Nursing and pre-hospital emergency care
: an exploratory study of roles and competencies - a Maltese perspective

  • Trevor Abela Fiorentino

Student thesis: Doctoral ThesisDoctor of Philosophy


Nurses’ involvement in pre-hospital emergency care is increasing. In some countries, such as Malta, nurses are established as the main providers of pre-hospital emergency care. In spite of this, literature on pre-hospital nursing is limited. The roles of nurses in pre-hospital care are not consistently established, and the nature of nursing care in the pre-hospital setting is under-researched and unexplored. Likewise, the competencies that nurses require to function effectively in this setting have not been comprehensively identified, and the knowledge and experience which nurses can bring to the pre-hospital arena are still unclear.

The purpose of this study was to explore the roles of nurses in pre-hospital emergency care, and to identify the competencies which nurses require to fulfil this role. To achieve this purpose, a sequential exploratory mixed-methods study was conducted. Pre-hospital patient records were analysed to develop a summed description of the case-mix of emergency ambulance calls in Malta. This informed data collection in the second phase of the study, in which individual interviews were conducted with immediate care physicians and experienced pre-hospital nurses. Data on the roles of nurses, areas of competence, and attributes which emerged from the interviews, were validated through focus group interviews with pre-hospital nurses. This study was conducted in a pre-hospital system where pre-hospital nursing is established as part of the roles of emergency department (ED) nurses, and this is unique to this study.

The primary function of the pre-hospital nurse emerged as that of providing emergency care to patients with serious illness or injury. Secondary roles of ‘gate-keeper’ and ‘satellite’ also emerged as important functions of the pre-hospital nurse. Competencies were mainly related to immediate medical care and scene management techniques, together with specific attributes which are required to function in this setting.

Various similarities were drawn between ED and pre-hospital nursing. The knowledge and experience of ED nurses emerged as valid contributors to patient care and to nurses’ competence in the pre-hospital setting.
Date of AwardAug 2019
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorRosie Kneafsey (Supervisor) & Gill Furze (Supervisor)

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