Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology

Abstract

BackgroundSelf-harm (SH) accounts for over 5% of the workload of emergency ambulance services, and therefore Paramedics are often the first health professional in contact with people who SH. The authors of this paper have reported elsewhere the significant gaps in our understandings which exist surrounding this early care interaction, and some of the challenges paramedics and opportunities in paramedic care for people who SH. This study aimed to explore paramedics’ perceptions of caring for those who SH using Evolved Grounded Theory Methodology.MethodsThis study took place between 2014–2016 in one UK ambulance service covering a population of three million people. Semi structured interviews were conducted, purposively sampling paramedics until saturation was reached. Interviews were recorded, transcribed verbatim, and coded through open, axial, and selective levels of coding, identifying the Basic Social Process (BSP) and developing a Grounded Theory. A second researcher (SH) independently reviewed early results, which were also member-checked with participants.ResultsEleven paramedics were interviewed. The following six categories emerged: Context; Judgements and values; Isolation and system failure; Managing risk; Competence at the boundary of mental and physical health needs; Professional, legal and ethical tensions. The BSP Decision making in a context of risk was identified. The final Grounded Theory that emerged was one of ‘Wicked Complexity of paramedic care for people who SH, which includes usual factors such as tiredness and frequent callers, heightened factors including lack of support and pathways, and factors specific to SH such assessing mental health and suicide risk.ConclusionsThis study builds on a very small body of literature to have explored paramedic care for people who SH and has found that this care interaction provides uniquely complex challenges. The multiple influences within the categories defined in this study need considering conjointly when making improvements to care.

‘You’re not just a medical professional’: Exploring paramedic experiences of overdose response within Vancouver’s downtown eastside

“…An interview guide was developed prior to conducting the interviews (S1 File). This guide was informed by the researcher's experience working as a paramedic as well as existing literature on emergency responder experiences [32,33]. One pilot interview was conducted by JWY with a part-time paramedic in order to assess whether questions were phrased clearly for the participant, and also to allow the researcher to become familiar with using the interview guide in practice [34,35].…”

Mental health training for Australian undergraduate paramedic science students: a review

“…The third aspect of mental health literacy is a person's attitude towards mental illness and treatment (Jorm et al, 1997). McCann et al (2018a) suggest paramedics generally have positive attitudes towards mental illness and are supportive of treatment, yet frequently report frustration when attending to patients who call for mental illness (Rees et al, 2018). The conclusion drawn by McCann et al (2018a) is that paramedics have a positive attitude towards mental illness in general but have a negative view of patients who use emergency services for mental illness.…”

“…More specifically, paramedics consider EMS to lack the appropriate resources to help patients with mental illness (McCann et al, 2018a) or that mental illness is not a life-threatening condition and, therefore, the use of emergency services in these situations is inappropriate (Ford-Jones and Chaufan, 2017;Prener and Lincoln, 2015). Two themes emerged across several studies in regard to the source of paramedics' frustration: one, that attending calls related to mental illness draws resources away from "more important" jobs (Rees et al, 2018;Hutchison et al, 2019) and two, that the EMS system was not appropriately resourced to help patients with mental illness without physical illness or injury (Cook, 2020;McCann et al, 2018a). Rees et al (2018) reported common problems for paramedics when attending calls related to mental illness include compassion fatigue as a result of attending the same type of job (e.g.…”

“…Two themes emerged across several studies in regard to the source of paramedics' frustration: one, that attending calls related to mental illness draws resources away from "more important" jobs (Rees et al, 2018;Hutchison et al, 2019) and two, that the EMS system was not appropriately resourced to help patients with mental illness without physical illness or injury (Cook, 2020;McCann et al, 2018a). Rees et al (2018) reported common problems for paramedics when attending calls related to mental illness include compassion fatigue as a result of attending the same type of job (e.g. self-harm) multiple times in a row or attending the same person repeatedly for the same reason; frustration at resources being redirected from other jobs, particularly during busy periods; limited options for patient referral and ongoing quality of care; fear of violence or aggression from patients or bystanders on the scene; and a lack of confidence in interpreting legal and ethical principles regarding mental illness.…”

“…Discriminatory attitudes and negative experiences from health-care providers are often quoted by people with mental illness as the reason they discontinue or avoid medical care, even in emergencies (Andrade et al, 2014;Ferguson et al, 2019;Morgan et al, 2016). Multiple studies from the UK (Rees et al, 2018;Rolfe, Pope and Crouch, 2020), the USA (Prener and Lincoln, 2015) and Australia (Emond et al, 2019;Holmes et al, 2017) report that paramedics feel underprepared to care for patients whose primary reason for presenting to EMS was related to mental illness. It remains unclear whether the ability of paramedics to care for and their attitudes towards patients with mental illness is related to the training they receive during their undergraduate degrees.…”