Evaluation of the CARES skills framework as a peer support model in the paramedic undergraduate curriculum: Facilitating challenging discussions in a safe environment

Authors and presenter*

• Belinda Flanagan, School of Paramedicine, CoHM*

• Matthew Warren James, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast

• Jeanine Young, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast

Abstract

Infant or child death is reported as the most distressing case paramedics attend (Regehr et al., 2002). Paramedics have conveyed that they find it difficult to deal with bereaved parents and families: and make more concerted efforts to resuscitate even when efforts are futile (Hall et al., 2004). One of the main factors that impact the decision to resuscitate children is fear of confrontation with the parents of the deceased child (Munoz, 2016). Student paramedics also identify supporting bereaved families as an area associated with low confidence (Anderson et al., 2019). This study evaluated the CARES skills framework (Connect to emotion, Attention training, Reflective listening, Empathy, Support help seeking) as a peer support model to encourage student paramedics to talk about grief and death related to infants and children.

A convenience sample of first-year paramedic students (target n=154) were recruited from a single Australian regional university. A modified Nominal Group Technique method was used following a student debriefing session designed to identify problems, generate solutions, and make decisions regarding the efficacy of the CARES skills framework.

Of 154 eligible participants, 141 participated (92% response-rate). Peer social support normalised students’ emotions related to death and dying. Although naming emotions was challenging, students reported that the CARES model facilitated a safe environment to talk about death and dying. Students reported feeling heard and connected to their peers during the exercise and an enhanced sense of belonging after the exercise.

Findings contribute to evidence that suggests the CARES model is a useful mechanism to enhance peer social support in paramedic students: a framework that can be used by any health profession as an educational tool when teaching the management of bereaved and grieving families.

References

Anderson, N. E., Slark, J., Faasse, K., & Gott, M. (2019). Paramedic student confidence, concerns, learning and experience with resuscitation decision-making and patient death: A pilot survey. Australasian emergency care, 22(3),156-61. https://doi.org/10.1016/j.auec.2019.07.001

Hall, W. L., Myers, J. H., Pepe, P. E., Larkin, G. L., Sirbaugh, P. E., & Persse, D. E. (2004). The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients. Resuscitation, 60(2),175-87. https://doi.org/10.1016/j.resuscitation.2003.09.013

Munoz, M. G. (2016). Delivering Death Notifications. Performing and emotionally surviving notifications of death to a patient's family. Jems, 41(8), 42-4.

Regehr, C., Goldberg, G., Hughes, J. (2002). Exposure to human tragedy, empathy, and trauma in ambulance paramedics. Am J Orthopsychiatry, 72, 505-13. https://doi.org/10.1037/0002-9432.72.4.505