The Pandemic's Toll-A Case for Clinician Support.

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response.

An Evaluation of Nurses' Perception and Confidence After Implementing a Workplace Aggression and Violence Prevention Training Program.

Workplace violence is highly prevalent for nurses, often going unreported. Regrettably, the very patients and visitors being cared for often perpetrate the majority of violence. This article's purpose is to describe how an institution implemented a workplace violence prevention training program designed to increase nurses' perception and confidence with aggressive and violent events. Evaluation of this quality improvement program posttraining was positive, suggesting this approach may influence nurses' abilities to prevent and manage these events.

When Clinicians Drop Out and Start Over after Adverse Events.

BACKGROUND: The impact of adverse clinical events on health care workers has become a growing topic of research. Previous research has confirmed that after adverse clinical events, clinical staff often feel as though they failed not only their patient but also themselves, resulting in second-guessing of their clinical skills, competencies, and even career choices. This exploratory study reports on the experiences of health care providers who changed career paths as a consequence of an adverse clinical event. METHODS: The authors designed a 39-question survey capturing personal and professional demographics, participant recall of the clinical event, insights into their lived experiences, health care institutions' response(s) to the event, decision-making influences relating to future employment, and insights into interventional strategies. RESULTS: Consistent with prior research, clinicians reported a pattern of inadequate social support after the event. Results further show the salience of emotional labor as a driving force among those who changed roles. In clinicians' own assessments about the lasting impact of the event, many felt less joy and meaning in their new clinical roles, but others thrived by rededicating their careers toward implementing patient safety initiatives and enhancing peer-support networks. Clinicians reported a desire for more transparency and support to help them recover. CONCLUSION: Clinicians aligned their emotional displays to be consistent with organizational expectations, resulting in suppressed feelings of guilt and shame that may have contributed to burnout, changed roles, or even premature retirement. Study findings highlight the need to develop better support systems for clinicians who are party to an adverse clinical event.

Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations.

PURPOSE: To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present. DATA SOURCES: Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety. STUDY SELECTION: Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals. DATA EXTRACTION: Study characteristic and outcome data were abstracted by two authors and reviewed by the research team. RESULTS OF DATA SYNTHESIS: Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization. CONCLUSION: Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE.

Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses.

BACKGROUND: Second victim experiences can affect the wellbeing of health care providers and compromise patient safety. Many factors associated with improved coping after patient safety event involvement are also components of a strong patient safety culture, so that supportive patient safety cultures may reduce second victim-related trauma. A cross-sectional survey study was conducted to assess the influence of patient safety culture on second victim-related distress. METHODS: The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC) and the Second Victim Experience and Support Tool (SVEST), which was developed to assess organizational support and personal and professional distress after involvement in a patient safety event, were administered to nurses involved in direct patient care. RESULTS: Of 358 nurses at a specialized pediatric hospital, 169 (47.2%) completed both surveys. Hierarchical linear regres sion demonstrated that the patient safety culture survey dimension nonpunitive response to error was significantly associated with reductions in the second victim survey dimensions psychological, physical, and professional distress (p < 0.001). As a mediator, organizational support fully explained the nonpunitive response to error-physical distress and nonpunitive response to error-professional distress relationships and partially explained the nonpunitive response to error-psychological distress relationship. CONCLUSIONS: The results suggest that punitive safety cultures may contribute to self-reported perceptions of second victim-related psychological, physical, and professional distress, which could reflect a lack of organizational support. Reducing punitive response to error and encouraging supportive coworker, supervisor, and institutional interactions may be useful strategies to manage the severity of second victim experiences.

Automated fall detection with quality improvement "rewind" to reduce falls in hospital rooms.

The purpose of this study was to test the implementation of a fall detection and "rewind" privacy-protecting technique using the Microsoft® Kinect™ to not only detect but prevent falls from occurring in hospitalized patients. Kinect sensors were placed in six hospital rooms in a step-down unit and data were continuously logged. Prior to implementation with patients, three researchers performed a total of 18 falls (walking and then falling down or falling from the bed) and 17 non-fall events (crouching down, stooping down to tie shoe laces, and lying on the floor). All falls and non-falls were correctly identified using automated algorithms to process Kinect sensor data. During the first 8 months of data collection, processing methods were perfected to manage data and provide a "rewind" method to view events that led to falls for post-fall quality improvement process analyses. Preliminary data from this feasibility study show that using the Microsoft Kinect sensors provides detection of falls, fall risks, and facilitates quality improvement after falls in real hospital environments unobtrusively, while taking into account patient privacy.

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic.

PURPOSE: The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim. METHODS: A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles. RESULTS: Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings. CONCLUSION: Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.

COVID-19 Preparedness, Stressors, and Data-Driven Solutions for Healthcare Workers at a Regional Rural-Urban Hospital System: A Longitudinal Total Worker Health® Study.

BACKGROUND: During the COVID-19 pandemic in the United States, healthcare workers were devastated by the insufficient preparedness to respond to their patients' and personal health needs. A gap exists in resources to prevent or reduce acute and long-term healthcare worker mental illnesses resulting from COVID-19 frontline response. METHODS: We performed an exploratory, mixed methods, longitudinal study of healthcare workers at a regional rural-urban hospital system in the Midwest United States during the COVID-19 response (4 timepoints, 2020). Using the Total Worker Health® (TWH) participatory needs assessment approach, self-identified frontline COVID-19 workers participated in a survey including Health-Related Quality of Life, Impact of Event Scale, and a modified version of the American Nursing Association COVID-19 survey; and a hospital timeline tracked system-level activities. FINDINGS: Response rate at Timepoint (T)1 was 21.7% (N = 39) and of those, 14 (36%) completed all four surveys. From T1 to T4, the rate of COVID-19 patients steadily increased, staff exceeded the threshold for post-traumatic stress disorder at T1 and T4; staff reported not enough rest or sleep 50% of the month, T1-T4. Helpfulness of family support increased but community support decreased, T1-T4. Concerns with performing new tasks increased; the challenges related to lack of protective equipment and negative media decreased. Workers wanted to be involved in decision-making, desired timely communication, and needed adequate physical, environmental, and psychological supports. CONCLUSIONS/APPLICATIONS FOR PRACTICE: Utilization of a TWH® strategy for describing health needs, hospital response, and multi-level staff suggestions to workplace health solutions during the COVID-19 pandemic identified evidence-based health promotion interventions in a hospital system.

Evaluation of health alerts from an early illness warning system in independent living.

Passive sensor networks were deployed in independent living apartments to monitor older adults in their home environments to detect signs of impending illness and alert clinicians so they can intervene and prevent or delay significant changes in health or functional status. A retrospective qualitative deductive content analysis was undertaken to refine health alerts to improve clinical relevance to clinicians as they use alerts in their normal workflow of routine care delivery to older adults. Clinicians completed written free-text boxes to describe actions taken (or not) as a result of each alert; they also rated the clinical significance (relevance) of each health alert on a scale of 1 to 5. Two samples of the clinician's written responses to the health alerts were analyzed after alert algorithms had been adjusted based on results of a pilot study using health alerts to enhance clinical decision-making. In the first sample, a total of 663 comments were generated by seven clinicians in response to 385 unique alerts; there are more comments than alerts because more than one clinician rated the same alert. The second sample had a total of 142 comments produced by three clinicians in response to 88 distinct alerts. The overall clinical relevance of the alerts, as judged by the content of the qualitative comments by clinicians for each alert, improved from 33.3% of the alerts in the first sample classified as clinically relevant to 43.2% in the second. The goal is to produce clinically relevant alerts that clinicians find useful in daily practice. The evaluation methods used are described to assist others as they consider building and iteratively refining health alerts to enhance clinical decision making.

Navigating the Storm: Documenting the Experience of Inpatient Registered Nurses Amid the COVID Pandemic-Palliative Care Team Insights.

Nominal research illustrates the lived experience of intensive care unit registered nurses during the COVID pandemic. Palliative care team leaders and nurse researchers designed this cross-sectional study to discover opportunities for palliative care team members to enhance the experience of nurses who cared for critically ill patients during this challenging time. The study aimed to compare the effect of caring for patients in COVID versus non-COVID units. Surveys were distributed after the area's initial COVID patient influx. Questions included general demographics, the Professional Quality of Life survey instrument (measuring compassion satisfaction, burnout, and secondary traumatic stress), and open-ended questions to identify protective factors and unique challenges. Across 5 care settings with 311 nurses eligible for the study in total, 90 completed the survey. The population consisted of COVID-designated unit nurses (n = 48, 53.33%) and non-COVID unit nurses (n = 42, 46.67%). Analysis between COVID-designated and non-COVID units revealed significantly lower mean compassion scores and significantly higher burnout and stress scores among those working within COVID-designated units. Despite higher levels of burnout and stress and lower levels of compassion, nurses identified protective factors that improved coping and described challenges they encountered. Palliative care clinicians used insights to design interventions to mitigate identified challenges and stressors.

How to develop a second victim support program: a toolkit for health care organizations.

A toolkit was developed to help health care organizations implement support programs for clinicians suffering from the emotional impact of errors and adverse events. Based on the best available evidence related to the second victim experience, the toolkit consists of 10 modules, each with a series of specific action steps, references, and exemplars.

The Well-Being of Peer Supporters in a Pandemic: A Mixed-Methods Study.

BACKGROUND: Peer support is an effective, well-received approach to caring for health care professionals who face stress, challenges, and reduced well-being. Peer supporters may be at risk for emotional exhaustion and secondary traumatic stress due to their primary roles and involvement as peer supporters during the COVID-19 pandemic. METHODS: Peer supporters from five well-established peer support programs completed surveys (ProQOL and a five-item emotional exhaustion measure) to assess secondary traumatic stress, compassion satisfaction, and burnout during the pandemic. Analysis of variance models analyzed differences in these well-being outcomes by role, age, years in health care, and working in high-risk areas. Qualitative content analysis was performed for open-response questions about challenges, needs, and successful well-being strategies using Braun and Clarke's six-phase thematic analysis. RESULTS: A total of 375 peer supporters completed the survey between spring and summer 2021 for a response rate of about 38%. Most participants had low secondary traumatic stress and moderate to high compassion satisfaction; nearly 44% had concerning levels of emotional exhaustion. Compassion satisfaction was significantly lower (p = 0.003) and emotional exhaustion significantly higher (p < 0.001) among the youngest cohort, and both compassion satisfaction and emotional exhaustion differed across career stages (p = 0.003 and p = 0.04, respectively). Emotional exhaustion was significantly higher in peer supporters working in COVID units than in non-COVID units (p = 0.021). Peer supporters identified numerous protective and risk factors associated with serving as a peer supporter. CONCLUSION: Despite having moderate to high levels of compassion satisfaction, peer supporters report high levels of burnout and numerous challenges and needs to sustain their well-being. To maintain effective peer support programs during the ongoing pandemic, health care organizations must study and support the well-being of health care professional peer supporters.

The Effects of the Second Victim Phenomenon on Work-Related Outcomes: Connecting Self-Reported Caregiver Distress to Turnover Intentions and Absenteeism.

OBJECTIVES: Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim-related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes. METHODS: A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression. The tool assesses organizational support, distress due to patient safety event involvement, and work-related outcomes. RESULTS: Second victim distress was significantly associated with turnover intentions (P < 0.001) and absenteeism (P < 0.001), while controlling for the effects of demographic variables. Organizational support fully mediated the distress-turnover intentions (P < 0.05) and distress-absenteeism (P < 0.05) relationships, which indicates that perceptions of organizational support may explain turnover intentions and absenteeism related to the second victim experience. CONCLUSIONS: Involvement in patient safety events and the important role of organizational support in limiting caregiver event-related trauma have been acknowledged. This study is one of the first to connect second victim distress to work-related outcomes. This study reinforces the efforts health care organizations are making to develop resources to support their staff after patient safety events occur. This study broadens the understanding of the negative effects of a second victim experience and the need to support caregivers as they recover from adverse event involvement.

The Role of Institution-Based Peer Support for Health Care Workers Emotionally Affected by Workplace Violence.

BACKGROUND: Academic health centers with peer support programs have identified a significant increase in requests linked to workplace violence (WPV) exposure. However, no known research has focused on supportive interventions for health care workers exposed to WPV. This study aimed to describe the expansion of two long-standing programs-University of Missouri Health Care's (MU Health Care) forYOU Team, The Johns Hopkins Hospital's (JHH) RISE (Resilence in Stressful Events) team-to WPV support, retrospectively summarize the related data, and share generalizable lessons. METHODS: A retrospective extraction and summary of the forYOU and RISE databases and the MU Health Care and JHH databases was performed tracking hospitalwide data on WPV. Two cases describe the experience of WPV victims. RESULTS: Between 2009 and 2019, forYOU documented 834 peer support interventions, 75 (9.0%) related to WPV (57 one-on-one encounters, 18 group support encounters). In 2018-2019 the forYOU Team experienced an increase in WPV encounters, with 43 of the team's activations (20%) related to WPV. Between 2011 and 2019, RISE recorded 367 peer support interventions, 80 (21.8%) of which were WPV-related (61 group support encounters, 19 one-on-one encounters). Forty-eight (60.0%) of these 80 encounters occurred in 2018-2019 alone, marking an increase in WPV encounters. Nurses were the most frequent callers of both programs. CONCLUSION: This study indicates the growing need for health care workers' support in the aftermath of WPV exposure in today's health care environment. Health care institutions should take a holistic approach to WPV, including timely access to interventional peer support programs.

Caring for our own: deploying a systemwide second victim rapid response team.

A unique rapid response system was designed to provide social, psychological, emotional, and professional support for health care providers who are "second victims"--traumatized as a result of their involvement in an unanticipated adverse event, medical error, or patient-related injury.

The Impact of Adverse Events on Clinicians: What's in a Name?

Unanticipated patient adverse events can also have a serious negative impact on clinicians. The term second victim was coined to highlight the experience of health professionals with these events and the need to effectively support them. However, there is some controversy over use of the term second victim. This article explores terminology used to describe the professionals involved in adverse events and services to support them. There is a concern that use of the term victim may connote passivity or stigmatize involved clinicians. Some patient advocates are also offended by the term, believing that it deemphasizes the experience of patients and families. Despite this, the term is now coming into widespread use by clinicians and health care managers as well as policy makers. As the importance of emotional support for clinicians continues to gain visibility, the terminology surrounding it will undoubtedly change and evolve. At this time, it may be most appropriate to label this important phenomenon in a way that local leaders are comfortable with-in a way that promotes its recognition and adoption of solutions. For example, for policy makers and health care managers, the term second victim may have value because it is memorable and connotes urgency. For support programs that appeal directly to health care workers, different language may attract more users. Debate concerning the benefits and drawbacks to this terminology will enhance and further drive its evolution, while helping retain our industry's focus on the importance of developing and evaluating programs to support clinicians in need.

Uncovering differences among health professions trainees exposed to an interprofessional patient safety curriculum.

In response to the Institute of Medicine challenge to improve patient safety and quality of care, an office directing patient safety/quality of care at an academic medical center and faculty from health professions schools collaborated on design, delivery, and evaluation of an interprofessional student curriculum on patient safety, quality, and teamwork. Annually for 6 years, second-year medical students, senior baccalaureate nursing students, second-year masters in health administration students, and junior baccalaureate respiratory therapy students participated. A pre-/postsurvey assessing students' attitudes about quality, safety, and teamwork was developed and modified to reflect course revisions. Survey items were grouped into 1 of the 6 subscales: human fallibility, disclosure, teamwork/communication, error reporting, systems of care, and curricular time spent with other professionals. At pretest, there were significant professional group differences in all the 6 subscales. At completion, differences in 4 subscales were resolved with the exception of human fallibility (P < .001) and curricular time spent together (P < .001). Interprofessional exercises within our curriculum mediated most differences among student groups. As more interprofessional curricular experiences are designed, examining baseline group differences is essential to optimize learning outcomes.

'New professionalism'-shifting relationships between nursing education and nursing practice.

New professionalism values egalitarian professional-client partnerships and considers competence integral. Within nursing competence has been accepted as the legitimate indicator of professional practice. There is a growing emphasis on instrumental competence and this has been accompanied by some erosion of relational care. In this paper I argue that new professionalism is problematic and nursing education faces particular challenges. These include negotiating service-education partnerships which reflect service user involvement and enable the integration of wider notions of competence.

Nursing students and Internet health information.

This study investigates use of the internet by nursing students to access health information and their evaluation practices in relation to this information. The research method was a retrospective descriptive postal survey. A questionnaire was sent to all undergraduate students enrolled in a Bachelor of Nursing programme at a New Zealand university in 2005. The response rate was 50% or 174 responses. Findings from the study included marked variations in respondents ability to successfully search for and evaluate relevant internet health and nursing information. Few respondents assessed patients use of the internet to gather health information or assisted patients with evaluation. As searching, evaluating and sharing online information is a core element of nursing practice, formal education to develop competency in the ability of all nursing students to retrieve and assess internet health information is essential. The integration of these skills into nursing practice is a vital step in developing new approaches to working with knowledgeable consumers of internet health information.