Reflective Practice in Paramedic Head Injury Management: Exploring the Need for Quality Improvement and Implementation in Clinical Practice.

Hosznyak, Rachael (2025) Reflective Practice in Paramedic Head Injury Management: Exploring the Need for Quality Improvement and Implementation in Clinical Practice. Doctoral thesis, Birmingham City University.

Preview

Text Rachael Hosznyak PhD _Thesis_Final Version_Final Award May 2025.pdf - Accepted Version Download (14MB)

Abstract

Objective

Head injuries, a leading cause of death and disability (NICE, 2023) demand swift identification and intervention due to the 20% mortality rate associated with elevated intracranial pressure (ICP) (Fakhry et al., 2004). The lack of specific pre-hospital guidance and ICP monitoring poses challenges. Recognising the need for change in clinical practice, paramedic professions must assess the feasibility of implementing evidence-based medicine for improved pre-hospital head injury patient outcomes (Institue for Health Improvement, 2019).

This research has used a 3-phased design to answer the overall research question:

To improve the assessment and management of pre-hospital head injury patients, is there a need to introduce a change ‘in to’ clinical practice or change how paramedics clinically practice?

Methods

This research has used Mediated Discourse Analysis, a specific form of discourse analysis, whereby ‘discourse’, ‘agency’ and ‘practice’ are mediated into a ‘nexus of practice’. Unlike some other of forms of discourse analysis, MDA focuses on discourse ‘in’ action as opposed to discourse ‘as’ action, in doing so researchers aim to enable the various discourse into practical application (Scollon, 2001c). The overall aim of this thesis was achieved through three phases, comprising of the analysis of 12 semi structured interviews, analysis of 10 written reflections in practice and analysis of transcripts from 4 online case studies involving 94 participants with post case study questionnaires.

Results

Key findings reveal that paramedics face challenges in implementing best practices due to issues such as outdated guidelines, conflicting recommendations, and the complexity of clinical decision-making. Reflective practice is identified as a critical tool for enhancing clinical skills and fostering a culture of continuous improvement. The study introduces the “What, Why, How, QI” model of reflection and the TRIAD 9 Model (Triangulation of Reflective Improvement Activities and Dissemination) to support reflective practice and QI initiatives.

Conclusion

The research concludes that both introducing changes into clinical practice and changing how paramedics practice are necessary to improve the assessment and management of head injury patients. Recommendations include enhancing clinical guidelines, promoting continuous professional development, fostering a reflective culture, and addressing barriers to implementation. The findings contribute to the broader field of paramedicine and healthcare, offering valuable insights and practical frameworks for improving patient care in the pre-hospital setting.

Item Type:	Thesis (Doctoral)
Dates:	Date Event 19 May 2025 Accepted
Uncontrolled Keywords:	Reflective Practice in Paramedic, Head Injury, Quality Improvement, Implementation
Subjects:	CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-03 - medicine by specialism CAH02 - subjects allied to medicine > CAH02-05 - medical sciences > CAH02-05-02 - healthcare science (non-specific) CAH02 - subjects allied to medicine > CAH02-05 - medical sciences > CAH02-05-04 - anatomy, physiology and pathology CAH02 - subjects allied to medicine > CAH02-06 - allied health > CAH02-06-01 - health sciences (non-specific)
Divisions:	Doctoral Research College > Doctoral Theses Collection Faculty of Health, Education and Life Sciences > College of Health and Care Professions
Depositing User:	Louise Muldowney
Date Deposited:	11 Jun 2025 10:37
Last Modified:	11 Jun 2025 10:37
URI:	https://www.open-access.bcu.ac.uk/id/eprint/16421

Actions (login required)

View Item