Compassion Meditation to Improve Psychological Wellbeing Among Volunteer Collegiate Emergency Medical Technicians (EMTs) Restricted; Files Only
Sonsurkar, Sayli (Spring 2024)
Abstract
Emergency Medical Technicians (EMTs) play a crucial role delivering life-saving care to acutely ill or injured patients. On some college campuses, student volunteer EMTs provide emergent care to their peers and the greater community. EMTs routinely face significant physical and psychological stressors, with frequent exposure to traumatic events, and often with little to no knowledge of patients’ outcomes. Providers at these collegiate-based emergency medical services (CBEMS) may be at greater risk for psychological distress due to their dual status as EMTs and college students. CBEMS providers must balance an already grueling profession with the demands and rigor of a college education. CBEMS providers also experience
Here, we used a randomized, waitlist-controlled design to investigate the feasibility, perceived benefit, and effectiveness of CBCT (Cognitively-Based Compassion Training) to improve CBEMS provider wellbeing. CBCT is derived from the Indo-Tibetan Buddhist lojong (Tib: བློ་སྦྱོང་, Wylie: blo sbyong) or mind-training tradition and was adapted to be accessible to those of any or no faith tradition. CBCT is an analytical style of meditation that combines exercises for stabilizing attention with contemplation of aphorisms, visualizations, self-inquiry, and related meditative exercises for cultivating and reinforcing compassion.
First, we conducted semi-structured interviews with volunteer CBEMS EMTs (n=5) to elucidate the prehospital environment and factors exacerbating stress and potentially bolstering their resilience. Participants (n=13) also responded to open-ended prompts regarding their interactions with patients, providers, and the EMS system. Transcripts were coded by two independent coders. Next, EMT providers were randomly assigned to CBCT or to a waitlist group (n=23, 8 CBCT, 15 waitlist), and all participants completed validated self-report measures of burnout, compassion satisfaction, secondary traumatic stress, perceived stress, and compassion malleability before and after CBCT. We conducted paired and independent t-tests on all self-report variables to identify significant effects of group and time; group-by-time interactions were assessed using PROC MIXED repeated measures to evaluate the effectiveness of CBCT.
Semi-structured interviews and recorded prompts revealed important insights about factors that exacerbate stress among student EMTs. Participants discussed experiencing excessive rumination, difficulty transitioning between academic and occupational roles, and empathic entanglements from treating their peers. We found that participants randomized to CBCT training reported a significant increase in compassion malleability (p=0.003) and reduced burnout (p=.04). This mixed methods study indicates that CBCT is effective in improving well-being among undergraduate EMTs and it yields insights that could improve conditions for CBEMS EMT providers and their patient
Table of Contents
TABLE OF CONTENTS
CHAPTER ONE: INTRODUCTION...............................................................................................1
CHAPTER TWO: The Dual Status of CBEMS Providers: A Literature Review..............................8
The History and Breadth of CBEMS Organizations…………………………………………………………………….8
Sources of Stress as College Student Status. ……………………………………………………….…………………..12
Psychological Stressors and Symptomatology as EMT Providers………………………………………………14
CHAPTER THREE: MINDFULNESS AND COMPASSION BASED SOLUTIONS………………………………24
Mindfulness and Compassion Introduction…………………………………………………….…………………………24
Major Buddhist Traditions on Compassion……………………………………………………………………………….29
Predominant Compassion and Mindfulness-Based Interventions……………………………………………31
CHAPTER FOUR: METHODOLOGY…………………………………………………………………..………………………45
Research Overview…………………………………………………………………………………………………………………..45
Institutional Review Board Process & Approval………………………………………………………………………..48
Participants and EMS Agency………………………………………………………………………………………………..…48
Cognitively Based Compassion Training Course Delivery…………………………………………………………..53
Randomization and Blinding…………………………………………………………………………………………………….53
Quantitative Measures………………………………………………………………………………………………….…………54
Qualitative Measures………………………………………………………………………………….……………………………55
CHAPTER FIVE: RESULTS & FINDINGS……………………………………..……….……………………………………58
Demographics……………………………………………………………………………………….…………………………………58
Quantitative Results…………………………………………………………………………………………………………………59
Qualitative Results……………………………………………………………………………………………………………………71
CHAPTER SIX: DISCUSSION & CONCLUSION………………………………………………………………………….84
WORKS CITED……..…………..………………………………………………...…………..…………..…………..…………..91
SUMMARY OF FIGURES AND TABLES
CHAPTER 2:
FIGURE 1. Conceptual Model of the Development and Reduction of Compassion Fatigue.....….21
CHAPTER 3:
Figure 2. Comparison of Number of Publications between Mindfulness and CBT trials…...........25
Table 1. What and How Psychological Descriptions of Mindfulness…………………………………………28
Table 3. Connections Between Major Buddhist Traditions and Compassion and Mindfulness Based Interventions……….…………………………………………………………………………………………………….....32
Table 4. CBCT Practice Overview……………………………...........……………………………………………………..38
Figure 2. CBCT Integrative Model……………………………………………………………..……………………………..43
CHAPTER 4:
Figure 3. Methodology Flow Chart ……………………………………………………………………………………….…47
Figure 4. Emory EMS Patient Chief Complaint Distribution………………………………………………………50
Figure 5. Emory EMS Scene Location Distribution…………………………………………………………….........51
Figure 6. Emory EMS Patient Age Distribution………………………………………………………………………….52
CHAPTER 5:
Table 5: Sociodemographic Characteristics of Collegiate EMTs……………………………..…………………60
Table 6: Existing Meditation Characteristics of Collegiate EMTs…..………………………………………....62
Figure 7: Interest in CBCT……………………………..……………………………………………..…………………..........63
Table 7: Self Report Survey Measures Effect of Group and Time ……………………………..…….……….66
Figure 8: Participant view on CBCT Implementation Post-Delivery……………………………..……………68
Figure 9: CBCT Intervention Credibility and Expectancy……………………………..……………...........….. 69
Figure 10: CBCT Delivery Format……………………………..……………………………………………..…………...….70
Table 8: Pre-randomization Semi-Structured Interviews (n=5)… …………………………..………………..76
Table 9: Short Audio Prompts Thematic Code (n=13)…. …………………………..………………….............81
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