Abstract
BackgroundHaving to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel.MethodsThe present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis.ResultsThe results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues.ConclusionThe results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel’s professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel’s clinical decision-making skill.
Highlights
Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions
Based on the participants’ experiences, as a major professional capability which emergency care personnel should be skilled at, clinical decision-making is comprised of clinical knowledge, skills, experience, and judgment for identifying patients’ problems, analyzing their conditions, making the right decision, and taking effective measures based on that decision
In today’s healthcare systems, patients in critical conditions usually receive their first care from pre-hospital emergency care personnel
Summary
Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. In order for EMS personnel to provide timely care and evaluate patients’ status in the shortest possible time, it is necessary that they be equipped with effective clinical decisionmaking skills and be able to make the right decision for a patient in unpredictable conditions [3, 4]. Clinical decision-making, an important process in which the best action to achieve the desired goals is chosen, largely determines the quality of care, patient safety, and the possibility of future complications [5]. According to Emergency Nurses Association, clinical decision-making is one of the most important professional capabilities in emergency care personnel which can significantly improve the efficacy and quality of care provided [7]. Pre-hospital emergency care departments were gradually formed in the other provinces of Iran. In pre-hospital emergency care departments, there is not a single set of clinical guidelines for the personnel and, in certain cases, the personnel act according to the internal regulations laid down by their mangers, which limits their freedom and independence
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