title: Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: Constructivist metasynthesis of the qualitative literature.
abstract: OBJECTIVE
  Presentations of self-harm to paramedic and emergency staff are increasing, and despite being the first professionals encountered, patients who self-harm report the quality of care and attitudes from these staff are unsatisfactory. Understanding this care may provide opportunities to improve services. The aim of this study is to enhance knowledge building and theory generation in order to develop practice and policy through a metasynthesis of qualitative research relating to perceptions of paramedic and emergency care for people who self-harm.
  
  
  METHODS
  The metasynthesis draws on Evolved Grounded Theory Methodology (EGTM). A search was undertaken of CINAHL, MEDLINE, OVID and Psych INFO, and grey literature. Subject headings of 'self-harm' were used alongside key words 'suicide', 'paramedic' 'emergency', 'overdose', 'pre-hospital' mental health, ambulance, perceptions of care, emergency.
  
  
  RESULTS
  A total of 1103 papers were retrieved; 12 were finally included. No papers investigated paramedic care for self-harm. The following metaphors emerged: (a) frustration, futility and legitimacy of care; (b) first contact in the pre-hospital environment: talking, immediate and lasting implications of the moral agent; (c) decision making in self-harm: balancing legislation, risk and autonomy; (d) paramedics' perceptions: harnessing professionalism and opportunities to contribute to the care of self-harm.
  
  
  CONCLUSIONS
  Paramedics are often the first health professional contact following self-harm, yet limited qualitative literature has explored this encounter. Metaphors revealed in this paper highlight challenges in decision making and legislation, also opportunities to improve care through professionalization and tailored education.
authors.affiliation: Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom. Electronic address: nigel.rees5@wales.nhs.uk.
authors.forename: Nigel
authors.initials: N
authors.lastname: Rees
authors.affiliation: Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
authors.forename: Frances
authors.initials: F
authors.lastname: Rapport
authors.affiliation: Swansea University, Pre Hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
mesh_terms: D001315:Australia; D003657:Decision Making; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D004634:Emergency Medical Technicians / Q000523:psychology* / Q000706:statistics & numerical data*; D004645:Empathy; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D033262:Narration; D015588:Observer Variation; D026684:Personal Autonomy; D036301:Qualitative Research; D012449:Safety; D016728:Self-Injurious Behavior / Q000523:psychology / Q000628:therapy*; D012938:Social Perception; D013240:Stereotyping; D006113:United Kingdom
keywords: Ambulance; Care; Emergency Self Harm Paramedic; Pre-hospital