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

Nigel Rees Orcid Logo, Alison Porter Orcid Logo, Frances Rapport, Sarah Hughes, Ann John Orcid Logo

PLOS ONE, Volume: 13, Issue: 10, Start page: e0205813

Swansea University Authors: Nigel Rees Orcid Logo, Alison Porter Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1371/journal.pone.0205813

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 surr...

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Published in: PLOS ONE
ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2018
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URI: https://cronfa.swan.ac.uk/Record/cronfa44999
first_indexed 2018-10-19T04:19:21Z
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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&#x2019; perceptions of caring for those who SH using Evolved Grounded Theory Methodology.MethodsThis study took place between 2014&#x2013;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 &#x2018;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.</abstract><type>Journal Article</type><journal>PLOS ONE</journal><volume>13</volume><journalNumber>10</journalNumber><paginationStart>e0205813</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords/><publishedDay>17</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2018</publishedYear><publishedDate>2018-10-17</publishedDate><doi>10.1371/journal.pone.0205813</doi><url/><notes/><college>COLLEGE NANME</college><department>Swansea University Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm/><funders>This work was supported by a Falck Foundation grant to NR.</funders><projectreference/><lastEdited>2022-11-09T16:03:51.0862255</lastEdited><Created>2018-10-18T22:57:44.3613954</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Nigel</firstname><surname>Rees</surname><orcid>0000-0001-8799-5335</orcid><order>1</order></author><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>2</order></author><author><firstname>Frances</firstname><surname>Rapport</surname><order>3</order></author><author><firstname>Sarah</firstname><surname>Hughes</surname><order>4</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>5</order></author></authors><documents><document><filename>0044999-09112018171205.pdf</filename><originalFilename>44999.pdf</originalFilename><uploaded>2018-11-09T17:12:05.6300000</uploaded><type>Output</type><contentLength>726923</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><embargoDate>2018-11-08T00:00:00.0000000</embargoDate><documentNotes>Released under the terms of a Creative Commons Attribution License (CC-BY).</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling 2022-11-09T16:03:51.0862255 v2 44999 2018-10-18 Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology 8c440a0df599a0b6eef3927ebd515b72 0000-0001-8799-5335 Nigel Rees Nigel Rees true true fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2018-10-18 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. Journal Article PLOS ONE 13 10 e0205813 Public Library of Science (PLoS) 1932-6203 17 10 2018 2018-10-17 10.1371/journal.pone.0205813 COLLEGE NANME Swansea University Medical School COLLEGE CODE Swansea University This work was supported by a Falck Foundation grant to NR. 2022-11-09T16:03:51.0862255 2018-10-18T22:57:44.3613954 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Nigel Rees 0000-0001-8799-5335 1 Alison Porter 0000-0002-3408-7007 2 Frances Rapport 3 Sarah Hughes 4 Ann John 0000-0002-5657-6995 5 0044999-09112018171205.pdf 44999.pdf 2018-11-09T17:12:05.6300000 Output 726923 application/pdf Version of Record true 2018-11-08T00:00:00.0000000 Released under the terms of a Creative Commons Attribution License (CC-BY). true eng
title Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
spellingShingle Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
Nigel Rees
Alison Porter
Ann John
title_short Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
title_full Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
title_fullStr Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
title_full_unstemmed Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
title_sort Paramedics’ perceptions of the care they provide to people who self-harm: A qualitative study using evolved grounded theory methodology
author_id_str_mv 8c440a0df599a0b6eef3927ebd515b72
fcc861ec479a79f7fb9befb13192238b
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 8c440a0df599a0b6eef3927ebd515b72_***_Nigel Rees
fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Nigel Rees
Alison Porter
Ann John
author2 Nigel Rees
Alison Porter
Frances Rapport
Sarah Hughes
Ann John
format Journal article
container_title PLOS ONE
container_volume 13
container_issue 10
container_start_page e0205813
publishDate 2018
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0205813
publisher Public Library of Science (PLoS)
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description 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.
published_date 2018-10-17T13:37:52Z
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