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South African paramedics lived experience of critical incidents: an interpretative phenomenological PDF

191 Pages·2013·2.21 MB·English
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COPYRIGHT AND CITATION CONSIDERATIONS FOR THIS THESIS/ DISSERTATION This copy has been supplied on the understanding that it is copyrighted and that no quotation from the thesis may be published without proper acknowledgement. Please include the following information in your citation: Name of author Year of publication, in brackets Title of thesis, in italics Type of degree (e.g. D. Phil.; Ph.D.; M.Sc.; M.A. or M.Ed. …etc.) Name of the University Website Date, accessed Example Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD., M.Sc., M.A., M.Com. etc. University of Johannesburg. Retrieved from: https://ujdigispace.uj.ac.za (Accessed: Date). SOUTH AFRICAN PARAMEDICS LIVED EXPERIENCE OF CRITICAL INCIDENTS: AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS by JUSTIN ADRIAN SCOTT MINOR DISSERTATION Submitted in partial fulfilment of the requirements for the degree MASTER OF ARTS IN CLINICAL PSYCHOLOGY in the FACULTY OF HUMANITIES at the UNIVERSITY OF JOHANNESBURG Supervisor: Professor Christopher R. Stones Date: February 2013 Acknowledgments I would like to thank the following people for their contributions towards this study:  My supervisor, Professor Christopher R. Stones, for his patience, sharing his knowledge and providing valuable guidance.  The participants in this study, for their cooperation and willingness to share their experiences with me.  Erica Ortlepp, for her generous emotional and financial support, without which I would never have been able to follow my dream of completing this degree.  My family and friends, for their constant support and encouragement. Abstract South African paramedics are thought to be exposed to a high number of critical incidents as compared to paramedics elsewhere (Ward, Lombard & Gwebushe, 2006). Therefore, South African paramedics are at particular risk of suffering from negative effects associated from the exposure to critical incidents. This study aimed to gain an in-depth understanding of the meaning which paramedics attach to the experience of “critical incidents” (Mitchell, 1983). This information may be beneficial for those working in Emergency Medical Services in South Africa to further understandings of paramedics’ experience of work related trauma. Five paramedics, sourced from both public and private ambulance service, between the ages of 27 and 36 years old, who have had between 8 to 12 years of working experience were interviewed regarding their lived experiences of critical incidents. The semi-structured interviews were transcribed and analysed based on the Interpretative Phenomenological Analysis (IPA) framework suggested by Smith and Osborn (2008). The analysis of each of the participant’s transcripts provided four master themes, some of which are supported by superordinate themes. The master themes are: 1) Experiencing the trauma of critical incidents, 2) Experiencing in the “World” of EMS, 3) Intrinsic factors and active attempts of coping with stress, and 4)Personal consequence of being a paramedic. For most of the participants, their narratives highlighted that the organisational variables were considered to be more important than the nature of the critical incidents they experienced. Critical incidents were deemed traumatic as there was a disparity between the participant’s expectations of what was expected and what they were confronted with in “reality”. In addition, the participants described forming an emotional bond with their patients or the patient’s family, which added to their distress. The participants’ narratives emphasised the importance of the role of the EMS organisation in influencing their experiences. Despite employing a number of coping strategies to mediate the effects of organisational as well as critical incident stress, the participants reported experiencing long- term negative psychological symptoms that have impacted on their personal and familial lives. These findings support the growing body of knowledge that demonstrates that organisational variables play an important role in either mediating or exacerbating post- trauma outcomes. Table of Contents CHAPTER 1: INTRODUCTION .......................................................................................... 1 1.1 Introducing the Paramedics World ............................................................................... 1 CHAPTER 2: LITERATURE REVIEW .............................................................................. 5 2.1 What is a Critical Incident?.......................................................................................... 5 2.2 Consequences of Critical Incident exposure ................................................................. 7 2.2.1 Critical incident stress ....................................................................................... 7 2.2.2 Post Traumatic Stress Disorder (PTSD). ........................................................... 8 2.2.3 Burnout ........................................................................................................... 10 2.3 Interventions arising from Critical Incident research .................................................. 11 2.3.1 Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM). ..................................................................................... 11 2.3.2 For and against CISD/CISM ........................................................................... 12 2.4 Is it really all about Critical Incidents? ....................................................................... 13 2.4.1 Organisational stressors. ................................................................................. 13 2.4.2 Risk of violence and injury. ............................................................................ 14 2.4.3 Compassion fatigue. ........................................................................................ 14 2.5 The Paradox .............................................................................................................. 15 2.5.1 Compassion Satisfaction. ................................................................................ 15 2.5.2 Posttraumatic Growth. .................................................................................... 15 2.5.3 Salutogenesis. ................................................................................................. 16 2.6 Coping with Critical Incidents ................................................................................... 17 2.6.1 Dissociation or emotional detachment. ............................................................ 18 2.6.2 Black humour. ................................................................................................ 19 2.6.3 Substance abuse. ............................................................................................. 21 2.6.4 Support systems. ............................................................................................. 21 2.7 Help-seeking behaviour amongst ambulance personnel.............................................. 23 CHAPTER 3: METHODOLOGY ....................................................................................... 24 3.1 Interpretative Phenomenological Analysis ................................................................. 24 3.1.1 Sample. ........................................................................................................... 25 3.1.2 Data collection ................................................................................................ 26 3.1.3 Ethical considerations. .................................................................................... 27 3.1.4 Analysis. ......................................................................................................... 27 3.1.5 Trustworthiness............................................................................................... 28 3.1.6 Reflexivity ...................................................................................................... 29 3.1.7 Self reflexivity ................................................................................................ 29 CHAPTER 4: INDIVIDUAL ANALYSIS AND DISCUSSION OF THE PARTICIPANTS’ EXPERIENCE OF CRITICAL INCIDENTS .................................................... 33 4.1 Introduction: James’ EMS work experience ............................................................... 33 4.1.2. Analysis and Discussion of James’ lived experience .............................................. 34 4.1.2.1 Experiencing the trauma of Critical Incidents. .............................................. 34 4.1.2.2 Experiencing in the “World” of EMS. .......................................................... 36 1. EMS is a subculture. ................................................................................... 36 2. Negative experiences of the EMS organisation. ........................................... 36 3. Meaningful work environment. ................................................................... 39 4.1.2.3 Intrinsic factors and active attempts of coping with stress ............................. 40 1. Perceived need to be in control of the environment...................................... 40 2. Active attempts at reducing stress................................................................ 41 4.1.2.4. Personal consequences of being a paramedic. .............................................. 43 4.1.2.5 Summary. .................................................................................................... 44 4.2 Introduction: Paul’s EMS work experience ................................................................ 46 4.2.1 Analysis and Discussion of Paul’s lived experience ................................................ 47 4.2.1.1 Experiencing the trauma of Critical Incidents ............................................... 47 4.2.1.2 Experiencing in the “World” of EMS. .......................................................... 48 1. EMS is a subculture. ................................................................................... 48 2. Negative experiences of the EMS organisation. ........................................... 49 3. Meaningful work environment. ................................................................... 51 4.2.1.3 Intrinsic factors and active attempts of coping with stress ............................. 51 1. Perceived need to be in control of the environment ...................................... 51 2. Active attempts at reducing stress ................................................................ 52 4.2.1.4 Personal consequences of being paramedic. ................................................. 53 4.2.1.5 Summary. .................................................................................................... 54 4.3 Introduction: Sarah’s EMS work experience .............................................................. 56 4.3.1 Analysis and Discussion of Sarah’s lived experience .............................................. 56 4.3.1.1 Experiencing the trauma of Critical Incidents ............................................... 56 4.3.1.2 Experiencing in the “World” of EMS ........................................................... 57 1. EMS is a subculture. ................................................................................... 57 2. Negative experience of the EMS organisation. ............................................ 58 3. Meaningful work environment .................................................................... 58 4.3.1.3 Intrinsic factors and active attempts of coping with stress ............................. 60 1. Perceived need to be in control of the environment ..................................... 60 2. Active attempts at reducing stress................................................................ 61 4.3.1.4 Personal consequences of being a paramedic. ............................................... 63 4.3.1.5 Summary. .................................................................................................... 64 4.4. Introduction: André’s EMS work experience ............................................................ 66 4.4.1 Analysis and Discussion of André’s lived experience ............................................. 67 4.4.1.1 Experiencing the trauma of Critical Incidents. .............................................. 67 4.4.1.2 Experiencing in the “World” of EMS ........................................................... 69 1. EMS is a subculture. ................................................................................... 69 2. Negative experience of the EMS organisation ............................................. 70 3. Meaningful work environment. ................................................................... 72 4.4.1.3 Intrinsic factors and active attempts of coping with stress. ............................ 72 1. Perceived need to be in control of the environment ...................................... 72 2. Active attempts at reducing stress ................................................................ 73 4.4.1.4 Personal consequences of being a paramedic ................................................ 75 4.4.1.5 Summary. .................................................................................................... 76 4.5. Introduction: George’s EMS work experience .......................................................... 78 4.5.1 Analysis and Discussion of George’s lived experience ............................................ 79 4.5.1.1 Experiencing the trauma of Critical Incidents. .............................................. 79 4.5.1.2 Experiencing in the “World” of EMS ........................................................... 81 1. EMS is a subculture .................................................................................... 81 2. Negative experience of the EMS organisation ............................................. 81 3. Meaningful work environment .................................................................... 83 4.5.1.3 Intrinsic factors and active attempts of coping with stress. ............................ 84 1. Perceived need to be in control of the environment...................................... 84 2. Active attempts at reducing stress................................................................ 85 4.5.1.4 Personal consequences of being a paramedic ................................................ 86 4.5.1.5 Summary ..................................................................................................... 88 4.6 Integrated overview of the participants master themes ............................................... 90 4.6.7 Experiencing the trauma of Critical Incidents .................................................. 90 4.6.2 Experiencing in the “World” of EMS .............................................................. 92 4.6.3 Intrinsic factors and active attempts of coping with stress................................ 94 4.6.4 Personal consequences of being a paramedic ................................................... 96 CHAPTER 5: DISCUSSION .............................................................................................. 98 5.1 Overview. .................................................................................................................. 98 5.2 Discussion of the Master Themes .............................................................................. 98 5.2.1 Experiencing the trauma of Critical Incidents. ................................................. 98 5.2.1 Experiencing the “World” of EMS. ............................................................... 100 5.2.2 Intrinsic factors and active attempts at coping with stress. ............................. 103 5.2.3 Personal consequences of being a paramedic ................................................. 106 CHAPTER 6: CONCLUSION. ......................................................................................... 108 CHAPTER 7: LIMITATIONS AND RECOMMENDATIONS ......................................... 111 REFERENCES ................................................................................................................. 113 APPENDICES .................................................................................................................. 126 CHAPTER 1: INTRODUCTION Research conducted on emergency medical workers has focused mainly on the effects of exposure to traumatic scenes, and the resultant negative psychological symptomology (Donnelly & Siebert, 2009; Holland, 2008; Jonsson & Segesten, 2004). Studies have also investigated coping methods employed by emergency medical workers (Kirby, Shakespeare- Finch & Palk, 2011) as well as the positive growth (Shakespeare-Finch, Smith, Gow, Embelton & Baird, 2003) that emergency medical workers have experienced whilst performing their duties. Compared to elsewhere in the world, South African paramedics are thought to be exposed to the highest amounts of traumatic scenes (Ward, Lombard & Gwebushe, 2006). Few studies have been done in South Africa focusing on paramedics lived experience of traumatic scenes or critical incidents (Mitchell, 1983). This study aims to gain an in-depth understanding of the meaning which South African paramedics attach to the experience of “critical incidents” in order to add to the growing body of knowledge in this field. In order to explore in detail the paramedic’s subjective experience of critical incidents it is important to gain an account of the experience as well as examine the participant’s world in which this experience is embedded. The following section provides a brief introduction into the “world” of paramedics in South Africa. 1.1 Introducing the Paramedics World In order to introduce and contextualise the reader to the “world” of paramedics in South Africa, the following topics will be briefly discussed: 1) The varied contexts in which paramedics operate, 2) the prescribed training paramedics are required to undergo, 3) the specific duties paramedics are required to perform, and 4) the working environment in which paramedics operate. Paramedics operate in a variety of contexts where there may be a need for emergency medical assistance. These contexts may include the following: the event management arena, such as local sporting events or concerts; pre-hospital settings such as public and private ambulance services; law enforcement or military settings; as well as within the hospital environment providing support to hospital staff. 1

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