On first undertaking CardioPulmonary Resuscitation: a philosophical hermenuetic inquiry

Barton, Peter John Marian (2017) On first undertaking CardioPulmonary Resuscitation: a philosophical hermenuetic inquiry. Ed.D thesis, University of Glasgow.

Abstract

Introduction:
CardioPulmonary Resuscitation (C.P.R.) is a critical clinical intervention widely recognised (Laws, 2001) to evoke stress in attending clinicians. Little is known about how junior clinicians (doctors) understand their early experiences in performing C.P.R., or whether their preparation could be improved.
Problem:
Undergraduate medical students have traditionally reported anxiety (Duns et al., 2008) at participating in CardioPulmonary Resuscitation. A recent systematic review of best practice in C.P.R. education focused on clinical knowledge and skills, but not emotional preparation (Mosley et al, 2012). No study has critiqued whether doctors’ pre-qualification anxieties align with their clinical reality. Less is known about the extent of their post hoc support needs.
Methodology:
Previous studies of doctors’ experience (Morgan and Westmoreland, 2002) have used exclusively quantitative data collection. Early qualitative data on young nurses’ experience of C.P.R (Ranse and Arbon, 2008), which used a focus group method, has identified: the experience of a chaotic environment; inadequate post-C.P.R. debrief; and unrealistic rehearsal in training. This qualitative study has used 1:1 interviewing and a Philosophical Hermeneutic (Gadamer 1975) lens to explicate how young doctors experience (and make sense of) their early attempts at C.P.R. The sociological framework of Symbolic Interactionism (Blumer, 1969, Charon, 2010, Mead, 1934) was deployed to offer a human interaction based interpretation of participants’ accounts. An experiential learning theory (Jarvis et al., 2003) offered further insights into the dimension of experiential learning.
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Results:
Eighteen participants were interviewed over 18 months. Using NVIVO 9 software, a thematic analysis technique, and a hierarchical analysis ladder (Spencer et al., 2003), four major themes were identified:
1. Current C.P.R. education is, at a skills and knowledge level, comprehensive and adequate.
2. Simulation rehearsal practises higher responsibilities than those clinically experienced, and usually fails to accommodate the “ambient” conditions of the real event.
3. C.P.R. offers novice clinicians a variety of experiential learning opportunities about leadership and about professional expectations of personal resilience (stoicism) as a doctor.
4. Participant support needs are usually unique, contextually generated, and largely unrecognised. Almost invariably unidentified, these needs reflect a variety of emotional states experienced during C.P.R.: surreality; exhilaration; satisfaction; or distress.
Implications:
This study has demonstrated the feasibility of 1:1 interviewing to generate deep, rich and granular accounts. Analysis through the lenses of Philosophical Hermeneutics, the sociological framework Symbolic Interactionism and the revised experiential learning theories of Jarvis offered unique perspectives and understandings of these experiences. The influence of “ambient” contextual conditions during C.P.R. has been partially, though not exhaustively, explicated. Whilst educational rehearsals should attempt simulation of reality, not all realities can be simulated. Post hoc support needs are unrecognised and educational responses unquantified. A modern duty of care to staff should require high quality interventions in three areas: pre hoc preparation; intra hoc conduct; and post hoc support.

• Item Type: Thesis (Ed.D)
• Qualification Level: Doctoral
• Keywords: Cardiopulmonary resuscitation; cardio pulmonary resuscitation; Philosophical Hermeneutics; Experiential learning theory of Peter Jarvis; novice healthcare practitioners; influential experiences; transitional experiences
• Subjects: L Education > L Education (General); L Education > LB Theory and practice of education > LB2361 Curriculum; R Medicine > R Medicine (General); R Medicine > RZ Other systems of medicine
• Colleges/Schools: College of Social Sciences > School of Education
• Supervisor's Name: Osborne, Professor Michael
• Date of Award: 2017
• Depositing User: Dr Peter John Marian Barton
• Unique ID: glathesis:2017-8044
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 23 Mar 2017 16:39
• Last Modified: 01 May 2017 08:39
• URI: https://theses.gla.ac.uk/id/eprint/8044