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Title: Clinical decision making by South African paramedics in the management of acute traumatic pain
Authors: Mulder, Richard Kevin 
Issue Date: 25-Apr-2013
In the emergency setting, the onus is on the individual practitioner’s ability to make
critical decisions at critical moments in order to provide the best level of care to their
patient. In order to ensure that these decisions fall in line with the best interests of the
patient, the South African paramedic requires a better understanding of how to arrive at
such a decision; they need to understand the clinical decision making process. This
study focused on South African paramedic clinical decision making with specific
reference to acute traumatic pain management, with the aim of determining the factors
which influence South African paramedic clinical decision making by revealing the
current method of pain management employed by South African paramedics, how they
view the priority of pain management in the continuum of care and if there were any
context specific factors influencing their clinical decision making.
A mixed method design was used to determine the factors contributing to the clinical
decision making process of South African paramedics in the acute pain management of
patients with acute traumatic pain. A mixture of qualitative and quantitative approaches
was utilized by means of a research questionnaire as well as in-depth interviews. The
questionnaires were targeted at all South African paramedics while the in-depth
interviews were conducted with five participants who had been purposefully selected
from the questionnaire respondents. The data analysis was conducted in a descriptive
manner in order to inform the explanatory nature of the answers to the research
questions and objective.
The results provided insight into the current methods and clinical decision making
processes employed by South African paramedics in the management of patients’
experiencing acute traumatic pain. The study determined that the South African
paramedic’s clinical decision making process involves three key phases in the acute
traumatic pain management setting, the assessment phase, the initiation/pain
management phase and the conclusion/re-evaluation phase, with each phase utilizing
different decision making models, the intuitive/humanist model, the hypothetico-
deductive model and a model which combined both of the aforementioned models.
In addition to this, numerous factors such as the provision of care in order to facilitate
further management and transportation to an appropriate facility, which influenced
clinical decision making, were identified. Amongst South African paramedics, pain
management was identified as coming second only to the interventions required to
manage immediately life threatening conditions in terms of the prioritization of
A variety of recommendations which included the need to further the development of
clinical decision making and pain management through research and education as well
as considerations for investigation into the potential expansion of South African
paramedic scope of practice in the pain management environment were made.
Dissertation submitted in fulfillment of the requirements for the Degree of Master of
Technology: Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2012.
Appears in Collections:Theses and dissertations (Health Sciences)

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