Type of Document Dissertation Author Donnelly, Elizabeth Anne URN etd-05282010-093008 Title Occupationally Related Stress Exposures and Stress Reactions in the Emergency Medical Services Degree Doctor of Philosophy Department Social Work, College of Advisory Committee
Advisor Name Title Jim Hinterlong Committee Chair Nick Mazza Committee Member R. Jay Turner University Representative Keywords
- Emergency Medical Services
- Occupational Stress
- Occupational Health
- Social Work
- Posttraumatic Stress
Date of Defense 2010-05-18 Availability unrestricted AbstractThis study explored the phenomenon of occupationally related stress exposures and stress reactions in the emergency medical services. While the emergency services are nearly ubiquitous in the United States, very little exploration has been done into the prevalence and sequelae of occupationally related stresses to which emergency medical technicians (EMTs) are exposed as part of their work. This study, based on the Stress Process Model (Pearlin, 1989) explored the impact of both chronic and critical incident stress. Chronic stressors are defined as persistent difficulties (e.g., insufficient salary, conflict with colleagues or supervisors). Critical incident stress relates primarily to the provision of patient care in emergencies and the emotional reactions caused by the exposure to gruesome or tragic circumstances. Posttraumatic stress symptomatology and alcohol use are identified as potential sequelae of exposure to occupational stress. Six hypotheses are presented to elucidate the relationship between the variables and to guide the research process. The overall aim of this study was to improve upon previous research efforts by exploring how different types of occupational stress may relate to different possible stress reactions. By gaining a detailed view into how different types of stress exposures may influence stress reactions in EMTs, more insight was gained into what factors may influence pathological outcomes.
In order to assess the relationship between occupationally related stress exposures and stress reactions, this study used a combination of previously validated measures (PTSD, alcohol use) and stress measures adapted for this research effort. Following the tailored design method (Dillman, 2009), data were collected from a probability sample (N=1633) of nationally registered EMTs and paramedics utilizing an internet-based survey methodology. Data were examined using both bivariate and multivariate analytic approaches.
The findings revealed that in this population, a lower rate of posttraumatic stress symptomatology in this sample than in previous research or in population-based samples. Rates of risky and hazardous alcohol use in this sample were comparable with previous research for the general population. Multivariate findings indicated that chronic stress, critical incident stress, and alcohol use contribute to posttraumatic stress symptomatology. Interactions between chronic stress and alcohol use as well as chronic stress and critical incident stress further improved the explanatory power of the model. Regression of alcohol use on the predictor variables illustrated a relationship between alcohol use and chronic stress as well as alcohol use and posttraumatic stress symptomatology. Critical incident stress did not retain a significant relationship with alcohol use when controlling for posttraumatic stress symptomatology.
The findings advanced knowledge regarding the relationship between occupational stress exposure and stress reactions in EMTs in several ways. This study placed the phenomenon of occupational stress within a widely utilized theoretical framework, allowing for better understanding of this particular process within the context of a wider body of stress literature. The methodology used in this study (specifically the use of probability sampling) represents a modest improvement from previous studies that have almost exclusively used convenience sampling. Further, this study revealed the differential relationship of chronic and critical incident stress with posttraumatic stress symptomatology and alcohol use in the population, illustrating that both types of stress are influential in stress reactions in EMTs.
This research has important implications for both EMS and social work. This research benefits the emergency medical services at both at the individual and organizational levels. With greater empirical evidence of the impact of occupationally related stress, individuals may be better able to take steps to reduce the impact of occupationally related stress exposures. At an organizational level, these findings may provide data to educators, supervisors, and administrators who may need to address occupationally related stress in the workplace.
This research enhances the social work practice and research. Social work practice benefits by expanding the knowledge base from which evidence-based practices may be developed. This is especially important, as social workers are often called to work with this population. Understanding the relationship between stress exposures and stress reactions may make it possible to develop an evidenced-based intervention that social workers may utilize for individuals who are struggling to manage the stresses of the job. Additionally, in pursuing this work, social work researchers will gain a greater knowledge of how occupational stressors affect EMTs. Any understanding may inform future investigations into occupational stress exposures and stress reactions within the social work profession. While different in many ways, both EMS and social work share risk for exposure to traumatic stressors, and this research may inform parallel efforts to understand the impact of occupationally related stressors on social workers
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