Beyond Vicarious Trauma: Exploring Adversarial Growth in a Sample of South African Paramedics ...

230 Pages·2017·1.94 MB·English

Beyond Vicarious Trauma: Exploring Adversarial Growth
in a Sample of South African Paramedics
by
Charlene René Reinecke
Dissertation presented for the degree of
Doctor of Philosophy (Psychology)
in the Faculty of Arts & Social Sciences at Stellenbosch University
Supervisor: Professor Desmond W. Painter
March 2017
Stellenbosch University https://scholar.sun.ac.za
ii
DECLARATION
By submitting this dissertation electronically, I declare that the entirety of the work contained
therein is my own, original work, that I am the sole author thereof (save to the extent explicitly
otherwise stated), that reproduction and publication thereof by Stellenbosch University will not
infringe any third party rights and that I have not previously in its entirety or in part submitted
it for obtaining any qualification.
Charlene René Reinecke
Date: March 2017
Copyright © 2017 Stellenbosch University. All rights reserved.
Stellenbosch University https://scholar.sun.ac.za
iii

Abstract
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 reported
Stellenbosch University https://scholar.sun.ac.za
iv

by 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.
Keywords: paramedics, emergency medical care, vicarious trauma, adversarial
growth, posttraumatic growth, positive psychology, thematic analysis
Stellenbosch University https://scholar.sun.ac.za
v

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
Stellenbosch University https://scholar.sun.ac.za
vi

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.
Sleutelwoorde: paramedici, nood mediese sorg, substituerende trauma, opponerende
groei, posttraumatiese groei, positiewe sielkunde, tematiese analise
Stellenbosch University https://scholar.sun.ac.za
vii

Table of Contents
Declaration ii
Abstract iii
Opsomming v
Acknowledgements xii
Dedication xiii
CHAPTER 1 INTRODUCTION 1
Background of Study and Rationale 1
Research Objectives 7
Organization of Study 7
CHAPTER 2 THEORETICAL FRAMEWORK 9
Introduction 9
Positive Psychology Defined 10
The History and Founding of Positive Psychology 13
Positive Psychology Versus Clinical Psychology 15
Motivation for the Use of Positive Psychology as Theoretical Framework 18
CHAPTER 3 LITERATURE REVIEW 23
Emergency Medical Care 23
The Psychology of Work 24
Emergency Medical Care: A Critical Occupation 25
Individual Differences 27
Paramedics: Emergency Medical Care Practitioners 28
Emergency Medical Care Training 31
Emergency Medical Care Curricula 31
Psychological Preparedness 34
Stellenbosch University https://scholar.sun.ac.za
viii

Support and Intervention Services 37
Emergency Medical Care in South Africa 39
Qualification and Training Routes 40
South African Emergency Medical Care Overview 43
Vicarious Trauma 50
Traumatic Stress 51
Stressors 52
The Effects of Trauma on Paramedics 53
Physical Effects 55
Psychological and Emotional Effects 56
The Concept and Definition of Vicarious Trauma 60
The Effects of Vicarious Trauma 64
Coping with Vicarious Trauma 65
Coping Methods 66
Psychological 66
Cognitive 67
Social 69
Occupational 70
Positive Coping 70
Posttraumatic Growth 71
The Concept of Posttraumatic Growth 71
Defining Posttraumatic Growth 73
Adversarial Growth 75
Theoretical Approaches to Adversarial Growth 77
Variables Associated with Adversarial Growth 79
Stellenbosch University https://scholar.sun.ac.za
ix

The Positive Effects of Adversarial Growth 80
Resilience and Adversarial Growth 83
Adversarial Growth and Meaning in Life 87
Conclusion 88
CHAPTER 4 METHOD 89
Research Design 90
Participants 91
Data Collection 93
Procedure 94
Thematic Analysis 96
Descriptive Analysis 99
Experiential Analysis 99
Personal Reflection 100
Ethical Clearance 101
CHAPTER 5 RESULTS 102
Descriptive Analysis 102
Qualifications and Training 102
Metro Western Cape EMS 104
ER24 108
Similarities Between EMC Organizations 111
Characteristics of Effective Paramedics 115
Support Services 118
Metro Western Cape EMS 118
ER24 120
Similarities Between EMC Organizations 122
Stellenbosch University https://scholar.sun.ac.za
x

Coping Mechanisms 124
Experiential Analysis 129
Service 129
Helping People 130
Saving People 132
More than Service 133
Receiving Positive Feedback 133
Realism 136
Ambivalence 136
Acceptance 137
Adaptation 138
Emotional Impact 139
Personal Growth 142
Respect 144
Working Environment 147
Gender Realities 149
Changed Life Perspective 151
Different Outlook 152
Adversarial Growth 152
Gratitude 158
Meaning 160
Mortality 164
Impermanence of Life 164
Clearly Defined Focus 165
Living Life to the Fullest 166