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Exploring firefighters' health and wellbeing
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0003-0079-3816
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: This thesis supports the assumption that firefighters’ health and mental well-being is important, in order to cope with the stress that the profession implies. As health is an essential part of everyday life, it seems substantially to understand how an almost exclusively male workforce of firefighters construct their discourse in relation to health and well-being. The overall purpose of this thesis is to explore health and ill-health among firefighters in relation to their work environment, including coping strategies, critical incidents and ‘ordinary’ day-to-day work at the fire and rescue service station.

Methods: In Study I, 180 firefighters (16 women, 164 men) answered an open-ended question. Qualitative content analysis was used based on free text answers and focused on critical incidents. Study II, was based on a cross-sectional survey measuring burnout, psychosocial work environment and coping strategies. Participants were randomly selected and the final sample consisted of 476 firefighters (58 women, 418 men) and analyzed with multiple linear regression. In Study III and Study IV, a total of 28 fire-fighters (4 women and 24 men) participated in the study. Regarding Study IV a strategic sample of policy documents was also included. For Study III and IV, the research questions was dealt with applying critical discourse analysis on the focus group discussions (FGD) and individual interviews. In Study IV the analysed material also included policy documents.

Results: Findings from Study I were presented in four categories; ‘overwhelming critical situations’, ‘risks of delay, ‘risk of failure’ and ‘risks to oneself’. Women in Study I described their experiences in a more distanced account, while men described their experiences more vividly. Results from Study II showed overall low mean values in the burnout scales of emotional exhaustion (EE) and depersonalization (DP) among both women and men. Only 2 % of women and 1% of men scored high levels of EE, and only 2% of women and 3% of men scored high level of DP. A multiple linear regression showed that high demand and lack of social support contributed significantly to predicting EE among men. The coping strategies among firefighters influence the level of EE and DP, and these strategies were different between women and men. In Study III six dominant themes were identified. A strong sense of the firefighter community was articulated as health promoting. The physical exercise at work and the balance between emergency and station work were also two recurrent theme supporting firefighters’ health. Another health-promoting theme concerns clarity of roles among firefighters. Peer support and tolerance in the work group was another common theme, alongside with expressions of the firefighter as hero or helper. Themes described as hindrances to health and well-being in firefighters’ discourse were; diversity, preventive work and education. All hindrance themes were articulated as important struggles in the firefighter discourse against changes in work. In Study IV, we have identified two sides in the struggles, on the one hand we have the ‘insiders’, a majority of male firefighters working in the fire and rescue services representing a collective defending its autonomy and traditions. On the other hand we have the ‘outsiders’, represented by the government, the Swedish Civil Contingencies Agency, (MSB), municipalities, politicians at different levels and academic researchers.

Conclusion: Firefighters described critical incidents at work as overwhelming situations, along with negative experiences of organizational and practical tasks. Despite these experiences firefighters were reported as healthy according to EE and DP (Study I and II). Results of Study II also showed a relationship between psychosocial work environment and burnout among men, but not among women. The coping strategies among firefighters influence the level of burnout, and these strategies differ between women and men. The well-being in firefighters’ discourse, at least partly, is gained from a strong sense of belonging to a homosocial group characterized by closeness to each other and peers who take care of each other. The firefighters in our studies articulate this community-sense, and describe the importance of the similarity, rather than diversity (Studies III and IV). Findings from our studies regarding health and well-being, add knowledge to the current explanations relating to firefighters’ resistance to change.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2018. , p. 64
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1963
Keywords [en]
Firefighters, health, well-being, burnout, psychosocial work environment, coping strategies, critical incidents, experiences, discourse analysis, focus groups, focus group discussion
National Category
Occupational Health and Environmental Health Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
URN: urn:nbn:se:umu:diva-147637ISBN: 978-91-7601-882-8 (print)OAI: oai:DiVA.org:umu-147637DiVA, id: diva2:1205115
Public defence
2018-06-07, Vårdvetarhusets aula, Umeå Universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-05-16 Created: 2018-05-10 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Experiences of critical incidents among female and male firefighters
Open this publication in new window or tab >>Experiences of critical incidents among female and male firefighters
2015 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 100-104Article in journal (Refereed) Published
Abstract [en]

Background: A critical incident is defined as an event stressful enough to overwhelm the usually effective coping skills of an individual. Firefighters are frequently exposed to critical incidents that might have consequences for individuals and their performance in organization. Aim: The aim of this study was to describe experiences of critical incidents among female and male Swedish firefighters. Method: In all 180 participants (16 women, 164 men) who had been involved in up to 25 critical incidents during the last year responded to a survey describing critical incidents experienced in the past year. A qualitative content analysis identified several areas for improvement in firefighters' working conditions. Results: Female firefighters were terse in describing their experiences, while the men described their experiences of critical events more vividly. The critical incidents described by the firefighters concerned such overwhelming situations as traffic accidents, huge fires, and other fatal incidents such as drownings and suicides. Risk of delay due to lack of equipment training and lack of medical education was mentioned. Lack of resources and organizational problems was mentioned as causing risks of failure. Several firefighters expressed frustration over being assaulted and threatened, or exposed to other kinds of violence. Not knowing how close, physically or mentally, one can get to people during ongoing rescue can lead to unsuccessful operations. Conclusions: Gender patterns should always be taken into account, making it possible for all firefighters to express and reflect on existentially tough experiences. Education needs to focus more on medical and mental health issues. Firefighters were sometimes exposed to the difficult challenge of violence and assault during rescue operations. The complexity of this problem needs to be highlighted, not only in firefighter organizations, but also in society in general. 

Keywords
Experiences, Critical incidents, Firefighters, Gender patterns, Content analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-106371 (URN)10.1016/j.ienj.2014.06.002 (DOI)000354139000011 ()25028063 (PubMedID)
Available from: 2015-07-15 Created: 2015-07-14 Last updated: 2018-06-07Bibliographically approved
2. Burnout and association with psychosocial work environment among Swedish firefighters
Open this publication in new window or tab >>Burnout and association with psychosocial work environment among Swedish firefighters
Show others...
2017 (English)In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 9, no 5, p. 214-225Article in journal (Refereed) Published
Abstract [en]

Firefighters are exposed to traumatic and stressful psychosocial and physical strain in their work, and thus they are considered to be a group at high risk of burnout. The aim of this study was to investigate burnout (emotional exhaustion (EE) and depersonalization (DP) among Swedish female and male firefighters and to examine the gender-stratified relationship between psychosocial work environment and burnout when considering the moderating effect of coping strategies among Swedish firefighters. The overall mean values of both EE and DP were notably low in comparison with the general population in Sweden. We found that psychosocial work environment factors increase the risk of burnout among male firefighters. Among men, EE was associated with high demands and lack of social support in work. The association was also confirmed with DP as the outcome and lack of good leadership as the exposure among men. However, among female firefighters the association between psychosocial work environment factors and burnout failed to appear. Among women, EE and DP were only associated with the coping strategy Psychological distancing (PDi). A negative association with DP and the coping strategy Positive Reappraisal (PRe) was also found among women. Regardless of the result from the regression analyses, we must consider that the majority of the female and male firefighters in our study had low scores on the outcome variables EE and DP. Future studies should explore female and male firefighters' context and possible health-protecting environment.

Place, publisher, year, edition, pages
Canadian Center of Science and Education, 2017
Keywords
burnout, coping strategies, firefighters, psychosocial work environment, Sweden
National Category
Nursing Occupational Health and Environmental Health
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-126032 (URN)10.5539/gjhs.v9n5p214 (DOI)
Available from: 2016-09-26 Created: 2016-09-26 Last updated: 2018-06-07Bibliographically approved
3. ‘There is nothing wrong with diversity and equality as long as the right people are employed’. Promoting and hindering health and well-being in firefighter discourse
Open this publication in new window or tab >>‘There is nothing wrong with diversity and equality as long as the right people are employed’. Promoting and hindering health and well-being in firefighter discourse
(English)Manuscript (preprint) (Other academic)
National Category
Occupational Health and Environmental Health Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-147678 (URN)
Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2018-06-09
4. Diversity, preventive work and education: matters of health and well-being in firefighter discourse
Open this publication in new window or tab >>Diversity, preventive work and education: matters of health and well-being in firefighter discourse
(English)Manuscript (preprint) (Other academic)
National Category
Occupational Health and Environmental Health Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
urn:nbn:se:umu:diva-147679 (URN)
Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2018-06-09

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