Here is a curated list of peer-review literature for the Peer Support Learning Community, beginning with research published since 2021. For earlier research, please download the annotated bibliography. For suggested additions, please contact


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Clinician mental health
Moral injury and distress
Programming and implementation
Randomized control trial
Second victim



Association between physician burnout and self-reported errors: Meta-analysis doi: 10.1097/PTS.0000000000000724

Owoc J, Mańczak M, Jabłońska M, Tombarkiewicz M, Olszewski R

(Jan 2022) Thirteen studies on 20,643 physicians and residents were included in this meta-analysis quantifying the association of burnout with self-reported medical errors. The overall burnout among participants was associated with a significantly increased risk of self-reported errors. The authors write that, as self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to health care organizations. Read more

Burnout • Meta-analysis

COVID-19 pandemic and overall mental health of health care professionals globally: A meta-review of systematic reviews doi:10.3389/fpsyt.2021.804525

Chutiyami M, Cheong AMY, Salihu D, et al.

(Jan 2022) This meta-review aims to provide a comprehensive overview of overall mental health of health care professionals during the COVID-19 pandemic through a comprehensive literature search. The methodology quality of eligible studies was assessed using Joanna Briggs Institute checklist for systematic reviews. It was concluded that health care professionals have experienced various mental health issues during COVID-19 pandemic. The meta-review, therefore, recommends targeted interventions and health policies that address specific mental health issues to support health professionals worldwide during the duration of the COVID-19 pandemic and similar future health crises. Read more

COVID-19 • Clinician mental health • Meta-analysis

Healing our own: A randomized trial to assess benefits of peer support doi: 10.1097/PTS.0000000000000771

Rivera-Chiauzzi E, Smith H, Moore-Murray T, Lee C, Goffman, D, Bernstein, P, Chazotte, C

(Jan 2022) This study aimed to develop and evaluate a structured peer support program. In this pilot randomized controlled trial, participants were providers who experienced an obstetric-related adverse outcome. Fifty participants were enrolled and 42 completed the program. Researchers concluded that for supporting health care providers involved in adverse outcomes, structured peer support is a practicable intervention that can be initiated with limited resources. Read more

Programming and implementation • Randomized control trial

Support opportunities for second victims lessons learned: A qualitative study of the top 20 US News and World Report Honor Roll Hospitals doi: 10.1186/s12913-021-07315-1

Marr R, Goyal A, Quinn M, Chopra V

(Dec 2021) Researchers performed a prospective study and interviewed individuals representing second victim support programs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Most program representatives reported that participants sought support voluntarily. Poor physician participation due to the stigma associated with seeking support was commonly reported as a challenge. However, acceptance of the mission of second victim programs, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. To ensure success, participants suggested training a variety of volunteers and incorporating the programs within quality improvement processes. Read more

Programming and implementation • Second victim

Validation of the second victim experience and support tool-revised in the neonatal intensive care unit doi: 10.1097/PTS.0000000000000659

Winning A, Merandi J, Rausch J, et al.

(Dec 2021) The aim of the study was to validate a revised version of the Second Victim Experience and Support Tool (SVEST-R), which was developed to measure the impact of medical errors and adverse patient events on providers and can help organizations evaluate the effectiveness of support resources. An SVEST-R was completed by 316 health care providers from seven neonatal intensive care units affiliated with a large, pediatric hospital. Researchers concluded that the SVEST-R is a valid measure. Additionally, the SVEST-R now includes positive outcomes (i.e., resilience) that may result from the second victim experience. Read more

Programming and implementation • Second victim

COVID-19 and moral distress: A pediatric critical care survey doi:10.4037/ajcc2021999

Thomas T, Davis FD, Kumar S, Thammasitboon S, Rushton CH

(Nov 2021) The aim of this survey is to investigate whether pediatric critical care professionals are experiencing moral distress during the COVID-19 pandemic and, if so, for what reasons. An exploratory survey of pediatric critical care professionals was conducted via the Pediatric Acute Lung Injury and Sepsis Investigators Network from April to May 2020. Overall, 85.8% of survey respondents reported moral distress. Inducers of moral distress were related to challenges to professional integrity and lack of organizational support. Five themes were identified: psychological safety, expectations of leadership, connectedness through a moral community, professional identity challenges, and professional versus social responsibility. Read more

COVID-19 • Moral injury and distress

Let's embed peer-support groups into the medical curriculum for all doi:10.7861/fhj.2021-0041

Higham A, Behrman S, Vlachos H, Lightfoot H, Stevens R, Stegen G

(Nov 2021) Group-based peer support and regular reflective practice are interventions known to reduce clinician burnout and optimize wellbeing. The NHS Staff and Learners' Mental Wellbeing Commission report advocates establishing explicit peer support mechanisms and the use of peer support as part of the first line of psychological first aid. Because junior doctors are the most likely of all medical groups to be at a high risk of burnout, authors recommend that regular peer-support reflective groups are provided during protected time for all trainees. Read more

Programming and implementation

The role of perceived organizational support in mental health of health care workers during the COVID-19 pandemic: A cross-sectional study doi:10.3389/fpsyt.2021.707293

Chatzittofis A, Constantinidou A, Artemiadis A, Michailidou K, Karanikola MNK

(Nov 2021) The study aimed to assess the association between perceived organizational support (POS) and mental distress in health care workers during the COVID-19 pandemic. The role of POS in stress, depressive and trauma symptoms was investigated. This was an online cross-sectional study in 424 health care workers. Data were collected during the first wave of the pandemic, and included demographics, a 7-item questionnaire assessing POS, the "Patient Health Questionnaire" assessing depressive symptoms, the "Impact of Events Scale Revised," measuring PTSD symptoms and the "Perceived Stress Scale.” Self-perceived organizational support was significantly associated with workers’ self-assessed mental status during the pandemic. Read more

COVID-19 • Clinician mental health

Understanding and mitigating moral injury in nurses doi:10.7748/ns.2021.e11703

Rowlands SL

(Nov 2021) The concept of moral injury has its origins in the context of military personnel encountering ethically challenging decisions during armed conflict. The term has been applied to health care and is increasingly acknowledged to be a challenge for health care professionals. Nurses across all specialties and settings are frequently required to make or witness ethically challenging decisions about patient care. This article discusses the manifestations of moral injury and its associated risk factors, including the effects of the COVID-19 pandemic. It also outlines various strategies that can be used to mitigate and/or prevent moral injury in nurses. Read more

COVID-19 • Moral injury and distress

Moral distress in frontline health care workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning doi:10.1002/da.23205

Norman S, Feingold J, Kaye-Kauderer H, et al.

(Oct 2021) Authors examine moral distress in frontline health care workers caring for COVID-19 patients during the height of the spring 2020 pandemic surge in New York City. The analysis revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Read more

COVID-19 • Moral injury and distress

Peer assessment after clinical exposure (PACE): An evaluation of structured peer support for staff in emergency care doi:10.12968/bjon.2021.30.19.1132

Sillitoe K, Kimbya N, Milliken J, Bennett P

(Oct 2021) Peer Assessment After Clinical Exposure (PACE) is a structured program designed to support staff following traumatic or chronic work-related stressful exposure. This study aims to explore the thoughts and experiences of the staff who used PACE support services in one emergency department. Overall, PACE was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure. Read more

Programming and implementation

Implementation of a second victim peer support program in a large anesthesia department

Finney R, Jacob A, Johnson J, Messner H, Pulos B, Sviggum H

(Jun 2021) This article describes the implementation of a second victim peer support program in a large academic anesthesiology practice, with the goal of augmenting emotional support for anesthesia providers. A total of 130 peer support encounters were documented. Trained peer supporters were able to provide helpful support to affected colleagues nearly all (98.8%) of the time. Nearly 97% of second victims reported the support as extremely or very beneficial, and 96.8% would recommend the program to colleagues. Read more

Programming and implementation • Second victim

The second victim requires more than Medice Cura Te Ipsum doi:10.5489/cuaj.7229

Koyle M, Chua M, Kherani T, Pereira N, Heiss K

(Jun 2021) Second victim syndrome, a consequence of an unforeseen adverse event, often precipitated by an error, can lead to a post-traumatic stress-like reaction, that is unique to health care workers. Often, the second victim suffers in silence, forced to rely on resilience. Peer support has been demonstrated to be beneficial in assisting health care workers in recovering from both burnout and second victim syndrome. The authors of this article advocate for institutions and organizations to be more responsive in supporting physicians and other health care workers in need. Read more

Programming and implementation • Second victim

Preventing clinician suicide: A call to action during the COVID-19 pandemic and beyond doi:10.1097/ACM.0000000000003972

Moutier CY, Myers MF, Feist JB, Feist JC, Zisook S.

(May 2021) In this commentary, the authors offer a call to action in the long-standing fight to prevent clinicians from dying by suicide. In April 2020, the nation was shocked by the suicide of New York City emergency physician Dr. Lorna Breen, who died while recovering from COVID-19. She joins an unknown number of clinicians who have taken their lives over the past year. The authors sort through the science of clinician distress; critique how the COVID-19 pandemic is affecting the lives of clinicians; and describe existing national initiatives to address clinician stress, burnout, and suicide. Finally, they recommend evidence-based actions to prevent clinician suicide. Read more

COVID-19 • Clinician mental health

Promoting the psychological well-being of health care providers facing the burden of adverse events: A systematic review of second victim support resources doi:10.3390/ijerph18105080

Martina Busch I, Moretti F, Campagna I, Benoni R, Tardivo S, Wu A, Rimondini M

(May 2021) This study aims to describe the types of support resources available in health care organizations, their benefits for second victims, peer supporters’ experiences, and implementation challenges. The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Read more

Programming and implementation • Second victim

Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses doi:10.1111/jonm.13168

Labrague LJ, de Los Santos JAA

(Apr 2021) This study examines the relative influence of fear of COVID-19 on nurses' psychological distress, work satisfaction and intent to leave their organisation and the profession. This is a cross-sectional research design involving 261 frontline nurses in the Philippines. Five standardized scales were used for data collection. Frontline nurses who reported not having attended COVID-19-related training and those who held part-time job roles reported increased fears of COVID-19. Addressing the fear of COVID-19 may result in improved job outcomes in frontline nurses, such as increased job satisfaction, decreased stress levels and lower intent to leave the organisation and the profession. Read more

COVID-19 • Clinician mental health

Clinician mental health, nursing shortages and the COVID-19 pandemic: Crises within crises doi:10.1111/inr.12674

Turale S, Nantsupawat A.

(Mar 2021) Before the COVID-19 pandemic, the nursing profession was struggling to be adequately respected and compensated despite the vital role they play in the health care system. The nursing profession has been dealing with a shortage crisis that will potentially become worse/exacerbated by the COVID-19 pandemic. During the pandemic, nurses were inundated with frontline health care delivery while not being cared for by the very institutions that rely on their expertise.Read more

COVID-19 • Clinician mental health

COVID-19-related occupational burnout and moral distress among nurses: A rapid scoping review doi:10.12927/cjnl.2021.26459

Sriharan A, West KJ, Almost J, Hamza A

(Mar 2021) This paper aims to synthesize existing literature on COVID-19-related burnout and moral distress among nurses and identify recommendations for nurse leaders to support the psychological needs of nursing staff. Comprehensive searches were conducted in Medline, Embase and PsycINFO (via Ovid); CINAHL (via EBSCOHost); and ERIC (via ProQUEST). The rapid review was completed in accordance with the World Health Organization Rapid Review Guide. Thematic analysis of selected studies suggests that nurses are at an increased risk for stress, burnout and depression during the ongoing COVID-19 pandemic. Younger female nurses with less clinical experience are more vulnerable to adverse mental health outcomes. Read more

COVID-19 • Moral injury and distress

Clinician satisfaction with rapid adoption and implementation of telehealth services during the COVID-19 pandemic doi:10.1089/tmj.2020.0575

Gentry MT, Puspitasari AJ, McKean AJ, et al.

(Feb 2021) This study examines clinician perspectives on the acceptability, suitability, and feasibility of video telehealth mental health services during the COVID-19 pandemic. 112 mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Participants showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Read more

COVID-19 • Clinician mental health

Mental health and COVID-19: The psychological implications of a pandemic for nurses doi:10.1188/21.CJON.69-75

Shah M, Roggenkamp M, Ferrer L, Burger V, Brassil KJ

(Feb 2021) The aim of this article is to explore the potential psychological sequelae of nursing during a pandemic and to provide recommendations to support a psychologically healthy work environment. Highlights from the literature on psychological sequelae, symptoms, and outcomes related to COVID-19 and prior pandemics is presented, along with insight from the experiences of oncology nurses caring for patients with COVID-19. Hospital administrators must develop proactive wellness plans for the triage and management of mental and emotional health needs during a pandemic that prioritize transparent communication, resources for health care providers within and beyond the clinical setting, and training. Read more

COVID-19 • Clinician mental health

Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic doi:10.1177/0969733020961825

Hossain F, Clatty A

(Feb 2021) This article aims to investigate moral distress and offer tools and recommendations to support health care nurses as they respond to this crisis and its aftermath. As most health care workers are passionate nursing professionals, frustration and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. For nurses, the experience of this significant event can inflict ongoing moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Read more

COVID-19 • Moral injury and distress

What we have learned from two decades of epidemics and pandemics: A systematic review and meta-analysis of the psychological burden of frontline health care workers doi:10.1159/000513733

Busch IM, Moretti F, Mazzi M, Wu AW, Rimondini M

(Feb 2021) This study aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. Studies reporting psychological and/or psychosomatic symptoms of health care workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family, perceived stress, concerns about own health, sleeping difficulties, burnout, symptoms of depression, anxiety, PTSD, mental health issues, and somatization. Read more

COVID-19 • Clinician mental health • Meta-analysis

Web-based peer support education program for health care professionals

van Buschbach S, van der Meer C, Dijkman L, Olff M, Bakker A

(Apr 2020) This study describes the development and evaluation of a new online program to educate peer supporters. Forty-four health care professionals including nurses, physicians, residents and staff, completed the e-learning Peer Support and the online evaluation survey. The e-learning was well received and positively evaluated with regard to all studied indicators of acceptance, including perceived usefulness, ease of use, actual use, and effectivity. All participants would recommend the e-learning to future trainees. Read more

Programming and implementation