Rees Nigel, Rapport Frances, Snooks Helen
Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
J Psychosom Res. 2015 Jun;78(6):529-35. doi: 10.1016/j.jpsychores.2015.03.007. Epub 2015 Mar 16.
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.
向护理人员和急救人员呈现的自我伤害案例正在增加，尽管护理人员和急救人员是患者遇到的首批专业人员，但自我伤害患者报告称这些人员提供的护理质量和态度不尽人意。了解这种护理情况可能为改善服务提供机会。本研究的目的是通过对与护理人员和急救人员对自我伤害者护理认知相关的定性研究进行元综合分析，以加强知识构建和理论生成，从而制定实践方法和政策。
元综合分析采用了进化扎根理论方法（EGTM）。对CINAHL、MEDLINE、OVID和Psych INFO以及灰色文献进行了检索。使用了“自我伤害”的主题词以及“自杀”“护理人员”“急救”“过量用药”“院前”心理健康、救护车、护理认知、急救等关键词。
共检索到1103篇论文；最终纳入12篇。没有论文调查护理人员对自我伤害的护理情况。出现了以下隐喻：（a）护理的挫败感、徒劳感和合理性；（b）院前环境中的首次接触：交谈、道德主体的即时和持久影响；（c）自我伤害中的决策：平衡立法、风险和自主权；（d）护理人员的认知：发挥专业精神以及为自我伤害护理做出贡献的机会。
护理人员通常是自我伤害后患者接触的首批医疗专业人员，但探索这种接触情况的定性文献有限。本文揭示的隐喻凸显了决策和立法方面的挑战，也有通过专业化和针对性教育改善护理的机会。
