Sinead Keeney

Background: Many people spend their last year of life at home, with most wishing to die there. Evidence suggests paramedics facilitate over half of Emergency Department visits for palliative care patients, many of which are avoidable. Objective: To explore the perceptions and experiences of providing end-of-life care amongst paramedics in one region of the United Kingdom. Design: Online descriptive cross-sectional survey design using the ParAid Questionnaire. Quantitative data analysed using descriptive statistics. Setting and Participants: 182 paramedic respondents completed the questionnaire online (34% response rate). Results: Respondents reported numerous barriers to delivering end-of-life care. Access to medicines was problematic, with 54% reporting that they ‘always’ or ‘often’ had no access to specific medicines needed for symptom control. Education gaps were also evident: 67% reported that lack of pre-registration end-of-life care education and 71% that lack of post-registration education ‘always’ or ‘often’ influenced their ability to meet patients’ needs. Only 28% felt ‘very’ or ‘extremely’ competent in supporting patients and families in the last year of life, while 47% reported experiencing a ‘fear of doing the wrong thing’ ‘always’ or ‘often’. Access to information and referral pathways also presented challenges: 88% reported that they ‘always’ or ‘often’ lacked access to existing Advance Care Planning documentation, while 62% reported that they ‘rarely’ or ‘never’ had access to a specialist palliative care team out-of-hours. Conclusions: Findings emphasise the need for improved palliative care education, support structures, and improved access to information and medicines for paramedics. Findings identify potential areas for service development, including training, communication, and referral pathways, which may better support paramedics in providing end-of-life care.

Background: The phenomenon of ‘failing to fail’ underperforming pre-registration nursing students in clinical placements is widely recognised. In the United Kingdom, updated Nursing and Midwifery Council guidelines aim to support registered nurses (RNs) in supervising and assessing students. The aim of the study is to explore RNs’ experiences of the phenomenon of ‘failing to fail’ underperforming pre-registration nursing students in clinical placements. Methods: This research is a qualitative descriptive study. Semi-structured one-to-one online interviews with 14 RNs enrolled in postgraduate nursing courses at a university in the United Kingdom. Data were analysed using Elo and Kyngäs’ content analysis framework. Results: Four key categories were identified: (1) The Stigma of Failure – failure perceived as stigmatised; (2) Organisational Constraints and Time Pressures – limiting effective mentoring and assessment; (3) Emotional and Relational Barriers to Failing – including personal relationships, lack of confidence and fear of repercussions and (4) Enablers – including supportive workplace culture, collaboration with universities, training and clear guidance. Conclusions: Failing to fail is a complex issue influenced by cultural, organisational and individual factors. It has significant implications for patient safety, professional standards and the future nursing workforce. Addressing these challenges requires changes in mentorship practices and institutional support.

Background: Paramedics are increasingly involved in community end‐of‐life care, yet ambulance services often lack structures to support this expanding role. Objective: To explore paramedic workforce perspectives on the development of paramedic‐delivered services for patients in their last year of life, in order to identify priorities for service development. Methods: A qualitative descriptive analysis was undertaken using narrative free‐text responses from an online cross‐sectional survey of registered paramedics employed by the Northern Ireland Ambulance Service ( n = 137). Responses were analysed thematically, informed by Braun and Clarke’s (2006) framework, to identify system‐level priorities for service development. Results: Three interconnected themes were identified: professional, organisational and system factors influencing delivery of end‐of‐life care. Paramedics highlighted the need for enhanced education and role clarity, specialist clinical support, improved interdisciplinary communication and stronger integration with palliative care pathways. Participants emphasised challenges related to out‐of‐hours support, access to anticipatory medications and availability of patient information, alongside the importance of public and family engagement in advance care planning. Conclusion: Findings show that paramedics identify clear workforce, organisational and system enablers required to support community‐based end‐of‐life care. Addressing these priorities may facilitate more integrated, patient‐centred care and inform approaches intended to support care at home and avoid hospital conveyance where clinically appropriate. Workforce perspectives may provide evidence to inform ambulance service policy, workforce development and integrated palliative care planning.

Summary: Background: Parastomal hernia is a common complication after colostomy, especially end colostomy. It is unclear whether prophylactic placement of a three-dimensional mesh at the time of stoma formation could prevent parastomal hernia formation after surgery for rectal cancer. Methods: A systematic review was undertaken to evaluate the efficacy of prophylactic mesh placement in end colostomy construction from 2000 to 2025 using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trails, and Clinical trials including CT.gov. The gray literature was searched, including reference lists of included studies and clinical practice guidelines. Observational studies were also included due to the scarcity of randomized controlled trials (RCTs) on this topic. The primary outcome of the study was the incidence of parastomal hernia. Results: Five observational studies and two RCTs were included, comprising 512 patients across the seven selected studies. Parastomal hernia occurred in 10.2% (32/313) of patients with mesh and 50.7% (97/191) of patients without mesh. Thematic analysis identified four overarching themes that could have influenced the efficacy of three-dimensional mesh placement: (1) follow-ups and parastomal hernia, (2) postoperative complications, (3) surgical technique, and (4) demographic make-up. Conclusion: Prophylactic placement of a three-dimensional mesh at the time of stoma formation is associated with a significant reduction in the incidence of parastomal hernia. However, findings need to be interpreted with caution due to the heterogeneity of the studies retrieved regarding clinical and non-clinical parameters. The variability in the diagnosis of parastomal hernia, surgical techniques, sample characteristics (age, gender, and medical history), and methodology (follow-up time) limits comparisons of the results.