Emotion work in paramedic practice: the implications for nurse educators

"I don't have any emotions": An ethnography of emotional labour and feeling rules in the emergency department

AIMS

This study aims to apply Hochschild's theory of emotional labour to emergency care, and uncover the 'specialty-specific' feeling rules driving this labour. Despite the importance of positive nurse well-being, the emotional labour of nursing (a great influencer in wellbeing) remains neglected.

DESIGN AND METHODS

Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team. We undertook first-hand observations at one major trauma centre ED and one district general ED including semi-structured interviews (18). A reflexive and interpretive approach towards thematic analysis was used.

RESULTS

We unearthed and conceptualized four feeling rules born from this context and offer extensive insights into the emotional labour of emergency nurses.

CONCLUSION

Understanding the emotional labour and feeling rules of various nursing specialties offers critical insight into the challenges facing staff - fundamental for nursing well-being and associated retention programs.

IMPACT

What problem did the study address? What were the main findings? Where and on whom will the research have impact? Academically, this research expands our understanding - we know little of nurses' feeling rules and how specialties influence them. Clinically, (including service managers and policy makers) there are practical implications for nurse well-being.

Prehospital emergency nurses' experiences of care in critical incidents

INTRODUCTION

The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs' experiences of care in CIs.

METHOD

A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden.

RESULTS

PENs' experiences can be described as: "In a critical incident, personal ability based on experiential knowledge is central to patient care". Three generic categories underpinned the main category: "Clinical expertise", "Professional approach" and "Broad knowledge base".

CONCLUSIONS

The care given during a CI in the ambulance care setting depends on PENs' personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.

Doing care work on the fly - exploring the unnoticed socio-emotional skills of male ambulance staff

Prehospital ambulance work is a healthcare arena hitherto neglected by sociologists of health and illness. This is unfortunate because it is an interesting and dynamic area, and in contrast to most healthcare sectors, it is male dominated. Via ethnographic fieldwork, this article examines the particular caring practices and socio-emotional skills that ambulance staff use in practising prehospital care work. The empirical analysis outlines six recurring prehospital practices: medicine work, machine work, scene management, becalming work, communication work and bodywork. Each practice represents a different element of prehospital care practice and is best understood as a repertoire, as many different assemblages of these care practices can work effectively in prehospital situations. The article concludes that despite institutionalised blue-collar masculinity, numeric dominance and scarce formal education in ambulance psychology, male ambulance staff are generally proud and reflexive care practitioners.

Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics

OBJECTIVE

Continuing stigma towards mental health problems means that many individuals-especially men-will first present in crisis, with emergency services often the first point of call. Given this situation, the aims of this paper were to assess paramedics' ability to recognise, and their attitudes towards, males with clinically defined depression and psychosis with and without comorbid alcohol and other drug (AOD) problems.

METHODS

A cross-sectional national online survey of 1230 paramedics throughout Australia. The survey was based on four vignettes: depression with suicidal thoughts, depression with suicidal thoughts and comorbid alcohol problems, and psychosis with and without comorbid AOD problems.

RESULTS

Just under half of respondents recognised depression, but this decreased markedly to one-fifth when comorbid AOD problems were added to the vignette. In contrast, almost 90% recognised psychosis, but this decreased to just under 60% when comorbid AOD problems were added. Respondents were more likely to hold stigmatising attitudes towards people in the vignettes with depression and psychosis when comorbid AOD problems were present. Respondents endorsed questionnaire items assessing perceived social stigma more strongly than personal stigma. Desire for social distance was greater in vignettes focusing on psychosis with and without comorbid AOD problems than depression with and without comorbid AOD problems.

CONCLUSIONS

Paramedics need a well-crafted multicomponent response which involves cultural change within their organisations and more education to improve their recognition of, and attitudes towards, clients with mental health and AOD problems. Education should focus on the recognition and care of people with specific mental disorders rather than on mental disorders in general. It is essential that education also focuses on understanding and caring for people with AOD problems. Educational interventions should focus on aligning beliefs about public perceptions with personal beliefs about people with mental disorders and AOD problems.

Australian Hospital-Based Nurse Educators' Perceptions of Their Role

This article presents the findings from a phenomenological study that explored the understandings of Australian hospital-based nurse educators' experiences of their role. Purposive sampling resulted in 11 nurse educators from four large metropolitan hospitals within an Australian jurisdiction. The participants were asked how they understand their role and translate that understanding into practice. Thematic analysis identified four themes representative of nurse educators' understanding of their role: Becoming an Educator, Capability Building, Panacea, and Tension. A coherent picture emerged from subthemes highlighting that nurse educators were undervalued and value is added. Being undervalued and value adding are translated into nurse educator practice as resilience, being educationally literate, investing, and having a presence. This article identifies a gap in knowledge related to understanding the nurse educator role and informs recruitment and subsequent retention of nurses into nurse educator roles at a time when the nursing workforce in Australia and internationally is about to experience a major shortfall. Findings are specific to the Australian context and are not necessarily generalizable to other hospital jurisdictions. J Contin Educ Nurs. 2018;49(6):274-281.

Mental Disorder Symptoms among Public Safety Personnel in Canada

BACKGROUND

Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP.

METHODS

An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures.

RESULTS

There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure.

INTERPRETATION

The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Paramedicine students' perception of preparedness for clinical placement in Australia and New Zealand

BACKGROUND

Clinical placement is an essential element of paramedicine education and training as the profession completes the transition from vocational training to a pre-employment, university based model. The objective of this study was to survey pre-employment paramedicine students at Universities in Victoria, Australia and Auckland, New Zealand to measure their self-assessed preparedness for clinical placement.

METHODS

This was a cross-sectional study involving paper-based questionnaires employing a convenience sample of 682 undergraduate paramedicine students (years 1-4) who had completed at least one clinical placement. Student perceptions of preparedness for clinical placement were measured using an adaptation of the 'Preparedness for Hospital Practice' questionnaire.

RESULTS

There are significant differences in students' perception of preparedness for clinical placement, which reflects the differences between universities in relation to structure of their paramedicine programs, the timing of clinical education and the number of hours of clinical placement.

DISCUSSION

There needs to be clinical placement agreements between the ambulance services and universities that clearly describe the standards and expected elements of a quality clinical placement.

CONCLUSIONS

In order to improve the preparedness for placement for paramedicine students, a united approach is required by all stakeholders, including ambulance services, students and universities.

Student paramedic experience of transition into the workforce: A scoping review

OBJECTIVES

In this article we present the findings from a scoping review that sought to identify what is known about the experiences of paramedic students transitioning into the workforce.

BACKGROUND

Within the emergency healthcare sector, paramedics are primarily tasked with the assessment, treatment and safe transport of patients to hospital. New paramedics entering the workforce are exposed to the full extent of human emotion, injury and suffering as part of their everyday work. There is evidence from other healthcare disciplines that the transition to practice period can be difficult for new graduates.

METHODS

We utilised Arksey and O'Malley's five-stage scoping review framework to identify what is known about the transition of paramedicine graduates to the workplace. The framework involves identifying relevant studies; study selection; charting the data; and collating, summarizing and reporting results.

RESULTS

We identified eleven articles that explored transition of newly qualified paramedics. Thematic content was identified and discussed into four separate categories. Each theme revealing the emotional, physical and social impacts new paramedics face as they strive to find acceptance in a new workplace and culture.

CONCLUSION

Given the significant role that paramedics have in modern healthcare, the transition from student to practitioner is a period of significant stress to the new paramedic. Limited research in this field though inhibits a thorough understanding of these issues.

A qualitative thematic review: emotional labour in healthcare settings

AIMS

To identify the range of emotional labour employed by healthcare professionals in a healthcare setting and implications of this for staff and organisations.

BACKGROUND

In a healthcare setting, emotional labour is the act or skill involved in the caring role, in recognizing the emotions of others and in managing our own.

DESIGN

A thematic synthesis of qualitative studies which included emotion work theory in their design, employed qualitative methods and were situated in a healthcare setting. The reporting of the review was informed by the ENTREQ framework.

DATA SOURCES

6 databases were searched between 1979-2014.

REVIEW METHODS

Studies were included if they were qualitative, employed emotion work theory and were written in English. Papers were appraised and themes identified. Thirteen papers were included.

RESULTS

The reviewed studies identified four key themes: (1) The professionalization of emotion and gendered aspects of emotional labour; (2) Intrapersonal aspects of emotional labour - how healthcare workers manage their own emotions in the workplace; (3) Collegial and organisational sources of emotional labour; (4) Support and training needs of professionals

CONCLUSION

This review identified gendered, personal, organisational, collegial and socio-cultural sources of and barriers to emotional labour in healthcare settings. The review highlights the importance of ensuring emotional labour is recognized and valued, ensuring support and supervision is in place to enable staff to cope with the varied emotional demands of their work.

Grief, Anger, and Relationality: The Impact of a Research-Based Theater Intervention on Emotion Work Practices in Brain Injury Rehabilitation

BACKGROUND

Therapeutic emotion work is performed by health care providers as they manage their own feelings as well as those of colleagues and patients as part of efforts to improve the physical and psychosocial health outcomes of patients. It has yet to be examined within the context of traumatic brain injury rehabilitation.

OBJECTIVE

To evaluate the impact of a research-based theater intervention on emotion work practices of neurorehabilitation staff.

RESEARCH DESIGN

Data were collected at baseline and at 3 and 12 months postintervention in the inpatient neurorehabilitation units of two rehabilitation hospitals in central urban Canada.

SUBJECTS

Participants (N = 33) were recruited from nursing, psychology, allied health, recreational therapy, and chaplaincy.

MEASURES

Naturalistic observations (N = 204.5 hr) of a range of structured and unstructured activities in public and private areas, and semistructured interviews (N = 87) were conducted.

RESULTS

Preintervention analysis indicated emotion work practices were characterized by stringent self-management of empathy, suppression of client grief, adeptness with client anger, and discomfort with reactions of family and spouses. Postintervention analysis indicated significant staff changes in a relationality orientation, specifically improvements in outreach to homosexual and heterosexual family care partners, and support for sexual orientation and intimacy expression. No improvements were demonstrated in grief support.

CONCLUSION

Emotion work has yet to be the focus of initiatives to improve neurorehabilitative care. Our findings suggest the dramatic arts are well positioned to improve therapeutic emotion work and effect cultures of best practice. Recommendations are made for interprofessional educational initiatives to improve responses to client grief and potential intimate partner violence.