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TITLE PAGE
FACTORS AFFECTING THE FUNCTION OF PARAMEDIC STUDENTS ON PRACTICAL IN DELTA STATE TEACHING HOSPITAL OGHARA
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DECEMBER,2018
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Paramedic students at Delta state Teaching Hospital undertake clinical placements to assist the hospital. Anecdotally, students report a lack of opportunity to practise their clinical skills whilst on placements due to some factor that worked as a barrier. The barriers to participation and the theory-practice gap have not been studies. The purpose of this study was to investigate the theory-practice gap for paramedic students by linking education and skill level to case exposure and skills praxis during clinical placements. A cross-sectional retrospective study using a convenience sample of second and third year paramedic undergraduate students. Ethics approval was granted. Eighty four second and third year BEH students participated. 59.5% were female (n = 50), 40.5% were male (n = 34). Overall, students most commonly reported exposure to cardiac and respiratory cases and were satisfied with the number of cases encountered during placement. However, over half (n = 46) reported being exposed to < 50% of cases that allowed skills praxis. The most common barrier to participation (34.5%) was the opportunity to participate in patient care and 68% of student's were unsure if paramedics understood their role during clinical placements.
TABLE OF CONTENT
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWLEDGEMENT
ABSTRACT.
TABLE OF CONTENT
LIST OF ABBREVIATIONS
CHAPTER ONE
INTRODUCTION
- BACKGROUND OF THE STUDY
- AIM OF THE STUDY
- STATEMENT OF THE PROBLEM
- OBJECTIVE OF THE STUDY
- SIGNIFICANCE OF THE STUDY
- RESEARCH QUESTIONS
- SCOPE OF THE STUDY
- RESEARCH HYPOTHESIS
- DEFINITION OF TERMS.
REVIEW OF RELATED LITERATURE
- CONCEPTUAL FRAMEWORK
- PARAMEDIC IN NIGERIA TODAY
2.3 EFFORTS OF NIGERIA TO IMPROVE PARAMEDICS
2.3.1 Moving Paramedics Forward
DUTIES AND FUNCTIONS OF A PARAMEDIC
2.4.1 Early ambulance services
2.4.2 Prehospitalisation emergency medical care
2.4.3 Public notability
2.4.4. Evolution and growth
2.4.5 Structure of employment
2.4.6 Paramedic skills
Medications administered
HISTORICAL BACKGROUND OF THE STUDY
PARAMEDIC HISTORIC RULE IN NIGERIA
- TYPES OF PARAMEDIC REVIEWED
CHAPTER THREE
METHODOLOGY
- INTRODUCTION
- STUDY AREA
- RESEARCH DESIGN
- POPULATION OF THE STUDY
- INSTRUMENT
- SURVEY CONTENTS
- SURVEY METHODOLOGY
- STATISTICAL METHODS
CHAPTER FOUR
RESULT ANALYSIS
4.1. RESULT ANALYSIS
4.2 DISCUSSION
CHPATER FIVE
CONCLUSION AND REFERENCES
- CONCLUSION
- REFERENCES
QUESTIONNAIRE
CHAPTER ONE
1.0 INTRODUCTION
In some countries, paramedic education has evolved from post-employment (diploma) to pre-employment (bachelor) education model since 1998 [1]. Paramedic students within the pre-employment model are now required to complete a three year bachelor degree before commencing paramedic employment. This model encompasses an extensive theoretical base, however in contrast to the post-employment model; students are provided with limited 'on the job' skill acquisition via clinical placements. Clinical placements form a fundamental component to undergraduate programs and provide students with a means of developing communication skills, professional socialisation, working in an interdisciplinary team environment, learning professional etiquette and practicing psychomotor skills [2-4].
While clinical placements form a fundamental role in professional development for undergraduate students, a theory-practice gap has been identified across multiple health care disciplines [3,5-8]. This gap between knowledge and practical application can affect professional competence and contribute to difficulties in progressing from student to novice professional [6,9]. The opportunity to integrate theory with practice is currently being affected by a constrained health care system and general shortage of clinical placement opportunities. The scarcity of clinical placements limits training opportunities for students to work with real life patients, which is undisputed as an invaluable learning experience [8]. Placement shortages have derived from limited funding for training, staff shortages, patient availability, competition for placements between health care disciplines and an increasing number of students [10-15]. In addition, this is further compounded with a pressured health care system that can not adequately support student placements and the theory-practice gap has become an evident paradigm [5,16-19]. In particular, international ambulance services have stretched resources [20-23] and in Nigeria, ambulance services are unable to meet pre-employment clinical placement demands [8].
Several Nigeria universities now offer undergraduate paramedic education, including Delta State Teaching Hospital who provide the degree certificate in Health Education (BEH). Despite the challenge of scarce clinical placements the course has been designed to maximise clinical placement hours to assist with theory being transferred into practice. First year Delta State Teaching Hospital students undertake 4 days of observer shifts as an orientation to the paramedic discipline and broader health sector. While second and third year students are expected to actively engage in patient care and complete approximately 140 hours of clinical placement in a rural (Rural Ambulance) and metropolitan (Metropolitan Ambulance Service) emergency ambulance setting each semester. In addition, third year paramedic students also complete clinical placements within a hospital setting in obstetrics, mental health, paediatrics, accident and emergency departments, critical care units and intensive care units to assist with clinical skill development. Furthermore, the paramedic program integrates skill praxis via 'real time/life' scenarios and simulations via case-based learning to assist with the theory-practice gap [8]. This approach, whilst offering authentic patient problems, also provides students with learning empowerment and capacity to formulate their own learning outcomes based on previous experiences and critical reflection. Similar pedagogical approaches, such as problem-based learning have been suggested to bridge the gap between theory and practice in other health care disciplines [24].
Little research has evaluated the effectiveness and value of clinical placements for paramedic students, adding to the need for further research in this area, Levett-Jones (2007) correctly points out, that simply sending students on clinical placements does not necessarily guarantee learning or indeed clinical competence [25]. Waxman and Williams (2006) have published student's concerns of "not having enough clinical experience to make a smooth transition from uni student to paramedic student" [p.6, [23]] and that there seems to be a negative mentality towards pre-employment students resulting in students being treated poorly during clinical placements [26]. Boyle et al (2008) also found that although clinical placements were a positive experience within the ambulance setting, students reported unproductive downtime, not being given the opportunity to participate in patient care and that the learning environment was not always supportive [27]. The attitudes of some paramedics towards slightly built females undertaking the physical role of a paramedic was also counter productive for learning [27]. These studies questioned what skills and knowledge paramedic students are being reinforced during clinical placements and whether paramedic clinical placements are as successful as they could be in assisting with the theory-practice gap paradigm. While these studies have importantly added to the body of knowledge in paramedic education, there still appears to be gap in the literature relating to clinical placement education and more specifically theory-practice gap. While commentators continue to describe the difficulties obtaining placements, and potential alternatives in educational delivery [28]. Little discourse has emerged surrounding the notion of how best to utilise the available clinical placements, how to better prepare students for their placements or how to engage students in reflection and reflective practice as described by Boud (1999) and Schon (1987) [29,30]. Reflection is central for students in making sense of clinical dilemmas experienced during clinical placements, particularly when they are engaged in situated or deliberate learning opportunities [29].
The theory-practice gap has not previously been researched in the paramedic discipline. This study aims to investigate paramedic theory practice gap by matching learning objectives appropriate to the students education level to case exposure whilst undertaking clinical placement. Secondly, it aims to examine students' participation levels in patient care according to their clinical scope of practice and to identify factors preventing clinical skills practise during clinical placements. Thirdly, this study aims to document student's perceptions of theory enhancement during clinical placement down time.
1.1 PROBLEM STATEMENT
Paramedic students undertake clinical placements to assist the hospital In Nigerian government hospitals, there are many factors that hinder paramedic students who are on their duty placement have reported as a challenge in carrying out their duty effective. It has been reported that many Government hospital lack some important and major medical facilities which can be useful to paramedic in carrying out their duty effectively, such medical facilities like ambulance, stretching bed, first aid box. The lack or insufficiency of all these facilities ahs hinders the operation or emergency response of the. However, this study is aimed at discussing these challenges.
1.2 AIM OF THE STUDY
The main aim of this work is to ascertain factors affecting the function of paramedic students on practical in Delta State teaching hospital Oghara.
1.3 SIGNIFICANCE OF THE STUDY
This study is important in that it focuses on the function and factors affecting paramedic student on practical. Finally, it explains how their functions in a hospital can make huge impact in delta state teaching hospital.
1.4 SCOPE OF THE STUDY
Paramedics play very important role in hospital or anywhere they were assign to carry out a responsibility. Although paramedicine is a relatively young profession compared to many others, it has found its footing as a unique part of the healthcare system. The Paramedic’s role has evolved from simply responding to emergencies to now practicing an expanded scope of practice as a physician extender. In this way, the Paramedic has proved to be a vital part of the public health and safety team. This topic not only examines the origins of paramedicine but also how national education standards and accreditation of educational programs coupled with professional organizations have helped to validate paramedicine as a profession. The topic also examines the Paramedic’s core values and his or her role as healer, clinician, and teacher. As the Paramedic’s scope of practice and community responsibilities continue to develop, quality assurance, quality improvement, and continuing educational programs need to be established. The Paramedic’s independent and interdependent role as a physician extender relies on leadership and stewardship. Dispict all this roles, there are challenges that face them which can be a hindrance to them that can lead them not to carryout out there responsibility effectively.
1.5 OBJECTIVE OF THE STUDY
The main objective of this study was to: highlight and study those factors affecting the function of paramedic students on practical in delta state teaching hospital oghara. At the end of the study the students involve shall be able to:-
- Study those factors affecting the function of paramedic students on practical in delta state teaching hospital oghara
- Determine the level of reaction/response of paramedic student on those factors.
- Ascertain the role or function of paramedic student in hospitals.
1.6 LIMITATION OF THE STUDY
Every research work require a thorough examination of the large pool of people and reading materials as it is a research that requires lots of one on one discussion from health workers of the hospital. This means that lots of questionnaires would be distributed the health worker of the hospital with questions designed to assess factors that affect the function of paramedic students on practical. The above are the limitations of this research work namely the time constraints and financial inadequacies to cover wider grounds.
1.7 RESEARCH QUESTION
This study is on factors affecting the function of paramedic students on practical in Delta State teaching hospital Oghara. To achieve this, the following specific research questions were asked.
- Who is a paramedic student?
- What are the role of a paramedic?
- What are the factors that affect paramedic student on practical?
- What is the role of a paramedic based on their levels of education, age and position in the hospital?
1.8 DEFINITION OF TERMS
I. Transportation Unit Supervisor: coordinates operations with Staging Officer and the Transportation Supervisor; gets patients into the ambulance and routed to hospitals.
2. Tertiary Injury: An injury that occurs when the victim is thrown against an object, struck by a large object thrown by the blast, or crushed beneath collapsed structural material. Injuries of the tertiary phase are similar to a victim ejected during a vehicular crash or who fell from a height.
3. Swelling: An enlargement due to accumulation of body fluid
4. Symptom: During the history taking process, symptoms are communicated by a patient describing how they feel. They are subjective findings that you may not be able to determine on your own.
5. Tenderness: A sensitivity to pain.
6. Thoracic Cavity: The space in the chest, which contains the heart, lungs, and large blood vessels.
7. Trauma Center: Specialized facilities equipped to provide comprehensive emergency services to severely injured victims. In the U.S., a hospital can receive trauma center verification by meeting criteria established by the American College of Surgeons (ACS) or designation by state or local authorities. Trauma centers are categorized from Level I to Level IV and pediatric trauma care, according to the level of care that is provided. Level I trauma center provides the highest level of care to injured patients.
8. Trauma: Physical damage produced by energy that exceeds the body's limits of resilience
9. Paramedic: A person who is trained to provide all of the skills of the Emergency medical technician (EMT) and Advanced emergency medical technician (AEMT) in addition to the full extent of advanced life support skills. Paramedics must be certified as an EMTs to begin paramedic training. The general length of training is at least 1,100 hours. It incluces classroom, skills and training time spent performing clinical observations.
10. Emergency medical technicians (EMT) are clinicians, trained to respond quickly to emergency situations regarding medical issues, traumatic injuries and accident scenes.
11. Advanced emergency medical technician (AEMT): is provider of prehospital emergency medical services in the United States. The AEMT is not intended to deliver definitive medical care in most cases, but rather to augment prehospital critical care and provide rapid on-scene treatment. AEMTs are most usually employed in ambulance services, working in conjunction with EMTs and paramedics, however are also commonly found in fire departments and law enforcement agencies as non-transporting first responders.
12. Student: A student is anyone who is still undergoing any form of training. That is, anyone who is still undergoing learning is regarded as a student.
13. Education: Education is simply described as the process of providing information to an inexperienced person for him or her to develop physically, mentally, socially, emotionally, spiritually, politically and economically. Education is the process through which individuals are made functional members of their society. It is a process through which the young acquires knowledge and realizes her potentialities and uses them for self-actualization, to be useful to her and others. Education is a means of preserving, transmitting and improving the culture of the society.
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 CONCEPTUAL FRAMEWORK
A paramedic is a specialist healthcare professional who responds to emergency calls for medical help outside of a hospital. Paramedics mainly work as part of the emergency medical services (EMS), most often in ambulances. The scope of practice of a paramedic varies among countries, but generally includes autonomous decision making around the emergency care of patients…
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