Differentiating social environments of high-risk professionals and specialised nurses: a qualitative empirical study on social embeddedness

<b>Objective:</b> High-risk professionals and specialised nurses in hospitals are frequently exposed to potentially traumatic events. Psychotrauma researchers have extensively studied personal risk factors of traumatisation among high-risk professionals, but it is hard to understand psychological functioning when professionals are decontextualised from their social environment. Generally, it has been well documented that to reduce the risk of posttraumatic stress disorder (PTSD) or other mental health problems related to traumatisation, it is essential to be embedded in a supportive social environment. However, study results among and within these occupational groups show great variety and even inconsistencies as to what is a supportive social environment. <b>Method:</b> This ethnographical research, including participant observation, in-depth interviews, and document analysis, explored the social environment of firefighters, police officers, ambulance paramedics, specialised nurses, and military personnel and aims to explore their social connections and embeddedness. We performed a thematic content analysis of data to identify themes related to social or emotional support, social relationships, and stress or traumatisation. <b>Results:</b> An analysis of the observational field notes, which covered 332 h of participant observation and 71 evenly distributed formal in-depth interviews, identified four themes related to social connections and embeddedness: <i>Family</i>, <i>Hierarchical relations versus autonomy</i>, <i>Group versus individual</i>, and <i>Conditional family ‘love’</i>. Results revealed that the military, police, and professional firefighters have family-like hierarchical connections and highly value group unity. Paramedics and most specialised nurses, however, tend to value individuality and autonomy in their work relationships. <b>Conclusion:</b> This research shows noticeable differences in the social environments and social connections of these professionals, which implicates that prevention and mental health treatment might also have to be differentiated among occupational groups. It is of great importance for high-risk professionals or frontline professionals who are frequently exposed to potential traumatic events, to be embedded in a supportive social environment; to work with the conviction that others ‘have your back’. However, their social environments differ so much that we cannot lump them together in one category.The military, police, and professional or career firefighters have family-like hierarchical connections and highly value group unity. Ambulance paramedics and most nurses working in specialised departments, such as emergency rooms, operating rooms, and intensive care units, on the other hand tend to value individuality and autonomy in their work relationships.To be effective, programmes for preventions, such as professional support or formal peer support, as well as mental health treatments might have to be differentiated accordingly between occupational groups. It is of great importance for high-risk professionals or frontline professionals who are frequently exposed to potential traumatic events, to be embedded in a supportive social environment; to work with the conviction that others ‘have your back’. However, their social environments differ so much that we cannot lump them together in one category. The military, police, and professional or career firefighters have family-like hierarchical connections and highly value group unity. Ambulance paramedics and most nurses working in specialised departments, such as emergency rooms, operating rooms, and intensive care units, on the other hand tend to value individuality and autonomy in their work relationships. To be effective, programmes for preventions, such as professional support or formal peer support, as well as mental health treatments might have to be differentiated accordingly between occupational groups.

<b>研究目标：</b> 医院内的高风险从业者与专科护士常暴露于潜在创伤性事件。创伤心理学研究者已针对高风险从业者创伤后的个人风险因素展开了大量研究，但倘若脱离从业者所处的社会环境，便难以准确理解其心理机能。现有研究已充分证实，要降低创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）或其他与创伤相关的心理健康问题的发病风险，身处支持性社会环境至关重要。然而，在这些职业群体内部及群体间开展的相关研究，针对“何为支持性社会环境”这一问题的结论存在显著差异，甚至相互矛盾。<b>研究方法：</b> 本项民族志研究涵盖参与式观察、深度访谈与文献分析，旨在探究消防员、警察、急救医护人员、专科护士及军事人员的社会环境，并剖析其社会联结与社会嵌入性。我们对研究数据开展主题内容分析，以识别与社会或情感支持、社会关系、压力或创伤相关的研究主题。<b>研究结果：</b> 针对涵盖332小时参与式观察记录与71例分布均匀的正式深度访谈的实地观察笔记进行分析后，共提炼出4项与社会联结及社会嵌入性相关的主题：<i>家庭</i>、<i>层级关系与自主性</i>、<i>集体与个体</i>以及<i>有条件的家庭式“关爱”</i>。结果显示，军事人员、警察与职业消防员拥有类似家庭的层级联结，且高度重视集体团结；而急救医护人员与多数专科护士则更倾向于在工作关系中强调个体性与自主性。<b>研究结论：</b> 本研究揭示了上述从业者在社会环境与社会联结方面的显著差异，这意味着心理健康预防与干预措施或许也需要针对不同职业群体进行差异化调整。对于经常暴露于潜在创伤事件的高风险从业者或一线从业者而言，身处支持性社会环境、秉持“他人会鼎力支持自己”的信念开展工作至关重要。但不同职业群体的社会环境差异巨大，因此无法将其笼统归为同一类别。军事人员、警察与职业/现役消防员拥有类似家庭的层级联结，且高度重视集体团结；而急救医护人员与多数在专科科室（如急诊室、手术室与重症监护室）工作的护士，则更倾向于在工作关系中强调个体性与自主性。因此，诸如专业支持或正式同伴支持等预防项目，以及心理健康治疗方案，或许都需要根据不同职业群体进行相应调整。