Beyond vicarious trauma: exploring adversarial growth in a sample of South African paramedics

Reinecke, Charlene Rene (2017-03)

Thesis (D.Phil)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: This qualitative study firstly explores the strategies that a sample of South African emergency medical care (EMC) practitioners, or paramedics, employ to cope with the vicarious trauma (VT) they are consistently exposed to as a result of their occupation. The paramedics work in both a public (Metro Western Cape EMS) and a private (ER24) EMC service in the Western Cape Province of South Africa. The trauma is exacerbated by the dangerous working conditions of paramedics in the country. The study secondly explores the paramedics’ responses to vicarious trauma, which may be termed posttraumatic, or adversarial growth (AG). In this regard the study deliberately applies a positive psychology approach, which facilitates the exploration of vicarious trauma from the perspective of which the results may be termed ‘adversarial growth’, with specific reference to adaptation and resilience. This signals a departure from the way consequences of traumatic events have typically been studied from a pathogenic perspective, and connects with research that has shown that the experience of trauma may result in growth through adversity that go beyond mere adjustment and coping. Positive effects are often yielded which include revised ideas, beliefs, expectations and assumptions. In-depth interviews were conducted with eighteen participants, and thematic analysis was employed to analyse their narratives. Two distinct analytic categories were identified. Factual interview responses were processed by using descriptive analysis as regards the participants’ study and training, support services, and coping mechanisms they utilize. Experiential analysis facilitated the coding of the participants’ work experiences, and four main themes were extracted, namely service, realism, changed life perspective, and mortality. The findings confirm the reality of the vicarious trauma paramedics are exposed to due to the nature of their work, as well as its effects which often result in emotional blunting and detachment. The findings further reveal how paramedics manage and cope with increasing primary trauma due to high-risk working conditions, and that the most meaningful coping mechanisms reportedby the participants are talking to colleagues, engaging in post-call evaluations, applying self debriefing, and personal introspection. The participants’ narratives capture their perceptions of growth through adversity. Their descriptions of adversarial growth not only correspond to the definition of the construct in the literature, but contribute towards further developing the definitions in the literature as presented in this study. The study found that the participants’ responses to trauma and adversarial growth are dependent on individual differences, that is, their personal characteristics and support resources, and the manner in which they appraise and proactively process the traumatic events they are exposed to. In spite of the participants’ critical and high-risk occupation where they experience vicarious and primary trauma in the fulfilment of their duties, there is evidence of the existence of psychosocial resources in this sample of paramedics which support positive functioning. Should the issues in EMC training and support services be addressed as identified in this study, it may contribute to increased positive functioning and warrants further exploration.

AFRIKAANS OPSOMMING: Hierdie kwalitatiewe studie ondersoek eerstens die strategieë wat ‘n steekproef Suid Afrikaanse nood mediese sorg (NMS) praktisyns of paramedici, gebruik om die substituerende trauma te hanteer waaraan hul deurlopend blootgestel word as gevolg van hul beroep. Die paramedici is werkagtig in beide die staatsdiens (Metro Wes-Kaap EMS) en ‘n private (ER24) NMS organisasie in die Wes-Kaap Provinsie van Suid Afrika. Die trauma word vererger deur die gevaarlike werksomstandighede van paramedici in die land. Die studie ondersoek tweedens die paramedici se response tot substituerende trauma, wat beskryf kan word as opponerende, of posttraumatiese groei. Die studie pas doelbewus ‘n positiewe sielkunde benadering toe, wat die verkenning van substituerende trauma fasiliteer vanuit ‘n perspektief waarvan die resultate as ‘opponerende groei’ beskryf kan word, met spesifieke verwysing na aanpassing en veerkragtigheid. Dit verteenwoordig ‘n alternatiewe vertrekpunt van die wyse waarop die gevolge van traumatiese gebeure gewoonlik vanuit ‘n patogeniese perspektief bestudeer word, en hou verband met navorsing wat toon dat die ervaring van trauma mag lei tot groei deur swaarkry wat verder gaan as blote aanpassing en die hantering van die trauma. Positiewe effekte word dikwels opgelewer wat hersiene idees, oortuigings, verwagtings en aannames insluit. In-diepte onderhoude is uitgevoer met agtien deelnemers, en tematiese analise is toegepas om hul verhalings te ontleed. Twee duidelik onderskeibare ontledingskategorieë is identifiseer. Feitelike onderhoudsresponse is verwerk deur gebruik van beskrywende ontleding ten opsigte van die deelnemers se studie en opleiding, ondersteuningsdienste, asook die hanteringsmeganismes wat hul toepas. Die kodering van die deelnemers se werkservarings is gefasiliteer deur belewingsontleding, en vier hooftemas is geëkstraheer, naamlik diens, realisme, veranderde lewensperspektief, en sterflikheid. Die bevindings bevestig die werklikheid van die substituerende trauma waaraan paramedici blootgestel word as gevolg van die aard van hul werk sowel as die effekte wat dikwels lei tot emosionele afstomping en afsydigheid. Die bevindings openbaar voorts hoe paramedici die primêre trauma behartig wat hul toenemend ervaar as gevolg van hoë-risiko werksomstandighede, en dat die mees betekenisvolle hanteringsmeganismes gerapporteer deur deelnemers gesprekke met kollegas, die beoefening van nabetragting, en toepassing van self-ontlonting en persoonlike introspeksie is. Die deelnemers se narratiewe vervat hul persepsies in verband met groei deur swaarkry. Hul beskrywings van opponerende groei stem nie net ooreen met die definisie van die konstruk in literatuur nie, maar dra by tot die verdere ontwikkeling van die definisies in die literatuur wat in hierdie studie aangebied is. Die studie het bevind dat die deelnemers se response tot trauma en opponerende groei afhanklik is van hul individuele verskille, dit wil sê, persoonlike eienskappe en ondersteuningshulpbronne, en die wyse waarop hul die traumatiese gebeure waaraan hul blootgestel word beoordeel en proaktief verwerk. Ten spyte van die deelnemers se kritiese en hoë-risiko beroep waar hul substituerende en primêre trauma ervaar tydens die uitvoer van hul pligte, is daar bewys van psigososiale hulpbronne in hierdie steekproef paramedici wat positiewe funksionering ondersteun. Sou die kwessie in NMS opleiding en ondersteuningsdienste aangespreek word soos geïdentifiseer in hierdie studie, mag dit bydra tot vermeerderde positiewe funksionering en word verdere ondersoek geoorloof.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100803
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