TESIS SOBRE LA INJERENCIA NORTEAMERICANA.

“Symbolic Interaction involves interpretation, or ascertaining the meaning of the actions or remarks of the other person, and definition, or conveying indications to another person as to how he is

to act.” (Blumer, 1986, p. 66)

Throughout Section 5.3 I have discussed the findings of this study regarding the language used to describe the role paramedics take when working with learners, aligning with Blumer’s definition of symbolic interaction (above). It is clear from the data in this study that the term mentor is unsuited for this role as it is not aligned with how the role is undertaken in the profession. Mentors, in a traditional context, as viewed by the participants in this study are not formally appointed; rather they are personally selected and are not focussed on the goals of a specific educational experience for a learner. Limited as it was, participants’ descriptions of their

understanding of the term preceptor, is more related to the role they actually perform with learners. Participants recognised that a preceptor is a jack of all trades, covering elements of the various terms supplied to them, these being Mentor, Clinical Instructor

96 and Clinical Supervisor, and best represents the actuality of their practice in the clinical setting. As such, from this point on throughout this thesis, I will use the term preceptor to reflect the role of a paramedic working with a learner, regardless of learner type or level. In this final section of Chapter 5 I will analyse these findings in relation to the literature and demonstrate how this informs an emerging theory of preceptorship in the paramedic profession.

Despite having argued that mentor is not the right term to describe the role paramedics take on when working with learners, there are still elements of the mentor function incorporated in the findings of this study. As stated, from their experience participants reflected a jack of all trades view of the paramedic preceptor role. Studies that

comment upon the diversity of roles undertaken in a health professional setting such as mentor, preceptor and clinical supervisor, are typically in health professions and work environments that are quite disparate from the paramedicine work environment, such as nursing, medicine and midwifery (Bray & Nettleton, 2007; Mills, Francis, & Bonner, 2005). In discussing the paramedic process, Carter and Thompson (2015) highlight the challenges in transferring evidence from other health disciplines; this can also be said of translating educational evidence from disciplines in which the working environment, and therefore the clinical learning environment is substantially different. In the

statutory ambulance service setting, paramedics primarily work as two-person crews, or in cases where a learner is on placement from an external agency such as a university, as three-person crews. This working environment necessitates the paramedic

preceptor taking on multiple roles such as supervision and support in addition to training and development roles. This creates a point of difference between

paramedicine and other health professions working in larger teams, where a health professional might have a mentor, preceptor and supervisor, all as different people.

97 Preceptorship has been described, in nursing, as a structured period of education during which a learner is placed with a qualified professional (Mills et al., 2005).

Preceptorship, unlike mentoring, is a formalised relationship for a defined period during which the learner has set goals to achieve. This aligns with the findings of this research in which participants reinforced the short-term nature of preceptorship. Participants in this study reflected the functions of preceptorship as being a mentor, role model, guide teacher, assessor, and being a supervisor. This supports the multifactorial approach to paramedic preceptorship identified by Carver (2016) who undertook a hermeneutic study of “being a preceptor to novice paramedics in their first year of practice” (p. 78). From his findings, Carver articulated a multidimensional role for paramedic preceptors comprising coach, role model, protector and socialiser. My research supports these functions within preceptorship and extends these findings by reflecting a similar

multifactorial role that still incorporates a teaching and assessment function not evident in Carver’s findings.

Each of the functions outlined above inform a preceptorship capability that paramedics need to develop, and be aware of, in order to successfully perform their role when working with learners. Returning therefore to the concept of the actor analogy, this is in effect setting the scene and outlining the plot in which the role is to be played as well as scripting the role in terms of giving it an explicit name. The clear articulation of the role, through the use of consistent and accurate nomenclature, enables the process of structuring a role performance based theory of paramedic preceptorship to begin.

5.4 Chapter summary

The findings from my research outlined in this chapter indicate a lack of shared language and therefore a reduced capacity to describe what it is that paramedics do when working with learners in clinical practice. In the absence of clear expectations of

98 the preceptor role through a well-defined and shared language used to communicate those expectations, performance in this role is subject to inadequacy, and/or role insufficiency (Meleis, 1975). This chapter has demonstrated the variability in

understanding, and therefore potential variability in performance of the preceptor role in the field of paramedicine. It has also been demonstrated that the unique working environment and organisational culture of paramedicine results in a need to define the preceptor role for their professional context rather than attempt to translate role terminology from other health disciplines. I have demonstrated the multifactorial functions that make up the paramedic preceptor role when working with learners, and demonstrated the utility of the term preceptor to describe those functions. Having established the nature of the role, and the language used to define and describe it, the next chapter will explore the challenges in selecting paramedics to act as preceptors.

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Chapter Six – Recruitment and selection

6.1 Introduction

Figure 6.1. Analysis stage 2 – Identifying the Preceptors, finding the right person.

Chapter five analysed the findings of this study in relation to how the terms used in paramedic clinical education were understood by participants and discussed the implications of how not holding a shared understanding of language (or symbols) can impact on the uptake of and performance of roles in society. Chapter five concluded with the proposition that the term preceptor most accurately reflects the role

paramedics perform when working with learners. This chapter analyses the data that emerged regarding who fulfils the preceptor role, continuing the actor analogy derived from role theory, this chapter depicts the casting process. Section 6.2.1 describes participants’ concerns about lack of choice in working with learners; Section 6.2.2 presents findings on the barriers to selecting the right person for the job; Section 6.2.3 highlights the negative impact that can result when the wrong person is allocated to preceptor the role; and Section 6.2.4 reports participants’ views on how paramedics should be selected and what the considerations should be with regard to experience

Hearing what Paramedics have to say on preceptorship understanding the factors that affect the preceptor role Understanding paramedics experience of the preceptor role? Identifying the preceptors, finding the right person. Identifying the role, giving it a name.

100 and qualifications. Section 6.3 will follow the pattern established in Chapter 5 of

discussing the findings reflected in Section 6.2, in relation to the literature, foreshadowing recommendations for change and improvement.