Introduction
Background
Method
Study design
Panel of experts
Demographics | Number (percent) | |
---|---|---|
Total of included experts | 32 (100%) | |
Gender | Male | 12 (37.5%) |
Female | 20 (62.5%) | |
Academic degree | Registered nurse | 9 (28%) |
Specialist nurse (Pre-hospital emergency care)
| 18 (56%) | |
Other specialist nurse | 5 (16%) | |
Geographic region | Urban | 16 (50%) |
Sub-urban | 10 (31%) | |
Rural | 6 (19%) | |
Months of experience (in the EMS)
| 12–24 | 25 (78%) |
> 25 | 7 (22%) | |
Years of RN experience | < 5 | 11 (34%) |
5–10 | 15 (47%) | |
> 10 | 6 (19%) |
Round 1:
Interview | Meaning unit | Code | Category | Item |
---|---|---|---|---|
When you need it to just flow, where time is of essence…and…it’s hard to say exactly but you can think of situations where someone dies, gives birth, is severely ill or children…you can do a lot of exercises on those situations…we do practice traffic accidents and stuff like that, but we should have more exercises on the ordinary things… (Expert #1) | Practice situations where time is of the essence and the ordinary things (Expert #1) | Practical exercises (Experts#1, 3, 5, 12, 13, 14, 16, 17, 18, 19, 20, 22, 23, 27, 31) | Support from practical exercises | Practice situations that occur rarely (Experts #1, 5, 12, 13, 14, 16, 17, 19, 22, 23, 31) Practice situations that occur frequently (Experts#1, 3, 5, 14, 17, 18, 19, 20, 27) |
To me, it would have been supportive to have some kind of mentor…maybe a mentor that you would come back to and have discussions with and meetings where you could discuss different situations you have experienced with other colleagues or patients…to have someone to bounce things off… (Expert #16) | It would have been supportive to have a mentor to discuss situations that had been encountered with colleagues or patients (Expert #16) | To have a mentor (Experts #2, 5, 6, 7, 8, 9, 12, 14, 16, 17, 19, 21, 24, 25, 26, 27, 29, 30) | Support from colleagues and work environment | Have a mentor that supports your personal development (Experts #2, 5, 6, 7, 9, 12, 14, 16, 17, 19, 21, 25, 26, 27, 29, 30) |
Round 2:
Round 1 | → | Round 2 | → | Round 3 | → | Round 4 | |
---|---|---|---|---|---|---|---|
Number of participants | 32 | 32 | 32 | 31 | |||
Response rate | 100% | 100% | 97% | 100% | |||
Drop-out | 0 | 0 | 1 | 0 | |||
Round activity | Interviews analyzed by manifest content analysis | → | Questionnaire with 65 items | → | Questionnaire with 19 items (14 not reaching consensus in round 2 + 5 new) | → | Questionnaire with 9 items |
↓ | ↓ | ↓ | |||||
51 items with consensus reached | 10 items with consensus reached | 3 items with consensus reached |
Round 3:
Round 4:
Ethical considerations
Results
Mean value | Standard deviation SD | Consensus reached in round | |
---|---|---|---|
Support from practical skills exercises | |||
Practice methods to get a structured way to work (e.g. according to the ABCDE-principle) | 4,8 | 0,7 | 2 |
Practice ways to lead the work at the scene of an accident | 4,5 | 0,8 | 2 |
Get a structured run-through of the medications used in the EMS | 4.5 | 0.8 | 3 |
Practice through simulation | 4,4 | 0,7 | 2 |
Practice with the radio communication equipment | 4,4 | 0,9 | 2 |
Practice with the medical equipment in the ambulance | 4,4 | 0,9 | 2 |
Practice techniques for immobilization | 4,4 | 0,9 | 2 |
Practice in collaboration with police and rescue service | 4,4 | 1,0 | 2 |
Practice situations that occur rarely | 4,3 | 0,8 | 2 |
Practice techniques for removing people from vehicles | 4,3 | 0,9 | 2 |
Have practical skills tests | 4.3 | 1.0 | 2 |
Practice situations that occur frequently | 4,3 | 1,1 | 2 |
Driving and parking exercises | 4,1 | 1,1 | 2 |
Practice techniques to maneuver the stretcher | 4.0 | 0.9 | 3 |
Support from theoretical knowledge | |||
Have access to lectures on medical conditions in children | 4,5 | 0,7 | 2 |
Get a structured run-through of the EMS medical guidelines | 4,5 | 0,8 | 2 |
Get access to concept educations such as AMLS, PHTLS, PS, PEPP | 4,4 | 0,8 | 2 |
Have access to lectures on medical conditions in adults | 4,3 | 0,8 | 2 |
Have written tests on theoretical knowledge | 4,3 | 0,9 | 2 |
Have access to lectures on how to lead the work at the scene of an accident | 4,2 | 0.8 | 3 |
Have access to lectures on child birth | 4,2 | 0,9 | 2 |
Support for experience-based knowledge | |||
Get feedback on the own actions from the receiving unit | 4,8 | 0,4 | 2 |
Participate in courses along with experienced colleagues | 4,7 | 0,6 | 2 |
Participate in group discussions about authentic patient situations | 4,7 | 0,5 | 2 |
Participate in group discussions about ethics | 4,5 | 0,8 | 2 |
Participate in group discussions about threats and violence | 4.1 | 0.9 | 3 |
Theoretical support | |||
Have access to applicable medical guidelines | 4,8 | 0,4 | 2 |
Have access to internet-based instruction films on the ambulance’s technical equipment | 4.3 | 0.6 | 3 |
Have access to written guidelines on when and how to contact a physician | 4,2 | 0,8 | 2 |
Have access to written guidelines about how to report deviations | 4.1 | 0.9 | 3 |
Have access to instruction films about how to realign a fracture | 4.0 | 0.8 | 3 |
Support from an introduction period | |||
Get regular feedback on the own development during an introduction period | 4,9 | 0,2 | 2 |
Have a structured introduction period | 4,9 | 0,3 | 2 |
Have an individually fitted introduction period | 4,7 | 0,7 | 2 |
Have a supervisor with formal supervisor competence | 4,4 | 0,8 | 2 |
Work with the same supervisor during the introduction period | 4,0 | 0.7 | 3 |
Work with the same ambulance team (supervisor and his/her colleague) during the introduction period | 3.7 | 0.8 | 4 |
Support from colleagues and work environment | |||
Get peer support debriefing in extreme situations | 5,0 | 0,2 | 2 |
Have a trustworthy colleague | 4,9 | 0,4 | 2 |
Have an experienced colleague | 4,8 | 0,5 | 2 |
Be respected and accepted by the colleagues at the ambulance station | 4,8 | 0,5 | 2 |
There is an open climate at the ambulance station | 4,8 | 0,6 | 2 |
Have one person in the organization to contact with logistics questions during off-hour | 4.6 | 0.6 | 2 |
Have a mentor to contact about routines | 4,5 | 0.8 | 3 |
Have a mentor to support professional development | 4,3 | 0,8 | 2 |
Have a mentor to talk to about conflicts | 4,3 | 1,0 | 2 |
Have a mentor to contact about practical issues | 4,2 | 0,8 | 2 |
Have a mentor to support personal development | 4,0 | 0,9 | 2 |
Work with another RN | 3.9 | 0.9 | 4 |
Support from management and organization | |||
Trust in the ambulance station manager | 4.8 | 0.4 | 2 |
Have confidence in the organization | 4,8 | 0,4 | 2 |
The organization is characterized by professionalism | 4,8 | 0,6 | 2 |
Get feedback on the own professional development from the ambulance station manager | 4,7 | 0,6 | 2 |
The organization accepts that new professionals need more time to perform patient assessments | 4,6 | 0,6 | 2 |
The organization provides time for professional development activities | 4,6 | 0,7 | 2 |
The organization is characterized by equally | 4,6 | 0,7 | 2 |
The organization has clear competence descriptions of what is expected of each role in the team | 4,5 | 0,8 | 2 |
The organization is characterized by ethical considerations | 4,5 | 0,7 | 2 |
The dispatch center accepts that new professionals need more time to perform patient assessments | 4,4 | 0,7 | 2 |
Trust in the organization director | 4,3 | 1,0 | 2 |
Get feedback on the own professional development from the organization director | 4.1 | 0.9 | 3 |
Other support | |||
Being exempt from introducing new colleagues | 4,6 | 0,9 | 2 |
Have access to an interpreter service | 4.1 | 0.7 | 4 |
Being exempt from life-threatening assignments with the highest level of priority | 1,4 | 0,7 | 2 |
Mean value | Standard deviation SD | |
---|---|---|
Support from theoretical knowledge | ||
Get access to lectures about psychiatric conditions | 3.7 | 0.7 |
Be able to visit and auscultate at different intra-hospital wards | 3.6 | 1.0 |
Theoretical support | ||
Have access to written ethical guidelines | 3.5 | 0.8 |
Have access to written guidelines regarding how to manage conflicts | 3.5 | 0.8 |
Support from colleagues and work environment | ||
Work with the same colleague during the first year | 2.9 | 0.9 |
Other support | ||
Receiving an extra unit when being given life-threatening assignments with the highest level of priority | 2.4 | 0.8 |