Let's say that you're a nurse on a hospital unit, and a colleague has recently been involved in a medication error. It was a mistake that anyone might make — a tenfold overdose that occurred when she wrote down an order and accidentally moved a decimal point one space to the right. Luckily, it didn't lead to major harm, but the nurse is visibly shaken by the event and the investigation that followed. She looks to you for help dealing with her feelings of professional inadequacy and fear.
Now the pressure is on you. What do you say? What words should you avoid?
It’s tempting to try to "fix" the problem. You may want to rehash the event ehealth pharmacy online and figure out what would have prevented it. You may want to pry into the nurse's mental state at the time of the error. You might want to share that similar things have happened to you, in an effort to get her to move on and feel normal.
Though well-intentioned, these approaches likely won't help the nurse to process the complicated emotions that follow such an event or help her to focus on her current patient care duties. In fact, too often the responses that naturally follow when a colleague is upset may serve our own interests more than theirs. Maybe we can't help but try to dig into the event and figure out how to avoid a recurrence. Or perhaps we just want to avoid the awkwardness of having someone unload their feelings to us. Our traditional training prepares us to heal bodies, but not to soothe tormented minds.
At The Johns Hopkins Hospital, we sought to bridge that gap by developing a confidential peer support program for caregivers who are traumatized by stressful patient-related events (See recent blog post). Called Resilience in Stressful Events, or RISE, this program trains health care professionals to administer emotional first aid to individuals or groups.
We hope that such "caring for the caregiver" programs become commonplace across hospitals. But even if that happened, there would still be occasions when we need to be there for a distressed colleague, to know what to say and what to do when providing emotional support. In creating our peer responder training curriculum, we learned what works in these situations.
These tips are seemingly commonsense, but it's surprising how often we say and do things that we shouldn't in these situations, whether at work or in personal situations when a loved one is coping with a traumatic situation.
- Find a quiet place.
- Ask open-ended question and help the person to process how the event has impacted him or her.
- Listen and offer support to the person, regardless of whether you endorse his or her actions or believe the story.
- Paraphrase what you’re hearing. For example: "It sounds like you’re pretty angry with the situation. Is that right?"
- Make empathetic statements, such as "That must be overwhelming for you."
- Ask the individual to identify resources in his or her life that are positive, such as running or cooking.
- Help the person plan the next day or week, and incorporate positive activities into his or her schedule.
- Direct the person to resources, such as an employee assistance program or Medically Induced Trauma Support Services.
- Ask questions about the event or try to investigate whether he or she was at fault. You are there for the person.
- Try to "fix" anything. You are just there to listen.
- Tell the person how you feel about the event.
- Use statements that belittle the person’s feelings, such as "I know how you feel," "The same thing happened to me" or "It's a routine complication; get over it."
- Tell the caregiver what to do, how to feel or how not to feel.
- Shut the person down. If they are crying, don't hug them or give them tissues just to make them stop.
- Share any information about the encounter unless there is an overwhelming reason, such as fear they may hurt themselves.
Whether you volunteer to do so or not, you're likely to find yourself in the position of an informal peer responder at some point in your career. And you may feel like you’re in over your head, trying to fix a problem that can't be fixed. But in truth, just being there for someone is the most important thing you can do. As long as you focus on the caregiver who is the "second victim," you can help this colleague to begin the path to recovery.
Johns Hopkins Hospital RISE Program
Hospital employees can visit the RISE intranet to request peer support, learn how they can get trained to deliver emotional support to colleagues, and find resources for dealing with stressful events.
Good points Cheryl.
If everyone was exposed to knowing how to avoid these situations while studying their professional education programs and it was reinforced during the clinical training and post training periods, professionals would take advantage of The Science of Patient Safety course, by first knowing it exists, and many problems could be better handled when errors occur and many more errors could be avoided.
Thanks Elizabeth! I fully agree. We need to infuse such education as we are developing our clinicians and preparing them to enter this stressful arena that we call healthcare. More harm can be done to an individual if responses are non-supportive. The Science of Safety is a great place to start as it helps us to understand our defects from a systems perspective and as a result, focus on systems soltuions rather than blaming an individual.
I really appreciated this wonderfully insightful description of a situation that is commonly overlooked, but critical to developing a robust risk culture. Very impressive how HRO ideas of resilience are given a very well grounded process in RISE. Thank you for sharing!
Thanks David! This has been a powerful initiative as we strive to meet the principles of HRO. Even though it has helped to shift our culture, it has been a slow process.
Great work of the Johns Hopkins team. This second victim phenomenon is an international problem. Also in Europe several teams are working on this topic, including the 2 most recent systematic reviews on this topic (by Seys et al).
I would like to inform you about:
- Seys. D. , Scott SD, A.W. Wu, ... & Vanhaecht, K. Supporting involved health care professionals (second victims) following an adverse health event: A literature review. International Journal of Nursing Studies 2013;50(5):678-87.
- D. Seys, A.W. Wu, E. Van Gerven, ... & Vanhaecht, K. Health care professionals as second victims after adverse events: a systematic review. Evaluation & the Health Professions 2013;36(2):135-62.
- Van Gerven E, Seys D, Panella M, ... & Vanhaecht, K. Involvement of health-care professionals in an adverse event: the role of management in supporting their workforce. Pol Arch Med Wewn 2014;124(6):312-20.
I have experienced this myself having been fired for not turning an IV from 75 to 25/hr on a day we were severely understaffed. I had been at that job for 20 yrs with a good record. Very punitive environment.
Hi Jane, I am so sorry to hear about your experience. I hope you were provided with support, if not through work, from a friend or family member. We are trying to move away from such environments. It sounds like you were set up in an unsafe system, but that was not acknowledged. Hoping you are well.