Psychiatry

Biography

Biography: Nigel Rees

Abstract

Background: The U.K. has one of the highest rates of SH in Europe. SH is amongst the five top causes of acute hospital admissions. Paramedics are often the first professionals encountered following SH, yet few have investigated their care Methods: The theoretical perspective draws on Evolved Grounded Theory. Systematic reviews of quantitative and metasynthesis of qualitative literature were conducted. Fifteen paramedics participated semi structured interviews, generating themes by constant comparison, open, axial and selective coding. Results: Systematic review identified themes: Effect of SH education and training, age of staff, gender, attitudes towards SH, setting, influence of policies and guidelines. Metasynthesis revealed metaphors: Frustration, futility and legitimacy of care. First contact in the pre hospital environment: Talking, immediate and lasting implications of the moral agent. Decision making in SH: balancing legislation, risk and autonomy. Paramedics’ perceptions: harnessing professionalism and opportunities to contribute to the care of SH. Paramedicine: Culture and education in transition. Themes emerging from interviews including professionalism, legislation and ethical issues. The theme: Relationships with Police: Procedural, historical practices and evolution of surreptitious strategies. “if you wanted somebody detained then we all know detention under Section 136 needs to take place in a public place. Therefore often the easiest way to do it, to prevent somebody, or to treat somebody with self harm was normally to try to coax them into a public place where a police officer could take action, because they were, obviously, very reluctant to do it in a private property.” (para3) Conclusion: Paramedic care for SH is a complex professional, clinical and social interaction, the developing theory is continuing to evolve our understanding of this encounter, and potential contribution of paramedics to SH care.