Bystander decision-making in an emergency: a constructivist grounded theory

Author: Anna Hall

Hall, Anna, 2017 Bystander decision-making in an emergency: a constructivist grounded theory, Flinders University, School of Nursing & Midwifery

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Each year there are millions of emergency events around the world. These events can occur anywhere and at any time. Out-of-hospital emergencies are events which endanger or threaten to endanger life, including cardiac arrest, vehicle crashes, drownings and falls. Despite emergency services personnel doing their best to assist the victims, many are left with temporary or permanent disabilities and many others die. Up to one-third of these deaths are thought to be preventable if early application of simple first aid measures were implemented; for example, controlling bleeding, which can be administered by people (bystanders) who witness or encounter an emergency. These bystanders are faced with potentially traumatic scenes and are required to make the decision about whether to stop to provide assistance.

Discussion about bystander assistance in emergencies has intensified within the literature since the 1960s, after the rape and murder of Kitty Genovese in 1964. Kitty’s attack was witnessed by thirty-eight bystanders who did nothing to help her, each believing that someone else was assisting. The body of research into helping behaviour in out-of-hospital emergencies supports the importance of bystander intervention in saving lives of victims of emergencies. If people are willing to provide assistance they have the potential to save lives. Yet despite evidence that bystander assistance increases the rate of survival of victims of emergencies, the rates of bystander assistance remain relatively low.

Current bystander research is skewed toward empirical methods limiting the ability to gather in-depth data concerning people’s experiences of being a bystander. A constructivist grounded theory approach was used to examine the cues and factors that influence bystander decision-making for people who witness or encounter an out-of-hospital emergency. In-depth interviews were conducted with people who had an experience of being a bystander in at least one emergency. Some of these people stopped to provide assistance and others left the scene of the emergency without helping. The application of grounded theory methods facilitated the generation of a theory grounded in participants’ experiences.

The substantive grounded theory constructed in this study was Motivated Responsibility and the Construction of Reasoned Justification, which helps to explain bystander decision-making in an emergency. After witnessing or encountering an emergency, bystanders enact a series of analyses, assessments and decisions in order inform the decision of whether to provide assistance. Bystander decision-making is a complex, cyclical process, which is influenced by various cues and factors that form barriers and facilitators for bystander assistance in emergencies.

The theory encompasses the subjective variations in response to the multitude of cues and factors that influence the decision, including the dichotomy of being motivated by responsibility to provide assistance and constructing justification for either providing assistance or leaving the scene of the emergency without helping. Decision-making was influenced by people’s beliefs, views and experiences and the analyses and assessments conducted upon witnessing or encountering an emergency. This substantive theory adds to the existing literature and knowledge of bystander decision-making in an emergency and has important implications for policy, education, future research and practice for health professionals and emergency services personnel.

Keywords: Bystanders, decision-making, constructivist, grounded theory, emergencies, assistance

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Nursing & Midwifery
Supervisor: Professor Paul Arbon