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Continued Support for the Second Victims

Tracey Bagwell a patient and fam­ily education coordinator who has been a nurse for over 30 years, recalls the countless number of times she has witnessed colleagues experience a traumatizing patient event, such as a serious injury or even death, and then are expected to “pick themselves up” and move on to the next patient.

According to the Johns Hopkins Armstrong Institute for Patient Safety and Quality, many providers experience stressful, patient-related events, such as an unexpected patient death or prevent­able complications. These employees are considered “second victims” in the sense that the provider who is involved in the adverse event may become traumatized as a result. The RISE (Resilience in Stressful Events) Peer Responder Train­ing, implemented three years ago at The Johns Hopkins Hospital, addresses this growing need to support second victims with proven approaches for peer support and stress management, with special ap­plication to the needs of clinicians.

“We put our staff in emotionally, physically and intellectually intimate situations, and when bad things hap­pen, they’re expected to march on,” says Bagwell, who works at Johns Hopkins Bayview Medical Center and partici­pated in the May RISE training.

Cheryl Connors, a patient safety specialist with the Armstrong Insti­tute, co-developed the RISE training and says it’s important to permeate the institution with people who can provide “psychological first aid” and emotional support. Approximately 150 employees have participated in the rigorous, all-day trainings at Armstrong Institute, and 35 of these employees provide round-the-clock support through the 24-hour hotline, Connor says.

Participants learn how to provide peer support based on seven principles: show up, stay calm, listen, empathize, avoid fixing, maintain confidentiality and activate a debrief. Matt Norvell, a chap­lain at The Johns Hopkins Hospital and training instructor, teaches the coping mechanism “grounding.”

“A way to help someone in a stressful situation is to ask them to check their pulse and let them know they’re safe,” Norvell says. “This helps to draw them out of the traumatic event and remind them that they are OK right now.”

Albert Wu, an internist at The Johns Hopkins Hospital and RISE co-founder who coined the term “second victim” in an article in the British Medical Journal in 2000, says the training is valuable because stressed-out, unsupported staff members cause a vicious cycle of low morale and high turnover, poor pa­tient care and dissatisfied patients and employees.

“We are frail human beings,” says Wu. When we are stressed, we react in predictable ways. Second victims often feel like they did something wrong— like if you talk to people who have been robbed, they say, ‘I shouldn’t have been walking at 3 a.m. on the street.’ ”

Senior Director of Patient Safety Lori Paine and former Director of Pediatric Nursing Shelley Baranowski recognized the need to more effectively care for second victims after discussions with the pediatric nurses who still experi­enced pain almost 10 years after the 2001 tragic death of toddler Josie King at The Johns Hopkins Hospital. Paine and Baranowski formed a committee in 2010 to develop resources for the nurses and similar providers.

Wu says part of patient safety should be taking care of the caregivers because you need healthy people to effectively serve our patients: “If we are all burned out or spiritually sick, we can’t do the job we need to do every day.”

The next RISE training is Nov. 15. To register, visit insidehopkinsmedicine.org/ RISE or email questions to ailearning@ jhmi.edu.

To reach a RISE counselor and receive support, call 410-283-3953.

If you would like to apply to be a peer responder on the RISE team, email cci­cio1@jhmi.edu.

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