P085: What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine

Introduction: Patient assessment is a fundamental feature of non-emergency community paramedicine (CP) home visit programs. In the absence of a recognized standard for CP assessment, current assessment practices in CP programs are unknown. Without knowing what community paramedics are assessing, it is difficult to ascertain what should be included in patient care plans, whether interventions are beneficial, or whether paramedics are meeting program objectives. Our objective was to summarize the content of assessment instruments used in CP programs in order to describe the state of current practice. Methods: We performed an environmental scan of all CP programs in Ontario, Canada, and employed content analysis to describe current assessment practices in CP home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy. Findings were compared at the domain and sub-domain of the ICF. Results: Of 54 paramedic services in Ontario, 43 responded to our request for information. Of 24 services with CP home visit programs, 18 provided their intake assessment forms for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Overall, most assessments included some content from each of the domains outlined in the ICF, including: Impairments of Body Functions, Impairments of Body Structures, Activity Limitation and Participation, and Environmental Factors. At the sub-domain level, only assessment of Impairments of the Functions of the Cardiovascular, Haematological, Immunological and Respiratory systems appeared in all assessments. Few CP home visit program assessments covered most ICF sub-domain categories and many items classified to specific categories were included in only a few assessments. Conclusion: CP home visit programs complete multi-domain assessments as part of patient intake. The content of CP assessments varied across Ontario, which suggests that care planning and resources may not be consistent. Current work on practice guidelines and paramedic training can build from descriptions of assessment practices to improve quality of care and patient safety. By identifying what community paramedics assess, evaluation of the quality of CP home visit programs and their ability to meet program objectives can be improved and benchmarks in patient care can be established.

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What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine

CJEM ◽

10.1017/cem.2019.379 ◽

2019 ◽

Vol 21 (6) ◽

pp. 766-775

Author(s):

Matthew S. Leyenaar ◽

Brent McLeod ◽

Sarah Penhearow ◽

Ryan Strum ◽

Madison Brydges ◽

...

Keyword(s):

Content Analysis ◽

Home Visit ◽

Assessment Instruments ◽

Assessment Practices ◽

Care Planning ◽

Inclusion Criteria ◽

Patient Assessment ◽

Environmental Scan ◽

Community Paramedicine ◽

Current Assessment

ABSTRACTObjectivesPatient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.MethodsWe performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.ResultsA total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.ConclusionAlthough community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.

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Examining consensus for a standardised patient assessment in community paramedicine home visits: a RAND/UCLA-modified Delphi Study

BMJ Open ◽

10.1136/bmjopen-2019-031956 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031956

Author(s):

Matthew S Leyenaar ◽

Ryan P Strum ◽

Alan M Batt ◽

Samir Sinha ◽

Michael Nolan ◽

...

Keyword(s):

Delphi Study ◽

Home Visit ◽

Assessment Instrument ◽

Urinary Continence ◽

Patient Assessment ◽

Modified Delphi ◽

International Panel ◽

Community Paramedicine ◽

Additional Domain ◽

High Level

ObjectiveCommunity paramedicine programme are often designed to address repeated and non-urgent use of paramedic services by providing patients with alternatives to the traditional ‘treat and transport’ ambulance model of care. We sought to investigate the level of consensus that could be found by a panel of experts regarding appropriate health, social and environmental domains that should be assessed in community paramedicine home visit programme.DesignWe applied the RAND/UCLA Appropriateness Method in a modified Delphi method to investigate the level of consensus on assessment domains for use in community paramedicine home visit programme.Setting and participantsWe included a multi-national panel of 17 experts on community paramedicine and in-home assessment from multiple settings (paramedicine, primary care, mental health, home and community care, geriatric care).MeasuresA list of potential assessment categories was established after a targeted literature review and confirmed by panel members. Over multiple rounds, panel members scored the appropriateness of 48 assessment domains on a Likert scale from 0 (not appropriate) to 5 (very appropriate). Scores were then reviewed at an in-person meeting and a finalised list of assessment domains was generated.ResultsAfter the preliminary round of scoring, all 48 assessment domains had scores that demonstrated consensus. Nine assessment domains (18.8%) demonstrated a wider range of rated appropriateness. No domains were found to be not appropriate. Achieving consensus about the appropriateness of assessment domains on the first round of scoring negated the need for subsequent rounds of scoring. The in-person meeting resulted in re-grouping assessment domains and adding an additional domain about urinary continence.ConclusionAn international panel of experts with knowledge about in-home assessment by community paramedics demonstrated a high level of agreement on appropriate patient assessment domains for community paramedicine home visit programme. Community paramedicine home visit programme are likely to have similar patient populations. A standardised assessment instrument may be viable in multiple settings.

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Nighttime Calls, Pages, and Interruptions to the On-Call Surgery Resident

The American Surgeon ◽

10.1177/0003134821991987 ◽

2021 ◽

pp. 000313482199198

Author(s):

Raphael H. Parrado ◽

David M Notrica ◽

Mark S. Molitor

Keyword(s):

Patient Care ◽

Clinical Assessment ◽

Resident Physician ◽

Direct Patient Care ◽

Patient Assessment ◽

Good Medical Practice ◽

Physician Wellness ◽

Night Call ◽

Surgery Resident

Background Communication is a keystone to good medical practice. At night, as physician numbers decrease, frequent, nonurgent interruptions have shown to disrupt patient care and impact resident/physician wellness. Potentially, interruptions can lead to an increase in medical errors. The frequency and activities interrupted during night calls have not been fully described. Methods For a period of 44 days (August through September), all calls and pages received during the 12-hour night call session were documented. Calls were analyzed by caller, urgency, need for intervention, and resident interrupted by the communication. Results A total of 494 communications were identified with a mean of 10 calls per shift (IQR 7-14). Communications lasted a mean of 2.7 +/− 2.9 minutes. Direct calls occurred in 78% and pages in 22% of the cases. From the non-ED calls (n = 335), most of them came from nursing staff (85%), followed by other specialties (12%). Five percent of the calls were directed to the wrong service. Communications occurred during charting (41%), patient assessment (33%), interrupted resident’s sleep (12%), or during a surgical procedure (6%). Communication required no action in 47% of the cases. A physician order was needed in 41%, while bedside clinical assessment was required in 12% of the calls. Conclusions Communications are common at night, but most did not require clinical assessment. A large portion of communications interrupted direct patient care. An opportunity exists to eliminate nonproductive communications and improve the quality of medical education.

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Defining and measuring quality cancer survivorship care: An environmental scan.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.219 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 219-219

Author(s):

Lena Ly ◽

Karolina Lisy ◽

Melanie Clode ◽

Helana Kelly ◽

Michael Jefford

Keyword(s):

Outcome Measures ◽

Cancer Survivorship ◽

Delphi Study ◽

Quality Care ◽

Survivorship Care ◽

Environmental Scan ◽

Care Plans ◽

Essential Components ◽

Patient Reported

219 Background: It is recognised that current models of survivorship care are suboptimal and unsustainable. The landmark Institute of Medicine (IOM) report ‘From Cancer Patient to Cancer Survivor: Lost in Transition’ suggested four essential components of survivorship care: prevention of recurrent and new cancers; surveillance for recurrent or second cancers; intervention for consequences of cancer and its treatment, and coordinated care between health providers. The report also recommended “quality of survivorship care measures should be developed... and quality assurance programs implemented to monitor and improve the care that all survivors receive.” Nekhlyudov et al (JNCI 2019) built on the IOM’s recommendations to develop a quality of cancer survivorship care framework. We undertook an environmental scan to understand how quality survivorship care is conceptualised internationally, and what metrics are available. Methods: This scan comprised limited literature review, review of organisations’ websites, and expert consultation to source documents that described and measured quality survivorship care. Documents were assessed against the domains proposed by Nekhlyudov et al. Metrics were categorised as policy, process or outcome measures. Results: The search yielded 40 documents from six countries. There was agreement that quality survivorship care is founded on the IOM elements, expanded by Nekhlyudov et al. The review also noted risk stratification/personalised pathways of care and patient self-management as other elements of quality care. Many countries have proposed or implemented quality measures, with greater emphasis on processes over outcome assessments. Only the USA was found to have implemented policy measures. In the process domain, frequently reported metrics included completion of needs assessments and survivorship care plans, and adherence to recommended follow up guidelines. Regarding outcome measures, patient-reported outcomes and experiences were commonly proposed, however there was a lack of specific elements, or recommended instruments. Conclusions: There is broad agreement on what constitutes quality survivorship care internationally. Future work should consider policy or structural elements that support optimal care. Findings from this scan will inform a modified reactive Delphi study to establish consensus-based criteria for high quality survivorship care. Additional work should consider how to define and implement metrics of quality care, and how to use metrics to improve survivors’ outcomes.

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Assessment or Surveillance? Panopticism and Higher Education

Philosophical Inquiry in Education ◽

10.7202/1070559ar ◽

2020 ◽

Vol 24 (1) ◽

pp. 102-109 ◽

Cited By ~ 1

Author(s):

Emery Hyslop-Margison ◽

Ramonia Rochester

Keyword(s):

Higher Education ◽

Psychological Impact ◽

Assessment Practices ◽

Academic Experience ◽

Academic Quality ◽

Social Imagination ◽

Institutional Control ◽

Current Assessment ◽

The Impact

In this paper, we explore Jeremy Bentham’s panopticon and consider its possible contribution to understanding more fully the impact of current assessment protocols and practices within higher education. More pointedly, we ask the following question: Are the plethora of assessment practices within higher education actually designed to improve student academic experience, or are they instead mechanisms of surveillance intended to control, dominate and invoke paranoia among university workers? In response to this question, we argue that the prevailing preoccupation with assessment in U.S. universities is motivated less by a genuine desire to enhance the actual academic experience of students than it is to offer hegemonic interests a psychological instrument of control to eliminate potential dissent over neo-liberal and managerial class imposed policies. To illustrate our central claim, we first review some general details of Bentham’s panopticon. Secondly, we briefly discuss Foucault’s analysis of the panopticon and consider his accompanying postulate on the tendency of individuals to self-regulate their behavior according to externally imposed and monitored expectations. We also examine in greater depth the relationship between the panopticon and the Lacanian gaze, with a focus on considering the latter’s psychological impact. Finally, we contend that the prevailing obsession with assessment in universities is a mechanism of institutional control that hinders rather than enhances the academic quality of contemporary higher education by limiting the scope of academic dialogue, social imagination and democratic structural critique.

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Qualitative Inquiry into the Patients' Expectations regarding Nurses and Nursing Care

Advances in Nursing ◽

10.1155/2014/647653 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Majid Najafi Kalyani ◽

Raziyeh Illon Kashkooli ◽

Zahra Molazem ◽

Nahid Jamshidi

Keyword(s):

Content Analysis ◽

Patient Care ◽

Nursing Care ◽

Qualitative Content Analysis ◽

Individual Characteristics ◽

Qualitative Inquiry ◽

Comprehensive Care ◽

Study Results ◽

Semistructured Interviews

Background and Objectives. Awareness about the patients’ needs and expectations is quite important in improving the quality of the services they are provided with. Since meeting the needs and expectations of the patients is one of the basic issues in patient care, the present study aimed to investigate the patients’ expectations from nurses and nursing care. Methods. In this qualitative study, 20 hospitalized patients were interviewed. The data were gathered through deep, semistructured interviews. Then, all the recorded interviews were transcribed, reviewed for several times, and analyzed using qualitative content analysis approach. Results. By analyzing of data, three main categories were extracted. The main categories of the patients’ expectations from nurses and nursing care were comprehensive care, ethical performance, and having proper individual characteristics. Discussion and Conclusion. The study results revealed that the patients expected comprehensive care from the nurses. In addition, the nurses were required to apply the ethical principles in what they do as their duties. The findings of the study can be helpful in improving the patient care.

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Impacto de la evaluación de competencias en la calidad del aprendizaje: percepción de discentes y docentes de Grado en Enfermería

Enfermería Global ◽

10.6018/eglobal.17.2.263041 ◽

2018 ◽

Vol 17 (2) ◽

pp. 400-429

Author(s):

Esther Martínez-Miguel ◽

María del Carmen Solano Ruiz ◽

Eva García-Carpintero Blas ◽

César Manso Perea

Keyword(s):

Assessment Practices ◽

Teachers Perceptions ◽

Competency Based Education ◽

Assessment Of Learning ◽

Quality Feedback ◽

Current Assessment ◽

Competency Based ◽

Education And Employment ◽

Quality Awareness

Introducción: El enfoque de educación basada en competencias pretende reducir la brecha entre educación y empleo buscando lograr un aprendizaje profundo, significativo, para toda la vida, transferible a situaciones reales, complejas y cambiantes. Conceptualizar la evaluación a partir de este enfoque implica asumir su carácter multidimensional diseñando una evaluación para el aprendizaje y no sólo del aprendizaje, en la búsqueda de formas de evaluación capaces de mejorar la calidad del mismo. La conciencia del impacto de la evaluación en el aprendizaje obliga a plantear la evaluación como un proceso compartido que sea simultáneamente causa y efecto de los aprendizajes. En este contexto, el objetivo de este estudio es conocer la percepción de discentes y docentes en relación a las prácticas actuales de evaluación de competencias y su impacto en la calidad del aprendizaje. Metodología: Estudio descriptivo interpretativo. Análisis cualitativo de los datos recogidos mediante cuestionarios abiertos y grupos de discusión de discentes y docentes del Grado en Enfermería. Resultados: Ambos grupos consideran que las prácticas actuales de evaluación de competencias condicionan el aprendizaje, sin embargo, existen grandes diferencias en sus percepciones. Los docentes perciben este impacto como negativo y afirman que para los estudiantes la evaluación consiste sólo en superar asignaturas. Los estudiantes manifiestan que la evaluación les influye positivamente al orientar su aprendizaje y ofrecerles oportunidades de mejora. Conclusiones: Los docentes perciben dificultades para superar la orientación tradicional de la evaluación, mientras los estudiantes perciben su función más formativa y demandan para ella un feedback suficiente y de calidad. Introduction: Competency based education offers the promise of reducing the gap between education and employment and concerns in Higher Education have revolved around how to achieve deep and meaningful learning, a long life learning, so that learning transfer to real situations, complex and changing, would be possible. Conceptualizing assessment from competency based education approach requires assuming its multidimensional character and designing an assessment for learning and not only assessment of learning seeking to improve learning quality. Awareness of the assessment impact on learning requires raising evaluation as a shared process able to be simultaneously cause and effect of learning. In this context, the aim of this study is to determine learners and teachers perceptions about current practices of competence assessment and its impact on the quality of learning. Methodology: Interpretative descriptive study. Qualitative analysis of data collected through open questionnaires and discussion groups with Degree in Nursing learners and teachers. Results: Both teachers and learners believe that current assessment practices determine learning skills, but there are big differences in their perceptions. Teachers perceive negatively this impact and claim that for student’s evaluation is only overcoming subjects while students state that assessment influences them positively, guiding their learning and offering improvement opportunities. Conclusions: teachers perceive difficulties in overcoming evaluation`s traditional, while students perceive its most formative function and demand for it sufficient and quality feedback.

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Adapting the Environmental Scan for Gerontology Graduate Students’ Career Exploration

Innovation in Aging ◽

10.1093/geroni/igab046.2801 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 762-762

Author(s):

Nasreen Sadeq ◽

Brianne Stanback

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Patient Care ◽

Assisted Living ◽

Graduate Program ◽

Career Exploration ◽

Memory Training ◽

Environmental Scanning ◽

Environmental Scan ◽

Care Plans

Abstract Environmental scanning is a process that provides organizations with information about their internal and external strengths, challenges, and opportunities. Although traditionally used in business and strategic planning, environmental scanning is now being utilized in health care to evaluate currently available programs and services, identify gaps in patient care or research, and make educational, organizational, and policy recommendations. The current study explores adapting the environmental scan for students enrolled in a gerontology graduate program as a tool to facilitate career exploration. Students learned about environmental scanning and were instructed to perform an environmental scan on an important issue, program, or service relevant to their overall career goals. Because students completed their environmental scan while enrolled in an Alzheimer’s Disease Management course, they were encouraged to factor in the increasing prevalence of Alzheimer’s disease into their project. Students’ environmental scan projects spanned several timely topics, including an evaluation of the services currently offered in assisted living facilities from the perspective of a geriatric social worker, a review of memory training interventions and a proposal for a new research study, and preliminary plans for opening an assisted living facility catering to older adults in the LGBTQ community that outlined financial considerations, staff training goals, and patient care plans. Completing the environmental scan project gave students an opportunity to investigate the current state of the career field they are planning to enter, and provided them with a product that they can build upon as they complete the graduate program and begin their careers.

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