2nd victims in the NHS
Key observations from the presentation delivered by Dr. Ceri Jones
DEFINITION: Healthcare team members involved in an unanticipated patient event, a medical error and/or a patient related injury and become traumatised by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base.
Recent studies in the sector suggest that almost 50% of healthcare professionals have a second victim experience during their career, and that it leads to experiences similar to PTSD.
Like policing, the NHS operates in a life-changing environment that sees trauma of varying degrees on a daily basis for the majority of its staff. This daily exposure to trauma, and the association with specific incidents, has serious psychological effects on the worker including compassion fatigue, intrusive thoughts and images, difficulties separating work from personal life, decreased feeling of work competence, and burnout.
A pilot project is underway in the NHS. The creation of an Emotional Resilience Support Unit is underway at University Hospital London and Nottingham University Hospital. This sees a 3-tier approach involving training local leaders on supportive leadership of human factors, implementing peer support programmes, and access to an expedited referral network with external provision.
The second tier, peer support, focuses on providing 1:1 crisis intervention, support, mentoring, and debriefing initiatives. Acting as an ‘emotional first aid’ programme, it is available immediately or soon after a difficult work-related event and provides a confidential and safe place to talk.
The programme has been built around evidenced-based guidelines developed by the National Institute for Health and Care Excellence (NICE) on treating PTSD, and is designed to be delivered by staff with no pre-existing expert knowledge. Most importantly, there is no implication of legal liability beyond the normal NHS workplace duty of care.
The peer support programme provides a useful way to address the issues for an individual within an environment that is comfortable without the stigma.
It is not about implementing a clinical process. It allows the individual to reflect out loud to a colleague who understands the environment they operate in, and encourages their brain to process the information it has built up.
The Injury on Duty report produced by the Police Dependants’ Trust highlighted that there was a need for “…Not a counselling service but like an off-loading service. You know, we suck up so much trauma but there is no release for that…”. That is what the ERSU is designed to do, but it also has the next tier of support built in as well for when the peer support programmes are not enough.