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April 19, 2013 // By Sally Sapega // Comments

Emotional First Aid for 'Second Victims'

Health Care Quality and Safety // Nursing Share this article

  • A trauma nurse faces the tragic loss of a young patient close to his own son’s age.
  • A transporter must bring an infant who died in the Neo-ICU down to the morgue.
  • A pharmacist hears that his patient had an anaphylactic reaction to a medication.  He discovers the medication allergy was documented but not acknowledged during the patient’s admission.
  • A housekeeper learns that a long-time patient she has grown close to has coded and is now in an intensive care unit.

 Second victim photo

What do all these hospital employees have in common?  They are ‘second victims’ of a tragic patient outcome.  For years, many have suffered in silence, trying to retain the expected stoic façade. 

But, now, at the Hospital of the University of Pennsylvania, a new program launching this summer will pro-actively provide immediate ‘emotional’ first aid to those who need it.

Studies show that health-care providers often have strong feelings of guilt or inadequacy following an unanticipated bad outcome or medical mistake. “They feel responsible and may see it as a personal failure,” said Jill Huzinec, RPh, director of Patient Safety at the hospital. While most staff are resilient and will recover after a traumatic event, nearly one-third report experiencing personal problems after such an event.  Even more concerning: 30 percent have seriously contemplated leaving their profession as a result of an event.

“It’s a stigma in the medical profession; you don’t get upset ,” she said. “You just go on to care for the next patient.  But how can a provider help someone else when he or she is suffering emotionally?”

At HUP, the Care for the Care Provider program will be available to any employee who might be emotionally traumatized by an event, not just the clinical staff:  all disciplines, all departments, all shifts. And it will be available 24/7.  “No one should have to wait till Monday to talk about their emotional distress related to an event that happened on Saturday night.” It will also support those who have experienced violence in the workplace, such as employees who have been attacked by patients or family members.

A Three-Tiered System of Support

The program’s ‘Rapid Response Support System’ comprises three tiers of support. A leader in the department or unit who has been trained in basic ‘emotional’ first aid will provide the first level.  At HUP, staff need to inform a supervisor when an event happens. This provides the perfect opportunity to suggest a brief respite – five minutes to take a walk, clear their thoughts or just talk with someone – if someone needs it, Huzinec said.  “The support is offered proactively, without waiting for the employee to seek it out.”

An adverse or unexpected event rarely affects only those directly involved. In addition to providing emotional support, Care for the Care Provider will focus on team discussions to prevent the event from happening again. “We want people to feel comfortable speaking about the event and its emotional impact in a nonjudgmental environment.”

The second tier of the program will provide support from specially trained peers who will have "their finger on the pulse of what’s going on in the unit at all times. If these peers observe an increased level of stress in their area, they can call a huddle, a moment to talk. This lets the staff know someone is listening and is there to support their needs.”

The third tier will be for those who need professional counseling from staff specially trained to do so, such as a chaplain, EAP (employee assistance program) personnel, social workers or clinical psychologists.

“It is a human response to feel sad when someone dies or when something bad happens to a patient. We want to eliminate the stigma and make this support system part of normal practice, a part of our culture of safety.”



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