Sharing the Load of a Nurse "Second Victim"

Rescuing the Healer After Trauma

December 2008’s RN Magazine’s cover story shares the University of Missouri Healthcare System’s journey toward better understanding and providing support for its nurses on the sharp end of a medical error or unexpected patient decline. (Click here to view the entire text of the article.)

As the authors point out, there were no nursing specific studies found in the literature regarding helpful interventions, so the UMHS began to compile their own data and gathered anecdotal information from their nursing staff through a series of interviews. Upon review of the findings, UMHS has now begun developing an institutional response to formalize three levels of support for its nurses: (1) peer/colleagues; (2) department leader; and, (3) other institutional resources. Ultimately, they came to the conclusion that a comprehensive response plan must be in place for staff who may be suffering as “second victims” either as a result of a medical error or an unexpected patient decline. Second victims need support in timely and predictable ways, and support systems (peers/colleagues as well as leadership) should be anchored throughout the institution. Supportive peers and department leaders must be properly trained, and staff members need to be made aware of the availability of support services before something happens.

The MITSS mission of Supporting Healing and Restoring Hope has always included the emotional impact on the clinician (in this case the nurse) involved in an adverse event. We have consistently recognized the immense psychological (and sometimes physical) suffering of the medical caregiver in these instances. Barriers to open and honest dialogue and providing the necessary supports have included fear of retribution, loss of employment, guilt, shame, and the list goes on. The culture of “sucking it up” and suffering in silence has been slow to change, but programs such as those at UMHS serve to give us hope.

MITSS will continue to advocate for institutions to develop formalized support programs for all of their clinicians. The UMHS program featured in the article appears to focus on the nursing staff, but we know that these events can negatively impact physicians, pharmacists, and other medical caregivers as well. We have been the sole voice calling for emotional support for everyone involved in an adverse event since our inception, and it is gratifying to see that our persistent calls for change are beginning to be heard.

A No Cost Gift Idea with Lots of Benefits

Frank Federico, Executive Director, Strategic Partners at IHI and former MITSS Board Member, was kind enough to send along a wonderful and useful idea for holiday giving --

Medications are the most common intervention in health care. It is estimated that over half of older adults take 5 medications or more. In addition, many may be taking over-the-counter and/or herbal remedies. When these patients visit a hospital or their doctor’s office, it is difficult for them to remember all of their medications. The names of the medications do not make this task any easier.

Jennie Chin Hansen from AARP came up with a great idea. Encourage people to give their loved ones a list for Mother’s Day and Father’s Day. I am jumping ahead. Get started right now. For Christmas, why not ensure that each member of your family, immediate and extended, has an up-to date medication list. Imagine how much easier it will be for the patient to remember the medications he/she is taking, and for health care providers to review when providing care. And, promise to help keep that list up to date.

There are many formats to choose Check out http://www.macoalition.org/initiatives.shtml (Medication List) or visit the Institute for Healthcare Improvement (www.IHI.org ) for examples from participants in the 5 Million Lives Campaign (key word search: medication list).

By the way, if you or your loved ones do not take medications, how about a card that indicates that you do not take medications. In the event of an emergency, healthcare providers will not have to spend time trying to collect information about your medications.

Frank Federico
Executive Director, Strategic Partners
IHI

MITSS and CarePages

In our most recent newsletter, you may have noticed that we had an announcement about MITSS and CarePages new partnership. We have done these to offer patients, families and clinicians a free, private web page to journal and share their experiences during a time when support maybe needed. At MITSS, we have come to appreciate the amazing healing power that comes with chronicling one's story. Setting up a CarePage is also a great way to share photos, news, and updates. A CarePage can be created and used at any stage of care, and it doesn’t have an end date. So,
visit www.carepages.com/mitss today and click on “Create” to start your own journal. In order to have the MITSS logo on your web page you must create through the above web page. Linda Kenney, the president of MITSS has created her own web page that chronicles her ankle replacement surgery and the subsequent infection. She will continue to update as she progresses and you can access her page by going to http://www.carepages.com/carepages/LindaKKenney .

If you know anyone that may benefit from using this tool, please pass it along.

Let us know what you think.

Arrogance and Etiquette

There were two interesting pieces in the New York Times this week on physician's attitudes and communication in the workplace, and the effects on quality of care.

"Arrogant, Abusive and Disruptive - and a Doctor" discusses how the intimidating and aggressive attitudes of some doctors lead to errors in care. Staff working with aggressive physicians feel they do not have the right to speak up about problems with care and may be shouted down if they do. The article also discusses institutional responses to the problem, including communication requirements in medical schools and increasing enforcement of hospital codes of conduct.

In a related column, "The Six Habits of Highly Respectful Physicians", Michael W. Kahn, a Boston area psychiatrist, advocates for basic etiquette training for physicians.

We'd really like your thoughts on both of these pieces. Have you ever witnessed any kind of abusive behavior? Have you ever been on the receiving end of something like that? Do you think this type of behavior is commonplace, rare, or somewhere in between? Why? Do you think etiquette training for physicians would help?