Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: Constructivist metasynthesis of the qualitative literature

• Published in: Journal of psychosomatic research Vol. 78; no. 6; pp. 529 - 535
• Main Authors: Rees, Nigel, Rapport, Frances, Snooks, Helen
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.06.2015
• Subjects: Ambulance; Australia; Care; Decision Making; Emergency Medical Services - methods; Emergency Medical Services - standards; Emergency Medical Technicians - psychology; Emergency Medical Technicians - statistics & numerical data; Emergency Self Harm Paramedic; Empathy; Female; Humans; Judgment; Male; Middle Aged; Narration; Observer Variation; Personal Autonomy; Pre-hospital; Psychiatry; Qualitative Research; Safety; Self-Injurious Behavior - psychology; Self-Injurious Behavior - therapy; Social Perception; Stereotyping; United Kingdom; Emergency Self Harm Paramedic; Ambulance; Care; Pre-hospital
• ISSN: 0022-3999; 1879-1360; 1879-1360
• DOI: 10.1016/j.jpsychores.2015.03.007

Presentations of self-harm to paramedic and emergency staff are increasing, and despite being the first professionals encountered, patients who self-harm report the quality of care and attitudes from these staff are unsatisfactory. Understanding this care may provide opportunities to improve services. The aim of this study is to enhance knowledge building and theory generation in order to develop practice and policy through a metasynthesis of qualitative research relating to perceptions of paramedic and emergency care for people who self-harm. The metasynthesis draws on Evolved Grounded Theory Methodology (EGTM). A search was undertaken of CINAHL®, MEDLINE®, OVID ® and Psych INFO®, and grey literature. Subject headings of ‘self-harm’ were used alongside key words ‘suicide’, ‘paramedic’ ‘emergency’, ‘overdose’, ‘pre-hospital’ mental health, ambulance, perceptions of care, emergency. A total of 1103 papers were retrieved; 12 were finally included. No papers investigated paramedic care for self-harm. The following metaphors emerged: (a) frustration, futility and legitimacy of care; (b) first contact in the pre-hospital environment: talking, immediate and lasting implications of the moral agent; (c) decision making in self-harm: balancing legislation, risk and autonomy; (d) paramedics' perceptions: harnessing professionalism and opportunities to contribute to the care of self-harm. Paramedics are often the first health professional contact following self-harm, yet limited qualitative literature has explored this encounter. Metaphors revealed in this paper highlight challenges in decision making and legislation, also opportunities to improve care through professionalization and tailored education. •Studies have explored care from emergency staff and paramedic care for self-harm within mental health context.•Staff report feelings of frustration, futility and question legitimacy of care for self-harm.•First contact following self-harm is important, and paramedics provide this care opportunity.•Decision making involves balancing legislation, risk and autonomy