Blaber's Foundations for Paramedic Practice A Theoretical

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 Contents

List of contributors vii

Acknowledgementsxiii

Introduction 1
Amanda Y. Blaber

1 Interpersonal communication: a foundation of practice 2

Paul Street

2 Reflective practice in relation to out-of-hospital care 17

Marion Richardson

3 Using clinical audit to improve patient care 30

Rachael T. Fothergill and Joanna Shaw

4 Ethics and law for the paramedic 39

Vince Clarke, Graham Harris and Steve Cowland

5 Research and evidence-based practice 57

Julia Williams, Rachael T. Fothergill and Joanna Shaw

6 Human factors affecting paramedic practice 75

Christopher Matthews

7 Introduction to psychology and child development 89

Jackie Whitnell and Chris Preston

8 Mental health: Children, young people and adults 119

Jackie Whitnell

9 An introduction to sociology, social factors and social policy 140

Amanda Y. Blaber and Chris Storey

10 Psycho-social aspects of health and illness: an introduction 161

Amanda Y. Blaber and Chris Storey

v
Contents

11 Child protection 179

Mike Brady

12 Public health from a paramedic perspective 200

Gemma Chapman and David Rea

13 Safeguarding adults 213

Dave Blain

14 Caring for people with dementia 232

John Krohne and Vicky Milburn

15 End of life care 249

Ann French and Gary Vale

16 Leadership styles and the impact on practice 265

Alison Cork and Kath Jennings

17 Theories of decision-making 278

Alison Cork and Mike Brady

18 Continuing professional development (CPD): pre- and

post-registration295
Graham Harris and Bob Fellows

Index307

vi
 Contributors

Amanda Y. Blaber has 17 years teaching in higher education institutes, with many
years of emergency care experience. Amanda contributes to the Forum for Higher
Education for Paramedics and the Council of Deans Paramedic Advisory group.
Amanda is an Honorary Fellow of the College of Paramedics and is extremely proud
of the literary contribution she and her colleagues have made to the education of
paramedics in the UK. She has extensive knowledge and experience in curriculum
design and validation processes and is a Senior Fellow of the Higher Education
Academy.

Dave Blain is a dedicated professional for safeguarding adults, with 37 years in the
ambulance sector as PTS, EMT, Paramedic and management roles. This included a
period as a clinical tutor and safeguarding children and adults posts for seven
years. He has been involved in over 100 safeguarding multi-agency reviews and 30
Domestic Homicide Reviews across the Yorkshire and Humber region and previously
was involved in national safeguarding work, as national ambulance sector representative
with the Department of Health and Department for Education for policy and guidance
in safeguarding children. Dave established the National Ambulance Safeguarding
Group (NASG) in 2009 and chaired this until 2014. Dave has a BA Hons in Teaching
and Learning, a PGCE and currently is at NHS Hull Clinical Commissioning Group in the
above role and also safeguarding advisor to the College of Paramedics.

Mike Brady is a paramedic by background, a lecturer in emergency and unscheduled

care, a doctoral student (PhD), and a clinical team leader within an ambulance service
clinical hub. Mike has contributed heavily to the paramedic literature in areas including
end-of-life care, healthcare quality, death anxiety, as well as child safeguarding and
remote clinical decision-making (RCDM). Paramedics have an underplayed but integral
role in both child safeguarding and RCDM and Mike is keen to advertise and research
these roles as much as possible, to inform future paramedic practice, policy, and
education.

Gemma Chapman qualified as a paramedic in 2012, working on a double-crewed

ambulance and rapid response vehicle for two years, during which time she completed
a mentorship module and successfully mentored undergraduate student paramedics.
Gemma became an Operations Officer in 2014, providing day-to-day leadership,
management and incident command cover at incidents and various public events.

vii
Contributors

Gemma completed the CMI leadership and management programme before embarking
on an MSc Healthcare Management programme. She contributed to the Student
Paramedic Survival Guide in 2015. She is currently seconded to an Operational
Support Officer role within the clinical hub, looking at reducing the unavailability of
resources as part of a Trust-wide Quality Performance Improvement Plan. Gemma
feels passionately that students should develop both the clinical skills required and
possess the knowledge in other areas where they can make a difference, such as
public health.

Vince Clarke is a Senior Lecturer in Paramedic Science at the University of

Hertfordshire, where he has been employed since 2016. Vince joined the London
Ambulance Service in 1996, qualified as a paramedic in 1998 and entered the
Education and Development Department in 2001. He worked as part of the Higher
Education team and developed in-house paramedic programmes, as well as working
closely with higher education partner institutions. A Health & Care Professions
Council partner since 2006, he has been involved in the approval of a wide range
of paramedic educational programmes across the country as well as assessing
Continuing Professional Development (CPD) submissions and sitting on Conduct and
Competence Fitness to Practise panel hearings. Vince also works as an independent
paramedic expert witness for the Court and prepares reports on breach of duty for
both claimants and defendants.

Alison Cork qualified as a nurse in 1989 and worked in emergency care for 15 years.
Alison then chose a career in education and teaches student paramedics and nurses
at the University of Greenwich. Alison has a particular interest in leadership and
clinical decision-making.

Steve Cowland joined the London Ambulance Service in 1984. He has been a
paramedic since 1991. He has been involved with education programmes for a
number of years in his role as ambulance tutor and now works at Kingston St.
George’s, London, and continues to be a paramedic educator.

Bob Fellows has been in and around the ambulance world as a paramedic
(working for the London Ambulance Service), clinical tutor and leader for close on
40 years and continues in his role on the executive of the paramedic professional
body, the College of Paramedics, as Head of Professional Development. He continues
to be active in clinical teaching and writing as a pioneer in several fields of education.
In addition, his passion for life-long learning has led to many productive years as a
CPD assessor for the regulatory body, the HCPC.

Rachael T. Fothergill has worked for the London Ambulance Service for the past 17
years, and as Head of Clinical Audit and Research is considered to be one of the
national leaders in this field. Rachael is also an Honorary Research Fellow at the
University of Warwick’s Clinical Trials Unit. She has a long track record in managing
large-scale clinical research trials and

viii
 Contributors

health-related projects. Her involvement in research and clinical audit, both within the
UK and internationally, has led to changes in clinical practice and patient care and
influenced pre-hospital clinical guidelines.

Ann French qualified as a Registered Nurse in 1988 and worked as a Staff Nurse
in Neurosciences. In 1994, Teesside Hospice opened and Ann became the Sister
in the in-patient unit providing specialist palliative care for patients with life-limiting
illnesses. Following this, she became a Macmillan Clinical Nurse Specialist working
in the community. Ann is now a Principal Lecturer at Teesside University and is
involved in a variety of palliative care modules. She has recently completed a PhD
in Palliative Care at the International Observatory on End of Life Care, Lancaster
University. Her research focused on how people with a life-threatening illness cope
at the end of life.

Graham Harris has a 46-year history in pre- and out-of-hospital care which covers
working in the military, in the NHS, in higher education, and the professional body
for UK paramedics. He co-edited with Amanda Blaber the first and second editions
of Assessment Skills for Paramedics, and Clinical Leadership for Paramedics, and
co-authored chapters in all three editions. He has held Council, Executive and Board
positions in the College of Paramedics, and for the past two years has been employed
as the National Education Lead, developing pre-registration and post-graduate
curriculums, and other national standards for the paramedic profession.

Kath Jennings, Senior Lecturer in the Faculty of Education and Health, University of
Greenwich, is programme leader for the BSc (Hons) Paramedic Science (LONDON)
programme. Kath believes that paramedics have always had to be leaders. By
studying how leadership has evolved we can better relate theory to the development
of our own leadership practice. Her research interests cover a wide range of paramedic
practice and she currently has a number of funded research projects underway,
including paramedic management of pelvic injuries, palliative and end-of-life care, as
well as leadership in paramedic practice.

John Krohne has clinical experience in a variety of mental health settings including
psychiatric intensive care and working-age/older adult in-patient services. Since
2003, he has worked in education roles supporting nurse mentors and students in
clinical practice across adult, child and mental health fields. John was the Education
Lead for a Community NHS Trust before joining the University of Brighton as a Senior
Lecturer in 2016. This role contributes to dementia, ethics, psychosocial studies and
leadership teaching for pre-registration nursing and Foundation Degree programmes.
John also teaches new paramedic and nurse mentors on the Mentorship module.

Christopher Matthews is a Fellow of the Higher Education Academy, Critical Care

Paramedic Practice Lead and a Senior Lecturer at the University of Brighton. Chris
started his ambulance career after being medically discharged as a Commissioned
Officer, after a varied and exciting career in the Royal Marine Commandos. On

ix
Contributors

joining the Ambulance Service, he quickly progressed to become a paramedic after

completing a three-year course at St. George’s Hospital Medical School. Keen to
develop his interest in the management of high acuity patients, he completed
a post-graduate course at the University of Hertfordshire to become a Critical
Care Paramedic. He is now a Critical Care Paramedic Practice Lead (CCPPL) and
passionately believes that expert pre-hospital critical care must become an integral
component within all ambulance services. Alongside his role as a CCPPL, Chris also
works as a Senior Lecturer on a BSc (Hons) Paramedic course. His time in the military
and in pre-hospital critical care has led him to realise the importance of human factors
within paramedicine. He developed a university module integrating human factors
and leadership skills into the BSc (Hons) course. He hopes all paramedic courses will
embrace teaching in this field. He is currently in the process of completing his MSc.

Vicky Milburn is a specialist paramedic in urgent and emergency care. Her interest
in dementia stems from years of experience attending patients with dementia in both
an emergency situation when working for an ambulance service and more recently
in an urgent care setting, being based in a GP surgery. Vicky found assessing pain
challenging in cognitively impaired patients; this has fuelled her interest in this group
of patients. She has been lecturing on the BSc (Hons) Paramedic Practice programme
at the University of Brighton for over two years.

Chris Preston is an Advanced Paramedic Practitioner, North West Ambulance Service.

Chris has 15 years paramedic experience, the last five years in an advanced practice
role. He leads on all aspects of paediatric practice at North West Ambulance Service
as well as undertaking shifts at a Children’s Emergency Department. He completed
an advanced practice MSc in 2014 and undertook additional MSc level study to
specialise in advanced paediatrics and is currently in his fourth year of a PhD
exploring paramedic clinical reasoning during non-time critical clinical interactions with
children. Chris is also a fitness to practise panel member for the Health and Care
Professions Council and a member of the College of Paramedics.

David Rea is Head of the Department of Public Health, Policy, and Social Sciences at
Swansea University, where he leads a multi-disciplinary team whose work contributes
to increasing the health and social care workforce and fostering academic expertise.
David has a PhD in Social Policy and Administration (Kent 1988). He has taught
healthcare management in a number of countries, is an experienced qualitative
researcher, and regularly publishes on management and service improvement.

Marion Richardson is a Senior Lecturer, Paramedic Science. Marion joined the

Ambulance Service in 1986 and qualified in 1992 as a paramedic. During her time
in the Ambulance Service, she has held many posts, including Leading Ambulance
Woman, Team Leader, Ambulance Tutor and Divisional Education Lead. As Divisional
Education Lead it was Marion’s responsibility to develop, coordinate and deliver
educational programmes for all levels of staff within her division of the organisation.
Marion now teaches at Teesside University.

x
 Contributors

Joanna Shaw is a Clinical Audit Manager. Since joining the London Ambulance Service
(LAS) NHS Trust, Joanna has had responsibility for managing the Service’s clinical
audit programme, producing changes to LAS clinical practice and improving the care
delivered to patients. She monitors clinical audit activities across the LAS, supporting
and facilitating other staff undertaking clinical audit, both internally and externally,
by providing individual tuition and running clinical audit training sessions. Joanna has
accreditations as Advanced Clinical Audit, Trainer in Clinical Audit and Significant Event
Audit.

Chris Storey graduated with a BSc (Hons) in Paramedic Practice from the University
of Brighton, after a 15-year career as a church minister and five years working as a
Teaching Assistant for young people with physical and sensory impairments. In 2015,
he took up a position as a Senior Lecturer on the same Paramedic Practice course
at the University of Brighton and now divides his time between the classroom and
working as an A&E ambulance paramedic.

Paul Street is a Teaching Fellow and has a broad background in clinical practice,
education and practice development. He started as an enrolled nurse in general
surgery in 1982. Before becoming a Teaching Fellow and completing his Doctorate,
he worked clinically in medical, surgical areas, ear and nose, HIV & AIDS areas
and practice development. He has worked with practitioners from a wide range of
disciplines in both practice and educational settings to develop practice initiatives.
He passionately believes that communication and interpersonal skills lie at the heart
of quality healthcare practice.

Gary Vale is Senior Lecturer, School of Health and Social Care, Teesside University.
Gary joined the West Midland Ambulance Service in 1976, he gained his paramedic
status in 1986, also becoming an IHCD clinical and driving instructor. He moved to
North Yorkshire Ambulance Service in 1996 as an Executive Director, heavily involved
with communication and the fast emerging unscheduled care agenda. In 2004,
Gary became part of a partnership arrangement with Teesside University to develop
a Foundation Degree programme for paramedics. In 2012, he left the Ambulance
Service to join the academic team at Teesside University full-time to help develop the
BSc (Hons) Paramedic Practice programme. He is committed to the increasing trend of
the profession extending beyond its birthplace of the Ambulance Service.

Jackie Whitnell worked in the NHS for 28 years. Her career spans theatre and
intensive care nursing, plus she worked for 18 years in Children’s Services as a
children’s nurse and Health Visitor. Jackie has a MA in sociology and BSc (Hons)
in psychology. She has worked as a Senior Lecturer since 2002 in Hertfordshire,
Greenwich and Chichester universities. She has taught abnormal and developmental
psychology and aspects of child health to students studying paramedic science,
nursing, midwifery and childhood studies. Jackie continues to work as an Associate
Lecturer in her chosen topic areas and prides herself on the professional and fun way
in which she delivers her teaching sessions.

xi
Contributors

Julia Williams is Professor of Paramedic Science at the University of Hertfordshire.

Julia has been involved in the development and delivery of higher education
programmes for both already qualified paramedics and also for students on pre-
registration Paramedic Science programmes since 1996. As Head of Research for the
College of Paramedics, she is committed to increasing the capacity and capability of
paramedics within clinical research, and she takes every opportunity to inform other
agencies about the rich talent that exists within the paramedic profession in relation
to clinical research, highlighting the positive contribution paramedics can make to
the healthcare research agenda. Over the years, she has been involved in a variety
of qualitative, quantitative and mixed methods research studies related to different
aspects of paramedic practice and unscheduled emergency healthcare provision. Julia
describes herself as having an ‘amazing job’ as her primary role is at the University
of Hertfordshire teaching undergraduate students and supervising Paramedic post-
graduate research studies, but, at the same time, she has a secondment to an
ambulance Trust for part of the week where she undertakes research and clinical
practice. A perfect combination!

xii
 Acknowledgements

I am grateful to many colleagues I have met throughout my career who influenced me both
as a professional and a person. My thanks to all students who have read and commented
on previous editions of Foundations, it has helped shape this third edition. I would like to
say a special thank you to all the students I have had the pleasure of teaching; I too have
learnt from you and have enjoyed sharing your journey.

My warmest thanks to all my colleagues who have shared this third edition journey (and
previous editions); for their due diligence and commitment to a book that we hope will help
enlighten and educate a generation of future paramedics.

Thank you, Jackie (co-editor in all but name), for your innovative and unique thinking;
being my ‘sounding board’ for new ideas; for the hours of proof-reading and encourage-
ment, plus being involved from the very inception of the first Foundations.

Thank you to all of the contributors and their significant others (past and present) for their
unwavering support.

xiii
 Introduction
Amanda Y. Blaber

This book should be the start of your reading, investigation and research. Some of the
chapters have been written by paramedics, some written by a non-paramedic subject
experts and many jointly written by subject experts and paramedics. This provides
a strong contemporaneous academic focus together with application to the reality of
paramedic practice.

If you look through the chapter content of each of the three Foundations for Paramedic
Practice texts (2008, 2012 and 2018) some chapters have been removed, some
updated and many replaced. Together with the first and second editions, this text
reflects a historical journey of the paramedic role in the UK and the changing face of
society and expectations.

T hroughout the chapters there is a symbol which serves as a prompt to the

reader to ‘link to’ other chapters or specific pages, where you can read more
on a specific subject. There are also ‘Reflection: points to consider’ boxes
where you are invited to consider what you have just read and apply it to your
own life experience and/or practice. There are many case studies for you to
consider and think about applying the theory to the cases presented and the
questions the contributors pose for the reader. It is hoped that these features
bring the book to life for the reader and help make links to practice more
explicit and encourage additional critical thinking.

1
 Interpersonal communication:
1 a foundation of practice
Paul Street

1 In this chapter:
•• Introduction
•• Why is this relevant?
Respiratory assessment
•• The basics of communication
•• Verbal features of communication
Vince•• Clarke and Paul Townsend
Non-verbal communication
•• Communicating with patients: exploring the case study
•• Inter-professional communication tools
•• Conclusion
•• Chapter key points
•• References and suggested reading

IN TR O D U C T I ON
Communication is one of the most fundamental elements of human existence and is
integral to our lives from birth. It involves the transfer of information between people and
it is difficult to think of any situation when a person is not communicating in some way,
because even when you are not speaking, your body is constantly presenting a stream
of non-verbal messages to those around you (Gamble and Gamble 2017). Outwardly,
communication appears normal and straightforward, but actually it is complex and open
to many influences, which can lead to being misunderstood, if the meaning within the
communication is not clear and consistent in all the forms that the information is being
sent, received and understood (Pavord and Donnelly 2015).

W H Y I S TH I S R ELE VAN T ?
Vermier et al. (2015: 1257) state, ‘Effective communication is crucial to healthcare.’
Further, Hayley (2014) argues that communication is one of the most important skills
needed by a paramedic. Without interpersonal communication, paramedics would not
be able to talk to patients, know the location of their next call, hand over a patient to
the staff in an emergency department or really undertake most of their clinical skills
safely. Hence, the ability to communicate with patients, relatives, colleagues and the

2
 Interpersonal communication

public is seen as an essential skill required by ambulance clinicians and all health-
care practitioners (Pavord and Donnelly 2015; HCPC 2016). Despite the importance
of communication, it has often been seen as a soft skill and not as important as the
technical skills, such as cannulation and intubation, for example. However, Lucas et al.
(2015) are critical of this view, suggesting communication should be considered along-
side, and equal to, those technical skills, because they often cannot occur without it.
Despite communication being such a fundamental part of professional practice, over
13 per cent of written complaints received by the National Health Service are concerned
with communication issues alone (Health and Social Care Information Centre 2016). It
seems evident, then, that all health practitioners should be constantly aware of ‘what
and how they communicate’, because the results of this could have either a positive
or negative effect on every aspect of their relationships with patients, relatives and
colleagues. So, communication warrants a place at the heart of practice.

TH E B AS I C S O F C O MMU N I C AT I ON
Communication is a two-way process that includes the exchange of information,
thoughts and feelings by speaking, body language, or writing of some sort, according
to the Oxford English Dictionary (2017). It has been established for some time that
only 7 per cent of communication is attributed to the words used, while 38 per cent
is derived from the tone of voice and a further 55 per cent from non-verbal cues used
(Mehrabian 1981).

The most common model of interpersonal communication proposes that one person
is ‘the sender’ who will formulate a message and send it verbally, non-verbally, or in
a combination of both, to another person, ‘the receiver’. Once a message has been
sent, the receiver uses their senses (hearing, sight, etc.) to receive it. The receiver
then interprets that message and responds verbally or non-verbally or both, with what
they think is appropriate feedback to the sender, based on the receiver’s interpretation.
The original sender, then, in turn, interprets that feedback and responds, based on
what they think the feedback was (Shannon and Weaver 1949). If any messages con-
tain conflicting verbal and non-verbal cues within the same messages, these so-called
mix messages can easily be misunderstood and misinterpretations result. Hence, all
practitioners need to send clear messages where there is no inconsistency between the
verbal and non-verbal features they use to minimise any potential misunderstandings
(College of Paramedics and American Academy of Orthopedic Surgeons 2016).

However, communication is open to a range of factors that influence the way we formu-
late and send messages (encoding) and interpret messages (decoding). Both the sender
and receiver encode and decode the meaning of the message through the verbal and
non-verbal features of communication alongside their senses (Argyle 1988). This pro-
cess is influenced by many other factors within us – our social identity, personality,
values, beliefs, gender, culture, status, to name just a few (see Figure 1.1) (Hartley
1999). So all healthcare practitioners should consider how these factors may influence
what they communicate and how the patient’s sociocultural factors may influence its

3
Paul Street

Factors that influence how the sender and

receiver encode and decode messages

Primary, secondary and

professional socialisation
Values, beliefs and attitudes
Senses: sight, hearing, etc.
Memory and attention
Communication skills
Vocabulary and language
Perception and mood
Self-identity and culture
Confidence
Medical conditions
Prejudices
Tiredness and fatigue

Verbal & non-verbal

Messages
Sender Receiver
Encodes Decodes

Decodes Encodes
Feedback
Verbal & non-verbal

Social situation
Type of situation – emergency, non-emergency
Complexity of the situation
Location
Time (of day, time spent in the situation, time pressures, etc.)
Other people in the situation: relatives, professionals, etc.
Roles, responsibilities, status, hierarchies within it
Perceptions of the situation
Conflict
Pressure and stress
Privacy
Distractions: noise, bystanders, etc.

Factors within a social situation that could affect communication

Figure 1.1 A model of communication

Source: Adapted from Shannon and Weaver (1949), Hartley (1999), Pavord and
Donnelly (2015).

interpretation, particularly in the context of multicultural societies, where cultural dif-

ferences in values, beliefs and behaviours need to be respected to enable paramedics
to provide good quality care to a diverse patient group and prevent inadvertent offence
being caused (Pavord and Donnelly 2015; HCPC 2016). In addition to this, the social
situation in which the communication occurs can positively or negatively influence the

4
 Interpersonal communication

effectiveness of communication within it (see Figure 1.1). If the situation was time-critical
or complex, for example, this may influence how someone communicates, requiring
very clear direct communication.

V E R B A L FE AT U R ES O F C O MMU NICATION
Verbal communication is, in essence, a deliberate conscious process, because peo-
ple select the words from their vocabulary that they want to use in order to commu-
nicate (Gamble and Gamble 2017). The meaning of the messages we communicate
may change depending on the paralinguistic features used to convey them (Hogg and
Vaughan 2013). The paralinguistic features contributing to paralanguage outlined in
Figure 1.2 are used to emphasise the meaning of the message the sender wishes to
place on it.

Paramedics would be expected to use professional level vocabulary with colleagues and
other professionals who may have various levels of understanding of that terminology,
yet also be able to translate that communication to meet the needs of patients and
relatives who may have different levels of cognitive development and varied communica-
tion abilities. The optimum level of communication is one which is clear, understandable
and appropriate to the situation and people in it.

Evidently when the sender speaks in order to send a verbal message, it needs to be
sent at a volume that the receiver can hear (Pavord and Donnelly 2015). The volume
used to send a message may vary depending on the situation, for example, two para-
medics talking at a busy roadside would need a louder volume than those talking to
a patient in their home. Further, ensuring an appropriate volume level is important in
terms of the effectiveness of the communication – too loud and a patient may think you
are shouting at them, too soft and they may not hear you at all. Both these forms could
limit the patient’s ability to interpret the correct meaning of the message, let alone
having the potential to leave the patient with a lasting negative impression of how health
practitioners communicate.

Volume Rhythm Pitch Pace Intonation Tone

Paralinguistic features

Non-verbal features

Eye contact Facial expression Proximity Touch Gestures Posture

Figure 1.2 Paralinguistic and non-verbal features of communication