Dr Carin Magnusson

Background: Many specialist paramedics are moving from the ambulance service to primary care. There is a lack of empirical literature regarding this transition. Aims: This study aims to improve support for specialist paramedics undertaking the transition by ascertaining factors that may hinder or facilitate the process. Methods: The study used semi-structured interviews with eight specialist paramedics working in primary care in England. An interpretative phenomenological analysis approach was used to analyse data, and this was informed by a review of theoretical and empirical literature. Findings: Facilitators and barriers to transition were found, along with information regarding the transition. Five facilitators were identified: previous clinical experience; mentorship; support; clear role parameters; and opportunity to develop. Four barriers were identified: role misunderstanding; changing scope of clinical practice; time pressures; and gaps in education and knowledge. Conclusion: This study contributes to a limited field of research by highlighting barriers and facilitators to the transition of specialist paramedics to primary care. Practical steps can be taken to smooth this transition.

Introduction Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller’s smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS.Methods and analysisThe SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming.Ethics and disseminationThe study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents.Trial registration numberISRCTN11449333.

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile’s (Practice-based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt “on the job.” We suggest that learning “on-the- job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise.

'Organisational governance'--the systems, processes, behaviours and cultures by which an organisation leads and controls its functions to achieve its objectives--is seen as an important influence on patient safety. The features of 'good' governance remain to be established, partly because the relationship between governance and safety requires more investigation.

This paper describes how the use of methodological triangulation can enrich the research process. The first section of the paper provides a brief outline of a national research project that studied 'pairs' of student midwives and their mentors in practice, and discusses the strengths and weaknesses of the approach. It then moves on to describe the combination of methods chosen for one aspect of the project before providing illustrative examples from the data that show how the triangulation of methods gave depth to the analysis

BACKGROUND: Little is known about how newly qualified nurses delegate to health care assistants when delivering bedside care. AIM: To explore newly qualified nurses' experiences of delegating to, and supervising, health care assistants. DESIGN: Ethnographic case studies. SETTINGS: In-patient wards in three English National Health Service (NHS) acute hospitals. PARTICIPANTS: 33 newly qualified nurses were observed, 10 health care assistants and 12 ward managers. METHODS: Participant observation and in-depth interviews. FINDINGS: We suggest that newly qualified nurses learn to delegate to, and supervise, health care assistants through re-working (`recontextualising') knowledge; and that this process occurs within a transitional (`liminal') space. CONCLUSIONS: Conceptualising learning in this way allows an understanding of the shift from student to newly qualified nurse and the associated interaction of people, space and experience. Using ethnographic case studies allows the experiences of those undergoing these transitions to be vocalised by the key people involved.

Background. Despite a focus on user involvement in healthcare services and education in the UK, there is little evidence of women's views of education in midwifery practice. Aim. To identify women's perceptions of clinical teaching and learning in midwifery practice, in order to inform the midwifery curriculum. Method. Qualitative structured telephone interviews were conducted with 18 women who had been involved in a larger study that had used non-participant observation visits in hospital and community environments, 12 of whom were primiparae Thematic content analysis of the data was undertaken, based on a framework used in the larger study. Findings. Women described both physical and emotional support as being offered by student midwives. Some talked about student midwives' tentativeness and reduced confidence levels during episodes of care, but most expressed appreciation for the students' presence. Conclusions. More innovative ways to involve service users in the midwifery curriculum are needed, alongside research to evaluate them. More careful consideration needs to be given for student midwives' involvement in maternity care, with better preparation for both students and women. © 2007 The Royal College of Midwives.

In this article, the authors illuminate some of the hidden aspects of the mentor role, which often go unnoticed in challenging clinical settings. Four key areas have been selected for the purpose of stimulating thought and debate on current mentorship issues: preparedness for the mentor role; management of students' clinical learning and skills development; processes of practice assessment and support for the mentoring role. The findings demonstrate the need for increased funding to enhance the clinical curriculum. This includes formal protection of time for mentors to provide quality learning experiences. Investment in the mentor/student dyad is essential as successful mentoring can literally be a 'gift' to student midwives.