Self-reported stress and psychophysiological reactivity in paramedics

Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review

BACKGROUND

Paramedics play a pivotal role in delivering emergency medical care, contributing to excellence in the prehospital environment and ensuring a seamless continuum of healthcare. Achieving this objective is subject to various factors. This review aims to explore, the relationship between paramedic personality profiles and key factors including stress, burnout and employment retention or attrition.

METHODS

The JBI approach was used to perform a scoping review. Key words including paramedic* , ambulance* , personalit* , retention OR attrition and burnout OR stress were inserted into the search engines OVID, CINAHL Plus, Scopus, Web of Science Core Collection, Psychology ProQuest, and Nursing ProQuest. Titles and abstracts of 226 results were screened and inclusion and exclusion criteria applied. Full texts of the remaining 18 results were screened to inform the results.

RESULTS

Three themes emerged relevant to the objective including the correlation of neuroticism with stress and burnout, personality types and mental illness with the ability to cope during stressful situations and finally resilience and burnout with the intention to quit.

CONCLUSION

Further research should be completed into specific personality characteristics, including neuroticism, perfectionism, and excitability to facilitate the development of strategies aimed at improving the health and wellbeing of paramedics and EMT workers internationally.

Unplanned out-of-hospital birth apparatus benefits: A paramedic simulation trial

Unplanned births outside of hospitals have becoming an issue in cities. The majority of healthcare professionals are paramedics. When performed alone, this event frequently causes them strain and anxiety. Their primary worries were the safety of mothers and newborns, as well as insufficient obstetrical equipment. As a result, our team developed a portable birth bed equipped with newborn safety devices for this research. One hundred fourteen paramedics of local area participated in this study and were divided into intervention and conventional group. In simulation trials, the study found that this safety intervention outperformed the conventional setup. We determined that our technology aided in the delivery of unusual babies. However, it requires additional research in the actual situation.

A Comparison between a remote testing and a laboratory test setting for evaluating emotional responses to non-speech sounds

OBJECTIVE

To evaluate remote testing as a tool for measuring emotional responses to non-speech sounds.

DESIGN

Participants self-reported their hearing status and rated valence and arousal in response to non-speech sounds on an Internet crowdsourcing platform. These ratings were compared to data obtained in a laboratory setting with participants who had confirmed normal or impaired hearing.

STUDY SAMPLE

Adults with normal and impaired hearing.

RESULTS

In both settings, participants with hearing loss rated pleasant sounds as less pleasant than did their peers with normal hearing. The difference in valence ratings between groups was generally smaller when measured in the remote setting than in the laboratory setting. This difference was the result of participants with normal hearing rating sounds as less extreme (less pleasant, less unpleasant) in the remote setting than did their peers in the laboratory setting, whereas no such difference was noted for participants with hearing loss. Ratings of arousal were similar from participants with normal and impaired hearing; the similarity persisted in both settings.

CONCLUSIONS

In both test settings, participants with hearing loss rated pleasant sounds as less pleasant than did their normal hearing counterparts. Future work is warranted to explain the ratings of participants with normal hearing.

Emergency Medical Service Providers' Perception of Health-Threatening Stressors in Emergency Missions: A qualitative Study

Background

Unknown and unpredictable situations cause emergency medical service (EMS) providers to experience various stressful factors. These factors are affected by sociocultural conditions and expectations of the casualty and affect EMS providers' performance and health at the incident scene. The present study was conducted to explore EMS providers' perception of stressful and health-threatening factors in emergency missions.

Method

This qualitative conventional content analysis was conducted in 2020. The participants included 16 EMS providers working at the Emergency Medical Services Department in Hamadan Province, Iran. The participants were selected using purposive sampling and underwent semi-structured interviews until data saturation. Data were analyzed using the Graneheim and Lundman method.

Results

Analysis of the interview data yielded six subcategories (i.e., incident scene hazards, violence-related injuries, physical injuries caused by patient care/handling, ambulance crash-related injuries, emotional impact of patients' suffering and ailments, and highly stressful missions), two main categories (i.e., physical injuries and psychological tensions), and a theme of occupational injuries.

Conclusions

According to the results, in addition to having concerns about caring for patients and saving the injured, EMS providers also worry about potential threats to their own health. The present study identified and described some major stressors in emergency missions. Thus, for a better and more effective efficiency, the present study results can be used to reduce or modify stressors in EMS providers.

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

BACKGROUND

To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system.

MATERIALS AND METHODS

To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data.

RESULTS

Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system.

CONCLUSIONS

There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels.

Patient's Death From the Perspective of Nursing Students

Introduction: An exceedingly small amount of scientific research concerns the response to patient death among nursing students. There was a need to examine their perspective on patient death with which they experience during their studies. The authors wanted to check the subjective assessment of students' preparation for patient death and their perception of classes conducted in this area. Methods: The research used the diagnostic survey method and was conducted in May 2019 using Google Form on social media. The 467 nursing students answered 14 questions in the original questionnaire about their experience with patient death. The analyzed data were expressed as median, minimum and maximum values, or percentage, as appropriate. Comparison of groups was performed using the Mann-Whitney U-test or the Kruskal-Wallis test. The relationship between variables was analyzed with Spearman correlation coefficient or contingency coefficient (the χ²-test). Results: The authors analyzed 452 responses of nursing students, and 86.3% of them encountered death of a patient in the course of their studies. In the second-year master's studies, this value reached 99.3%. Among the most frequently mentioned accompanying emotions, students mentioned "reflection on the fragility of life" and "compassion." Students do not feel sufficiently prepared for the death of a patient. Conclusions: Nursing students encounter the death of a patient very often and very early. Although the curriculum includes content related to the care of a dying patient, students believe that there is still too little of it and that it does not prepare it in a satisfactory manner. Students feel different, often negative emotions related to patient death, and also have various methods of dealing with such a situation. They also feel the need to increase education in this area.

Low self-reported stress despite immune-physiological changes in paramedics during rescue operations

Despite the high stress levels, paramedics seem to ignore or even negate the stress. This can be detrimental and lead to stress-related diseases. Therefore, we investigated the divergence between physiological and psychological stress responses of paramedics. Participants were 16 paramedics and 17 white-collar workers. We assessed psychological stress parameters, cortisol awakening response (CAR), and quantified immune parameters. In paramedics, electrocardiogram (ECG) was measured during one complete 24-hour shift. Our results revealed that CAR was higher in paramedics compared to controls. An alteration of immune parameters was observed even during days of free time. Also, ECG recordings showed acute stress in paramedics during rescue situations. Questionnaires revealed that rescue-service specific stressors affect psychological outcomes. However, paramedics reported significantly less mental stress and higher levels of depersonalization than controls. Taken together, our results suggest higher stress in paramedics compared to controls. However, paramedics negate their daily stress. Our findings underline therefore the importance to develop stress-management interventions for paramedics including sensitization for their stress reactions.

Why are emergency medical technicians' coping strategies dysfunctional? Direct and indirect effects of resilience and perceived stress

BACKGROUND

Emergency Medical Technicians (EMTs) are at high risk for traumatic disorders, and these disorders are more likely if they resort to dysfunctional coping. However, few studies have examined how dysfunctional coping can be decreased, specifically by comparing the impact of personal characteristics, such as resilience, and of occupational factors, such as stress. This study examines the contribution of resilience and perceived stress on EMTs' dysfunctional coping.

METHODS

A total of 502 EMTs (66% men), with a job experience of approximately 8 years (SD = 3.84), answered the Resilience Scale (Self and Life Acceptance; Personal Competence; Total score), Brief Cope, and Anxiety Depression Stress Scales.

RESULTS

EMTs reported high resilience, low stress and dysfunctional coping. Resilience dimensions, specifically self and life acceptance, and stress contributed to dysfunctional coping. Stress displayed the highest regression coefficient. The effect of self and life acceptance on dysfunctional coping was no longer significant when accounting for stress, revealing a full mediation effect.

CONCLUSIONS

How EMTs perceive stress can mitigate the protective role of acceptance on the use of dysfunctional coping. These findings suggest EMTs' occupational training may benefit from focusing on how to manage stressful and critical incidents, as well as on how to cope with stress.

Empathy in Japanese paramedicine students: A cross-sectional study

Empathy is an important characteristic for healthcare students and professionals that may improve the quality of healthcare interactions. Empathy has predominantly been studied within medicine, but also among various allied health personnel. Within paramedicine, empathy has previously been examined internationally, but not within Japan. This study used a descriptive, cross-sectional methodology which aimed to examine self-reported empathy in Japanese paramedic students using the Jefferson Scale of Empathy, and compare results with similar international cohorts. Empathy levels in the Japanese cohort were higher among females compared to males. In addition, there was a decrease in empathy with each subsequent year of the paramedic program, and a general decrease as age increased. This contrasts with comparable Australian cohorts which demonstrate no significant change in empathy levels during the undergraduate program. Empathy levels measured in the Japanese paramedic cohort were generally lower than for Australian cohorts. The reasons for the differences are unclear at present and thus further research in this area is required to fully determine and describe the contributing factors.

Non-technical skills in paramedicine: A scoping review

This scoping review aims to identify which non-technical skills have been empirically identified in the literature, to create the first list of empirically identified non-technical skills for paramedics and allied health personnel. A five-stage scoping literature was undertaken in March 2020. The search retrieved a total of 4756 citations. A total of 93 studies met the inclusion criteria and were analyzed for data charting. A total of 26 non-technical skills were identified in the literature. The top five non-technical skills included decision-making (33%, n = 31), communication (24%, n = 23), empathy (17%, n = 16), leadership (12%, n = 12), and ethics (10%, n = 10). Furthermore, only five studies investigated the assessment or measurement of non-technical skills. This scoping review identified 26 non-technical skills that had been investigated in the paramedic literature to create the first list of empirically based desirable non-technical skills for a paramedic. Subsequently, research can then begin to focus on identifying the link that these have to paramedic practice and patient safety.

Emergencies in Pediatric Palliative Care: A Survey of Ambulance Officers to Understand the Interface between Families and Ambulance Services

Background: Pediatric palliative care occurs across contexts through the child's illness trajectory, including within the child or young person's community. Interactions with the ambulance service may occur with a child's deterioration, crisis, or when needing transfer, but there is little research on this interaction. Aim: To explore the experiences and attitudes of ambulance officers in managing pediatric patients with palliative care needs. Design: A targeted e-mail survey was sent exploring perceptions of the involvement with these patients including exposure, comfort, resuscitation topics, and supports available. Setting/Participants: Participants were Queensland ambulance officers known to have had an interaction with one of the last 50 pediatric palliative care referrals across Queensland. Results: Twenty-two survey responses were received. Most of the palliative group accessed ambulances for the 13-month study period. Most ambulance officers did not easily identify patients as receiving palliative care. Many participants felt these cases were challenging, confidence levels varied, and staff counselling services were felt to be relevant. Ambulance officers were most likely to use correspondence provided by the family from their usual team as a guide for emergency management. Half of the participants felt patients receiving pediatric palliative care should have a "not for resuscitation" order. Respondents suggested officer support could be improved through increased patient documentation and promotion of existing officer supports. Conclusions: These findings demonstrate challenges experienced by ambulance officers and suggest practical ways in which pediatric palliative care services can better support emergency services.

Stress coping styles among anaesthesiology and intensive care unit personnel - links to the work environment and personal characteristics: a multicentre survey study

BACKGROUND

High levels of stress among anaesthesiology and intensive care unit workers are commonly reported. Personnel in these units are prone to stress because of specific characteristics of their work. Their development of skills to cope with stress may affect their psychophysical condition and, consequently, patient safety.

OBJECTIVES

The aim of this study was to define the coping styles of anaesthesiology and intensive care unit personnel and to evaluate the connections between the work environment as well as personal characteristics and the dominant coping styles.

METHODS

Anaesthesiology and intensive care unit personnel from 15 selected Polish hospitals were surveyed using the Coping Inventory for Stressful Situations, which examines task-oriented coping, emotion-oriented coping and avoidance-oriented coping. The Perceived Stress Scale was used to assess stress levels.

RESULTS

The analysis included 425 successfully completed surveys. The examined population was divided into two groups: Group N comprised 311 nurses (73.18%) and group P comprised 114 physicians (26.82%). For 167 participants (39.29%), the dominant coping style was defined. The most common style was the task-oriented coping style; it was dominant in 96 participants (22.58% of the entire examined population). This style was significantly predominant among men. The domination of some coping styles coexisted with marital status, number of children and financial situation. The occurrence of different coping styles did not significantly differ among workers at different-sized hospitals, with different job seniority or with different living locations. Perceived stress was correlated with all coping styles.

CONCLUSIONS

Work-related stress among anaesthesiology and intensive care unit workers is an important problem. Further investigations of stress levels and the causes and effects of stress in this population are necessary.