MU Program Helps Health Care Workers Move Past Tragedy

Program has been recognized nationally

March 26, 2013

Story Contact(s): Christian Basi, 573.882.4430

COLUMBIA, Mo. ­—When a patient dies unexpectedly, whether suddenly or after a long illness, the loss can hit loved ones hard. In some of these cases, health care workers can be affected deeply due to the emotional bonding that can occur between patients and their caregivers. Now, studies have shown that a new program that provides support and training at the University of Missouri Health Care System is helping health care workers get back on their feet and heal both mentally and physically.

“Our staff is here to help patients, but when the care doesn’t lead to a positive outcome, it can take a toll on our staff’s psyche,” said Susan Scott, a registered nurse, patient safety coordinator and director of the forYOU peer support program at MU Health Care and doctoral student in the Sinclair School of Nursing. “The term “second victim” is used to describe health care workers who suffer physically or emotionally following a negative outcome in a medical setting. The ‘first victim’ is the patient and his or her family, but the health care worker becomes the ‘second victim.’”

Situations that can result in an emotional burden for a health care provider include an unanticipated decline in a patient’s condition, caring for young trauma victims, the first death experienced as a health care worker, caring for young victims of violence or neglect, the death of a patient who was starting to recover, violence in the workplace, dealing with elder abuse cases or even a colleague’s death.

“As a caring being, individuals enter into health care to help people; after a while you may become resilient to many situations, but some cases can drill through that armor that builds up over years and can leave an emotional scar,” Scott said.

To support health care providers through these emotional situations, in 2006 Scott and her colleagues established a team that supports caregivers after any adverse event. In the last several years, Scott and her team have conducted numerous studies to determine what is needed to most effectively provide the necessary support for second victims to help them recover from their respective clinical event.

“Following an event, clinicians are willing to review the outcome of the case and determine if any actions could be taken to avoid a negative outcome in the future, but then many of them will immediately start questioning whether they wanted to continue their career in health care,” Scott said.

One such case involved a nurse, “Elaine,” who was attacked by a female patient waking up following a surgical procedure.

“I was in the recovery room with the adult patient, and as I was repositioning a bed pan, the patient took one of the monitoring cords that was attached to her and wrapped the cord around my neck and started to strangle me,” Elaine said. “It only lasted a few seconds, but it seemed like forever.”

Elaine stayed home the following day, but was back at work within 48 hours. When she arrived, her co-workers and the peer support team greeted her.

“Eventually, I was fine, but after something like that happens, you question every move you make; it shakes the core of your foundation as a health care worker,” Elaine said.

According to Laura Hirschinger, R.N., M.S.N., co-investigator and forYOU tam leader, Elaine’s response to the event is very common. The forYOU research team identified eight actions in three tiers of clinician support with action items that should be addressed following an event.

-Tier I (basic, immediate emotional first aid offered by supervisors/colleagues in the same department as the second victim)

  • Address potential second victims to ensure that they are “OK” immediately following a critical clinical event.
  • Provide basic awareness training to unit leaders and colleagues to educate them on key actions to take following an event.

-Tier II (guidance and nurturing of second victims by colleagues specifically trained on the second victim experience)

  • Embed specially trained peer supporters within clinically high-risk departments
  • When necessary, refer second victims to internal resources, such as patient safety experts, for support.
  • Provide long-term assistance for legal action if necessary.
  • Offer group debriefings when an entire team is affected.
  • -Tier III (ensure prompt availability and access to professional counseling and guidance)

    • Provide a fast-track referrals to individuals specifically trained to handle crisis intervention, if necessary.
    • Provide access to additional hospital resources such as chaplains, social workers and clinical psychologists if necessary.

    “Every day, well-meaning health care providers working in clinically complex environments face the harsh reality of unanticipated and sometimes tragic patient outcomes in their chosen professions,” Scott said. “By studying this program that we put in place, we believe we have established a network that can help health care professionals so they know what is available, what to expect, and how to access assistance in the aftermath of unanticipated clinical events.”

    Studies on the program have been published in The Joint Commission Journal on Quality and Patient Safety and BMJ Quality & Safety. The forYOU Team recently received the 2012 Institute for Safe Medication Practice CHEERS award for this patient safety innovation and assistance to countless clinicians.

MU’s Rebecca Johnson to Take on National Advisory Role

March 04, 2013

Story Contact(s): Nathan Hurst, 573.882.6217

COLUMBIA, Mo. — Rebecca Johnson, a professor at the MU College of Veterinary Medicine, director of Research Center for Human-Animal Interaction, and the Millsap Professor of Gerontological Nursing in the Sinclair School of Nursing, has been elected to the National Academies of Practice (NAP) and the Veterinary Medicine Academy (VMA) as a distinguished scholar and fellow. Johnson will be inducted into the NAP in April during the organization’s annual meeting and forum.

The NAP was founded in 1981 to advise Congress in health care practice and delivery. The Academy comprises 10 interdisciplinary organizations: dentistry, medicine, nursing, optometry, osteopathic medicine, pharmacy, podiatric medicine, psychology, social work and veterinary medicine. NAP fellows are considered among the most distinguished in their fields and are chosen only after a rigorous selection process. Membership is limited in order to maintain the Academy’s high standards.

Johnson earned her baccalaureate degree in nursing from the University of Dubuque, Iowa in 1980, her Masters of Philosophy degree from the University of Edinburgh, Scotland in 1982 (as a Rotary Foundation Scholar), and her doctorate from the University of Iowa in 1992. She joined the University of Missouri Sinclair School of Nursing (SSON) in August 1999 as the Millsap Professor of Gerontological Nursing and Public Policy and shortly thereafter was given a joint appointment as associate professor in the College of Veterinary Medicine (CVM) for her research on human and companion-animal interaction. She was promoted to full professor in the CVM and SSON in 2012.

Johnson established the Research Center for Human-Animal Interaction (ReCHAI) in 2005. Her externally funded program of research and community projects merges her work on wellness and relocation of the elderly, assistance of war veterans who have post-traumatic stress disorder and prisoners with the benefits of human-companion animal interaction. Her research shows that companion animals provide a unique source of social support and facilitate motivation for exercise and other wellness-promoting behaviors.

The author of many scholarly publications in peer-reviewed journals and books, Johnson presents her research findings nationally and internationally. She also is called upon as a consultant regarding the relocation of older adults, and human and companion-animal interaction programs. In 2005 she was named the University of Missouri’s William H. Byler Distinguished Professor, an award given for “outstanding abilities, performance and character.” In 2007 she was inducted as a Fellow of the American Academy of Nursing, the highest honor in academic nursing joining only 1,500 nurse academics nationwide to achieve such an accomplishment. In 2011 she had two books published by Purdue University Press: Walk a Hound, Lose a Pound: How You and Your Dog can Lose Weight, Stay Fit, and Have Fun Together, and The Health Benefits of Dog-Walking. Since 2010, she has served as president of the International Association of Human-Animal Interaction Organizations (IAHAIO), a global umbrella association of more than 40 organizations doing practice, education, or research in human-animal interaction. In July, 2013, IAHAIO will hold its triennial conference in collaboration with the American Association of Human-Animal Bond Veterinarians, and the AVMA’s 150th convention in Chicago, Ill.

Johnson’s studies have received funding from the National Institutes of Health, Missouri Foundation for Health, the Waltham Foundation, Pedigree Foundation, Banfield Charitable Trust, and the University of Missouri’s Mizzou Advantage One Health/One Medicine initiative, which facilitates collaborative research projects that benefit human and animal health.

“As a member of the NAP-Veterinary Medicine, it will be my privilege to help this wonderful organization continue to move the importance of the human-animal bond to the forefront with policy-makers nationally,” Johnson said.

The mission of the National Academies of Practice is to promote excellence in practice of health care professionals, and quality health care for all through interprofessional collaboration in service delivery, research, education, and public policy advocacy. To achieve this goal, NAP holds interprofessional healthcare policy forums, Congressional briefings, membership symposiums, and combined conferences. NAP also publishes public policy and position papers, distributing key findings to members of Congress, healthcare planners, public agencies and other interested parties. The Academy publishes the NAP Journal of Interprofessional Healthcare, a free, online journal focused on interprofessional topics in practice, education, research and policy.