Undergraduate paramedic student experience with workplace violence whilst on clinical placement

Author: Brad Mitchell

Mitchell, Brad, 2021 Undergraduate paramedic student experience with workplace violence whilst on clinical placement, Flinders University, College of Medicine and Public Health

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Paramedics frequently face violence and aggression directed toward them while performing their duties. This is an international problem with studies worldwide showing that paramedics experience workplace violence (WPV) due to their unique working environment. Culturally there appears to be a normalisation of the experience of WPV by paramedics due to its frequency and is considered a ‘normal part of the job’. True prevalence rates are predicted to be higher than documented due to a lack of reporting partly due to the perceived normalisation of this phenomenon. Undergraduate paramedic students undertake placements in the clinical setting as part of Work Integrated Learning (WIL) for their university studies, exposing them to the same environment of WPV. Currently a paucity of evidence exists regarding the lived experience of paramedic students with WPV and how they perceive their own safety and preparedness for WIL given the existence of WPV. This study investigated the prevalence, and experience of, paramedic students’ exposure to potentially violent situations whilst on clinical placement and identifies the training needs of undergraduate student paramedics to inform the design of a contextualised Operational Safety Training (OST) program. The findings from this study demonstrate that currently paramedic students are at risk of injury while undertaking mandatory education component of their degree. This has a significant impact on the future of undergraduate paramedic education internationally by highlighting the required training needed for students to be safe.

An extensive literature review was performed to determine the prevalence data of health care worker experience with WPV internationally, with a focus on paramedics and paramedic students. This informed the development of a survey and in-depth interviews as part of a mixed methods approach using a convergent parallel design. The participants were undergraduate paramedic students and the study examined the lived experience of paramedic students with WPV and evaluated the current training that students receive as part of their education. Constructivist grounded theory was utilised to acknowledge and explore the social and cultural nature of this issue.

This research confirms that paramedic students are exposed to WPV when undertaking clinical placements as part of their university studies. The results show that 35% of paramedic students have experienced verbal abuse, and 9.5% physical abuse whilst on clinical placement. In addition, almost half of the respondents experienced further exposure via witnessing WPV directed toward the paramedic preceptors they were working with. Concerningly not one of these incidents was reported to the University which supports the literature around the underreporting of WPV in this space. The characteristics of each incident also aligns with the literature with the patient being the perpetrator in the majority of cases, and the incidents occurred late in the afternoon or overnight. Despite these statistics, students feel overall prepared and safe while on placement. This feeling of safety comes from the protective nature of the supervision that the paramedics they are working with provide. Students feel they need more education around communication and de-escalation to assist them on placement, as well as more time dedicated to disengagement/breakaway techniques. Overall, they feel the training they receive should be more frequent.

This study advocates for the promotion of reporting any WPV incident so that more accurate data can be collected to inform what and how often training is needed, and to develop and instigate appropriate support and guidance post an incident for students. Findings from this study provide useful background to the development of a contextualised OST program for all undergraduate paramedic students in the future. Undergraduate curriculum must include a tailored safety training program delivered at least twice per year. This is to be supported by a repository of information and resources pertinent to OST for students to access and review as they need. This allows for students to be better prepared for WPV as part of their university curriculum providing a more holistic and realistic education.

Keywords: paramedic, paramedicine, student paramedic, paramedic education, workplace violence, violence and aggression, safety training, operational safety, deescalation, disengagement

Subject: Health Education thesis

Thesis type: Masters
Completed: 2021
School: College of Medicine and Public Health
Supervisor: Lisa Schmidt