Bringing trauma home: spouses of paramedics

The profession of emergency care inevitably brings along with it a lot ofstress, both mental and physical. Paramedics and other emergency care professionals are faced with a multitude of varying situations ranging from harsh weather to violent patients and emotionally draining experiences such as witnessing extensively injured patients or deaths. Moreover, these individuals are also faced with different hassles such as working in exhaustive shifts, overtime issues and variable schedules (Blakely & Timmons, 2008; Regehr, Goldberg, & Hughes, 2002).

All these factors not only influence the paramedics themselves but also have a significant impact on their families. Studies have shown the existence of the phenomenon of secondary trauma (Figley, 1995 cited in Regehr, Goldberg, & Hughes, 2002), or vicarious traumatization (McCann & Pearlman, 1990; Saakvitne & Pearlman, 1996 cited in Regehr, Goldberg, & Hughes, 2002) amongst mentalhealthworkers who have been exposed to individuals who are faced with traumatizing experiences.

It has been proven that being exposed to the traumatic experiences of others predisposes individuals to develop symptoms ofanxiety, sleep disturbances and affective arousal (Regehr, Goldberg, & Hughes, 2002). Studies have revealed that emergency workers including ambulance personnel have a high incidence of post-traumatic stress disorder (PTSD) (Jonsson, Segesten, & Mattsson, 2003). Other studies reveal that by witnessing the trauma and suffering of victims, paramedics develop secondary trauma and if they share their experiences with theirfamilymembers, they too might experience vicarious traumatization (Blakely & Timmons, 2008).

Different individuals have been shown to deal with the stress in different ways. Some individuals might share their experiences with their family members and seek emotional support from them. In doing so, they inadvertently expose their family members to the same distress and anguish that they are experiencing. Thus families when extending their support towards the paramedics, who need to cope with the work-related stress, may themselves fall prey to developing mental distress via the process of secondary trauma (Blakely & Timmons, 2008).

On the other hand, some individuals may cope with the work-related stress that they experience via emotional numbing, whereby they display a loss of affect and emotional detachment (Regehr, Bringing the trauma home: Spouses of Paramedics, 2005). They may thereby have impaired family functioning and limited interactions with their family members (Regehr, Bringing the trauma home: Spouses of Paramedics, 2005). Both these coping strategies have thus been proven to indirectly have a negative influence on the family members of paramedics.

In addition, work stress has also been shown to impair the family functioning of paramedics (Blakely & Timmons, 2008). Another problem that the family members, in particular the spouses of paramedics have to face is dealing with the tough routine that these individuals have. Other concerns of the family members include the health risks and the physicalviolencethat the emergency care personnel are prone to (Blakely & Timmons, 2008).

Thus, the work-related mental stress experienced by personnel involved in emergency care does not only have impact on their own life and health but also on their family members, in particular their spouses. It therefore becomes imperative to study the influence and consequences of the mental distress which the paramedics face on their family lives and relationship, determine factors which influence the development of these problems, and hence improvise strategies to minimize the potential harm and risks associated with these problems.

Qualitative versus Quantitative research design for addressing this issue When undertaking research to address any issue, two different kinds of research methods exist, viz. qualitative and quantitative methods. The choice of the research method depends on the study question. When an exploration of the various aspects of a particular issue is required, qualitative research should be undertaken (Marshall, 1996). Qualitative research allows an in-depth study of the phenomenon of interest and involves observing the phenomenon in its naturalenvironmentwithout any interventions (Runciman, 2002).

The results yielded as a result of qualitative studies are transferable and such research answers ‘ why’ and ‘ how’ questions (Marshall, 1996). It provides a conceptual analysis of the issue and serves various different purposes including hypothesis generation, which can be further tested via using quantitative methods, to assess the pre-existing systems and functions and to convey to the policy makers the views and experiences of the individuals in question, amongst others (Fitzpatrick & Boulton, 1994).

Qualitative research is thus “ complex, contextual and influenced by the interaction of physical, psychological and social factors (Runciman, 2002). ” In the other hand, quantitative research uses a deductive or reductionalist approach and is aimed at testing preset hypothesis (Marshall, 1996). The main implications of this kind of research is in assessing the effectiveness of various interventions or comparing two different study groups. Quantitative methodology yields generalizable results and produces answers to ‘ what’ questions (Marshall, 1996).

Keeping in mind the above mentioned basic differences between qualitative and quantitative research and their applicability in various situations, the best suited form of methodology which can be used in identifying the impact of the work-related stress of the paramedics on their family lives is qualitative methodology. This is because the issue at hand requires an in-depth exploration of the various aspects and consequences of the work-related stress on the individuals, their family life and their spouses and qualitative approach is the most suitable for answering such questions.

Problem identification and definition The introduction section of a research article is aimed at identifying the research problem, to determine the magnitude of the problem in the society and to provide the rationale behind carrying out the study (Parahoo, 2006). In this article, the author clearly defines the problem which led to the conduction of this study viz. the negative impact of the work-related mental stress that paramedics face on their spouses (Regehr, 2005) and adequately explain the theoretical framework behind this problem.

According to the author, paramedics experience a considerable amount of mental and physical stress while at work and this influences their overall mood and affect. There are two main types of coping strategies that paramedics can adopt in order to overcome the mental distress they experience and these involve either remaining detached and emotionally aloof from the situations faced, i. e. emotional numbing, or explicitly sharing their experiences with others (Regehr, 2005).

Neither of these strategies have been found to be useful since the former leads to a poor quality of relationships as the numbing prevails in everyday life and leads to an inability to emotionally engage and interact with others, and the latter has been found to induce symptoms of post-traumatic stress disorder in the family members whereby they start experiencing stress similar to that faced by the paramedics (Regehr, 2005).

The author thus surmises that the work related stress of paramedics does not only bring significant distress to the individuals in question, but also to their family members, in particular their spouses, and this is a considerable problem that warrants research in order to elucidate the factors contributing towards this problem (Regehr, 2005). Thus, in this article, the phenomenon of interest is clearly identified and the theoretical underpinnings of the problem have been adequately addressed.

However, when defining the problem, the author does not explain why the qualitative study design would be best suited for this particular problem. Moreover, this section also lacks a discussion of the significance of this research and its outcome to everyday clinical practice, i. e. How would identifying and addressing this particular problem prove to be beneficial for paramedics and their spouses in the short and long-term? Literature Review The literature review provided in an article provides an in-depth view of the research done on the topic.

It should be based on an extensive review of literature and discuss all aspects of the topic in question (Parahoo, 2006). In this article, a thorough and comprehensive literature regarding the different aspects of the effect of paramedics’ work-related mental distress on their family and spouses has been provided. Moreover, the literature is logically organized and leads the readers sequentially from problem identification to its impact and consequences.

Using the literature, the author initially discusses the magnitude and nature of the emotional stress that paramedics face and then moves on to describe the role of the family in helping paramedics to deal with this stress (Regehr, 2005). The author then quotes and discusses the different studies which been carried out to elucidate the coping strategies used by paramedics to vercome the mental distress that they encounter and the effect of these strategies on the family members (Regehr, 2005), thus providing a framework and the rationale for conducting the study in question.

However, the literature review of this article has certain shortcomings. Firstly, the literature review fails to identify the strengths and weaknesses of the studies carried out previously and the gaps in the research literature that exist. This is important so as to ascertain what new findings this study would contribute to the existing literature on the subject. Moreover, some of the literature qouted in this article dates back to almost two decades ago, e. g. Verboski and Ryan, 1988 and Nezu and Carnevale, 1987, and is thus outdated.

This shortcoming could have been avoided by using more recent and up to date literature, which would have contributed further towards the strength of the article. Thus in conclusion, the literature review is adequately performed and suffiently describes the previous research conducted on the topic but has certain limitations and shortcomings. Methodology The methodology section is one of the most important sections of any article as this part guides the readers on how the study is actually being conducted. It has several important components. The different components of methodology of this article are critically reviewed below.

Research Design The research design used is for this study is qualitative research. This method is appropriately chosen since this study aims to identify the different consequences that the paramedics’ lifestyle and the pressures associated with their job has on their family life and their spouses and these consequences are influenced by several factors and can be studied from different aspects (Regehr, 2005). Qualitative research serves the purpose of studying a problem from several different perspectives and is conducted in a natural setting.

It does not require any intervention or control group and is a mereobservationof the phenomenon of interest, giving a holistic picture of the problem being addressed (Runciman, 2002). This study is meant to be an exploration of the experiences, concerns and issues of the spouses of paramedics and thus the qualitative method is best suited method for it. Sampling The sample for this study consisted of spouses of fourteen paramedics who were employed at two different emergency medical organizations. The author describes the rationale of using a sample size of fourteen participants, viz. ensuring the occurrence of saturation (Regehr, 2005).

Saturation is an important concept applicable to qualitative research. In general, it is an established fact that as the sample size increases the chances of conducting a random sample error decrease and thus, larger sample sizes are preferred in order to reduce the variability in the results (Marshall, 1996). However, at a certain point, no new information or themes are revealed from the data set and this is termed as saturation (Marshall, 1996). For qualitative studies, the sample size required is usually small but recruiting an adequate number of participants in order to achieve saturation should be ensured.

In this article, the sampling method used is not stated explicitly but the technique used reveals that purposive sampling was used, i. e. spouses of paramedics were approached and asked to participate in this study (Regehr, 2005). This kind of sampling is best suited for qualitative studies, in particular those who focus on a particular group of individuals rather than on the general population. However, this article does not mention any particular inclusion or exclusion criteria for the study participants.

Inclusion and exclusion criteria are important in minimizing the variability amongst participants and in the reduction of any confounding factors which might lead to variation in the results and thus compromise the validity and reliability of the study findings. Data Collection Strategies The data collection tools used were audio taped interviews which followed a semi-structuredinterviewguide and notes on the impressions of the interviewers which were taken during peer debriefing sessions (Regehr, 2005). Using interviews for data collection has the advantage of focusing on human experiences and emotions regarding the problem.

Moreover, the use of semi-structured interviews in this case served a dual purpose viz. ensuring standardization of the responses, which facilitates organization and interpretation of the results, and providing opportunity for the exploration of arenas other than those limited to and specified in the interview guide. A limitation of the description of the data collection strategies for this study is that the particular questions and themes addressed during the interview are not mentioned explicitly and the article only mentions the broad categories to which the questions belonged, e. g. family situation, the effects of shift work, etc (Regehr, 2005).

This has the potential for leaving the readers in doubt as to which issues are being addressed and which ones are being focused upon in particular. Moreover, the time required for each interview is not mentioned, neither is the setting in which the interview was conducted. The article also fails to mention how many interviewers were involved in the data collection process and the steps taken, if any, to reduce the variations in data collection amongst different interviewers and to minimize interviewer bias.

Data Analysis Strategies The data thereby collected via the interviews was initially analyzed for common themes using computer based software named NUD*IST Vivo. As described by the author, open coding was utilized in the first stage for the broad categorization of data and subsequently, selective coding was done (Regehr, 2005). The author also mentions that throughout the research process, the input of emergency service organization members was acquired in order to ensure transferability and conformability (Regehr, 2005).

The data analysis section of this article is very brief and not enough information is presented for readers to replicate the methodology. The author does not mention the use of any particular data analysis strategies such as iterative analysis and data triangulation. Thus, the data analysis described by author, although possesses credibility, lacks in auditability. Results and Important Findings For qualitative studies, the results need to be extensively discussed and should include actual quotes and statements of the study participants to give a clear view of the outcome of the study to the readers (Parahoo).

The results section of this article is very comprehensive and gives a clear overview of the study findings. By organization of the results obtained under different subheadings such as concerns about the dangers of the job, effect of stress and trauma on the paramedic and the family, etc, the results have been made clear and easily interpretable by the readers (Regehr, 2005). Moreover, the use of actual quotes of the study participants gives a clearer view of and provides a better understanding of the participant’s experiences and feelings.

The results reveal that the author’s conceptualization and the theoretical framework presented initially were true to the data and the findings obtained. This study, in addition to describing the traumatic experiences and stressful situations faced by the paramedics and their effects on their lives and functioning which have also been previously elucidated by various studies, also provides an insight to the hassles which paramedics and their families encounter (Regehr, 2005).

As described in the results, these include shift work, overwork, scheduling issues and equipment and personnel issues (Regehr, 2005). The recognition of these hassles is also important in addition to identifying the consequences of traumatic and stressful experiences on family life as these hassles also contribute significantly towards the disruption of normal family routines and may give rise to conflicts and discontent amongst spouses.

In addition, in my opinion, the use of easy language in presenting the results adopted by the author facilitates the understanding of the readers and stimulates their interest in the article. Thus, the results section of this article effectively and comprehensively summarizes the main findings of the study conducted and presents them in an interesting, coherent and simple manner. Discussion, recommendations and conclusions The discussion section is, in effect, an integration of all the subsections of the article which leads to the generation of a concluding statement (Parahoo, 2006).

This section is aimed at linking the themes discussed in the introduction and background section of the study, the literature review and the important results generated (Parahoo, 2006). In this article, the discussion overviews all the important results and pertinent findings and compares them with the research which has been previously conducted. Almost all of the findings of this study conform to the findings generated by previously conducted studies. One limitation of the discussion is that the author does not report any conflicting results reported by previously conducted studies, if they exist.

Providing different points of view that exist regarding a particular matter helps in improving the reader’s perspective of the subject and aids them in forming their views and opinions regarding a particular matter. Another important component of the discussion is the identification of issues which require further research. In this article, the author correctly identifies the shortcomings of the study, where they exist and identify potential areas for future research.

For example, this study identifies two main coping strategies which paramedics use in the face of traumatic experiences, viz. expressing their distress and anguish via debriefing with family members or keeping their issues o themselves and “ putting up a wall (Regehr, 2005). ” This study, although identifies these issues, cannot investigate further in to which of these strategies is more effective in coping with the stress that paramedics experience. The author hence recommends that further studies should be conducted in this regard in order to further explore this arena.

Similarly, since the results of this study are generalizable to a particular subset of population only i. e. the spouses of paramedics, another recommendation proposed by the author is to conduct studies similar to this one involving participants belonging to other professions in which emotional management for dealing with traumatic experiences is required such as amongst firefighters, police and military personnel (Regehr, 2005). This study also identifies that formal and informal support systems did exist in the emergency medical service organization and were being underutilized. Moreover, no similar support systems existed for family members of the paramedics (Regehr, 2005).

The author, although identifies this issue, does not suggest any measures which can be taken to overcome the problem that this issue poses. Moreover, the implications of this research and the findings of this study in everyday clinical practice and for paramedics and their spouses have not been addressed by the author. All the above discussed sections of a research articles lead towards the conclusion section of the article. The conclusions are meant to answer the questions raised and the objectives that were defined prior to conducting the study.

They are also meant to summarize the important results generated from the study. The conclusions presented in this article serve all these purposes and briefly summarize and reflect the study findings. Ethical Issues As opposed to quantitative studies, observational and qualitative studies do not involve any intervention on the part of the researchers. Despite this, acquisition of ethical approval before conducting qualitative studies is as imperative as it is while undertaking quantitative studies.

In this study, the author does not mention taking ethical approval for conducting this study by the hospital ethical review boards of either of the two emergency medical organizations from which paramedics were identified for their spouses to be recruited in the study. Moreover, the article does not mention taking informed consent from the participants of the study. Informed consent is one of the most important basic principles of research and should always be obtained prior to recruiting participants for any study.

Another important ethical aspect which is not addressed in this study is that this study identifies several issues such as the problems faced by paramedics and their families as a result of job-related mental trauma, the underutilization of available support systems by the paramedics and the absence of the availability of any similar support systems for the spouses and families (Regehr, 2005). However, after identifying these issues, the author does not propose any interventions which might be useful in order to overcome these issues or the probable solutions for the problems identified.

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