University of Southern California Dissertations and Theses

Stress in the Fire Service

(USC Thesis Other)

Stress in the Fire Service

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content STRESS IN THE FIRE SERVICE 1
STRESS IN THE FIRE SERVICE – LARGE URBAN FIRE DEPARTMENT:
AN INNOVATION STUDY
by
Glenn Miyagishima
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
(Organizational Change and Leadership (On Line))
May 2020
Copyright 2020 Glenn Miyagishima
STRESS IN THE FIRE SERVICE 2

ACKNOWLEDGMENTS
To my wonderful wife for your support the past three years as I ventured into my
academic journey. This allowed me to spend the time to write, read and attend classes. When I
needed to hear the encouraging words to keep moving forward you provided the motivation
when I needed it most. To my sons for their understanding and patience. Sharlene, Trent, and
Tyler “thank you.”
To my committee Dr. Kenneth Yates, Dr. Mary Andres, and Dr. Krystle Madrid thank
you for your commitment and support during this process. A special thank you to Dr. Yates for
your continued encouragement as I assembled my chapters 1 through 5. I appreciate your
patience with all the meetings and the insightful suggestions which afforded value to my study.
To my classmates who made this life journey inspiring and I will never forget how you have
become an important part of my life.
To all the firefighters who volunteered to be interviewed and completed the survey for
my research, a huge thank you. It was the candid and open dialogue that kept me motivated to
finish this study. I wanted to share your real-life experiences and stories with the world. Your
stories were profound and now others can read about the stress a firefighter experiences. Finally,
I would like to thank the United Firefighters Union, Chief Officers Association, and the Fire
Department for the support with my research study.

STRESS IN THE FIRE SERVICE 3

TABLE OF CONTENTS
Acknowledgments 2
List of Tables 5
List of Figures 7
Abstract 8
Chapter One: Introduction 9
Introduction of the Problem of Practice 9
Organizational Context and Mission 9
Organizational Performance Status and Need 12
Related Literature 13
Importance of the Organizational Innovation 16
Organizational Performance Goal 17
Stakeholder Groups’ Performance Goals 18
Stakeholder Group for the Study 19
Purpose of the Project and Questions 19
Methodological Framework 20
Definitions 20
Organization of the Study 21
Chapter Two: Review of the Literature 22
Influences on the Problem of Practice 22
History of Stress in the Fire Service 23
Current Stress Issues Associated in the Fire Service 25
Stress Affecting Female Firefighters , Volunteers, Police, EMTs, and Paramedics 27
The Effects of Stress, PTSD, and Suicide 29
How to Manage the Causal Effects of Stress, PTSD, and Suicide 29
Learning and Designing a Stress Education Program 32
History of the Large Urban Fire Department Behavioral Health Program 32
Why Learn and Design a Stress Education Program 33
Design and Implement a Stress Education Program 34
Clark and Estes’ Knowledge, Motivation and Organizational Influences Framework 36
Stakeholder Knowledge, Motivation and Organizational Influences 37
Knowledge and Skills 37
Motivation 43
Organizational Influences 49
Conceptual Framework: The Interaction of Knowledge and Motivation and Organization 56
Conclusion 60
Chapter Three: Methodology 61
Participating Stakeholders 62
Survey Sampling Criteria and Rationale 63
Interview Sampling Criteria and Rationale 64
Data Collection and Instrumentation 66
Surveys 66
Interviews 67
Documents and Artifacts 69
Alignment of Influences and Data Collection Methods 69
STRESS IN THE FIRE SERVICE 4

Data Analysis 75
Credibility and Trustworthiness 75
Validity and Reliability 76
Ethics 77
Chapter Four: Results and Findings 80
Participating Stakeholders 80
Determination of Assets and Needs 82
Results and Findings for Knowledge Causes 83
Factual Knowledge 83
Conceptual Knowledge 85
Procedural Knowledge 90
Metacognitive Knowledge 92
Results and Findings for Motivation Causes 94
Expectancy Value 95
Attribution 98
Self-Efficacy 99
Results and Findings for Organization Causes 102
Cultural Models 104
Cultural Settings 105
Summary of Validated Influences 107
Knowledge 108
Organization 110
Chapter Five: Recommendations and Evaluation 112
Purpose of the Project and Questions 112
Recommendations for Practice to Address KMO Influences 112
Knowledge Recommendations 112
Motivation Recommendations 117
Organization Recommendations 121
Integrated Implementation and Evaluation Plan 126
Implementation and Evaluation Framework 126
Level 4: Results and Leading Indicators 127
Level 3: Behavior 129
Level 2: Learning 134
Level 1: Reaction 138
Evaluation Tools 139
Summary 141
Limitations and Delimitations 142
Recommendations for Future Research 143
Conclusion 144
References 145
Appendix A: Interview Protocol 157
Appendix B: Survey Protocol 160
Appendix C: Evaluation Tool 163
Appendix D: Delayed Evaluation Tool 164
Appendix E: Fire CARES 165

STRESS IN THE FIRE SERVICE 5

LIST OF TABLES
Table 1: LUFD Strategic Plan (2015–2017) Nine Goals 10
Table 2: Large UrbanFire Department Strategic Plan 2.0 - 2018 to 2020 11
Table 3: LUFD Diversity Breakdown for 2017–2018 12
Table 4: Organizational Mission, Organizational Goal and Stakeholder Performance Goals 19
Table 5: Knowledge Influence, Knowledge Types, and Knowledge Assessment 42
Table 6: Motivational Influence Assessments 48
Table 7: Organizational Influences 55
Table 8: Data Collection Methods for Assumed Knowledge, Motivational, and Organizational
Influences 70
Table 9: How Many Years Have You Served the Department? 81
Table 10: What is Your Rank? 81
Table 11: What is Your Gender? 81
Table 12: Survey Results for Factual Knowledge of Stress in the Fire Service and strategies 84
Table 13: Survey Results for Conceptual Knowledge of Stress in the Fire Service and
Strategies 86
Table 14: Survey Results for Conceptual Knowledge of Stress in the Fire Service and
Strategies 88
Table 15: Survey Results for Procedural Knowledge of Stress in the Fire Service and
Strategies 90
Table 16: Survey Results for Metacognitive Knowledge of Stress in the Fire Service and
strategies 92
Table 17: Survey Results for Expectancy-Value and Attribution Influences 94
Table 18: Survey Results for Motivational Knowledge of Stress in the Fire Service and
Strategies 100
Table 19: Survey Results for Organizational Knowledge of Stress in the Fire Service and
Strategies 103
Table 20: Knowledge Assets or Needs as Determined by the Data 108
STRESS IN THE FIRE SERVICE 6

Table 21: Knowledge Assets or Needs as Determined by the Data 109
Table 22: Knowledge Assets or Needs as Determined by the Data 110
Table 23: Summary of Knowledge Influences and Recommendations 113
Table 24: Summary of Motivation Influences and Recommendations 118
Table 25: Summary of Organization Influences and Recommendations 122
Table 26: Outcomes, Metrics, and Methods for External and Internal Outcomes 127
Table 27: Critical Behaviors, Metrics, Methods, and Timing for Evaluation 130
Table 28: Required Drivers to Support Critical Behaviors 132
Table 29: Evaluation of the Components of Learning for the Program 136
Table 30: Components to Measure Reactions to the Program 139

STRESS IN THE FIRE SERVICE 7

LIST OF FIGURES
Figure 1: Conceptual framework interaction of stakeholder knowledge, motivation, and
organizational cultural models and settings. 59
Figure 2: Example of digital dashboard to track and monitor Levels 1, 2, and 3. 141

STRESS IN THE FIRE SERVICE 8

ABSTRACT
This study examined stress in the fire service in a large urban fire department, including
fire chief, deputy chiefs, fire officers, and firefighters, to develop an innovative stress education
program. Using the gap analysis problem-solving framework, the knowledge, motivation, and
organizational influences associated with stress were identified. Mixed methods were used to
collect survey data from 305 participants and interview data for 15 participants. Results from the
survey and findings from the interview data revealed a need to understand the characteristics,
antecedents, and effects of stress among firefighters. The data revealed that 92.13% of
participants know sleep deprivation is a characteristic of stress, 82.62% believe having a stress
education is important, and there is a need to change the fire culture to increase the perception of
stress, suicidal ideations, and post-traumatic stress disorder. Recommendations for the
organization to support an innovative stress education program are made, including developing a
sustainable culture environment for firefighters. The New World Kirkpatrick Model was used to
design an implementation and evaluation plan to measure the effectiveness of the new program.
This study may be useful for other high-stress service organizations to optimize performance
through strategies and program development to reduce stress on the job.

STRESS IN THE FIRE SERVICE 9

CHAPTER ONE: INTRODUCTION
Introduction of the Problem of Practice
This study addressed the problem of stress associated with the professional fire service.
Compared to the civilian community, stress and suicide have been underreported problems in the
fire service (Henderson, Van Hasselt, LeDuc, & Couwels, 2016). The responsibilities of a
firefighter have dramatically changed from extinguishing structure fires to an increase in other
duties, including vehicle extrications, hazardous materials, and medical calls, which have
triggered an increase in stress (Henderson et al., 2016). Furthermore, research has reported that
firefighters fear of being viewed as weak results in a reluctance to express their feelings of
vulnerability, leading to indications of stress and mental health issues (Kronenberg et al., 2008).
According to Turner (2011), increased expectations from the public have imparted added
responsibilities of a firefighter, regardless of the significance of the incident causing emotional
disorders. Therefore, this problem is important to address because stress in the professional fire
service is causing firefighters to internalize and deal with posttraumatic stress disorder (PTSD),
which can result in firefighter suicides (Turner, 2011).
Organizational Context and Mission
The organization of focus for this problem of practice is the Large Urban Fire
Department (LUFD- All information regarding the organization came from the organization
itself and is not cited to maintain confidentiality). The LUFD has been serving the city since the
1800’s and currently protects a large population of people. In the 1800’s, when the city covered a
few square miles, the population was approximately 11,000 citizens. Today, the city covers
hundreds of square miles. The fire department responds to over 700,000 emergency calls, with
over 100 local fire stations and over 3,000 uniformed fire personnel to serve and protect the
STRESS IN THE FIRE SERVICE 10

communities. The LUFD has an organizational mission statement to preserve life and property,
promote public safety, and foster economic growth through commitment to prevention,
preparedness, response, and recovery as an all-risk life safety response provider (LUFD, 2014).
The core values of the organization are service, professionalism, integrity, respect, innovation
and trust (LUFD, 2014). In 2015, the department introduced, for the first time a Strategic Plan.
This plan was developed through the collaboration of various stakeholders, which included
department staff, leaders, and the community. The plan established nine goals which focuses on
the motto of “A Secure City” (LUFD, 2014).
As the organization began to move forward on providing optimum service delivery to the
citizens, the organizational goals were focused toward the Strategic Plan. The Strategic Plan
(2015–2017), A Secure City, established nine goals for the organization as listed in Table 1.
Table 1
LUFD Strategic Plan (2015–2017) Nine Goals
Strategic Goal Strategic Plan
Goal 1 Provide Exceptional Public Safety and Emergency Service
Goal 2 Implement and Capitalize on Advanced Technologies
Goal 3 Identify Cost Effective Solutions to Manage Expenditures
Goal 4 Enhance Qualities of Leadership, Management and Project Delivery
Goal 5 Enhance Risk Management Systems
Goal 6 Strengthen Community Relationships to Improve Infrastructure and
Enhance Resiliency during Emergency Events
Goal 7 Implement Green Initiatives that will Improve Emergency Systems
and Reduce Impact
Goal 8 Recruit, Develop and Retain a Professional and Diverse Workforce
Goal 9 Support New Business and Improve Development Services

STRESS IN THE FIRE SERVICE 11

In 2018, the organization achieved nearly 70% of the goals in the strategic plan. The
organization set out to strive for more with the implementation of the new 2018–2020 Strategic
Plan, which is called A Secure City 2.0. This new strategic plan focuses on a plan that represents
fewer but more refined strategies focused on critical objectives. A Secure City 2.0 aligns five
goals with strategies within each goal. The Secure City 2.0 Strategic Plan (2018–2020)
establishes five goals for the organization as shown in Table 2.
Table 2
Large Urban Fire Department Strategic Plan 2.0 - 2018 to 2020
First in Safety Goal 1: Provide Exceptional Public Safety and
Emergency Service
A Well-Run City Goal 2: Embrace a Healthy, Safe and Productive
Work Environment
Goal 3: Implement and Capitalize on Advanced
Technology
A Livable & Sustainable City Goal 4: Enhance Sustainability and Community
Resiliency
A Prosperous City Goal 5: Increase Opportunities for Personal
Growth and Professional Development

Even with a guiding plan, there are internal challenges that affect the behavior and
wellness of firefighters, specifically the effects of stress, PTSD and suicide. According to the
new strategic plan, a strategy focuses on the development of robust mental health support
initiatives, which include developing a behavioral health program (BHP) to address mental
health needs and provide training to increase awareness of firefighter suicide and PTSD.
The organization is no stranger to stress, PTSD, and suicide. According to the Large
Urban Firemen’s Association (2018), coping with firefighter deaths and suicides is recorded in
the Ten Bells section of the website. According to the Firefighter Recruitment Plan, workforce
STRESS IN THE FIRE SERVICE 12

diversity during 2017–2018 for the organization consisted of six ethnic groups as seen in Table
3.
Table 3
LUFD Diversity Breakdown for 2017–2018
Ethnicity Percentage
Caucasian 47.23%
Hispanic 31.28%
Black 11.09%
Asian 5.36%
Filipino 1.82%
Native American .44%

The impact of stress can lead to PTSD or eventually suicide, and the results can be
devastating. According to Henderson et al. (2016), stress and suicide in the fire service have
gone underreported, and the organization faces these comparable challenges, which are a concern
for the department. Haslam and Mallon (2003) explain there are three types of symptoms that a
leader should recognize: re-experiencing, avoidance, and arousal. Signs and symptoms are
critical for a leader to recognize because the culture in the fire service is to suppress feelings and
portray a macho image to avoid looking weak, which could lead to stress and suicide
(Kronenberg et al., 2008).
Organizational Performance Status and Need
Currently, the organization has an existing BHP that provides emotional support and care
for members of the organization. This program has been in existence since 1988 and is currently
staffed by two fire psychologists. Firefighter support is provided through entities such as the
STRESS IN THE FIRE SERVICE 13

BHP and peer support. The BHP is focused toward therapy and programming and the peer
support is under the guidance of the fire union. Both entities work together and collaborate
together to support behavioral wellness but are separate entities. The program is available to
members dealing with emotional challenges. However, this study aimed to research the
probability of designing and implementing an innovative stress education program to share
knowledge regarding managing stress. The innovation will enhance the department’s leaders’
emotional intelligence to avert any impending firefighter suicide and manage stress.
Furthermore, the program will offer the emotional support needed by members of the
organization.
Related Literature
The stress associated with the first responder and the effects of stressors after a critical
incident are a problem. The stressors can precede a firefighter’s PTSD and suicidality. Therefore,
the organizational concern in the fire service is to understand the relevance and importance of
firefighter stress, PTSD, and suicide.
Stress associated with the professional fire service can lead to outcomes of PTSD and
suicide. According to researchers, the fire service has shown cognitive disorders recognizing
various forms of stress (Martin, Tran, & Buser, 2016). Martin et al. (2016) found that
correlations of firefighter suicides are related to alcohol use, depression, PTSD, years of service,
relationship status, and suicides. The authors explained the different types of stressors a
firefighter will experience, concluding that firefighters/emergency medical service (EMS)
professionals have the highest suicidal ideation and attempts associated with depression and
PTSD. In one study, 173 urban professional firefighters were asked to rate and rank the level of
stress associated with duty-related incident stressors (Beaton, Murphy, Johnson, Pike, & Corneil,
STRESS IN THE FIRE SERVICE 14

1998). The authors explained there are variables of stress that firefighters experience. Rated at
the highest level of stress were catastrophic injury to self or co-worker; gruesome victim
incidents; rendering aid to seriously injured, vulnerable victims; minor injury to self; death;
dying; exposure; and catastrophic injury to self or co-worker.
First responders typically resist sharing their emotions and suppress feelings as they
confront stressors (Kronenberg et al., 2008). Research found there is a reluctance to share the
emotional effects of a critical incident because of fear of showing weakness with fellow
firefighters. The research explains PTSD and depression present symptoms like difficulty
sleeping, reports of being unhappy, experiences of re-occurrences, avoidance and hyperarousal.
Additionally, with time, an increase in alcohol consumption and partner conflict are reported.
Therefore, awareness of emotional difficulties will improve the quality of life and enable the first
responder to recognize potential stressors.
Improving quality of life requires awareness of the stressors associated with PTSD and
suicide in the fire service. According to Henderson et al. (2016), stress in the fire service has
gone underreported and lacks the empirical data to support awareness of suicide and PTSD. In
2011, at the National Fallen Firefighters Foundation Summit, fire service representatives opened
the discussion regarding developing a suicide initiative to enhance awareness of stress in the fire
service (National Fallen Firefighters Foundation, 2014). The initiative was established to prevent
suicides such as those that recently affected the Phoenix, Chicago, and Houston fire departments
and to improve the quality of life for firefighters.
Prevention of stress disorders begins with recognizing the critical traumatic incidents
firefighters experience (Henderson et al., 2016). The research discovered that 31% of firefighters
surveyed found the most common type of disastrous incident is child fatality. Research
STRESS IN THE FIRE SERVICE 15

conducted by Haslam and Mallon (2003) focused on nine posttraumatic stress symptoms among
firefighters. According to Hokanson (1997), the Los Angeles County Fire Department created a
critical incident stress debriefing (CISD) program in 1985 to address a recent firefighter suicide,
outlining a comprehensive wellness program focused on the reduction of stress. The CISD
program goals were to reduce the impact of traumatic events, accelerate the normal recovery
process from an event, normalize the stress response for emergency workers, and provide
education in stress management and coping techniques. Furthermore, the development of a CISD
program increased awareness of stress and suicide in the fire service. Subsequently, knowledge
and the predictability of the stressors can reduce the risk of PTSD and suicide.
Predicting the symptoms of stress in the fire service can lower the risk of PTSD and
suicide. Learning to predict stress among firefighters, through awareness and prevention
programs, can improve survival rates. A two-year study was conducted of 43 probationary
firefighters who graduated from the fire academy to research the effects of PTSD (Heinrichs et
al., 2005). After two years, researchers discovered a higher level of hostility and low efficacy
among the 43 firefighters, finding 42% of the firefighters had symptoms of PTSD.
Stanley, Hom, Spencer-Thomas, and Joiner (2017) conducted a correlation study
examining female firefighters and stressors associated with the job. The research revealed that
female firefighters in the fire service are also vulnerable to stress and suicidal tendencies, and
they have emerging thoughts of suicide. Data were collected from 313 female firefighters who
completed an online questionnaire. Findings showed pre-career and career prevalence correlates
in suicide ideation at 28.4% (pre-career) and 37.7% (career). Researchers discovered there are
potential risk factors among female firefighters that will require further research: gender-based
discrimination and workplace bullying are considerations in this unique study group (Leach,
STRESS IN THE FIRE SERVICE 16

Poyser, & Butterworth, 2016). The research further suggested that exposure to stressors is not
always a prediction of psychological symptoms.
According to Meyer et al. (2012), professional firefighters are susceptible to traumatic
stressors and exposed to mental problems; conversely, others are found to be resilient. The study
indicated the assessment of 143 firefighters exposed to trauma-exposed events had low rates of
PTSD, depression and anxiety compared to previous studies of firefighters utilizing a gold-
standard clinical diagnostic interview. Predictability of stressors are critical to the behavior
wellness of firefighters and their survivability in a stress-related profession.
Importance of the Organizational Innovation
The problem is important to address because stress and suicide in the fire service is
underreported, and developing awareness will increase the survivability of first responders
(Henderson et al., 2016). According to Turner (2011), stress and suicide cause firefighters to
internalize and deal with PTSD, which can result in suicide. In 2007, the Houston Fire
Department began a suicide prevention program to address the seven suicides that occurred in
2006 and 2007 (Finney, Buser, Schwartz, Archibald, & Swanson, 2015). The study showed that
understanding the signs of stressors through awareness and education can diminish the cognitive
disorder that a first responder may encounter. This problem is important because understanding
and developing awareness will reduce the suicidality and stress associated with the fire service.
Knowing when stressors are affecting a firefighter may prevent a suicide.
It is important for the organization to design and implement an innovative stress
education program for a variety of reasons. If the organization is to provide emotional care to
manage the stress related to the job of a firefighter, educating members before an emotional
stressor surfaces is critical. The current BHP targets support after an emotional occurrence or
STRESS IN THE FIRE SERVICE 17

death. The innovative stress education program will seek to provide the knowledge and
emotional support to prepare for the potential stress associated with the fire service. The design
and implementation of an innovative stress education program may save the life or prevent the
suicide of a firefighter.
Organizational Performance Goal
The organizational performance goal for the LUFD is to manage stress and suicide while
enhancing the BHP. According to the LUFD (2014), the organization has created a goal to
improve employee wellness and incorporate education. The organization has a mission statement
supported with a vision statement, core values and operating principles to protect the more than
four million people who live in the city (LUFD, 2018b). Beaton, Johnson, Infield, Ollis, and
Bond (2001) explained it is important for leaders within an organization to acknowledge the
reduction of stress. Therefore, the organization should research how to improve employee
wellness and utilize the strategic plan as a guide.
The organizational goal is to understand that stress and suicide are important to the
LUFD. According to the American Foundation for Suicide Prevention, suicide is the 10th
leading cause of death (American Foundation for Suicide Prevention, 2020). Therefore, stress
and suicide education are essential to the wellness of a firefighter. Currently, the organization
does not have metrics for tracking suicide prevention and stress reduction (LUFD, 2014).
However, a benchmark for stress and suicide should become measurable through interaction and
education of firefighters. Developing a stress education program for the organization is a
measurable and attainable goal. Currently, according to internal correspondence, the organization
offers assistance for firefighters with behavioral health needs or critical incident stress
management challenges (LUFD Information Notice, 2018b). By the year 2020, the organization
STRESS IN THE FIRE SERVICE 18

will develop an innovative stress education program to reduce stress by instituting a determinate
benchmark.
Description of Stakeholder Groups

The main stakeholder of focus are the fire chief, deputy chiefs, fire officers, and
firefighters. The fire chief and deputy chiefs are important because they provide oversight and
leadership. Whether a firefighter requires stress intervention is usually first observed by the first
line fire officer. Determining and observing behavior is a fire officer’s responsibility. However,
because of accountability to the organization, the fire chief and deputy chiefs will be the
principal focus of this study.
Determining the importance of a stress education program is based on the leadership role
of the stakeholders. Responsibility and daily observation of firefighters are normally at the fire
officer level (assistant chief, battalion chief, fire captain), which maintains direct supervision of
firefighters. Currently, the organization does not have a formal education curriculum for fire
officers on the importance of stress recognition. It is incumbent upon the organization to develop
a curriculum to teach members how to recognize when stress is affecting a firefighter’s
performance. To date, the organization has not developed any measurable goals to determine or
develop a benchmark to identify stressors. However, by May 2020, an innovative stress
education program will be implemented.
Stakeholder Groups’ Performance Goals
Table 4 shows the organization’s mission and performance goal. The four primary
stakeholder goals are also listed.

STRESS IN THE FIRE SERVICE 19

Table 4
Organizational Mission, Organizational Goal and Stakeholder Performance Goals
Organizational Mission
The Large Urban Fire Department preserves life and property, promotes public safety and fosters
economic growth through a commitment to prevention, preparedness, response and recovery as an all-
risk life safety response provider.
Organizational Performance Goal
By May 2020, the Large Urban Fire Department will implement a stress education curriculum to address
the stress associated with the fire service.
Fire Chief and Deputy Chiefs
Stakeholder Goal

By May 2020, fire chief and
deputy chiefs will design and
implement a curriculum to
educate the fire officers and
firefighters to understand the
stress associated with the fire
service.

Firefighters Stakeholder Goal

By May 2020, firefighters will
demonstrate the knowledge and
skills to manage their stress
associated with the fire service.

Fire Officers Stakeholder Goal

By May 2020, fire officers will
demonstrate the knowledge and
skills to provide training and
education to firefighters for the
stress education program.
Stakeholder Group for the Study
The stakeholder group of focus consists of the fire chief, deputy chiefs, fire officers and
firefighters. The performance goal for the fire chief and deputy chiefs is to design and implement
a stress education program to train the fire officers and firefighters by May 2020. This research
provides an informative study for the organization and stakeholders to better understand the
effects of stress associated with the fire service so the program can be designed and developed.
Purpose of the Project and Questions
The purpose of this project was to conduct a needs assessment in the areas of knowledge
and skill, motivation, and organizational resources necessary to reach the organizational
performance goal of creating a curriculum. The analysis begins by generating a list of possible
needs and will move to examining these systematically to focus on actual or validated needs.
While a complete needs analysis would focus on all stakeholders, for practical purposes, the
STRESS IN THE FIRE SERVICE 20

stakeholders of focus in this analysis are the fire chief and deputy chiefs, who, by May 2020 will
design and implement a curriculum on stress associated with the fire service. Two questions
required analysis regarding the knowledge and skills, motivation, and organization resources and
solutions for the fire chief, deputy chiefs, fire officers and firefighters for this dissertation study:
1. What is the fire chief, deputy chiefs, fire officers and firefighters knowledge and
motivation assets and needs related to the Large Urban Fire Department goal of creating a
curriculum to address stress associated with the fire service?
2. What are the recommendations regarding knowledge, motivation, and organizational
needs to be met in the Behavior Health Program that will provide a guide to reduce stress
within the Large Urban Fire Department?
Methodological Framework
Improving performance through a gap analysis (Clark & Estes, 2008) was the framework
for the analysis of the organizational performance goals. Using the systematic process that Clark
and Estes (2008) provided clarified and identified the gap between the performance level and the
organizational goal. The focus was to increase the knowledge, skills, and motivation of the
organization to narrow gaps. The validation of the research was supported through surveys,
interviews, literature review, and content analysis. Research-based solutions are recommended
and evaluated in a comprehensive manner.
Definitions
Fire chief: is the chief administrative officer of the fire department and shall have control
of all its activities, including fire extinguishment, fire protection and fire prevention. The fire
chief is responsible for the proper management, discipline, and training of fire department
personnel.
STRESS IN THE FIRE SERVICE 21

Deputy chiefs: are subordinate in rank to the fire chief, and, in the absence of the chief,
assume control of the department and perform the duties and exercise the powers incidental to
the office of the chief, in such order of precedence as may be designated.
Fire officers: are designated as assistant chief, battalion chief, and fire captain and are
subordinate to the deputy chiefs.
Firefighters: are designated as all positions subordinate to fire officers and include
paramedics, fire boat operators-mates, helicopter pilots, scuba divers, apparatus operators,
engineers, fire inspectors, arson investigators, and emergency incident technicians.
Organization of the Study
Five chapters are used to organize this study. This chapter provides the reader with the
key concepts and terminology commonly found in a discussion about stress in the fire service.
The organization’s mission, goals and stakeholders as well as the initial concepts of gap analysis
adapted to needs analysis were introduced. Chapter Two provides a review of current literature
surrounding the scope of the study. Topics of stress in the fire service, supports and
interventions, policy, and wellness behavior will be addressed. Chapter Three details the
assumed needs for this study as well as methodology when it comes to choose of participants,
data collection and analysis. In Chapter Four, the data and results are assessed and analyzed.
Chapter Five provides solutions, based on data and literature, for addressing the needs and
closing the performance gap as well as recommendations for an implementation and evaluation
plan for the solutions.

STRESS IN THE FIRE SERVICE 22

CHAPTER TWO: REVIEW OF THE LITERATURE
Research shows stress associated with the professional fire service is a real problem. This
problem of practice is that stress within the organization calls for the design and implementation
of an innovative stress education program. Compared to the civilian community, stress and
suicide have been underreported problems in the fire service (Henderson et al., 2016). Further,
research has shown cognitive disorders from various forms of stress, which can lead to PTSD
and suicide (Martin et al., 2016). Finney et al. (2015) acknowledged this problem is important to
solve because understanding and developing awareness will reduce the suicidality and stress
associated with the fire service. Focusing on the problem of stressors within the organization will
provide an assessment of the organization’s stakeholders, culture, and performance goals.
This chapter will first review the literature on stress, suicides, and PTSD to help inform
the problem of practice. The chapter will also provide an explanation Clark and Estes’ (2008)
knowledge, motivation and organizational influences lens used in this study. Next, the chapter
turns attention to defining the types of knowledge, motivation and organizational influences
examined and the assumed knowledge, motivation and organizational influences on
performance. The chapter ends with a presentation of the conceptual framework guiding the
study. Therefore, the focus of the study is the organization in terms of understanding and
educating firefighters of the emotional effects of stress.
Influences on the Problem of Practice
The focus of the study was to educate firefighters and leaders of the organization on the
fact that stress can result in suicide because suicide is underreported compared to the civilian
community (Henderson et al., 2016). The culture in the fire service is to suppress feelings and
not share expressions of sensitivity because these can be viewed as a sign of weakness; however,
STRESS IN THE FIRE SERVICE 23

suppressing these feelings can lead to stress and suicide (Kronenberg et al., 2008). Turner (2011)
explains perception from the public has amplified the expectations that a firefighter is
responsible for solving a tragedy, which has added stress to resolving an emergency regardless of
the significance of the incident, triggering emotional disorders. Therefore, recognizing when
stressors affect a firefighter can prevent emotional disorders and the suicide of a first responder.
Knowledge, understanding, and education regarding stress for first responders and the emotional
intelligence of the leaders may prevent a firefighter suicide.
History of Stress in the Fire Service
Stress in the fire service is a problem that has plagued firefighters for many years.
However, understanding the emotional effects of stress, PTSD, and suicide can yield a positive
outcome in managing this condition. Research shows the effects the first responders experienced
only days and weeks after the attack that occurred on September 11, 2001, in New York City
(Schuster et al., 2001). After the attack, researchers conducted a survey study and discovered
44% of 560 adults had one or more symptoms of stress (Schuster et al., 2001). The study also
revealed how the first responders coped with their feelings of stress: talking to others, spiritual
influences, group activities, and making donations as a means of coping (Schuster et al., 2001).
The researchers discovered a barrier to emotional wellness for first responders for a full recovery
was the drawn-out media attention on the tragedy, which prevented full rehabilitation from the
incident. Prior studies have suggested that stress is minimized after time. However, an event such
as the September 11, 2001, attack and the enduring reminder by the media may bring recurring
triggers of stress (Schuster et al., 2001).
Marmar, Weiss, Metzler, Ronfeldt, and Foreman (1996) indicated first responders are
affected with stress after responding to critical incidents. They identified the importance of
STRESS IN THE FIRE SERVICE 24

training first responders to prepare for stressors which affect their emotional wellness. First
responders know their profession is associated with tragedy and trauma. According to Taylor and
Frazer (1982), a study conducted of first responders who worked to recover and identify bodies
from the Mt. Erebus air tragedy showed one-third of the workers had initial problems, and one-
fifth had challenges three months after the incident. A study by McFarlane (1986) asserted that
firefighters, 29 months after the disaster, presented early signs of distress. Research has pointed
out the importance of training first responders to prepare for emotions which may trigger stress
after experiencing a tragic incident. It is the embedded negative images that affect the long-term
recovery of a first responder.
Recovery and coping can provide a method to manage stress. Mitani et al. (2006)
examined burnout among first responders associated with job-related stress. Mitani et al. had 243
fire service personnel complete a questionnaire to research if there is a correlation between
PTSD and burnout. The results are as follows: (a) burnout is a long-term reaction to occupational
stress, associated with and related problems of a first responder, (b) job stress has transpired as a
key psychosocial stimulus on physical and mental health, associated with burnout, (c) rescue
personnel such as firefighters, paramedics, police, and medical staff, are regularly exposed to
disastrous incidents in their occupation (Mitani et al., 2006, p. 7). Additional studies have
reported prevalence of PTSD among ambulance personnel, firefighters and rescue workers to be
18% to 30% (Mitani et al., 2006, p. 7). Mitani et al. asserted firefighters have a correlate to
PTSD which is an acute or chronic stress reaction associated with specific traumatic events. The
results showed workers who suffer from acute or chronic stress will exhibit emotional exhaustion
and depersonalization (Mitani et al., 2006). The study further indicated 10% and 20% of
firefighters should pay attention to the risk of burnout. Mitani et al. (2006) pointed out an
STRESS IN THE FIRE SERVICE 25

assumption as to why experienced firefighters display lower job stressors: they learn to use
coping skills while at work.
Cermak (1991) studied the early pioneering of aerial forest fire service men and the
importance of a recovery period. The “nerve” camp was an area for the wearied first responders
to rehabilitate after a long deployment. In 1921, the aerial service men patrolled the brush areas
in California looking for large fires caused by lightning storms. According to Cermak (1991), the
1921 program established for airmen was known as the “nerve” camp at Gold Lake in Sierra
County. Under orders from the commanders, the airmen were sent to the “nerve” camp to hunt,
fish, camp, read, and to “shop talk” to de-stress and recover. The “nerve” camp, which occurred
nearly one hundred years ago, is a reminder of the importance of providing emotional wellness
support for first responders. This is an example of the importance for the fire service to continue
to provide recovery and coping skills for first responders.
The history of stress in the fire service has led to signs of PTSD, suicide, and suicidal
ideations. Stress in the fire service has a significant impact on the mental health and wellness of
firefighters. Providing the education for firefighters to promote their understanding of burnout,
PTSD, and stress relief will assist in managing their mental wellness and reduce stress.
Therefore, enhancing their emotional wellness and to understand the current issues associated
with stress to aid in a restorative life.
Current Stress Issues Associated in the Fire Service
Current issues associated with stress in the fire service have exposed firefighters to risks
of emotional trauma based on their high hazard occupation and exposure to traumatic incidents,
resulting in suicidal ideations and posttraumatic stress-disorder symptoms. Research by Stanley
Hom, Hagan, and Joiner (2015) explained the prevalence and correlates of suicidal ideations and
STRESS IN THE FIRE SERVICE 26

behaviors which firefighters experience. According to Stanley et al. (2015) suicide is a leading
preventable cause of death. Therefore, because of the occupational experiences firefighters
confront every day, they are an important group to study (Stanley et al., 2015). There are
probabilities of suicidal ideations among firefighters because of disruptions to family and social
support (Stanley et al., 2015). The work of Stanley et al. (2015) indicated firefighters have
increased levels of psychiatric disorders and symptoms, including depression, use of alcohol, and
sleep disruptions. This supports the need for stress research among firefighters.
In 2011, the National Fallen Firefighters Foundation formed a workgroup of researchers,
practitioners, and firefighters to collaborate on suicidal ideations among firefighters (Stanley et
al., 2015). Stanley et al. (2015) asserted there is a higher rate of suicidal thoughts and behaviors
among career firefighters compared to the general population. Further research revealed that
suicidal ideation and behaviors are a significant issue among firefighters (Gist, Taylor, & Raak,
2011). Additionally, 5% of firefighters reported a history of suicide attempts; therefore, the need
to accurately identify firefighters who may be at risk to themselves supports the development of
a behavior wellness program to reduce risk of suicide (Brown & Jager-Hyman, 2014; Stanley et
al., 2015; Mann et al., 2005; National Fallen Firefighters Foundation, 2014).
Research on occupational stress and suicidality indicated firefighters are at risk for
suicide and stress associated with the job (Stanley et al., 2018). An empirical study by Boffa et
al. (2016) examined the symptoms of suicidal thoughts and behavior among firefighters and
revealed an elevated level of posttraumatic stress symptoms (PTSS) with both suicidal ideations
and suicide attempts. According to the authors, there is a probability of correlates between
suicidal ideations and suicide attempts associated with PTSS among firefighters (Boffa et al.,
2016). Additionally, a national survey conducted by Stanley et al. (2015) of 1,027 retired and
STRESS IN THE FIRE SERVICE 27

current firefighters in the United States identified rates of suicidal ideations (46.8%), plans
(19.2%), and attempts (15.5%). The findings are similar to reports from fire departments (e.g.,
Finney et al., 2015) and national fire service organizations (e.g., Gist et al., 2011); thus, the
prevalence of firefighter suicide must be addressed. The work by Stanley et al. (2018) indicated
an opportunity for the fire service to recognize the correlation of firefighter stress with suicide
risk, distress tolerance, and the conditioning required to manage and cope with the emotional and
physical stress.
Stanley et al. (2018) acknowledged stress and suicidal ideations require intervention and
education to manage distress. Work recovery strategies associated with exercise, spending time
with coworkers, and recreational activities related to distress tolerance mitigates the effects of
occupational stress on mental health symptoms (Stanley et al., 2018). The prevalence of suicide,
suicidal ideations, PTSD, and emotional exhaustion has become an occupational problem in the
fire service requiring coping skills to improve first responders’ mental wellness. However, the
impact of stress among specific work groups like female firefighters, volunteer firefighters,
police officers, EMTs, and paramedics will require self-efficacy and intervention by
organizations.
Stress Affecting Female Firefighters, Volunteers, Police, EMTs, and Paramedics
The stress affecting female firefighters, volunteers, police, EMTs, firefighters, and
paramedics has caused suicidal ideations among these groups. Stanley et al. (2017)
acknowledged that firefighters, police officers, emergency medical technicians (EMTs), and
paramedics who experience stressors associated with their job manifest cognitive thoughts of
suicide, PTSD, and suicidal ideations. The authors further examined the thoughts associated with
the stressors the first responders’ experience
STRESS IN THE FIRE SERVICE 28

The work by Stanley et al. (2016) examined exposure to thoughts of suicide, PTSD, and
suicidal ideations associated with first responders’ stressors. The research revealed intrinsic
behaviors such as camaraderie and pre-enlistment screening may help with managing mental
conditions (Stanley et al., 2016). Findings also revealed that police officers, firefighters, EMTs,
and paramedics may be at higher risk for suicidal thoughts and behaviors (Stanley et al., 2016).
The research affirms that PTSD among first responders can lead to cognitive challenges such as
suicidal thoughts and behaviors. Therefore, it is important to further examine firefighters who are
at risk for suicide.
The study by Stanley, Boffa et al. (2017) compared pre-career and career rates of suicidal
thoughts and behaviors to identify the sociodemographic and occupational correlates among
female firefighters. According to Stanley, Boffa et al. (2017), among female firefighters workers,
the highest rate of death by suicide was among protective service workers, which includes
firefighters (McIntosh et al., 2016). These findings revealed that screening, prevention, and
intervention plans are important in addressing the problem of suicide among female firefighters.
It is important to recognize suicidal ideation to predict career risks and to provide mental health
services to lower morbidity and mortality (Stanley, Boffa et al., 2017). According to research,
providing mental health services for female firefighters with a history of suicidality would be a
necessary intervention to reduce suicide risk (Stanley, Hom et al., 2017). Providing effective
intervention programs will be helpful with suicidal ideation, but there is a lack of supporting
research on the effectiveness of an intervention program (Stanley, Boffa et al., 2017).
Stanley, Boffa et al. (2017) researched the mental wellness and behavior of career and
volunteer firefighters. Their results revealed the differences in psychiatric symptoms and barriers
to mental health care between volunteer U.S. firefighters and those in career departments.
STRESS IN THE FIRE SERVICE 29

Stanley, Boffa et al. (2017) asserted organizational factors such as more systematic and stringent
recruitment and screening processes may cause differences in cognitive symptoms. According to
Stanley, Boffa et al. (2017), among the volunteer firefighters, there were elevated signs of
depression, post-traumatic stress, and suicidal symptoms, specifically suicide plans and attempts.
The research revealed less access to mental health services for volunteer firefighters may have
limited their cognitive condition. Additionally, mental health care is helpful only if services are
available (Stanley, Boffa et al., 2017). Cost and available resources may be factors affecting the
value of mental health services among volunteer firefighters, which may explain the elevated
psychiatric symptoms (Stanley, Boffa et al., 2017).
Stress affecting volunteer firefighters, female firefighters, police officers, EMTs, and
paramedics has caused suicidal ideations among these groups of first responders. The effects of
stress in the fire service revealed challenges to emotional wellness, which require mindfulness
and coping skills to manage. Providing purposeful coping skills and understanding stress
management is the knowledge that can be applied to promote stress reduction among firefighters.
The Effects of Stress, PTSD, and Suicide
How to Manage the Causal Effects of Stress, PTSD, and Suicide
Stress in the fire service presents difficult challenges to manage the emotional behavior
of firefighters. The first responders who face stress, suicide, and PTSD need to know self-
efficacy appraisals of mindfulness and coping are avenues to better manage their emotional
environment. Stress and coping theory define stress as a “particular relationship between the
person and the environment that is appraised by the person as taxing or exceeding his or her
resources and endangers his or her well-being” (Lazarus & Folkman, 1984, p. 19). Managing the
causal effects of stress, PTSD, and suicide among firefighters will rely on self-efficacy of first
STRESS IN THE FIRE SERVICE 30

responders and the coping skills taught through the leadership of the organization. Coping is
related to mindfulness and self-awareness of the firefighters and the commitment of the
organization to provide a stress education program.
A firefighter who faces the challenges of stress will require the self-efficacy to improve
their own ability to cope and manage stress. Research reveals having the self-efficacy,
knowledge, and skills to cope with stress can provide a positive and manageable environment.
According to social cognitive theory (Bandura, 1997), self-appraisals and coping skills are
dependent upon one’s belief of having control over one’s function to cope with stressful events.
Bandura’s (1997) research drew attention to the fact that human regulating functions through
cognitive, motivational, affective, and decision processes are a baseline to personal efficacy. This
study examined the belief in one’s capability to practice self-control during stressful situations,
which promotes resilience (Bandura, 1997). Studies conducted with rescue workers have shown
an important factor to reducing stress is self-efficacy in that it lowers the levels of distress
(McCammon, Durham, Jackson Allison, & Williamson, 1988), which is related to lowering
traumatic stress symptoms and depression (Heinrichs et al., 2005; Regehr, Hill, & Glancy, 2000;
Regehr, Hill, Knott, & Sault, 2003).
Research by Prati, Pietrantoni, and Cicognani (2010) indicated self-efficacy moderates
the relationship between stress appraisal and professional quality of life. A survey conducted by
Prati et al. (2010) measured compassion, fatigue, burnout, and compassion satisfaction to
determine self-efficacy buffers to stressful situations of 451 Italian rescue workers. Prati et al.
asserted that self-efficacy may have a buffering effect. Research revealed first responders with a
high level of self-efficacy were less affected by high stress compared with those who had low
self-efficacy (Prati et al., 2010). The importance of self-efficacy in moderating a firefighter’s
STRESS IN THE FIRE SERVICE 31

quality of life is relevant, but the influence of leadership may have a compelling effect on
reducing stress.
Leadership provides the guidance and path needed to manage stress. According to Beaton
et al. (2001), poor leadership can contribute to job dissatisfaction and burnout. Additionally,
effective leadership in any organization contributes to organizational success. However, most
professional fire service officers in the United States received minimal formal management
training regarding leadership (Gist & Woodall, 1995). According to Revicki and Gershon (1996),
job dissatisfaction is a correlate to poor supervision and has been shown to contribute to
occupational distress among EMTs. In addition, the perception is supervisors who lack
leadership training and management skills can cause stress and distress for leaders (Revicki &
Gershon, 1996). Leadership is an influence that requires the knowledge and skills to aid in stress
reduction. Furthermore, education and training are the influence required to facilitate the
knowledge to manage and reduce stress.
Kaplan, Bergman, Christopher, Bowen, and Hunsinger (2017) examined the intervention
developed for first responders known as Mindfulness-Based Resilience Training (MBRT) to
reduce burnout. The study analyzed police officers and firefighters to determine psychological
resilience related to burnout. Psychological resilience is a manageable process to lower burnout
and improve mental health (Kaplan et al., 2017). To prevent burnout, the MBRT program was
developed to reduce negative health outcomes. Another source for psychological resilience is
mindfulness training, which has been shown to strengthen psychological resilience among
military service members (Johnson et al., 2014; Stanley et al., 2011). Research has shown that
self-awareness and mindfulness are related to increased resilience and reduced burnout. Thus,
psychological resilience and mindfulness training alter negative cognitive challenges to improve
STRESS IN THE FIRE SERVICE 32

firefighter behavior wellness. Coping, resilience and mindfulness will assist firefighters in
managing the stress associated with suicide, PTSD, and suicidal ideations. A stress education
program will elevate awareness of stress and may save the life of a firefighter.
Learning and Designing a Stress Education Program
History of the Large Urban Fire Department Behavioral Health Program
The organization has managed the challenges of stress with the critical incident stress
management program since the 1980s. This program has recognized the importance of
firefighters’ emotional behavior to manage stress, suicide, and PTSD. The stress management
program was first introduced in 1988 (LUFD, 1988). The Fire Chief encouraged all members to
be aware of the complex factors in their lives to remedy the challenges that elevate stressors. The
booklet that was introduced to the organization covered two approaches, which was to provide
the health and safety of the members (LUFD, 1988). These programs were implemented to
support the need to provide the behavioral health and wellness of members of the organization.
Firefighters routinely responded to critical incidents that brought the emotional and
physical stress when responding to horrific emergency calls. In 1988 the Critical Incident Stress
Debriefing Program began, which was to aid firefighters to better cope from these traumatic
incidents (LUFD, 1988). Additionally, the organization recognized the need to assist members
and made available the Peer Support Program to all employees and families during times of
crisis (LUFD, 1988). First responders across the United States and the world have experienced
catastrophic emergency incidents culminating with the effects of stress and the need to cope and
manage these critical incidents. Therefore, the organization implemented the CISD and Peer
Support Program.

STRESS IN THE FIRE SERVICE 33

Why Learn and Design a Stress Education Program
History has shown that devastation occurs across the United States and the world, with
first responders saving the lives of people in need. The consequence of these disastrous events is
the stress experienced by first responders. Tragic events such as the September 11, 2001, attack
on the United States, Hurricane Katrina that flooded the city of New Orleans, and the wildfires in
California will require a realignment to design and implement a stress education program for the
organization.
The National Volunteer Fire Council (2008), with the assistance of the Firefighter
Behavioral Health Alliance and HOPE Health Research Institute, developed a report to review
the impact of ignoring mental health in the fire service. This was the result of the negative
perception associated with mental health in the fire service, suicide prevention awareness, the
effects of PTSD, and the significance of recognizing the psychological effects of personal
relationships. According to the National Volunteer Fire Council (2008) experiencing a traumatic
event will trigger both physical and mental defense mechanisms, resulting in negative mental
health and suicidality. Behavioral wellness is a challenge and is critical for a firefighter to
understand because it requires mental preparedness. One important factor to take into account is
the new generation of firefighters, as this generation shares feelings more as compared to
previous generations (National Volunteer Fire Council, 2008).
The National Volunteer Fire Council (2008) acknowledged PTSD as the mind fighting
the body, which is associated with a symptom known as the “hidden victim” or survivor’s guilt
and is described as feeling unable to do enough to save the ones who passed away or experienced
a serious injury (National Volunteer Fire Council, 2008). The National Volunteer Fire Council
(2008) stated the emotional challenge of the first responder is the flashback, or reliving the tragic
STRESS IN THE FIRE SERVICE 34

event. Treatment and intervention are valuable in overcoming PTSD. There are measures which
can assist a first responder, such as participating in critical incident debriefing, seeking a
psychological evaluation, learning about PTSD through self-education (without self-diagnosing),
and welcoming assistance by an experienced counselor or professional (National Volunteer Fire
Council, 2008).
Research has discovered additional mental health treatments can aid in recovery.
According to Kronenberg et al. (2008), empirical research examined the cultural sensitivity of
providing mental health treatment to first responders, identified factors of post-disaster
treatment, and the interventions after Hurricane Katrina. For example, on August 29, 2005, after
the disaster that devastated the city of New Orleans, Mayor Ray Nagin asked Dr. Howard
Osofsky, chair of the Louisiana State University Health Sciences Center Department of
Psychiatry to facilitate wellness services for the New Orleans first responders. Kronenberg et al.
pointed out that the police and firefighters were a close-knit community and rarely allowed
outsiders to enter their circle, which hindered communication between the clinicians and first
responders (Kronenberg et al., 2008). An additional discovery from the research asserted the
police and firefighters had differing cultures. Clinicians claimed that trust was a building process
and establishing confidence with first responders was critical for open dialogue (Kronenberg et
al., 2008). First responders have faced and experienced devastation across the world when saving
the lives of people. Therefore, an innovative stress education program can provide them long and
prosperous lives.
Design and Implement a Stress Education Program
Designing and implementing a stress education program will enhance the BHP the LUFD
currently has in place. The goal of the program is to provide first responders the knowledge to
STRESS IN THE FIRE SERVICE 35

understand, cope, and identify stress associated with the fire service. This will further the
understanding of potential consequences that may affect their emotional behavior and encourage
a healthy and prosperous career on and off duty. Hammond and Brooks (2001) identified critical
incident stress management components to reduce the stress associated with healthcare and
prehospital workers; thus, CISD is an important component of critical incident stress
management.
The fire service in its early years of mental wellness measures revealed how to enhance
knowledge to manage stressors associated with critical incidents. In 1983, Jeffrey T. Mitchell
introduced an intervention technique for first responders to be used immediately after a traumatic
incident: the CISD (Hammond & Brooks, 2001). What began in 1983 as the CISD evolved into
what is currently known as the critical incident stress management program. This program was
developed to assist in defusing and managing stress experienced by first responders after a
traumatic incident. The adaptation of the program is important for the fire service because it
provides a source of remedy to deal with stressors. The CISD infrastructure is important to
incorporate into a disaster plan in all facets of public and private sector agencies. However, there
is a need for remedies to combat stress and assist in coping, which one can draw from programs
currently recognized, such as psychological first aid.
Research by Ruzek et al. (2007) acknowledged the psychological first aid system as a
process to help reduce initial post-trauma distress and manage short and long-term effects. The
Psychological First Aid Field Operations Guide was developed by the National Child Traumatic
Stress Network and the National Center for PTSD (Ruzek et al., 2007). Psychological first aid
has eight core actions: (a) contact and engagement, (b) safety and comfort, (c) stabilization, (d)
information gathering, (e) practical assistance, (f) connection and social support, (g) information
STRESS IN THE FIRE SERVICE 36

on coping support, and (h) linkage with collaborative services (Ruzek et al., 2007, p. 26).
Psychological first aid is an evidence-informed modular approach to help children, adolescents,
adults, and families in the initial aftermath of disaster and terrorism. Principles, objectives, and
techniques of psychological first aid are designed to meet four basic standards:
1. Consistent with research evidence on risk and resilience following trauma.
2. Applicable and practical in field settings.
3. Appropriate for developmental levels across the lifespan.
4. Culturally informed and delivered in a flexible manner. (Vernberg et al., 2008, p. 382)
Mitigating stress can reduce the emotional distress faced by first responders, so intervention
techniques such as a critical stress management program, MBRT, and psychological first aid can
help. The development of an innovative stress education program for first responders will enable
organizations to provide the support for firefighters to live healthier and prosperous lives.
Clark and Estes’ Knowledge, Motivation and Organizational Influences Framework
A gap analysis (Clark & Estes, 2008) improves performance by studying organizational
and stakeholder performance goals to identify whether a gap exists. Using the systematic and
analytical process provides clarification and identifies whether a gap exists between the
stakeholder performance level and the organizational goal (Clark & Estes, 2008). The focus is to
increase the knowledge, skills, and motivation of the organization to narrow any gaps (Clark &
Estes, 2008). According to Krathwohl (2002), there are four- categories of knowledge and skills:
(a) knowledge, (b) conceptual, (c) procedural, and (d) metacognitive. These enable the
stakeholders to understand how to close the organizational gap. The conceptual framework is a
model or concept of what the researcher plans to study and investigate (Maxwell, 2013). The
STRESS IN THE FIRE SERVICE 37

validation study is supported by utilizing methods such as surveys, interviews, literature review,
and content analysis.
Describing the performance gap and identifying the problem is enabled by understanding
the knowledge, motivation, and organizational barriers to meet the performance goal related to
stress in the fire service. Clark and Estes (2008) explained the three causes of performance gaps,
and this section will analyze stakeholder knowledge and motivation to align with the
performance goal of the organization. Organizational barriers can influence motivation regarding
organizational performance; therefore, research on the influences of motivation is discussed.
Methodology and construct of stakeholders’ knowledge, motivation, and organizational
influences will be further reviewed and examined in the following chapters.
Stakeholder Knowledge, Motivation and Organizational Influences
Knowledge and Skills
The literature review is needed for this study on stress in the fire service and an
innovative stress education program for the LUFD. The stakeholder group of focus consists of
the fire chief, deputy chiefs, fire officers, and firefighters. The performance goal for the fire chief
and deputy chiefs is to design and implement a stress education program by May 2020. This
research provides an informative study for the organization and stakeholders to better understand
the effects of stress associated with the fire service.
The influences of knowledge and skills are important for the engagement of the fire
chief, deputy chiefs, fire officers, and firefighters to enrich their knowledge and understanding of
stress related to the fire service. Complex knowledge has a correlation to stress relief; if
firefighters are unable to know the effects of stress, they will not know how stress may influence
their emotional behavior. If people do not know what they are supposed to know, they will not
STRESS IN THE FIRE SERVICE 38

attain any realistic goal (Rueda, 2011). An aspect of knowledge and skills is to recognize a need
to improve performance within the organization, which is the initial step towards advancement.
According to Rueda (2011), and Anderson and Krathwohl (2001), there are four specific
cognitive approaches to learning: factual knowledge, conceptual knowledge, procedural
knowledge, and metacognitive knowledge. Factual knowledge refers facts and is basic
familiarity with a subject. Conceptual knowledge is the understanding of categories,
classifications, theories, etc. Procedural knowledge is how to do something, and metacognitive
knowledge is self-awareness (Rueda, 2011). To narrow a performance gap, the organization will
need to recognize what needs to change and accept the influences required to make the necessary
improvements.
A gap analysis influences the development of a stress education program utilizing
research and knowledge to close any discoverable gaps. Clark and Estes (2008) explained gap
analysis research aims to determine if the organization knows how, when, what, why, where, and
who to attain their performance goals. If the stakeholders cannot figure out the effects, then the
problem will need to be solved to decrease the organization’s deficiency (Clark & Estes, 2008).
According to Grossman and Salas (2011), a realistic training environment has importance when
authentic training and practice settings are applied. The LUFD has taught firefighters that
training for emergency incidents requires repetitive motor skills. Design training of real-life
scenarios for firefighters during field training operations supports authentic training. Therefore,
developing a stress education program with supporting research on knowledge and skills
influences will be implemented.
In the following review, there are three knowledge influences that will be discussed to
explain the methodology to determine the need for a stress education program. According to
STRESS IN THE FIRE SERVICE 39

Krathwohl (2002), a revision of Bloom’s taxonomy categorizes the types of knowledge into four
categories: factual knowledge, conceptual knowledge, procedural knowledge, and metacognitive
knowledge. These influences will further explain the rationale, methodology, and research
analysis to implement and develop a stress education program for the organization. Further
discussion will explain the three causes of performance gaps: people’s knowledge, their
motivation, and organizational barriers (Clark & Estes, 2008).
Conceptual knowledge influence. The fire chief and deputy chiefs need knowledge to
understand the emotional effects of stress in the fire service. Understanding the four knowledge
types will influence and determine the process to identify whether there is a need to design and
implement a stress education program. Clark and Estes (2008) further support the conceptual
knowledge influence as any knowledge one is aware of thinking, which is comprised of facts,
concepts, processes, and principles of what an individual has learned, recalled, and thought
about. Conceptual knowledge will influence the organization in thinking about the improvement
of emotional behavior, process the need for a program, gather the facts through the gap analysis,
and analyze the research. The need to educate the stakeholders will be determined by the fire
chief and deputy chiefs. Through the research analysis, a decision will be made by the
organization to narrow any gap, to solve any problem, and to develop a stress education program.
Conceptual knowledge has basic elements which enable the functionality of interrelationships
(Krathwohl, 2002). Further research discovered, according to Krathwohl’s (2002) revised
taxonomy, that there are sub-categories: knowledge of classifications and categories; knowledge
of principles and generalizations; and knowledge of theories, models, and structures. The fire
chief and deputy chiefs will determine the need to close any influences discovered through the
research.
STRESS IN THE FIRE SERVICE 40

Factual knowledge influence. The fire chief and deputy chiefs need factual knowledge
to design and implement a curriculum to educate fire officers and firefighters regarding the
effects of stress in the fire service. In order for the fire chief and deputy chiefs to do so, the
factual knowledge influence was analyzed to determine the need for a program.
The organization’s hierarchy begins with the fire chief and deputy chiefs determining
policy and practices for the organization. The fire chief and deputy chiefs have the authority to
implement a stress education program. They will require knowledge on whether the program can
save a life. During the research, there was a manageable method for determining a need for a
program: identifying the knowledge barriers. During the research, hindsight bias and
overconfidence should be averted to prevent the performance specialists from making
predetermined predictions of how stress education affects the organization (Clark & Estes,
2008).
Procedural knowledge influence. The fire chief and deputy chiefs need to know how to
incorporate strategies to implement an educational curriculum regarding stress in the fire service.
This procedural knowledge type will be beneficial for the fire chief and deputy chiefs to
incorporate strategies to design and implement the curriculum. Krathwohl (2002) describes
procedural knowledge types as methodology, algorithms, techniques, and methods. Rueda (2011)
and Krathwohl further explain and support the procedural knowledge type as how to do things.
Rueda further supports procedural knowledge as very specific and finite. Procedural knowledge
has a methodology, algorithms, and techniques: knowing how to do things (Rueda, 2011). The
cognitive process of knowledge is further applied to six different levels: remember, understand,
apply, analyze, evaluate, and create (Rueda, 2011). The taxonomy for teaching and learning is
based on the matrix by Anderson et al. (2001). People knowing what they need to know is
STRESS IN THE FIRE SERVICE 41

critical to achieving their goals, and the knowledge matrix provides a helpful instrument to
establish detailed goals.
Metacognitive knowledge influence. The Fire chief, deputy chiefs, fire officers, and
firefighters need to know how stress education can improve stress management. Metacognitive
knowledge will be beneficial for the fire chief, deputy chiefs, fire officers, and firefighters to
incorporate strategies to improve stress management. According to Rueda (2011) metacognitive
knowledge is awareness of one’s own cognition. Rueda further explains this is the strategic
behavior in solving problems and presents contextual and conditioned situations or problems. As
such, to know how stress education can improve the reduction of stress, metacognitive
knowledge can enhance understanding of the need for a stress education program.
Table 5 below provides a summary of the knowledge influences and how they will be
assessed.

STRESS IN THE FIRE SERVICE 42

Table 5
Knowledge Influence, Knowledge Types, and Knowledge Assessment
Organizational Mission
The Large Urban Fire Department preserves life and property, promotes public
safety and foster’s economic growth through a commitment to prevention, preparedness,
response and recovery as an all-risk life safety response provider.
Organizational Global Goal
By May 2020, the Large Urban Fire Department will design and implement an
educational curriculum to address the stress associated with the fire service.
Stakeholder Goal
By May 2020, fire chief and deputy chiefs will design and implement a curriculum
to train and educate the fire officers and firefighters to understand the stress associated
with the fire service.
Knowledge Influence Knowledge Type
(i.e., declarative
(factual or
conceptual),
procedural, or
metacognitive)
Knowledge Influence Assessment
Fire chief and deputy
chiefs know the
emotional effects of
stress in the fire service.

Fire chief and deputy
chiefs know what stress
is and the causes of
stress in the fire service.

Conceptual

Factual

Methodology Proposal:
Mixed Method. Surveys, interviews and
observations.

Methodology Proposal: Mixed Method.
Surveys, interviews and observations.

Fire chief and deputy
chiefs know how to
reduce stress in the fire
service.
Procedural Methodology Proposal:
Mixed Method. Surveys, interviews and
observations

Fire chief , deputy
chiefs, fire officers, and
firefighters need to know
how stress education can
improve stress
management.
Metacognitive Methodology Proposal:
Mixed Method. Surveys, interviews and
observations
STRESS IN THE FIRE SERVICE 43

Motivation
Motivation is an important construct to consider in the development of an innovative
stress education program. The desire to reduce stress, burnout and suicide will motivate the
stakeholders to implement a stress education program. Motivation is an intrinsic or a
psychological process that instills the drive to keep us moving and causes people to accomplish
their goals (Pintrich & Schunk, 1996). According to Clark and Estes (2008), motivation can
influence three important points in one’s personal and work life: choosing to work towards a
goal, being determined to finish the task, and the amount of cognitive effort to attain the goal.
The formal explanation of motivation is “the process whereby goal-directed activity is instigated
and sustained” which influences motivation both internally and externally (Schunk, Pintrich, &
Meece, 2009, p. 4). These factors are instrumental in keeping a cognizant approach to
motivation. Additional indicators associated with motivational factors include active choice,
persistence, and effort (Schunk et al., 2009).
The supporting research will enable the organization to influence the development of a
stress education program for the prevention of suicide and PTSD. The motivation for the
organization is to provide an opportunity to design and implement an innovative stress education
program. The organization can benefit from the influences of motivation in terms of how to do
things and how motivation provides the effort required to keep things moving (Clark & Estes,
2008). There are noticeable benefits to organizations when research discovers a gap during
analysis (Clark & Estes, 2008). However, active choice, persistence, and mental effort make up
the motivation indexes (Clark & Estes, 2008). Therefore, there is a motivation influence for the
organization to create a stress education program.
STRESS IN THE FIRE SERVICE 44

Expectancy value model. The fire chief, deputy chiefs, fire officers, and firefighters
need to believe they are capable of effectively understanding the importance of stressors, thus
aiding members to understand the emotional effects of stress. Motivation has various constructs
related to the variables associated with expectancy and value. The constructs of motivation are
influences that characterize the intrinsic behavior of the stakeholders in terms of seeing the
importance of developing a stress education program. According to Rueda (2011), values, self-
efficacy, attributions, goals, and goal orientation are dimensions of motivational principles.
Expectancy value has two constructs that are predictors of achievement performance and choice
and are influenced by psychological, social, contextual, and cultural influences (Wigfied &
Cambria, 2010). Expectancy and value are influenced by the task and specific beliefs based on
competence, perceptions of task difficulty, and goals (Wigfied & Cambria, 2010). According to
Wigfield, Cambria & Eccles (2019) the original definition constructs of the expectancy-value
model are a child’s beliefs in how well they will do in upcoming tasks. This explored the success
of the person’s belief regarding competence or ability.
Expectancy value theory is also defined as constructs that include ability beliefs,
expectancies for success, and the components of subjective task values (Wigfield & Eccles,
2000). The work of Wigfield and Eccles (2000) indicated belief in one’s ability is based on how
well one does on an activity and the achievement and value seen in the task. The specific task of
the firefighter to improve their stress management is crucial to their belief (self-efficacy) and
with incentive, task, and reinforcement believe a stress education program will reduce stress.
Therefore, beliefs for success should be focused on the present ability and expectancies targeting
the future through stress education and training. Recognizing expectancy and value to attain
success in a task will influence motivation (Wigfield & Eccles, 2010).
STRESS IN THE FIRE SERVICE 45

In the fire service, there exists a team concept that drives the organization to attain high
levels of accomplishment. The perception of self and collective expectancy is a key piece in the
analysis of the LUFD. The fire service profession requires teamwork plus the collective lens to
motivate the stakeholders. The effectiveness of a team can be structured to reflect a collective
expectancy effort to attain a positive outcome. The influences of expectancy and value contribute
to the behavior and wellness of the stakeholders of the LUFD.
Self-efficacy theory. The fire chief, deputy chiefs, fire officers, and firefighters need to
believe they are capable of effectively understanding the importance of stressors, thus aiding
members to understand the emotional effects of stress. Motivation has various constructs that are
related to the variables of self-efficacy. The constructs of motivation are influences that
characterize the intrinsic behavior of the stakeholders of the organization and the importance of
supporting research to develop a stress education program. According to Rueda (2011), self-
efficacy, attributions, value, goals, and goal orientation are dimensions of motivational
principles. Self-efficacy beliefs are bases for social cognitive theory and are defined as the
judgements regarding individual value as an expectation for performance (Pajares, 2006). The
desire for personal accomplishments, self-motivation, and well-being is associated with social
cognitive theory and self-efficacy (Pajares, 2006). Pajares (2006) explained that self-efficacy
beliefs can help a person overcome barriers and aid when an individual faces obstacles, difficult
situations, or confront adversity. Pajares also explained self-efficacy beliefs influence a person’s
cognitive process and emotional reactions, resulting in elevated self-efficacy and providing a
sense of calmness during difficult tasks and situations.
Self-efficacy beliefs are defined as “people’s judgement of their capabilities to organize
and execute the course of action required to attain designated levels of performances” (Bandura,
STRESS IN THE FIRE SERVICE 46

1986, p. 391). A person who has high self-efficacy and confidence in their own ability for
positive outcomes is self-motivated and engaged to set higher goals (Rueda, 2011). Providing
awareness of the self-efficacy influence will yield a closer understanding of the effectiveness of
implementing a stress education program. Providing a clean lens and perception of the
organization’s goals through self-efficacy will enhance clarity and inference for a stress
education program.
The perception of self and collective efficacy is a key component in the analysis of the
organization. The fire service profession requires teamwork and self-efficacy, plus the collective
lens to influence the lives of the stakeholders. The effectiveness of a team can be structured to
reflect a collective efficacy effort to attain a positive outcome. Collective efficacy references an
individual’s perception which affects a group’s interaction (Borgogni, Dello Russo, & Latham,
2011). Borgogni et al. (2011) addressed the rationale between self- and collective efficacy in
three areas. First, group efficacy reflects individual judgements. Second, self-efficacy influences
the group efficacy in different situations, and, third, individuals with high self-efficacy are
willing to contribute to the group’s effectiveness. There is a perception that self-efficacious
people tend to believe they can develop positive relationships (Borgogni et al., 2011). Collective
efficacy directs the individual’s self-efficacy and is a collection of an emerging team (Bandura,
2000). The influences of self-efficacy and collective efficacy contribute to the behavior and
wellness of the stakeholders.
Attributions. The fire chief and deputy chiefs need to understand that a stress education
program will improve understanding of stress, PTSD and suicide. When the fire service faces a
death or injury on the department, many questions are asked. Why did this occur? Or, is there
something I can do to prevent this from occurring again? In attribution theory, individuals
STRESS IN THE FIRE SERVICE 47

attempt understand their environment by thinking about behavioral actions attributed to results.
The macro social environment that someone is encountering makes up attribution beliefs and is
part of the process in rationalizing an occurrence (Rueda, 2011). Theorists have defined
attribution with three dimensions: stability, locus, and control (Weiner, 2005). Locus attributions
are both external and internal and fall under the control dimension (Rueda, 2011). Rueda (2011)
pointed out that attribution and control beliefs are the reason for success or failure at a task or
activity and the controllable outcome. The locus dimension is related to feelings of pride and
self-esteem (Weiner, 1985, 2006). Stability is an attribution that is temporary or permanent and
affects the learner’s motivation (Rueda, 2011). The attribution motivation principle is the belief
that not meeting a goal is not permanent and is influenced by controllable factors, such as effort
to succeed, to stay focused to stay persistent, and to continue to work hard at the task or activity
(Rueda, 2011). The organization can apply attribution theory to the development of a stress
education program. This will enable the organization to educate the stakeholders on the effects of
stress as it relates to the fire service. The authors have affirmed the locus attribution theory as
external and internal attributes, and these attributions are directly related to the fire service in that
emergency incident factors are controllable and uncontrollable.
Table 6 below provides a summary of the motivation influences and how they will be
assessed.

STRESS IN THE FIRE SERVICE 48

Table 6
Motivational Influence Assessments
Organizational Mission
The Large Urban Fire Department preserves life and property, promotes public
safety and fosters economic growth through a commitment to prevention, preparedness,
response and recovery as an all-risk life safety response provider.
Organizational Global Goal
By May 2020, the Large Urban Fire Department will design and implement an
educational curriculum to address the stress associated within the fire service.
Stakeholder Goal
By May 2020, fire chief and deputy chiefs will design and implement a curriculum
to educate the fire officers and firefighters to understand the stress associated within the fire
service.
Assumed Motivation
Influences
Motivational Influence Assessment

Expectancy Value - Fire
chief, deputy chiefs, fire
officers, and firefighters
need motivation to know
how a stress education
program can reduce stress
Written survey item “The rate to which a firefighter will agree
or disagree that a stress education program will improve stress
management.”
Interview item:
Participants will be asked, have you received or participated in
any training related to stress and describe the education
provided by the organization?
Self-Efficacy – Fire chief
and deputy chiefs are
confident they can design
and implement an
educational curriculum to
address stress within the
fire service.
Written survey item “I feel confident about my ability to
understand the effects of stress associated in the fire service”
(strongly disagree-strongly agree)
Interview item:
“How do you feel about your ability to understand the effects
of stress associated in the fire service?”
Attributions – Fire chief,
deputy chiefs fire officers,
and firefighters believe
that it is through their own
efforts that they attribute
success and failure of a
stress education program.
Written survey item “Firefighter understanding of stress in the
fire service is strongly influenced by the effort I put into
understanding the stressors.” (strongly disagree-strongly agree)
Interview item:
What are some of the causes for a firefighters’ success or
failure to understand stress effects in the fire service?

STRESS IN THE FIRE SERVICE 49

Organizational Influences
General theory. Organizational culture is the most important work process that
establishes and sets the tone for an organization because it shows how individuals work together
to attain the organization’s goals (Clark & Estes, 2008). According to Clark and Estes (2008),
culture is a descriptive development of a group’s core values, goals, beliefs, emotions, and the
processes that are learned from family and the professional setting. There are three common
approaches to the cultural performance of an organization: (a) culture in the environment, (b)
culture groups, and (c) culture in individuals (Clark & Estes, 2008). Schein (2017) explained
organizational influences are explicit behavior patterns such as formal rituals which reflect
cultural assumptions. Therefore, shared assumptions are the perceptions of how we feel and
think about ourselves. Schein further explained that occupations have shared assumptions related
to internal performance of the organization and the evolution of cultures and subcultures. The
following sections will explain the relevancy of influences that affect the stakeholders as it
relates to organizational constructs, such as fire service culture and organizational leadership.
Stakeholder specific factors – Fire service culture. Organizational culture in the fire
service has challenges parallel to those of other public and private sector organizations. The
unique culture of the fire service lies in the daily exposure to chronic traumatic incidents that
cause firefighters to contend with and manage their stress, PTSD, and suicidal ideations. The fire
chief, deputy chiefs, fire officers, and firefighters will acquire the skills to influence the
organization to improve and understand the culture of stress in the fire service. According to
Haslam and Mallon (2003), fire service personnel are at high risk of PTSD symptoms of sleep
disorder and reflection of past critical incidents they may have experienced. As a result, opening
the fire service culture to deal and cope with a traumatic emotional event will entail displacing a
STRESS IN THE FIRE SERVICE 50

social culture of machismo. Because firefighters may be reluctant to use support services due to
the image of a firefighter (Joyce, 1989), this will require the efforts of the organization to create
a sustainable culture change to aid in managing the stress associated with the fire service.
As mentioned in this section, culture is described as the core values, goals, beliefs,
emotions, and the process learned over time frame which affect the cultural environment at work
or at home (Clark & Estes, 2008). Culture also influences an organization’s work process. There
are three factors that Clark and Estes (2008) explain as the approaches to culture and
organization. The first is the culture in the environment and the belief that changing the cultural
patterns can be altered by changing the work environment. Secondly, understanding a cultural
group can help to change the pattern, beliefs, and knowledge of the individuals within a group.
Third is the culture in individuals, and knowing what motivates an individual is derived from
their personal beliefs and life experiences, which influences their decisions and actions. The
question regarding culture is whether occupations have cultures. According to Schein (2017),
there are macro cultures which are known as nations, ethnic groups, religions, and various social
groups. These macro groups are similar to the LUFD where subcultures are formed throughout
time. Categorizing a subculture and recognizing stress in the fire service can affect a firefighter’s
performance. Therefore, recognizing the subculture is critical for the health and longevity of the
organization.
A fire service cultural stigma is that suicidal ideation and mental health disorders are a
sign of weakness. Addressing the stigma will require persistent effort by the organization to
educate and train firefighters to change. The fire service culture regarding mental disorders as a
sign of weakness, vulnerability, and failure is a problem that needs to be addressed (Henderson,
Leduc, Couwels, & Van Hasselt, 2015). Henderson et al. (2016) further explained the
STRESS IN THE FIRE SERVICE 51

“brotherhood” is a barrier of protection against PTSD and depression, giving peer support to
firefighters, which becomes a risk for the firefighter who cannot openly talk to their peers,
preventing them from seeking help from mental health care programs. This focuses the need for
the fire service to be aware of firefighters who isolate themselves and are reluctant to reach out
for professional care, which can become a hindrance to mental health wellness (Henderson et al.,
2016).
Cultural climate can help an organization attain goals when stakeholders believe there is
buy-in from the hierarchy. However, creating the climate to attain or sustain organizational goals
requires the altering of the fundamental psychological belief that steers and motivates the
members to give their best effort for the organization (Schneider, Brief, & Guzzo, 1996). The
sustainability of cultural change is based on changing the psychology of the people, and, if
people do not change, the organization cannot alter the course of change (Schneider et al., 1996).
To make an organizational change, the climate requires the members to believe in the values
exuded by the hierarchy of the organization, such as policies, practices, and procedures
(Schneider et al., 1996). Therefore, focusing on cultural climate change can lead to cultural
change within an organization. Schneider et al. (1996) explained the model and methods of total
organizational change as a process to develop and alter change: the human potential philosophy,
the socio-technical philosophy, and the total quality philosophy. The human potential philosophy
has strong perspectives that create a strong feature between management and members: peers
value interaction with peers and supervisors, people need trust and support, and people desire
growth and development. These features allow the organization to function effectively, as
members’ views and attitudes further enrich the culture and leadership of the organization
(Schneider et al., 1996).
STRESS IN THE FIRE SERVICE 52

Stakeholder specific factors – Fire service leadership. The fire chief, deputy chiefs,
fire officers, and firefighters need to effectively understand the importance of leadership,
teaching, and aiding fire department members to understand the emotional effects of stress.
Leadership has had many definitions through the years, from domination to influence and the
interaction of a leader’s ability to use their personality traits with the followers (Northouse,
2016). Northouse (2016) explained the themes of leadership during the 1950s were a continuance
of group theory and leadership as a relationship that develops shared goals and effectiveness.
The 21st

century emerges as an era of leadership approaches that include authentic leadership,
spiritual leadership, servant leadership, transformational leadership, and adaptive leadership
(Northouse, 2016). Leadership is best explained by Burke (2017): “without leadership, planned
organization change will never be realized” (p. 296). Competent leadership is a distinct factor
that can change an organization’s ability to succeed or fail (Burke, 2017).
Currently, leadership is viewed as the leader being more about the person than the role or
position (Burke, 2017). The stakeholders of the organization will demonstrate their leadership
effectiveness utilizing contemporary leadership styles. Leadership is the ability to influence and
requires the skills to persuade, listen actively, show empathy, and be self-aware as a leader as
well as note the effectiveness of the followers (Burke, 2017). Leadership is essential to the
success of an organization, but there are leadership styles such as transformational and adaptive
leadership that will be discussed in this section.
A current approach to leadership that has been a focus since the 1980s is the
transformational style of leadership (Northouse, 2016). Bass and Riggio (2006) suggested that
the popularity of transformational leadership is based on intrinsic motivation and follower
development which is relative to the climate of today’s work groups. Transformational
STRESS IN THE FIRE SERVICE 53

leadership is how a person engages with others and develops a relationship that encourages
motivation and morality in the leader and follower (Northouse, 2018). This type of leadership
provides an attentiveness by the leader and brings out the full potential of the follower to show
their best performance for the organization. The Multifactor Leadership Questionnaire (MLQ) is
a transformational evaluation tool for an individual to measure and perceive themselves. There
are qualities of a transformational leader that have emerged from the MLQ: (a) charismatic
leadership – admired, respected, trusted, willing to take risks, consistent, high moral and ethical
conduct; (b) inspirational motivation – leader provides meaning and challenge, team spirit, leader
communicates well, and strong commitment to goals; (c) intellectual stimulation – urges
followers to be innovative and creative, question assumptions, approach old situations in new
ways, and when followers make mistakes, the leader does not criticize them in public; (d)
individual stimulation – leader pays close attention to followers needs for achievement, leader is
a mentor and coach, individual differences are recognized by the leader, management by
walking, and (e) leader ensures a feeling autonomy for followers to complete tasks (Burke, 2017,
p. 305). Burke (2017) concluded the transformational leader is someone who stays the course,
keeps everyone focused, deals with resistance, has a clear vision about the future, and is self-
aware.
A quality measure of an effective contemporary leader is the focus on the authentic
leadership style. According to Northouse (2016) authentic leadership is a newer area which
focuses on a leader’s ability to be genuine and real. Northouse further explained that authentic
leadership is very complex and has perspectives that are considered intrapersonal, highlighting
what goes on internally as the leader and internalizes self-knowledge, self-regulation, and self-
concept. A second perspective is the interpersonal process in which the leader and followers
STRESS IN THE FIRE SERVICE 54

create their relationships. Third, the authentic leader is nurtured and developed after many years
through life events causing them to focus an introspective lens toward the followers. A summary
of the authentic leader is someone who understands their personal values and carries out their
own values with the follower, conveying the willingness to share their personal story and listen
to others, thus building trust and understanding with the followers (Northouse, 2016).
A strong leader has strengths that influence others to follow through and show
compassion, trust, communication, empathy, and humility. The leader requires knowledge to
lead but should also understand why a follower connects with the leader. According to Rath and
Conchie (2008), a Gallup Poll survey identified what followers define in terms of how leaders
make a difference. The survey concluded with the 25 most commonly mentioned words that a
follower needed from a leader in their lives, and four basic categories of needs: trust,
compassion, stability, and hope (Rath & Conchie, 2008). Other words that were shared were
honesty, integrity, and respect. The compassion category included words such as caring,
friendship, happiness, and love. Stability brought the core values of security, strength, support
and peace for the moment, and hope referred to interest in the future (Rath & Conchie, 2008).
The research by Rath and Conchie (2008) explains that connecting with the follower by
understanding why people follow is an opportunity for organizational growth. Effective
leadership in the fire service is the cornerstone of success, and the leadership of the fire chief,
deputy chiefs, and fire officers will determine the outcome of the organization’s management of
stress.
Table 7 below provides a summary of the organization’s influences and associated
assessments for the LUFD to develop a stress education program to relieve the stress associated
with the fire service.
STRESS IN THE FIRE SERVICE 55

Table 7
Organizational Influences
Organizational Mission
The Large Urban Fire Department preserves life and property, promotes public safety and
foster’s economic growth through a commitment to prevention, preparedness, response and
recovery as an all-risk life safety response provider.
Organizational Global Goal
By May 2020, the Large Urban Fire Department will design and implement an educational
curriculum to address the stress within the fire service.
Stakeholder Goal
By May 2020, fire chief and deputy chiefs will design and implement a curriculum to educate
the fire officers and firefighters to understand the stress within the fire service.
Assumed
Organizational
Influences
Organizational
Influence Assessment
Research-Based
Recommendation or
Solution Principle
Proposed
Solution
The fire chief, deputy
chiefs, fire officers, and
firefighters need to
have a commitment to
reduce stress.
(Cultural Models)
The fire chief, deputy
chiefs, fire officers, and
firefighters will acquire
the skills to influence
the organization to
improve and
understand the culture
of stress in the fire
service.
Effective change
efforts ensure that
everyone has the
resources (equipment,
personnel, time, etc.)
needed to do their job,
and that if there are
resource shortages,
then resources are
aligned with
organizational
priorities (Clark &
Estes, 2008).
Provide resources
to design and
implement a
stress education
program.
The organization needs
to have a commitment
to reduce stress.
(Cultural Models)
The organization will
create a climate of
sustainable culture
change as it manages
the stress associated
with the fire service.

Effective change
begins by addressing
motivation
influencers; it ensures
the group knows why
it needs to change. It
then addresses
organizational barriers
and then knowledge
and skills need (Clark
& Estes, 2008).
Provide and
educate the
organization to
ensure
confidence and
understanding
that changing the
culture to reduce
stress.

STRESS IN THE FIRE SERVICE 56

Table 7, continued
Assumed
Organizational
Influences
Organizational
Influence Assessment
Research-Based
Recommendation or
Solution Principle
Proposed
Solution
The fire chief, deputy
chiefs, fire officers, and
firefighters need to
have a commitment to
design and implement
an innovative stress
education program.
(Cultural Settings)
Fire chief, deputy
chiefs, fire officers, and
firefighters need to
understand the
importance of
leadership to change
the views of the effects
of stress in the fire
service.

Effective change
efforts ensure that
everyone has the
resources (equipment,
personnel, time, etc.)
needed to do their job,
and that if there are
resource shortages,
then resources are
aligned with
organizational
priorities (Clark &
Estes, 2008).
Provide an
effective change
effort to ensure
the organization
provides
resources to
reduce stress.

The organization needs
to have a commitment
to design and
implement an
innovative stress
education program.
(Cultural Settings)
The organization will
function effectively
with members views
and attitudes to further
enrich the culture and
leadership of the
organization.

Changes in the
environment can affect
behavior. (Daly, 2009;
Tuckman, 2009)
Effective organizations
ensure that
organizational
messages, rewards,
policies and
procedures that govern
the work of the
organization are
aligned with or are
supportive of
organizational goals
and values (Clark &
Estes, 2008).
Provide a
sustainable
environment
change to align
the leadership to
support the
values to reduce
stress.

Conceptual Framework: The Interaction of Knowledge, Motivation, and Organization
Figure 1 outlines the conceptual framework that influences the organization’s interaction
between the stakeholders representing the knowledge, motivation, and organizational cultural
models and settings. The cultural settings and models influence describe how the fire service
perceives and manages the current ideology concerning stress in the organization. The fire chief,
deputy chiefs, fire officers, and firefighters’ organizational cultural setting is the current
Stakeholder
Knowledge (i.e.,
knowledge types),
Skills, Motivation
(i.e., self-efficacy,
value, etc.)

STRESS IN THE FIRE SERVICE 57

influence of how stress is managed with resources. The cultural influences affecting the
stakeholders are factual, procedural, and conceptual models. The motivation influence is
connected through expectancy value, self-efficacy and attributions. The organizational influences
are supported by the leadership and cultural models. Designing and implementing a stress
education program by May 2020 will change the cultural setting and model for the organization.
Therefore, joining the influences of knowledge, motivation, and organization will provide a
roadmap to design and implement a stress education program to improve the management of
stress with the LUFD. The main questions that guide this study are the following:
1. What is the fire chief, deputy chiefs, fire officers and firefighters knowledge and
motivation assets and needs related to the Large Urban Fire Department goal of creating a
curriculum to address stress within the fire service?
2. What are the recommendations regarding knowledge, motivation, and organizational
needs to be met in the behavioral health program that will provide a guide to reduce stress
within the Large Urban Fire Department?
The conceptual framework, according to Maxwell (2013), is the understanding of the
concept or model being studied and the tentative theory of the phenomena which is to be
researched. Maxwell further explained the conceptual framework is the system of concepts,
assumptions, expectations, beliefs, and theories that provide a descriptive understanding to the
readers. The framework can be explained through narrative form or a graphic known as a
concept map. Framing helps to justify your research or the research problem of what is
considered theoretical, describing what is going on in the world (Maxwell, 2013). Combining the
problem of practice with the justification of the study, explains why the research has importance.
The diagram (Figure 1) supports the influences that affect the stakeholders.
STRESS IN THE FIRE SERVICE 58

In the conceptual framework diagram (Figure 1) below, the blue circle is the LUFD as the
organization, which holds the belief that stress affects the emotional behavior of firefighters.
Shown in the green circle are the stakeholders of the organization: the fire chief, deputy chiefs,
fire officers, and firefighters. This represents the theory and conceptual framework that a
correlation exists between a firefighters’ job, stress, PTSD, and suicide. The gold box represents
the goal of the fire chief, deputy chiefs, fire officers, and firefighters as stakeholders, which is to
design and implement a curriculum to educate fire officers and firefighters to understand and
manage stress.
The fire chief and deputy chiefs are considered the policy and decision makers of the
organization, and their motivation to reduce stress affects the provision of an education
curriculum to manage emotional behaviors. Providing educational awareness to fire officers and
firefighters can reduce emotional stress and, therefore, can save a firefighters life. Knowing the
self-efficacy influences of the firefighter will enhance the understanding that stress can be
emotionally to provide a safe and healthy life. Attributions are defined in three categories:
stability, locus, and control (Weiner, 2005). Locus provides self-esteem and pride, with stability
being the learner’s motivation, and controllable factors, such as additional effort to succeed, are
required to stay focused to stay persistent and continue to work hard at a task or activity (Rueda,
2011). The LUFD will have the opportunity to design and implement an innovative stress
education program using the attribution, self-efficacy, and motivation theory to support the need
for a curriculum of great significance to potentially save the life of a firefighter.

STRESS IN THE FIRE SERVICE 59

Figure 1. Conceptual framework interaction of stakeholder knowledge, motivation, and
organizational cultural models and settings.

STRESS IN THE FIRE SERVICE 60

Conclusion
This chapter is an overview of the methods used to examine knowledge, motivation and
organization in terms of managing stress in the fire service. This innovation study sought to
research the influences that validate gaps discovered during the study and to improve
understanding of the stress associated with firefighters. The literature review in this chapter
presents the need for education among firefighters to improve their understanding that stress,
PTSD, and suicidal ideations require management of their emotional behavior. This literature
review outlined knowledge, motivation and organizational influences that affect the stakeholders
of the organization.
The stakeholders are the fire chief, deputy chiefs, fire officers, and firefighters. Their
knowledge and skills are important to identify because they will enhance the understanding of
stress and narrow any gaps discovered. The fire chief, deputy chiefs, fire officers, and firefighters
require the conceptual, factual, and procedural knowledge to identify the barriers to stress
management. This chapter includes the research as it relates to the organizational culture
influences and leadership in the organization’s construct. The influences and assessments of
stress are supported by the methodology used for the research, which is mixed methods
consisting of include surveys and interviews to provide the data to discover any achievement
gaps. Finally, the quantitative and qualitative research will explain the organization’s influences
to provide the reasons for the achievement gap. Chapter Three will describe the validation
process for the influences explained in this chapter.
STRESS IN THE FIRE SERVICE 61

CHAPTER THREE: METHODOLOGY
The purpose of Chapter Three is to present a method for data collection using Clark and
Estes’ (2008) framework to examine and analyze the stress associated with the fire service and
introduce an innovative stress education program to the current BHP. Clark and Estes’ gap
analysis framework is the alignment of knowledge, motivation, and organizational goals to
identify gaps to improve performance. According to Henderson (2016), stress and suicide in the
fire service has been underreported compared to the civilian community. The problem of stress
and suicide can lead to less productivity, causing minimal interaction with others, lost focus on
daily tasks, isolation, and potentially a danger to self (Henderson, et al., 2016). The
contemporary firefighter has become the individual that the public expects to solve all problems,
ultimately resulting in the internalization of stressors leading to PTSD and suicide (Turner,
2011). The main questions that guide this study are the following:
1. What is the fire chief, deputy chiefs, fire officers and firefighters knowledge and
motivation assets and needs related to the Large Urban Fire Department goal of creating a
curriculum to address stress associated with the fire service?
2. What are the recommendations regarding knowledge, motivation, and organizational
needs to be met in the behavioral health program that will provide a guide to reduce stress
within the Large Urban Fire Department?
This study explored the effects of stress as it relates to firefighters’ emotional behavior,
suicidal ideation prevention, and a stress education program. Does stress exist in the fire service?
Is stress associated with the duties of a LUFD firefighter? Would an innovative stress education
program improve the management of stress associated with the fire service? Surveys were
distributed to the firefighters utilizing the LUFD intranet reaching out to the approximately 3,300
STRESS IN THE FIRE SERVICE 62

firefighters. Concurrently, interviews with the deputy chiefs, fire officers, and firefighters began.
The data converged to assist in identifying gaps related to stress and education in the fire service.
At the completion of the research an analysis of the data was conducted to address stress in the
fire service and a realignment of the existing BHP with an innovative stress education program.
Participating Stakeholders
The stakeholder group of focus for this study was the fire chief, deputy chiefs, fire
officers, and firefighters of the organization. The LUFD has approximately 3,300 uniformed
firefighters and serves the citizens in the city, with the responsibility of protecting a large
jurisdiction. The sampling includes uniformed firefighters from various ranks of the
organization, such as fire chief, deputy chiefs, fire officers, and firefighters. The research focused
on interviews and surveys of the stakeholders using both quantitative and qualitative data to
retrieve data to identify any existing gaps.
The methodology used is the mixed method utilizing both quantitative and qualitative
research. Creswell (2014) defines mixed method as a combined collection of quantitative and
qualitative resources. Therefore, the sample consisted of subjects from the organization to allow
various strategies for collecting data. Surveys were distributed utilizing the department’s
intranet, which is a direct method of communication with the firefighters of the organization.
Additionally, with the assistance of the Firefighters Union and Fire Chiefs Association, an email
was sent to all fire chiefs and firefighters to access the survey. This assisted in the collection of
quantitative data.
The deputy chiefs, fire officers, and firefighters were selected as interview subjects for
the qualitative research. The interviews consisted of 12 questions. Utilizing standardized open-
ended interview questions for the interviews provided a structured set of questions written
STRESS IN THE FIRE SERVICE 63

exactly in the same order for each interviewee (Johnson & Christenson, 2014). The interviewees
were a sample of uniformed firefighters of the LUFD who shared their experiences with stress
and the need for an innovative stress education program.
Survey Sampling Criteria and Rationale
Survey sampling is the “process of drawing a sample from a population” (Johnson &
Christenson, 2014, p. 248). Sampling the approximate 3,200 uniformed firefighters generated
data from firefighters who may have experienced stress. Also, a needs assessment was
incorporated to determine if differing ranks or positions of responsibility within the organization
trigger stress. Therefore, the aim was to determine if there is a correlation related to stress among
differing ranks or positions within the organization and if there is a need for an innovative stress
education program.
Criterion 1. Organizational classification (LUFD). The influence of knowledge and
skills is important for the engagement of the fire chief, deputy chiefs, fire officers, and
firefighters to enrich their knowledge and understanding of stress and education related to the
fire service. Complex knowledge has a correlation to stress relief; if firefighters do not know the
effects of stress, they will not know how stress may influence their emotional behavior.
Organizational culture is the most important work process that establishes and sets the tone for
all organizations because it shows how we people together to attain the organization’s goals
(Clark & Estes, 2008). Surveying the stakeholder groups will provide an assessment for the
organization to determine the need for stress management among firefighters.
Criterion 2. Fire chief, deputy chiefs, chief officers, and firefighters. The fire chief,
deputy chiefs, chief officers, and firefighters need knowledge to understand the emotional effects
of stress in the fire service. Understanding the four knowledge types will influence and
STRESS IN THE FIRE SERVICE 64

determine the process to identify whether a need exists to design and implement a stress
education program. Clark and Estes (2008) further support the conceptual knowledge influence
as any knowledge one is aware of thinking, which is comprised of facts, concepts, processes, and
principles an individual has learned, recalled, and thought about. Surveying the stakeholder
groups provided an assessment for the organization to determine the need for stress management
of and education for firefighters.
Interview Sampling Criteria and Rationale
Interviews were conducted with the deputy chiefs, fire officers, and firefighters using the
KMO standardized open-ended interview approach and a predetermined set of questions.
According to Merriam and Tisdell (2016), purposeful sampling occurs when the investigator is
looking to discover, understand, and gain insight from a specific group. Sampling of the fire
chief, deputy chiefs, fire officers, and firefighters provided an understanding of the
organization’s ranks and file. An invitation to participate in the interviews was available for all
ranks in the organization to validate the KMO study. This ensured the sampling of differing
ranks in the organization and the collection of experiences from field and administrative
positions.
Criterion 1. Interview fire chief. The fire chief needs to effectively understand the
importance of leadership, teaching, and aiding fire department members to understand the
emotional effects of stress. Interviewing the fire chief aided in determining the need and
importance of managing stress on the LUFD and the need for an innovative stress education
program. The purpose of the interview with the fire chief was to obtain rich data regarding
STRESS IN THE FIRE SERVICE 65

knowledge and motivation needs to design an innovative stress education program and identify
the levels of stress among the rank and file to ensure a successful BHP.
Criterion 2. Interview deputy chiefs. The deputy chiefs need to effectively understand
the importance of leadership, teaching, and aiding fire department members to understand the
emotional effects of stress. Interviewing the deputy chiefs determined the needs assessment and
importance of managing stress and developing an innovative stress education program. The
purpose of the interview with deputy chiefs was to obtain rich data of the knowledge and
motivation needs to design an innovative stress education program to identify the levels of stress
among the rank and file to ensure a successful BHP.
Criterion 3. Interview fire officers. Fire officers are supervisors and managers to
firefighters and have direct influence on emotional behavior that may result from a stressful
situation. The fire officers need to effectively understand the importance of leadership, teaching,
and aiding fire department members to understand the emotional effects of stress. Interviewing
the fire officers determined the needs assessment and importance of managing stress in the
LUFD. Fire officers will implement an innovative stress education program with the rank and
file to ensure a successful BHP.
Criterion 4. Interview firefighters. Firefighters need to effectively understand the
effects of stress. Interviewing the firefighters determined the needs assessment and importance of
managing stress and an innovative stress education program. Interviewing firefighters
determined causal effects of stress to firefighters and a need for an innovative stress education
program for the rank and file to ensure a successful BHP.

STRESS IN THE FIRE SERVICE 66

Data Collection and Instrumentation
The method for data collection for this study used both qualitative and quantitative
approaches with surveys and interviews to assess the stakeholders’ knowledge, motivation, and
organizational influences. Creswell (2014) explains survey design as a description of numeric
trends, attitudes, or views of a sample population. The survey design for this study helped to
determine the influences of stress and education. The survey was distributed to the
approximately 3,200 uniformed members of the organization using the organization’s intranet.
The qualitative method approach used for the study was interviewing to draw on
experiences related to stress in the fire service. The researcher included statements about past
experiences to assist the readers to understand the narrative between the study and researchers
(Creswell, 2014). The interviewees were selected from among deputy chiefs, fire officers,
firefighters, and fire chief based on years of experience on the job, years of experience in the
assignment, knowledge of stress, and the diverse demographic composition of the organization.
The surveys and the interviews were to determine the level of stress that firefighters experience
and the need for an innovative stress education program.
Surveys
Survey instrument. A survey is an instrument or tool used to collect data that is
composed of questions given to a group (Robinson & Firth Leonard, 2019). The survey
questionnaire was populated with 13 closed-ended items with a combination of multiple choice
and Likert-style items. The survey was used to assess the knowledge, motivation, and
organizational influences related to the research questions.
Survey procedure. The survey was distributed utilizing the Qualtrics software to the
approximately 3,300 uniformed members using the LUFD intranet. The researcher’s goal was to
STRESS IN THE FIRE SERVICE 67

receive approximately 350 survey participants. Prior to the distribution of the surveys the
researcher contacted the deputy chiefs and fire officers to notify members of the organization to
participate in the survey. Participants were asked to complete a 13-item questionnaire. The
survey remained open for three weeks with a reminder sent out after the first week and each
week after. At the conclusion of the survey, 305 participants voluntarily completed the survey.
At the completion of the survey, the participant received a thank you for their time in
completing the survey. At that time, an invitation screen remained open, asking if the participant
would volunteer for the interview portion of the study. If the participant volunteered, they were
asked to click on a link that re-directed them to an information form. The information screen
asked for demographic data: age, gender, years of service, and rank/position. Once the
demographic data screen was completed, a message explained they would receive an email to
schedule an interview with the researcher. A sample survey guide is included in Appendix B.
Interviews
The purpose of the interview was to capture the type of information that the researcher
needs to obtain of what is “in and on someone else’s mind” (Patton, 2015, p. 426). The
interviews helped acquire a firefighter’s deep and innermost thoughts on what they experience
related to stress. According to Merriam and Tisdell (2016) interviewing is a common process of
data collection in qualitative research. The interviews consisted of 12 questions which followed a
semi-structured process using the KMO influences. The stress experiences of interview subjects
from various ranks and positions in the organization were explored. The deputy chiefs, fire
officers, and firefighters were the interview subjects and the researcher provided a set of
questions that were asked during the interview.
STRESS IN THE FIRE SERVICE 68

The researcher scheduled 20 interviews from the ranks, which resulted in 15 interviews
being used for the study. The ranks of participants for the interviews were deputy chiefs, fire
officers, and firefighters. The subjects provided a cross section of the rank and file of the LUFD
reflecting the diverse experiences of the organization. All interviews were conducted in an office
setting, providing a private environment where the participants were able to feel comfortable
sharing their personal experiences. The interview questions followed a semi-structured open-
ended approach, making it easier to locate answers to the set of questions for data analysis
(Patton, 2002). The interviews captured the experiences and understanding of how each
respondent views the world and their attributions through their personal lens (Merriam & Tisdell,
2016). This ensured the data collected focused on the knowledge, motivation, and organizational
influences related to this study. All interviews were voluntary, audio recorded, and transcribed to
ensure the narrative were recorded with the participants’ understanding the interviews will be
confidential. The interviews followed all professional and ethical rules of conduct of the
University of Southern California (USC) Institutional Review Board (IRB). A sample interview
guide can be found in Appendix A.
Interview procedures. Each of the interviewees received an invitation to participate
following the researcher’s IRB approval. Interviews were conducted during a six-week period
during the months of August and September of 2019. The interview setting was private to create
a professional and comfortable atmosphere to ensure the participants felt an intimate
environment. Each interviewee shared their personal experiences regarding stress in the fire
service to explore the emotional effects of the stressors and firefighters’ needs. Each interview
was blocked for one-half to one hour, but a few exceeded the time that was anticipated. Interview
questions followed the semi-structured open-ended approach. The interview consisted of 12
STRESS IN THE FIRE SERVICE 69

questions and was electronically recorded to ensure the narrative of the interview was captured
and transcribed. All interviews were recorded on the researcher’s iPhone using the Rev Voice
and/or Otter.ti. The researcher ensured the interview recordings were captured immediately
following each interview and transcribed for data collection. Questions focused on the research
questions and needs assessment regarding the knowledge, motivation, and organizational
influences to determine effects of stress.
Documents and Artifacts
The researcher utilized the LUFD intranet to study all pertinent documents related to
stress, PTSD, and suicidal ideation studies. Using the intranet to search documents provided rich
data to support the research. According to Merriam and Tisdell (2016), data discovered in
documents can be utilized as a resource similar to interviews and surveys. The data from
documents can provide descriptive information, historical perspectives, and emerging hypotheses
that can be used for research (Merriam & Tisdell, 2016). Findings from the documents are a third
resource for research validation and can be used to triangulate the data. Evaluating the
interviews, surveys, and documents aligned the research questions to the knowledge, motivation,
and organizational influences for the study to validate stress in the fire service and the
development of an innovative stress education program.
Alignment of Influences and Data Collection Methods
Table 8 provides a summary of the data collection methods that were used to assess the
assumed knowledge, motivational, and organizational influences affecting stress associated with
the fire service. This table demonstrates the alignment between the assumed influences and the
data collection methods.

STRESS IN THE FIRE SERVICE 70

Table 8
Data Collection Methods for Assumed Knowledge, Motivational, and Organizational Influences
Organizational Mission
The Large Urban Fire Department preserves life and property, promotes public safety and fosters
economic growth through a commitment to prevention, preparedness, response and recovery as an all-
risk life safety response provider.
Organizational Global Goal
By May 2020, the Large Urban Fire Department will design and implement an educational curriculum
to address the stress associated with the fire service.
Stakeholder Goal
By May 2020, fire chief and deputy chiefs will design and implement a curriculum to train and
educate the fire officers and firefighters to understand the stress associated with the fire service.
Knowledge Influences
Assumed Knowledge
Influences
Knowledge Type &
Influence Assessment
Surveys Interviews Document
Analysis
Triangulation
Fire chief, deputy
chiefs, fire officer,
and firefighters (All
members) know the
characteristics of
stress in the fire
service.
Factual
Members will be asked
to answer questions to
identify the
characteristics of stress.
The characteristics
of stress in FF
includes:
a. Depression
b. Anxiety
c. Headaches
d. Digestive
problems
e. Hypertension
f. Heart attacks
g. Irritability
h. Sleep problems
i. Job performance
j. Isolation
k. Tardy
l. Argumentative
Participants will
be asked to
describe the
characteristics of
stress.
(Experiences,
specific details).
Tell me what you
think stress is?

What are the
indicators?
Document
analysis to
probe for
knowledge
discovered
from the
LUFD intranet
system
regarding
stress and
research
documents.
Fire chief, deputy
chiefs, fire officer,
and firefighters (All
members) know the
emotional causes of
stress in the fire
service.
Conceptual
Members will be asked
to answer questions to
identify the causes of
stress.
Conceptual
Questionnaire will
ask the causes of
stress.

For FF, stress can be
caused by:
a. Critical emergency
incident
b. Administrative
responsibility
c. Sleep deprivation
d. Organizational
demands
e. Inadequate
training
f. Malicious co-
worker
g. Inconsistent policy
Tell me what you
think are the main
causes of stress in
FF.

See Appendix A
Document
analysis to
probe for
knowledge
discovered
from the
LUFD intranet
system
regarding
stress and
research
documents.
STRESS IN THE FIRE SERVICE 71

Table 8, continued
Assumed
Knowledge
Influences
Knowledge Type &
Influence
Assessment
Surveys Interviews Document
Analysis
Triangulation
h. Poor leadership
i. Technical
problems
j. Pressures of home
life

Fire chief, deputy
chiefs, fire officer,
and firefighters (All
members) know the
effects of stress in
the fire service
Conceptual
Members will be
asked to answer
questions to identify
the effects of stress.
The effects of stress
in FF may include:
a. Poor health
b. Low job
performance
c. Low morale
d. Poor family life
e. Family life
f. Infidelity
g. Alcohol use
h. Drug use
i. Attrition
j. Divorce
k. Depression
Tell me what you
think the effects
or results of
stress are at work
and at home.

See Appendix A
Document
analysis to
probe for
knowledge
discovered
from the
LUFD
intranet
system
regarding
stress and
research
documents.
Fire chief, deputy
chiefs, fire officers,
and firefighters (All
members) know how
to reduce stress in
the fire service.

Procedural
Members will be
asked to explain the
organization’s
Behavior Health
Program.

What does the
participants know
of procedures to
reduce stress?

FF procedural:
a. FF knows the
department
behavioral health
program procedures
Participants will
be asked of their
procedural
knowledge to
reduce stress.

See Appendix A

Document
analysis to
probe and
match the
data for
procedural
knowledge of
participants
regarding
stress.

Fire chief, deputy
chiefs, fire officers,
and firefighters (All
members) need
metacognitive
knowledge to know
how a stress
education program
can improve.

Metacognitive
Members will be
asked to explain the
stress education they
have received and
their understanding of
the effects of stress
and how to cope with
it.

What do you think
about first after a
stressful situation?

a. Am I experiencing
stress at the
moment?
b. I take a moment
to just think about
it.
c. I asked myself
“What happened?”
d. Am I
experiencing good
or bad feelings at
the moment?

Tell me about
your thought
processes (What
do you think
about?) after a
stressful situation
in FF.

Participants will
be asked of their
own knowledge
and experience
of a stress
education
program to
reduce stress.
Document
analysis to
probe and
match the
data for
metacognitive
knowledge of
participants of
stress.

STRESS IN THE FIRE SERVICE 72

Table 8, continued
Assumed
Knowledge
Influences
Knowledge Type &
Influence
Assessment
Surveys Interviews Document
Analysis
Triangulation
e. Am I capable of
managing my stress
this incident is
causing?
f. Am I capable of
asking for assistance
when I experience
stress?

What does the FF
know of the stress
education program
regarding stress?

a. What does the FF
think about a pre-
education stress
program?
b. What is the FF
experience with the
Behavior Health
Program?
c. Does the FF think
the pre-education
stress program will
improve stress
management?
d. Is the FF capable
of managing stress?

FF awareness of
knowledge of
stress education:

a. Describe the
organizations
education
program related to
stress in the fire
service.
b. Have you
participated in
any training or
utilize resources
that have been
provided directly
by the
organization
related to stress?
c. How would you
describe your
experience with
the department’s
Behavior Health
Program?

Motivational Influences

Assumed
Motivation
Influences
Motivational
Influences
Assessment
Surveys Interviews Document
Analysis
Triangulation
Self-Efficacy – Fire
chief, deputy chiefs,
fire officers, and
firefighters are
confident they can
design and implement
an educational
curriculum to address
stress.
Fire chief, deputy
chiefs, fire officers,
and firefighters will be
asked questions
regarding their
confidence to develop
a stress education
program.
Questionnaire will
ask the motivation to
have a stress
education program to
reduce stress.

FF motivation to
have program:
Participants will
be asked of their
motivation for a
stress education
program to reduce
stress.

FF motivation to
have program:
Document
analysis to
probe and
match the data
for motivation
to design and
implement a
stress
education
program to
reduce stress.

STRESS IN THE FIRE SERVICE 73

Table 8, continued
Assumed
Motivation
Influences
Motivational
Influences
Assessment
Surveys Interviews Document
Analysis
Triangulation
Expectancy Value -
Fire chief, deputy
chiefs, fire officers,
and firefighters need
to value how a stress
education program
can reduce stress

Fire officer,
firefighters will
benefit from the
implementation of an
educational
curriculum to address
stress.
Members will be asked
questions regarding
their motivation to
have a stress education
program.
a. Manage your
personal stress
b. Can identify if
stress is affecting
your mood
c. Understands the
department
behavioral health
program procedures
a. Describe the
organizations
education
program.
b. Have you
participated in
any training or
utilize resources
that have been
provided directly
by the
organization?
c. How would you
describe your
experience with
the department’s
Behavior Health
Program?

Attributions – Fire
chief, deputy chiefs,
fire officers, and
firefighters believe
that it is through their
own efforts that they
can attribute success
and failure of a stress
education program.

Fire officers, and
firefighters (All
members) will benefit
from the
implementation of an
educational
curriculum to address
stress.
Fire chief, deputy
chiefs, fire officers,
and firefighters will be
asked questions
regarding their own
confidence to design
and implement a stress
education program.

Members will be asked
questions regarding
their own confidence
to receive a stress
education program.

Questionnaire will
ask of their belief to
have a stress
education program to
reduce stress.

FF, why reduce
stress and design a
stress education
program?

See Appendix B
Participants will
be asked to
describe their
belief of a stress
education
program to reduce
stress.

FF, why reduce
stress and design
a stress education
program:

See Appendix A
Document
analysis to
probe and
match the data
of participants
belief to
design and
implement a
stress
education
program to
reduce stress.

STRESS IN THE FIRE SERVICE 74

Table 8,continued
Assumed
Knowledge
Influences
Knowledge Type &
Influence
Assessment
Surveys Interviews Document
Analysis
Triangulation

Organizational Influences

Assumed
Organizational
Influences
Organizational
Influence Assessment
Surveys Interviews Document
Analysis
Triangulation
Cultural Model
Influence 1:
Organization needs to
the fire chief, deputy
chiefs, fire officers,
and firefighters need
to have a commitment
to reduce stress.
Members will be asked
questions of their
commitment to reduce
stress.

Questionnaire is a
needs assessment of
the fire chief, deputy
chiefs to determine if
the culture is open to
design and
implement a stress
education program to
reduce stress.

Organizational
culture to reduce
stress and design a
pre-education stress
program:

See Appendix B
Participants will
be asked if the
culture is open to
receive a stress
education
program to reduce
stress.

Organizational
culture to reduce
stress and design
a stress education
program:

See Appendix A
Document
analysis to
probe and
match the data
of participants
to design and
implement a
stress
education
program to
reduce stress.
Cultural Setting
Influence1:
Organization needs to
the fire chief, deputy
chiefs, fire officers,
and firefighters need
to have a commitment
to design and
implement an
innovative stress
education program.
Fire chief, deputy
chiefs, fire officers,
and firefighters will be
asked questions of
their commitment to
reduce stress through
an innovative stress
education program.

Firefighters will be
asked questions of
their commitment to
change the culture to
reduce stress through
an innovative stress
education program.
Questionnaire is a
needs assessment of
the fire officers, and
firefighters to
determine if the
culture is open to
receive a stress
education program to
reduce stress.

Organizational
culture to reduce
stress and design a
stress education
program:

See Appendix B
Participants will
be asked if the
culture is open to
receive a stress
education
program to reduce
stress.

Organizational
culture to reduce
stress and design
a stress education
program:

See Appendix A
Document
analysis to
probe and
match the data
of participants
to develop a
stress
education
program to
reduce stress.

STRESS IN THE FIRE SERVICE 75

Data Analysis
The goal of data analysis was to process make sense of the data through consolidation,
reduction, and interpretation (Merriam & Tisdell, 2016). Data analysis for this study began with
interviews, surveys, and document research. At the conclusion of each interview, the researcher
documented the narrative to capture the thoughts, concerns, interpretations of the interview to
ensure accurate note taking. Once each interview was concluded the researcher recorded a
descriptive analysis memo which aligns with the knowledge, motivation, and organizational
influences of the study. After each interview, the researcher transcribed and coded the interview
and transferred the data to the researcher’s iPhone Rev App and/or Otter.ti for documentation
and record keeping. The first phase of analysis was conducted where a priori codes based on the
KMO influences are aggregated into analytic/axial codes. In the second phase of data analysis,
the researcher identified pattern codes and themes that emerged outside of the conceptual
framework and study questions.
Credibility and Trustworthiness
In this study, the researcher collected the data with accurate note taking and audio
recordings of the interviews. Qualitative validity occurs when the researcher checks for accurate
discoveries of the findings, and qualitative reliability points to the researchers’ consistency
(Creswell, 2014). Therefore, to ensure the highest standards of credibility and trustworthiness,
the researcher listened, took notes on the events, and processed the accuracy of the participants’
storytelling. Accuracy of the interview was based on the researcher providing accurate notes and
interpreting the interview story to reflect the participant’s voice. To ensure the credibility and
trustworthiness of the research, the strategy was to triangulate data sources and support the
evidential findings (Creswell, 2014). In this study, the researcher used the interviews and survey
STRESS IN THE FIRE SERVICE 76

analysis to examine the evidence to establish a justifiable theme. The researcher’s strategy was to
collect the data from the surveys and interviews and then formulate a plan to identify gaps that
address the research questions.
Establishing the trust of the participants began with the narrative of the events they
shared. Another strategy to establish credibility was to member check the accuracy of the
interview. According to Creswell (2014), member checking helps to determine the accuracy of
the interview findings and to describe the narrative themes back to the participants for an
accurate account. To ensure the accuracy of the findings and to support the narrative provided by
the participant, a member checking process was added to determine the accuracy of the findings.
In this study, the researcher could not overlook the reflexivity of the study. Creswell (2014)
explains reflexivity in qualitative research as the role of the researcher’s bias, personal
background, culture, and experiences in determining the lens for interpretation. The intent of the
research was to provide an accurate narrative of the study and to discover any bias that may
surface during the study through reflexivity. Developing shared trust between the researcher and
participants ensured an accurate, credible, and trustworthy collection of data for the research.
Validity and Reliability
In quantitative research, it is important to show validation and reliability of the data
gathered in a manner that meets ethical standards (Merriam & Tisdell, 2016). Merriam and
Tisdell (2016) explained the trustworthiness of qualitative research depends on the credibility of
the researcher. The instrument for the study is the researcher who is a retired firefighter with 33
years of experience and has built the trust of members of the organization. Reliability and
validity of the researcher is the trust bestowed by the organization that the study is for the needs
assessment of firefighters to improve behavior wellness in the fire service. Therefore, conducting
STRESS IN THE FIRE SERVICE 77

quantitative and qualitative research in an ethical manner ensured the highest standard of trust for
the participants and the organization (Merriam & Tisdell, 2016). The researcher conducted and
behaved in the utmost professional manner with the highest ethical behavior to provide an
accurate, valid, and reliable study for the end user of the research.
Trustworthiness is challenged when the researcher is the key instrument that collects data
and analyzes the validity and reliability of the findings. The researcher is a veteran firefighter
and conducted the study with validity and reliability with an accurate and truthful lens. In order
for the researcher to impart validity and reliability of the data and capture an open lens, the
strategy of using interviews and surveys was applied for the research (Merriam & Tisdell, 2016).
To safeguard the validity and reliability of the survey questions, a peer review of the questions
was conducted before distribution to the organization to attain accuracy in the study. Validating
the accuracy of the information from the interviews included interpretation of the meaning of the
theme/descriptions, interrelating themes/description, coding the data, reading through the data,
organizing and preparing data for analysis, and transcribing the raw data (Creswell, 2014).
During the collection of data from the surveys, the highest standards of trustworthiness were
adhered to because trust is directly dependent on the researcher collecting and analyzing the data
(Merriam & Tisdell, 2016).
Ethics
The research study of the problem of practice ensured the trustworthiness of the
qualitative research established by the USC’s IRB. The participants of this study were protected
through the institution’s ethical standards utilizing the IRB procedures which adhered to the
standards (Rubin & Rubin, 2012). Participation in the interviewees was voluntary, confidential,
and followed all ethical responsibilities and the code of conduct. The researcher conducted the
STRESS IN THE FIRE SERVICE 78

research with reliability and validity and followed all ethical concerns. The interviews and
surveys were conducted with empathy and sensitivity, remaining mindful of the participant’s
right to terminate the interview. Therefore, the relationship between the researcher and
participants was the focal point to ensure the ethical standards to treat the participants as humans
and not subjects (Merriman & Tisdell, 2016).
The researcher is a retired member of the department having served the city and
community for 33 years, and held positions as a firefighter, apparatus operator, fire captain I &
II, and battalion chief. The inherent bias for the study is that the researcher is a retired member of
the organization and understands the internal organization’s policies and procedures. The
experiences of stress by the researcher is a bias. The researcher anticipated discoveries that stress
does exist with firefighters. Furthermore, as a retired member of the department, the researcher
no longer has a supervisory or management role, so does not have a direct influence on the
participants as a peer or supervisor. This study is important in that it identified the emotional
thoughts of a firefighter to recognize knowledge and motivation regarding stress. All interviews
were voluntary, and the human subjects were informed by the researcher that they were protected
by the USC Human Subjects Protection Program. All participants were notified they had no
obligation to the study and could withdraw at any time, and the researcher had the obligation to
ensure no harm came to any participants (Glesne, 2011).
The researcher’s assumptions regarding the organization are based on 33 years of
experience with the department. The collection of data for the research came from surveys and
interviews to comprise a report. Data collection is confidential to ensure the protection of
information based on trustworthiness and credibility. This safeguarded the subjects’ responses to
the interview questions and surveys (Creswell, 2014). At the beginning of each interview, the
STRESS IN THE FIRE SERVICE 79

researcher asked permission to record the interview and transcribe all audio. All transcriptions
were coded and confidential until the completion of the research. The researcher secured the
surveys and interview records in file storage to protect respondents confidentiality during and
after the completion of the research. To foster the trustworthiness and confidence of the study,
the researcher remained mindful of confidentiality during the surveys and interviews. This
qualified the researcher to articulate and validate the research and data collection with honesty
and credibility, providing an ethical, trustworthy, and valid research to deliver the best
interpretation of the data collected (Glesne, 2011).
STRESS IN THE FIRE SERVICE 80

CHAPTER FOUR: RESULTS AND FINDINGS
The purpose of this chapter is to understand the assumed knowledge, motivation, and
organizational influences as they relate to stress in the fire service. The study aimed to assess the
effects and impact of stress among firefighters in the organization. A survey and interviews were
conducted to collect quantitative and qualitative data to determine if a gap existed in the
organization. The survey was distributed to the organization for three weeks asking for voluntary
participants. A total of 305 firefighters from the organization volunteered and completed the
survey. After the conclusion of the survey, 20 firefighters volunteered to be interviewed to
further assess the influences associated with stress in the fire service. Fifteen interviews were
evaluated to assess the KMO influences. As a result, the findings from the survey and interviews
were collected to address the knowledge, motivation, and organizational influences.
The data collection process from the survey and interviews allowed the needs assessment
and analysis of the data. This study utilized the mixed-methods approach to evaluate the assumed
influences. Furthermore, the firefighters who participated in the survey and interviews were
voluntary participants.
Participating Stakeholders
There were 305 firefighters who participated in the voluntary survey. The demographics
of the survey participants represented the various ranks within the organization: fire chief, deputy
chiefs, fire officers and firefighters. The demographic data of participants completing the survey
are presented in Tables 9, 10, and 11. It should be noted that each question was not required to be
answered, so the items do not total to 305.

STRESS IN THE FIRE SERVICE 81

Table 9
How Many Years Have You Served the Department?
1 year or
less
1 to 5 years 6 to 10
years
11 to 20
years
21 to 30
years
31 plus
years
Did Not
Answer
0 25 5 142 63 63 7

Table 10
What is Your Rank?
Fire Chief Deputy Chiefs Fire Officers Firefighters Did Not Answer
1 6 134 155 9

Table 11
What is Your Gender?
Male Female Did Not Answer
282 12 11

The data collection process began with the distribution of the survey to the organization.
This survey was distributed to approximately 3,300 firefighters and available for three weeks.
During this period, 305 firefighters completed the survey. At the end of the survey, an option
was made available for any firefighters willing to volunteer in the interviews. This resulted in
firefighters willing to participate in the interview phase of the research. Twenty interviews were
scheduled during a three-week period with 15 interviews utilized for the qualitative data analysis.
During analysis, the data reached a point of saturation at 15 interviews. The point of saturation
was determined when the participants began to describe similar and repetitive experiences of
stress. Therefore, 15 interviews were used for the analysis of this study.
STRESS IN THE FIRE SERVICE 82

Determination of Assets and Needs
This study utilized two data sources: a survey and interviews. The data sources were used
to determine the assets and needs of the assumed influences. The survey data provided the
criteria to determine the assumed influences for the knowledge, motivation, and organizational
influences. Assumed influences from the survey were used to determine the validity of the nine
influences, which include (a) factual, (b) conceptual, (c) procedural, (d) metacognitive, (e)
expectancy value, (f) attribution, (g) self-efficacy, (h) cultural model, and (i) cultural settings.
Determining the cut score varied in each of the research influences based on the relevant data,
evaluative results, and sample size to determine the knowledge, motivation, and organizational
influences. For the survey analysis, the cut score for the nine influences was determined to meet
a 70% threshold. Therefore, if one item did not meet the 70% threshold, the influence was
determined to be a need.
The threshold for the interviews was to determine whether the assumed influence was an
asset or need. Measuring the firefighters’ knowledge, motivation, and organizational influences
enabled the analysis of the behaviors, beliefs, confidence, and commitment to reduce stress.
Additionally, the qualitative data were to measure the firefighters’ knowledge, motivation, and
organizational influences to design and implement a stress education program. The criteria for
determining the influence to be an asset or need was agreement among participants. The cut
score for the interviews was determined to be 100% agreement among all the interview
participants for each question asked. Determining the cut score for each of the nine influences
was based on the relevant data, evaluative results, and sample size. For the 12 questions asked
during the interviews, none of the answers resulted with a 100% agreement among the
participants. Therefore, the qualitative data collected from the assumed influences is determined
STRESS IN THE FIRE SERVICE 83

to be a need. The findings from the survey and interviews support the need for a stress education
program.
Results and Findings for Knowledge Causes
This section reports on the knowledge categories for each assumed influence. Both
quantitative and qualitative data were collected to validate the research. Data sources utilized
were interviews and a survey to identify the knowledge, motivation, and organizational
influences of the fire chief, deputy chiefs, fire officers, and firefighters. The data aided in
determining the influences associated with the causes, characteristics, effects of stress that
firefighters experience as well as the education and training of firefighters to manage and cope
with the stress associated with the fire service.
Factual Knowledge
Influence 1. Fire chief, deputy chiefs, fire officers, and firefighters know the
characteristics of stress in the fire service: survey results. The firefighters were asked to
identify the characteristics of stress from a list of 11 items. Accuracy in identifying the strategies
ranged from 45.90% for one item to 92.13% for one item. Survey participants selected eight out
of 11, which met the cut score of 70%. Additionally, three out of 11 did not meet the 70%
threshold. The three items not meeting the 70% threshold are (a) heart attack, (b) headaches, and
(c) tardiness. However, to determine this influence to be an asset, all 11 items were required to
meet the cut score of 70%. Therefore, this influence is determined to be a need. Table 12 shows
the percentages and count for each response to this item.

STRESS IN THE FIRE SERVICE 84

Table 12
Survey Results for Factual Knowledge of Stress in the Fire Service and strategies
# Factual Knowledge Items: Characteristics of Stress (n = 305) Percentage Count
I know the characteristics of stress of a firefighter include.
(select all that apply)

1 Sleep Problems 92.13% 281
2 Irritability 87.86% 268
3 Anxiety 86.88% 265
4 Anger 86.88% 265
5 Depression 83.27% 254
6 Job Performance 81.31% 248
7 Hypertension 72.45% 221
8 Isolation 72.73% 216
9 Heart Attack 68.85% 210
10 Headaches 56.06% 171
11 Tardiness 45.90% 140

Interview findings. Participants were asked to describe the characteristics of stress. It
was evident from the findings that 15 participants have some knowledge of the characteristics of
stress. During the interviews, 10 of the participants were able to describe a few of the
characteristics of stress but could not describe all 11 items, and five participants were not able to
describe any of the 11 items. For example, Participants 3 and 4 explained how job performance
is a characteristic of stress. They both explained doing a good job helps to minimize and alleviate
the feeling of stress. Participants’ knowledge of having sleep problems surfaced from the
interview findings. Participant 5, 7, 11, 12, and 15 shared how sleep problems are characteristics
of stress. Participant 7 further explained, “it’s the amount of calls you respond to, the lack of
STRESS IN THE FIRE SERVICE 85

sleep and disruptions with your sleep patterns that are characteristics of stress.” Participant 12
shared how not getting enough sleep is physically exhausting, but, mentally, not getting rest
causes the brain to not recover, therefore causing stress. The findings from the interviews support
the need for a stress education program.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence that firefighters know the characteristics of stress was
determined to be a need from the survey results. Survey participants selected eight out of 11,
which met the cut score with three out of 11 not meeting the 70% threshold. Additionally, the
factual knowledge influence was determined to be a need from the interview data, with five of
the 15 participants explaining and identifying sleep problems being a characteristic of stress. The
experiences described by the participants of child fatalities, witnessing death, administrative
pressures, setting high personal expectations, and saving lives support the assumed factual
knowledge. However, participants were not able to provide a complete list of the 11
characteristics of stress and fell short of the threshold. Therefore, this influence is determined to
be a need.
Conceptual Knowledge
Influence 1. Fire chief and deputy chiefs, fire officers, and firefighters know the
emotional causes of stress in the fire service: survey results. The firefighters were asked to
identify the causes of stress. The survey data identified the accuracy of the strategies ranging
from 55.40% for one item to 93.77%. Survey participants selected seven out of 10 items, which
met the cut score of 70%. Additionally, three of the 10 items identified did not meet the 70%
threshold. The three items not meeting the cut score are (a) administrative responsibility, (b)
STRESS IN THE FIRE SERVICE 86

inadequate training, and (c) technical problems. However, to determine this influence to be an
asset, all 10 items were required to meet the 70% threshold. Therefore, this influence was
determined to be a need. Table 13 shows the percentages and count for each response to this
item.
Table 13
Survey Results for Conceptual Knowledge of Stress in the Fire Service and Strategies
# Conceptual Knowledge Items: Causes of Stress (n = 305) Percentage Count
I know firefighter stress can be caused by
(select all that apply)

1 Sleep Deprivation 93.77% 286
2 Critical Emergency Incidents 88.52% 270
3 Poor Leadership 86.88% 265
4 Pressures of Home Life 85.90% 262
5 Organizational Demands 73.77% 225
6 Malicious Co-Worker 73.44% 224
7 Inconsistent Policy 71.47% 218
8 Administrative Responsibility 64.91% 198
9 Inadequate Training 64.26% 196
10 Technical Problems 55.40% 169

Interview findings. Participants were asked to describe the causes of stress. It was
evident from the interview findings no participant could describe all 10 causes of stress.
However, many of the participants shared one or two experiences from the 10 items. For
example, Participant 2 explained how it is stressful when you are a rookie firefighter and the
expectations of being a good firefighter causes stress (organizational demands). Participant 5
shared how sleep deprivation is a cause and effect of stress. Additionally, Participants 7, 11, 12,
STRESS IN THE FIRE SERVICE 87

and 15 also explained and support their experiences that sleep deprivation is a cause of stress.
Participant 7, a fire officer said, “managing emergency incidents both medical and fire related is
a very stressful situation and knowing that literally your decision is a matter of life and death.”
This further supports that firefighters responding to critical emergency incident causes stress.
Participant 7 also explained how sleep deprivation is a causal effect of stress. Participant 8, also a
fire officer, explained the effects of stress can be caused by the burden of responsibility as an
officer to ensure the firefighters under his command are safe and protected from injury. The
qualitative findings discovered each participant was able to describe one or two of the causes of
stress. However, no participant could describe all 10 items associated with the causes of stress.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence that firefighters know the cause of stress was
determined to be a need from the survey results. Survey participants selected seven out of 10
items, which met the cut score of 70%. Additionally, three of the 10 items identified did not meet
the 70% threshold. Additionally, the conceptual knowledge influence is determined to be a need
from the interview data, with participants explaining and identifying their experiences associated
with the causes of stress. The shared experiences during the interviews described causes of stress
to be associated with sleep deprivation, critical emergency incidents, and organizational
demands. However, no participant could describe all 10 items associated with the causes of
stress. Therefore, this influence is determined to be a need.
Influence 2. Fire chief, deputy chiefs, fire officers, and firefighters know what the
effects of stress are in the fire service: survey results. The firefighters were asked to identify
the effects of stress from a list of 12 items. The accuracy in identifying the strategies ranged from
STRESS IN THE FIRE SERVICE 88

40.32% for one item to 88.85% for one item. Survey participants selected eight out of 12, which
met the cut score of 70%. Additionally, four out of 12 did not meet the 70% threshold. The four
items not meeting the 70% threshold are (a) financial hardship, (b) infidelity, (c) attrition, and (d)
gambling. However, to determine this influence to be an asset, all 12 items were required to meet
the cut score of 70%. Therefore, this influence is determined to be a need. Table 14 shows the
percentages and count for each response to this item.
Table 14
Survey Results for Conceptual Knowledge of Stress in the Fire Service and Strategies
# Conceptual Knowledge Items: Effects of Stress (n = 305) Percentage Count
I know the general effects of stress of a firefighter include.
(select all that apply)

1 Poor Family Life 88.85% 271
2 Alcohol Use 87.54% 267
3 Poor Health 85.24% 260
4 Low Morale 83.93% 256
5 Depression 81.63% 249
6 Divorce 80.98% 247
7 Low Job Performance 71.80% 219
8 Drug Use 70.49% 215
9 Financial Hardship 64.26% 196
10 Infidelity 53.77% 164
11 Attrition 42.95% 131
12 Gambling 40.32% 123

Interview findings. Participants were asked to describe the effects of stress. It was
evident from the findings that 13 of the 15 participants have some knowledge of the effects of
STRESS IN THE FIRE SERVICE 89

stress. During the interviews, participants were able to describe a few of the effects of stress but
could not describe all 12 items. For example, Participant 6 explained what causes stress and the
effects is “the feeling you have going into a chaotic situation and you are not exactly sure what to
expect, this is the effects of stress.” Participant 8 explained, ”there is always stress when you
have to meet expectations and goals of the organization and how you are viewed within the
organization.” Additionally, four of the participants explained the effects of a poor family life
having an influence on the effects of stress. Participant 8 also shared how family life can
influence stress: “an example is when you respond to an emergency incident and you treat a
patient that is the same age as your kids, that is a cause and effect of stress.” With respect to how
experiencing financial hardships contributes to the effects of stress, Participant 3 described
financial hardship can be the effects of stress. The findings from the interviews support the need
for a stress education program.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence that firefighters know the effects of stress was
determined to be a need from the survey results. Survey participants selected eight out of 12
which met the cut score of 70%, with four out of 12 not meeting the 70% threshold.
Additionally, the conceptual knowledge influence is determined to be a need from the interview
data with the participants explaining and identifying actual life experiences of stressful situations
as a firefighter. The shared experiences during the interviews described the effects of stress to be
associated with poor family life, low job performance, and financial hardship. However, no
participant could describe all 12 items associated with the effects of stress. Therefore, this
influence is determined to be a need.
STRESS IN THE FIRE SERVICE 90

Procedural Knowledge
Influence 1. Fire chief and deputy chiefs know how to reduce stress in the fire
service: survey results. The firefighters were asked to identify how stress can be reduced in the
fire service. The accuracy in identifying the strategies ranging from 91.14% for one item to
67.21% for one item. Survey participants selected three out of four items, which met the cut
score of 70%. Additionally, one of four items identified did not meet the 70% threshold.
However, to determine this influence to be an asset, all four items were required to meet the 70%
threshold. Therefore, this influence is determined to be a need. Table 15 shows the percentages
and count for each response to this item.
Table 15
Survey Results for Procedural Knowledge of Stress in the Fire Service and strategies
# Procedural Knowledge Items: How to Reduce Stress (n = 305) Percentage Count
Stress can be reduced in the fire service by (select all that
apply)

1 Knowing how to cope with stress 91.14% 278
2 Knowing how to recognize stress 83.27% 254
3 Receive training and education regarding stress 73.44% 224
4 Knowing a non-punitive communication system exist to
discuss concerns with senior management
67.21% 205

Interview findings. Participants were asked to describe how to reduce stress in the fire
service. It was evident from the findings all 15 participants have some procedural knowledge of
how stress can be reduced in the fire service. During the interviews, the participants described
coping skills, recognizing stress, and receiving education related to stress. For example,
Participant 7 asserted, “I think we need to reduce it through consistent and manageable training
and is a key component to understand how we can manage our stress.” Participant 13 added that
STRESS IN THE FIRE SERVICE 91

developing a curriculum will help with reducing stress. Seven of the 15 participants suggested
receiving training and education courses to reduce the stress. Participants suggested the
organization should provide courses which teach mindfulness, coping skills, circular breathing,
yoga, implicit bias, self-care, and culture sustainability associated with stress in the fire service.
During open coding, the data revealed the culture within the fire service has limitations
for firefighters in terms of expressing their feelings about stress. Participant 1 shared the fire
service is a culture of being “macho.” He said, “I think the culture part we need to change, that
macho thing.” Participant 7 added his perspective of making culture change and shifting the idea
of feeling stress as taboo when expressing feelings. The methods shared by the participants to
cope with and recognize stress were self-taught. The participants described their experiences of
stress management and how they learned to manage stress using their own personal coping skills.
During the interviews, the participants described coping skills, recognizing stress, and receiving
education related to stress.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence that firefighters know how to reduce stress was
determined to be a need in the survey results and in the interview responses. Survey participants
selected three out of four items, which met the cut score of 70%. Additionally, one of four items
identified did not meet the 70% threshold. The interview participants identified and explained
stress reduction techniques they utilized were from self-education and personal experiences. A
discovery was identified during research and open coding. The research identified the culture
within the fire service has limitations for firefighters when expressing their feelings, which
STRESS IN THE FIRE SERVICE 92

restricts asking for assistance when trying to cope with stress. Therefore, this influence is
determined to be a need.
Metacognitive Knowledge
Influence 1. The fire chief, deputy chiefs, fire officers, and firefighters need to know
how a stress education program can improve stress management: survey results. The
firefighters were asked to identify what they think about after experiencing a stressful critical
incident. The accuracy in identifying the strategies ranged from 20.32% for one item to 63.93%
for one item. The survey participants did not meet the 70% threshold for all six items. However,
to be determined to be an asset, all six of the components were required to meet the 70%
threshold. Therefore, this influence determined in the survey to be a need. Table 16 shows the
percentages and counts for each response to this item.
Table 16
Survey Results for Metacognitive Knowledge of Stress in the Fire Service and strategies
# Metacognitive Knowledge Items: (n = 305) Percentage Count
What do you think about after you experience a stressful critical
incident?

1 I take a moment to just think about it 63.93% 195
2 Am I capable of managing my stress this incident is causing? 40.65% 124
3 I ask myself, what happened? 34.42% 105
4 Am I capable of asking for assistance when I experience stress? 28.52% 87
5 Am I experiencing good or bad feelings at the moment? 21.96% 67
6 Am I experiencing stress at the moment? 20.32% 62

Interview findings. Participants were asked to identify what they think about after they
experience a stressful critical incident. It was evident from the findings that participants have
STRESS IN THE FIRE SERVICE 93

some knowledge of what they are thinking after experiencing a stressful critical incident. For
example, Participant 1 explained, “the firefighter death I experienced, I was not prepared for. It
took me by surprise.” Participant 3 shared he talks to his mentors to manage stressful situations,
which is an effective model when coping with stress. Participant 7 described knowing he was
able to manage his feelings after experiencing a critical incident. All 15 participants shared an
experience of a critical incident and the thoughts that followed. Participant 14 described an
emergency incident that he experienced when responding to a bank robbery and said, “the scary
part was I could hear and feel the gunman getting closer to the fire engine. You could hear the
concussion of the gun firing.” The experience of feeling bad during an emergency incident is a
shared emotion described by all 15 participants. During the interviews, the participants shared
their personal experiences and were able to describe what they think about. However, no
participant could describe all six items after experiencing a critical incident.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence that firefighters have the metacognitive knowledge of
one’s cognition was determined to be a need. Survey participants did not meet the 70% threshold
for all six items. However, to be determined an asset, all six of the components were required to
meet the 70% threshold. All participants interviewed explained and identified actual life
experiences of stress and having bad feelings after the critical incident. Yet, no participant could
describe all six items. The findings from the survey and interviews support the need for a stress
education program. Therefore, this influence is determined to be a need.

STRESS IN THE FIRE SERVICE 94

Results and Findings for Motivation Causes
The expectancy value and attribution influences from the survey findings are shown in
Table 17. Specifically, items 1, 3, 5, and 6 are of the expectancy value influence, with items 2
and 4 being of the attribution influence. For this influence section, the results and findings from
the survey for the motivation causes refer to Table 17. Table 17 represents the degree to which
participants agree or disagree with the following statements. The survey scale range presented
options of Strongly Disagree, Disagree, Agree, Strongly Agree. To meet the threshold as an
asset, the categories of Agree and Strongly Agree are combined.
Table 17
Survey Results for Expectancy-Value and Attribution Influences
# Motivation Influence Items: (n = 305)

Percentage total of items scored as Agree and Strongly Agree
with a threshold of 70%.
Percentage
Total
Count
Please rate how confident you are that your organization can
manage stress.

1 I think having a stress education program is important for my
work as a firefighter. (Expectancy-Value)
82.62% 252

2 I attribute my success or failure in managing stress in the fire
service to my own efforts. (Attribution)
81.62% 249

3 A stress education program will improve my stress management.
(Expectancy-Value)
71.47% 218

4 I would feel positive about participating in a stress education
program. (Attribution)
68.19% 208

5 A stress education program is interesting to me.
(Expectancy-Value)
62.54% 206

6 I think I would be a more effective firefighter if I knew more
about stress.
(Expectancy-Value)
63.27% 193

STRESS IN THE FIRE SERVICE 95

Expectancy Value
Influence 1. Fire chief, deputy chiefs, fire officers, and firefighters need to believe
that a stress education program can reduce stress: survey results. The firefighters were
asked four items to measure their expectancy for success and value for a stress education
program. The participants’ choices for each item ranged from strongly disagree to strongly agree.
To meet the threshold, participants needed 70% of the expectancy value percentages for the
accuracy of each item. The accuracy of the items ranges from 63.27% for one item to 82.62% for
one item. Survey participants selected two out of four items, which met the cut score of 70% for
the expectancy value influence. Additionally, two did not meet the cut score of 70% and fell
short of meeting the threshold. The two items not meeting the 70% threshold are (a)” a stress
education program is interesting to me” and (b) “I would be a more effective firefighter if I knew
more about stress.” Therefore, this influence is determined in the survey as a need.
Interview findings. The following three interview questions represent the firefighter’s
ability to describe the stress education program and the value it provides: (a) “Please describe
your organization’s education program related to stress in the fire service;” (b) “Have you
received or participated in any training provided by the organization related to stress?” and (c)
“How would you describe your experience with the department’s behavioral health program?”
For the first question, “Please describe your organization’s education program related to
stress in the fire service,” 12 of the 15 participants either said they were unaware of any program
or said, “I don’t think we have a program.” For example, Participant 1 explained the organization
does not have a stress education program for officers and said, “as far as I know, I don't think
there’s even a segment to train officers on stress.” Participant 2 described, “people just aren’t
STRESS IN THE FIRE SERVICE 96

educated about where to turn to in the time of need. But as far as formal education on stress I
can't think of anything in particular.” Participant 12 stated, “I don’t think we have a program.”
With respect to the value of having a stress education program, eight out of 15
participants said they would value such a program. For example, Participant 11 responded the
organization should provide a mandatory stress education training where firefighters can log onto
a training website where they can learn to cope and understand stress. Participant 12 shared,
“there’s no mandatory stress reduction training, which I would like to see.” Additionally,
Participant 13 said, “would like to see a curriculum developed.” The data collected from this
question posited having a stress education program provides value.
A second question was asked during the interview, “Have you received or participated in
any training provided by the organization related to stress?” Nine of the 15 participants said they
did not receive or participate in any training. For example, Participant 3, said, “I have not
personally received any training.” Participant 4 shared, he has not received any formal education
on stress that the organization has provided, and said “yes, I would absolutely like to see this
topic presented at a fire officer training session.” Participant 5 added, “firefighters would do well
with stress training.”
With respect to the value of receiving or participating in a stress education program, 11 of
the 15 participants asserted, even though the organization did not provide a stress education
program, they would value receiving or participating in a program. For example, Participant 5
said, “I would like to see a program, to know if you have stress.” Participant 10 stated, “I’m
interested.”
The third question asked was, “How would you describe your experience with the
department’s behavioral health program?” Twelve of the 15 participants described their
STRESS IN THE FIRE SERVICE 97

experience with the department’s BHP provided value and was a positive experience. For
example, Participant 1 explained, as a fire officer, his experiences with the BHP have been
positive. Participant 3 shared, “I’ve spoken to them one on one at the hospital, they were good
and readily available. They are batting 1000% with me.” Participant 13 said, “The two doctors
are doing a very good job.” Participant 15 stated, “Good... I used it myself.”
With respect to the value of the department’s BHP, three out of the 15 participants did
not use the BHP and were not aware of any resources. For example, Participant 5 stated, “I really
haven’t heard much about it.” Participant 6 shared, “You don’t really know about them until you
need them.” Participant 7 explained how the BHP needs to be readily available and has to be
convenient for the firefighters.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence was that firefighters value knowing that receiving
stress education will reduce stress. Survey participants selected two out of four, which met the
cut score of 70%. Additionally, two did not meet the cut score of 70% and fell short of meeting
the threshold. The data findings showed that the participants interviewed asserted value and
described from their experiences that a stress education program can reduce stress. However,
there is not a process currently provided by the organization for firefighters to receive training
regarding stress management. The findings further revealed the participants have self-awareness
and believe having a stress education program would provide intrinsic value to reduce stress.
Additionally, providing a stress education program will enhance a firefighter’s motivation and
value regarding reducing stress. Therefore, this influence is determined to be a need.

STRESS IN THE FIRE SERVICE 98

Attribution
Influence 2. The fire chief, deputy chiefs, fire officers, and firefighters believe it is
through their efforts that they can design and implement a stress education program:
survey results. The firefighters were asked to identify the extent to which they agree or disagree
from a list of two items: items 2 and 4 in Table 17 above. The accuracy in identifying the items
ranged from 68.19% for one item to 81.62% for one item. Survey participants selected one out of
two items, which met the cut score of 70% for the attribution influence. The one item not
meeting the cut score is “I would feel positive about participating in a stress education program.”
However, to determine this influence to be an asset, the two items were required to meet the 70%
threshold. Therefore, this influence was determined to be a need. Table 17shows the percentage
totals and count for each response to this item.
Interview findings. Attribution is one’s belief of success or failure when engaging in a
task or looking for specific outcome. It is the sense-making process, meaning how firefighters
are trying to make sense of why a stress education program is important to reduce stress. One
question was asked to analyze the attribution influence to reduce stress.
When asked how stress can be reduced in the fire service, all 15 participants said, when
experiencing stress, they have a self-technique and believe it helps to reduce stress. For example,
Participant 6 asserted, “restorative sleep and better beds” would be helpful to reduce and manage
stress. Participant 7 said, “through consistent and manageable training, educate firefighters how
to deal with stress in a positive way.” The officer added changing the culture through education
will provide a culture that is accepting when a firefighter is reaching out for help. Participants 9,
12, and 15 shared their applied techniques, such as mindfulness training, meditation, yoga, and
circular breathing as a way to reduce and manage stress. All 15 participants described and
STRESS IN THE FIRE SERVICE 99

believe stress can be reduced with training, education, stress relief techniques, leadership, and a
sustainable culture change. Additionally, the findings were that training and education are a
controllable component and an attribution influence that provides stability. Therefore, this
influence is determined to be a need.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence was that firefighters believe stress education will
reduce stress. Survey participants selected one out of two items, which met the cut score of 70%
for the attribution influence. The one item not meeting the cut score is “I would feel positive
about participating in a stress education program.” However, to determine this influence to be an
asset, the two components were required to meet the 70% threshold. The interviews discovered
all 15 participants believe the self-taught techniques can reduce stress. However, because the
techniques are self-taught, this influence is unstable, and the internal factor can be controllable
with training, education, leadership, and a sustainable culture change. Therefore, this influence is
determined to be a need.
Self-Efficacy
Influence 1. The fire chief, deputy chiefs, fire officers, and firefighters are confident
they can manage stress: survey results. The firefighters were asked to identify the extent to
which they agree or disagree about their confidence in performing 13 behaviors. The accuracy in
identifying the behaviors ranged from 28.52% for one item to 84.59% for one item. Survey
participants identified five of the 13 behaviors, which met the 70% threshold. However, to be
determined to be an asset, all 13 behaviors were required to meet the 70% threshold. Therefore,
STRESS IN THE FIRE SERVICE 100

this influence is determined to be a need. Table 18 shows the percentage totals and count for
each response to this item.
Table 18
Survey Results for Motivational Knowledge of Stress in the Fire Service and strategies
# Self-Efficacy Influence Behaviors: (n = 305)

Percentage total of behaviors scored as Agree and Strongly Agree
with a threshold of 70%.
Percentage
Total
Count
Using the scale below select the degree to which you agree or
disagree with the following statement. The degree of confidence I
have to do the following...

1 Recognize I am feeling stress 84.59% 258
2 Assist another firefighter if they experience stress 83.93% 256
3 Recognize the effects of stress 81.63% 249
4 Able to manage my personal stress 79.34% 242
5 Identify if stress is affecting my mood 74.75% 228
6 Seek assistance from a family member 68.62% 209
7 Seek assistance from the union/employee assistance program 39.67% 121
8 Seek assistance from a department psychologist 39.34% 120
9 Seek assistance from another firefighter if I feel stress 39.01% 119
10 Seek assistance from a peer support member 36.72% 112
11 Apply the steps in the department behavioral health program
procedures
35.40% 108
12 Seek assistance from a department chaplain 32.13% 98
13 Seek assistance from a fire officer 28.52% 87

Interview findings. The following questions represent the firefighters’ ability to describe
behaviors associated with stress: (a) In these moments of stress, how did you manage your
STRESS IN THE FIRE SERVICE 101

feelings? (b) how were you able to manage or cope with your feelings?” It is evident from the
findings participants described self-efficacy behaviors associated with reducing stress.
For the two questions about how they managed their feelings in moments of stress, all 15
participants were able to identify self-efficacy behaviors associated with reducing stress. For
example, Participant 1 explained, when experiencing a traumatic event, he is self-aware and
believes it helps to manage and cope with stress. Participant 5 shared, when he experiences stress
after a critical incident, the firefighters joke around with each other and talk about what
happened, which helps to relieve the stress. He also asserted, “the important part is how you
manage and handle stress.” All 15 participants described how they managed their feelings and
behaviors to reduce stress.
With respect to the behaviors associated with stress. One of 15 participants asserted
firefighters believe they can manage and cope with their feelings but are not prepared. For
example, Participant 7 stated, “it is a matter of time before you have to deal with stress, and this
is where firefighters will have issues. Because firefighters don’t know how to handle the stress.”
The coping skills described by the participants are self-taught, which describes the
behaviors needed to manage their own stressors. The data showed techniques such as gallows
humor, compartmentalizing feelings, talking to someone, talking to peers, self-regulation of
stress, joking around with peers, exercise, and spiritual life were behaviors applied to manage
stress. The research discovered firefighters are aware of stress and their self-efficacy to reduce
stress. Firefighters are motivated to reduce stress and know resources are available but are
hesitant to ask for help. As such, there is a need for a stress education program to improve their
coping and stress management skills. Therefore, this influence is determined to be a need.
Observation. Observations were not conducted for this influence.
STRESS IN THE FIRE SERVICE 102

Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence was that firefighters have self-efficacy or confidence
that they can manage stress. The survey questions identified five of the 13 behaviors met the
70% threshold. However, to be determined an asset, all 13 behaviors were required to meet the
70% threshold. Fifteen participants described their experiences during the interviews. It is
evident from the findings that participants have the self-efficacy behaviors to know when they
recognize stress and believe they know how to cope with the effects. However, each participant
described their own self-taught techniques to reduce stress. The findings from the survey and
interviews support the need for a stress education program. Therefore, this influence is
determined to be a need.
Results and Findings for Organization Causes
The organizational influences from the survey findings are shown in Table 19 and
address two organizational influences. Specifically, items 1, 2, 3, 4, 7 and 8 address the cultural
setting influences and items 5, 6, and 9 address cultural model influences. The results and
findings from the survey for the organizational causes refer to Table 19. Table 19 represents the
perceptions that participants have of the organization in terms of managing stress. The
organizational confidence survey asked participants to select from five choices: Not at all
Confident, Slightly Confident, Moderately Confident, Very Confident, Extremely Confident. The
table below shows the percentage totals which represent four choices of Slightly Confident,
Moderately Confident, Very Confident, and Extremely Confident to meet the threshold of 70%.

STRESS IN THE FIRE SERVICE 103

Table 19
Survey Results for Organizational Knowledge of Stress in the Fire Service and strategies
# Organizational Influence Items: (n = 305)

Percentage total of items scored as Slightly Confident, Moderately
Confident, Very Confident, and Extremely Confident with a threshold
of 60%.
Percentage
Total
Count
Please rate how confident you are that your organization can manage
stress.

1 I have confidence with seeking assistance from the Union/Employee
Assistance Program regarding stress.
(Cultural Setting)
75.73%

231

2 I have confidence that the organization can design a new stress
education program.
(Cultural Setting)
75.40%

230

3 I have confidence that the organization can design a train the trainer
stress education program.
(Cultural Setting)
74.09%

226

4 I have confidence in the organization's behavioral health program.
(Cultural Setting)
68.19%

208

5 I have confidence that a fire officer can assist me with coping skills
related to stress.
(Cultural Model)
62.62%

191

6 I have confidence with how the organization assists me with
managing stress.
(Cultural Model)
60.98%

186

7 I have confidence with how the organization provides a stress
education program.
(Cultural Setting)
59.67%

182

8 I have confidence with how the organization educates firefighters
regarding stress.
(Cultural Setting)
57.70%

176

9 I have confidence in the organization to manage the firefighter who
experiences stress.
(Cultural Model)
54.42%

166

STRESS IN THE FIRE SERVICE 104

Cultural Models
Influence 1. The fire chief, deputy chiefs, fire officers, and firefighters need to have a
commitment to reduce stress: survey results. The firefighters were asked to rate how confident
they were the organization could manage stress from a list of the items from Table 19: (a) I have
confidence that a fire officer can assist me with coping skills related to stress, (b) I have
confidence with how the organization assists me with managing stress, and (c) I have confidence
in the organization to manage the firefighter who experiences stress. The accuracy in identifying
the items ranged from 54.42% for one item to 62.62% for one item. None of the three items met
the 70% threshold. To determine this influence to be an asset, all three of the items were required
to meet the cut score of 70%. Therefore, this influence is determined to be a need.
Interview findings. Participants were asked to describe the organization’s education
program related to stress in the fire service as a representation of its commitment to reducing
stress. During interviews, 11 of the 15 participants were able to describe some aspects of the
organization’s education program. However, none of the participants could describe the
education program related to stress representing its commitment to reduce stress, and, thus, this
influence is a need. When asked to describe the organization’s education program related to
stress in the fire service Participant 1 explained, “the culture part [is what] we need to
change…the macho thing.” Participant 2 shared, “they [firefighters] don’t want to say anything...
because they don’t want others to think, [such as,] Oh, this, firefighter is weak.” Participant 3
said, “[we] have to change the culture because we're different…asking for psychological help is
a sign of weakness... we're all raised to be macho.” Participant 6 explained, “they [firefighters]
may not reach out to the peer support program...there is still a fear or stigma of something
STRESS IN THE FIRE SERVICE 105

coming back...affecting your career.” Participant 15 added, “no one wants to talk about stress,
it’s a sign of weakness.” As such this influence is determined to be a need.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence was that firefighters can describe the organization’s
education program as a representation of its commitment to reduce stress. The findings from the
survey identified none of the three items met the 70%threshold. Therefore, this influence is a
need.
During the interviews, the participants described a “macho” culture in the fire service
and explained how talking about stress should not be a “sign of weakness.” Additionally, there is
a need to change the fire culture and provide a sustainable culture environment for firefighters,
which will enable firefighters to feel comfortable when they ask for assistance related to stress
management. The findings from the interviews support the need for a stress education program
and a sustainable culture change. Therefore, this influence is determined to be a need.
Cultural Settings
Influence 2. The fire chief, deputy chiefs, fire officers, and firefighters need to have
the resources to design and implement an innovative stress education program, survey
results. The firefighters were asked to rate how confident they were that the organization had the
resources to design and implement a stress education program from a list of six items from Table
19: (a) I have confidence with seeking assistance from the Union/Employee Assistance Program
regarding stress, (b) I have confidence the organization can design a new stress education
program, (c) I have confidence the organization can design a train the trainer stress education
program, (d) I have confidence with the organization's behavioral health program, (e) I have
STRESS IN THE FIRE SERVICE 106

confidence with how the organization provides a stress education program, and (f) I have
confidence with how the organization educates firefighters regarding stress. The accuracy in
identifying the strategies ranged from 57.42% for one item to 75.73% for one item. Survey
participants met the 70% threshold for three of the six items. The three items not meeting the
70% threshold are (a) I have confidence with the organization's behavioral health program, (b) I
have confidence with how the organization provides a stress education program, and (c) I have
confidence with how the organization educates firefighters regarding stress. However, to
determine this influence to be an asset, six of the items were required to meet the cut score of
70%. Therefore, this influence was determined to be a need. Table 19 shows the percentage
totals and count for each response to this item.
Interview findings. Participants were asked to describe their confidence in having the
resources to design and implement a stress education program. Eleven of 15 participants
answered the organization did not provide resources for stress education training. The findings
from the interviews discovered four of the 15 participants would like the organization to provide
the resources for a stress education program and make it a routine setting. Therefore, this
influence is determined to be a need.
When asked if they have received or participated in any training provided by the
organization related to stress, Participant 1 said, “we need a little bit more [referring to stress
education] just to let the members know what's available.” Participant 6 said, “we would like to
see stress training for firefighters and fire officers.” Participant 8 stated, “we need to expand the
behavioral health program.” Additionally, Participant 13 explained, “we lose more firefighters to
suicide than fires, the amount of money we put into training for fires we should focus on
behavior health training, because it's going to save lives.” The findings from the interviews
STRESS IN THE FIRE SERVICE 107

support the need for the organization to provide the resources for a stress education program.
Thus, this influence was determined to be a need.
Observation. Observations were not conducted for this influence.
Document analysis. Document analysis was not conducted for this influence.
Summary. The assumed influence was that firefighters can describe their confidence in
having the resources to design and implement a stress education program. Survey participants
met the 70% threshold for three of the six items. Additionally, three of the six did not meet the
70% threshold. Therefore, this influence is determined to be a need. The interview findings
described firefighters participating in the peer support program or an officers training course.
However, the peer support program and officers training course were only available to a select
group. Additionally, the interviews identified four of the 15 participants would like the
organization to routinely provide resources for stress education. It is evident from the findings
that resources are needed to design and implement an innovative stress education program.
Therefore, this influence was determined to be a need.
Summary of Validated Influences
The following tables show the knowledge, motivation and organization influences for this
study and their determination as an asset or a need.

STRESS IN THE FIRE SERVICE 108

Knowledge
Table 20
Knowledge Assets or Needs as Determined by the Data
Assumed Knowledge Influence Asset or Need?
Factual
Fire Chief, deputy chiefs, fire officer, and
firefighters (All members) know the
characteristics of stress in the fire service.
Need
Conceptual
Fire chief, deputy chiefs, fire officer, and
firefighters (All members) know the emotional
causes of stress in the fire service.

Fire chief, deputy chiefs, fire officer, and
firefighters (All members) know the effects of
stress in the fire service
Need

Need
Procedural
Fire chief, deputy chiefs, fire officers, and
firefighters (All members) know how to reduce
stress in the fire service.
Need
Metacognitive
Fire chief, deputy chiefs, fire officers, and
firefighters need metacognitive knowledge,
how a stress education program can improve
stress management.
Need

STRESS IN THE FIRE SERVICE 109

Motivation
Table 21
Knowledge Assets or Needs as Determined by the Data
Assumed Motivation Influence Asset or Need?
Expectancy Value
Expectancy Value - Fire chief, deputy chiefs,
fire officers, and firefighters need motivation
to know how a stress education program the
organization can reduce manage stress
management.

Fire chief, deputy chiefs, fire officer,
firefighters believe they will find value with
the implementation of an educational
curriculum to address stress.
Need

Need
Attributions
Attributions – fire chief and deputy chiefs
believe that it is through their own efforts that
they can design and implement an educational
curriculum to address stress.

Fire officers, and firefighters (All members)
will benefit from the implementation of an
educational curriculum to address stress.
Need

Need
Self-Efficacy
Self-efficacy – Fire chief and deputy chiefs are
confident they can design and implement an
educational curriculum to address stress.

Fire officer, firefighters will benefit from the
implementation of an educational curriculum
to address stress.
Need

Need

STRESS IN THE FIRE SERVICE 110

Organization
Table 22
Knowledge Assets or Needs as Determined by the Data
Assumed Organization Influence Asset or Need?
Cultural Model
The fire chief, deputy chiefs, fire officers, and
firefighters need to have a commitment to
reduce stress.
Need
The organization needs to have a commitment
to reduce stress.
Need
Cultural Setting
The fire chief, deputy chiefs, fire officers, and
firefighters need to have a commitment to
design and implement an innovative stress
education program.
Need
The organization needs to have a commitment
to design and implement an innovative stress
education program.

Need

Chapter Four has provided the analysis of the quantitative survey and qualitative
interviews related stress in the fire service. The responses addressed the influences to determine
if a gap existed or were determined to be affecting the assumed influences. The assumed
influences from Chapter Three and conceptual framework with the supportive evidence were
provided in this chapter. The data from the survey and interviews offer a perspective that
education, training, and a sustainable culture change are important for firefighters to reduce
stress.
The efforts of the leadership will be required to change the current cultural setting and
model of the “macho” culture of the organization. Changing the culture to forge a sustainable
culture change will allow firefighters to feel confident asking for help. More importantly, when a
firefighter is seeking help for mental health care, they should not feel it is a “sign of weakness”
to ask for support. It will be the leadership that will enable the organization to enhance the
STRESS IN THE FIRE SERVICE 111

current stress education program. The commitment by the organization and the leadership can
provide a culture change to transform the current fire service culture. The analysis showed a
stress education program can provide the knowledge and motivational skills to manage and cope
with stress.
Chapter Five will present recommendations with solutions from the findings discovered
from the influences.

STRESS IN THE FIRE SERVICE 112

CHAPTER FIVE: RECOMMENDATIONS AND EVALUATION
Purpose of the Project and Questions
The purpose of this project was to conduct a needs assessment in the areas of knowledge,
motivation, and organization to create an innovative stress education program. This study used
Clark and Estes’ (2008) framework to identify the needs and assets of firefighters to reduce
stress. The analysis began by generating a list of possible needs and assets and then moved to
examining these to collect data to identify actual or validated needs. The questions that guided
the study were
1. What is the fire chief, deputy chiefs, fire officers and firefighters knowledge and
motivation assets and needs related to the Large Urban Fire Department goal of creating a
curriculum to address stress associated with the fire service?
2. What are the recommendations regarding knowledge, motivation, and organizational
needs to be met in the behavioral health program that will provide a guide to reduce stress
within the Large Urban Fire Department?
Recommendations for Practice to Address KMO Influences
Knowledge Recommendations
The data collection for this study is complete, and the knowledge influences in Table 23
represent the complete list of validated needs or assets. An analysis of the data identified the
assumed knowledge influences and showed the factual, conceptual, declarative, procedural and
metacognitive needs. According to Clark and Estes (2008), as job issues arise within an
organization, educating people builds the conceptual knowledge that will assist in solving
problems to manage organizational concerns. Managing organizational issues through education
provides individuals with solid and general conceptual and analytical knowledge (Clark & Estes,
STRESS IN THE FIRE SERVICE 113

2008). Table 23 shows the influences and the recommendations for these influences based on
theoretical principles.
Table 23
Summary of Knowledge Influences and Recommendations
Assumed Knowledge
Influence
Validated
as a Need
or Asset?

Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Fire chief, deputy chiefs,
fire officers, and
firefighters know what
stress is and the causes
of stress in the fire
service. Factual

Fire chief, deputy chiefs,
fire officer, and
firefighters know the
characteristics of stress
in the fire service.
Factual

Need Y How learners organize
knowledge influences
to learn and apply what
they know (Schraw &
McCrudden, 2006).

Creating schemata aids
learners to establish
declarative knowledge
in a domain (Schraw,
Veldt, & Olafson,
2009).

Provide FFs with a
visual organizer
(table or
infographic job aid)
that shows the
definition of stress
and the causes in
the department and
the consequential
characteristics of
stress.
(Appendix E,
sample)
Fire chief, deputy chiefs
fire officers, and
firefighters know the
emotional effects of
stress in the fire service.
Conceptual-Declarative

Fire chief, deputy chiefs,
fire officer, and
firefighters (All
members) know the
emotional causes of
stress in the fire service.
Conceptual
Need

Y Creating schemata aids
learners to establish
declarative knowledge
in a domain (Schraw,
Veldt, & Olafson,
2009).
Provide a visual
(table or
infographic job aid)
that shows the
organization of the
relationship
between causes and
effects of stress in
the department
(Appendix E,
sample)
STRESS IN THE FIRE SERVICE 114

Table 23, continued
Assumed Knowledge
Influence
Validated
as a Need
or Asset?

Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Fire chief and deputy
chiefs know how to
reduce stress in the fire
service.
Procedural
Need Y The integration of a
visual and auditory for
the learner will increase
the memory capacity
(Mayer, 2011).

Learning is highly
influenced by “goal-
directed practice” and
“targeted feedback”
(Ambrose, Bridges,
DiPietro, Lovett, &
Norman, 2010).
Learning is enhanced
when individuals are
provided guidance,
modeling, coaching,
and other scaffolding
during performance
(Mayer, 2011).
Provide training
with guidance and
coaching combined
with practice and
feedback on
strategies to reduce
stress in the fire
service.

Fire chief, deputy chiefs,
fire officers, and
firefighters need
metacognitive
knowledge to know how
a stress education
program can improve
behavior wellness.
Metacognitive
Need Y Monitoring,
controlling, and
regulating thinking of
the learner is through
self-regulation and
metacognitive thinking
(Pintrich, 2002).

Learners are more
aware of their own
metacognitive
knowledge for learning
and thinking through
self-regulation and after
useful activities
(Pintrich, 2002).

Levels of performance
improve and
completion times
decrease with elevated
self-regulation skills
(Clark & Estes, 2008).
Provide coaching,
practice and
feedback on self-
regulation skills to
reduce stress.

STRESS IN THE FIRE SERVICE 115

Factual and conceptual knowledge solution: Provide firefighters with a visual
organizer (table or infographic job aid) that shows the definition of stress and the causes in
the department and the consequential characteristics of stress. The findings and results
showed a need in factual and conceptual knowledge about the characteristic causes of stress and
the emotional causes and effects of stress. Information processing theory can be applied to make
recommendations. Schraw and McCrudden (2006) discuss individuals organize knowledge
influences, learn, and apply what they know. Moreover, Schraw, Veldt, and Olafson (2009) hold
creating schemata helps learners to organize knowledge in a domain. This suggests that
firefighters would benefit from an organized visual as a job aid. Thus, the recommendation is to
provide firefighters with a visual organizer (table or infographic job aid) that shows the
definition of stress and the causes in the department and the consequential characteristics of
stress.
According to Schraw et al. (2009) creating a schemata will assist learners to organize
knowledge in a specific area of study. Therefore, integrating and providing a visual learning tool
to show the relationship between the causes and effects of stress can help the learner. Mayer
(2011) explains the integration of a visual and auditory learning will increase memory capacity.
The recommendation is to provide a visual organizer (table or infographic) that shows the
definition of stress, the causes in the department, and the consequential characteristics of stress.
Procedural knowledge solution: Provide training with guidance and coaching
combined with practice and feedback on strategies to reduce stress in the fire service. The
results showed a need for procedural knowledge on how to reduce stress in the fire service.
Information processing theory can be applied to make recommendations. Mayer (2011)
suggested the integration of visual and auditory learning will increase the memory. Moreover,
STRESS IN THE FIRE SERVICE 116

learning is enhanced when individuals are provided guidance, modeling, coaching, and other
scaffolding during performance (Mayer, 2011). This suggests that firefighters would benefit
from training. Thus, it is recommended the organization provide training with guidance and
coaching combined with practice and feedback on strategies to reduce stress in the fire service.
According to research, effective learning can facilitate transfer knowledge (Schraw &
McCrudden, 2006). Supporting the learner is dependent on goals with practice and specific
feedback (Ambrose, Bridges, DiPietro, Lovett, & Norman, 2010). A job aid such as the
psychological first aid system can help with effective learning (Ruzek et al., 2007). Empirical
research examined the psychological first aid system as a process to help reduce initial post-
trauma distress and manage short and long-term functioning.
Metacognitive knowledge solution: Provide coaching, practice and feedback on self-
regulation skills to reduce stress. The results showed a need for metacognitive knowledge that
a stress education program can improve behavior wellness. Information processing theory can be
applied to make recommendations. According to research, learners monitor, control, and regulate
their cognitive learning through self-regulation and metacognition (Pintrich, 2002). Self-
regulation after useful activities ensures individuals are more aware of their own metacognitive
knowledge for learning and thinking (Pintrich, 2002). This suggests that firefighters would
benefit from training to improve behavior wellness. Thus, it is recommended to provide
coaching, practice, and feedback on self-regulation skills to reduce stress.
According to research, performance levels increase and completion times decrease with
increased self-regulation skills (Clark & Estes, 2008). The level of performance among learners
increase and a decrease in time with heightened self-regulation skills (Clark & Estes, 2008).
Pintrich (2002) recommended self-reflection after an activity, so the learner is aware of their
STRESS IN THE FIRE SERVICE 117

metacognition, which increases strategies for learning and thinking. The recommendation is to
provide coaching, practice, and feedback on self-regulation skills to reduce stress
Motivation Recommendations
The data collection for this study is complete, and the motivation influences in Table 24
represent the complete list of validated needs or assets. An analysis of the data identified the
assumed motivation influences and showed the expectancy value, self-efficacy, and attribution
needs. According to Clark and Estes (2008), motivation gets people moving forward, keeps them
moving, and explains the collection of experiences. Motivation is also “the process whereby
goal-directed activity is instigated and sustained” (Schunk et al., 2009, p. 40). The stakeholder
motivational influences align with the self-efficacy needed to manage stress. Self-efficacy is
defined as “People’s judgements’ of their capabilities to organize and execute a course of action
required to attain designated levels of performances” (Bandura, 1986, p. 391). Managing
organizational issues through education provides individuals with solid and general conceptual
and analytical knowledge (Clark & Estes, 2008). Table 24 shows the influences and the
recommendations based on theoretical principles.

STRESS IN THE FIRE SERVICE 118

Table 24
Summary of Motivation Influences and Recommendations
Assumed
Motivation
Influence
Validated as
a Need or
Asset
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Expectancy Value
- Fire chief,
deputy chiefs, fire
officers, and
firefighters need to
believe that a
stress education
program can
reduce stress.
Need Y Learning can help
learners develop positive
values with rationales
that include a discussion
of the importance and
utility value of the work
(Eccles, 2006; Pintrich,
2002).
Provide FFs
information about
the value of a stress
education program
which can reduce
stress through
discussion and
modeling.
Self-Efficacy –
Fire chief, deputy
chiefs, fire
officers, and
firefighters are
confident they can
design and
implement an
educational
curriculum to
address stress
within the fire
service.
Need Y Achieving small
successes improves one’s
confidence to achieve
more challenging tasks
(Bandura, 1997).
Learning and motivation
are enhanced when
learners have positive
expectancies for success
(Eccles, 2006).
Provide feedback on
successful
performance of
managing stress to
build the confidence
and motivation to
succeed in designing
an education
curriculum to reduce
stress with feedback
on successful
performance.
Attributions – Fire
chief, deputy
chiefs, fire
officers, and
firefighters believe
that it is through
their own efforts
they can design
and implement an
educational
curriculum to
address stress
within the fire
service.
Need Y Focusing on feedback
and communication to
the learner. Private,
specific, and timely
enhances behavior
performance (Shute,
2008).
Expectancies for success
or failure is attributed to
effort and leading to
more positive success
(Rueda, 2011).
Provide
communication and
modeling positive
feedback efforts and
strategies to reduce
stress.

STRESS IN THE FIRE SERVICE 119

Expectancy value influence solution: Provide firefighters information about the
value of a stress education program which can reduce stress through discussion and
modeling. The results showed a need in expectancy value to believe a stress education program
can reduce stress. Expectancy value theory can be applied to make recommendations. According
to research, rationales that include a discussion of the importance and utility value of the work or
learning can help learners develop positive values (Eccles, 2006; Pintrich, 2002). Further
research from Pintrich (2002) explains the correlate of activities and materials aid learners to
improve self-interests associated with real-life tasks. This suggests firefighters would benefit
from the belief that a stress education program will provide value. Thus, a stress education
program to reduce stress can provide value for the learners. Therefore, it is recommended that
the organization provide information about the value of a stress education program through
discussion and modeling.
Expectancy value model has constructs that are predictors of achievement performance
and choice and are influenced by psychological, social, contextual, and cultural influences
(Wigfied & Cambria, 2010). Moreover, positive values with open discussions can aid in utility
value of learning (Eccles, 2006; Pintrich, 2002). According to Eccles (2006), perceived value has
four constructs: intrinsic value, attainment value, utility value, and the cost value. The one
construct that provides value to the fire service is the intrinsic value, which enhances the feeling
of engagement. The recommendation is to provide firefighters information about the value of a
stress education program which can reduce stress through discussion and modeling.
Self-efficacy value solution: Provide feedback on successful performance of
managing stress to build the confidence and motivation to succeed in designing an
education curriculum to reduce stress with feedback on successful performance. The results
STRESS IN THE FIRE SERVICE 120

showed a need in self-efficacy that stakeholders can design and implement an educational
curriculum to address stress. Self-efficacy theory can be applied to make recommendations.
According to research achieving small successes increases one’s confidence to achieve more
challenging tasks (Bandura, 1997). Learning and motivation are improved when learners have
positive expectancies for success (Eccles, 2006). This suggests that stakeholders are confident
they can design an educational curriculum to reduce stress. Therefore, it is recommended the
organization provide feedback on successful performance of managing stress.
Self-efficacy is defined as “people’s judgements of their capabilities to organize and
execute a course of action required to attain designated levels of performances” (Bandura, 1986,
p. 391). The study by Prati et al. (2010) corroborate that rescue workers are frequently exposed
to critical incidents, such as highly stressful or traumatic events, in their daily operational duties
(Andersen, Christensen, & Petersen, 1991). Self-efficacy is the ability to self-appraise and self-
awareness. Studies have shown that self-efficacy is an important factor in reducing levels of
distress among rescue workers (McCammon et al., 1988). The recommendation is that the
organization provide feedback on successful stress management to build the confidence and
motivation to succeed in designing an education curriculum to reduce stress with feedback on
successful performance.
Attribution influence solution: Provide communication and modeling positive
feedback efforts and strategies to reduce stress. The results regarding attribution knowledge
were that stakeholders have a need to believe they can design and implement an educational
curriculum to address stress within the fire service through their own efforts. Attribution theory
can be applied to make recommendations. According to Shute (2008), behavior performance is
enhanced through feedback which focuses on communication to the learner. Moreover, successes
STRESS IN THE FIRE SERVICE 121

or failures attributed to effort can lead to positive expectancies for success (Rueda, 2011). This
suggests that firefighters would benefit from organized communication and positive feedback
efforts. Therefore, it is recommended that the organization provide communication and model
positive feedback efforts and strategies to reduce stress.
In attribution theory, people are trying to make sense of the broader social environment
and how they assert themselves into place, which is the sense-making process (Rueda, 2011).
The attribution motivation principle is the belief that not meeting a goal is not long-lasting and
attributable to controllable factors, to succeed, to stay focused and persistent, and work hard
towards the task or activity (Rueda, 2011). Attribution influences align with the social culture of
the fire service of sense making. The recommendation is to provide communication and model
positive feedback efforts and strategies to reduce stress.
Organization Recommendations
The data collection for this study is complete, and the knowledge influences in Table 25
represent the complete list of validated needs or assets. An analysis of the data identified the
assumed organization influences and showed the cultural model and cultural setting needs.
According to Clark and Estes (2008), organizational culture is the most important work process
that establishes and sets the tone for all organizations because it shows how individuals work
together to attain the organization’s goals. Schein (2017) further stated occupations have shared
assumptions related to the organization’s internal performance and the growth of cultures and
subcultures. Table 25 shows the influences and priority of stakeholders’ goals and the
recommendations based on theoretical principles.

STRESS IN THE FIRE SERVICE 122

Table 25
Summary of Organization Influences and Recommendations
Assumed
Organization
Influence

Validated
as a Need
or Asset
Priority
Yes, No
(Y, N)
Principle and Citation

Context-Specific
Recommendation
The fire chief,
deputy chiefs,
fire officers, and
firefighters need
to have a
commitment to
reduce stress.
(Model)
Need Yes Effective change efforts
ensure that everyone has
the resources needed to
do their job, and resource
shortages, then resources
are aligned with
organizational priorities
(Clark & Estes, 2008).
Provide resources
to design and
implement a stress
education
program.

The organization
needs to have a
commitment to
reduce stress.
(Model)
Need Yes Effective change begins
by addressing motivation
influencers; it ensures the
group knows why it
needs to change. It then
addresses organizational
barriers and then
knowledge and skills
need (Clark & Estes,
2008).
Provide and
educate the
organization to
ensure confidence
and understanding
that changing the
culture begins to
reduce stress.
The fire chief,
deputy chiefs,
fire officers, and
firefighters need
to have a
commitment to
design and
implement an
innovative stress
education
program.
(Setting)
Need Yes Effective change efforts
ensure that everyone has
the resources needed to
do their job, and resource
shortages, then resources
are aligned with
organizational priorities
(Clark & Estes, 2008).
Provide an
effective change
effort to ensure the
organization
provides resources
to reduce stress.

STRESS IN THE FIRE SERVICE 123

Table 25, continued
Assumed
Organization
Influence

Validated
as a Need
or Asset
Priority
Yes, No
(Y, N)
Principle and Citation

Context-Specific
Recommendation
The organization
needs to have a
commitment to
design and
implement an
innovative stress
education
program.
(Setting)
Need Yes Changes in the
environment can affect
behavior. (Daly, 2009;
Tuckman, 2009)
Effective organizations
ensure that organizational
messages, rewards,
policies and procedures
that oversee the
organization align with or
are supportive of
organizational goals and
values (Clark & Estes,
2008).
Provide a
sustainable
environment
change to align the
leadership to
support the values
to reduce stress.

Cultural model influence solution: Provide resources to design and implement a
stress education program and educate the organization to ensure confidence and
understanding that changing the culture begins to reduce stress. The results in cultural
model influence showed a need to have a commitment to reduce stress. Organization theory can
be applied to make recommendations. According to Clark and Estes (2008), effective change
efforts ensure that everyone has the resources needed to do their job, and, with resource
shortages, resources can be organized by organizational priorities. Clark and Estes (2008),
explain organizational processes require the resources to be efficiently and effectively attained to
meet performance goals. The authors addresses organizational barriers and then knowledge and
skills need (Clark & Estes, 2008). This suggests that firefighters would benefit from a
commitment from the organization to provide resources to reduce stress. Therefore, it is
recommended the organization provide resources to design and implement a stress education
STRESS IN THE FIRE SERVICE 124

program and educate the organization to ensure confidence and understanding that changing the
culture begins to reduce stress.
Organizational culture is the most important work process that establishes and sets the
tone for all organizations because it shows how we work together to attain the organization’s
goals (Clark & Estes, 2008). Effective change starts with motivation, which entails knowing why
a change is needed (Clark & Estes, 2008). According to Daly (2009) and Tuckman (2009),
changes in the environment can affect behavior. Schein (2017) further explained occupations
have shared assumptions related to the organization’s internal performance and the evolution of
cultures and subcultures. This suggests ensuring confidence to change the culture to reduce stress
and incorporating an education program to address the cultural model of the fire service to
enhance the understanding of stress in the fire service. The fire service culture regarding mental
disorders as a sign of weakness, vulnerability, and failure is a problem that needs to be addressed
(Henderson et al., 2015). This will remove the barrier for firefighters who are suppressing
feelings of stress. The recommendation is to conduct training and education to address the
“macho” culture of the fire service and to provide resources to design and implement a stress
education program and educate the organization to ensure confidence and understanding that
changing the culture begins to reduce stress.
Cultural setting influence solution: Provide an effective change effort to ensure the
organization provides resources to reduce stress and provide a sustainable environment
change to align the leadership to support the values to reduce stress. The results in cultural
setting influences showed a need to have a commitment to design and implement an innovative
stress education program. Organization theory can be applied to make recommendations.
Effective change efforts ensure that everyone has the resources needed to do their job, and if
STRESS IN THE FIRE SERVICE 125

there are resource shortages, organizational priorities must be adjusted (Clark & Estes, 2008).
According to research, changes in the environment can affect behavior (Daly, 2009; Tuckman,
2009). Clark and Estes (2008) stated effective organizations ensure that organizational messages,
rewards, policies and procedures are aligned with or support the organizational goals and values.
This suggests that firefighters would benefit from resources and an environment change to align
the leadership to support the values to reduce stress. Therefore, it is recommended that the
organization provide an effective change effort to ensure the organization provides resources to
reduce stress and provide a sustainable environment change to align the leadership to support the
values to reduce stress.
An effective change effort requires the resources needed to complete the job, and, if
resources are limited, then there needs to be an alignment with the organizational priorities
(Clark & Estes, 2008). An effective organization ensures messages, rewards, policies and
procedures are aligned with and support the organization’s goals and values (Clark & Estes,
2008). Competent leadership is a factor that can change the organization’s ability to succeed or
fail (Burke, 2018). Leadership is best explained by Burke (2017): “without leadership, planned
organization change will never be realized” (p. 296). This suggests providing a sustainable
environment change to align the leadership to support the values of stress education and
incorporating an education program to address the cultural settings of the fire service to enhance
the understanding of stress in the fire service.
The organizational goal is to provide a stress education program to support the current
BHP. According to Bass and Riggio (2006), the trendy style of transformational leadership is
based on the intrinsic motivation and follower development which is adaptive to the
contemporary climate of today. However, Northouse (2016) has drawn attention to the authentic
STRESS IN THE FIRE SERVICE 126

leadership style as newer area which focuses on a leader as genuine and real. The leadership
styles are examples of enhancing the leadership settings within the organization to provide an
understanding to reduce stress in the fire service. This can provide the change to influence the
cultural settings of the organization. The recommendation is to provide an effective change effort
to ensure resources are provided to reduce stress and provide a sustainable environment change
to align the leadership to support the values to reduce stress.
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
In the 1950s, Dr. Don Kirkpatrick identified four levels to evaluate training programs for
the actual application and use of the Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016). The
four levels are (a) Level 1 - reaction is the degree to which participants find the training
favorable, engaging and relevant to their jobs, (b) Level 2 - learning is the degree to which
participants acquire the intended knowledge, skills, attitude, confidence and commitment based
on their participation in the training, (c) Level 3 - behavior is the degree to which participants
apply what they learned during training when they are back on the job, and (d) Level 4 - results
is the degree to which targeted outcomes occur as a result of the training and the support and
accountability package (Kirkpatrick & Kirkpatrick, 2016). Consideration of the New World
Kirkpatrick Model’s four levels during the planning phase should begin in reverse order, from
Level 4 to Level 1 (Kirkpatrick & Kirkpatrick, 2016). This will provide the implementation and
evaluation plan to elicit success for learning associated with stress education, focusing on the
New World Kirkpatrick Model.
The recommendation for the stakeholders is to provide a stress education program and
provide a sustainable culture change to reduce stress. Results and outcomes are to reduce stress
STRESS IN THE FIRE SERVICE 127

in the fire service and align with the New World Kirkpatrick Model for training and evaluations.
These recommendations are to enhance the current BHP and provide additional resource for
firefighters when they experience stressful events.
Level 4: Results and Leading Indicators
The leading indicators are short-term observations and measurements suggest the
stakeholders goals which will need to be evaluated and re-evaluated (Kirkpatrick & Kirkpatrick,
2016). The tables below provide recommendations for the outcomes, metrics, and methods for
the organization to utilize. These recommendations will provide short-term observations and
measurements to ensure a guide for a successful implementation of the stress education program.
Table 26
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
Increase the positive
perception of stress with the
local fire union in the fire
service.
Number of positive articles and
mentions from news media outlets,
state agencies, national agencies.

Number of positive comments from
surveys and interviews from
stakeholders to track the increase or
decrease in perception of stress in
the fire service.
Union office (director of
behavioral health) to track
media mentions of stress,
suicidal ideations, and PTSD
for the local fire union office.

Union office (director of
behavioral health) to track
surveys and interviews from
stakeholders.

Increase the positive
perception of stress with the
local fire chiefs association
in the fire service.

Number of positive articles and
media mentions from news media
outlets, state agencies, national
agencies, surveys.

Number of positive comments from
surveys and interviews from
stakeholders to track and identify
the increase or decrease in
perception of stress in the fire
service.
Chief Officers Association
administrators to track media
mentions of stress, suicidal
ideations, and PTSD.

Chief Officers Association
administrators to track surveys
and interviews from
stakeholders.

STRESS IN THE FIRE SERVICE 128

Table 26, continued
Outcome Metric(s) Method(s)
External Outcomes
Increase the positive
perception of stress with the
fire families, community,
and the local political
offices.
Number of positive articles and
media mentions from news media
outlets, state agencies, national
agencies, surveys.

Number of positive comments from
surveys and interviews from
stakeholders to track and identify
the increase or decrease in
perception of stress in the fire
service.
Union office director of
behavioral health, Chief
Officers Association
administrators, community
groups, and local political
officials to track media
mentions of stress, suicidal
ideations, and PTSD.

Union office director of
behavioral health, Chief
Officers Association
administrators, community
groups, and local political
officials to track surveys and
interviews from stakeholders.
Internal Outcomes
Increase the positive
perception of stress within
the department, including
the fire chief, deputy chiefs,
fire officers, and firefighters.
Number of positive articles and
media mentions on fire service
intranet and other communications.

Number of positive comments from
surveys and interviews from
stakeholders to track and identify
the increase or decrease in
perception of stress in the fire
service.
Planning section, public
information director, and BHP
to track media mentions of
stress, suicidal ideations, and
PTSD for the fire chief, deputy
chiefs, fire officers, and
firefighters.

Planning Section, Public
Information Director, and BHP
to track surveys and interviews
from stakeholders.
Increase a positive climate
of sustainable culture change
within the department
regarding stress in the fire
service.
Number of positive articles and
media mentions from fire service
intranet and other communications.

Number of positive comments from
surveys and interviews from
stakeholders to track and identify
the increase or decrease in
perception of stress in the fire
service.
Planning section, public
information director, and BHP
to track an increase of a positive
culture change regarding stress
for the fire chief, deputy chiefs,
fire officers, and firefighters.

Planning section, public
information director, and BHP
to track surveys and interviews
from stakeholders.

STRESS IN THE FIRE SERVICE 129

Table 26, continued
Outcome Metric(s) Method(s)
Internal Outcomes
Increase a positive
leadership climate within
the department for a
sustainable culture change
regarding stress in the fire
service.

Number of positive articles and
media mentions from fire service
intranet and other communications.

Number of positive comments from
surveys and interviews from
stakeholders to track identify the
increase or decrease in perception
of stress in the fire service.
Planning section, public
information director, and BHP
to track an increase in the
positive leadership climate for a
sustainable culture change
regarding stress for the fire
chief, deputy chiefs, fire
officers, and firefighters.

Planning section, public
information director, and BHP
to track surveys and interviews
from stakeholders.
Increase a positive
perception from the focus
group within the department
(deputy chiefs, fire officers,
and firefighters) to monitor
the effectiveness of stress
education in the
organization.
Number of positive articles and
media mentions from fire service
intranet and other communications.

Number of positive comments from
surveys and interviews from
stakeholders to track identify the
increase or decrease in perception
of stress in the fire service.
Focus group, planning section,
and BHP to track an increase in
the positive perception of stress
and the effectiveness of stress
education for the fire chief,
deputy chiefs, fire officers, and
firefighters.

Planning section, public
information director, and BHP
to track surveys and interviews
from stakeholders.

Level 3: Behavior
Critical behaviors. According to the New World Kirkpatrick Model, critical behaviors
are the few key behaviors that a primary group can consistently perform while on the job to show
specific results (Kirkpatrick & Kirkpatrick, 2016). It is important to know that critical behaviors
can be identified as the most meaningful behavior for an organization to achieve a goal. Level 3
behaviors are the degree to which the learner can apply what they learned during training and
perform the task when they are back on the job (Kirkpatrick & Kirkpatrick, 2016). The fire chief
and deputy chiefs will focus on the performance of the learners to ensure they can explain what
was taught in the courses. Fire officer and firefighters will need to provide specific, observable,
and measurable metrics to know the stress education courses were captured and understood.
STRESS IN THE FIRE SERVICE 130

Combining the lessons learned during training sessions, knowing critical behaviors, and the
desired learning indicators are factors to an organization’s delivery of value to training.
Table 27
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
1. Fire chief and
deputy chiefs create a
positive cultural
climate change
associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.
Number of stakeholders
engaging and
participating in a
positive cultural climate
change associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.

Provide a Dashboard
tracking system to monitor
cultural climate change
associated with stress
education.
● Follow-up modules
● Executive modeling
● Coaching
● Mentoring
● Interviews
● Observations
● Surveys
Report every six
months and during the
Level 3 behavior
evaluation.
2. Fire chief and
deputy chiefs create a
positive cultural
climate change with
the leadership
associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.
Number of stakeholders
engaging and
participating in a
positive cultural climate
change with the
leadership associated
with reinforcement,
encouragement,
rewarding, and
monitoring behavior.

Provide a Dashboard
tracking system to monitor
leadership climate change
associated with stress
education.
● Follow-up modules
● Executive modeling
● Coaching
● Mentoring
● Interviews
● Observations
● Surveys
Report every six
months and during the
Level 3 behavior
evaluation.
3. Fire Officers and
Firefighters create a
positive cultural
climate change
associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.
Number of fire officers
and firefighters
engaging and
participating in a
positive cultural climate
change associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.

Provide a Dashboard
tracking system to monitor
the effectiveness of
cultural climate change
associated with stress
education.
● Follow-up modules
● Executive modeling
● Coaching
● Mentoring
● Interviews
● Observations
● Surveys
Report every six
months and during the
Level 3 behavior
evaluation.

STRESS IN THE FIRE SERVICE 131

Table 27, continued
Critical Behavior Metric(s)
Method(s)
Timing
4. Stakeholders
create focus groups
to evaluate the
effectiveness of a
positive cultural
climate change
associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.
Number of members
from the Focus group
engaging and
participating in a
positive cultural climate
change associated with
reinforcement,
encouragement,
rewarding, and
monitoring behavior.

Provide a Dashboard
tracking system to monitor
sustainable acceptance of
cultural climate change
associated with stress
education.
● Follow-up modules
● Executive modeling
● Coaching
● Mentoring
● Interviews
● Observations
● Surveys

Report every six
months and during the
Level 3 behavior
evaluation.

Focus Group to meet
and report annually.
And to monitor the
increase or decrease
in the perception of a
cultural climate
change.

Required drivers. The New World Kirkpatrick Model explains required drivers as the
processes and systems that reinforce, monitor, encourage, and reward performance of critical
behaviors (Kirkpatrick & Kirkpatrick, 2016). Required drivers are the desired on-the-job training
that is applied after a training session. The success of reinforcing the knowledge and skills
learned during training through the support of the organization will yield successful application
when the individual returns to work. Monitoring and commitment to execute what was learned
during training sessions is perhaps the key indicator of a program’s success for the learner
(Kirkpatrick & Kirkpatrick, 2016).

STRESS IN THE FIRE SERVICE 132

Table 28
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors
Supported
1, 2, 3 Etc.
Reinforcing
Provide a refresher training to reinforce a positive sustainable
cultural change and a climate of innovative leadership
associated with stress.
Ongoing 1, 2, 3.4
Provide a refresher training on stress education for fire
officers and firefighters with continuous positive
reinforcement of a sustainable culture change associated with
stress.
Ongoing 1, 2, 3, 4
Provide a refresher training for external stakeholders with
continuous positive reinforcement of a sustainable culture
change associated with stress.
Ongoing 4
Encouraging
Fire chief and deputy chiefs to collaborate and administer
encouragement messages to the organization associated with
stress education and sustainable cultural change.
Ongoing 1, 2
Fire chief and deputy chiefs to collaborate and administer
encouragement messages regarding leadership for a
sustainable culture change associated with stress.
Ongoing 1, 2
Fire officers and firefighters collaborate and administer
encouragement messages to the organization associated with
stress education and cultural change.
Ongoing 3
External stakeholders groups to collaborate and administer
encouragement messages to the external stakeholder
associated with stress education and cultural change.
Ongoing 4
Rewarding
Fire Chief and Deputy Chiefs acknowledge progress and
reward the organization for stress education and a positive
sustainable cultural change associated with stress.
Bureau Staff
Meetings
1, 2
Fire Chief and Deputy Chiefs acknowledge progress and
reward the leadership for a positive sustainable culture change
associated with stress.
Bureau Staff
Meetings
1, 2
Fire Officers and Firefighters acknowledge progress and
reward firefighters for stress education and a positive
sustainable cultural change associated with stress.
Bureau, Division,
Battalion, and Fire
Station meetings.
3
External stakeholders groups acknowledge progress and
reward external stakeholder for stress education and a positive
sustainable cultural change associated with stress.
Monthly meetings. 4

STRESS IN THE FIRE SERVICE 133

Table 28, continued
Method(s) Timing
Critical Behaviors
Supported
1, 2, 3 Etc.
Monitoring
Fire Chief and Deputy Chiefs will track and monitor progress
towards stress education and a positive sustainable cultural
change associated with stress.
Ongoing 1, 2
Fire Chief and Deputy Chiefs track and monitor progress
towards a climate of positive leadership for a sustainable
culture change associated with stress.
Ongoing 1, 2
Fire Officers and Firefighters will track and monitor progress
of stress education and a positive sustainable cultural change
associated with stress.
Ongoing 3
External stakeholders groups will track and monitor stress
education and a positive sustainable cultural change associated
with stress.
Ongoing 4

Monitoring. The four strategies could be used to ensure the required drivers transpire
into action. Providing monitoring of all the stakeholders would mean (a) the fire chief and deputy
chiefs receive ongoing updates from the fire officers of the progress of the stress education and
sustainable cultural climate change associated with stress, (b) the fire officers and firefighters
provide the support and encouragement to participants of the stress education and sustainable
cultural climate change courses, and (c) the fire officers, firefighters and stakeholders focus
groups continue to foster, encourage, and reinforce the stress education and sustainable cultural
climate change to improve the quality of the organization’s change behavior.
Organizational support. The organization, with the support of the fire chief and deputy
chiefs, will perform critical behaviors for climate change and to support a positive sustainable
cultural climate change to pillar stress education. Promoting trust and leadership will enable the
organization to further the current critical behaviors associated with stress management among
firefighters. The organization will need to provide a stress education program that will motivate
the fire officers and firefighters to learn the importance of stress management and behavior
wellness. Finally, the organization will need to provide fire officers and firefighters the tool kit to
STRESS IN THE FIRE SERVICE 134

foster, encourage, reinforce, and motivate individuals that stress management will provide a
healthier lifestyle in the fire service.
Level 2: Learning
According to Kirkpatrick and Kirkpatrick (2016), learning is simply a means to an end,
which enables the learner to perform their job better and contribute to the organization. There are
five components applied to Level 2 Learning: knowledge, skills, attitude, confidence, and
commitment. Through the application of stress education training that the organization will
provide the stakeholders the importance of the five components of Level 2: Learning. The
correlation of the Level 2 Learning and stress education will provide the attributes and tools for a
firefighter to improve their skills to reduce stress.
Learning goals. Based on the recommendations identified in this chapter, learning goals
have been developed. At the completion of the stress education program learners will be able to
1. Describe the information from the visual organizer (table or infographic).
2. Describe the importance of training with guidance and coaching combined with practice
and feedback on strategies.
3. Describe the importance of coaching, practice and feedback on self-regulation skills.
4. Describe the value of a stress education program and the importance of discussion and
modeling.
5. Explain the importance of feedback on successful performance to build confidence and
motivation.
6. Explain the importance of communication and modeling positive feedback efforts and
strategies to reduce stress.
STRESS IN THE FIRE SERVICE 135

7. Describe the importance of creating a focus group to monitor the behavior of a positive
sustainable culture change.
8. Describe the importance of creating a timeline to review the stress education curriculum
and focus group progress.
Program. The stakeholder goals is to provide a stress education curriculum with
classroom course sessions, online courses, asynchronous courses, a visual table (infographics), a
train-the-trainer program, a peer support team, the Mindful LUFD app, focus groups, leadership
courses associated with stress education, stress and coping skills courses, developing a stress
education manual, and provide additional staffing to the current behavioral health section. The
fire chief and deputy chiefs will encourage the continued support to create and provide a
sustainable cultural change to improve the quality of the organization’s change behavior
associated with reducing stress. The organization will begin to introduce courses with the
development of a timeline and budgetary analysis to complete the recommendations.
During the classroom, online, asynchronous, and leadership courses, the organization will
provide refresher courses and job aid applications. The job aid application will provide scenarios
and a stress checklist that will explain indicators of stress characteristics, effects, and coping
skills. Mindful LUFD is a mobile phone application that will enable access to assist firefighters
to manage stress through the use of meditation. Mindful LUFD will be an additional resource for
firefighters to aid with managing stress. The focus groups will provide the organization a
feedback process to monitor the progress of the stress education curriculum during a 10-year
period. Additionally, providing leadership classes for fire officers to encourage coaching and
mentoring will enhance the climate for a sustainable behavior and culture change associated with
STRESS IN THE FIRE SERVICE 136

stress management. Finally, increasing the staffing in the behavioral health section will assist in
attainable goals for the organization to support the stress education program.
Evaluation of the components of learning. Demonstrating declarative knowledge and
procedural skills is often necessary as a precursor to applying the knowledge and skills to solve a
problem. There is an importance to evaluating both the declarative and procedural knowledge
being taught. It is important for the learner to value using their learned knowledge and skills on
the job. Therefore, they must also demonstrate confidence they can succeed when applying their
knowledge and skills and have a commitment to using them on the job. As such, Table 29 lists
the evaluation methods and timing for these components of learning.
Table 29
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge checks using surveys, interviews, and
focus groups.
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Knowledge check during the stress education courses
to identify the knowledge the learner can share.

Brief pulse-check during each course.
(Mobile Device)
During the stress education courses to
document the learners knowledge of the
course content.
Knowledge check of the infographic visual table. Fire chief, deputy chiefs, fire officers, and
firefighters can ask what the infographic
message provides during (e.g., line-up,
meetings, training sessions, etc.).
Procedural Skills “I can do it right now.”
During the stress education training have learners
explain the characteristics, effects, coping skills, and
other components of stress through group activities.

Brief pulse-check during each course.
(Mobile Device)
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
STRESS IN THE FIRE SERVICE 137

Table 29, continued
Method(s) or Activity(ies) Timing
Procedural Skills “I can do it right now.”
Demonstrate individual knowledge that the learner
can “apply the stress education content” to real
application.

Brief pulse-check during each course.
(Mobile Device)
During the stress education courses to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Knowledge check of the infographic visual table. Fire chief, deputy chiefs, fire officers, and
firefighters can ask what the infographic
message provides during (e.g., line-up,
meetings, training sessions, etc.).
Attitude “I believe this is worthwhile.”
During the stress education training have the learners
explain “why it is important to recognize when they
are affected by stress” therefore, believing stress
education is worthwhile.

Brief pulse-check during each course.
(Mobile Device)
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Observer’s or facilitator’s observations of the learners
statements and actions demonstrating the knowledge
that “they believe knowing how to cope and manage
stress” will benefit the learner and peer firefighter.
During the stress education course.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Interest check of the infographic visual table. Fire chief, deputy chiefs, fire officers, and
firefighters can ask what the infographic
message provides during (e.g., line-up,
meetings, training sessions, etc.).
Confidence “I think I can do it on the job.”
During the stress education training have the learners
explain, “if a peer or myself recognize the feeling of
stress” what will they do to manage these feelings
and assist a peer firefighter. I can do it.

Brief pulse-check during each course.
(Mobile Device)
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Discuss how to practice and feedback.

Brief pulse-check during each course.
(Mobile Device)
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Confidence check of the infographic visual table. Fire chief, deputy chiefs, fire officers, and
firefighters can ask what the infographic
message provides during (e.g., line-up,
meetings, training sessions, etc.).
STRESS IN THE FIRE SERVICE 138

Table 29, continued
Method(s) or Activity(ies) Timing
Commitment “I will do it on the job.”
During the stress education training have the learner
explain, “what they would do if they experience
stress or a fellow peer firefighter begins to feel the
effects of stress” I will do it.

Brief pulse-check during each course.
(Mobile Device)
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Discuss how to practice and feedback.

Brief pulse-check during each course.
(Mobile Device)
During the stress education course to
document the learners knowledge of the
course content.

Upon return from the stress education course
the fire officer will check the learners
knowledge.
Commitment check of the infographic visual table. Fire chief, deputy chiefs, fire officers, and
firefighters can ask what the infographic
message provides during (e.g., line-up,
meetings, training sessions, etc.).

Level 1: Reaction
According to Kirkpatrick and Kirkpatrick (2016), Level 1: Reaction is the “degree to
which participants find the training favorable, engaging, and relevant to their jobs” (p. 39). This
section provides the components to measure reactions to the program. Table 30 lists the methods
utilized to measure the stakeholders’ learned knowledge, engagement to the curriculum, tools
and methods of their reactions.

STRESS IN THE FIRE SERVICE 139

Table 30
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Completion of the stress education program, and
online course.

Attendance rate.

Brief pulse-check during each course.
(Mobile Device)
During course modules/lessons.

During the stress education courses.
Completion and engagement of the stress
education program from the asynchronous
lessons.
During asynchronous lessons.
Observation by the instructors/facilitators.

Brief pulse-check during each course.
(Mobile Device)
During the class sessions.
Course evaluation using Mobile Device. Two weeks after the courses.
Reading the message from the infographic table. During line-up, meetings, training session, etc.
Relevance
Group discussion during each course.

Brief pulse-check during each course.
(Mobile Device)
After every course.
Brief pulse-check during each course.
(Mobile Device)
During every course.
Course evaluation using Mobile Device. Two weeks after the courses.
Reading the message from the infographic table. During line-up, meetings, training session, etc.
Customer Satisfaction
Group discussions during each course.

Brief pulse-check during each course.
(Mobile Device)
After every course.
Brief pulse-check during each course.
(Mobile Device)
During every course.
Course evaluation using Mobile Device. Two weeks after the courses.
Reading the message from the infographic table. During line-up, meetings, training session, etc.

Evaluation Tools
Immediately following the program implementation. During the stress education
course, the learner will participate in a group analysis of the class material. The instructors will
monitor and indicate on a data sheet the learners’ knowledge of the course curriculum. At the
STRESS IN THE FIRE SERVICE 140

completion of the stress education course, all learners will complete a survey using their mobile
device to enable the collection of data of the learners knowledge: (a) I know it, (b) I can do it
right now, (c) I believe it is worthwhile, (d) I think I can do it on the job, (e) I can do it on the
job. The instructors will provide instruction and will assist the firefighters in completing the
survey.
For Level 1, during the stress education course, the instructor will stop and introduce a
periodic brief pulse-check by asking the learners of the applicability of the course curriculum,
organization, delivery, and learning environment. Level 2 will include similar periodic brief
pulse-checks and ask the learners of their understanding of the course material and application.
Additionally, instructors will provide groups scenarios which will include realistic situational
scenarios, group competitions, survey, and mobile learning (M-Learning). Appendix C shows the
instrument for the immediate evaluation.
Delayed for a period after the program implementation. Approximately two months
after the stress education course, the organization will provide a survey for all learners to
complete using their mobile devices or office computers. According to Kirkpatrick and
Kirkpatrick (2016), the survey will allow the organization to monitor the effectiveness of the
curriculum and to collect data to measure the learners: Satisfaction and relevance (Level 1),
confidence and value of applying their training (Level 2), application of the training to stress
management and coping (Level 3), the application, review process, and targeted outcomes as a
result of the training for the stress education program (Level 4). Appendix D shows the
instrument for the delayed evaluation.
Data analysis and reporting. The Level 4 objective is to measure the effectiveness of
the stress education program and the knowledge learned to manage and cope with stress. The
STRESS IN THE FIRE SERVICE 141

focus groups and reviewers will track reports and surveys using a dashboard. This application
will report the data to measure and monitor the knowledge and effectiveness of the course
curriculum. Similar dashboards will be created for Levels 1, 2, and 3 to monitor asynchronous
courses, stress management course, Mindful LUFD, focus group feedback, sustainable culture
change, and learner knowledge associated with stress management and coping skills.

Figure 2. Example of digital dashboard to track and monitor Levels 1, 2, and 3.
Summary
The New Kirkpatrick Model frames the learning into four levels to apply into the new
work environments (Kirkpatrick & Kirkpatrick, 2016). In 2010, the four levels were
strengthened to achieve the goals of (a) incorporating the forgotten or overlooked teachings of
Donald Kirkpatrick especially with respect to Level 3 and Level 4 evaluation and (b) correcting
common misinterpretations and misuse of the model and illustrating how the model applies to
current talent development and performance paradigms. The Four Levels recommended are (a)
Level 1: Reaction, (b) Level 2: Learning, (c) Level 3: Behavior, and (d) Level 4: Results. The
New Kirkpatrick Model is a tool for the organization to follow and implement a designed plan
STRESS IN THE FIRE SERVICE 142

and evaluate the recommendations for the organization to achieve the stakeholders and
organizational goals (Kirkpatrick & Kirkpatrick, 2016).
Implementation of the recommendations will require the organization to utilize the tools
suggested in the study which provide the guiding lens to assist firefighters in managing stress.
The researcher’s expectation of the recommended framework will enable the reduction of stress,
improve techniques to manage stress, provide a curriculum and framework to plan, provide an
evaluation, and optimize a sustainable culture change to improve the understanding of reducing
stress. Ultimately, the organization’s goal is to save the life of a firefighter and provide resources
to manage stress. In conclusion, it is the intervention, prevention, and implementation of the
recommendations that will provide the tools to reduce stress in the fire service and perhaps save
the life of a firefighter.
Limitations and Delimitations
The limitations and delimitations of this study focus on the knowledge, motivation, and
organizational needs and assets associated with stress in the fire service. This research focused
on the stress firefighters face and the implementation of an innovative stress education program.
The study focused on the data collected from a survey and interviews. There were limitations the
study presented. For example, the sample size for the survey was limited to the 305 participants
who completed the survey compared to the approximately 3,300 firefighters in the organization.
This resulted in a small sample of 9.2% of firefighters who voluntarily completed the survey,
limiting the broader experiences. Another limitation was the demographic data which identified
zero participants with less than one year on the job completed the survey. Therefore, the sample
did not reflect the broad experiences and behaviors of younger firefighters. An additional
limitation, which was not completed during this study, was the survey sampling criteria and
STRESS IN THE FIRE SERVICE 143

rationale of differing ranks and positions. Based on the time limitations of completing this study
there was no data collected and analyzed for these criteria.
The delimitations of the study include limits defining the boundaries of this research. For
example, the stakeholder groups for this study were identified as the fire chief, deputy chiefs, fire
officers, and firefighters. However, to ensure broader inclusion of the population, future
stakeholders for surveys and interviews should include fire families, community, and political
officials. This will provide a broader scope of the population and include additional variables of
experiences and beliefs. The exclusion of the external stakeholders delimits the participants and
limits external stakeholder experiences and beliefs associated with stress in the fire service.
Recommendations for Future Research
Future research can address the limitations and delimitations of this study. The focus of
the study were the fire chief, deputy chiefs, fire officers, and firefighters to collect data to
address the assumed influences associated with stress. Expanding the sample size for future
surveys and not limiting participation to volunteers will enrich analysis and collection of data to
reflect the larger organization. Addressing the delimitations of this study to broaden the
stakeholder groups by adding research on fire families, communities, and political officials could
provide more data to analyze. Future researchers should consider sampling a broader stakeholder
group to expand the experiences and beliefs that are external influences. This will provide a
different lens associated with the cause and effects of stress firefighters experience and the
external effects to fire families, communities, and political officials. Future research of specific
categories or items such as: sleep deprivation, alcohol use to cope with stress, low morale, poor
family life, etc., may provide further analysis to stress reduction. Additionally, expanding the
research to other fire organizations would provide a larger set of data. Therefore, there is a need
STRESS IN THE FIRE SERVICE 144

for a study to determine the similarities or differences of the assumed influences at other fire
organizations associated with stress in the fire service.
Conclusion
This study examined the knowledge, motivation, and organizational needs and assets
associated with stress in the fire service. Utilizing Clark and Estes’ (2008) framework to conduct
a gap analysis provided the data to analyze the assumed influences to determine the effects of
stress in the fire service. Recommendations such as increasing the positive perception of stress
with the fire chief, deputy chiefs, fire officers, and firefighters will position the organization
towards progressive change. Based on the findings, there is a need to design and implement an
innovative stress education program and provide a sustainable culture change to reduce stress in
the fire service.
Finally, the implementing a stress education program will establish inclusion and
participation among the firefighters in the organization. Utilizing the New World Kirkpatrick
Model (Kirkpatrick & Kirkpatrick, 2016) will provide a detailed process to plan and evaluate the
program. As a result of the discussed recommendations in this study, a road map to address the
knowledge, motivation, and organizational goals will ensure a positive culture with an innovative
approach to reduce stress in the fire service.

STRESS IN THE FIRE SERVICE 145

REFERENCES
Ambrose, S. A., Bridges, M. W., DiPietro, M., Lovett, M. C., & Norman, M. K. (2010). How
Learning Works: 7 Research-Based Principles for Smart Teaching. San Francisco, CA:
Jossey-Bass.
American Foundation for Suicide Prevention. (2020). Suicide statistics. Retrieved from
https://afsp.org/about-suicide/suicide-statistics/
Andersen, H. S., Christensen, A. K., & Petersen, G. O. (1991). Post-traumatic stress reactions
amongst rescue workers after a major rail accident. Anxiety, Stress, and Coping, 4, 245–
251.
Anderson, L., & Krathwohl, D. (2001). A taxonomy for learning, teaching, and assessing (1st
ed.). New York: Longman.
Anderson, L. W., Krathwohl, D. R., Airasian, P. W., Cruikshank, K. A., Mayer, R. E., Pintrich,
P. R…. & Wittrock, M.C., (2001). A taxonomy for learning, teaching, and assessing: A
revision of Bloom’s taxonomy of educational objectives. New York, NY: Longman.
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice
Hall.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W. H. Freeman.
Bandura, A. (2000). Exercise of human agency through collective efficacy. Current Directions in
Psychological Science, 9(3), 75–78. https://doi.org/10.1111/1467-8721.00064
Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nded.). Mahwah, NJ:
Lawrence Erlbaum. https://doi.org/10.4324/9781410617095
STRESS IN THE FIRE SERVICE 146

Beaton, R., Johnson, L., Infield, S., Ollis, T., & Bond, G. (2001). Outcomes of a leadership
intervention for a metropolitan fire department. Psychological Reports, 88(3_suppl),
1049–1066.
Beaton, R., Murphy, S., Johnson, C., Pike, K., & Corneil, W. (1998). Exposure to duty-related
incident stressors in urban firefighters and paramedics. Journal of Traumatic Stress,
11(4), 821–828. https://doi.org/10.1023/A:1024461920456
Boffa, J., Stanley, I., Hom, M., Norr, A., Joiner, T., & Schmidt, N. (2016). PTSD symptoms and
suicidal thoughts and behaviors among firefighters. Journal of Psychiatric Research,
84(C), 277–283. https://doi.org/10.1016/j.jpsychires. 2016.10.014
Borgogni, L., Dello Russo, S., & Latham, G. (2011). The relationship of employee perceptions
of the immediate supervisor and top management with collective efficacy. Journal of
Leadership & Organizational Studies, 18(1), 5–13.
https://doi.org/10.1177/1548051810379799
Brown, G. K., & Jager-Hyman, S. (2014). Evidence-based psychotherapies for suicide
prevention: Future directions. American Journal of Preventive Medicine, 47(3), S186–
S194. https://doi.org/10.1016/j.amepre.2014.06.008
Burke, W. W. (2017). Organization change: Theory and practice. Thousand Oaks, CA: SAGE.
Cermak, C. (1991). Pioneering aerial forest fire control: The Army Air Patrol in California,
1919-1921. California History (San Francisco), 70(3), 290–305.
https://doi.org/10.2307/25158571
Clark, R. E., & Estes, F. (2008). Turning research into results: A guide to selecting the right
performance solutions. Atlanta, GA: CEP Press.
STRESS IN THE FIRE SERVICE 147

Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods
approaches. Thousand Oaks, CA: SAGE.
Daly, A. J. (2009). Rigid response in an age of accountability. The potential of leadership and
trust. Educational Administration Quarterly, 45(2), 168–216.
https://doi.org/10.1177/0013161X08330499
Eccles, J. (2006). Expectancy value motivational theory. Retrieved from
http://www.education.com/reference/article/expectancy-value-motivational-theory/
Finney, E. J., Buser, S. J., Schwartz, J., Archibald, L., & Swanson, R. (2015). Suicide prevention
in fire service: The Houston Fire Department (HFD) model. Aggression and Violent
Behavior, 21, 1–4. https://doi.org/10.1016/j.avb.2014.12.012
Gist, R., Taylor, V. H., & Raak, S. (2011). Suicide surveillance, prevention, and intervention
measures for the US Fire Service: Findings and recommendations for the Suicide and
Depression Summit. Emmitsburg, MD: National Fallen Firefighters Foundation
Gist R, Woodall SJ. 1995. Occupational stress in contemporary fire service. Occu Med
10(4):763±787.
Glesne, C. (2011). Becoming qualitative researchers: An introduction (4th ed.). Boston, MA:
Pearson.
Grossman, R., & Salas, E. (2011). The transfer of training: What really matters. International
Journal of Training and Development, 15(2), 103–120. https://doi.org/10.1111/j.1468-
2419.2011.00373.x
STRESS IN THE FIRE SERVICE 148

Hammond, J., & Brooks, J. (2001). The World Trade Center attack. Helping the helpers: The
role of critical incident stress management. Critical Care, 5(6), 315–317.
https://doi.org/10.1186/cc1059
Haslam, C., & Mallon, K. (2003). A preliminary investigation of post- traumatic stress
symptoms among firefighters. Work and Stress, 17(3), 277–285.
https://doi.org/10.1080/02678370310001625649
Heinrichs, M., Wagner, D., Schoch, W., Soravia, L. M., Hellhammer, D. H., & Ehlert, U. (2005).
Predicting posttraumatic stress symptoms from pretraumatic risk factors: A 2-year
prospective follow-up study in firefighters. The American Journal of Psychiatry, 162(12),
2276–2286. https://doi.org/10.1176/appi.ajp.162.12.2276
Henderson, S. N., Leduc, T. J., Couwels, J., & Van Hasselt, V. B. (2015). Firefighter suicide:
The need to examine cultural change. Fire Engineering, 168, 71–73.
Henderson, S. N., Van Hasselt, V. B., LeDuc, T. J., & Couwels, J. (2016). Firefighter suicide:
Understanding cultural challenges for mental health professionals. Professional
Psychology: Research and Practice, 47(3), 224–230. https://doi.org/10.1037/pro0000072
Hokanson, M. (1997). Evaluation of the effectiveness of Critical Incident Stress Management
program for the Los Angeles County Fire Department. Executive Fire Officer Program.
NFA: Emmitsburg, MD.
Hokanson, M., & Wirth, B. (2000). The critical incident stress debriefing process for the Los
Angeles County Fire Department: Automatic and effective. International Journal of
Emergency Mental Health, 2(4), 249–258.
Johnson, D. C., Thom, N. J., Stanley, E. A., Haase, L., Simmons, A. N., Shih, P. B., . . . Paulus,
M. P. (2014). Modifying resilience mechanisms in at-risk individuals: A controlled study
STRESS IN THE FIRE SERVICE 149

of mindfulness training in Marines preparing for deployment. The American Journal of
Psychiatry, 171(8), 844–853. https://doi.org/10.1176/appi.ajp.2014.13040502
Joyce, D. (1989). Why do police officers laugh at death? The Psychologist, 2, 379–381.
Kaplan, J., Bergman, A., Christopher, M., Bowen, S., & Hunsinger, M. (2017). Role of resilience
in mindfulness training for first responders. Mindfulness, 8(5), 1373–1380.
https://doi.org/10.1007/s12671-017-0713-2
Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick’s four levels of training evaluation.
Alexandria, VA: ATD Press.
Krathwohl, D. R. (2002). A revision of Bloom’s taxonomy: An overview. Theory into Practice,
41(4), 212–218. https://doi.org/10.1207/s15430421tip4104_2
Kronenberg, M., Osofsky, H., Osofsky, J., Many, M., Hardy, M., & Arey, J. (2008). First
responder culture: Implications for mental health professionals providing services
following a natural disaster. Psychiatric Annals, 38(2), 114–118.
https://doi.org/10.3928/00485713-20080201-05
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York, NY: Springer.
Leach, L. S., Poyser, C., & Butterworth, P. (2016). Workplace bullying and the association with
suicidal ideation/thoughts and behavior: A systematic review. Occupational and
Environmental Medicine. https://doi.org/10.1136/oemed-2016-103726
Large Urban Fire Department. (1988). Stress management program (1988). De-identify
pseudonym. All information regarding the organization came from the organization itself
and is not cited to maintain confidentiality.

STRESS IN THE FIRE SERVICE 150

Large Urban Fire Department. (2014). Large Urban Fire Department strategic plan (2015-
2017). De-identify pseudonym. All information regarding the organization came from the
organization itself and is not cited to maintain confidentiality.
Large Urban Fire Department. (2018a). LUFD recruitment plan fiscal year (2017-2018). De-
identify pseudonym. All information regarding the organization came from the
organization itself and is not cited to maintain confidentiality.
Large Urban Fire Department. (2018b). Our mission. De-identify pseudonym. All information
regarding the organization came from the organization itself and is not cited to maintain
confidentiality.
Large Urban Firemen’s Association. (2018). Death notices & funerals. De-identify pseudonym.
All information regarding the organization came from the organization itself and is not
cited to maintain confidentiality.
Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., . . . Hendin, H. (2005).
Suicide prevention strategies: A systematic review. Journal of the American Medical
Association, 294(16), 2064–2074. https://doi.org/10.1001/jama.294.16.2064
Marmar, C. R., Weiss, D. S., Metzler, T. J., Ronfeldt, H. M., & Foreman, C. (1996). Stress
responses of emergency services personnel to the Loma Prieta earthquake interstate 880
freeway collapse and control traumatic incidents. Journal of Traumatic Stress, 9(1), 63–
85. https://doi.org/10.1002/jts.2490090107
Martin, C. E., Tran, J. K., & Buser, S. J. (2016). Correlates of suicidality in firefighter/EMS
personnel. Journal of Affective Disorders, 208(15), 177–183.
https://doi.org/10.1016/j.jad.2016.08.078
STRESS IN THE FIRE SERVICE 151

Maxwell, J. A. (2013). Qualitative research design: An interactive approach (3rd ed.). Thousand
Oaks, CA: SAGE.
Mayer, R. E. (2011). Applying the science of learning. Boston, MA: Pearson Education.
McCammon, S., Durham, T. W., Jackson Allison, E., & Williamson, J. E. (1988). Emergency
workers’ cognitive appraisal and coping with traumatic events. Journal of Traumatic
Stress, 1(3), 353–372. https://doi.org/10.1002/jts.2490010307
McCrudden, M.T., Schraw, G. Relevance and Goal-Focusing in Text Processing. Educ Psychol
Rev 19, 113–139 (2007). https://doi.org/10.1007/s10648-006-9010-7
McFarlane, A. C. (1986). Posttraumatic morbidity of a disaster: A study of cases presenting for
psychiatric treatment. The Journal of Nervous and Mental Disease, 174(1), 4–14.
https://doi.org/10.1097/00005053-198601000-00002
McIntosh, W. L., Spies, E., Stone, D. M., Lokey, C. N., Trudeau, A.-R. T., & Bartholow, B.
(2016). Suicide rates by occupational group — 17 states, 2012. Morbidity and Mortality
Weekly Report, 65(25), 641–645. https://doi.org/10.15585/mmwr.mm6525a1
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and
implementation (4th ed.). San Francisco, CA: Jossey-Bass.
Meyer, E., Zimering, R., Daly, E., Knight, J., Kamholz, B., Gulliver, S., & Meyer, E. (2012).
Predictors of posttraumatic stress disorder and other psychological symptoms in trauma-
exposed firefighters. Psychological Services, 9(1), 1–15.
https://doi.org/10.1037/a0026414
Mitani, H., Shirayama, Y., Yamada, T., Maeda, K., Ashby, C. R., Jr., & Kawahara, R. (2006).
Correlation between plasma levels of glutamate, alanine and serine with severity of
STRESS IN THE FIRE SERVICE 152

depression. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 30(6),
1155–1158. https://doi.org/10.1016/j.pnpbp.2006.03.036
Mitchell, J. T., & Everly, G. S., Jr. (2001). Critical Incident Stress Debriefing: An operations
manual for CISD, defusing and other group crisis intervention services (3rd ed.). Ellicott
City, MD: Chevron.
National Fallen Firefighters Foundation. (2014). Confronting Suicide in the Fire Service:
Strategies for Intervention & Prevention. MD: Emmitsburg.
National Volunteer Fire Council. (2008). Suicide in the fire and emergency services. Greenbelt,
MD: Author.
Northouse, P. (2016). Leadership theory and practice. Thousand Oaks, CA: SAGE.
Pajares, F. (2006). Self-efficacy theory. Retrieved from
http://www.education.com/reference/article/self-efficacy-theory/
Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA:
SAGE Publications.
Patton, M. Q. (2015). Qualitative research & evaluation methods (4th ed.). Thousand Oaks, CA:
SAGE Publications.
Pintrich, P. R. (2002). The role of metacognitive knowledge in learning, teaching, and assessing.
Theory into Practice, 41(4), 219–225. https://doi.org/10.1207/s15430421tip4104_3
Pintrich, P.R. and Schunk, D. (1996) The Role of Expectancy and Self-Efficacy Beliefs:
Motivation in Education. Theory, Research and Application. Englewood Cliffs, NJ:
Prentice-Hall.
STRESS IN THE FIRE SERVICE 153

Prati, G., Pietrantoni, L., & Cicognani, E. (2010). Self-efficacy moderates the relationship
between stress appraisal and quality of life among rescue workers. Anxiety, Stress, and
Coping, 23(4), 463–470. https://doi.org/10.1080/10615800903431699
Rath, T., & Conchie, B. (2008). Strengths based leadership. Great leaders, teams, and why
people follow. New York, NY: Gallup Press.
Regehr, C., Hill, J., & Glancy, G. D. (2000). Individual predictors of traumatic reactions in
firefighters. The Journal of Nervous and Mental Disease, 188(6), 333–339.
https://doi.org/10.1097/00005053-200006000-00003
Regehr, C., Hill, J., Knott, T., & Sault, B. (2003). Social support, self-efficacy and trauma in new
recruits and experienced firefighters. Stress and Health, 19(4), 189–193.
https://doi.org/10.1002/smi.974
Revicki, D. A., & Gershon, R. R. (1996). Work-related stress and psychological distress in
emergency medical technicians. Journal of Occupational Health Psychology, 1(4), 391–
396. https://doi.org/10.1037/1076-8998.1.4.391
Robinson, S. B., & Firth Leonard, K. (2019). Designing quality survey questions. Los Angeles:
SAGE.
Rubin, H. J., & Rubin, I. S. (2012). Qualitative interviewing: The art of hearing data (3rd ed.).
Thousand Oaks, CA: SAGE.
Rueda, R. (2011). The 3 dimensions of improving student performance. New York, NY:
Teachers College Press.
Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., Vernberg, E. M., & Watson, P. J.
(2007). Psychological first aid. Journal of Mental Health Counseling, 29(1), 17–49.
https://doi.org/10.17744/mehc.29.1.5racqxjueafabgwp
STRESS IN THE FIRE SERVICE 154

Schein, E. H. (2017). Organizational culture and leadership. Hoboken, NJ: Wiley.
Schneider, B., Brief, A., & Guzzo, R. (1996). Creating a climate and culture for sustainable
organizational change. Organizational Dynamics, 24(4), 7–19.
https://doi.org/10.1016/S0090-2616(96)90010-8
Schraw, G., Veldt, M., & Olafson, L. (2009). Knowledge. Education.com. Retrieved September
11, 2012, from www.education.com/reference/article/knowledge/
Schunk, D. H., Pintrich, P. R., & Meece, J. L. (2009). Motivation in education: Theory, research,
and application. Upper Saddle River, NJ: Pearson/Merrill Prentice Hall.
Schuster, M. A., Stein, B. D., Jaycox, L. H., Collins, R. L., Marshall, G. N., Elliott, M. N., . . .
Berry, S. H. (2001). A national survey of stress reactions after the September 11, 2001,
terrorist attacks. The New England Journal of Medicine, 345(20), 1507–1512.
https://doi.org/10.1056/NEJM200111153452024
Shute, V., (2008). Focus on formative feedback. Review of educational research. Sage
publication. doi: 10.3102/0034654307313795
Stanley, S. A., Schaldach, J. M., & Kiyonaga, A. (2011). Mindfulness- based mind fitness
training: a case study of a high-stress pre-deployment military cohort. Cognitive and
Behavioral Practice, 18, 566–576.
Stanley, I., Boffa, J., Hom, M., Kimbrel, N., & Joiner, T. (2017). Differences in psychiatric
symptoms and barriers to mental health care between volunteer and career firefighters.
Psychiatry Research, 247(C), 236–242. https://doi.org/10.1016/j.psychres.2016.11.037
Stanley, I., Boffa, J., Smith, L., Tran, J., Schmidt, N., Joiner, T., & Vujanovic, A. (2018).
Occupational stress and suicidality among firefighters: Examining the buffering role of
STRESS IN THE FIRE SERVICE 155

distress tolerance. Psychiatry Research, 266, 90–96.
https://doi.org/10.1016/j.psychres.2018.05.058
Stanley, I., Hom, M., Hagan, C., & Joiner, T. (2015). Career prevalence and correlates of
suicidal thoughts and behaviors among firefighters. Journal of Affective Disorders,
187(15), 163–171. https://doi.org/10.1016/j.jad.2015.08.007
Stanley, I., Hom, M., Spencer-Thomas, S., & Joiner, T. (2017). Examining anxiety sensitivity as
a mediator of the association between PTSD symptoms and suicide risk among female
firefighters. Journal of Anxiety Disorders, 50, 94–102.
https://doi.org/10.1016/j.janxdis.2017.06.003
Taylor, J. W., & Frazer, A. G. (1982). The stress of post-disaster body handling and victim
identification work. Journal of Human Stress, 8(4), 4–12.
https://doi.org/10.1080/0097840X.1982.9936113
Tuckman, A. (2009). More attention, less deficit: Success strategies for adults with ADHD.
Plantation, FL: Specialty Press.
Turner, M. W. (2011). The comparative effectiveness of levels of training and years of work
experience in firefighters as determining factors in the development of posttraumatic
stress disorder (Doctoral dissertation) Retrieved from ProQuest Dissertations and Theses
database. (UMI No. 3458034).
Vernberg, E., Jacobs, A., Watson, P., Layne, C., Pynoos, R., Steinberg, A., … Ruzek, J. (2008).
Innovations in disaster mental health: psychological first aid. Professional Psychology,
Research and Practice, 39(4), 381–388. https://doi.org/10.1037/a0012663
Weiner, B. (1985). An attribution theory of achievement motivation and emotion. Psychological
Review, 92(4), 548–573. https://doi.org/10.1037/0033-295X.92.4.548
STRESS IN THE FIRE SERVICE 156

Weiner, B. (2005). Motivation from an attributional perspective and social psychology of
perceived competence. In A. J. Elliot & C. S. Dweck (Eds.), Handbook of competence
and motivation (pp. 73–84). New York, NY: Guilford.
Weiner, B. (2006). Social motivation, justice, and moral emotions: an attributional approach.
Mahwah, NJ: Lawrence Erlbaum Associates. https://doi.org/10.4324/9781410615749
Wigfield, A., & Cambria, J. (2010). Expectancy-value theory: Retrospective and prospective. In:
S. Karabenick & T. Urdan (Eds.), Advances in motivation and achievement. The next
decade of research on motivation (Vol. 16). New York: Taylor Francis Group.
Wigfield, A. and Eccles, J.S. (2000) ‘Expectancy-Value Theory of Achievement Motivation’,
Contemporary Educational Psychology 25: 68–81.
Wigfield, A., & Cambria, J., & Eccles, J.S. (2019). The oxford handbook of human motivation.
Oxford University Press.

STRESS IN THE FIRE SERVICE 157

APPENDIX A
Interview Protocol
The summary of interview questions below are comprised of open-ended strategies,
which shares the qualitative approach which allows the interviewee to answer in his or her own
words (Patton, 2002). The questions are targeted to identify knowledge, feelings, sensory,
background, distinguishing, and time frame questions (Patton, 2002). These open-ended
questions will focus on the experiences of firefighters and their views, and opinions related to
stress. Also, identifying how the organization will manage the stress education program.

Narrative for the interview:
Hello, I appreciate the time you are providing me to conduct this interview, and I know
you are very busy. So, thank you for the opportunity to interview with you today. I would like to
share with you why I am conducting this interview. The interview is related to my dissertation
study or problem of practice, which is “Stress in the Fire Service.” As a retired firefighter I felt
that this topic of study is important for the health and wellness of firefighters in the fire service.
My interview will follow the highest standards of ethical protocols. I will be following the
University of Southern California’s (USC) code of ethics as it applies to proper interviews and
research. The interview has been processed through the USC IRB. At any time, you wish to end
the interview you have the right to terminate or withdraw from the process. I can assure you that
I will proceed and conduct this interview with a professional lens with your personal protection
as the highest priority. If you have any questions about your rights regarding this study, please
contact our Ethics Officers, or our Chief Human Resources Officer at (xxx) xxx-xxxx.
The interview is confidential, and the interview transcription will be secured, where no
public access will be allowed. With your approval, I will be recording this interview to capture
STRESS IN THE FIRE SERVICE 158

the narrative of this interview and will be using a recorder during the interview. Before we begin,
I would like for you to read and review the “Letter of Consent” and when you finish reading,
please sign and date the document. The consent form is provided for you as a participant of this
interview. This interview is voluntary, all discussions will be kept confidential and you can
withdraw at any point. When you finish reading and signing the letter, you will receive a copy
for your records, and I will file the second form. May I have your permission to record and get
started. Record date and time of interview. (END)

Opening: Please tell me your name, rank or position, years on the job, and current assignment.

Transition: I will be asking you about your experiences regarding stress and education in your
organization. You will be sharing your involvement, impressions and observations related to
stress and education in the fire service.

Key Questions:

1. How would you describe stress and the emotional feelings you experience as a firefighter?
(Knowledge-Factual)
a. Probe: Tell me more about how stress affects a firefighter.
b. Probe: How did this experience affect your emotional feeling?

2. While at work, provide a time or experience when you felt stress affected you as a
firefighter? (Knowledge-Factual)
a. Probe: Tell me more about your thought process after this experience. (metacognitive)

3. Could you describe a specific incident at work that you experienced that was stressful?
(Knowledge-Factual)
a. Probe: Describe further your experience(s) with the incident.
b. Probe: Could you describe another emergency incident that you experienced that may have
affected feelings of stress.
c. Probe: Describe a fire station interaction that you experienced that may have affected
feelings of stress.
d. Probe: Describe an experience of an administrative responsibility that may have caused
stress.
e. Probe: Can you describe your experience with assign hiring that may have affected feelings
of stress.

4. Describe a time when you were at work that stress affected the performance of a peer
firefighter. (Knowledge-Factual)
STRESS IN THE FIRE SERVICE 159

a. Probe: Tell me how this experience changed or didn’t change your peer(s) behavior.

5. In these moments of stress, what did you do to manage your feelings? And, how were you
able to manage or cope with your feelings? (Knowledge-Procedural, Motivation-Self-Efficacy,
and Organization)
a. And, how were you able to manage or cope with your feelings?
b. Probe: Tell me more.

6. Could you describe what causes, and the effects to a firefighter?

7. How can stress be reduced in the fire service? (KMO)

8. Describe the organizations education program related to stress in the fire service.
(Knowledge-Factual, and Organization)
a. Probe: Explain further how to attain education regarding stress.
b. Probe: Have you received training or education before a stressful situation occurred?
c. Probe: Would a pre-education stress program assist in managing stress?
d. Probe: Would a pre-education stress program assist officers to manage stress with
firefighters?

9. Have you received or participated in any training provided by the organization related to
stress? (Knowledge-Factual, and Organization)
a. Probe: Please describe the nature of those training/resources.
b. Probe: Have you received training to manage stress before a critical incident, please describe
the training you received? (Knowledge, and Organization)

10. How would you describe your experience with the department’s Behavioral Health
program? (Knowledge-Factual/Procedural, and Organization)
a. Probe: Tell me more about your experience(s)
b. Probe: What suggestions if any would you make regarding the current Behavioral Health
program, what recommendations would you suggest? (Knowledge, Motivation, and
Organization)

11. What suggestions, if any, would you make regarding the current Behavioral Health Program,
what recommendations would you suggest?

12. In closing, is there anything else you would like to add? (Knowledge, Motivation, and
Organization)

STRESS IN THE FIRE SERVICE 160

APPENDIX B
Survey Protocol
Survey Questions

How many years have you served on the Department?
(1) Under 1 year
(2) 1-5 years
(3) 6-10 years
(4) 11-20 years
(5) 21-30 years
(6) 31+ years

What is your current rank?
(1) Fire Chief
(2) Deputy Chief
(3) Fire Officer (Assistant Chief, Battalion Chief, Fire Captain II or I)
(4) Firefighter (Includes all ranks other than the choices above)

What is your gender?
(1) Male
(2) Female

Knowledge:

I know firefighter stress can be caused by. (Select all that apply) (knowledge)

Firefighter stress can be caused by. (Select all that apply)
● Critical emergency incident
● Administrative responsibility
● Sleep deprivation
● Being assigned hired
● Organizational demands
● Inadequate training
● Malicious co-worker
● Inconsistent policy
● Poor leadership
● Technical problems
● Pressures of home life

I know the general characteristics of stress of a firefighter include. (Select all that apply)
● Depression
● Anxiety
● Headaches
● Hypertension
STRESS IN THE FIRE SERVICE 161

● Heart attacks
● Irritability
● Sleep problems
● Job Performance
● Isolation
● Tardiness
● Anger

I know the general effects of stress of a firefighter include. (Select all that apply)
● Poor health
● Low job performance
● Low morale
● Poor family life
● Infidelity
● Alcohol use
● Drug use
● Attrition
● Divorce
● Depression
● Financial hardship
● Gambling

Firefighter’s Knowledge of Stress Scale

This questionnaire is designed to help better understand the things that are stress related
for a firefighter. Please rate how certain you are of what knowledge you have regarding
firefighter stress by writing the appropriate number below. Your answers will be kept strictly
confidential and will not be identified by name.

Stress can be reduced in the fire service by. (Select all that apply)
● Knowing how to cope with stress
● Knowing how to recognize stress
● Receive training and education regarding stress
● Knowing a non-punitive communications system exist to discuss concerns with senior
management
What do you think about after you experience a stressful critical incident? (Select all that apply)
● Am I experiencing stress at the moment?
● I take a moment to just think about it
● I ask myself “What happened?”
● Am I experiencing good or bad feelings at the moment?
● Am I capable or managing my stress this incident is causing?
● Am I capable of asking for assistance when I experience stress?

Using the scale below select the degree to which you agree or disagree with the following
statement. The degree of confidence I have to do the following right now.
(Strongly Disagree) (Disagree) (Agree) (Strongly Agree)
STRESS IN THE FIRE SERVICE 162

● Recognize I am feeling stress
● Recognize the effects of stress
● Able to manage my personal stress
● Identify if stress is affecting my mood
● Seek assistance from another firefighter if I feel stress
● Seek assistance from a fire officer
● Seek assistance from a Department Psychologist
● Seek assistance from a family member
● Seek assistance from a Department Chaplain
● Seek assistance from a Peer Support member
● Apply the steps in the Department Behavioral Health Program procedures
● Seek assistance from the Union/Employee Assistance Program
● Assist another firefighter if they experience stress

Using the scale below rate the degree to which you agree or disagree with the following
statement.
(Strongly Disagree) - (Disagree) - (Agree) - (Strongly Agree)
● A stress education program will improve my stress management
● I think having a stress education program is important for my work as a firefighter
● A stress education program is interesting to me
● I think I would be a more effective firefighter if I knew more about stress
● I would feel positive about participating in a Stress Education Program
● I attribute my success or failure in managing stress in the fire service to my own efforts

Please rate how confident you are that your organization can manage stress.
(Not at All Confident) (Slightly Confident) (Moderately Confident) (Very Confident)
(Extremely Confident)
● I have confidence with how the organization assists me with managing stress
● I have confidence with the organization's Behavioral Health Program.
● I have confidence with how the organization provides a stress education program
● I have confidence with how the organization educates firefighters regarding stress
● I have confidence in the organization to manage the firefighter who experiences stress
● I have confidence that a fire officer can assist me with coping skills related to stress
● I have confidence with seeking assistance from the Union/Employee Assistance Program
regarding stress
● I have confidence the organization can design a new stress education program
● I have confidence the organization can design a train the trainer stress education program

Are interested in participating in the interview portion of the research? If you answer yes, please
click the arrow below to direct you to the next page.
(Yes) (No)

STRESS IN THE FIRE SERVICE 163

APPENDIX C
Evaluation Tool
Level 1 & 2

Level 1 Survey Questions: Learner will be asked to rate what they learned in the course.
Rating Scale: Strongly Disagree, Disagree, Agree, Strongly Agree.

1. I know how stress can affect me.
2. I can apply what I learned in the stress education course right now.
3. I believe understanding stress management is worthwhile.
4. I think I can apply what I learned in the stress education class to help me and peer
firefighters.

Level 2 Survey Questions: Learner will be asked to rate what they learned in the course.
Rating Scale: Strongly Disagree, Disagree, Agree, Strongly Agree.

1. I understand how stress can affect me as a firefighter.
2. I understand how to apply coping skills to assist in managing stress.
3. I understand what resources are available to me if I begin to feel stress.
4. I understand how to contact available resources.
5. I understand how I can help a peer firefighter.
6. I understand how to apply what I learned from the stress education course to assist
myself or peer firefighters.

Level 3 Survey Questions: Learner will be asked to rate what they learned in the course.
Rating Scale: Strongly Disagree, Disagree, Agree, Strongly Agree.

1. I understand the change for a cultural behavior setting is important to improve stress
management in the fire service.
2. I understand a sustainable cultural change will require reinforcement and
encouragement from all firefighters in the organization.
3. I understand the need to provide reinforcement and encouragement to all firefighters
in the organization will improve the culture in the fire service associated with stress
management.

STRESS IN THE FIRE SERVICE 164

APPENDIX D
Delayed Evaluation Tool
Level 1, 2, 3, 4

Level 1 Survey Questions: Learner will be asked to rate what they learned in the course.
Rating Scale: Strongly Disagree, Disagree, Agree, Strongly Agree.

1. I am satisfied with what I learned from the stress education course.
2. I am satisfied I can apply what I learned in the stress education course.
3. I am satisfied understanding stress management is worthwhile for my daily life.
4. I am satisfied and can apply what I learned in the stress education course to help me
and peer firefighters.

Level 2 Survey Questions: Learner will be asked to rate what they learned in the course.
Rating Scale: Strongly Disagree, Disagree, Agree, Strongly Agree.

1. I can apply the training learned in the stress education course to assist me with
managing stress.
2. I can apply the training learned in the stress education course to cope with stress.
3. I have recently applied the lessons learned from the stress education course.
4. I have recently applied the coping skills from the stress education course.

Level 3 Survey Questions: Learner will be asked to rate what they learned in the course.
Rating Scale: Strongly Disagree, Disagree, Agree, Strongly Agree.

1. I feel the stress education program is relevant to the fire service.
2. I feel the stress education program is relevant to me as a firefighter.
3. I feel the coping skills learned from the stress education course is relevant to me.
4. I feel a sustainable culture change is important to provide to improve the outlook
(macho culture) of stress culture in the fire service.
5. I am satisfied with the stress education course.

STRESS IN THE FIRE SERVICE 165

APPENDIX E

Fire
CARES
(Infographic Visual Aid – Sample)

Abstract (if available)

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Sticks and stones: achieving educational equity for Black students through board advocacy: an innovation study

PDF

Universal Wellness Network: a study of a promising practice

PDF

Knowledge, motivation, and organizational influences within leadership development: a study of a business unit in a prominent technology company

PDF

Strategic support for philanthropic fundraising: a needs analysis of development officers in higher education

PDF

Increasing workplace training transfer

PDF

Increasing collaborative practices in the military: an improvement study

PDF

Implementation of the Social Justice Anchor Standards in the West Coast Unified School District: a gap analysis

PDF

Leadership in an age of technology disruption: an evaluation study

PDF

Readiness factors influencing the ability of institutions of higher education to align the budget with organizational goals: an evaluation study of a college

PDF

Creating the conditions for change readiness in higher education: an innovation study

PDF

Middle-management's influence on employee engagement in the ambulatory practices

PDF

Improving the evaluation method of a military unit: a gap analysis

PDF

Initial and continuing physical and behavioral health and wellness education in the fire service: an innovation study on heart attack, suicide, and cancer prevention for Howard County Fire and Rescue

PDF

Teacher role in reducing the achievement gap: an evaluation study

PDF

Leadership readiness: evaluating the effectiveness for developing managers as coaches

PDF

Developing socially intelligent leaders through field education: an evaluation study of behavioral competency education methods

PDF

Societal violence against women and national insecurity: an evaluation study of teaching a gendered security perspective

PDF

Delivering client discovery training to financial advisors through peer-led podcasts

PDF

Theory-practice gap: MBA curricula as preparation for business practice in marketing

PDF

Developmental education pathway success: a study on the intersection of adjunct faculty and teaching metacognition

Asset Metadata

Creator Miyagishima, Glenn (author)

Core Title Stress in the Fire Service

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 04/08/2020

Defense Date 03/04/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag attribution,behavior,behavioral health program,conceptual knowledge,coping,cultural models,cultural settings,education,expectancy theory,factual knowledge,influences,Knowledge,Learning and Instruction,metacognitive knowledge,Motivation,OAI-PMH Harvest,organization,procedural knowledge,PTSD,reaction,self-efficacy,Stress,stress education,stress in the Fire Service,Suicide

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Yates, Kenneth (committee chair), Andres, Mary (committee member), Madrid, Krystle (committee member)

Creator Email glenn.miyagishima@yahoo.com,gmiyagis@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-279850

Unique identifier UC11673379

Identifier etd-Miyagishim-8248.pdf (filename),usctheses-c89-279850 (legacy record id)

Legacy Identifier etd-Miyagishim-8248.pdf

Dmrecord 279850

Document Type Dissertation

Rights Miyagishima, Glenn

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA