Predictors of problem focused coping style amongst international paramedic students.

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Predictors of problem focused coping style amongst international paramedic students.

NameCourseCourse instructorDate of submissionAbstractBackground

Paramedicine is among the professions whose practitioners suffer high risks of stress and associated symptoms. Extensive studies have been carried out on the effects of these stress factors on the paramedics. The need for pre service training on stress management is a factor that has been widely discussed. The current study aimed at identifying the stress predictors among international students training as paramedics and the different coping mechanisms that they adopt.

Methods

The research took a quantitive approach and used a questionnaire as the main avenue for data collection. The questionnaire was composed of closed ended questions with choices structured on the Licker scale and a Yes/No type of collection. A cross sectional sample was targeted for the survey. A total of 30 respondents were interviewed for the survey.

Results

Computer software (SPSS Version 16) was used to analyse the data for both descriptive and statistical results. The data was presented in tabular and statistical formats. The analysis of the data showed a correlation between predictors and stress levels among the international paramedicine students.

Conclusion

The study concluded that just like other members of the paramedic profession, students in paramedicine are also prone to work related stress. It was recommended that measures be put in place to reduce these stress levels and increase job satisfaction. The study further recommends further research on ways and means of reducing the effects of exposure to the trauma that paramedicine students suffer in the course of training and practice.

IntroductionLiterature Review

Paramedics and other first responders are at high risk of psychological distress and associated symptoms such as burnout (McFarlane, Williamson and Barton, 2009). The effects of stress factors on paramedics are well studied and the correlation between these known factors and job burnout and dissatisfaction has resulted in paramedics making errors and a decreased level of patient care (Le Blanc et al. 2005). Understanding the predictors would enable policies to be instituted to help prevent and intervene and reduce such stresses (Bennett et al. 2004, McFarlane, Williamson & Barton, 2009). Vettor and Kosninski (2000) identified paramedic characteristic responses as emotional exhaustion; depersonalisation, and lastly personal negative assessment, one question is whether international paramedic students suffer similar feelings as they undergo their training and more specifically, the coping strategies they utilise to manage these feelings?

Managing stress factors for paramedics include peer support, and this along with how they express their emotions, are two types of predictors of psychological distress and burnout (Porter 2008). Clohessy and Ehlers (1999) state that the daily encounters that paramedic’s face impacts their lives and leaves an indelible mark on a paramedic’s psychological state. As an international paramedic student they learn how to assess and initiate pre-hospital care after the occurrence of the emergency mostly in the ambulance. Paramedic students learn about critical incidences that prepare them for situations that they are likely to come across in their career, which is always stressful and has negative outcomes like stress, fatigue, and burnout (Alexander & Klein 2001).

In the coping literature, two broad types of coping have been described. These are known as problem focused coping and emotion focused coping. Problem-focused coping is seen as putting effort into solving or managing the problem, which has caused the initial distress (Kilburn & Whitlock n.d.). In this process strategies focus on assimilating the necessary information in order to plan, make decisions, and resolve differences; only through gathering resources can one expect to address the problem(s) that requires specified action to resolve them (Kilburn & Whitlock n.d.). With emotion-focused coping the focus is on alleviating emotional distress by using the cognitive processes like having a positive attitude, or adopting behavioural strategies such as getting emotional support, or by using drugs or alcohol as a mechanism to cope (Kilburn & Whitlock n.d.).

Predictors to paramedic stress include factors like, avoidance, social support, and coping, like that of problem-focused and emotion-focused coping. International paramedic students gain experience how to deal with issues in situational training and are trained how to cope (Alexander & Klein 2001). International paramedic students are exposed to learn about both physical and emotional health (Corneil et al. 1999). It is from the impacts of stress and burnout that the correlations between these consequences that affect a paramedic to self-evaluate their chosen career (Nirel et al. 2008). The correlation then between predictors and stress and burnout can result in establishing estimates of length of service that a paramedic might have and, which in turn affects the continual demand for future paramedics (Nirel et al. 2008).

The need for pre service training of stress management coping is something that Regehr and Millar (2007) and Okada et al. (2005) explored and that there is an essential need for stress management tools and education. While peer support has not been linked directly to psychological stress and burnout, a paramedics’ negative attitude towards emotional expression and coping are predictors, which are related to fatigue rates, stress symptoms, and burnout (Bennett et al. 2004; Porter 2008). Just as paramedics require peer support for them to be able to cope with stress, rejection from society, confidentiality issues, people’s judgments on how they are inadequate, and ways to express their emotions (Blumenfield & Byrne 1997) another question is how does an international paramedic students learn to cope when facing the rigours of the programs they undertake?

It can be assumed that all international paramedic students suffer from stress, so the aim is to identify the coping styles and strategies that paramedic students currently use to manage this stress. By undertaking a quantitative study it is hoped that a greater understanding of the predictors associated with pre-service stress factors for international paramedics students can enable greater levels of coping mechanisms, such that, these students will have greater coping mechanisms as paramedics so as to manage their stress levels better and this will reduce burnout and improve patient care. From this there is potential to develop positive coping mechanisms for students that may help when they are in-service (Creswell 2009).

Specifically, this study involved an investigation of the current coping styles and strategies of international paramedic students and the factors that predict positive, problem focused coping style that is the most adaptive form of coping. The research question that was addressed was: What are the predictors of a problem focused coping style amongst international paramedic students? It is hypothesized that:

1) Problem focused coping style are associated with Personal control; and

2) Peer and institutional support, while

3) Emotion focused coping style were associated with depersonalisation.

Research plan, methods and techniques

Study Design

The study design involved the use of a cross-sectional survey and this provided a simplified design and expedited the collection and analysis of the data (Creswell 2009). Kraus (2005) defines a cross sectional survey or prevalencetransversal study as one where the researcher identifies a subset of the whole population under study. This subset must be well representative of the whole population. The cross sectional survey questionnaires interviews were conducted on one day again with an emphasis on time and expedience. The data collection and analysis was quantitive in nature, this approach was favoured as it would eventually produce data that was systematically arranged and that was easy to logically analyse (Creswell, Trout and Barbuto, 2004). The data hence collected was easy to analyse through various methods and mediums and help the researcher come to a deductive conclusion.

Participants and Sampling

The population was a random selection of 100 international paramedic students who were given an opportunity to participate and form this it was hoped that 6-10 participants will make up the survey. A clustering technique was used so as to offer a notification to participate in several meetings as it is impossible to ascertain a sample without a list (Creswell 2009). Since surveys were handed out to only those who were international paramedic students and were available to participate it was a convenience sample (Babbie 1990, in Creswell 2009). Convenience sampling involves picking respondents from among those who are easily available, this helps ease the rigours involved in searching for respondents from a large sample. The major shortcoming of this approach though is that the data collected might not be representative of the whole population (Creswell 2009). There was no stratification, only male participants were invited to participate (Creswell 2009). With 100 surveys and an estimated 10% response sample the calculated margin of error is 4.9% with a confidence rating of 90% (Relevant Insights 2012).

Data Collection

Data collection was done from the self-administered questionnaires (Appendix 1) that were designed using a five point Likert scales, multiple choice and yes/no questions this enables participants to rank responses (Huck 2008). The questions were closed and answers were from a limited population that enabled generalization of findings for comparison (Creswell 2009). I was able to make estimates of attributes from a small group and thereby, make assertions about a larger population (Fowler 1998; Babbie 1990, in Charema 2004). From this it was possible to make generalisations about behavioural characteristics of the population.

The survey was sectionalised first section addressed demographic information, the second discussed experience and the third directly as to stress predictors. The researcher looked at previous studies in the field of job related stress for paramedics and narrowed down the questions from these studies to suit his research question and hypotheses. The researcher was fortunate to have had the input of the course supervisor who has also written extensively on the topic of job stress previously. The quantitative data collected from the questionnaires was time efficient and enabled the researcher to rapidly turn around the data and evaluate the information to publish findings (Creswell 2009).

Data analysisThe data collected was descriptively and statistically analyzed. Descriptive analysis involves analyzing the data according to demographic characteristics such as age, year of study and number of years in the paramedic profession. This descriptive data was then presented in terms of tables, graphs and charts. Electronic means for data analysis and in particular statistical package for Social Sciences (SPSS) version 16 was used to analyze the statistical aspect of the data and to test the hypotheses.

Ethical Implications

All ethical considerations as stipulated for researchers were upheld to the best knowledge of the researcher, no participant were exposed to risk; the requirement for anonymity was foremost in these considerations. To this end, the respondents were not required to write their names on the questionnaires, for the sake of analysis; the questionnaires had unique identification numbers. The data collection was done on the basis of informed consent and the researcher went to great lengths to explain the purpose of the study and the use(s) of the data collected thereof (Creswell, 2009). The questionnaire was given out together with an introduction letter from the supervisor detailing the commissioning of the study and a consent form (Appendix 2) for the respondents to sign. The research proposal was reviewed and approved as was the methodology and a verbal script to introduce the researcher and his research topic was prepared (Creswell 2009). Since no identity information were collected all confidentiality will preserved no data were falsely manipulated to influence the findings (Creswell 2009). The respondents were also informed of their right to discontinue or withdraw from the research either before or during the filling of the forms and the right to omit any question they felt uncomfortable answering. (Fowler 2008). Measures to ensure that the questionnaires could not be identified from one another were also put in place to protect respondents from any attempts to identify their responses once collected.

Results

1.0 Descriptive statistics for demographic variables

The overall study utilized a convenience sample of 30 international students. All the participants (100%) were currently enrolled in the bachelor’s level of education. Table 1 presents the demographic characteristics of the sample participants.

TABLE 1

A summary of the demographic characteristics of the participants

Frequency Percent Valid Percent

Age

<22 years 1 3.3 3.3 22-25 years 1 3.3 3.3 25-30 years 10 33.3 33.3 30-35 years 17 56.7 56.7 >35 years 1 3.3 3.3

Education level

Bachelors 30 100.0 100.0

Education year for Bachelors’

1st year 5 16.7 16.7

2nd year 17 56.7 56.7

3rd year 8 26.7 26.7

A majority of the study participants were aged between 25 and 35 years. Notably, there were few participants (3.3%) in the age categories <25 years and >35 years.

2.0 Preliminary results for the main study outcomes

The present study was aimed at identifying the factors (predictor variables) that contribute to pre-service stress amongst international paramedic students. Five main outcome variables were identified and the descriptive results are as summarized in table 2.

TABLE 2

Descriptive statistics for the main outcome variables

Frequency Valid Percent

How much paramedic experience do you have?

2 years 5 17.2

1-5 years 8 27.6

5-10 years 12 41.4

>10 years 4 13.8

What degree of control do you have at work?

Rarely 3 10.0

50/50 9 30.0

Occasionally 11 36.7

Always 7 23.3

What is the level of support you receive from co-workers/fellow students?

Never 1 3.3

Rarely 5 16.7

Occasionally 9 30.0

Sometimes 11 36.7

almost always 4 13.3

What is the level of support you receive from supervisors/teachers?

Never 2 6.9

Rarely 2 6.9

Occasionally 7 24.1

Sometimes 12 41.4

almost always 6 20.7

Is there organizational support?

Yes 19 63.3

No 11 36.7

The results indicate that a majority of the study participants, 41.4%, had 5-10 years of paramedic experience. However, only a minor proportion of the participants, 13.8%, had more than 10 years of paramedic experience. Just over one third (36.7%), affirm that they occasionally have control at work. Notably, only a minor proportion, 10%, indicated that they rarely have control at work. On the other hand, the results indicate that co-workers and fellow students provide a great level of support to the study participants. More than one third (36.7%) of participants, indicated that they sometimes provide support while 30% indicated that they occasionally provide support. Only a minor proportion, 3%, indicated that they never provide support.

In addition, supervisors and teachers provide an equally great level of support to the participants. A majority, 41.4%, indicated that they sometimes provide support. Similarly, large proportions of the participants, 24.1% and 20.7%, indicate that supervisors and teachers occasionally and almost always provide support respectively. Essentially, a majority of the study participants, 63.3%, affirm that there is organizational support (Table 2).

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