Resilience, posttraumatic growth and psychological wellbeing of paramedicine clinicians: An integrative review

Abstract

Clinicians in paramedicine are exposed to stressful events at work that have potential to cause negative psychological outcomes. Posttraumatic growth (PTG), resilience and psychological wellbeing, however, are adaptive psychological states that can also occur following trauma and adversity. Synthesis of knowledge on these positive outcomes can provide insight into resources needed to support paramedicine clinicians. To examine and synthesise what is known of PTG, resilience and psychological wellbeing of paramedicine clinicians, including the experience of these phenomena and relationship between them. An integrative review of peer-reviewed empirical literature published in English from 2013 to 2022 was conducted, following Whittemore and Knafl’s method. CINAHL Complete, MEDLINE Complete, PsycINFO, Scopus and Embase databases were searched. Included articles were quality appraised, with data analysed using the constant comparison method. Thirteen articles were included, with results synthesised into four categories. Mean PTG scores were reportedly moderate, and resilience ranged from average to above average. PTG and resilience had positive and negative relationships with specific coping strategies including dysfunctional coping, active coping, planning, venting emotions, social and emotional support and mental and behavioural disengagement. PTG scores were significantly lower for clinicians with longer shift duration and paramedics compared to emergency medical technicians. Resilience scores were higher for clinicians working part-time. Wellbeing was reportedly moderate and associated with the psychosocial climate established by managers. Qualitative findings indicated that workplace culture was perceived as stoic and masculine, which served to undermine staff resilience and willingness to disclose emotions. To support PTG and resilience, organisations should work to reduce stressors in workplace culture, including management and clinical supervision style, and offer employment flexibility. Organisations can upskill clinicians’ capacity for positive adaptation to adversity with professional development targeting identified coping strategies. Future research could examine clinicians’ experiences of PTG, resilience and wellbeing, and the relationship between them.