The moral distress and posttraumatic growth of the ambulance workforce : A systematic review and meta-synthesis

Berry, Suzy and Sellwood, Bill and Parry, Sarah (2024) The moral distress and posttraumatic growth of the ambulance workforce : A systematic review and meta-synthesis. PhD thesis, Lancaster University.

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Abstract

Ambulance personnel (AP) face repeated traumatic events that may affect their wellbeing. This thesis concerns resultant moral distress and post-traumatic growth. Chapter One reports a systematic review and meta-synthesis exploring moral distress (MD) for APs. MD is the psychological distress experienced due to a moral event involving a moral decision that may challenge, threaten, or violate one’s core beliefs and integrity. Systematic searches screened 8,264 unique records against a priori eligibility criteria. Nineteen papers were selected, comprising 689 participants across nine countries. MD was often experienced as frustration, guilt, fear, helplessness, and shame and varied in its onset, duration, and intensity. MD arose from differences between APs expectations of themselves, their role, and their performance and the actualities of the day-to-day role. Other sources were the nature of the emergency call and patient presentations and being constrained from taking the morally correct course of action. Implications for prevention and interventions are explored. Chapter Two was a quantitative systematic literature review of positive changes APs experience following exposure to traumatic events (posttraumatic growth, PTG) and how coping may be related to this. A systematic search against a priori eligibility criteria identified five papers for inclusion out of 952 unique records. PTG was a common occurrence, but the majority of studies finding low levels of PTG. Coping was consistently related to and significantly predictive of PTG, as well as mediating the effects of personality and resilience. There was also evidence that the effects of coping may be moderated by factors such as self-efficacy/affectivity. Chapter Three describes the intended thesis and how this was not feasible due to COVID-19 and personal circumstances. A critical reflection on how biases were mitigated due to author’s personal experiences of topics covered, the structural impacts of MD, and the conceptual links between MD and PTG.