Confronting the inevitable: When a urologist feels like a second victim.

There are many opportunities for urologists to be emotionally impacted, and possibly injured, in the regular course of their work. In particular, urologists are vulnerable to become Second Victims as a result of errors, adverse events, and distressing clinical events. This article reviews best practices that individuals, training programs, hospitals, and healthcare systems can implement to intentionally and programmatically mitigate the short and long-term effects on healthcare professionals.

Helping without harm: providing emotional support to health care workers in 2023.

Reflecting on the efforts to provide acute emotional support to health care workers (HCWs) before and after the COVID­ 19 pandemic, 3 guiding principles are proposed for health care organizations, with the aim to support their workers by an efficient combination of disciplines and resources: 1) normalize the use of support resources for HCWs; 2) assess actual needs rather than act on assumptions; 3) reduce barriers for HCWs to get the support they need. Each of these principles is described in terms of their usefulness and potential for further developments that might provide better emotional support for HCW in the future.

RISE: Exploring Volunteer Retention and Sustainability of a Second Victim Support Program.

EXECUTIVE SUMMARY: The Resilience In Stressful Events (RISE) program that supports healthcare professionals traumatized by stressful clinical events has had a stable, volunteer-based membership since its inception in 2011 at Johns Hopkins Hospital. For this study, we explored RISE members' perceptions of the program that contribute to their retention and the program's sustainability. We distributed a survey with quantitative and qualitative elements to assess perceptions in seven domains of interest. The response rate was 100%. Pearson chi-squared tests established statistical associations among quantitative variables. Qualitative data were explored using content analysis. Of 27 respondents, 19 had been members for 3 or more years. The training completion percentage was 100%, and the annual turnover percentage was 12%. Members found their duties to be meaningful (100%), personally satisfying (96%), and positively impactful (93%). A total of 89% reported confidence in their competency to perform RISE duties, 84% in their autonomy, and 56% in their personal resilience; 28% reported some burnout from RISE duties. Cronbach's α for these domain scores ranged from 0.65 to 0.97. Content analysis also revealed positive perceptions of RISE volunteering and personal empowerment. Members indicated a personal affinity with RISE and gains in energy and enjoyment from their membership. Contributing factors to volunteer retention may include members' perceptions that RISE builds valued skills and supports their affinity for others.

Adapting RISE: meeting the needs of healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has placed extraordinary stresses on healthcare workers. Combined with disruptions to daily life outside of work, health care professionals experience a high prevalence of anxiety, depression, acute stress reaction, burnout, and PTSD. Top leaders at Johns Hopkins Medicine appreciated the mission-critical importance of maintaining the well-being and resilience of its essential workers. In March 2020 they asked the Johns Hopkins RISE (Resilience in Stressful Events) peer support program to help organize support for all staff. RISE made several adjustments, including adding virtual encounters to the usual in-person support, training additional peer responders, and rounding proactively on active units. Communication was broadened to reach less visible and lower wage workers. RISE collaborated actively with hospital epidemiology and infection control and began reporting regularly at incident command centre briefings. RISE also began to coordinate efforts with the other helping programs within the institution including the Office of Well-being, Employee Assistance, Spiritual Care, and Psychiatry. The number of calls and staff supported rose sharply. RISE supported over 4226 workers in the first 9 months of the pandemic. The adoption of RISE programs was accelerated at affiliated hospitals, as well as at other hospitals across the country in partnership with the Maryland Patient Safety Center. Experience with large scale disasters predicted correctly that worker distress would increase and persist beyond the initial wave of the pandemic. With subsequent surges of COVID-19, exhaustion and moral distress became nearly universal among workers. It is urgent for institutions to provide mechanisms to help their workers cope with the ongoing crisis and other crises that will inevitably occur in the future.

Case: A Second Victim Support Program in Pediatrics: Successes and Challenges to Implementation.

PURPOSE: While there is growing attention to making health care safer, there has been less emphasis on helping health care workers to cope with stressful patient related events (these workers are commonly referred to as second victims). We used the RISE (Resilience In Stressful Events) peer support program at the Johns Hopkins Hospital as a case study for evaluating effectiveness, and identifying barriers to addressing the needs of second victims. DESIGN AND METHODS: The study used a mixed-method approach that included: 1) quantitative analysis of surveys of health care workers in the Department of Pediatrics before RISE implementation and four years after, and 2) content analysis of open-ended commentaries about respondents' experience with seeking second victim support, as well as feedback on RISE. RESULTS: Survey response rates were 22.4% and 23.3% respectively. Quantitative analysis showed that respondents at the later time point were more likely to contact an organizational support structure, and had greater awareness of the availability of support. Respondents were very likely (93%) to recommend RISE to others. Content analysis identified barriers to using RISE: overcoming blame culture, need to promote the initiative, and need for more staff time to handle adverse events. Respondents reported varied preferences for the support format and specific support interventions. CONCLUSIONS: The mixed-method approach allowed a comprehensive evaluation of RISE and provided some evidence for its effectiveness in supporting pediatric health care workers. PRACTICE IMPLICATIONS: The findings suggest an important role of organizational culture in second victim support program implementation and evaluation.

Hospital Chaplains: Through the Eyes of Parents of Hospitalized Children.

BACKGROUND: Chaplain services are available in 68% of hospitals, but hospital chaplains are not yet incorporated into routine patient care. OBJECTIVES: To describe how families of hospitalized children view and utilize hospital chaplains. DESIGN: Telephone survey with 40 questions: Likert, yes/no, and short-answer responses. SUBJECTS: Parents visited by a hospital chaplain during their child's hospitalization in a tertiary care center. MEASUREMENTS: Descriptive statistics were used to characterize the sample. Nonparametrics were used to compare religious versus nonreligious parents. Regression was used to identify independent predictors of a chaplain visit positively influencing satisfaction with hospital care. RESULTS: Seventy-four parents were interviewed; most were 25-50 years old, and 75% felt their child was very sick. Children ranged from newborn to adolescence. Forty-two percent of parents requested a chaplain visit; of the 58% with an unsolicited visit, 11% would have preferred giving prior approval. Parents felt that chaplains provided religious and secular services, including family support and comfort, help with decision making, medical terminology, and advocacy. Chaplains helped most parents maintain hope and reduce stress. Seventy-five percent of parents viewed chaplains as a member of the healthcare team; 38% reported that chaplains helped medical personnel understand their preferences for care and communication. Most parents (66%) felt that hospital chaplaincy increased their satisfaction with hospital care. CONCLUSION: Families play a fundamental role in the recovery of hospitalized children. Parents view hospital chaplains as members of the healthcare team and report that they play an important role in the well-being of the family during childhood hospitalization. Chaplains positively influence satisfaction with hospital care.

Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study.

BACKGROUND: Second victims are healthcare workers who experience emotional distress following patient adverse events. Studies indicate the need to develop organisational support programmes for these workers. The RISE (Resilience In Stressful Events) programme was developed at the Johns Hopkins Hospital to provide this support. OBJECTIVE: To describe the development of RISE and evaluate its initial feasibility and subsequent implementation. Programme phases included (1) developing the RISE programme, (2) recruiting and training peer responders, (3) pilot launch in the Department of Paediatrics and (4) hospital-wide implementation. METHODS: Mixed-methods study, including frequency counts of encounters, staff surveys and evaluations by RISE peer responders. Descriptive statistics were used to summarise demographic characteristics and proportions of responses to categorical, Likert and ordinal scales. Qualitative analysis and coding were used to analyse open-ended responses from questionnaires and focus groups. RESULTS: A baseline staff survey found that most staff had experienced an unanticipated adverse event, and most would prefer peer support. A total of 119 calls, involving ∼500 individuals, were received in the first 52 months. The majority of calls were from nurses, and very few were related to medical errors (4%). Peer responders reported that the encounters were successful in 88% of cases and 83.3% reported meeting the caller's needs. Low awareness of the programme was a barrier to hospital-wide expansion. However, over the 4 years, the rate of calls increased from ∼1-4 calls per month. The programme evolved to accommodate requests for group support. CONCLUSIONS: Hospital staff identified the need for a multidisciplinary peer support programme for second victims. Peer responders reported success in responding to calls, the majority of which were for adverse events rather than for medical errors. The low initial volume of calls emphasises the importance of promoting awareness of the value of emotional support and the availability of the programme.

Pediatric residents do not feel prepared for the most unsettling situations they face in the pediatric intensive care unit.

BACKGROUND: Critical care rotations involve emotionally unsettling situations with greater frequency and intensity than those that are encountered in other portions of residency training. New approaches are needed to optimize the preparation and professionalism of postgraduate medical trainees when managing crisis management scenarios. METHODS: An anonymous survey was conducted that focused on preparedness for dealing with emotionally unsettling situations, training preferences for these encounters, and the utility of resource personnel. A total of 58% of four classes of pediatric residents responded over a 2-year period. RESULTS: Pediatric residents in our program identified sudden patient death and conflicts about goals of care within the team as the most unsettling situations. These were also the scenarios with which they had the least experience and for which they felt least prepared. Team discussion was designated as the most helpful educational tool, in addition to a combination of didactic educational programs and end-of-rotation sessions. CONCLUSIONS: The focus and design of clinical education programming on preparation for crisis management during the care of critically ill patients benefit from the incorporation of trainee perceptions of preparedness and the efficacy of educational formats. Trainee feedback in these areas can be harnessed as a continuous quality improvement tool and as a metric of success in meeting professional training goals.