Stress and Grief Impacts and Management in Paramedicine

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Paramedics correspondingly manage an enormous load of injuries and troubling occurrences of certain events as a standard protocol of their work and often experience greater extent sightings of accidental or natural forms of injuries and illnesses within a day than certain individuals may be presented to in their lifetime (Scully, 2011). Paramedics are often disclosed with highly emotionally vulnerable and distressing situations which in result lead to displaying sentiments of empathy, fatigue, grief and stress post-event occurrence.

Paramedics provide additional medical care for unscheduled and emergency events for people who suffer from chronic or acute illness and injuries. Therefore, repeated exposure to death and illness has many mental well-being challenges such as psychological and adverse behavioral impacts for the paramedics, patients and their families.  Therefore, the complex demands of the job can lead to paramedics often experiencing work overload, psychological constraints such as stress, depression, suicidal thoughts, post-traumatic stress disorders, and prolonged grief are evident. Empathetic communication significantly aids paramedic professionals to manage these stressful and grief causing events by establishing patient positive relationships and healthier grieving moments with their families. (Williams, B., Lau, R., Thornton, E., & Olney, L. S. (2017).

Paramedicine inherently displays heroic deeds of paramedics handling higher levels of exposure to psychological trauma. (Furness and Pascal 2013). As health care professionals paramedics often handle multitude issues such as poor health literacy, family domestic violence, poor survival conditions of patients, palliative care, drug and alcohol abuse resulting in experiencing damaging mental health stressors such as work overload, frustration,  depression, anxiety, post-traumatic stress disorder (PTSD), vulnerability, and multiple burnouts. (Williams, B., Lau, R., Thornton, E., & Olney, L. S. (2017).

When homeostatic disturbance causes the hypothalamus activates the sympathetic nervous system enabling the pituitary gland to inform the adrenal glands to secrete the adrenocorticotrphic hormone.  (Yaribeygi, Panahi, Sahraei, Johnston, & Sahebkar, 2017). Adrenocorticotrophic hormone develops from the hypothalamus releasing the corticotrophin-releasing factor enabling the production of a protein proopiomelanocortin. The adrenocorticotrphic hormone activates the secretion of adrenaline and cortisol hormones within the blood cells leading to higher frequency levels of increasing cardiac, respiratory and metabolic high blood pressure, diabetic diseases accommodating the causes of stress. (Stephens & Wand, (2012) (Boardman, 2004).

Therefore, elongated stress diminishes receptors that control the stress hormone, further complicating the use of the immune system by displaying symptoms of endocrine imbalances, gastrointestinal irritation, cardiac and nervous tissue impairment. (Silverman & Sternberg, 2012). The physical representation of patients' in taking stress is based on the dependency of panic attacks, short and long term memory problems, higher blood pressure, increased heart rate and loss of appetite (Aehlert, 2011). For paramedics, stress is influenced by daily intense trauma exposure such as deaths, threats and severe injuries (Andel, 2017). Patterson, Klapec, Weaver, Guyette, Platt, & Buysse, (2016) suggested that paramedics are deployed with prolonged shift hours which validate the occupational stress occurrence. Therefore, longer shift hours increase the levels of fatigue, anxiety, and decreased nutrition intake, lack of sleep and safety outcomes. (Patterson, Klapec, Weaver, Guyette, Platt, & Buysse, 2016). The social impact of handling stress significantly impacts the numerous aspects of family life. The mechanism of stress represents challenges associated with negotiating role responsibilities, concerns over physical safety, poor communication and understanding amongst spouse and family. (REGEHR, 2005)

Therefore, the significance of domestic unrest paramedics experience due to a high frequency of stress and obtaining the culture of stoicism. This leads to paramedics to develop fearful characteristics to not seek any counseling or stress managing guidance. Thus, inadequate numbers of paramedics at St John explored more options to handle their stress and grief process which tends to lose their employment due to the system perceiving them as weak colleagues. (Ryburn, 2011)

Furthermore, this culture portrays the decreased performance progress among paramedics stating the prolong struggle of maintaining professionalism rather than better psychological mental health. This reflects the demanding nature of resilience paramedics have to display to be taken seriously in the profession. (Delgado, Upton, Ranse, Furness & Foster, 2017)

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(Klimley, Van Hasselt & Stripling, 2018) state that often paramedics have higher hormonal levels of cortisol during early morning shift hours which validates the prolonged struggle living with a disrupted lifestyle. Thus, developing interventional strategies to manage stress is efficient to help paramedics stabilize their mental health and personal wellbeing (Kleim & Westphal, 2011). There are variable symptoms for displaying characteristics of stress management such as smoking, alcohol, aggression and physical violence leading to negative circumstances. (Aehlert, 2011). The key factors that contribute to reducing stress are provoking fitness regularly, meditating, accumulating good nutrition and providing your loved ones with quality time to improve relationships. (Mistovich & Karren, 2014).

Thus, cognitive-behavioral coping skills can aid with the prevention of emotional stress implications.  (Monson et al., 2006) States that the contextualization of reflecting on stressful and natural emotions, to explain the challenges each emotion brings in writing describing and resolving the adversity of those events. During the prolonged shifts, the severity of stress is reduced through physical activity such as deep breathing which activates reduced cardiac and adrenaline levels. (Bledsoe, Porter & Cherry, 2013).

New Zealand paramedics undergo potential risks in their jobs by exploring administrative support however, St John paramedics’ intake mental health assistance from contract psychologists and other paramedics. (Ryburn, 2011). New Zealand health sectors portray a vital role in providing support by diminishing stress and grief from a paramedic. For instance, counseling and psychologists services deprived by the Doctor’s Health Advisory Service (DHAS) (Doctor’s health advisory service, 2019). Paramedic organizations are given fewer resources in comparison to New Zealand doctors. The DHAS develops assurance of assistance by providing social workers, psychiatrists, and other specialists. The intake of extended training is given for the positive wellbeing outcome through issues raised at conferences. (Doctor’s Health Advisory Service, 2019).

The lives of paramedics revolve around frequently handling patients with illness and sudden death where grief outcomes are expected in worst to worst condition. (Le Baudour and Bergeron, 2011). Therefore, paramedics need to establish characteristics to uptake the grieving challenges. Bowlby (1980) is one of the models used to reduce the bereaving and distressing experience causing emotional disruption (Boyd & Bee, 2011). Similarly, the Sanders’ (1989) model tends to cause ‘awareness’ exposing to feelings of anger and guilt about how they could have saved a loved one. (Boyd & Bee, 2011). However, these models are not appropriate to display the extent of grief manifests amongst people. (Boyd & Bee, 2011). Stroebe, Schut, and Boerner (2017) recognize that grief models are complex resulting in false misinterpretation of the grief process (Stroebe et al, 2017). However the Stroebe and Schut model enables individuals to overcome grief by confronting actual emotions instead of not disclosing any emotional distress. Thus, this allows paramedics to evaluate situations efficiently and the feelings of guilt and stress don’t cause psychological stress causing a good balance of mental health.

Paramedics often deal with emotional and professional aspects of delivering negative outcomes of sudden or accidental demise to patients in the first instance. Thus, structured and empathetic communicating with families leads to social and emotional barriers build up in which grief bereavement process must be utilized amongst other cultures to introduce the ‘GREIV_ING’ strategy.  (Hobgood, Mathew, Woodyard, Shofer & Brice, 2013).  Hobdgood and colleagues (2013) state that after sudden death outcomes, the paramedics should gather the trust of relatives and gather all various forms of support systems and brief them with an emotionally distressing event of the death of the loved one and while respecting and caring for the family.

The impact of sharing the moment of grief with patients of different cultural contexts paramedics have to be aware of adjusting the comfort levels of cultural preferences. Therefore, paramedics have to be pre-prepared for signs of confusion, language barrier and disclosing adequate information about the patient in a professional empathetic and calm manner.  SPIKES model represents an integrated approach to communicate in a way in which it is patient-centered, humanistic and culturally responsive. (Rollins, & Hauck, 2015).

The preference of disclosing negative news in the western countries states respect for autonomy but approaching different cultures varies as due to certain adjustments in comforting families can often be very challenging. For instance, the Chinese culture highlights the emphasis of hormonal interdependence hence; the death of a loved one is often reviewed as causing a worse impact on the psychological and spiritually wellbeing of a family.  The Chinese oppose the override of truth disclosure and often fear any healthcare professional repeatedly bragging the bad news leads to more psychological trauma.

The Chinese prefer hearing the news once heavily hearted but they preprepare life insurance of every family member to secure fast recovery but no disclosure of death. Paramedics often openly communicate with the Chinese to obtain language barriers and decent manners to readdress any further issues they feel towards death. In the context of culture, The Chinese believe the adverse events are managed poorly by using euphemisms. Thus, the line of trust and belief is converted into misinterpretation and false hope.  Paramedics interact with Chinese patients by making sure sentiments are not hurt hence the avoidance of words such as “illness or death” are avoided along with early treatment and stress management plans are discussed with families with belief and passion. (Tse, Chong & Fok, 2003)

Thus, stress and grief are the unchangeable adverse events in the lives of every individual. However, paramedics ease the stress and grief concept by openly communicating however disclosure of private information usually causes them psychological trauma by rewarding them the status of maintaining respect and supporting every citizen to believe in the concept of empathy and trust and benefit of good mental wellbeing. Paramedics must improve the effective measure of occupational stress by preventing the impact of physical, cultural and social damage on themselves and serving patients with compassion. Furthermore, paramedics gain experience by acknowledging grieving techniques that implement respecting all different cultures processes in times of vulnerability.

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