Slide 1

Hello, my name is Ruth, I am a Paramedic Working in Christchurch, this paper is part of my

journey to gaining an Extended Care Paramedic qualification. I will be covering my paradigm, a
research area of interest, present a research question, and end with critical discussions
surrounding my research considerations.
Slide 2
My positionality arises from being a woman who has had 2 normal labors with no
complications. There was no period of extended recovery or separation from my babies
enabling me to bond and care for them freely. A luxury taken for granted until I became a
paramedic and witnessed firsthand the horror of post-partum hemorrhages (PPH).
Slide 3
The paradigm of a positivist is most suited for my intended area of research. This is because I
need clear objective observation with reliability that is reproducible in a general population of
woman with minimal bias and maximum certainty to gain the results that I require. This was a
subtle paradigm shift from the post-positivism view that I favor.
Slide 4
My paradigm shift occurred because post positivism did not “fit” the aim or value for my study -
my axiology. I had to ask myself what the reality of the study is, how, I gain this knowledge, will
I methods will be used? Ontology dictates epistemology which dictates methodology and
methods. Which dictates paradigm.
Slide 5
The ontological stance of positivist researcher is one of realism, holding the belief there is only
one reality, one single unchangeable truth, utilizing the laws of cause and effect with
objectivity. My research seeks one truth. One cause, being the administration of a medicine,
and effect, the subsequent effect of that medicine.
Slide 6
Post positivists also belief one truth exists but accept truth is contextual and changeable so is
not suitable for my research. A single reality theory does not align with the other ontological
stance of nominalism also known as relativism. Thes stances are more useful for the critical,
interpretive, or post structural paradigms where multiple realities exist.
Slide 7
Epistemology is how we gather knowledge. I will be using an ettic, or outside the fishbowl,
epistemology. This stems from the realism of ontology, linked by objectivity. Ettic knowledge is
discovered with no relationship between researcher and participants. Data is not influenced by
the researcher. A stark contrast to the emic epistemology.
Slide 8
Axiology is the theory of value, of good and bad, and is complex. The positivist’s paradigm
values objectivity in research and places worth on the act of being objective. The researcher has
values. Yet almost in contradiction, within the research itself the researcher remains value free
in attempts to be as individual and as objective as possible.
Slide 9
Methodology as the blueprint of research describes how knowledge is discovered and analyzed.
Given the positivist’s stance of reality, ettic epistemology and objective axiology it is not
surprising that methodologies use a deductive approach from measurable data collected from
large quantitative surveys, random control trials or experiments.
Slide 10
My research area of interest is the prevention of postpartum hemorrhage. Patients are forced to
undergo medical interventions that can include bimanual compression, to emergency
hysterectomies. I question can we prevent these situations from occurring. And if so why not.
Slide 11
A recent addition to the paramedic tool kit is Tranexamic acid, commonly called TXA. As some
women are prescribed TXA to be taken orally throughout pregnancy, it is logical that we could
be considering prophylactic use of TXA during normal labor in the prehospitally instead of the
current indication for use - post blood loss exceeding 500ml.
Slide 12
Searching via AUT library and Google Scholar I found only 1 article post 2018 to be included in
my systematic literature review, I removed the terms prehospital and paramedic, with greater
results, resting with RCT, prophylactic TXA, vaginal birth. An incidental finding was the WOMAN
RCT involving 20000 women.
Slide 13
In reviewing abstracts, initial impressions are positive for the use of prophylactic TXA. As well, it
quickly became obvious there is a large gap in prehospital research. As 4.6 % of all births took
place outside of a hospital here in NZ in 2020, there is clearly room for future research in this
area.
Slide 14
Casual research questions are used when examining cause and effect in research and should be
clear, show the aim of the research and be researchable. My question is “ What is the risk vs
benefit of prehospital prophylactic TXA administered for the prevention of PPH following normal birth?”

Slide 15
When undertaking research there are several factors that require careful consideration. Ethics
is by no means the least of them. For a systematic literature review it is not always required to
seek approval from an ethics committee, however principles of research ethics should still be
followed. All research should strive to do good and to do no harm.

Slide 16
One way to ensure systematic research is ethical is to include studies with published ethical
information, such as The WOMAN trial authored by Picetti et al in 2020. An article outlining the
details of their proposed trial was published in 2010 .

Slide 17

Culture is an individual's way of life; people can belong to multiple cultures at the same time. Objective
research does not normally consider a value such as culture. By being culturally competent I accept all
participants may not identify as being female and will come from differing ethnic backgrounds.

Slide 18

I can also consider culture by looking for higher incidences of PPH existing in differing demographic
groups. As I live in Aotearoa; I believe it important to include data that captures both Māori and Pacifica
demographics. I would be inviting guidance from Te Mana Raraunga before embarking on such
research.
Slide 19
Practical considerations are needed such as the time available for research, who will help in the
collection of data – especially if we are to move slightly sideways into demographics? A suitable
space, data capturing software.
Slide 20

In closure, thank you for watching my presentation. Topic discussed were LO 1 Research Paradigm and
Positionality, LO2 My research area of interest and LO3 My research considerations. References will
appear on the following slide.

https://www.qizzle.co.nz/wall-border-nz-pasifika-pkt-7.html
https://www.warehousestationery.co.nz/product/W2686573.html?lang=default
https://www.vecteezy.com/vector-art/313235-word-of-data-on-a-broken-white-surface-vector-illustration
https://www.presentermedia.com/powerpoint-clipart/jackhammer-the-concrete-pid-7525