References
Paramedic clinical decision-making in mental health care: a new theoretical approach
Abstract
This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decisionmaking in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.
Clinical decision-making can be thought of as a process of applying medical knowledge and skills to a clinical situation. In the prehospital environment, this process is a vital part of paramedic clinical life that often takes place in settings that are chaotic and unpredictable (Shaban, 2005). Lord (2003) purported that unlike controlled clinical settings (emergency departments and inpatient units), where clinicians have access to expert opinion, medical records and advanced diagnostic tests, the assessment and management of patients in the prehospital setting is usually characterized by independent and time critical factors and where access to similar support systems and medical technology is unavailable. In this context, the role of a paramedic is a complex one, centred on performing a range of assessments aimed at gathering, evaluating and synthesizing information that relates to a patient's presentation before deciding on appropriate treatment and transport decisions (Saunders, 2005; Caroline, 2008). Throughout this decision-making process, paramedics must continuously evaluate and decide the degree to which they are making the correct clinical decisions in relation to a particular patient.
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