Following exposure to adverse events, medical errors, or unanticipated clinical outcomes, healthcare providers manifest a predictable trajectory of emotions, including depression, guilt, embarrassment, questioning clinical skills, PTSD, and, even, suicide. The patient is the first victim and healthcare provider, second victim. This phenomenon was studied by a team of clinicals at The University of Missouri Healthcare System; out of that research, The Second Victim Experience Support Tool (SVEST) was created and identified that clinicians desire more organizational and colleague “peer support” following adverse events. The Second Victim Transpersonal Caring Model was created and implemented to provide emotional first aid to all levels of healthcare providers to foster more rapid return to pre-event functioning without lingering effects. There remains a gap in healthcare providers’ understanding of second victimization and availability of peer support programs in a large number of healthcare organizations. The purpose of this DNP project was to implement a pilot peer support program to provide ongoing empathetic peer support to second victim teammates.
The methodology included distribution and analysis of the SVEST to determine needs of healthcare providers in the pilot departments, increase awareness, and build momentum for the program. Secondly, creation of program guidelines and protocols for tracking of program metrics and utilization. Third, to recruit and train a cross-disciplinary cadre of peer supporters, including members from outside the pilot area. Finally, increase institutional awareness of the second victim phenomenon to promote further awareness and buy-in from stakeholders.
The SVEST instrument resulted in high percentages of employees that completed the survey had experienced manifestations of the second victim phenomenon, a perceived lack of organizational resources, and, 80% desired a respected peer colleague to discuss events. Implementation strategies included increasing department and institutional awareness of the second victim phenomenon, allowing further buy-in from stakeholders via meetings, presentations, and marketing strategies. Using the Second Victim Transpersonal Caring Model and in collaboration with Employee Assistance Program and Chaplain services, program guidelines and peer support training programs were executed successfully, with the initial cohort of seven, including two outside the pilot area. Further implementation included development of program guidelines, an organization-wide Share point site, and private email address to the peer support team. Marketing strategies to build awareness included use of badge buddies, business cards, Facebook live discussion and presentations, and posters displayed in prominent areas of the surgical services suite.
Although healthcare organizations offer various resources for support via Employee Assistance Programs or Chaplain services, there remains a gap in many organizations in providing a respected peer colleague to provide emotional support to all levels of employees following exposure to unanticipated clinical outcomes. It is impossible to obliterate adverse events and unexpected clinical outcomes; this was heightened by the Covid-19 pandemic crisis. The ability to provide desired peer support to those suffering from the second victim phenomenon can mitigate the negative consequences and allow the employee to return to their pre-event level of functioning.