Changing identity across the ‘flaky bridge’
The transition from student to qualified healthcare practitioner can be challenging, with previous studies identifying the initial transition phase as an especially emotionally turbulent time. It is during this phase that new clinicians are at highest risk of leaving the profession, which exacerbates current concerns over the recruitment and retention of healthcare practitioners. Health Education England employed the term ‘flaky bridge’ to describe the initial transition period for newly qualified practitioners and identified a need to decrease anxiety and increase confidence for clinical decision-making in newly qualified practitioners. This is true for all newly qualified health professionals, including newly qualified paramedics (NQPs).
The present study sought to highlight the experiences of NQPs as they advance over the ‘flaky bridge’ and record their emotions while going through the transition. The researchers employed a mixed-methods convergent study design that collected both quantitative and qualitative data. The quantitative element focused on self-assessed resilience using the 25-point CD-RISC 25 questionnaire, while qualitative data were collected through semi-structured interviews. A constructivist grounded theory approach was used, meaning that the theories are constructed by the researchers from the data. A convenience sample of 18 NQPs taking up their first paramedic post were recruited from an NHS ambulance trust.
The resilience tests recorded a mean score of 74.7 (± 9.6) out of 100 (higher scores suggest higher resilience), which is similar to, or slightly higher than other studies. The qualitative data identified that NQPs navigate three new identities simultaneously: personal, professional, and social. Seemingly, the trigger for navigating a changed identity was when they attended what was described as a catalyst event. This event normally entailed a high-acuity, high-stress situation and was often a cardiac arrest. It was then that NQPs began to see themselves differently. Participants took different pathways through this transitional period, but it is evident that the transition from student to NQP can be emotionally challenging and, therefore, interventions such as group supervision, could improve resilience during the journey.
When life-saving treatment is not indicated—paramedics can still contribute
Demands for palliative and end-of-life care at home are growing rapidly at a time when the availability of services is diminishing. In the UK, there has been a rapid decline in the number of community nurses, with most community nursing teams reporting insufficient staffing to meet the needs of patients. If this trend continues, it seems likely that the requirements for ambulance services to provide palliative care will increase.
This qualitative interview study aimed to explore patient and family caregiver experiences of the contribution of extended care paramedics to palliative care at home. Participants were adult patients with palliative care needs, and self-nominated family carers. The participants were receiving specialist palliative care in the community of a metropolitan city of Australia, and requested an ambulance between January and August 2018, inclusive.
Once identified, participants were offered the opportunity to participate in face-to-face or telephone interviews with two of the researchers in the team. Data were generated from six patients, and 11 family carers. The researchers asked broad opening questions and then used clarifying questions, prompts and cues, according to participant narratives. The following themes became evident:
This article is worth seeking out just to read the comments made by the participants—paramedic practice at its best!