My friend and colleague, Dr Ruth Townsend, along with Derek Collings-Hughes and Brett Williams has written a paper on ‘Paramedic use and understanding of their professional code of conduct’ published in the journal Nursing ethics. (Collings-Hughes D, Townsend R, Williams B. Paramedic use and understanding of their professional code of conduct. Nursing Ethics (2022).
The authors say:
This study was the first known to the authors examining paramedic perspectives and understanding of their professional code. The findings of this study are consistent with the existing literature in both nursing and medicine and add to the growing understanding of health professional interaction with professional codes. Existing research suggests professional codes are poorly understood and utilised in the health professions. Overall, paramedics also appear to lack specific knowledge surrounding the content of their professional code. … As regulation, including the code, is new to paramedicine, participants were still navigating the increased responsibility associated with the introduction of a national set of professional standards, and some felt there was still some way to go before paramedics understand their place in the post-registration era of paramedic professionalism.
The study was based on a survey of a small number of paramedics (n = 11) and that brought its own limitations, which the authors acknowledge. Further, the study was limited by ‘a notable shortage of representation from both paramedics in the private sector and female paramedics…’ and:
Self-selection bias also may have been present in the participants of this study and several participants stated they expressed interest in participation due to an existing interest in the subject matter. Thus, the results of this study may not adequately capture the broad views of those who practice within the Australian paramedic profession.
Another issue that arises in my mind is when was the study done, and what code does it refer to? The Paramedicine Board has replaced the original, interim code of conduct that was put in place when registration commenced with a new, generic code. The Code of Conduct that applies to Paramedicine is not a stand alone Code but is now shared with 11 other registered health professions (see https://www.ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.aspx). This generic code may make it even harder for paramedics to identify how the Code is to be applied to their practice
This shared code of Conduct came into effect on 29 June 2022 so I infer that when Collings-Hughes, Townsend and Williams were conducting their interviews, the participants were discussing the old code. This may be a limitation in the Collings-Hughes, Townsend and Williams paper. If their study was how paramedics use and understand the ‘old’ code the results may not be transferable to the new code.
On the other hand, and I think more importantly it may also mean that the author’s conclusions are even more important and relevant. In their discussion the authors note
Some felt the code was too vague, broad or not relevant to ‘actual paramedic work’, citing a lack of detail and specificity to the role paramedics performed to be of any practical use. Because the document was not interpreted as being specific enough, they were concerned it left too much open for interpretation and as such, they felt the application of the code was likely to be difficult and inconsistent….
A few participants understood that the broadness of the code was necessary to allow for it to cover all possible situations and the varied working environments (including outside of emergency ambulance work) in which paramedics work. There was also a strong desire for the general principles within the code to be more clearly articulated or annotations added to help make the code both more relevant to paramedic practice and user friendly.
Now that the Code is shared across 12 health professions, the lack of direct application to paramedicine and paramedic practice is likely more pronounced. To that extent the conclusions, in particular that ‘Most participants felt the integration of clearly articulated principles through annotations or examples would increase their understanding and use of the code’ is timely. This paper demonstrates to the Paramedicine Board of Australia the value they could add by adding ‘annotations or examples’ to the shared code to show paramedics how the code can be applied to their practice.
The paper by Collings-Hughes, Townsend and Williams does not purport to explain the Code of Conduct, rather it explores what paramedics know of the Code and, importantly, it makes the case why paramedics should have a better understanding of the code. To that end the paper also has some recommendations to make the Code more ‘user friendly’. Those recommendations are particularly timely given that the Code is now a shared, rather than paramedic specific code of conduct. The Paramedicine Board, as the regulator of the profession should consider the recommendations to take steps to assist paramedics to apply the code in their daily practice.
Paramedics may also find the paper interesting particularly if they want to better understand why they should understand the Code of Conduct that applies to them.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.
Thank you for your commentary on this paper, I believe the Code of Conduct is an important area of our profession that could really do with some more attention.
To clarify, as you suspected this study was conducted when the Paramedicine Code of Conduct (interim) 2018 was still the relevant code for Australian paramedics. The study was conducted in mid-2021 and completed before the change to the new shared code in June of this year.
In my opinion, the introduction of clearly articulated overarching principles within the new shared code was a good step forward. Although, I do think it further removes the perceived relevance for paramedics, who like other health professions seem to want to be able to see a direct link to their practical work. I think an individual code for the paramedic profession with plenty of consultation/engagement with paramedics would be the best solution. However, it appears the Boards have favoured a shared approach though and given that, I think profession-specific annotations would be a good step in the right direction.