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.