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Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting

BACKGROUND: Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this...

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Autores principales: Reay, Gudrun, Rankin, James A., Smith-MacDonald, Lorraine, Lazarenko, Gerald C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238402/
https://www.ncbi.nlm.nih.gov/pubmed/30442096
http://dx.doi.org/10.1186/s12873-018-0194-1
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author Reay, Gudrun
Rankin, James A.
Smith-MacDonald, Lorraine
Lazarenko, Gerald C.
author_facet Reay, Gudrun
Rankin, James A.
Smith-MacDonald, Lorraine
Lazarenko, Gerald C.
author_sort Reay, Gudrun
collection PubMed
description BACKGROUND: Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this study was; a) to understand how paramedics conduct decision-making in the field, and b) to develop a grounded theory of paramedic decision-making in the prehospital setting. METHOD: This study was conducted using classical grounded theory. Paramedics (n = 13) with five or more years’ experience, who worked in a large urban center in Western Canada were interviewed. Field observations were conducted, each lasting 12 h, with five different ambulance crews. The data were analyzed and coded using the constant comparative method. RESULTS: The resultant theory, Creative Adapting in a Fluid Environment, indicates paramedic decision-making is a fluid iterative process. Unpredictable and dynamic features of the prehospital environment require paramedics to use a flexible and creative approach to decision-making. The model consists of the three categories constructing a malleable model, revising the model, and situation-specific action. Two additional components, safety and extrication, are considered at each stage of the call. These two components in conjunction with the three categories influence how decisions are made and enacted. CONCLUSION: Paramedic decision-making is highly contextual and requires accurate interpretation and flexible cognitive constructs that are rapidly adaptable. Evaluation of paramedic decision-making needs to account for the complex and dynamic interaction between the environment, patient characteristics, available resources, and provider experience and knowledge.
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spelling pubmed-62384022018-11-26 Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting Reay, Gudrun Rankin, James A. Smith-MacDonald, Lorraine Lazarenko, Gerald C. BMC Emerg Med Research Article BACKGROUND: Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this study was; a) to understand how paramedics conduct decision-making in the field, and b) to develop a grounded theory of paramedic decision-making in the prehospital setting. METHOD: This study was conducted using classical grounded theory. Paramedics (n = 13) with five or more years’ experience, who worked in a large urban center in Western Canada were interviewed. Field observations were conducted, each lasting 12 h, with five different ambulance crews. The data were analyzed and coded using the constant comparative method. RESULTS: The resultant theory, Creative Adapting in a Fluid Environment, indicates paramedic decision-making is a fluid iterative process. Unpredictable and dynamic features of the prehospital environment require paramedics to use a flexible and creative approach to decision-making. The model consists of the three categories constructing a malleable model, revising the model, and situation-specific action. Two additional components, safety and extrication, are considered at each stage of the call. These two components in conjunction with the three categories influence how decisions are made and enacted. CONCLUSION: Paramedic decision-making is highly contextual and requires accurate interpretation and flexible cognitive constructs that are rapidly adaptable. Evaluation of paramedic decision-making needs to account for the complex and dynamic interaction between the environment, patient characteristics, available resources, and provider experience and knowledge. BioMed Central 2018-11-15 /pmc/articles/PMC6238402/ /pubmed/30442096 http://dx.doi.org/10.1186/s12873-018-0194-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Reay, Gudrun
Rankin, James A.
Smith-MacDonald, Lorraine
Lazarenko, Gerald C.
Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
title Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
title_full Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
title_fullStr Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
title_full_unstemmed Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
title_short Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
title_sort creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238402/
https://www.ncbi.nlm.nih.gov/pubmed/30442096
http://dx.doi.org/10.1186/s12873-018-0194-1
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