Background: There is increasing demand for access to mental health support services both for ongoing care and at time of crisis. Preparation of undergraduate students for encounters with those with ongoing mental health care and/or at a time of psychological distress/crisis remains sporadic and difficult to encompass. Simulation gives students opportunities to develop technical and non-technical skills through the recreation of an experience that is as close to reality as possible. Method: An exploratory evaluation of teaching practice of student self-perceptions of self-awareness and self-regulation in encountering clinical situations with persons in high states of arousal and potential conflict was conducted. To evaluate the exercise and its value, students were asked to self-evaluate their confidence and knowledge both prior to and subsequent to the teaching exercise. Results: There was a positive shift in self-awareness and self-regulation post training. Confidence in being able to de-escalate a situation was reported as the key outcome to take from the session, along with techniques on how to de-escalate a scenario. Conclusion: While it is not possible at this stage to definitively measure the impact of the teaching on practice or draw firm conclusions for education providers, the evaluation exercise does evidence individual impact and enjoyment. The teaching approach may prepare the future workforce with the skills and knowledge needed to provide high-quality care.

Action plans are commonly used in nursing practice and nurse education to support nurses and nursing students to meet specific objectives, particularly if they face challenges in achieving the level of knowledge and/or skills required by their role or course. Action plans may be used, for example, with preregistration or post-registration nursing students during a placement or with registered nurses for whom there are concerns regarding their professional practice. In that context, an action plan is essentially a set of objectives that the nurse or student is asked to work towards.• The objectives set in an action plan should be SMART – specific, measurable, achievable, realistic and time-bound.• An action plan should feature resources and activities that will support the person to achieve the objectives, as well as the evidence needed to demonstrate successful completion and a time frame.• An action plan is one strategy that can be used to support nurses or nursing students to progress in their practice or learning.‘How to’ articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of:• How this article might improve your practice when writing an action plan with a nurse or nursing student.• How you could use this information to educate colleagues on writing an effective action plan with a nurse or nursing student.

Pain is one of the most common symptoms presented by patients of all ages to ambulance services. While children in pain make up a relatively small proportion of the patients attended by prehospital care services, medical intervention is needed in only 40% of cases. This might go some way to explaining why management of paediatric pain is perceived as poor. Aim: To establish and explore published barriers and facilitators to out-of-hospital pain management for children aged <18 years. Methods: Key search terms were used to search the three databases (CINAHL, MEDLINE and PSYCHInfo) individually and simultaneously. Inclusion and exclusion criteria were applied and 15 papers were identified as meeting the criteria and were subject to data extraction. Results: Three broad themes were identified; organisational factors, patient factors and clinician factors. Conclusion: From considering international systems and aspects of care, it can generally be accepted that the assessment and management of paediatric pain is below what would be expected, and compared with with that for adults, it is sub-optimal. Multiple demographic influences are evident and appear to influence clinician decisions.

Background: Pain is one of the commonest symptoms in patients of all ages presenting to ambulance services. Children in pain make up a relatively small proportion of the number of those attended by prehospital care and pain management is needed in only 40% of cases. This might go some way to explain why the management of paediatric pain is perceived to be poor. Aim: The primary aim of this study was to explore the experiences of UK paramedics in treating children in pain. Methods: A phenomenological study was undertaken using a purposeful sample of UK paramedics (n=12) to explore their experiences and decision-making during the treatment of children in pain. Results: Five themes became apparent through analysis—preparation and education; adaptation and change of approach; organisational and legal factors; support and guidance; familial and carer impact—with some crossover between themes noted. Conclusion: Clinicians are aware of multimodal techniques for managing pain in children but are often less confident in the use of pharmacological than non-pharmacological management methods. Advances in the use of technology in practice have enabled clinicians to use alternative measures to manage children in pain. However, while using these methods, practitioners lack confidence that they are meeting social expectations of their roles.

Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction.

Aims: This study aimed to evaluate the ‘think aloud’ teaching exercise's ability to develop clinical reasoning skills of student paramedics, and to ascertain its feasibility as an ongoing method to enhance clinical reasoning teaching and potentially alleviate problems around applying theoretical learning to practice. Methods: A qualitative approach was taken to seek the opinions and experiences of students taking part in the activity to determine levels of enjoyment, how relatable it was to students, and awareness of the skills it was intended to develop. Data collected via an online survey tool were analysed to identify themes and comments. Findings: Student enjoyment and engagement were evident, and the exercise permitted independence of thought and working, promoting self-appraisal among students of the effectiveness of the working strategy. Conclusion: The results of this case study indicate that the think aloud exercise could be effective in developing students' clinical reasoning skills. It complements established teaching strategies, such as core lectures, seminars and supervised practice.