The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals

Campos, Abraham; Ernest, Eric; Cash, Rebecca E.; Rivard, Madison K.; Panchal, Ashish R.; Clemency, Brian M.; Swor, Robert A.; Crowe, Remle P.

doi:10.1080/10903127.2020.1785599

Cited by 16 publications

(17 citation statements)

References 41 publications

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“…Communication skills to confirm and clarify goals of care during acute crisis, in particular transportation, is well within the scope of practice of paramedics, but this skill benefits from communication training. Similar communication skills training has been successful for death notification [15], and can even have a protective effect for EMS clinicians against burnout [16]. When empowered with the communication tools, interactions can be rewarding rather than morally distressing [13].…”

Section: Discussionmentioning

confidence: 96%

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

et al. 2022

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Background Physician Order for Life-Sustaining Treatment forms (POLST) exist in some format in all 50 states. The objective of this study is to determine paramedic interpretation and application of the California POLST for medical intervention and transportation decisions. Methods This study used a prospective, convenience sample of California Bay Area paramedics who reviewed six fictional scenarios of patients and accompanying mock POLST forms. Based on the clinical case and POLST, paramedics identified medical interventions that were appropriate (i.e. non-invasive positive pressure airway) as well as transportation decisions (i.e. non-transport to the hospital against medical advice). EMS provider confidence in their POLST interpretation was also assessed. Results There were 118 paramedic participants with a mean of 13.3 years of EMS experience that completed the survey. Paramedics routinely identified the selected medical intervention on a patients POLST correctly as either comfort focused, selective or full treatment (113-118;96%-100%). For many clinical scenarios, particularly when a patient’s POLST indicated comfort focused treatment, paramedics chose to use online medical oversight through base physician contact (68-73;58%-62%). In one case, a POLST indicated “transport to hospital only if comfort needs cannot be met in current location”, 13 (14%) paramedics elected to transport the patient anyway and 51 (43%) chose “Non-transport, Against Medical Advice”. The majority of paramedics agreed or strongly agreed that they knew how to use a POLST to decide which medical interventions to provide (106;90%) and how to transport a patient (74;67%). However, after completing the cases, similar proportions of paramedics agreed (42;36%), disagreed (43;36%) or were neutral (30;25%) when asked if they find the POLST confusing. Conclusion The POLST is a powerful tool for paramedics when caring patients with serious illness. Although paramedics are confident in their ability to use a POLST to decide appropriate medical interventions, many still find the POLST confusing particularly when making transportation decisions. Some paramedics rely on online medical oversight to provide guidance in challenging situations. Authors recommend further research of EMS POLST utilization and goal concordant care, dedicated paramedic POLST education, specific EMS hospice and palliative care protocols and better nomenclature for non-transport in order to improve care for patients with serious illness.

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Section: Discussionmentioning

confidence: 96%

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

et al. 2022

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“…In 2018, Emam et al stated that verbal violence was the most common type of violence against nurses and that patients' companions were the most common source of violence [ 22 ]. Breaking bad news is considered one of the main reasons for violence against health care workers, mostly against emergency departments personnel, with disastrous consequences for staff (frustration and burn-out), patients, and organizations [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

The experience of pre-hospital emergency personnel in breaking death news: a phenomenological study

2022

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Background Today, breaking the death of patients to their families has become one of the challenges for medical staff. Considering the lack of study in the pre-hospital emergency, the present study aimed to explore the experience of pre-hospital emergency personnel regarding the breaking death news to families. Method In this qualitative study with a descriptive phenomenological method, data were collected by purposeful sampling method through in-depth interviews with thirteen pre-hospital emergency personnel in Kermanshah and Kurdistan provinces. After recording and writing the interviews, the data were managed by MAQUDA-10 software and analyzed using the Collaizi approach. Results Of 13 participants, five from Kermanshah, eight from Kurdistan, and 12 (92%) were married. The mean age and work experience were 34.38 and 10.38 years, respectively. Five main extracted themes were 1) perceived stress, 2) challenge factors of breaking death news, 3) unnecessary actions, 4) death breaking precautions, and 5) BDN requirements. They were covered fifteen sub-themes. Conclusion In this study, emergency medical employees were always faced with stress and challenges to announce the patient's death to families, including the stress of violence against employees. Hereof, personnel had to take unnecessary care actions such as slow resuscitation to transfer the patient to the hospital.

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“…In fact, adequate training could help professionals feel more prepared and increase their self-esteem [ 39 ]. Some professional figures have expressed concern about the long-term effects that the role of death notifier could have; in fact, a continuous and prolonged exposure to the theme of death and tasks of this type could lead to a considerable degree of professional burnout [ 7 ] and emotional exhaustion [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, somatic reactions such as tachycardia or heart rate instability may occur [ 3 ], but also insomnia and fatigue [ 21 ]. Understandably, repetitive exposure to this task can lead to a greater likelihood of emotional ‘exhaustion’ [ 22 , 23 ]. These are just some of the reasons why it is important for professionals to acquire adequate skills and strategies, in order to improve their sense of self-efficacy [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Communicating Unexpected and Violent Death: The Experiences of Police Officers and Health Care Professionals

Leo

Congregalli²,

Guarino³

et al. 2022

IJERPH

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Background: The notification of unexpected and violent death represents a challenging experience for police officers and health workers. These professionals are exposed to very intense emotions during this task. Aim: We aimed to investigate the degree of preparation, and the emotions and attitudes of police officers and health professionals while communicating such a death. Method: An ad hoc online questionnaire was created and disseminated through Qualtrics software. The participants were recruited through the institutional channels of Police, the College of Physicians, the ONG De Leo Fund and the Department of General Psychology of the University of Padua. In this qualitative study, thematic content analysis was used to examine the responses. Results: A total of 155 individuals participated in the study (44 females, 111 males): 102 individuals were police officers, 23 were doctors and were 30 nurses. Five main themes were identified: (1) how the communication took place; (2) the experiences during the communication; (3) the difficulties encountered; (4) coping strategies, and (5) forms of support. Most communications were performed in person, and most represented an intense emotional experience for the notifiers. There is a generalised lack of specific preparation and training for this practice. The recipient’s characteristics (culture of origin, language, age, health conditions, psychological vulnerability) may add to the difficulties of the notification process. Professionals unload their tension by practicing sport, relying on their hobbies or interacting socially. The presence of other colleagues during and after the death notification is usually able to alleviate the burden of the communication. Conclusions: Communication modalities can have a profound impact on the recipients and intensify the trauma of the loss; however, they also have the possibility of mitigating it. The notification of a violent and unexpected death remains a difficult and challenging task for the notifier, which is potentially stressful and emotionally charged. The topic is of great relevance and more research should be promoted in this area.

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The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals

Cited by 16 publications

References 41 publications

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions

The experience of pre-hospital emergency personnel in breaking death news: a phenomenological study

Communicating Unexpected and Violent Death: The Experiences of Police Officers and Health Care Professionals

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