The Strategies Used by Paramedics in Handling Stress - Essay Example

?HOW TO HANDLE STRESS AS A PARAMEDIC The purpose of this research is to identify and evaluate the strategies used by paramedics in handling stress. This also aims to identify the research method that will best provide the necessary supporting data to the overall research. A review of the available literature regarding the existence of stress among paramedics is initially done. This is followed by a research on the techniques generally used by paramedics in handling workplace stress. After deciding which research method best fits the study, a survey design is done and interviews are conducted on paramedics in order to gain deeper insights and first-hand accounts on dealing with work-related stress. A total of four paramedics from the ambulance and operations departments participated in the in-depth, one-on-one interviews. Review of the literature shows that stress are classified according to physical, cognitive, emotional, and behavioural or a combination of symptoms and stress-coping techniques are either pre-mission or post-mission. The results of the interviews support this preliminary data gathered from previous empirical studies on stress among paramedics. The results also show that stress should be diagnosed and treated immediately; otherwise, it could have a debilitating effect on the personal and professional well-being of the paramedics. The findings of this research can provide not only supporting details on the existing studies on stress, but also a deeper understanding on the use of different designs and methods in research that support a particular study. Furthermore, it provides information on stress management strategies that are favoured by paramedics who experienced stress. Introduction According to studies, paramedics experience stress almost on a daily basis (Galloucis, Silverman and Francek, 2000, pp.13). However, too much stress can affect their ability to be at their best in the performance of their duties. Issues such as this can be critical to emergency personnel because this is one job where lives are almost always at risk (Regehr and Millar, 2007). Given the threat of natural calamities, or threats from other environmental occurrences, mass casualties, or even accidents, society depends on the ability of the paramedics to perform well on their duties (Galloucis, Silverman and Francek, 2000, pp.6). But one should also understand the stress involved in such sensitive duties. To be exposed to dangers and other life-threatening situations, or injuries suffered by other people, on almost a daily basis can be very stressful even for the most able person (Buurman, Mank, Beijer and Olff, 2011). Studies on stress management imparts the importance of diagnosing stress symptoms as early as possible. Furthermore, it is stated that stress management strategies should be in place to at least decrease the impact of stressors among paramedics. Stress management strategies can either be pre-mission or post-mission. Studies show that there are some negative impacts on the lives of paramedics in response to the stress experienced at work. If the symptoms go undiagnosed or left untreated for a long time, the impact can grow into bigger proportions and go out of hand. According to Galloucis, Silverman, and Francek (2000), an individual's ability to function normally is affected by stress. Moreover, stress impacts the health of the affected individual due to his or her susceptibility to health concerns like stomach aches, colds, sore throat, and joints and body aches, and the possibility of aggravated health problems such as leukaemia, cancer, myocardial infarctions, and diabetes. Furthermore, aside from physical impacts, emotional and psychological issues are also widespread among people who go through traumatic events (Regehr and Millar, 2007). There are a number of researches that investigate the existing relationship between personal and professional well-being and job performance to stress among emergency services people. Regehr and Millar (2007) state that stress adds risk to sensitive missions of emergency medical people due to second-guessing judgement and lack of cognitive functioning on a mission site. It is also stated that people under stress have flashbacks, sleep problems, recurring nightmares, and even loss of appetite after a traumatic event (Shakespeare-Finch, et al., 2003). Such stress symptoms makes it even harder for paramedics who are exposed to traumatic incidents, risky missions, and stressful situations which all require coping strategies and adaptive measures (Saberi, 2010). Such findings make it important to recognize the importance of stress management techniques, whether they are done prior to or after the mission. While there are available data of stress diagnosis and stress management strategies done by emergency medical personnel, it is better to gain further understanding on how these people really attempt to manage work-related stress specific to paramedics. This is why one-on-one interviews is chosen to try to gain in-depth information on what really works for these people, and what they really go through before, during, and after the missions. With this purpose, ethnographic research is chosen and is applied on one-on-one interviews, with the specific design of using qualitative research as a means of interpreting data (Grbich, 2012a; b; c; d). Method As stated above, the primary method of collecting data for the research is the review of different available literature on the topic of stress among paramedics. However, no research is done by merely “gathering information from resources” or “transporting facts from one resource to another” (Gbrich, 2012a,p.7). “Contributing new knowledge is necessary” (Gbrich, 2012a,p.7) to complete a high-quality research. This is the purpose of the ethnographic research that is applied in this study. Ethnography is the “study of the regulations and variations of a culture by gaining and describing the understandings and meanings constructed by people as they undertake daily activities” (Gbrich, 2012c, p.4). Ethnography can be conducted using a qualitative research method, and one of the “data collection [methods under] qualitative research [is] interviewing” (Gbrich, 2012d, p.3). Interviewing is one method which purpose is “to gain understanding of the meanings constructed by individuals and groups regarding the events and experiences of their lives” (Gbrich, 2012d, p.6). One-on-one in-depth interviews is the secondary data collection technique in the research. Balancing between identification of respondents for authenticity and confidentiality is the sole ethical issue of the project. Four paramedics were randomly chosen for the interviews. However, despite the random sampling strategy, a set of generic respondent qualifications is still created prior to the interviews. This is to ensure that the research will have the maximum benefit possible from the responses. Since the researcher is a paramedic at the Saudi Red Crescent Society, access to respondents that fit the set criteria is fairly easy. The criteria for respondents are: 1) should be a paramedic, ) should be working as a paramedic for over 5 years, 3) should still be working as a paramedic at the time of the interview. Ethical considerations in the interviews are 1) respondent participation should be voluntary, 2) respondent can refuse to go further with the interview at any time, 3) respondent can refuse to answer question/s, 4) respondent is informed of the purpose of the interview and, 5) respondent is assured of confidentiality and anonymity (Gbrich, 2012b). Table 1 below show the respondents' profile. Table 1: Profile table for the participants Name Years of Employment Age Department / Role Data Collected Bader 8 37 Ambulance interview Fares 7 35 Ambulance interview Shabab 8 35 Operations interview Ali 8 37 Ambulance interview The qualitative questions answered by the respondents are: 1. What is your immediate reaction to a death or serious injury encountered in missions, especially that of a child of a child? 2. What are the major categories of stress symptoms and how essential are they in identification and management of stress? 3. What are some of the common techniques used in evaluation and management of stress in your scope of work? 4. Which method has been the most effective for you in stress management? 5. Which other techniques would you recommend for stress management among paramedics? The responses are tallied against the results gathered from the review of the literature to see if responses collaborate with or go against the data gathered from the texts. The only problem encountered is the means to identify the respondents in the research. Due to ethical considerations,nicknames are used to identify the respondents. Results Every count of death or severe injury induces emotional imbalance, especially if a helpless innocent child is involved. There is always an induced stress because of the fact that the rescue team was not available in time to help the victim or the fact that the team cannot offer required help due to late arrival or impossibility. There is always a significant level of stress and remorse (Buurman, Mank, Beijer and Olff, 2011, pp.324-325). Respondents mention: “I immediately feel shock and pain.,” “I feel immense guilt especially if the child dies.,” “I feel guilty and I blame myself for not being that fast to help.,” and “I feel angry at whatever the cause sometimes.” Stress symptoms can be either physical, cognitive, emotional, and behavioural or a combination. Physical symptoms are felt in the physical sense and include exhaustion and body pain. A person may also be confused for some time, lose focus, or even have nightmares. Similarly, stress may manifest through emotional characteristics such as fear, guilt, anger, and denial. Isolation, drug abuse and loss of appetite characterize behavioural symptoms. Identification of these symptoms are essential because they form a basis for diagnosis for stress management initiatives (Shakespeare-Finch, et al., 2003, pp.61-63). Respondents say: “Nightmares, body pain, and lack of focus...,” “It's like I forget how to have fun and always remember how the victim looked like...,” “Sometimes it is emotional.,” and “For me, especially if I encounter child accidents during a mission, I feel paranoid for my family – paranoid and helpless.” Considerable factors in evaluating the level of work induced stress includes the period of time in which symptoms are reported, the degree to which the paramedic is affected by stress and the number of symptoms registered in a person. These factors are considered because they help in the identification of the most appropriate approach to managing the stress (Regehr and Millar, 2007, pp.51-52). Respondents state that: “Sometimes one experiences it for weeks up to several months.,” A common technique I'm familiar with is checking how much a person is affected by the stress symptoms...like, does it really affect him much?,” “The degree and number of stress symptoms that a person feels is the most common technique used to determine the stress level of a person., and “Questions like how long have I felt it, or how many times have I felt it.” Prevention is always the best approach to managing problems. Stress management among paramedics can be prevented by psychological preparation though briefs of the expected situations and cases. Similarly, operations management aimed at controlling pressure and confusion in a paramedic exercise prevents stress (Saberi, 2010, p.1471). According to the respondents: “Preparation is always the best for me – psychological preparation.,” “Defusing is good, and also demobilization...it's like debriefing...and you do it in large groups.,” “Defusing is the most common I have experienced and it really helps a lot because it lets me immediately vent out the emotional turmoil at the moment I feel it.,” and “If I am prepared for what I will see and experience, the effect is not so bad and easy to resolve even through talks or such.” Demobilization and defusing are some of the effective stress management techniques for paramedics. These are however applicable after encounter with a mission (Galloucis, Silverman and Francek, 2000, pp.11). According to the respondents: “I would recommend defusing as a good stress management technique.,” “...when you do defusing, you get emotional social support from people around you...,” “Any form of prevention like psychological preparation is best.,” and “Talking to other people is also good, like defusing.” Discussion How Do These Findings Compare with the Literature? This paper sought to perform a qualitative research aimed to understand stress as it occurs among paramedics. It pays particular attention to things that cannot be quantified (Grbich, 2012a), such as experiences or feelings of the paramedics in their performance of duty. According to the literature, research is a process by which one establishes knowledge or obtains information. Qualitative research fits well in the topic of stress among paramedics because it provides the researcher with crucial information that supports the concepts presented in empirical researches done on the topic. Stress is something that cannot be quantified, thus, the qualitative research strategy is appropriate in establishing the accuracy of the data on stress. Through the ethnographic research, questions that cannot be answered through counting were addressed (Grbich, 2012c). It provided better understanding on why stress occurs, and why stress management is necessary especially among paramedics. Review of the available literature is not enough to establish a fact, and accounts of first-hand experiences on the topic would give the research more credibility. Hearing what paramedics have to say on their experiences on stressful missions and stress management strategies opens an avenue for the formulation of new theories on the topic. According to the experts, stress among paramedics is widespread (Buurman, Mank, Beijer and Olff, 2011, pp.321). Furthermore, stress management strategies are crucial in ensuring that the emotional, physical, and mental well-being of the people involved are looked after (Regehr and Millar, 2007, pp.49). Through ethnography, opinions coming from the fact that not all groups of people view things the same way are eliminated (Grbich, 2012c). However, according to the literature, high ethical standards should be applied in research, and this is why random sampling was done to avoid, or at least limit, bias. How Does Theory Explain the Findings? Ethnography provided the means to gather appropriate information on a specific group of people (Grbich, 2012c) --- the paramedics. It can be said that stress is a common word thrown around everyday, but through the ethnographic research, one is able to understand that stress could really be a serious matter among paramedics, and that stress management strategies are crucial and taken seriously. According to the literature, guilt and feelings of helplessness can occur after a rescue mission. Through the interviews done, it is established that such feelings occur at a high-rate when paramedics deal with vulnerable populations such as the children. Moreover, according to the findings, stress preventive measures such as psychological preparation prior to a mission alleviate the feelings of guilt and helplessness that trigger stress. According to the available literature on stress among paramedics, getting the paramedics prepared for what they will see on the mission site can help them to be emotionally and mentally ready (Shakespeare-Finch, et al., 2003, pp.65). Through the interviews, it can be gleaned that focus on getting the paramedics physically ready, but emotionally and mentally unprepared for what they will witness on the site aggravate negative feelings and thoughts, which caused them to succumb to stress in time. Furthermore, ethnography also provided information on which stress management strategy is preferred by interviewed paramedics. According to them, defusing is highly recommended because it can be more personal. In the findings, defusing and demobilization are the mostly done strategies in managing stress, and the interview responses support this data. Conclusion and Recommendation In this study, there are three main conclusions regarding stress among paramedics and stress management strategies. One, paramedics get stressed mostly in tragic events that involve vulnerable population like the children, and stress management strategies are crucial for them to keep on performing well in their jobs. Disregarding stressors and symptoms of stress can create a negative impact on the overall well-being of the paramedics, and it could be both personally and professionally debilitating. Two, preventing occurrence of stress is the best way to combat it. Three, interventions through post-mission stress management strategies are also good in minimizing the after-effects of stressful missions. The ethnographic research through the qualitative data collection of one-on-one interviews provided a more insightful detail of paramedics favouring prevention over any other strategies of stress management. Prevention is still the best way to combat stress (Shakespeare-Finch, et al., 2003, pp.58). Paramedics should go through psychological preparation through briefs of the expected situations and cases. Moreover, presence of operations management aimed to control pressure and confusion in a paramedic exercise helps in decreasing post-mission stress among paramedics (Saberi, 2010, p.1471). If paramedics went through psychological preparation before a mission, defusing and demobilization yields greater positive results after a mission. Moreover, according to the findings, demobilization and defusing are some of the effective stress management techniques for paramedics. These are however applicable “after encounter with a mission” (Saberi, 2010, p.1471). In the interview responses with the paramedics, both defusing and demobilization are good strategies, although some prefer defusing more, because of the personal touch that comes with it. Prevention is the recommended strategy among respondents. One cannot disregard the importance of being ready for what is to come. It could help the paramedics have an easier time dealing with the feelings of guilt. Furthermore, release of feelings of stress after a mission is also helpful and very necessary. It can be concluded that the post-mission stress management strategies would have a more positive effect had pre-mission psychological preparation been done. It is recommended that a follow-up research on the impact of stress among paramedics be done. Ethnographic research can again be applied for the follow-up study. It will aim to show further the importance of paying attention to stressors and stress symptoms among paramedics, and delve deeper into the low-range and high-range impacts of stress in their personal and professional lives. Such study could provide more understanding and details on how to best decrease and combat stress among this group of professionals. List of References BUURMAN, B., MANK, A., BEIJER, H., & OLFF, M. (2011). Coping With Serious Events at Work: A Study of Traumatic Stress Among Nurses. Journal of the American Psychiatric Nurses Association. 17, 321-329. GALLOUCIS M, SILVERMAN MS, & FRANCEK HM. (2000). The impact of trauma exposure on the cognitive schemas of a sample of paramedics. International Journal of Emergency Mental Health. 2, 5-18. GRBICH C. Qualitative methods for social health research - Lecture 1. 2012a. [lecture] Adelaide: The Flinders University of South Australia. GRBICH C. Qualitative methods for social health research - Lecture 2: Ethics in research Literature Review. 2012b. [lecture] Adelaide: The Flinders University of South Australia. GRBICH C. Qualitative methods for social health research - Lecture 3. 2012c. [lecture] Adelaide: The Flinders University of South Australia. GRBICH C. Qualitative methods for social health research - Lecture 5: Qualitative Interviewing. 2012d. [lecture] Adelaide: The Flinders University of South Australia. REGEHR, C., & MILLAR, D. (2007). Situation Critical: High Demand, Low Control, and Low Support in Paramedic Organizations. Traumatology. 13, 49-58. SABERI, H. (2010). PW01-52 - Post-traumatic stress disorder (PTSD) among emergency medicine staff. European Psychiatry. 25, 1471. SHAKESPEARE-FINCH, J., SMITH, S., GOW, K., EMBELTON, G., & BAIRD, L. (2003). The Prevalence of Post-Traumatic Growth in Emergency Ambulance Personnel. Traumatology. 9, 58-71. Appendices Appendix A Interview Transcript: Bader 1. What is your immediate reaction to a death or serious injury encountered in missions, especially that of a child? => I immediately feel shock and pain. It's like seeing my own child in that condition. Sometimes I have to fight back tears because I feel helpless. 2. What are the major categories of stress symptoms and how essential are they in identification and management of stress? => Nightmares, body pain, and lack of focus are for me important signs of stress and it is urgent to identify them immediately because it could lead to more serious matters if left undiagnosed and untreated. 3. What are some of the common techniques used in evaluation and management of stress in your scope of work? => Usually it is diagnosed by the length of time that the person is experiencing the symptoms. Sometimes one experiences it for weeks up to several months. 4. Which method has been the most effective for you in stress management? => Preparation is always the best for me – psychological preparation. And then after the mission, demobilization is good especially for large-scale missions. It's like a good rest and recharge. 5. Which other techniques would you recommend for stress management among paramedics? => I would recommend defusing as a good stress management technique. It is comfortable, private, and a bit personal. It can also be done a bit immediately after a mission so it's like a quick stress-relief after all the emotional imbalance during the mission. Appendix B Face Sheet: Bader Participant Profile: Experience/Age/Role: 8/37/ambulance Research Topic / Question: How to Handle Stress as a Paramedic Interview Number: 1 of 4 Interview Date: 26/04/2012 Place of Interview: Respondent’s work station Relevant Info: Special Comments: The interview questions were developed around data from previous researches done on the topic, available literature, and commonly-known and accepted facts. Issues Emerging from This Interview: The symptoms are so common that it takes a while to diagnose Prevention of stress through psychological preparedness is the best management approach Prevention is the best control initiative They are able to cope more when they come prepared . Issues to be Followed Up in the Next Interview: What makes them more prone or less prone to stress, after going through stress themselves? How do they deal with the similar mission/s that induce stress in their lives before? Does experience teach them how to become more prepared? Does experience lessen their susceptibility to stress? Is there such a thing as relapse? After they go through stress management, are they more prone to stress now than before? Appendix C Interview Transcript: Fares 1. What is your immediate reaction to a death or serious injury encountered in missions, especially that of a child? => Guilt. I feel immense guilt especially if the child dies. It's like I'm partly to blame because I wasn't there by the time the child really needs me. 2. What are the major categories of stress symptoms and how essential are they in identification and management of stress? => A combination of emotional and behavioural stress symptoms. It's like I forget how to have fun and always remember how the victim looked like...and I feel guilty again...and sometimes I get angry for no reason. 3. What are some of the common techniques used in evaluation and management of stress in your scope of work? => A common technique I'm familiar with is checking how much a person is affected by the stress symptoms...like, does it really affect him much? Does it affect the family already? 4. Which method has been the most effective for you in stress management? => Defusing is good, and also demobilization...it's like debriefing...and you do it in large groups. You get to share what you're going through with other people who might be going through the same thing. It's good. 5. Which other techniques would you recommend for stress management among paramedics? => Maybe defusing...because not all missions are large-scale...and at least when you do defusing, you get emotional social support from people around you, and it is very important. Appendix D Face Sheet: Fares Participant Profile: Experience/Age/Role: 7/35/ambulance Research Topic / Question: How to Handle Stress as a Paramedic Interview Number: 2 of 4 Interview Date: 26/04/2012 Place of Interview: Respondent’s work station Relevant Info: Special Comments: The interview questions were developed around data from previous researches done on the topic, available literature, and commonly-known and accepted facts. Issues Emerging from This Interview: An impact, be it physical or mental, starts from emotional imbalances / disturbances Stress affects even the people around the personnel like colleagues, friends, and family Stress impacts can either be physical, cognitive, emotional, behavioral or a combination Issues to be Followed Up in the Next Interview: What makes them more prone or less prone to stress, after going through stress themselves? How do they deal with the similar mission/s that induce stress in their lives before? Does experience teach them how to become more prepared? Does experience lessen their susceptibility to stress? Is there such a thing as relapse? After they go through stress management, are they more prone to stress now than before? Appendix E Interview Transcript: Shabab 1. What is your immediate reaction to a death or serious injury encountered in missions, especially that of a child? => I feel guilty and I blame myself for not being that fast to help. Sometimes it comes to the point when you question your work and what its value is if you can't really save even a small child. 2. What are the major categories of stress symptoms and how essential are they in identification and management of stress? => Sometimes it is emotional. It could also be cognitive. It really affects the person and sometimes even the immediate family members and co-workers, so it is essential to diagnose it immediately to know the best intervention. 3. What are some of the common techniques used in evaluation and management of stress in your scope of work? => The degree and number of stress symptoms that a person feels is the most common technique used to determine the stress level of a person. 4. Which method has been the most effective for you in stress management? => Defusing is the most common I have experienced and it really helps a lot because it lets me immediately vent out the emotional turmoil at the moment I feel it. 5. Which other techniques would you recommend for stress management among paramedics? => Stress is really best prevented at first. Any form of prevention like psychological preparation is best. One really needs to be ready for whatever motional and mental shock he can feel on a mission because it is dangerous to be in shock especially during the rescue. Appendix F Face Sheet: Shabab Participant Profile: Experience/Age/Role: 8/35/operations Research Topic / Question: How to Handle Stress as a Paramedic Interview Number: 3 of 4 Interview Date: 27/04/2012 Place of Interview: Respondent’s work station Relevant Info: Special Comments: The interview questions were developed around data from previous researches done on the topic, available literature, and commonly-known and accepted facts. Issues Emerging from This Interview: Prevention is the best control initiative They are able to cope more when they come prepared . Prevention of stress through psychological preparedness is the best management approach Stress affects even the people around the personnel like colleagues, friends, and family An impact, be it physical or mental, starts from emotional imbalances / disturbances Issues to be Followed Up in the Next Interview: What makes them more prone or less prone to stress, after going through stress themselves? How do they deal with the similar mission/s that induce stress in their lives before? Does experience teach them how to become more prepared? Does experience lessen their susceptibility to stress? Is there such a thing as relapse? After they go through stress management, are they more prone to stress now than before? Appendix G Interview Transcript: Ali 1. What is your immediate reaction to a death or serious injury encountered in missions, especially that of a child of a child? => Anger is always common for me. I feel angry at whatever the cause sometimes, and it could be lack of security or anything. 2. What are the major categories of stress symptoms and how essential are they in identification and management of stress? => For me, especially if I encounter child accidents during a mission, I feel paranoid for my family – paranoid and helpless. It is disturbing. I always try to prevent possible causes although I know it is almost impossible. It is crucial to diagnose it because it can affect life. 3. What are some of the common techniques used in evaluation and management of stress in your scope of work? => Questions like how long have I felt it, or how many times have I felt it. It is also good to determine if it affects the personal and professional life of the person. For me, it does. 4. Which method has been the most effective for you in stress management? => Defusing is most effective for me. Also prevention thought preparation. If I am prepared for what I will see and experience, the effect is not so bad and easy to resolve even through talks or such. 5. Which other techniques would you recommend for stress management among paramedics? => I would recommend preparation, because it works best for me. Talking to other people is also good, like defusing. It gives me emotional support and strength to see it is not only me who is affected. 5. Appendix H Face Sheet: Ali Participant Profile: Experience/Age/Role: 8/37/ambulance Research Topic / Question: How to Handle Stress as a Paramedic Interview Number: 4 of 4 Interview Date: 27/04/2012 Place of Interview: Respondent’s work station Relevant Info: Special Comments: The interview questions were developed around data from previous researches done on the topic, available literature, and commonly-known and accepted facts. Issues Emerging from This Interview: The symptoms are so common that it takes a while to diagnose An impact, be it physical or mental, starts from emotional imbalances / disturbances Stress affects even the people around the personnel like colleagues, friends, and family Paramedics under stress seemed to show feelings of detachment from the real world Prevention is the best control initiative They are able to cope more when they come prepared . Issues to be Followed Up in the Next Interview: What makes them more prone or less prone to stress, after going through stress themselves? How do they deal with the similar mission/s that induce stress in their lives before? Does experience teach them how to become more prepared? Does experience lessen their susceptibility to stress? Is there such a thing as relapse? After they go through stress management, are they more prone to stress now than before? Appendix I Thematic Analysis: Question #: Common Theme: 1 Highly affected when the victims are from the vulnerable population like children 2 Physical manifestations of stress like headaches, stomachaches, body pains, etc. 3 Stress is diagnosed, but only after some time, and usually by counting the manifestations and the period of time these symptoms are felt 4 Prevention is preferred, and also immediate means to release the emotional and mental turmoil right after a mission 5 Stress management strategies work best when coupled by psychological preparation Appendix J Ethics Form (Interview invitation Letter): Research Topic: How to Handle Stress as a Paramedic Invitation: You are being invited to take part in a research interview. Before you decide to agree or refuse to participate, it is important for you to understand the purpose of the research and how you will be involved. Please take time to read this form. Purpose of the Research: The purpose of this research is to identify how paramedics handle stress, and how ethnographic research can help reach a deeper understanding on the available data regarding stress among paramedics. Why were You Invited for an Interview? As a co-paramedic in the same emergency services facility, and as one of the senior members of the paramedics group, your input is deemed highly valuable for this research. A few other paramedics who are equally experienced are also invited to participate. Are You Required to Participate? Participation in the research is absolutely voluntary. Should you decide to take part, you are still able to change your mind at anytime prior to or during the interview. What will Happen During the Interview? You will be asked a few questions. The answers will mainly be based on your own observations and experiences. The whole interview could take 10-15 minutes. What are the Disadvantages of Participating? Aside from time consumption, there is no risk or disadvantage viewed regarding participation in this research. What are the Advantages in Participating? You participation will surely aid in helping toward the better understanding of the topic. Confidentiality: All private information will be kept in strict and high confidence. Your identity will remain absolutely anonymous. However, you will be asked to sign a copy of this letter as proof of informed consent. What Should I Do if I Want to Participate? If you have further questions or want to take part in this research, kindly contact: Almutairi Abdullah at (email address) or (contact number) on or before April 23, 2012. Thank you for your time. April 20, 2012 Read More