105: 9 Using quantitative research methods in paramedic practice. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . Vulnerable patients are at an increased risk of harm or exploitation in healthcare. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. John had arrived at a friend's house during the night, behaving in a strange, confused manner. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Decision-making is central to the everyday practice of paramedicine. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. Practical decision-making strategies are provided and illustrated by brief examples. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. There were no obvious physical causes for John's behaviour at this stage. Legal & Ethical issues associated with paramedic practice during COVID19. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. N2 - Decision-making is central to the everyday practice of paramedicine. Monday, January 2, 2017. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. Aircraft Accidents and Emergency Management, Live Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. Consumer rights in advocacy and health care. This principle refers to both physical and mental damage, which can be done to the clients. The crew's assessments and thought processes surrounding the management of John will be discussed. He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. B. crew control. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. There are many ethical issues that are encountered during the prehospital care of children and adults. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. Vulnerable patients are no exception. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. The ethical principle of non-maleficence means that paramedicine practitioners should discuss the probable negative consequences of their decisions and prevent them in order not to harm the patients. In other words, paramedics need to adopt the principle of confidentiality and credence. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Notify the family that once CPR has been initiated, you are required to transport the patient. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). Purpose of the fitness to practise process. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. The approach to both participation and trial protocol training varied between ambulance services. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Copyright 2023 Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Although provider judgment plays a large role in the . Therefore, it is important to consider those principles more precisely. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. Copyright 2023 It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. 136: 11 The future for paramedic research. are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015). While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. Ethics, bioethics and legal issues in paramedic practice. In this case, both ethical and legal principles are important. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Psychiatric admission for assessment and subsequent treatment if required. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Dominique Moritz, Phillip Ebbs, Hamish Carver An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Chat. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life.
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