by Tara Ramey, DNP, RN, NPD-BC
It is no secret COVID has ravaged the mental health of care providers throughout the country. In December 2020 the Joint Commission published a safety alert regarding the negative impact COVID was having on healthcare workers. Nurses are fleeing the profession in record numbers yielding a staffing crisis across the country. Within the last month, a report was released that found female nurses are roughly twice as likely to die by suicide than the general female population.
Often haunted by their experience after an adverse event, care providers may demonstrate an array of symptoms. These can range from mild anxiety and distractedness, to life altering symptoms of PTSD. Feelings of shame, sleep disturbances, and depression are common, and may lead to the interruption of their ability to function at work and or home.
Second Victim is a term coined by Dr. Wu in 2000 to identify those healthcare workers who have been involved in a patient adverse event. He felt that while the patient was clearly a victim, the “first victim”, those involved in the event were also victims, hence, the “second victim”. He found that nurses and physicians often suffered negative psychological effects after the incident, marked by common feelings of anxiety, guilt, and depression. Research surrounding this phenomena continues to grow and has identified that as many as 50% of healthcare workers state they have experienced at least one second victim incident within the last year. These statistics were prior to COVID. Without intervention, the second victim may have prolonged and increasing symptoms leading to an inability to focus, a common symptom, that increases risk to patient safety. Limited support for second victims leads to increased burnout, a decrease in compassion, and higher absenteeism and turnover rates.
Second victim peer support programs come in all shapes and sizes, but there are a few characteristics that are consistent throughout. First and foremost, they are limited in scope. This is not therapy. An intervention consists of a team member or members, meeting with a group or individual to provide peer support helping to normalize the emotions of the victims and provide them information on additional resources upon request. These team members are healthcare workers and can range from physicians, phlebotomist, nurses, basically, anyone who provides direct patient care and can relate to the emotions surrounding an adverse event. Secondly, peer support programs are like Vegas. What is said in an intervention stays in the intervention. These conversations are not meant to be used in an incident report or review and certainly not documented in the medical record. It is meant to be a safe place where the impacted providers can talk about their feelings and what they are doing to cope with the event. Finally, they are time sensitive. Most research recommends peer support intervention take place within 24-48 hours of the incident.
Because of this, these programs are designed to have team members available within a few hours of the initial request. There are several examples in the literature of second victim peer support programs. There are two seen most frequently in the literature and are often the foundation of other programs. These are University of Missouri Hospital’s forYou program and The Johns Hopkins Hospital’s Resiliency In Stressful Events (RISE) program. They are both based in large hospitals, but the concepts can be scaled down to be implemented in a small community hospital. Additionally, there are four common curriculums used to train peer support team members. These include Psychological First Aid (PFA), Care for the Caregiver, Medically Induced Trauma Support services (MITSS) and Critical Incident Stress Management Debriefing (CISMD). Each of these have their own strengths and weakness and should be evaluated as to the best fit for the specified hospital.
Second victim peer support groups work. I’ve seen this both in the literature and my own personal experience. As leaders with a passion and skill set to encourage and develop other healthcare workers, it is important we utilize any effective tools available to help us support our hospitals and each other during this time of crisis. Sharing education around second victims and resources to provide care for these individuals is a good start.