How to Resolve the Stress Encountered by Paramedics as a Result of Shift Work - Research Paper Example

How to resolve the stress encountered by paramedics as a result of shift work? [Name] [Professor Name] [Course] [Date] How to resolve the stress encountered by paramedics as a result of shift work? Abstract: This paper discusses the methods of qualitative research used in determining how to resolve the stress encountered by paramedics as a result of shift work. The items discussed include sampling strategies, date collection methods, analytical process and ethical issues. The results section examines the analytical steps in analyzing the data collected from the four interviews and provides the themes developed from the study. The study found that the more experience the paramedics had, the less stress they had. In addition, it was found that the greatest and predominant source of stress originates from huge workload and night shifts that resulted to fatigues. This underscores the need for hospitals to develop stress management strategies and programs for the paramedics in consistency with the Cognitive-relational theory as proposed by Lazarus and Folkman (1984b, p. 19). Literature Review The work of paramedics is on average unscheduled and characterized by working in environments or under situations that are often chaotic, urgent and random. Under such circumstances, fast clinical decisions have to be made thus placing significant pressure on the paramedics, thus contributing to stress (Porter 2008.). Patterson et al (2005) concurs with the view and further reiterates that the level of stress depended on an individual’s years or service or experience. The extreme emotional pressure that the paramedics faced resulting from unpredictable environments and situations aggravates the level of stress that the paramedics face. Iranmanesh et al (2013) identified wide spectrum of symptoms of the stress, such as irritability, anxiety, anger, poor concentration and nightmares of the incidents. Iranmanesh et al (2013) further observed that the levels of stress among the paramedics are among the highest compared to other healthcare professionals such as the nurses or physicians. This is explained by the logic that the paramedics encounter many patients who suffer from severe trauma resulting from road accidents or other accidents such as fire among others and this is often worsened by long shift works and the uncertain environment and situations (Iranmanesh et al 2013). Patterson et al (2005) further observed that work-related stress affects the attitudes of employees. For instance, increase in stress decreased employees’ morale. Mildenhall (2012) argues that frustrations from long hours of work in shifts are also a major contributor of stress. The personal cost of stress can be high to the paramedics as the financial and social impacts of the depressive tendencies can impinge on the economic and social life of their families. However, according to Vicki et al (2011), although it is clear that paramedics are frequently exposed to traumatic or stressful situations, that affect their physical, mental and social well-being, what is not clear is the effect of the traumatic stress symptoms on the response of these workers to acute stress situations. Acute stress is both physiological and psychological experience. From the psychological point of view, when the requirements of a particular situation overwhelm an individual’s resources, the situation will be thought to be a threat to the individual’s well-being and the immediate response would be either anxiety or stress (Vicki et al 2011). From the physiological perspective, stressful situations cause sympathetic nervous system response that result in impaired adaptive response during acute stress (Vicki et al 2011) According to Mildenhall (2012), the greatest consequence is however the self-inflicted lifestyle diseases including depression, hypertension and stroke. Halpern et al (2009) agrees that paramedics are frequently faced by traumatic incidents that can result in considerable emotional breakdowns. Psychological interventions that enable the paramedics to have the resources to handle the stressful conditions as well as be mentally prepared can help improve an individual’s coping styles. This is consistent with Cognitive-relational theory as proposed by Lazarus and Folkman (1984b, p. 19) that defines stress as a specific relationship between an individual and the environment that is viewed by the individual as stressing or exceeding his resources and endangering is well-being. It is critical for organizations to contain stress before it is felt and the response mechanisms initiated, as every emergency case that the paramedics respond to have the potential to cause stress (Mildenhall 2012). The Cognitive-relational theory is critical in identifying the possible interventions for resolving the stress encountered by paramedics as a result of shift work. Halpern et al (2009) proposes two methods of intervention to ensure that the paramedics recover from the aftermath of the stressful incidents. The two include supervisor support and brief timeout period that allows the paramedics to talk freely with peers. (Vicki et al 2011) however argue that the potentially significant mediating factor during acute stress response and posttraumatic stress depends with an individual paramedic’s coping style. For instance, the thoughts and behavior the individual applies in managing the demands of the stressful conditions. Methods To answer the question, “How to resolve the stress encountered by paramedics as a result of shift work?” qualitative research methods were used. The approach is the most appropriate given that it emphasizes on translating, decoding or describing people’s experiences. Technically, qualitative research methods are conceived as suitable for establishing the meanings that people place to experiences, processes, events and systems based on their assumptions, attitudes, perceptions or suppositions (Dean, Lam and Natoli, 2009). Towards this end, phenomenology theory was selected for the research as the study aims to derive meaning from paramedic’s experiences as a result of shift work. Phenomenology approach aims to explore how participants make sense of their experiences and the meanings they give to these experiences. The approach is widely in use in human and social sciences such as in sociology, nursing, psychology, and health sciences (Hycner 1985). A number of conditions were considered in determining whether the qualitative study was suitable. These included questions about paramedic participant’s experiences, inquiry into the meanings they placed on their experiences, and a study of the context of their interpersonal or social environment (Murphy 1998). Typically, qualitative research instruments essential for data collection comprises document analysis, observations and interviews. Given that the phenomenology approach was considered for the study, interviews were selected as the most appropriate research instruments for the study. In health sciences, interviews are the most suitable instruments especially if the research is interested in the interpersonal issues, social aspects of healthcare or in cases where the evidences are limited (Priest 2000). In particular, semi-structured interview was applied in interviewing the paramedic participants. This is since such instruments are characterized by flexible topic guides which present loosely structured open-ended questions for exploring attitudes and experiences (Denzin and Lincoln, 2000). Further, they are highly flexible and enable the interviews to be conducted at any setting and generate enriched data. For instance, the interviews for this particular study were conducted at home and at the university. Semi-structured interview also allows the researcher to develop a rapport with the interviewee. This is critical in qualitative research (Dean, Lam and Natoli, 2009). Data collection Data collection process took 3 days. Triaungulation was applied to ensure the date collected were accurate and of considerable integrity. According to Al-Busaidi (2008), triangulation is an approach used in viewing data from different points of view. Within this approach, multiple techniques are used to provide evidence that validate the study. The research used theories and literature reviews to offer varied ways to determine ways in which the stress encountered by paramedics as a result of shift work can be resolved (Mildenhall 2012). Triangulation adds credibility and confidence in the findings drawn from the research. In using triangulation, the perspectives of the paramedics from different points of view were compared. The target group of the study included four paramedics. One was interviewed at home while the rest at the university. Criteria for inclusion were selection of full time paramedic staff and paramedics who have worked in the profession for more than 5 years. The sampling strategy in the study was significantly determined by the objective of the study, since statistical representations were not regarded as a necessity, it was not sought. The aim of sampling was to identify the specific groups or people who work under circumstances that are relevant to the phenomenon under study (Halpern 2008; Shantz 2002; Patterson et al 2005). As a result, the identified paramedic participants were expected to provide the researcher with an opportunity to explore their attitudes and behaviors pertinent to the research. Of the two types of samples, namely homogenous and maximum variation samples, the researchers selected homogenous sampling as it enables selecting a small group expected to represent a particular subgroup in depth. In addition, the size of sample is not restricted by fixed rules but factors such as time, resources and depth of the study and what is practicable for the researcher (Crotty, 1998). The study was conducted in one phase. The paramedics were identified, selected and requested to participate in the study. The structure of the interview was aptly flexible to allow for broadening of more exhaustive or emotionally important data. The interviews were on case-by-case basis, and each individual interview took about 20 minutes and was exclusively conducted by the researcher. All the interviews took place away from their placements. Given the existence of numerous contraindicating findings on the stress factors encountered by paramedics as a result of shift work, as indicated by literature review, the study centered chiefly on the investigation on how to resolve the stress encountered by paramedics as a result of shift work (Murphy 1998; Vicki et al 2011). Hence, the paramedic’s orientation and ideas on their line of work and the prevalent issues associated with their work experiences while handling the patients were critical. In that case, the study conducted tested their opinions, attitudes and experiences (Barry and Yuill 2002). The inquiries included their experiences working as paramedics, their opinions about the reasons that make a paramedic to suffer from stress, their ideas about the relationship between stress results of emotion work, their experiencing about stress, and whether they believe that stress could affect paramedic’s family or friends or co-workers in shift work. Further probes included what the paramedics think the influences of the stress will affect the paramedic performance, their thoughts about the fact of paramedic's job, which is producing stress for this reason, and whether the job is a likely contributor to low employee retention, how they were affected by pediatric deaths and injuries and lastly, their stress management strategies to deal with stress. Data Analysis Since the researcher selected phenomenology method of study for the research, the modified van Kaam method of data analysis was used to organize, analyze and synthesize the data (Moustakas 1994). Step 1: Listing - The data transcribed from the interviews was listed and grouped. No statement from the respondents was omitted and each phrase was treated as equally relevant. This approach is called horizonalization. Step 2: Elimination - Some date were either eliminated or reduced by reading each transcript repeatedly to eliminated answers that did not answer the questions. Repetitive, vague or overlapping expressions were discounted. The remaining phrases were considered as invariant constituents of the paramedic participants’ experiences. They were considered to describe the origin of their stresses and how to resolve them in descriptive terms (Moustakas 1994, p. 121). Step 3: Grouping and Deriving themes from Invariant Constituents - The invariant constituents were grouped and the major themes of the experiences defined. Some of the themes included beliefs about paramedics profession, role expectation, motivational factors, deterrent factors, professional socialization and personal socialization attitudes. Step 4: Identification of Themes and Invariant Constituents and by Validation - The invariant constituents and the themes were checked against each of the four transcripts from the interviews to verify that the themes were either expressed explicitly or were related to the constituents. The relevance of the experiences was determined at this stage. Step 5: Creation of Textural Description - The experiences of each of the individual participant were described using extracts derived from the transcript. To ensure this, the themes were described through a narrative format. Step 6: Creation of Individual Description - Each participant was incorporated into the textural description to depict the experiences that occurred. This process required reflecting on what the paramedics experienced through inter-subjectivity (Moustakas, 1994, p. 79). This was critical for understanding how the paramedics’ attitudes came to be and the conditions that necessitated such attitudes. Step 7: Creation of Textural-Structural Description - For each individual participant, textural and structural narratives created in Step 5 and 6 were merged. The resulting narrative description comprised an understanding of “how” the experience occurred (structure) and what had occurred (texture). After the reflective study, the researcher explained the experiences from their vantage point. Moustakas (1994) explains that the outcome of deducing the meaning to a phenomenon should take consideration of the importance of the condition that must exist for the phenomenon to take place. Step 8: Composite description - The data was synthesized to enable the composite structural and composite description. This was helpful in determining the significance of the entire experience. For instance, the opinions and attitudes of the paramedics on their job as filled with stressing conditions changed depending on the conditions of the scenarios when performing their duties. Conditions such as bureaucracy and red tape of the management contributed to negative socialization and professional attitudes. Ethical Concerns Given that each institution or individuals have their own traditions values, cultures and principles, it is critical to observe them in the course of the study. As a result, the rights of the paramedic participants were valued. First, their permissions to take part in the interview were sought. In addition, the participants were accorded the right of consent, in which case, before they were each interviewed, they were duly informed on the extent the research and what the research entailed and what the objectives of the research. Additionally, all considerations that ensured that the participants were protected from emotional or physical harm were observed (Scambler 2013). For instance, the researcher ensures that the interview questions used did not hurt the feelings of the participants or embarrass the participants during the interview. Further, the interviewees were allocated enough time to answer the questions to avoid infringing on their work schedules. Additionally, the research was objective, as the interviewer avoided expressing all biases, personal prejudices or opinions during the interview. In addition, the participants were assured that their responses or reactions were kept anonymous. Lastly, the participant’s responses were not used out of context of their original meanings (Denzin and Lincoln 2000). During the interview, the researcher carefully set aside personal observations and views and viewed the experience from the perspective of the each participant. The researcher aimed to practice inter-subjectivity – meaning experiencing the experience of the participants. Results Section The study captured the lived experiences of the four paramedics and their attitudes and opinions about factors that contribute to stressful working conditions at work. The experience indicated “what” attitudes the paramedics had towards the causes or stress at work and “how” it affected their performances and ways they used resolved such stresses. In all, seven themes were identified as indicated in Table 1 below. Table 1: Themes derived from the study Themes Definition Beliefs about paramedics profession Role Expectation Causes of Stress Motivational Factors Deterrent factors Personal Socialization Attitudes Solutions to Stress Experiences as paramedics Personal Personal relationships Work-related policies Workload Bureaucracy and red tape with management Extrinsic – can reduce workload if done properly Intrinsic – career choice, fun, fulfillment Increased workload Stress from work Violent patients Concerns of liability Threat to quality patient care Lack of interest Poor health Long shifts takes personal time for socialization Personal Hobbies Family support Stress management plan Concerning the theme of ‘beliefs about paramedic profession,’ it entailed the cognitive ideas that the paramedics held as true concerning their kind of work. All the interviewees agreed that their profession is challenging and stressful. The theme of role expectations entailed the respondent’s awareness of the duties, obligations and responsibilities associated with working as paramedics. The paramedics showed awareness of their job descriptions and the stressful conditions associated with it, such as pressures to revive or resuscitate patients on their way to the hospitals. The theme of motivational factors includes psychological features that induced the paramedics to work towards the purpose of their profession. The respondent generally agreed that working in the profession was fun and a fulfillment of their career dreams. This motivated them in the job despite the work-related stress. However, they tended to be of the opinion that the high stress factors, low salaries and low advancement opportunities reduced their morale for the work Deterrent factors include those factors that prevent the respondents from working effectively. The predominant factor is increased workload related to shift work that contributed significantly to stress. Other factors mentioned that were also responsible for stress include Violent patients, Concerns of liability, Threat to quality patient care, Lack of interest and Poor health due to fatigue. On the theme of personal socialization attitudes, the respondents were of the opinion that the long shifts take personal time for socialization. Concerning the theme of solutions to stress, the respondents shared the view that support from family and the management in managing the stress was highly critical. Stress management plan and the need to see psychiatrists were also suggested. Other suggestions from the respondents included the need to have free time from work to undertake personal hobbies. Findings and Discussion The study found that the greatest and predominant source of stress originates from huge workload and night shifts that resulted to fatigues. In answering the research question “How resolve the stress encountered by paramedics as a result of shift work?”, the study found that there is the need for paramedics to understand fully their job descriptions and duties, team support during heavy workloads, family support back at home, using a stress management plan such as seeing a psychologist and lastly indulge in personal hobbies. The findings emphasize the need for organizations to adopt psychological interventions that can provide the paramedics with mental, financial and social capacities to handle the stressful conditions as well as be mentally prepared. This indeed can help improve an individual paramedic’s coping styles in consistency with Cognitive-relational theory as proposed by Lazarus and Folkman (1984b, p. 19). The theory suggests that an individual’s emotional response to a stressful condition is based on his appraisal of the stress and whether the stressful conditions exceed his resources and endangers his well-being. Based on this theory, this paper study concludes that it is critical for organizations to enables resources and psychological interventions that contain stress before it is felt and the response mechanisms initiated. This relates to a study by Mildenhall (2012). The study found that the more experience the paramedics had, the less stress they had. This is consistent with a study by Patterson et al (2005) that observed that the level of stress depended on an individual’s years of service or experience. In contrast however, this study further found that the the new paramedics with less experience needed stress management plan, resources and an enabling environment for coping with stress to avoid job turnovers and depressions. This also relates to the Cognitive-relational theory as proposed by Lazarus and Folkman (1984b, p. 19), which postulates that stress is a resultant of a relationship between an individual and the environment that is viewed by the individual as stressing or exceeding his resources and endangering is well-being. According to the findings, the paramedics tended to agree that there is the need to develop strategies to manage stress. They explained that there is the need for paramedics to understand fully their job descriptions and duties, team support during heavy workloads, family support back at home, using a stress management plan such as seeing a psychologist and lastly indulging in personal hobbies. The study also found that stress can lead to poor job performances and high employee turnovers caused by changed attitudes over the job. This is consistent with a study by Patterson et al (2005) that observed that work-related stress affects the attitudes of employees and another study by Mildenhall (2012) that pointed out that increase in stress decreased employees’ morale. Recommendations Four recommendations are suggested from the study, including: I. Hospitals should develop stress management strategies and programs for the paramedics II. Paramedics should be made fully aware of their job descriptions and duties to understand III. Paramedics should be trained on conflict resolution strategies to avoid stress resulting from possible conflicts IV. There is need for the hospitals to use employee motivation strategies, such as increased pay and career advancements. Since this research study was largely qualitative in nature, there is need for future evidence-based researches to investigate whether the level of experience is directly related to the level of stress that paramedics face. In conclusion, stress encountered by paramedics as a result of shift work can be solved by emotional support offered by the family and the organization’s management, availability of timeout period to indulge in hobbies or engage on free conversation with other peers and lastly, stress management plans such as sessions with psychiatrists. References Al-Busaidi, Z. 2008. "Qualitative Research and its Uses in Health Care." Sultan Qaboos Univ Med J. 8(1): 11–19. Barry, A. & Yuill, C.2002. Understanding Health: A Sociological Introduction. London. Sage Publications Crotty, M. 1998. The Foundations of Social Research: Meaning and Perspective in the Research Process. London. SAGE Publications Ltd. Denzin, N. & Lincoln, Y. 2000. Handbook of Qualitative Research. London: Sage Publication Inc. Halpern, J., Gurevich, M., Schwartz, B. & Brazeau, P. 2009. “Interventions for critical incidents tress in emergency medical services: a qualitative study.” Stress and Health 25: 139–149 Hycner, R. 1985. "Some Guidelines for the Phenomenological Analysis of Interview Data." Human Studies 8:279-303 Iranmanesh, S., Tirgari, B. & Bardsiri, S. 2013. "Post-traumatic stress disorder among paramedic and hospital emergency personnel in south-east Iran." World J Emerg Med, Vol 4, No 1. pp26-31 Lazarus, R. S., & Folkman, S. 1984. Stress, appraisal, and coping. New York: Springer. Mildenhall, J. 2012. "Occupational stress, paramedic informal coping strategies: a review of the literature." Journal of Paramedic Practice, Vol. 4, Iss. 6,pp 318 - 328 Moustakas, C.1994. Phenomenological research methods. Thousand Oaks, CA: Sage. Murphy, E., Dingwall, R., Greatbatch, D., Parker, S. & Watson, P. 1998. "Qualitative research methods in health technology assessment: a review of the literature." Health Technology Assessment, Vol. 2: No. 16 Patterson, P., Probst, D, Janice, C., Katherine H., Corwin, S. & Paige, P. 2005. "Recruitment and Retention of Emergency Medical Technicians: A Qualitative Study." Journal of Allied Health; Fall 34 (3): 153-160 Porter, S. 2008. Increasing Paramedic Students' Resilience to Stress: Assessing Correlates and the Impact of Intervention. (Online) Retrieved from: [https://www.fanshawec.ca/sites/default/files/assets/research/IncreasingParamedicStudentsResiliencytoStress-PorterMay08.pdf] Accessed 7 June 2013 Priest, H. 2000." An approach to the phenomenological analysis of data." Nurse Researcher, Vol 10 No. 2: 50-62 Scambler, G. 2013. GBH: Greedy Bastards and health inequalities. 4th November [http://grahamscambler.wordpress.com/2012/11/04/gbh-greedy-bastards-and-health-inequalities/ ] Accessed 6 June 2013 Shantz, M. 2002. Effect of Work Related Stress on Firefighter/Paramedic. Michigan. Eastern Michigan University Vicki R. LeBlanc, Cheryl Regehr, Arija Birze, Kevin King, Aristathemos K. Scott, MacDonald, R. & Tavares, W. 2011. "The Association Between Posttraumatic Stress, Coping, and Acute Stress Responses in Paramedics." 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Psychological interventions that enable the paramedics to have the resources to handle the stressful conditions as well as be mentally prepared can help improve an individual’s coping styles. This is consistent with Cognitive-relational theory as proposed by Lazarus and Folkman (1984b, p. 19) that defines stress as a specific relationship between an individual and the environment that is viewed by the individual as stressing or exceeding his resources and endangering is well-being. It is critical for organizations to contain stress before it is felt and the response mechanisms initiated, as every emergency case that the paramedics respond to have the potential to cause stress (Mildenhall 2012).

The Cognitive-relational theory is critical in identifying the possible interventions for resolving the stress encountered by paramedics as a result of shift work. Halpern et al (2009) proposes two methods of intervention to ensure that the paramedics recover from the aftermath of the stressful incidents. The two include supervisor support and brief timeout period that allows the paramedics to talk freely with peers. (Vicki et al 2011) however argue that the potentially significant mediating factor during acute stress response and posttraumatic stress depends with an individual paramedic’s coping style.

For instance, the thoughts and behavior the individual applies in managing the demands of the stressful conditions. Methods To answer the question, “How to resolve the stress encountered by paramedics as a result of shift work?” qualitative research methods were used. The approach is the most appropriate given that it emphasizes on translating, decoding or describing people’s experiences. Technically, qualitative research methods are conceived as suitable for establishing the meanings that people place to experiences, processes, events and systems based on their assumptions, attitudes, perceptions or suppositions (Dean, Lam and Natoli, 2009).

Towards this end, phenomenology theory was selected for the research as the study aims to derive meaning from paramedic’s experiences as a result of shift work. Phenomenology approach aims to explore how participants make sense of their experiences and the meanings they give to these experiences. The approach is widely in use in human and social sciences such as in sociology, nursing, psychology, and health sciences (Hycner 1985). A number of conditions were considered in determining whether the qualitative study was suitable.

These included questions about paramedic participant’s experiences, inquiry into the meanings they placed on their experiences, and a study of the context of their interpersonal or social environment (Murphy 1998). Typically, qualitative research instruments essential for data collection comprises document analysis, observations and interviews. Given that the phenomenology approach was considered for the study, interviews were selected as the most appropriate research instruments for the study.

In health sciences, interviews are the most suitable instruments especially if the research is interested in the interpersonal issues, social aspects of healthcare or in cases where the evidences are limited (Priest 2000). In particular, semi-structured interview was applied in interviewing the paramedic participants. This is since such instruments are characterized by flexible topic guides which present loosely structured open-ended questions for exploring attitudes and experiences (Denzin and Lincoln, 2000).

Further, they are highly flexible and enable the interviews to be conducted at any setting and generate enriched data. For instance, the interviews for this particular study were conducted at home and at the university. Semi-structured interview also allows the researcher to develop a rapport with the interviewee. This is critical in qualitative research (Dean, Lam and Natoli, 2009). Data collection Data collection process took 3 days. Triaungulation was applied to ensure the date collected were accurate and of considerable integrity.

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