Self-regulation strategies of emergency care practitioners

Abstract

Emergency care practitioners (ECPs) are daily exposed to highly arousing and extremely traumatising medical emergencies including road accidents, assaults, and shootings (Erasmus & Fourie, 2008). These incidents present them with the reality of physical, emotional and relational impacts, as well as realities that impact on their own personal sense of safety. In addition to sensory overload, ECPs’ assumptions about the world, meaning and the self could thus be seriously challenged. Intense emotional reactions, if unregulated, may interfere with the ability to think rationally and act purposefully (Bandura, Caprara, Barbaranelli, Gerbino, & Pastorelli, 2003). ECPs therefore need to be able to regulate their thoughts and emotions, need to act purposefully, must be able to stabilise emergency situations as well as act responsibly and efficiently. Self-regulation involves deliberately altering or overriding one’s unregulated responses (Baumeister, Vohs, & Tice, 2007; Muraven & Baumeister, 2000) and includes exerting control over one’s actions and inner states so as to focus them into line with meaningful, purposeful outcomes and standards such as goals, values, and expectations (Carver, 2004). As research data on this topic are nearly non-existent in the South-African context, the study aimed to explore the following: (i) what are the most important thoughts and emotions ECPs experience as a result of work-related exposure to human emergencies?; (ii) what are the self-regulation strategies ECPs apply as a result of work-related exposure to human emergencies? (iii) what are the perceived cause-effect relations between these thoughts, emotions and self-regulation strategies of ECPs?; and (iv) how could these perceived relationships be developed in a hypothetical model of self-regulation for ECPs? The aim of this study was to explore the self-regulation strategies emergency care practitioners apply in relation to their high risk job context. A purposive sample of 15 emergency care practitioners took part in the study. Interactive Qualitative Analysis (IQA) was used to generate and analyse data. Seven themes were identified, namely i) be ready; ii) job satisfaction; iii) feeling uncertain and anxious; iv) self-coping strategies; v) rational and clear thinking; vi) formal debriefing and vii) feeling frustrated and angry. Based on the participant’s perception of the relation between these themes, a hypothetical cause-effect model was constructed, explaining 86.76% of variance in the data. The model shows that participants experience strong negative emotions like uncertainty, anxiety, frustration and anger in relation to the risks and danger of their job, but these emotions also initiate the process of self-regulation. Carver and Scheier (2009) indicate that the purpose of emotions is to serve as part of a monitor feedback loop. When becoming aware of emotions, the possibility of reprioritising goals emerges. Participants in this study use knowledge and skills from formal debriefing sessions to reprioritise, apply learnt skills and to think more rationally by focussing on the task at hand and by blocking out distracting emotional responses. This may eventually end in job satisfaction, or result in the application of different constructive and destructive coping strategies that feeds back into the self-regulatory process. Rational thinking may result in denying and suppressing emotions in a way that is effective in the short term only. This causes the resurfacing of emotions that may interfere with effective job execution. The main contribution of this study is to put forward a theoretical model of how self-regulation unfolds within a specific group of ECPs, as well as the advantages and challenges of their self-regulatory strategies. It illustrates the complexity of human self-regulation, specifically in a high risk job environment. The most important limitation of the study is that no individual interviews with participants could be conducted due to practical constraints. As a result, some richness of data may have been lost and results can subsequently not be generalised to other groups of ECPs. The study emphasizes the need for further research in the self-regulatory strategies of ECPs to be able to provide them with better training.