'Send everyone, it's my son' - Combined Glaserian grounded theory and thematic analysis of paramedics attending their own families

Introduction
Medical clinicians treating relatives is ethically complex; in paramedicine, the time-critical nature of pathologies often precludes alternative treatment without risking morbidity or mortality.

Aims
This project had three aims: firstly, to retrieve baseline data for thematic analysis on the experiences of paramedics who have attended their own families; secondly, to generate explanatory grounded theory; and finally, to translate these findings into recommendations for practice.

Methods
Glaserian grounded theory and thematic analysis methods were both undertaken using a realist perspective. Acquiescence, wording, and habituation heuristics were mitigated in the interview design. There were 44 responses (n = 93 instances of treating family), with 21 participants (n = 34) from three countries interviewed. Saturation was determined using both Guest et al.'s and Thorne's criterion. Semantic and latent themes were generated inductively via a five-step process, with grounded theory generated simultaneously via a three-step Glaserian process. Cohen's kappa ranged from 0.82 to 0.93.

Results
Incidents were both traumatic (hangings, stabbings, traumatic arrests) and medical (paediatric arrests, cardiac arrests, overdoses). The core concept-category was ‘conflict between the roles of clinician and relative’. Paramedics reported a sympathetic hyperarousal response that they quickly suppressed, a rapid transition into ‘work mode’, and difficulty obtaining their normal state of flow, balancing dual roles as clinician and relative, transitioning out of work mode and into becoming a carer, and simultaneously processing the event. Organisational responses were frequently described as inadequate. Paramedics reported short-term experiences consistent with an acute stress response, and a large proportion suffered long-term, life-altering consequences. It is theorised that this phenomenon disrupts professional detachment, increases outcome self-expectations, interrupts normal routines, and promotes overmedicalisation.

Conclusion
This research provides baseline data and theory on the experiences of paramedics attending their own families. Five themes and 24 subthemes were identified, an explanatory theorem proposed, and a preliminary set of eight recommendations for translation into practice provided.

© The Author(s) 2023.

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