Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
Browse
7 results
Search Results
Item Restricted Clinical Feedback in Emergency Medical Service (EMS) Education: Identifying and resolving the training needs of clinical supervisors in Saudi Arabia(Cardiff Univeristy, 2024-03) Algabgab, Mohammed Fahad; Tombs, Michal; Riley, StephenClinical supervision and feedback are crucial in Emergency Medical Services (EMS) education, as they play a significant role in enhancing the competence and professional growth of EMS students . Supporting and addressing the training needs of supervisors is essential to ensuring they can provide effective feedback and guidance. However, there is no existing literature on the specific training needs of EMS supervisors in the unique cultural context of Saudi Arabia, highlighting the need for focused research in this area. Grounded in the Clinical Performance Feedback Intervention Theory (CP-FIT), the research navigated through a comprehensive examination of clinical feedback’s perceptions, challenges, and training needs from the perspectives of both EMS students and clinical supervisors. The thesis begins with a scoping review, finding that only twelve studies specifically targeted clinical feedback in EMS education over the past two decades, highlighting its importance but also underscoring gaps in the literature. Notably, existing studies fail to explore the perceptions of clinical feedback between students and supervisors and largely focus on the general context of clinical placements, thus diluting the potential insights into feedback’s effectiveness, challenges, and impact on learning and performance. Furthermore, it notes a lack of research in EMS education, especially within Saudi Arabia. To address these gaps, the thesis delves into the perceptions of EMS students and clinical supervisors in Saudi Arabia, thereby filling a regional research void. It investigates the specific challenges in feedback provision and receipt, emphasising the training needs of supervisors, including effective communication, personalised feedback, constructive methods, emotional intelligence, feedback follow-up, technology use, understanding feedback differences, and promoting a positive feedback environment. Furthermore, the thesis employs a Delphi study to consolidate expert consensus on the best approaches to address identified challenges and needs in clinical feedback, including the particular training needs of clinical supervisors. The findings highlight the need for a structured feedback approach that considers the diverse needs and perceptions of both students and supervisors. The thesis proposes a comprehensive strategy, including tailored training programmes and quality assurance and ongoing support, to improve clinical feedback standards. This strategy aims to bridge perceptual gaps, and to foster the students’ learning and professional growth.20 0Item Restricted The Impact of Prehospital Blood Transfusion for Trauma Patient with Haemorrhagic Shock(University of Glasgow, 2024) Alotaibi, Rawan; McGuire, AndrewTrauma significantly contributes to the annual global mortality rate. One of the major causes of death resulting from traumatic injury is haemorrhagic shock. Early resuscitation with blood and blood products in low ratios is recommended by the Advanced Trauma Life Support (ATLS) in patients with evidence of Class III and IV haemorrhage. Therefore, the aim of this dissertation is to determine the impact of Prehospital Blood Products Transfusion (PHBT) on mortality rate compared to crystalloid solutions in trauma patients experiencing haemorrhagic shock. Method: A systematic literature search was performed across three electronic databases (Ovid Medline, Embase Advanced Search and CINAHL Complete (EBSCO) database) for data published between 01 January 2013 to 20 October 2023. Eligibility criteria included randomised controlled trials (RCTs) and comparative cohort study comparing prehospital blood products transfusion with standard care. All included studies were screened and assessed utilising the Critical Appraisal Skills Programme (CASP) tool to evaluate their quality. Results: From an initial 2425 articles collected, 870 duplicates were removed, and a further 1534 were excluded. Following title and abstract screening of the 21 studies that has a full-text review, six studies met the predefined inclusion criteria. From these studies, PHBT did not cause any reduction in mortality rates compared with crystalloid fluids. Conclusion: While PHBT is increasingly being adopted as an intervention in pre-hospital settings, the results from the systematic literature search did not reveal a reduction in mortality rates in favour of PHBT recipients compared to crystalloid solution. Conducting a RCT would be required to fully address the proposed research question18 0Item Restricted Enhancing prehospital triage for patients with suspected cardiac chest pain using prediction models(University of Manchester, 2024-05-14) Alotaibi, Ahmed; Body, Richard; Brown, Benjamin; Martin, GlenBackground: Chest pain, a primary symptom of acute coronary syndromes (ACS), frequently prompts ambulance calls and emergency department (ED) visits. Despite this, a significant number of patients transported for chest pain ultimately receive diagnoses of self-limiting, non-cardiac conditions. This leads to systematic over-triage, elevating ambulance resource utilization and contributing to crowding in EDs. Aim: To understand and improve the accuracy of current processes for telephone triage and prehospital assessment of patients with acute chest pain. For telephone triage, specific objectives included to systematically review the literature; gain consensus on the life-threatening conditions (LTCs) that should be identified by call handlers; and to derive and validate a prediction model. I also aimed to refine and validate prediction models to enhance prehospital risk stratification by paramedics. Methods: I completed (a) a systematic review searching three databases with narrative synthesis; (b) a Delphi study to define the LTCs that should guide future telephone triage; and (c) a retrospective cohort study using North West Ambulance Services (NWAS) data linked with Manchester University NHS Foundation Trust (MFT) to derive and validate a prediction model. Further, I completed secondary analyses of a multi-centre prospective diagnostic test accuracy study to create meta-models of established decision aids using stacked regression, and I validated the Manchester only Acute Coronary Syndrome ECG (MACS-ECG) prediction model in prehospital setting. Result: The systematic review identified three relevant papers supporting the feasibility of using prediction models to reduce over-triage by telephone but highlighting a paucity of data. The Delphi study identified 26 LTCs that should receive a priority 1 or 2 ambulance response. Due to a cyber-attack, results of the derivation and validation of a new prediction model for telephone triage cannot be presented. The existing MACS-ECG risk model achieved a sensitivity of 2.3% (95% CI 0.3-8.1%) and specificity of 99.5% (95% CI 98.6-99.9%) for myocardial infarction with poor calibration (gradient 0.0628, intercept 0.0852). Meta-modelling did not enhance the accuracy of established prediction models. The paramedic ECG interpretation showed a 30.8% (95% CI: 22.1-40.6%) sensitivity and 89.7% (95% CI: 87.2-91.9) specificity. Conclusions: This work has (a) identified an important evidence gap to guide telephone triage for chest pain, (b) defined outcome measures for such future research, and (c) identified that currently available prediction models do not have any advantage over human interpretation of an ECG by a paramedic. Future research should focus on completing the work to develop a new prediction model a telephone triage and supporting training paramedics for ECG interpretation.20 0Item Restricted Determining the variables associated with EMS non-conveyance of patients with respiratory complaints in Western Cape, South Africa: A retrospective chart review(Saudi Digital Library, 2023-02) AlSufayan, Mohammed K; Stassen, Willem; Daryl, Wesley; Binks, FaisalIntroduction: The South African (SA) demand for emergency care is increasing, placing more strain on the emergency medical services (EMS) and the larger healthcare system. However, not all patients who call EMS require conveyance to hospital. It is intuitive that the increase in ambulance responses has also increased the probability for non-conveyance. By determining the variables associated with non-conveyance, EMS resource utilization can be adjusted accordingly. Local data on the phenomenon is lacking, however, international data suggests that respiratory complaints are common causes for responses resulting in non-conveyance. The aim of this study is to determine the variables that are associated with the non-conveyance of patients with respiratory complaints serviced by the Provincial Government Western Cape (PGWC) EMS, SA. Methods: A retrospective chart review was conducted using data from the PGWC EMS computer aided dispatch (CAD) and electronic patient care reports (ePCR). Data were collected over a one-year period (1 October 2018 - 30 September 2019). All records where the emergency was a respiratory complaint, and the ambulance response ended in non-conveyance were included. The rate of non-conveyance was determined using descriptive analysis. Logistic regression was performed to evaluate factors that affect the likelihood of non-conveyance of respiratory complaints. Results: Out of 33 295 total respiratory complaints, the median patient age was 46 years. Males represented 50.2%(n = 16702) of the sample. There were no significant differences between the age and gender of those who were and were not conveyed. Of the total, 4.48%(n = 1493) were not conveyed to the hospital. Of the non-conveyed calls, 73.34%(n = 1081) were assigned a priority level 1 at dispatch and the remainder were priority 2. The majority, 45.16% (n = 504), of cases had a final triage code of yellow, followed by 31% (n = 356) coded green. Following multivariate regression, the following variables increased the odds of non-conveyance: Green triage (OR 2.04; 95% CI 1.77-2.36; p<0.01), weekends (OR 1.27; 95% CI 1.12-1.44; p<0.01), and nebulization on scene (OR 1.47; 95% CI 1.23-1.74; p<0.01). Conversely, dispatch priority 2 (less urgent; OR 0.66; 95% CI 0.57-0.76; p<0.01), orange triage 21(OR 0.68; 95% CI 0.58-0.80; p<0.01), red triage (OR 0.22; 95% CI 0.13-0.37; p<0.01), and oxygen administration (OR 0.52, 95% CI 0.41-0.67; p<0.01) were all associated with decreased odds of non-conveyance. Conclusion: Several variables are associated with the non-conveyance of respiratory complaint patients seen to by PGWC EMS. Future research focusing on the predictors for ambulance non-conveyance could lead to raised efficiency and minimization in operational expenses, and provider fatigue amongst others.20 0Item Restricted Workplace Factors Associated with Psychological Effects in Paramedics, A systematic Review and Meta- Analysis(Saudi Digital Library, 2023-10-13) Zahran, Rahaf; Brad, MetcalfThis systematic review and meta-analysis study aims to assess the correlation between workplace factors and psychological effects on paramedics. A search of four databases found 1794 papers, from which 31 were deemed eligible from the years 2000 to 2023. Their methodological quality was assessed using the Critical Appraisal Skill Program (CASP, 2018) tool and the Strengthening the Reporting of Observational Studies in Epidemiology (STOBE) guidelines to help in assessing cross-sectional studies. The results give the overall effect size with an OR=1.65 and a P<0.001, indicating statistical significance for the first forest plot. Similarly, forest plot 2 demonstrates an overall effect size with a correlation r= 0.29 and a P<0.001, also indicating statistical significance. In summary, this review found a small and positive correlation in reported odds ratio studies. For Pearson correlation r reported studies, a moderate and positive correlation were found linking psychological effect to workplace factors in paramedics. The limitation of this study included research published in English and variation in reporting results in the studies. The findings will inform future research and help policymakers, healthcare organizations, and practitioners in developing strategies to support paramedics' mental health and enhance quality of care.23 0Item Restricted PARAMEDIC STUDENTS’ EXPERIENCES TOWARDS ONLINE LEARNING DURING THE COVID-19 PANDEMIC: A QUALITATIVE DESCRIPTIVE STUDY(2023) Al Alshaykh, Omar Abdullah; Hannigan, BenPurpose: The COVID-19 pandemic has significantly impacted education, necessitating a massive shift towards digital learning. As a result, healthcare, medical and nursing education have had to swiftly transfer and adapt to online instruction despite the substantial challenges this has presented, given that healthcare education involves crucial hands-on skills, laboratory practice and clinical experience. Consequently, previous research investigated healthcare students’ experiences with online learning for various healthcare professions during the COVID-19 pandemic; however, scarce evidence was found for the population of paramedic students. Therefore, this study aimed to explore the paramedic students’ experiences with online learning during COVID-19, particularly by examining their facilitators and barriers to this new learning modality. Methods: A qualitative descriptive design was adopted to explore paramedic students’ experiences with online learning during the COVID-19 pandemic. Purposive sampling was utilised to recruit six students in the eastern region of Saudi Arabia. Data collection employed in-depth, semi-structured virtual interviews, which were audiotaped and transcribed verbatim. Braun and Clarke’s reflexive thematic analysis was then used for data analysis. Findings: Eight main themes and four sub-themes were explored from the data. The main themes were: unfamiliarity requiring quick adaptation; lack of infrastructure hindering e-learning; troublesome learning clinical skills virtually; problematic communications within the online realm; difficulty maintaining active learning; online learning allows more flexibility and time; using e-tools effectively; and adapting blended learning approach. The analysis explored valuable findings regarding these students' learning facilitators and barriers alongside their suggestions for future improvements. Conclusion: The study’s findings provide crucial information for educators and stakeholders to improve online learning and ensure education quality that, in turn, could contribute to safer patient care. These findings may also help authorities understand students’ online learning experiences and better prepare them for this mode of learning.37 0Item Restricted Disaster Preparedness Among Emergency Medical Services Worker in Saudi Arabia(Saudi Digital Library, 2023-05-03) Almukhlifi, Yasir Matar D; Hutton, Alison; Crowfoot, GaryDisasters are unexpected events that impose destructive consequences which can adversely overwhelm countries' healthcare response systems. Countries are required to prepare their healthcare workers for disaster response effectively. A greater level of preparedness is associated with a more effective response to disasters. Emergency Medical Services (EMS) workers are vital and essential to effective disaster response in Saudi Arabia. This research aims to examine the perception of knowledge, skills, and preparation for disaster preparedness among EMS workers in Saudi Arabia. It further seeks to explore the needs of EMS workers and perceived barriers and facilitators of disaster preparedness within this context. This study used an explanatory sequential mixed method design to examine disaster preparedness among EMS workers in Saudi Arabia. A descriptive cross-sectional survey using the Disaster Preparedness Evaluation Tool (DPET) was distributed to EMS workers in military and government hospitals across three Saudi Arabian cities (Riyadh, Jeddah, and Dammam) in phase one of the study. This phase aimed to explore the perceived disaster knowledge, skills, and preparedness levels of EMS workers in Saudi Arabia. The findings from Phase One were used to inform phase two by providing direction for interview questions. Participants who expressed their interest in phase one were interviewed in phase two. This phase aimed to explore the facilitators, barriers, and cultural factors that affect disaster preparedness among EMS workers in Saudi Arabia. Two-hundred-and-eighty-seven EMS workers participated in this study. In phase one, participants reported moderate knowledge, skills, and preparedness levels for disasters. However, EMS workers were underprepared in certain areas of disaster preparedness, specifically a lack of isolation and decontamination skills during bioterrorist or biological attacks (CBRNE). Interview findings showed that three factors influenced their preparedness levels: personal preparedness, workplace preparedness, and socio-cultural influences. Participants reported difficulties in accessing workplace policies and procedures, a lack of standardisation in managing and implementing EMS regulations, and irregularity in providing drills and exercise regimes in Saudi Arabia. Results also highlighted the socio-cultural impact on disaster knowledge, skills, and preparedness of EMS workers. Prevailing social-cultural expectations in Saudi Arabia are biased against women. This results in a predominantly male and patriarchal structure within the EMS profession. Consequently, women in this study had fewer opportunities to enhance their knowledge, skills, and preparedness than their male EMS peers. This research was able to explore the perception of EMS workers’ disaster knowledge, skills and preparedness from a geographically and demographic representative sample of the Saudi Arabia EMS workforce. Important insights from the study could advance the EMS workforce and increase disaster preparedness. These include providing equitable, standardised, and inclusive education and training opportunities for all EMS workers in Saudi Arabia. In addition, local, postgraduate programs would further support Saudi Arabia’s disaster preparedness. Saudi Arabian workplaces will benefit from recruiting more female EMS workers and standardising staff rotation. This will empower EMS workers within all healthcare systems in Saudi Arabia. The Saudi Association of Emergency Medical Services (SAEMS) should implement these changes and be provided with appropriate governance powers to regulate the profession.51 0