What Factors Affect Resilience in UK Paramedics? A Structured Literature Review.

Abstract

Background 30% of NHS absenteeism is due to stress, with ambulance staff reporting the highest levels of stress. 91% of ambulance staff have experienced stress and poor mental health at work and ambulance staff are twice as likely to cite occupational stress as the main cause of mental health problems compared to the general population. Method A search of databases was undertaken, including Academic Search, MEDLINE, PsychINFO, CINAHL and ScienceDirect, with appropriate limiters. The references of relevant papers were searched for further articles. Final articles were selected against inclusion and exclusion criteria and were quality appraised using an appraisal tool. Qualitative results were analysed using line-by-line coding to generate themes. Quantitative papers were analysed descriptively in support of qualitative themes. Results 327 results were identified. Reading of the title and abstract excluded 307 papers. The full text of the remaining 20 papers was read and 12 were excluded based on inclusion and exclusion criteria. 8 papers were included in the final review: four qualitative and four quantitative papers. The review identified 2 overarching themes (Stressors and coping strategies) with 8 subthemes. Subthemes of Stressors were emotional labour, psychological trauma and organisational stress. Subthemes of coping strategies were humour, informal support, life before being a paramedic, suppression, dissociation and dehumanisation. Conclusion The resilience of paramedics is affected by the types of stressors faced and coping strategies employed. Some coping strategies are modifiable which supports research suggesting that resilience can be not only developed but can reduce over time.