At the frontline of aged-care resident transfers to hospital

: the paramedic experience

Abstract

Australian paramedics respond to residential aged-care facilities (RACFs) for calls regarding both emergency and non-emergency health issues affecting residents. On arrival at an RACF, paramedics interact with RACF staff to obtain information that is essential for their patient assessment and subsequent decision-making. While previous studies have examined the reasons RACF staff call for paramedics, only two have investigated the paramedic perspective of attending an RACF and interacting with staff. This inter-professional relationship formed the focus of this study, as the nature of the interaction between paramedics and RACF staff, and its potential influence on decision-making and resident outcomes, has been understudied. Aims: This study’s aim was to describe the paramedic experience of interacting with aged-care staff to examine how those experiences might shape paramedic decision-making and possibly impact the health outcomes of aged-care residents. Methods: A descriptive phenomenological methodology was chosen as an established approach to understanding the human experience of the world. It takes the participants’ experiences of the phenomenon and deconstructs them to discern their intrinsic features. Ultimately, the researcher then rebuilds those features into the essential structure of the phenomenon, describing them using psychologically sensitive language. Paramedics employed by Australian jurisdictional ambulance services were recruited for individual online interviews. The verbatim transcripts were analysed within NVivoTM. Results: Our study found that paramedic experiences of attending RACFs and interacting with staff are predicated on an imagined ideal. This included expectations that staff had called for a valid reason, they could appropriately manage any acute health issues, and they were available to handover knowledgeable resident information to the paramedics when they arrived. Any interaction that did not meet these standards led to a loss of professional trust from the paramedics, which would often lead to the default decision to initiate hospital transport. Intrinsic and extrinsic factors influenced paramedic decision-making, including the wishes of the resident and other stakeholders and the desire to avoid conflict or mitigate fatigue. Professional experience led to an adjustment of these expectations and a more positive experience overall. Conclusion: The paramedic experience of the inter-professional relationship with RACF staff is influenced by a set of expectations that dictate what should happen during any interaction. These assumptions have a negative effect on the relationship and appear to impact paramedic decision-making and, by extension, the outcomes for the resident.

Date of Award	2023
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Paul Simpson (Supervisor)