjee et al2017). This initiative in southern England -regular structured meetings with theperson with dementia and their family athome - has been embedded in medical,paramedic science and nursingundergraduate programmes at twolocations. But it is unique and there is still agap in our understanding of paramedicstudents’ willingness and intention to workwith people with dementia and whetherthey would enjoy or dislike doing so.Neither do we know how these factorschange from the beginning to the end ofthe undergraduate programme. The aim of our study was to exploreparamedic students’ attitudes to workingwith people with dementia along fourdimensions: willingness, interest,likelihood, and intentions.  We also wantedto find out if they thought they wouldenjoy or dislike this aspect of their work.  Study methodWe used a validated questionnaire, “FutureWork Intentions in Dementia Care”(McKenzie & Brown 2014), and distributedit via the online software Qualtrics,ensuring that it was accessible by a singlelink and appropriately formatted fordesktop computers, laptops, phones andtablets. It included six questions, coveringwillingness to work in dementia care,interest in this kind of work, likelihood ofgoing into it, and whether the studentsactually intended to go into it. Studentswere also asked whether they would enjoyor dislike the work, and a range of answersfrom “strongly agree” to “stronglydisagree” was possible for each of the sixquestions.  We also collected demographicdata on the students, such as gender, ageand ethnicity. Participants were paramedic studentsentering the first year or completing thethird year of their studies at a highereducation institute in the south of England.Students were introduced to our studyduring lectures and a link to the onlinesurvey was put up on their Moodleprogramme page. While it was a smallsample drawn from one university, thefindings do give an insight into theattitudes of paramedic students todementia care.Study resultsA total of 71 paramedic students completedthe online questionnaire: 41 were first yearstudents and 30 were third year students.The majority of students (71%) were agedbetween 18 and 25 years of age, and ofEnglish heritage (88%).Questionnaire results demonstrated bothpositive and negative trends from the firstyear to the third year across the dimensionswe surveyed (see table).DiscussionOverall, combining all the figuressignifying agreement (see table), third yearparamedic students (when compared tofirst years) showed slightly greaterwillingness to work in dementia care andwere a little more likely to enjoy it,although a few more also agreed that theywould dislike doing it.  Combining thefigures signifying disagreement, very fewdisagreed that they would be willing towork in the field and there was nodifference between first and third years.Fewer third years than first years disagreedthat they would enjoy working withpeople with dementia and more third yearsdisagreed with the suggestion that theywould dislike it.  So, these figures for willingness,enjoyment and dislike are generallypositive.  But, paradoxically, this did nottranslate into having an interest in or anintention to work in the field.  Far fewerthird years planned to (i.e. intended to)work in dementia care or said they wouldbe interested in doing so.  When the twogroups were asked whether it was likelyDr Joanne Brooke is reader in complexolder persons care at Oxford BrookesUniversity and Marlon Stiell is seniorlecturer in paramedic science at theUniversity of Greenwich  Paramedic students are learning more about dementia care, but how many intend to workin the field? Joanne Brooke and Marlon Stiell’s study produced some worrying findingsthey would work in dementia care, againthird years scored below first years. Sincethe latter figures are more directlyconcerned with actual career intentionsthan the former, the findings are worryingin the context of an ageing population andrising prevalence of dementia.It may be that third year paramedicstudents had less interest in or intention towork with people with dementia becauseof a lack of educational content ondementia and person-centred care in theirundergraduate programmes.  Theseprogrammes tend to focus on patientinteractions as a series of events requiredby assessment tools (Halter et al 2011) andparamedic students have reporteddifficulty with person-centred care becausethey have no standardised assessment toolto apply (Voss et al 2017). The College ofParamedics has called for the inclusion ofdementia, Alzheimer’s disease,Parkinson’s disease, palliative care and endof life care in the undergraduatecurriculum (2015), while individual highereducation institutes have begun toimplement different approaches to coverthese requirements.  Elements that should be expanded inundergraduate education have beenidentified by paramedic students andinclude advanced communication skillsand emotional support and guidance(Brooke & Stiell 2017).  Advancedcommunication skills were deemednecessary to support students tounderstand the needs of people withdementia and obtain informed consent,while adjusting to the uniqueness of eachperson. Emotional support and guidancewere seen as essential, first year paramedicstudents in particular saying it would helpin coping with the sadness they felt at theimpact of dementia. Third year paramedicstudents on the other hand expressedhelplessness, as they felt they were treatingan “event” and not the dementia, so notreally supporting the person.It is evident from our research thatemotional support and guidance shouldurgently be incorporated in undergraduateprogrammes, whether delivered in highereducation institutes or by experiencedparamedics when completing clinicalplacements. This support will only beeffective with increased education ondementia and a person-centred careapproach. nReferences:The Association of Ambulance Chief Executives(2017) Dementia: Best Practice Guidance forAmbulance Services. London: Association ofAmbulance Chief Executives.Alushi L, Hammond J, Wood J (2015) Evaluation ofdementia education programs for pre-registrationhealthcare students - A review of the literature. NurseEducation Today 35(9) 992-998. Banerjee S, Farina N, Daley S, Grosvenor W et al(2017) How do we enhance undergraduate healthcareeducation in dementia? A review of the role ofinnovative approaches and development of the Timefor Dementia Programme. International Journal ofGeriatric Psychiatry 32 68–75Brooke JM, Stiell M (2017) Paramedic students'beliefs, experiences, and development of clinical andinterpersonal skills to support people living withdementia. Journal of Paramedic Practice 9(8) 348-353.Clissett P, Porock D, Harwood R, Gladman J (2014)The responses of healthcare professionals to theadmission of people with cognitive impairment toacute hospital settings: an observational and interviewstudy. Journal of Clinical Nursing 23(13/14) 1820-1829. College of Paramedics (2015) Paramedic CurriculumGuidance (3rd edition). Bridgwater: College ofParamedics.Craggs B, Blaber A (2012) A Consideration of Historyin Blaber A (ed) Foundations for paramedic practice: atheoretical perspective. Maidenhead: Open University.Gaisford M (2014) An audit of 4679 consecutiveemergencies for an emergency care practitioner.Journal of Paramedic Practice 6(1) 28-36.Halter M, Vernon S, Snooks H, Porter A et al (2011)Complexity of the decision making process ofambulance staff for assessment and referral of olderpeople who have fallen: a qualitative study. EmergencyMedicine Journal 28(1) 44-50.Ham C (2017) Next steps on the NHS five year forwardview. BMJ: Clinical Research 357 j1678.King’s Fund (2016) What’s going on in A&E? (webpageat www.kingsfund.org.uk). London: King’s Fund. McKenzie EL, Brown PM (2014) Nursing Students’Intentions to Work in Dementia Care: Influence of Age,Ageism, and Perceived Barriers. EducationalGerontology 40 618–633.O’Meara P, Tourle V, Madigan V, Lighton D (2012).Getting in touch with paramedic student careerintentions. Health Education Journal 71(3) 376-385.Ross L (2012) Interpersonal skills education forundergraduate nurses and paramedics. Journal ofParamedic Practice 4(11) 655-661. Tavares W, Bowles R, Donelon B (2016) Informing aCanadian paramedic profile: framing concepts, rolesand crosscutting themes. BMC Health ServicesResearch 16 477. Voss S, Black S, Brandling J, Buswell M et al (2017)Home or hospital for people with dementia and one ormore other multimorbidities: What is the potential toreduce avoidable emergency admissions? TheHOMEWARD Project Protocol. BMJ Open 7e016651. Strongly Agree Agree Somewhat Agree Neither Agree or Disagree Somewhat Disagree Disagree StronglyDisagree1st Year Students 50% 28% 15% 5% / / 2%3rd Year Students 47% 37% 13% 1% / / 2%Difference -3% +9% -2% -2% / / 0%1st Year Students 23% 30% 23% 20% 2% 2% /3rd Year Students 13% 27% 27% 33% 0% 0% /Difference -10% -3% +4% +13% -2% -2% /1st Year Students 25% 20% 33% 17% / 5% /3rd Year Students 17% 17% 37% 20% / 10% /Difference -8% -3% +4% +3% / +5% /1st Year Students / 2% 5% 20% 8% 30% 35%3rd Year Students / 3% 7% 10% 13% 33% 33%Difference / +1% +2% -10% +5% +3% -2%1st Year Students 20% 25% 20% 25% 5% 5% /3rd Year Students 7% 20% 27% 30% 7% 10% /Difference -13% -5% +7% +5% +2% +5% /1st Year Students 15% 13% 28% 33% 10% 2% /3rd Year Students 7% 23% 30% 30% 3% 7% /Difference -8% +10% +2% -3% -7% +5% /I would be willing to work in dementia careI would enjoy working in dementia careI plan on working in dementia careIt is likely that I will work in dementia careI am interested in working in dementia careI would dislike working in dementia careFirst and third year students’ attitudes to working in dementia care

Paramedics and dementia

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Paramedics and dementia

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