Learning Program Needs Assessment

NEEDS ASSESSMENT INITIAL REPORT
Stress Management Strategies of Junior Paramedics
Course: ETEC 550/650
Irina Borcea
Concordia I.D.: 29712569
January 30th, 2017

Needs Assessm ent Initial Report
General information about the project
Name and title of the sponsor of the project:
Private Individuals - John Abbott Pre-Hospital Emergency Care Program graduates;

depending on how social media and promotion will work, might include a broader
audience of junior paramedics
Description of the problem or the need (according to the sponsor):

High stress and performance levels affecting psychological well-being necessary for job
performance. The unique nature of EMS intervention required on the job takes an
unexpected mental toll (with the potential of developing into PTSD) on Junior
paramedics.
Current performance of stress management task analysis:
- Junior Paramedics sporadically and post-factum apply stress management strategies
learned in their degree program (performance anxiety and the novelty of the
scenarios encountered hinder transfer of knowledge from stress management course)
- Junior Paramedics develop note taking skills intuitively (through trial-and-true and
on the job experience);
- Junior Paramedics devote between 5-10 minutes of reflective practice to help them
manage stress (this is done again on an adaptive trial and true basis, without any
guidance or scale of professional assistance)
- Junior Paramedics engage in stress reducing activities based on their personal
apprehension of the situation
- Junior Paramedics refrain from expressing their concerns about on the job stress and
establish informal systems of support which they sporadically refer to when going
through stressful events
- All the above-mentioned subtasks take an indefinite amount of free and/or on the job
time, ranging from 5-10 minutes/day to a full day (since there is no formal system of
reference for stress management tasks, they cannot analyze how productive they are
in their time management)
- All the above-mentioned subtasks do not have a formal content benchmark to
compare and provide in depth feedback (the stress management content of the
degree course does not appear to have transferred in their job performance in regards
to stress management skills) – assumption tested only on the four questionnaire
responders
This project will provide the following benefit to the sponsor: reduce mental
health risks
Desired stress management performance (general description):
With reported statistics of 40 Canadian first responders committing suicide in 2015, the
2
clients wish to insure a successful career in the EMS field, whilst simultaneously
reducing their risk of developing PTSD by recognizing and accepting the particular
stress performance factors associated with the EMS profession (i.e.: anxiety and
depression in the aftermath of a particularly challenging EMS intervention are to be
expected and experienced differently by any and all EMS service providers).
Name and title of the Subject Matter Experts (SME) or information sources:
Remus Stefan Florinca - (1st year) John Abbot Pre-Hospital Emergency Care graduate;
practicing junior paramedic
Jasmine Piche - (1st year) John Abbot Pre-Hospital Emergency Care graduate; practicing
junior paramedic
Andrew Cawston - (3rd year) John Abbot Pre-Hospital Emergency Care graduate;
practicing paramedic
Mathieu Morin - (1st year) John Abbot Pre-Hospital Emergency Care graduate;
practicing junior paramedic
Specific performance desired:

The paramedic is able to recognize the stress and crisis stages resulting from a
challenging EMS intervention. He/she is able to voice his/her concerns and ask for
support from APPEX or an established paramedics support organization. The junior
paramedic pro-actively addresses stress factors and post-intervention stress related
issues by following an adapted and personalized version of the introspection and
reflection task: recognize the nature of stress, analyze it based on your notes, reach out
to system of support, accept the experience as an opportunity for professional and
psychological growth.
Sources:
Interviews: Stefan Florinca, Jasmine Piche, Andrew Cawston, Mathieu morin
Documents (list them) journal articles and reports; Google questionnaire given to
interviewees
- the journal articles provided a starting point for backing up the need for stress
management techniques which stemmed from the interviews;
http://www.cbc.ca/news/canada/montreal/urgences-sante-mental-health-1.3598305 ;
http://montrealgazette.com/news/local-news/what-help-is-there-for-quebecs-paramedics
- the Questionnaire was aimed to test the validity of the initial need by having participants
pin-point potentially stressing events they have encountered in the junior paramedics
career; because all 4 participants have taken a course in stress management I also
wanted to assert the tool already in place they had gained from the course, as well as the
actual need for continuous training in developing stress management workshop which
are geared towards particular needs and particular learners (constructivist in nature)
more than serve as a “recipe” or “silver-bullet” toolbox of strategies;
Issues Affecting Learning and Performance Improvement:
Characteristics of the work environment (context analysis):

- 720 hours of probation for junior paramedics: the employee is routinely assessed on job
3
performance in relation to respecting protocol and procedures without ANY major

mistakes in patient treatment and colleague relationships (the probation period directly
impacts job security for junior paramedics)
- The junior paramedic needs to constantly adapt to a different work partner
- The junior paramedic has swing shifts (various hours) – sleep cycle/performance
disruption
- The junior paramedic works in an ambulance
- The junior paramedic works always on different locations
Characteristics of the teaching and learning environment (context analysis)

- personal network of colleagues and friends, insuring anonymity and free of judgement
(since this project is not part of or under the regulation of the employer, junior
paramedics do not feel the need to hide their anxieties and fears)
- Constraint: Outside of work effort (this project would most likely require the junior
paramedics to invest their free time to the extent of 1 to 2 hours / week, although the
initial training will consist of a 15-20 min. workshop)
- Constraint: introducing and promoting the program to a wider audience of Junior
Paramedics (the course and workshop could greatly benefit from a broader socio-
cultural learner perspective and the constructive nature of the course content would
greatly be improved by different interventions and stressful situations potential Junior
Paramedics have engaged in)
Characteristics of the learners or a sub category of learners:
- graduates from the John Abbott Pre-Hospital Emergency Care Program

- Bilingual (French/English) speakers
- Super-learners: they have graduated top of the class at John Abbott (this may also be a
constraint in developing engaging material)
- Problem-solvers
- Constraint: Afraid of making mistakes (perfectionists) – assumption for some additional
participants that might be introduced to the course
General demographic information:

- 23-30 years old; 23-year-old average (young, idealistic, highly driven and motivated) –
assumption from some other participants that may be introduced to the program
- 3 males and 1 female: it is interesting to note the candor and descriptive vividness in
Jasmine’s answers to the questionnaire; out of the learners interviewed she is the one
that provided most details about the sensations associated with stress – both cognitive
and psychological;
- “digital natives”: worked with LMS when completing their degree; have mobile apps
they frequently use to consult procedures; subscribed to social media in the EMS field –
assumption based on initially interviewed learners
Previous or prerequisite Knowledge:

350-183-AB Stress Management core-course given in the 5th out of 6 Semesters John
Abbott Pre-Hospital Emergency Care program: the main objectives of the course are to
4
help students “identify situations and/or factors that will trigger emotional or stressful
reactions in the workplace. This course will consider stress, stages of crisis, awareness
of safety and intervention associated with crisis response protocol and critical incident
stress.”
Influences:
Personal experiences from the situations and interventions performed during the
internship
Characteristics of the content / material
The content will be elaborated constructively and collaboratively: as a starting point for
determining strategy benchmarks, the ‘Emergency Services Stress’ book provides an
excellent starting point for reference. The subsequent content will aim to personalize
and adapt strategies to particular stress needs management of the learners. Instead of a
general recipe one-size-fits-all stress management guidebook, the learner will participate
and benefit from a personalized and adapted knowledge database of EMS stress
management procedures.
Tasks in Expert Performance
Tasks that learner will be able to perform after the instruction:
Main task 1: Recognize signals of distress

Supporting tasks:
 engage in self-reflection (minimum 5-10 min/day) based on personal notes
 identify changes in behavior (not sleeping well, being more prone to nervous responses,
reduced patience in accomplishing tasks)
 identify changes in behavior based on personal experience: outside textbook guidelines
(i.e.: maybe increased hunger or stress-eating for some is abnormal behavior)
Main task 2: Adapt to signals of distress

Supporting tasks:
 accept signals of distress as inherent to the job (they are not a reflection on
performance, nor are they indicators or predictors of success as a paramedic)
 Choose the appropriate channel of communication (i.e.: avoid imparting explicit and
highly-graphic incident details to family and friends who are un or ill-equipped to understand
the issue at hand and are thus unable to provide constructive criticism and adequate support)
 Communicate to a mentor/close friend in the business on changes in behavior
 Maintain a critical and open-mind to mentor/close friend suggestions
 Seek the help of the support-system – colleagues, APPEX, on-line sources
5
Main task 3: Use the stressful intervention as a

“professional growth” opportunity:
Supporting tasks:
 Contribute to the existing knowledge database of paramedics offering support to each other
established by this project
 Test numerous strategies of reducing stress as discussed with mentors and /or
colleagues, support system
Sources of task analysis:
- Interviews and questionnaires with participants
Mitchell, J., & Bray, G. (1990). Emergency Services Stress - Guidelines for Preserving The
Health and Careers of Emergency Service Personnel. NJ: Prentice-Hall.
6
1/29/201 ProActive PTSD Management Junior Paramedics Questionnaire
Responses cannot be edited
Pro-Active PTSD Management Junior Paramedics

Questionnaire
This form aims to analyze current applications of stress management strategies junior
paramedics use on their job.
Emailaddress*
andrew.cawston@gmail.com
1. What unexpected mental stress factors did you encounter on your 1st
day of internship/stage as a paramedic student? *
The most prominent stress factor I can remember from the begininning of mys
internship was the need to make rapid decisions of patient priority when faced
with a motor vehicle accident invovling 3 cars for a total of 8 patients.
2. When dealing with the scenario presented in the answer for question 1,
whatstrategy(ies)fromtheStressManagementCourse350-183-ABdidyou
use, if any? In the event this course was not offered when you completed your
degree, what strategies did you apply and which were your sources of
reference? *
I do not recall the speci韚�c stress mediating strategies that we learned in the
Stress management however, taking a step back and summarizing to myself
what I was seeing and what needed to be done, helped me get through that
event. It`s a strategy I continue to use on complex calls to this day.
https://docs.google.com/forms/d/1Aas5gZYdOe0p72yR0izBqOMZ5nJkTCrBqPrFX8zr_Vg/edit#response=ACYDBNjC3xoEJfffn6jwbMfprrjrSCMUqdgZ2...
3. Were you able to apply the strategy mentioned in question 2? Why? Why not? How did you
apply it? (i.e.: I took notes, re韈�ected on my notes during breaks) *
I feel the strategy I applied was successful. Everyone recieved the appropriate care in the acceptable
delays. As stated in question 2, I simply summarized what needed to be done to myself and it
permitted me to create a mental checklist in order of priority.
4. What were the limits of the strategy(ies) identi韚�ed in questions 2 and 3? Describe the
consequences of those limits if any. (i.e.: the strategy from the 'Emergency Services Stress'book by
Jeff Mitchell and Gary Bray was too general to apply to my particular context - the stressful
encounters I have experienced did not subscribe to the description offered in the book or in other
stress management educational resources) *
The limits of this strategy is that sometimes the situation is critical and requires immediate action
and this can be not only very distracting from the summarizing method but also, the time spent
summarizing may delay necessary actions to help correct the patient's condition.
5. In the aftermath of your 韚�rst months on the job, what stress factors still affect you the
most? Do you believe you are fully equipped to handle these stress factors? Please provide details
for either instances: if you are - how exactly, and if you are not - what could be done to facilitate
a positive outcome. *
The 韚�rst few months on the job (up to the end of my 韚�rst year I would say) I had the constant stress of
going into every shift wondering if I would face a situation where I would freeze or panic and not know
what to do. However as I went on and overcame situation after situation, I became comfortable in the
knowledge that I don't know everything and I haven't seen everything but I am con韚�dent that whatever
situation presents itself I will be able to come up with an adequate solution. And this I attribute to my
stress management technique.
https://docs.google.com/forms/d/1Aas5gZYdOe0p72yR0izBqOMZ5nJkTCrBqPrFX8zr_Vg/edit#response=ACYDBNjC3xoEJfffn6jwbMfprrjrSCMUqdgZ2...
6. What do you think is the mental health impact and negative

consequences of starting as a junior paramedic without having stress
management strategies in place? *
You never know what you are going to facewhen you step onto the ambulance
especially when you haven't had the time to accumulate experience (or con韚
�dence) on the road. If you don`t have the means to manage stressors both in
your daily life and on the job they will quickly break you down.
Pro-Active PTSD Management Junior Paramedics Questionnaire
Email address *
ퟢ�orincastefan@yahoo.com
The main stress factor I encountered/experienced most, during the 1st day of
internship, was the fact that I had to perform at a level that I, personally, did not
fully internalize that I was able to. I felt (possibly not the case from the
perspective of my preceptors, but nonetheless subjectively that's how I
thought ), that there was a high expectation threshold that I had to uphold
constantly and a low threshold for mistakes that added to my performance
stress. I realize now, after having gone through that process that it was mainly a
personal perspective and not necessarily the reality of the moment. After a
post-factum analysis I was able to understand that the initial perspective was
more a by-product of my personality pro韛�le and not as much a tangible reality.
https://docs.google.com/forms/d/1Aas5gZYdOe0p72yR0izBqOMZ5nJkTCrBqPrFX8zr_Vg/edit#response=ACYDBNhu7itlXBE86Wt_4uZvJklh8MO9ug...
2. When dealing with the scenario presented in the answer for question 1, whatstrategy(ies)from
theStressManagementCourse350-183-ABdidyou use, if any? In the event this course was not
offered when you completed your degree, what strategies did you apply and which were your
sources of reference? *
As aforementioned, having reached the milestone of understanding how my mind interpreted the
situation, I was able to allow myself more space to act and think, understanding that the learning
process toward professional improvement is healthily littered with moments of sub- standard
attempts at solving a given issue. Being more aware of the origin of one's thoughts and being prepared
or having the proper analyzing tools/pro韛�le, of course after reading about if from specialized sources,
to set ones experiences in a objective frame, with time, it became easier to adapt to new situations and
have the psycho-emotional buffer in place so as to remember what i had done wrong previously in a
similar situation and not repeat it, and even more so, to improve upon it.
apply it? (i.e.: I took notes, reퟢ�ected on my notes during breaks) *
In the moment is extremely dif韛�cult to be able to fully acknowledge if one is applying the strategy
actively. Only after the intervention is done or when one returns home can the process of analysis really
begin. Due to the hectic unraveling of events while on active duty/stage, I found that a very important 韛
�rst step, toward a close analysis and understanding, was to take notes or mark key points on ones
personal notebook of things that did not go as planned or rose questions about the level of
preparedness/knowledge. During an off day I would look upon my notebook entries and visualize/call
to mind the speci韛�c moment and go through it again with the additional knowledge acquired from
having gone through it the 韛�rst time and having researched it afterwards. It allowed me to consolidate
a pattern of speci韛�c actions that,韛�rstly, would alleviate the level of stress during a similar intervention,
and secondly, would diminish the cognitive load of having to 韛�nd on the ퟢ�y solutions that would
somewhat stop me in my tracks. It's well known that no intervention is quite like the next and that
paramedics are known to be able to, or better yet, actually required to 韛�nd quick and innovative
solutions to new presentations, but in my case, as a junior paramedic, that skill is still underdeveloped
so I would chose to train repetitive actions and build a stable reퟢ�ex arc before attempting to increase
my cognitive load and start fast and on the ퟢ�y problem-solving. Incremental steps.
4. What were the limits of the strategy(ies) identi韛�ed in questions 2 and 3? Describe the
stress management educational resources) *
One of the only limits i can call to mind about my approach was the sheer amount of information. Being
a high-performance and detail oriented individual i would soon 韛�nd myself a bit swamped by the ever
growing body of knowledge. As a ퟢ�uid process, learning on the job and off the job, it is necessary to strip
down all incoming information to its simplest form and incorporate it as that, a low-resolution tool to
be expanded on as one goes on maturing and acquiring more and more 韛�eld experience. The practical
and theoretical ends of the spectrum need to be held in close balance.
5. In the aftermath of your 韛�rst months on the job, what stress factors still affect you the
I can only speak about myself, obviously :P, so, in addition to what i mentioned above, a stress factor
that often and truly impacted me, during my experience as a student-paramedic, was the responsibility i
felt for the well being/positive evolution of my current patient. I knew that my preceptors were there to
make sure everything went as smooth and as safe as it could, but nonetheless, I felt that I was fully in
charge and responsible of my actions and their consequences. This position, if occupied by other junior
paramedics or student-paramedics for that matter should be well identi韛�ed and objectively placed in
the everyday duty activities.
While I 韛�nd it a normal reaction to have, as a caregiver, one should split the responsibility and burden
with his or her colleagues and supervisors in order to make the learning process more rich and more
positive and self-af韛�rming. Even if initially one is not entirely equipped to fully handle these emotions,
one should be patient and try, before going into the 韛�eld, to have some self-evaluating tools at the ready
so that stress can be articulated, managed and relieved, during and after each event.

It is statistically well documented that 韛�rst responders (韛�re韛�ghters and Police

of韛�cers) and most emergency medical professionals (Paramedics and Nurses)
have the highest rates of job-related stress, anxiety and depression. With such a
signi韛�cant chance of experiencing a high level of psycho-emotional stressors, an
inexperienced individual's best chance in navigating such a demanding 韛�eld
with relative ease or in an well-adaptive manner is to have a clear stress
management strategy in place. Without it the road is most likely paved with
sorrow, pain, and dissatisfaction.
Emailaddress*
jasmine.piche@hotmail.com
One of my first calls on the ambulance was a bad car accident and a young 20
year old man died in the crash. This was an unexpected stressful event. My lack
of experience in the field left me feeling not so confident and yet I had to
manage this difficult intervention. I remember feeling like it wasn't real, like I
was in a movie. I was focused and doing all the things I had to do but I wasn't
realizing what was actually happening...that only came later.
https://docs.google.com/forms/d/1Aas5gZYdOe0p72yR0izBqOMZ5nJkTCrBqPrFX8zr_Vg/edit#response=ACYDBNj6HOZRiKIEMJaZgFfeSG6ZUkN1g... 12
reference? *
During the intervention I wasn't thinking about stress management techniques

at all but the "surreal" feeling was a defence mechanism that allowed me to put
asside my emotions and do my job efficiently. It's only later that everything sunk
in. This is where my stress management technique helped me a lot. I combined
running for 20-30 mins and relaxing (taking a hot bath, watching tv). This
helped my accept what had happened and let out my anger towards that crash.
Relaxing also allowed my to leave this in the past and move forward.
3. Wereyou ableto applythestrategymentionedin question2? Why?Why not? How did you

apply it? (i.e.: I took notes, reflected on my notes during breaks)*
Yes I was able to apply my technique a couple times a week. I went to the gym after my night shifts. It
was important for me to take that time to releas my stress and anger. It took me about a month to stop
having "flashbacks" of the smells of that crash (a mix of burnt metal, blood and tree sap).
4. What were the limits of the strategy(ies) identified in questions 2 and 3? Describe the
stressmanagementeducationalresources)*
My stress management technique works very well for me but it's not something I can use during a
traumatic event. The stress management course helped me identify that my stress was mostly physical
and therefore physical activity was the best technique for me. Also, running and relaxing on their own
aren't enough. Talking about what I had seen helped a lot as well.
5. In the aftermath of your first months on the job, what stress factors still affect you the most?
Do you believe you are fully equipped to handle these stress factors? Please provide details for
either instances: if you are - how exactly, and if you are not - what could be done to facilitate a
positive outcome. *
My inexperience is what stresses me the most. I still haven't performed certain techniques or
managed certain situations and being afraid of making mistakes causes me a lot of stress. This of
course is a temporary situation, I need time to allow me to have more experience and feel more
confident about the difficult interventions. In the meanwhile, I manage my stress by continuing
physical activity and relaxing but also keeping a balanced lifestyle. Taking time to be with family and
doing fun activities helps to deal with everything we see.

I beleive that our stress management techniques allows junior paramedics to be

aware of the dangers of working in a very stressful environment everyday and it
helps us understand the importance of stress management and how to be
efficient at it. Without this course, I think junior paramedics would have more
difficulty finding ways to manage their stress and would have a harder time
recognizing the symptoms of PTSD. The course also helps to reduce the stigma
around mental illnesses such as depression that emergency workers often
experience during their career.
Emailaddress*
mathieu.morin@paramedic.quebec
It was not really unexpected, but it did come out stronger than I thought it
would. The shock of the difference between an in-class setting and the 'real
world' affected me greatly.
Furthermore, starting internship made me realise that I only knew the tip of the
iceberg, and that scared me a lot since I always thought I could deal with any
situation without any problem.
https://docs.google.com/forms/d/1Aas5gZYdOe0p72yR0izBqOMZ5nJkTCrBqPrFX8zr_Vg/edit#response=ACYDBNi1S2vaIxVDYgWOffYRw5Ig6XuXzd... 15
reference? *
I do not remember if it is a strategy that was mentioned in the Stress

Management Course, but the strategy I used was visualisation, putting
everything back in the right context. For instance, instead of focusing on what I
didn't know - I focused on what I knew and realise that I am a student and that
learning everything that was unknown for me at the time(and some parts are still
unknown!) was the goal for stage, and that every other students was in the same
basket than I.
apply it? (i.e.: I took notes, re�ected on my notes during breaks) *
Yes, and they worked well. After the ��rst day I simply went back home, layed down on my bed and
worked out everything that I was feeling and that happened on that day.
4. What were the limits of the strategy(ies) identi��ed in questions 2 and 3? Describe the
stressmanagementeducationalresources)*
I guess one of the limit of this strategy is if your ��rst day really went wrong for whatever reason.
I had the chance to have pretty simple calls that wasn't a dying or living situation. I therefore had
the chance to dip my foot in the water without burning myself.
5. In the aftermath of your ��rst months on the job, what stress factors still affect you the
Probably the same as before, added to working with paramedics who have a lot more experience. There
is still so much that I have to learn as a rookie paramedic, and you don't really want your partners to
feel like a stage preceptor. I feel like it is a lot easier to feel comfortable working with someone of the
same level of experience than a medic who's been on the road for the last 30 years.
Needs Anal ysis for D esigning Tr aining Progr am s

One of the biggest issue that one could have, in my opinion, is that the junior
paramedic might feel overwhelmed by the whole learning process that comes
with starting this new job and abandon after feeling helpless and blaming
him/herself for 'not learning fast enough'. But, one thing that we keep
forgetting about this ��eld(and many others) is that we learn new things
everyday until we retire. In my opinion, the day we stop learning is the day we
should quit this job.
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NEEDS ASSESSMENT INITIAL REPORT

Stress Management Strategies of Junior Paramedics

Course: ETEC 550/650

Concordia I.D.: 29712569

January 30th, 2017

General information about the project

Name and title of the sponsor of the project:

Private Individuals - John Abbott Pre-Hospital Emergency Care Program graduates;

Description of the problem or the need (according to the sponsor):

Specific performance desired:

Issues Affecting Learning and Performance Improvement:

Characteristics of the work environment (context analysis):

performance in relation to respecting protocol and procedures without ANY major

Characteristics of the teaching and learning environment (context analysis)

Characteristics of the learners or a sub category of learners:

- graduates from the John Abbott Pre-Hospital Emergency Care Program

General demographic information:

Previous or prerequisite Knowledge:

Characteristics of the content / material

Tasks in Expert Performance

Tasks that learner will be able to perform after the instruction:

Main task 1: Recognize signals of distress

Main task 2: Adapt to signals of distress

Main task 3: Use the stressful intervention as a

Responses cannot be edited

Pro-Active PTSD Management Junior Paramedics

6. What do you think is the mental health impact and negative

Responses cannot be edited

Pro-Active PTSD Management Junior Paramedics Questionnaire

6. What do you think is the mental health impact and negative

It is statistically well documented that 韛�rst responders (韛�re韛�ghters and Police

Responses cannot be edited

Pro-Active PTSD Management Junior Paramedics Questionnaire

During the intervention I wasn't thinking about stress management techniques

3. Wereyou ableto applythestrategymentionedin question2? Why?Why not? How did you

6. What do you think is the mental health impact and negative

I beleive that our stress management techniques allows junior paramedics to be

Responses cannot be edited

Pro-Active PTSD Management Junior Paramedics Questionnaire

I do not remember if it is a strategy that was mentioned in the Stress

6. What do you think is the mental health impact and negative

This content is neither created nor endorsed by Google.

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