Abstract
Background
An innovative program, ‘Paramedics Providing Palliative Care at Home,’ was implemented in Nova Scotia, Canada in 2015. Roles like this are part of an evolving professional identity; role discordance or lack of clarity not only hinders professionalization but may impair the wellbeing, and career longevity of paramedics. This study explored the alignment of providing palliative support at home with paramedic professional identity.
Methods
Qualitative description was employed, with thematic analysis of focus groups with paramedics and palliative health care providers. Recruitment posters were sent through the professional college (paramedics) and program managers (health care providers). Focus groups followed a semi-structured guide, discussing understanding of and experiences with the role and its alignment with professional identity. Challenges to paramedic palliative support and fit with professional identify were explored. Thematic content analysis was ongoing while focus groups were being conducted, until no new codes were found. Codes were combined, sorted into categories, and ultimately, agreed-upon themes. Saturation of themes was reached.
Results
Eleven paramedics and twenty palliative health care providers participated. Four themes reflected paramedic’s expanded role: (1) patient centeredness and job satisfaction with provision of palliative support, (2) a bridging role, (3) paramedic as advocate and educator, (4) provision of psychosocial support. Four themes reflected paramedic’s professional identity: (1) evolution of paramedicine as a skilled clinical profession, (2) helping people and communities, (3) paramedic skill set aligns with work in palliative care, and (4) changing paramedic mindset.
Conclusion
Paramedics and palliative health care providers highlighted the provision of palliative care as part of a positive growth of paramedicine as a health profession, and a good fit with professional identity. Novel roles like this are important in the evolution of our health care system faced with increasing pressures to get the right care with the right provider at the right time.
Résumé
Contexte
Un programme innovant, " Programme de soins palliatifs paramédicaux à domicile ", a été mis en œuvre en Nouvelle-Écosse, au Canada, en 2015. Les rôles de ce type font partie d'une identité professionnelle en évolution ; la discordance ou le manque de clarté des rôles non seulement entrave la professionnalisation, mais peut aussi nuire au bien-être et à la longévité de la carrière des ambulanciers paramédicaux. Cette étude a exploré l'alignement de la prestation de soutien palliatifs à domicile avec l’identité professionnelle des ambulanciers paramédicaux.
Méthodes
Une description qualitative a été employée, avec une analyse thématique de groupes de discussion avec des ambulanciers paramédicaux et des prestataires de soins palliatifs. Des affiches de recrutement ont été envoyées par le biais du collège professionnel (paramédicaux) et des gestionnaires de programmes (prestataires de soins de santé). Les groupes de discussion ont suivi un guide semi-structuré, discutant de la compréhension et des expériences du rôle et de son alignement avec l'identité professionnelle. Les défis du soutien palliatif paramédical et son adéquation avec l'identité professionnelle ont été explorés. L'analyse du contenu thématique s'est poursuivie pendant la tenue des groupes de discussion, jusqu'à ce qu'aucun nouveau code ne soit trouvé. Les codes ont été combinés, triés en catégories et, finalement, en thèmes convenus. La saturation des thèmes a été atteinte.
Résultats
Onze ambulanciers paramédicaux et vingt prestataires de soins palliatifs ont participé. Quatre thèmes reflétaient le rôle élargi des ambulanciers paramédicaux : 1) l’orientation vers le patient et la satisfaction professionnelle à l’égard de la prestation de soutien palliatifs, 2) un rôle de transition, 3) les ambulanciers paramédicaux à titre de défenseurs et d’éducateurs, 4) un soutien psychosocial. Quatre thèmes reflétaient l’identité professionnelle des ambulanciers paramédicaux : 1) l’évolution de la profession paramédicale en tant que profession clinique qualifiée, 2) l’aide aux personnes et aux collectivités, 3) l’ensemble des compétences des ambulanciers paramédicaux s’harmonise avec le travail en soins palliatifs, et 4) l’évolution de l’état d’esprit des ambulanciers paramédicaux.
Conclusion
Les ambulanciers paramédicaux et les prestataires de soins palliatifs ont souligné que la prestation de soins palliatifs faisait partie d’une croissance positive de la profession paramédicale en tant que profession de la santé et correspondait bien à l’identité professionnelle. Des rôles novateurs comme celui-ci sont importants dans l'évolution de notre système de soins de santé, confronté à des pressions croissantes pour obtenir les bons soins auprès du bon prestataire au bon moment.
Similar content being viewed by others
References
Cancer System Quality Index. Toronto (ON): Cancer Care Ontario; 2009. http://csqi.cancercare.on.ca. Accessed 4 Jan 2010.
Lawson BJ, et al. Palliative care patients in the emergency department. J Palliat Care. 2008;24(4):247–55.
Schrijvers D, van Fraeyenhove F. Emergencies in palliative care. Cancer J. 2010;16(5):514–20.
Schonberg AK, et al. Emergency department experiences of acutely symptomatic patients with terminal illness and their family caregivers. J Pain Symptom Mange. 2010;39(6):972–81.
Hjermstad MJ, et al. Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJ Open. 2013. https://doi.org/10.1136/bmjopen-2012-002515.
Carter AJE, Earle R, Gregoire M-C, MacConnell G, MacDonald T, Grager G. Breaking down silos: consensus-based recommendations for improved content, structure, and accessibility of advance directives in emergency and out-of-hospital settings. J Palliat Med. 2020;23(3):379–88.
Johnson T, Acher J. Using a sociological approach to answering questions about paramedic professionalism and identity. Australas J Paramed. 2016;13(1). https://doi.org/10.33151/ajp.13.1.301
Hercelinskyj G, Cruickshank M, Brown P, Phillips B. Perceptions from the front line: professional identity in mental health nursing. Int J Ment Health Nurs. 2014;23(1):24–32.
Australian Council of Professions. Definition of a Profession 2003. http://www.professions.org.au/what-is-a-professional/. Accessed Sept 14 2022.
Akerlof GA, Kranton RE. Identity economics: How our identities shape our work, wages, and well being. Princeton: Princeton University Press; 2010.
Sullivan-Bolyai S, Bova C, Harper D. Developing and refining interventions in persons with health disparities: the use of qualitative description. Nurs Outlook. 2005;53:127–33.
Sandelowski M. Focus on research methods: Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–40.
Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.
Vaismoradi M, Jones J, Turunen H, Snelgrove S. Theme development in qualitaitive content analysis and thematic analysis. J Nurs Ethics Practice. 2016;6(5):100–10.
Morse J. The significance of saturation. Qual Health Res. 1995;5:147–9.
Williams B, Brown T, Onsman A. From stretcher-bearer to paramedic: the Australian paramedics’ move towards professionalisation. J Emerg Primary Health Care. 2009;7(4):8.
McPherson M, Kersten P, George S, Lattimer V, Breton A, Ellis B, Kaur D, Frampton G. A systematic review of evidence about extended roles for allied health professionals. J Health Serv Res Policy. 2006;11(4):240–7.
Shalhani D, Coulter I. The politics of interprofessional working and the struggle for professional autonomy in nursing. Soc Sci Med. 2009;68(7):1121–8.
Skinner D, Franz B, Howard J, Kelleher K, Crabtree BF. The politics of primary care expansion: lessons from cancer survivorship and substance abuse. J Healthc Manag. 2018. https://doi.org/10.1097/JHM-D-16-00030.
Bishop A, Boyle TA, et al. Public perceptions of pharmacist expanded scope of practice services in Nova Scotia. Canad Pharm J. 2015;148(5):274–83.
Gibson BE, Nixon SA, Nicholls DA. Critical reflections on the physiotherapy profession in Canada. Physiother Can. 2010;62(2):98–100.
Reed B, Cowin LS, O’Meara P, Wilson IG. Professionalism and professionalization in the displine of paramedicine. Aust J Paramed. 2019;16:1–10.
Hirschi A. Callings and work engagement: Moderated mediation model of work meaningfulness, occupational identity, and occupational self-Efficacy. J Couns Psychol. 2012;59(3):479–85.
Acknowledgements
We are grateful to the Nova Scotia Health Research Fund for their support of this study. We also acknowledge the ongoing support of the Canadian Partnership Against Cancer, Healthcare Excellence Canada (previously Canadian Foundation for Healthcare Improvement), local partners and external resources, including Pallium Canada's LEAP-Paramedic course (https://www.pallium.ca/course/leap-paramedic), Canadian Virtual Hospice MyGrief Toolbox (https://mygrieftoolbox.ca), and the local palliative care, specialty care, home care, emergency health and paramedic services who are working together to support patients and caregivers in a palliative approach.
Funding
Nova Scotia Health Authority Research Fund (Grant no. 1021265).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr Carter has received payment from Healthcare Excellence Canada as a coach in the Paramedics Providing Palliative Care spread collaborative.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Carter, A.J.E., Harrison, M., Goldstein, J. et al. Providing palliative care at home aligns with the professional identity of paramedics: a qualitative study of paramedics and palliative health care providers. Can J Emerg Med 24, 751–759 (2022). https://doi.org/10.1007/s43678-022-00369-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43678-022-00369-y