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Paramedic Experiences of Providing Care in Wales (UK) During the 2020 COVID-19 Pandemic (PECC-19): a Qualitative Study Using Evolved Grounded Theory

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Paramedic Experiences of Providing Care in Wales (UK) During the 2020 COVID-19 Pandemic (PECC-19): a Qualitative Study Using Evolved Grounded Theory Open access Original research BMJ Open: first published as 10.1136/bmjopen-2021-048677 on 17 June 2021. Downloaded from Paramedic experiences of providing care in Wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory Nigel Rees ,1 Lauren Smythe,1 Chloe Hogan,1 Julia Williams2 To cite: Rees N, Smythe L, ABSTRACT Strengths and limitations of this study Hogan C, et al. Paramedic Objective To explore paramedic experiences of providing experiences of providing care care during the 2020 COVID-19 pandemic and develop in Wales (UK) during the 2020 ► The study was set up rapidly in one UK ambulance theory in order to inform future policy and practice. COVID-19 pandemic (PECC-19): service very early in their response to COVID-19. Design Qualitative study using constructivist evolved a qualitative study using evolved This was a unique opportunity to capture experienc- grounded theory. BMJ Open grounded theory (EGT) methodology. One- to-one es of Paramedics providing care as the pandemic 2021;11:e048677. doi:10.1136/ semistructured interviews were conducted using a general unfolded. bmjopen-2021-048677 interview guide. Voice over Internet Protocol was used ► A rich evolved grounded theory has been construct- through Skype. Prepublication history and ed on the Tragic Choices in providing paramedic care ► Setting Conducted between March 2020 and November additional online supplemental during the 2020 COVID-19 pandemic, but is limited material for this paper are 2020 in the Welsh Ambulance Services National Health by being conducted in one ambulance service. Services Trust UK which serves a population of three available online. To view these ► Remarkable consistency and agreement was found files, please visit the journal million. throughout analysis, member checking and previous online (http:// dx. doi. org/ 10. Participants Paramedics were recruited through a poster studies which adds to the trustworthiness and trans- 1136/ bmjopen- 2021- 048677). circulated by email and social media. Following purposive ferability of our findings. sampling, 20 Paramedics were enrolled and interviewed. Received 20 January 2021 ► Using the Voice over Internet Protocol of Skype Results Emergent categories included: Protect me to http://bmjopen.bmj.com/ Accepted 24 May 2021 was deemed a strength, especially in the context protect you, Rapid disruption and adaptation, Trust in of a pandemic due to social distancing. Technical communication and information and United in hardship. difficulties did occur and one recording became The Basic Social Process was recognised to involve Tragic corrupted. Choices, conceptualised through an EGT including Tragic ► The research team included insider researchers with personal and professional choices including concerns three practising paramedics and while this may be over personnel protective equipment (PPE), protecting considered a potential bias, we stated up front the themselves and their families, impact on mental health and constructivist nature of evolved grounded theory difficult clinical decisions, Tragic organisational choices and how the background of these researchers add- on September 27, 2021 by guest. Protected copyright. including decision making support, communication, mental ed to the richness of the grounded theory. © Author(s) (or their health and well-being and Tragic societal choices involving employer(s)) 2021. Re- use public shows of support, utilisation and resourcing of permitted under CC BY-NC. No health services. commercial re- use. See rights BACKGROUND and permissions. Published by Conclusions Rich insights were revealed into paramedic BMJ. care during the COVID-19 pandemic consistent with The SARS- CoV-2, the virus responsible for 1 other research. This care was provided in the context of COVID-19, was first reported in December, Pre- Hospital Emergency 1 Research Unit, Welsh National competing and conflicting decisions and resources, where 2019 in China. COVID-19 rapidly spread Ambulance Service NHS Trust, Tragic Choices have to be made which may challenge across the world, qualifying as a global Swansea, UK life’s pricelessness. Well-being support, clinical decision pandemic by the WHO (2020) on 11 March 2 School of Health and Social making, appropriate PPE and healthcare resourcing are 2020, affecting 220 countries, areas or terri- Work, University of Hertfordshire, all influenced by choices made before and during the Hatfield, UK tories, with 54 558 120 confirmed cases and pandemic, and will continue as we recover and plan for 1 320 148 deaths as of 11 Nov 2020.2 In the Correspondence to future pandemics. The impact of COVID-19 may persist, UK, plans prepared in the aftermath of the Dr Nigel Rees, Pre Hospital especially if we fail to learn, if not we risk losing more 2009 H1N1 global threat were enacted,3 Emergency Research Unit, lives in this and future pandemics and threatening the which included the response from ambulance Welsh Ambulance Services NHS overwhelming collective effort which united society in and wider health services and also wider soci- Trust, Institute of Life Sciences, hardship when responding to the COVID-19 Pandemic. etal measures including isolation methods, Swansea University, Swansea, Trial registration number IRAS ID: 282 623. UK; nigel. rees5@ wales. nhs. uk closing schools, businesses and self- isolation4 Rees N, et al. BMJ Open 2021;11:e048677. doi:10.1136/bmjopen-2021-048677 1 Open access BMJ Open: first published as 10.1136/bmjopen-2021-048677 on 17 June 2021. Downloaded from Prior to the COVID-19 pandemic, calls were repeatedly METHODS made for healthcare workers (HCWs) in the UK to ready Data collection themselves for such pandemics,5 6 which may involve diffi- Interviews cult and ethical challenging decisions shaped by the local One hour, one-to- one semistructured interviews were context and cultural values.7 HCW’s face personal chal- conducted using a general interview guide (online lenges and fears related to isolation, contracting disease, supplemental file 1). The internet carriage service Skype mortality and infecting family during pandemics.8–12 The was used, which is a Voice over Internet Protocol (VoIP).18 COVID-19 pandemic presented a unique opportunity to VoIP was beneficial in the COVID-19 pandemic context understand these issues from a UK paramedic perspec- as paramedics are a scattered workforce, practising social tive, and a programme of research was developed by our distancing during the study and this approach minimised team to explore paramedic experiences of providing care time needed away from clinical duties to participate. during the 2020 COVID-19 pandemic (PECC-19). We Interviews were video recorded with memos taken, tran- conducted an initial review of the literature which found scribed verbatim and checked for accuracy against the a paucity of published research concerning paramedics recordings. along with many of the challenges reported above.13 The present paper reports the finding of a qualitative study Patient and public involvement we conducted which aimed to explore paramedic expe- As this study was rapidly set up and due to the context riences of providing care during the 2020 COVID-19 of WAST responding to COVID-19 we did not involve pandemic and develop theory in order to inform future patients or members of the public. We do however intend policy and practice. to present our findings to public and patient groups. METHODOLOGY Data analysis 14 Strauss and Corbin’s14 evolved form of Grounded Theory Analysis followed Strauss and Corbin’s three levels (GT) methodology was used, which follows a construc- of open, axial and selective coding entered into NIVO tivist perspective and accepts that people construct the V.12 software to create a coding book. Open coding realities in which they participate and thus highlights compared data for similarities, differences and questions the researcher–participant dyad and the co-construction regarding emergent phenomena resulting in identifica- of data.15 In Evolved GT, the researcher is a ‘passionate tion of indicators; words or phrases of interest. Indica- participant as facilitator of multi-voice reconstruction’ tors were subsumed under higher level headings known (Lincoln & Guba 2005 p. 196).16 Three researchers as concepts, which stand for the emerging phenomena. within this study were practising paramedics and provided Axial coding involved subsuming concepts into higher- http://bmjopen.bmj.com/ (limited) front- line care during the 2020 COVID-19 level headings known as categories. Selective coding pandemic which in turn facilitated insight, awareness and also involved ‘explication of the story line’ (Strauss and ability to bring meaning to the data.17 Such background Corbin 1998, p. 148)14 which involves identifying the does though have the potential for preconceived ideas basic social process (BSP) at work, around which all other and previous encounters to influence the construction of categories revolve. The BSP meaningfully and easily the evolved GT, and to counteract this, member checking relates to all other categories and should have clear and and reflexivity methods were employed. grabbing qualities19 on which to theoretical construct the evolved grounded theory (EGT) through weaving all of on September 27, 2021 by guest. Protected copyright. Setting and sampling the fractured data back together and conceptualising the The study was conducted between March 2020 and relationship among these three levels of coding. A second
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