Communication in care situations between paramedic nurses and family members needs attention

The work of paramedic nurses focuses heaving on the technical skills of patient care. However, there are frequently onlookers on the scene, such as the loved ones of the patients who also need attention. Taking care of the communication needs of the bystanders can benefit them both in the short- and long-term.

Authors: Johanna Simola & Sini Hämäläinen

Paramedics nurses and the public

Paramedic services originate from the work of wartime medics who administered battlefield first aid and evacuated casualties (Furness et al. 2021). In the modern times, paramedic work is still seen as masculine, but the scope of it has expanded to include roles such as research and education (Hanna-Osborne 2022, 5; Eaton 2019). In Finland, at the field paramedic nurses attend situation which are classed to different groups based on the level of emergency needed, from immediate threats to health to situations where the vitals are stable yet an assessment is required (Sosiaali- ja terveysministeriön asetus ensihoitopalvelusta 585/2017, 6§).

Paramedics are required to be able to build rapport in their encounters with the patients in the space of a short time, but at the same time, the emotional work that paramedics do is less researched as opposed to the technical skills the paramedic nurses have (Anderson et al 2021, 87; Eaton et al 2021, 8). On the whole, the idea that the patient is the focal point of all actions is often noted (Mönkkönen et al. 2019, 4.1). Historically, there has also been a shift towards a patient-agency approach, where the patients have got more of say in their care (Armstrong 2014). In addition, there needs to be understanding that in prehospital settings, there are other people tied with the situation who also need communication and reassurance, such as the loved ones of the patients, or those bystanders who were involved in the start of the care before the paramedic arrival.

Onlookers and their communication needs in care situations

According to Simola (2024), there is a little research done on the way that paramedic nurses communicate with bystanders on the scene when working on the patients and this research is often focused on issues surrounding resuscitation situations. It is thus useful to examine the ways health care workers communicate with loved ones and bystanders in other emergency care settings where gravely ill patients are treated – the intensive care units and the emergency rooms. By examining the literature existing on the topic, a summary of the issues which help and hinder the communication that paramedic nurses can have with loved ones and bystanders can be synthesized to act as a starting point to further considerations.

Across different fields and situations, it is important to note that although those standing around the patient may be new to the health care situation itself, they may also be the experts of the patient and their situation. They may have experiences, or the situation is something completely new and traumatic to them, and the situation may also be emotionally taxing for the paramedic nurses attending the scene (Morphet et al. 2015, 3649-3650; Satchell et al. 2023, 2; Risson et al. 2023, 115; Barbee et al. 2017; Simola 2024)

Overall, the lack of information is reported to be one of the biggest failures in the way paramedic nurses communicate. Timely and honest information is both needed and appreciated, however bleak it may be. Communicating clearly can help the paramedic nurses to control and contain the situation and prevent long-term trauma for the bystanders in care site (Satchell et al. 2023, 13; Ali et al. 2023; Satchel et al. 2023; Risson et al. 2023; Ocak & Avsarogullari 2019, 330; Paavilainen et al. 2017, 6-7; Norton 2017).

Clarity, clear information, support and empathetic communication is both acknowledged and appreciated by the loved ones. This communication should be adapted to match the level of understanding and also to the possible emotional reaction of the receiving party (Ali et al. 2023, 12; Flinterud et al. 2023; Ocloo et al. 2020, 12; Simola 2024).

All in all, paramedic nurses work on scenarios that can be highly emotive and confusing to those standing by and witnessing the start of the treatment. The bystanders are often not well versed in how the health care system works, so they do not necessaryly understand what is going on and why certain decision are made. Additionally, the situation arises an emotional response which in turn affects to their comprehension of the situation. This may lead to misconceptions or further crisis.

Taking any time to give timely and honest information and guidance benefits the loved ones and bystanders in the immediate situation, but also in the long term when looking at factors such as trust in the health care system and the perceived capacity to take care of the patient in the future after a hospital admission. It also prevents further traumatization in the situation which can already be very difficult for the bystanders to navigate.

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