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APNA 29th Annual Conference Session 2021: October 29, 2015 Promoting Staff Resilience in Stressful Situations: The RISE Team Joyce Parks, DNP, RN BC, PMHCNS BC Psychiatric Nursing, The Johns Hopkins Hospital 1 Acknowledgement: Cheryl

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APNA 29th Annual Conference Session 2021: October 29, 2015 Parks 1

Promoting Staff Resilience in Stressful Situations: The RISE Team

Joyce Parks, DNP, RN‐BC, PMHCNS‐BC Psychiatric Nursing, The Johns Hopkins Hospital

1 2

Acknowledgement: Cheryl Connors, MS, RN

– Patient Safety Specialist, The Armstrong Institute for Patient Safety & Quality

The speaker has no conflicts of interest to declare.

Photo by R. Parks, ( April, 2012) used with permission

Learning objectives

Identify the cognitive, emotional and behavioral changes that

may impact the second victim of a medical error or stressful event.

Describe how psychiatric‐mental health nursing interventions

are used to support second victims.

Explore how psychiatric‐mental health nurses can contribute

to the Resilience in Stressful Events Team.

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APNA 29th Annual Conference Session 2021: October 29, 2015 Parks 2

The RISE Team at Hopkins

Our mission:

– To provide timely support to staff from a peer after a stressful, patient‐related event.

Outcomes

– Safer environment of care for patients – Decreased caregiver burden

4 Edrees, H. H., Paine, L. A., Feroli, R., & Wu, A. W. (2011) May, M. & Plews-Ogan, M. (2012)

Definitions

First victims

– Patients and their families

Second victims

– “A health care provider involved in an unanticipated adverse patient event, medical error, and/or a patient related–injury who become victimized in the sense that the provider is traumatized by the event.”

Third victims

5 Scott, Hirschinger, Cox, McCoig, Brant, J. & Hall (2009). p. 326 Wu, (2000) Mira et al., (2015)

Stages of Recovery

Event Chaos - Accident Response Intrusive Reflections Restore Personal Integrity Enduring the inquisition Obtaining Emotional 1st Aid Moving On

Adapted from Scott, et al., (2009)

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APNA 29th Annual Conference Session 2021: October 29, 2015 Parks 3

Stage 6: Moving On

Dropping Out Surviving Thriving Transfer/Leave Coping but with persistent intrusive thoughts and sadness; still trying to learn from the event. Maintains work/life balance; Gains insights; Advocates for change resulting in safer care. “Can I handle this type of work?” “How could I have prevented this from happening?” “Why do I feel so bad, so guilty?” ‘What can I learn from this?’ ‘What can I do to make it better?”

7 Scott, et al. ,(2009) Ullström, Sachs, Hansson, Øvretveit, & Brommels, (2013) Grissinger, (2014)

Types of calls

Unexpected patient related adverse event
Death of a staff member
Changing medical boundaries
Significant events including

– Medical error – Ebola – Distress secondary to inappropriate communication after an event

Who Provides Support? Volunteer Peer Responders

People who work all over the organization

– Nurses

Bedside clinicians, managers, advanced practice nurses,

administrators – Physicians – Pharmacists – Social workers – Pastoral care – Respiratory therapists

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APNA 29th Annual Conference Session 2021: October 29, 2015 Parks 4

What Does Support Look Like?

THE CONTINUUM OF CARING

PSYCHOLOGICAL FIRST AID CRISIS INTERVENTION COUNSELING PSYCHIATRIC CARE WITH MEDICATIONS AND THERAPY PHYSICAL FIRST AID BASIC LIFE SUPPORT ADVANCED LIFE SUPPORT MEDICAL SURGICAL INTERVENTION

10 Pekevski, (2013)

Psychological First Aid

The goal: immediate, targeted support

– Reflective Listening – Assessment of Needs – Prioritization – Intervention

Grounding, support, activation of resources

– Disposition

11 Johns Hopkins Center for Public Health Preparedness (2015)

Everly. McCabe , Semon, Thompson & Links (2014)

Najavits, (2002)

Grounding

Grounding is a simple set of strategies that

may be done anytime or anywhere

– May decrease anxiety, cravings, self‐harming behavior or low mood

Mental grounding techniques
Physical grounding techniques
Self‐soothing grounding techniques

12 Najavits, (2002)

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APNA 29th Annual Conference Session 2021: October 29, 2015 Parks 5

Bumps in the road

The first 18 months there were 18 calls for

peer support

– RISE was piloted for 12 months in the department

f Pediatrics; 1 call/month

– The next 6 months, RISE was available to the

rganization; 1 call/month
What were the barriers to using the RISE

team?

13 Scott, et al., (2010)

Focus Groups with Key Stakeholders in the Organization

Bedside nurses
Respiratory therapy
House staff

– Introduce the RISE team – What type of support is most desired? – Do you know the process for reaching a RISE peer responder? – How quickly do you desire a response? – What would prevent you from contacting RISE?

What services are not offered

Peer support is not psychotherapy.
Peer support is not an investigation of an

adverse event.

There is no report to the supervisor.

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APNA 29th Annual Conference Session 2021: October 29, 2015 Parks 6

Services Offered

Confidential, non‐judgmental, peer to peer support

available for individuals or groups

Available 24/7 within a 30 minute response time

Contributions of PMH Nurses

To the RISE team

Change to offering group

de‐briefing services in addition to individual support after events

Assisted team leaders with
ngoing training for current

peer responders To the organization

Culture change to promote
pen dialogue after a

stressful event

17 White, et al., (2015 Hart, Brannan, & de Chesney (2012)

Number of calls People supported: > 200

1call /month (18)

First 18 months

3‐4 calls each month (73)

Next 18

months