Morphine administration by paramedics: An application of the theory of planned behaviour

The core principles of the Queensland Ambulance Service (QAS) that are founded on improving the health and well-being of all persons have remained relatively stable since 1892. This is despite changes in organisational structure, policies, protocols and procedures employed by operational paramedics. The primary scope of QAS operations is focused on the pre-hospital aspects of the health care continuum and has seen changes over time, with particularly rapid changes in the last two years to the content and nature of paramedic clinical practice. Timely and appropriate pain management in the pre-hospital environment is paramount to effective patient care. It is readily identified as a priority within the paramedic profession. Numerous studies have identified many factors that hinder the delivery of adequate pain management to patients with pain. A comprehensive review of the literature related to prehospital pain management, education and barriers to pain management has been conducted. This thesis has attempted to identify if educational programs improved knowledge and changed clinical behaviour, specifically patient care interventions and patient health outcomes. This information is valuable to those who develop clinical standards and education for ambulance services. As a result, this information could be used to help design programs that better meet the educational needs of paramedics and ultimately the needs of their patients and the community. The literature did not sufficiently identify the influences on clinical behaviour other than knowledge, so from this outcome it was identified that future studies must examine a theoretical model that can be used to assess paramedics’ intention to administer morphine to patients experiencing pain. The Theory of Planned Behaviour (TPB) was identified as an effective model for analyzing paramedic behavioural intention; it was recognised that this theory might help to identify and better understand the constructs of attitudes, social norms and behavioural control beliefs that influence paramedics’ intention to administer opioids to patients with pain. The purpose of this study was to analyse the ability of the direct measures of the Theory of Planned Behaviour (TPB) Model to mediate factors influencing ambulance paramedics’ intention to administer Morphine to patients with pain. Participants of this study were Advanced Care and Intensive Care Paramedics who were deemed competent in Morphine administration through the education division of the Queensland Ambulance Service. Data were collected by means of a questionnaire that used the constructs of the TPB, including subjective norm, perceived behavioural control and attitude. While participants reported strong intentions to administer Morphine they also reported negative attitudes towards the behaviour (morphine administration). The constructs of the TPB explained 26 per cent of the variance in intention to administer Morphine with subjective norm being the strongest significant predictor. The findings related to specific attitudes and normative pressures provide an understanding into paramedic’s pain management behaviour. This research may be the first step to identify if concepts taught in the classroom are being transferred to the clinical setting. Potential findings that may be identified in this study could be used to improve organisational awareness of factors that contribute to the future education and professional development of QAS Paramedics.