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Journal article
The tensions between organisational culture and professionalisation and their influence on paramedic conveyance decision-making: A constructivist grounded theory framework
Paramedicine, Vol.22(5), pp.225-236
2025
Abstract
Conveyance decision-making is a critical area for research given the potential patient safety and health system efficiency implications. It is understood that numerous factors can impact clinical decision-making such as organisational policy and procedure, scene safety, and patient assessment, along with considerable changes to paramedic education in recent decades. Using constructivist grounded theory methodology, semi-structured interviews and an online asynchronous focus group were employed for data collection. Both data collection and data analysis occurred concurrently, guided by the principles of constant comparative analysis. Three main themes were constructed: fearing and mitigating the repercussions of a potential patient complaint , the evolving professionalisation and expectations of paramedics , and feeling constrained by the organisation and its culture . These themes contributed to the construction of the theoretical framework. The theoretical framework titled The Tensions between Organisational Culture and Professionalisation details how paramedics make conveyance decisions by navigating the tensions between fears of individual blame posed by existing organisational culture and the evolving professionalisation of paramedics. Paramedics were found likely to forego responsibility for making alternative or non-conveyance decisions when working in a culture of blame, resulting in transporting patients to an emergency department when this may not be clinically required. When working in an organisation with an existing blame culture, paramedics forgo clinical decision-making. Paramedics must be educated and supported to make quality, patient-focused conveyance decisions. The theoretical framework explains how paramedics navigate conveyance decisions.
Details
- Title
- The tensions between organisational culture and professionalisation and their influence on paramedic conveyance decision-making: A constructivist grounded theory framework
- Authors
- Alannah Morrison - University of the Sunshine Coast, Queensland, School of Health - NursingAlison Craswell - University of the Sunshine Coast, Queensland, School of Health - NursingFiona Bogossian - University of the Sunshine Coast, Queensland, School of HealthBill Lord - Monash University
- Publication details
- Paramedicine, Vol.22(5), pp.225-236
- Publisher
- Sage Publications Ltd.
- Date published
- 2025
- DOI
- 10.1177/27536386251335406
- ISSN
- 2753-6386
- Copyright note
- © The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
- Grant note
- The KJ McPherson foundation, a non-profit organisation supporting out of hospital research and staff development. Funding from the Australian Government Research Training Program Scholarship also supported this research.
- Organisation Unit
- Healthy Ageing Research Cluster; School of Health; School of Health - Nursing
- Language
- English
- Record Identifier
- 991123750002621
- Output Type
- Journal article
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