Thesis (Ph. D.)--Indiana University of Pennsylvania. / Includes bibliographical references.

M.A. / This study looks into the types of stressors specific to the Emergency Medical Services. The study was undertaken over a period of two years with the following objectives: • A literature survey regarding stress, organisational stress in general and stress in the context of Emergency Medical Services in particular. • An investigation of the personnel of the Emergency Medical Services to ascertain the stressors perceived as stressful by them. • Recommendations on how to prevent or lower stress in the Emergency Medical Services. The first part of this study is devoted to a theoretical investigation which gives an overview of stress in its broadest sense as well as stress in organisations which includes cumulative stress/burnout. Critical Incident Stress and Post Traumatic Stress are also closely examined, as well as the personality characteristics of members of the Emergency Medical Services. The point of departure for the researcher is an ecosystemic perspective where objectivity itself is questionable. Therefore, qualitative research was called for and the transactional/interactional model of Richard Lazarus was used to categorise stressors. The research results suggest that what the Emergency Medical Service personnel perceive as stressful are mainly organisational stressors but they acknowledge that in the long term the continual dealing with death and trauma starts to take its toll. Criticisms that could be levelled against the study are that the results are only generalisable to the personnel of the Johannesburg Emergency Services, whose demographic characteristics and backgrounds differ, for instance, from those who work at Bryanston, or Pretoria. As the study relied solely on personal disclosure and observation the results can be seen as somewhat subjective in nature. What was communicated as stress-related events was what was perceived as stressful by the personnel as well as the researcher's subjective perception of whether certain events were perceived as stressful for the personnel. After working on the ambulance with these personnel for over three years, the researcher is an accepted part of their system, and became subject to the same blunting of affect and depersonalisation of victims as the Emergency workers. Over an extended period in time, it became harder to divorce the researcher from the "worker" while on duty, to maintain a scientific perspective and to write objectively. However, the findings of this study concur with those done by previous researchers on this subject such as Sparrius (1992) and Du Toit & Botes (1996).

Electronic health records (EHRs) led to improvements in patient safety, care delivery, and efficiency; however, they have also resulted in significant increases in documentation time. EHR documentation burden, defined as “added work (e.g., documentation) or extraneous actions (e.g., clicks) performed in the EHR beyond that which is required for good clinical care”, has been linked to increased medical errors, poorer patient outcomes, reduced care quality, cognitive overload, and ultimately, burnout among clinicians. Relative to other clinical practice settings where patient flows are more predictable and of lower intensity, emergency department (ED) clinicians report markedly higher workload. Furthermore, EHR implementation research in the ED indicates that incongruities between EHR design and usability and the clinical workflow may intensify clinician workflow fragmentation. In our prior work, we identified workflow fragmentation, which we define as task switching, as one potential approach for evaluating documentation burden in ED practice settings. Yet, no standardized, scalable measures of documentation burden have been developed. Despite shortcomings, there have been increasing efforts to leverage information from EHR event logs as an alternative to direct clinical observation methods in evaluating user-centric behaviors and interactions with health information technology systems. Using EHR event logs, this dissertation aims to advance the study of evaluating burden by investigating EHR-mediated workflow fragmentation as a measure of EHR documentation burden among physicians and registered nurses (hereinafter interchangeably referred to as “clinicians”) in the ED. First, I review the literature on the existing quantitative approaches employed for measuring clinician documentation burden in clinical practice settings. Next, I explore EHR factors perceived to contribute to clinician documentation burden as well as the perceived role of workflow fragmentation on clinician documentation burden in the ED. Lastly, I investigate data-driven approaches to abstract clinically relevant concepts from EHR event logs for studying EHR documentation burden—culminating into a computational framework to evaluate ED clinician documentation burden in the context of cognitive burden. Collectively, the work conducted in this dissertation contributes computational methods that are foundational for investigating clinician documentation burden measurement at scale using EHR event logs, informed by current evidence and clinician perspectives, and grounded in theory.

Submitted in partial fulfilment of the requirements for the degree of Master of Arts in the Department of Psychology University of Zululand, 2004. / This report presents the findings of a study conducted in 2003-2004, involving eight members of emergency services in Stanger, KwaZulu Natal, South Africa. The emergency personnel included five firefighters and three paramedics. The aim of the study was to develop and evaluate a mutual aid group programme in order to prevent symptoms of trauma, with special reference to anxiety and depression, and promote psychological well-being in emergency personnel. Emergency personnel are exposed to traumatic events during the line of duty. The study investigated stressors, which were identified as organizational, management style, ineffective communication, stressors relating to patient care (personal loss, traumatic stimuli, high expectations) and low job and high workloads. The study also investigated psychological, physical and social effects of emergency work. Psychological effects that were identified were mental illnesses such as depression and posttraumatic stress disorder. Symptoms included irritability, anger, frustration, hopelessness, helplessness, fear and anxiety. Physical effects included fatigue, difficulty breathing, startle response, nausea, trembling and racing heart. Social problems such as conflicts with family, friends and colleagues were also identified. The study provided group members with the ability to identify symptoms of trauma and accept vulnerability, which served as important preventative measures for mental illness. The group created a safe atmosphere where members were able to share their feelings without the fear of being judged. It also provided members with new coping strategies for dealing with their feelings. Regarding further support systems the group members identified an ongoing need for help via psychologists, psychological debriefing and support from management, family as well as the community. / National Research Foundation

No description available.

Critical Incident Stress has the potential to affect emergency services personnel to the degree that it can change the way the responder acts and reacts in all facets of his or her life, including the job and his or her family. Research into these potential effects has produced a greater understanding of the responders experiences within a short period of time after the perceived critical incident. This study investigates the long-term effects of critical incident stress among emergency responders from two cities in the three emergency services professions were interviewed to determine what their experiences were at least six months post critical incident. A structured incident had in three areas of teh emergency responders lives: impact on job, impact on the individual responder, and perceived impact on emergency responders families. For particpants, symptoms of Critical Incident Stress lasted between 6 months and 2 years after the perceived critical incident. Analysis of the data indicatees that single responder critical incidents have the potential to negatively affect emergency responders resulting in the loss of enthusiasm and passion for their work, debilitating psychological distress, and isolation from valued support systems. Long-term effects of Critical Incident Stress change the perceptions that responders have about the job, about themselves, and the relationships with their families. The culture of emergency services, changing identities, and the lack of support from both within the system and outside of the system were seen as variables that contribute to the long-term effects of Critical Incident Stress. / xi, 181 leaves ; 29 cm.

M.A. (Psychology) / Please refer to full text to view abstract

Literature on the Emergency Medical Services (EMS) has paid much attention to stressors, stress and symptoms, coping, and support of Emergency Medical Workers (EMWs). However, it has paid little attention to the needs of EMWs, and the satisfaction thereof, which should result in their improved well-being and motivation. In an attempt to rectify this imbalance, this study investigated the needs of EMWs as suggested by descriptions of their experiences within the EMS. Interviews were conducted with EMWs employed by a private EMS company. The interviews were analysed for emerging needs by means of interpretive analysis. These needs comprised the Need for Freedom, the Need for Competence, the Need for Recognition, the Need for a Challenge, and the Need to be Understood. The findings were linked with theory and it is proposed that the relevant EMS company incorporates participative management into its management approach. In addition suggestions are made for future research. / Psychology / M. A.(Psychology)

Literature on the Emergency Medical Services (EMS) has paid much attention to stressors, stress and symptoms, coping, and support of Emergency Medical Workers (EMWs). However, it has paid little attention to the needs of EMWs, and the satisfaction thereof, which should result in their improved well-being and motivation. In an attempt to rectify this imbalance, this study investigated the needs of EMWs as suggested by descriptions of their experiences within the EMS. Interviews were conducted with EMWs employed by a private EMS company. The interviews were analysed for emerging needs by means of interpretive analysis. These needs comprised the Need for Freedom, the Need for Competence, the Need for Recognition, the Need for a Challenge, and the Need to be Understood. The findings were linked with theory and it is proposed that the relevant EMS company incorporates participative management into its management approach. In addition suggestions are made for future research. / Psychology / M. A.(Psychology)

D. Litt. et Phil. / This report presents the findings of a study conducted in February-March 1995, involving 109 members of different emergency services from three regions: Pretoria, Durban and Cape Town. The emergency services included in the study were three units of the South African Police Service (Visible Policing, the Internal Stability Unit and the Flying Squad), provincial fire and ambulance services, and municipal traffic services. The aims of the study were to: (1) describe the underlying causes of stress in the emergency services; (2) establish how stress is currently being dealt with by members and identify the structures and support systems available to assist members with stress-related problems; (3) identify constructive and destructive, effective and ineffective mechanisms used by members to cope with their stress, and (4) suggest solutions to problems experienced in managing stress in the emergency services. The study investigated stressors of SAPS members under the following themes: (1) public image of the SAPS, (2) management style in the SAPS, (3) communication in the SAPS, (4) working environment in the SAPS, (5) working conditions and remuneration packages, (6) distinct characteristics of the work of SAPS members, and (7) the priorities set by SAPS members that need to be addressed in order to reduce their level of stress. The stressors of members of the fire and ambulance services were dealt with under the following themes: (1) utilisation of manpower in the organisation, (2) training provided to members, (3) management style in the fire and ambulance services, (4) distinct characteristics of the work of members of the fire and ambulance services, (5) remuneration packages, and (6) the priorities set by members that need to be addressed in order to reduce their level of stress. The stressors of members of the traffic services were dealt with under the following themes: (1) the public image of the traffic services, (2) distinct characteristics of the work of traffic officials, (3) communication in the traffic services, (4) working conditions and remuneration packages and (5) the priorities set by members that need to be addressed in order to reduce their level of stress. Regarding the support members of the emergency services receive within their organisations for managing stress, a number of sources of support were mentioned, such as social workers, psychologists and chaplains in the SAPS, support by supervisors, debriefing after traumatic events, stress management training, nursing sisters at ambulance stations, drinking and socialising, with the biggest form of support being "buddies". Regarding the co-operation between members of the different emergency services, the perception was that there was a very good relationship and good co-operation. Number of problems experienced in their day-to-day contact with each other were however mentioned.