Critical incident stress and challenges for the emergency workplace

Critical incident experiences, related stress and support among Finnish paramedics: A cross-sectional survey study

INTRODUCTION

Paramedics work in diverse, demanding prehospital settings. We examined the prevalence of critical incident (CI) experiences, critical incident stress (CI-S), and CI-S association with the intention to leave the paramedic profession, as well as the needed and received support for CI-S among Finnish paramedics.

METHODS

In 2022, n = 427 Finnish paramedics from eight different organizations responded to a modified Emergency Medical Services (EMS) Critical Incident Stress Inventory and reported the CIs experienced during their EMS careers and the related CI-S within the last six months. Statistical analyses were stratified by gender.

RESULTS

All the listed 31 CIs had been experienced by the Finnish paramedics, and the experiences increased with work experience, especially among men. CI-S had wide variation, seemed to increase with work experience, and was mainly not associated with the intention to leave the profession. Support for coping with CI-S was most often received from colleagues, then from family members, friends, and to some extent, managers.

CONCLUSIONS

Because of the inherent nature of the demands and features of the paramedic work, experiencing CIs is unavoidable. Examining effective coping strategies, organizational support, and managerial practices are needed to support highly skilled paramedics in their demanding work.

Equilibrating resources and challenges during crises: a framework for service ecosystem well-being

Purpose

This article explores the impact of crises, such as the coronavirus pandemic, on service industries, service customers, and the service research community. It contextualizes pandemics in the realm of disasters and crises, and how they influence actors' well-being across the different levels of the service ecosystem. The paper introduces a resources–challenges equilibrium (RCE) framework across system levels to facilitate service ecosystem well-being and outlines a research agenda for service scholars.

Design/methodology/approach

Literature on disasters, crises, service and well-being is synthesized to embed the COVID-19 pandemic in these bodies of work. The material is then distilled to introduce the novel RCE framework for service ecosystems, and points of departure for researchers are developed.

Findings

A service ecosystems view of well-being co-creation entails a dynamic interplay of actors' challenges faced and resource pools available at the different system levels.

Research limitations/implications

Service scholars are called to action to conduct timely and relevant research on pandemics and other crises, that affect service industry, service customers, and society at large. This conceptual paper focuses on service industries and service research and therefore excludes other industries and research domains.

Practical implications

Managers of service businesses as well as heads of governmental agencies and policy makers require an understanding of the interdependence of the different system levels and the challenges faced versus the resources available to each individual actor as well as to communities and organizations.

Social implications

Disasters can change the social as well as the service-related fabric of society and industry. New behaviors have to be learned and new processes put in place for society to maintain well-being and for service industry's survival.

Originality/value

This paper fuses the coronavirus pandemic with service and well-being research, introduces a resources-challenges equilibrium framework for service ecosystem well-being and outlines a research agenda.

Exploring the meaning of critical incident stress experienced by intensive care unit nurses

The complexity of registered nurses' work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work-related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co-workers and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in 'autopilot', temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self-identity. Work-related critical incident stress has implications for nurses, the discipline, and the health care system.

Research Priorities for Physician Wellness in Academic Emergency Medicine: Consensus from the Society of Academic Emergency Medicine Wellness Committee

BACKGROUND

Physicians and trainees in academic health care settings face unique challenges to maintaining and enhancing their well-being compared to their community practice counterparts.

OBJECTIVE

Our objective was to develop a research agenda focused on well-being, resilience, and career longevity issues specific to practicing emergency medicine in an academic setting.

METHODS

We convened an expert group of academic emergency physicians prior to the 2018 annual meeting of the Society for Academic Emergency Medicine to determine a set of uniformly accepted research priorities in the field by consensus.

RESULTS

Three themes emerged as components of a comprehensive research agenda: 1) origins and natural history of burnout, resilience, well-being and other related concepts; 2) influence of early training and the learning environment; and 3) impact of burnout, attrition, and lack of organizational or system support for wellness on operations.

CONCLUSION

We believe that this agenda will inform future research and effective interventions to support physician and trainee well-being.

Conflicting priorities: emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care

INTRODUCTION

As hospitals compete for patients and their healthcare dollars, the emergency nurse is being asked to provide excellent nursing care to "customers" rather than patients. This has changed the approach in delivering quality care and has created favorable conditions for conflict as the nurse tries to achieve specific patient satisfaction goals.

METHODS

A sample of 9 emergency nurses from 2 hospitals in northern New Jersey participated in focus groups designed to learn about the types of conflict commonly encountered, and to identify the attitudes and understanding of the emergency nurses experiencing conflict and how interpersonal conflict is dealt with.

RESULTS

Thematic content analysis identified an overarching theme of conflicting priorities that represented a perceived disconnect between the priority of the ED leadership to achieve high patient satisfaction scores and nurses' priority to provide quality care. Three interacting sub-themes were identified: (1) staffing levels, (2) leaders don't understand, and (3) unrealistic expectations. The study also found that avoidance was the approach to manage conflict.

DISCUSSION

The core conflict of conflicting priorities was based on the emergency nurses' perception that while patient satisfaction is important, it is not necessarily an indicator of quality of care. Interacting sub-themes reflect the way in which conflict priorities were influenced by patient satisfaction and the nurses' ability to provide quality care. Avoidant conflict management style was used to resolve conflicting priorities because nurses perceive that there is not enough time to address conflict even though it could impact on work stress and patient care.

Enhancing community delivery of tissue plasminogen activator in stroke through community-academic collaborative clinical knowledge translation

Improving the clinical outcomes of stroke patients depends on the adoption of proven new therapies throughout the broader medical community. Approximately 1% of stroke patients in community settings are receiving tissue plasminogen activator (tPA) therapy 12 years after US Food and Drug Administration approval. Knowledge translation, the process by which the results of clinical investigations are adopted by clinicians and incorporated into routine practice, is important but often overlooked. This article reviews the history of tPA use in stroke as a case study of a breakdown of knowledge translation in emergency medicine. It reviews knowledge translation concepts and theory and explores practical community-academic collaborative methods based on these tenets to enhance acute stroke care delivery in the community setting.

Children's mental health emergencies-part 3: special situations: child maltreatment, violence, and response to disasters

OBJECTIVE

Children may be exposed to or even be the victims of a violent situation, or a disaster, and the likelihood of a child's exposure to a violent situation or a disaster is increasing.

METHODS

A review of the literature was done to address key mental health issues occurring with child maltreatment, violence in the home, community, in the emergency department, and disasters.

RESULTS

Although pediatric mental health issues regarding violence, disasters, and child maltreatment have often been overlooked or unrecognized, the consequences for the child in such situations can be devastating. However, recognition and appropriate treatment can favorably impact the child's recovery from exposure to such violent events or disasters.

CONCLUSIONS

Recognition and early intervention to address the mental health issues of children in violent situations or disasters can help ameliorate the negative psychological sequelae of such events. The importance of providing mental health and social services to children exposed to disasters was recognized by the Pediatric Institute of Medicine Report.

Syndrome de stress post-traumatique chez les survivants du séisme d’Agadir (Maroc) de 1960

INTRODUCTION

Agadir City is geologically located on a seismic line. This city witnessed an earthquake in February 1960 with a magnitude of 6 degrees in Richter scale. During this disaster more than 17,000 people died and 60% of the town was destroyed.

OBJECTIVES

Forty years later, the objective of this study was to assess post-traumatic stress disorders at the time of the disaster and currently among this population.

METHODS

Two groups, matched by gender and age were included: 1) a group (G 1) of 80 earthquake survivors with an age varying from 45 to 70 years ; 2) a control group (G2) with 80 people who experienced accidental events other than the earthquake. The instruments used were: a questionnaire concerning socio-demographic data, and the Post-traumatic Stress Diagnosis Scale-Edna Foa-1995 for the diagnosis of PTSD which was translated in Moroccan Arabic language. The epidemiological survey was conducted in two steps during 13 months. The first step consisted in the inclusion of the first group: victims of the disaster. One hundred and two survivors were contacted and 80 accepted to participate in the study. The second step, concentrated on the inclusion of the other group, according to gender and age of the survivors group. All interviews were conducted in the homes of the participants. Data analysis was performed on a PC microcomputer using Epi info 6.04 French version (Center for disease control and prevention CDC, Atlanta, USA). The statistical analysis was based on the descriptive techniques of statistics.

RESULTS

The main results were: 1) after the traumatic events and retrospectively, survivors from the earthquake had statistically more PTSD than G2: 38.8% vs 20%; 2) at the time of the study, the prevalence of PTSD between the two groups was not significantly different: 10% for the survivors of the earthquake vs 7.5% for G2 (victims of accidents) while the dates of trauma differed; 3) forty years later, the socio-professional life of the survivors was still perturbed.

DISCUSSION

These results are in accordance with the literature, even if the methodological differences constitute a limiting factor for the comparison. Nevertheless, the persistence of symptoms of PTSD many years later might be explained by the severity of the trauma, the existence of external stimuli, such as the frequent tremors felt in Agadir, the noise, the storms, the earthquake happening in other cities...create a persistent state of hyper-vigilance which maintains and/or worsens the symptoms of PTSD.

CONCLUSION

In conclusion, 40 years later, survivors are in need of care to overcome symptoms of PTSD. Preventive measures for victims of disasters should perhaps be developed.