An inpatient mental health placement for paramedic undergraduate students: a pilot study | BMC Medical Education

The aim of this study was to evaluate a pilot placement in a mental health unit for undergraduate paramedic students. The results showed that this educational innovation was effective and that it had the potential to improve and benefit both the students and the community. Participants reported that this experience and exposure to mental health patients allowed them to develop communication and clinical skills as well as deepen their knowledge and understanding of mental illness. Furthermore, the results suggested that previous negative stigma and attitudes toward mental health patients were challenging. Additionally, participants stated that the nursing staff were professional, welcoming, had individualised teaching styles and provided sufficient feedback, which in turn encouraged learning and assisted in clinical and professional development.

Triangulation of quantitative and qualitative data

As a means of emphasising the connections and correlation between the quantitative and qualitative datasets, triangulation and, more specifically, a convergence coding matrix were utilised to achieve this. Triangulation is a well-established and reputable process that allows researchers to explore convergence, complementarity and dissonance between quantitative and qualitative datasets [25]. The development of a convergence coding matrix involved listing findings from each component on a page and determining whether they agreed, offered complementary information, or contradicted each other, thereby highlighting the interactions between the quantitative and qualitative datasets. This comparison and comparison of quantitative and qualitative data increases the credibility and dependability of the results and validates the research questions [24, 26]. The convergence coding matrix is shown in Table 3.

Table 3 shows the list of identified themes and subthemes gathered from the qualitative data, as well as specific percentages attained from the quantitative data. The two sets of results were analysed and found to exhibit both convergence and divergence when interpreted through the framework of the developed matrix [25].

Table 4 shows how the results of this study align with those of previously published work. This table shows that while the results of our study can be directly compared to those of other studies, in some cases, this direct comparison was not possible. This is because our study measured different data from those of other studies.

Table 4 Shows the study itself with its reference number, the study’s major findings and the findings of this study. The text that is in bold is to help the reader directly compare both. This table shows that our findings directly align with 9 /11 of the studies listed. Our results did not align with one study and the patient’s perspective was not measured. The studies that did not align with our results are shown in italics.

This study showed that the placement experience presented in this study has the capacity to improve student confidence, knowledge and understanding of mental health. This has a major impact on student learning. The study was conceived with the anticipation of its results presenting some evidence to inform and support the integration of mental health placement experiences into the Bachelor of Paramedicine degree at Charles Sturt University.

The findings of this study support the integration of mental health placement into the paramedic curriculum. Therefore, based on the evidence provided by this pilot, the faculty at Charles Sturt University pursued the integration of mental health care WPL experiences into the cohort as valuable experiences that can meaningfully contribute to increased mental health literacy and skills for paramedic students.

Charles Sturt undergraduate paramedic students now participate in mental health WPL experiences for a minimum of two weeks during their degree, with the option to spend up to four weeks in these settings. These placements occur in either the second or third year of the program and occur in environments such as community outreach teams working alongside mental health nurses, within inpatient facilities and intake centers.

These placements provide students with learning opportunities in psychosocial health care, patient-centered and shared care health models, enhanced communication skills, non-invasive approaches to healthcare and referral services and complete health education. Together, these learning opportunities challenge any preconceived bias or stigmas the students may have held toward this patient population prior to engaging in these placements.

This research provides evidence that mental health placements for paramedics hold meaningful educational value. By incorporating this placement experience into the paramedic curriculum, paramedic students may be provided with a higher standard of education. This could assist students in providing safer and thus more effective care when entering the workforce. The potential result of this is that mental health patient outcomes improve. An additional potential benefit of this type of educational intervention could be the enhanced capacity of students to recognise and manage their own personal mental health and wellbeing. By being exposed to and developing greater knowledge surrounding mental health issues, students will hopefully gain stronger insight into their own mental health. This approach will in turn better prepare them to more adequately address personal mental health issues safely and effectively. As the prevalence of mental health issues within the paramedic profession is high, this approach could prove to be extremely beneficial to future paramedics [3].

A further benefit of this research is the possibility of minimising the risk to paramedics. If paramedic students can participate in educational interventions that provide a higher level of knowledge surrounding the management of mental health patients (improving their mental health literacy), they will have the ability to adopt a more effective and safer approach to mental health when entering the workforce. Interventions such as these could improve risk mitigation and de-escalation skills through enhanced learning and exposure to mental health patients, although further research is needed to confirm this phenomenon.

A further benefit mental health placements could have, although not focused on in this study, is the impact these types of placements could have on improving some of the negative stigmas surrounding mental health, particularly those held by paramedic students. While this study does not discuss this topic, there is a body of literature demonstrating how medical students undertaking mental health placements experience reduced levels of stigma concerning mental health upon completion of mental health placements [27]. It is speculated here that this benefit would also most likely translate similarly to the paramedic profession.

Dearman, Joiner, Gordon and Vince (2018) explored the interactions between mental health patients and medical students, intending to establish whether these interactions were positive or negative from the patient’s perspective [27]. This systematic review included all studies that reported on patients with a mental illness who interacted with medical students, had a primary diagnosis of mental illness and involved students who did not have any prior training. Two different databases were searched, resulting in 11,103 potential articles, which were narrowed down to eight articles that were examined in the study. These articles included 1088 patients from five different countries. This research revealed that patients experienced significant value, comfort and enjoyment when interacting with students on placement. Mental health patients disagreed with the notion of being talked down to and stated that they would be willing to interact with medical students in the future. Participants stated that they felt more involved in their care and reported enhanced self-esteem and a facilitator of learning. This evidence suggests that there are also benefits associated with mental health placements from the patient’s perspective. The patient’s perspective is one area that has not yet been explored with regards to paramedic mental health placements. This presents a very exciting opportunity for more research.

The main limitation of this study is the small sample size of participating students. Due to this being a pilot placement initiative and the extensive liaison time required to establish the clinical placement, only a limited number of student places were made available in the first offering. The placement experience that was evaluated for the purposes of this study was only available at one inpatient mental health unit in Port Macquarie, NSW, Australia.

The survey instrument used in this study has been found to be an effective tool for assessing nursing students but was not specifically designed for paramedic placement evaluations. A further limitation of this tool was that it contains only a limited range of questions, which restricts the amount of data available for analysis. A further limitation of this tool is the lack of reliability and validity available for this instrument.

The development of a survey instrument that is specific to both paramedic students and a mental health placement would be extremely beneficial for evaluating the success of future placements. One since this study was conducted has been developed [28]. Further studies could be done using this new tool to determine if those results align with that found here. Additional studies could also be conducted to assess paramedic students’ knowledge before and after participation in a mental health placement. This mental health placement could, in theory, sit alongside a mental health subject in the curriculum of the undergraduate paramedic degree.

To continuously improve the placement experience, the placement itself could also be reorganised to include an induction and supply students with further information and set clear learning objectives. This initial pilot placement was arranged within a limited timeframe, which resulted in students feeling that they were not provided with sufficient information or adequate orientation.

An additional research gap that was identified by this study was the paucity of research surrounding the assessment of stigmas held by paramedic students toward and surrounding mental health. Although mental health placements have been shown to reduce and improve stigma toward and associated with mental health held by medical students, the questions included and analysed in this research study did not involve specific questions regarding stigma.