Armstrong Center for Patient Safety and Quality. September 29, 2022.
The Resilience in Stressful Events (RISE) program provides peer assistance for healthcare workers who experience psychological effects after involvement in stressful adverse care events. This virtual session presents RISE implementation education and orientation for staff to respond when peer support is needed.
Strategies to reduce clinician burnout related to adverse events are critically needed. Physicians in the United States were surveyed on their experiences with adverse events to identify facilitators and barriers to reducing burnout. A common facilitator was peer support, and barriers included shame and a punitive work environment.
Buhlmann M, Ewens B, Rashidi A. J Adv Nurs. 2022;Epub Apr 22.
The term “second victims” describes clinicians who experience emotional or physical distress following involvement in an adverse event. Nurses and midwives were interviewed about “moving on” from the impact of a critical incident. Five main themes were identified: Initial emotional and physical response, the aftermath, long-lasting repercussions, workplace support, and moving on. Lack of organizational support exacerbated the nurses’ and midwives’ responses.
Khansa I, Pearson GD. Plast Reconstr Surg Glob Open. 2022;10:e4203.
Some clinicians experience profound emotional distress following an adverse event, known as the “second victim” phenomenon. This study of surgical residents in the US found that most residents who reported being part of a medical error had subsequent emotional distress, including guilt, anxiety, and insomnia. Importantly, while three quarters of residents reported they did not get emotional support following the event, all those who did get support reported benefiting from it.
Rivera-Chiauzzi EY, Smith HA, Moore-Murray T, et al. J Patient Saf. 2022;18:e308-e314.
Peer support programs are increasingly used to support clinicians involved in adverse events. This evaluation found that a structured peer support program for providers involved in obstetric adverse events can effectively support providers in short periods of time (for example, 92% of participants did not need follow-up after second peer support contact) and can be initiated with limited resources.
Samuels A, Broome ME, McDonald TB, et al. J Patient Saf Risk Manage. 2021;26:251-260.
Healthcare systems have implemented communication-and-resolution programs (CRPs) (aka CANDOR) to encourage early disclosure of adverse events. This evaluation found that CRP training participants demonstrated improvements in self-reported empathy and communication skills.
Marr R, Goyal A, Quinn M, et al. BMC Health Serv Res. 2021;21:1330.
Many hospitals are implementing programs to support clinicians involved in adverse events (‘second victims’). Researchers interviewed 12 representatives of second victim programs in the United States about the experiences of their programs. The article discusses representative feedback regarding the importance of identifying a need for second victim programs and services, perceived challenges to program success, structural changes after program implementation, and insights for success.
Healthcare professionals involved in a medical error often experience psychological distress. This article describes the validation of a revised version of the Second Victim Experience and Support Tool (SVEST-R), which was expanded to include measures of resilience and desired forms of support.
Draus C, Mianecki TB, Musgrove H, et al. J Nurs Care Qual. 2022;37:110-116.
“Second victims” are healthcare providers who experience negative feelings in their personal or professional lives after being involved in unanticipated adverse patient events. One hundred and fifty-nine nurses at one American hospital reported being a second victim and experiencing psychological and/or physical distress following the incident.
Clinicians can experience adverse psychological consequences after making a mistake. This survey of 1,167 nurses found that social capital (both alone and in combination with psychological capital) has a significant impact on the severity of these adverse psychological outcomes.
There has been some controversy around the term ‘second victim.’ Based on qualitative interviews with representatives of medical training organizations and legal professionals in Ireland, this study found that the use of term ‘second victim’ can be seen as insensitive to the patient and can erode the professional identity of the healthcare provider.
Finney RE, Czinski S, Fjerstad K, et al. J Pediatr Nurs. 2021;61:312-317.
The term “second victim” refers to a healthcare professional who was involved in a medical error and subsequently experiences psychological distress. An American children’s hospital implemented a peer support program for “second victims” in 2019. Healthcare providers were surveyed before and after implementation of the program with results showing the highest ranked option for support following a traumatic clinical event is peer support. Most respondents indicated they were likely to use the program if a future clinical event were to occur.
Klatt TE, Sachs JF, Huang C-C, et al. Jt Comm J Qual Patient Saf. 2021;47:759-767.
This article describes the implementation of a peer support program for “second victims” in a US healthcare system. Following training, peer supporters assisted at-risk colleagues, raised awareness of second victim syndrome, and recruited others for training. The effectiveness of the training was assessed using the Second Victim Experience Support Tool. The most common event supported was inability to stop the progress of a medical condition, including COVID-19.
Stovall M, Hansen L. Worldviews Evid Based Nurs. 2021;18:264-272.
Clinicians who are involved in a patient safety incident often experience significant emotional consequences. This study found that nurses involved in an patient safety incident resulting in patient death were more likely to change jobs, consider leaving the profession, and have suicidal ideation, compared to nurses involved in incidents that did not result in patient harm.
Clinicians involved in adverse events that harm patients can struggle to come to terms with error. This toolkit is designed to assist organizations in the development of initiatives to support clinicians and staff after an adverse event. Areas of focus include leadership buy-in, policy development, and training. An implementation guide is also provided.
Van Slambrouck L, Verschueren R, Seys D, et al. J Prof Nurs. 2021;37:765-770.
An online survey of nursing students in Belgium found that about one in three students were involved in a patient safety incident during their clinical training, and the majority experienced emotional distress after the event. Medical and nursing curriculum should include opportunities for competency development to support peers involved in patient safety incidents.
Fatima S, Soria S, Esteban- Cruciani N. BMC Med Educ. 2021;21:408.
Healthcare providers who are involved in a medical error and feel guilt, remorse, shame, and anger are sometimes referred to as “second victims”. This mixed-methods study surveyed medical residents about their well-being, coping strategies, and support following a self-perceived medical error. Residents reported feeling fear, shame, and feeling judged, and many used maladaptive strategies to cope.
Kappes M, Romero‐García M, Delgado‐Hito P. Int Nurs Rev. 2021;68:471-481.
Healthcare professionals who experience negative physical, psychological, or behavioral responses following an adverse event may be referred to as “second victims.” This review describes personal and organizational support strategies as well as barriers faced by second victims who are seeking support. The authors recommend further evaluation of support programs and implementation of support programs in Latin America.
Kruper A, Domeyer-Klenske A, Treat R, et al. J Surg Educ. 2021;78:1024-1034.
Physicians commonly experience adverse psychological outcomes after being involved in an adverse event. This mixed-methods study of health care providers in the Department of Obstetrics & Gynecology at one large academic hospital found that three-quarters of providers experienced symptoms of traumatic stress after involvement in an adverse event. Respondents reporting anxiety were more likely to be interested in peer-to-peer support programs, whereas those reporting symptoms of guilt preferred debriefing sessions.
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