Peer support research library

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

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 structured peer support is a practicable intervention that can be initiated with limited resources. Read more

Marr R, Goyal A, Quinn M, Chopra V

Researchers interviewed individuals representing second victim support programs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Most reported that participants sought support voluntarily, and that poor participation due to the stigma associated with seeking support was a challenge. However, acceptance of the mission, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. Read more

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

This study validated a revised version of the Second Victim Experience and Support Tool (SVEST-R), which was developed to measure the impact of adverse 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. Read more

Schiess C, Schwappach D, Schwendimann R, Vanhaecht K, Burgstaller M, Senn B.

“Second victims” are health care professionals traumatized by involvement in significant adverse events. This study aims to identify, describe, and interpret these experiences. The authors' transactional model of second-victim experience provides a foundation for strategies to maintain and improve patient safety. Read more

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

The study assessed the association between perceived organizational support and mental distress in health care workers during the COVID-19 pandemic. In this online cross-sectional study of 424 health care workers, researchers found that self-perceived organizational support was significantly associated with workers’ self-assessed mental status during the pandemic. Read more

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

Group-based peer support and regular reflective practice are interventions known to reduce clinician burnout and optimize wellbeing. 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

Sillitoe K, Kimbya N, Milliken J, Bennett P

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 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 reduce the stigma associated with stress reactions after work-related exposure. Read more

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

The aim of this survey was to investigate whether pediatric critical care professionals are experiencing moral distress during the COVID-19 pandemic and, if so, for what reasons. Overall, 85.8% of survey respondents reported moral distress, often 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

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

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

Rowlands SL

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

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

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

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

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. Nearly 97% of second victims reported the support as extremely or very beneficial, and 96.8% would recommend the program to colleagues. Read more

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

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

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

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

Guille C.

Findings from this large retrospective cohort study indicate that suicide rates among nurses exceed those of people in the general population and that female nurses are at twice the risk for suicide compared with women in the general population. Read more

Sriharan A, West KJ, Almost J, Hamza A

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. 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

Turale S, Nantsupawat A.

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

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

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. 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

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

The aim of this article is to explore the potential psychological sequelae of nursing during a pandemic and to provide recommendations to support a healthy work environment. Highlights from the literature 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 that prioritize transparent communication, resources for health care providers within and beyond the clinical setting, and training. Read more

Greenwald JL, Abrams AN, Park ER, Nguyen PH, Jacobsen J.

This article describes development and implementation of the Peer SIC Support Team (PSST), a program to offer real-time assistance to frontline clinicians who needed extra support conducting serious illness conversations during the pandemic. Read more

Labrague LJ, de Los Santos JAA

This study examines the relative influence of fear of COVID-19 on nurses' psychological distress, work satisfaction and intent to leave their organization and the profession. This is a cross-sectional research design involving 261 frontline nurses in the Philippines. 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 organization and the profession. Read more

Hossain F, Clatty A

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

Anderson GS, Di Nota PM, Groll D, Carleton RN.

This is a systematic review of studies investigating the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate post-traumatic stress injuries among health care workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. Read more

Shapiro J, McDonald TB.

Authors discus several strategies that medical institutions could use to design emotional support programs that clinicians will embrace. This includes funding peer support programs, developing systems for offering support to clinicians rather than relying on self-referral, and providing easily accessible and psychologically safe “reach-in” services for clinicians requesting help. Read more

Stone M.

The purpose of this study was to describe hospital nurses’ experiences with organizational support after an adverse event. Data collection and analysis followed a qualitative descriptive approach. Findings suggest that nurses yearn to feel valued and to receive timely support from nurse executives after an adverse event. Read more

Kruper A, Domeyer-Klenske A, Treat R, Pilarski A, Kaljo K.

This study aims to evaluate the incidence of secondary traumatic stress in obstetrics and gynecology physicians including symptoms, impact, and programmatic needs for support. Safety and transparency with opportunities for group processing are identified as essentials for positive institutional culture, as well as peer support programs. Read more

Mellins CA, Mayer LES, Glasofer DR, et al.

This paper describes CopeColumbia, a peer support program developed by faculty in a large urban medical center's Department of Psychiatry to support emotional well-being and enhance the professional resilience of health care workers.  Read more

Behrman S, Baruch N, Stegen G.

Authors describe a peer support initiative to support medical trainees during the COVID-19 pandemic, discuss the barriers to the success of such schemes, and reflect on the value of grass-roots peer support initiatives. Read more

Fisher ER, Miller SL, Evans MC, et al.

Researchers find that the role of peer support has increased and become more complicated amidst the pressing demands for food, housing, safety, and economic assistance. For behavioral medicine and public health, these findings make clear that preparedness needs to address not only clinical challenges and services but also the psychological and social needs of people. Read more

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

Thirteen studies on 20,643 physicians and residents were included in this meta-analysis. 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

Busch, I, Moretti, F, Purgato, M, Barbui, C, Wu, A, & Rimondini, M.

The data confirm that adverse events can be of traumatic nature which may lead to avoidance behaviors, thus negatively affecting second victims’ personal and professional well-being, the therapeutic alliance, and the quality of care delivered by the health care system. Read more

Cheng P, Xia G, Pang P, et al.

This article describes a peer support project developed and carried out by a group of experienced mental health professionals, organized to offer peer psychological support from overseas to health care professionals on the frontline of the COVID-19 outbreak in Wuhan, China. Such a model for intervention may be used elsewhere in the face of current global pandemic, or future disaster response. Read more

Wu AW, Connors C, Everly GS Jr.

On the basis of their experiences responding to other pandemics, the authors summarize lessons learned and offer some best practices for facilitating organizational resilience and supporting health care workers during the COVID-19 pandemic. Read more

Moore KA, O'Brien BC, Thomas LR.

Given the substantial role peer learning plays in intern development, senior residents can impact their interns by normalizing emotions, allowing vulnerability, and highlighting the importance of self-care. Authors propose a model illustrating key points at which near-peers can make an impact in reducing interns’ distress. Read more

Margulies SL, Benham J, Liebermann J, Amdur R, Gaba N, Keller J.

This is a single-institution observational study evaluating the impact of adverse perinatal/neonatal and maternal events on providers and staff. Non-physicians, those using substances, those considering career change, and those seeking mental health treatment were found more likely to experience anxiety/depression and post-traumatic stress symptoms after a maternal or perinatal/neonatal loss, suggesting that these individuals should be identified and offered additional support. Read more

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

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

Elizabeth Marran J.

This article explores the concept of health care professionals as "second victims," as well as the effects of adverse events on these individuals, their managers and organizations. It details the investigation process, the health care professional’s legal and professional responsibilities after an adverse event, and the resources and services available to support second victims. Read more

Johnson J, Ford E, Yu J, Buckey C, Fogh S, Evans SB.

A survey of 1,297 medical physicists finds that a majority is willing to seek social support after involvement in a medical error or adverse patient outcome, and that they want colleagues to provide support. Given these results, peer support could be considered among medical physicists. Read more

Lane MA, Newman BM, Taylor MZ, et al.

Many “second victims,” particularly physicians, do not receive adequate support by their organizations after an adverse event. Authors describe the multiple steps necessary to create a successful peer support program focused on physicians and midlevel providers. Read more

Carugno J, Winkel AF.

This commentary reviews common reactions to adverse events and strategies to support clinicians through the aftermath. The goal is to create awareness of the mental health impact and to describe options to help physicians involved in intraoperative adverse events to recover from their experience related to bad surgical outcomes. Read more

Wright AA, Katz IT.

High burnout rates among physicians are taking a high financial and human toll. This article describes how some medical organizations are starting to tackle the challenge. Read more

Robertson JJ, Long B.

Studies have found that many physicians feel a lack of personal and administrative support after a medical error. This review looks at potential solutions including provider counseling, learning from mistakes without fear of punishment, discussing mistakes with others, focusing on the system versus the individual, and emphasizing provider wellness. Read more

Mokhtari Z, Hosseini M, Khankeh HR, Fallahi-Khoshknab M, Nasrabadi AN.

This study was conducted to identify the barriers to supporting nurses as second victims of nursing errors in clinical settings in Iran. According to the results, mismanagement, cultural barriers, inadequate information, and legal barriers were the main barriers. Read more

Wu AW, Shapiro J, Harrison R, et al.

This article explores terminology used to describe the professionals involved in adverse events and services to support them. Authors suggest it is most appropriate to label this phenomenon in a way that promotes its recognition and adoption of solutions. For example, for policy makers and health care managers, the term second victim may have value because it is memorable and connotes urgency. For support programs that appeal directly to health care workers, different language may attract more users. Read more

DeCaporale-Ryan L, Sakran JV, Grant SB, et al.

For physicians in the aftermath of a medical error, learning from the event and working toward future safety improvements was correlated with growth and resilience. Authors say that to promote well-being, there must be relational trust within the organization, with a particular focus on large-scale projects promoting teamwork, respectful interpersonal communication, and peer support. Read more

Vandenbroeck S, Van Gerven E, De Witte H, Vanhaecht K, Godderis L.

This article investigates the prevalence of burnout in Belgian hospitals and its association with job demands, job resources, individual well-being, work-related attitudes and behavior in physicians and nurses across different specialties. Read more

Winning AM, Merandi J, Lewe D, et al.

Researchers measure the impact of adverse events on health care providers in the neonatal intensive care unit, and the moderating role of coworker support. Experiencing an event was associated with higher levels of anxiety and depression when coworkers were perceived as low in supportiveness, but not when they were viewed as highly supportive. Read more

Shanafelt TD, Noseworthy JH.

This article summarizes nine strategies to promote physician engagement and how the Mayo Clinic has successfully operationalized the approaches. Authors argue that deliberate and comprehensive efforts to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Read more

Van Gerven E, Elst TV, Vandenbroeck S, et al.

This study looks at the prevalence of health care professionals being personally involved in a patient safety incident, and its relationship to problematic medication use, excessive alcohol consumption, risk of burnout, work-home interference, and turnover intentions. Read more

Epstein RM & Privitera MR

Evidence suggests that burnout negatively affects physicians’ effectiveness and availability to patients as well as patient safety. Physicians, health care organizations, and the public are concerned about quality of patient care and the health of health care institutions. Read more

Van Gerven, Eva, Bruyneel, et al.

Survey data from physicians, nurses and midwives in 33 Belgian hospitals finds that the psychological impact of a patient safety event is higher when the degree of harm for the patient is more severe, when health care professionals feel responsible for the incident, and among female health care professionals. The impact of degree of harm differed across clinicians and decreased significantly over time. Read more

Lambert BL, Centomani NM, Smith KM, et al.

A study on the process for responding to patient safety incidents at a large, urban tertiary care centre in the United States. In the first two years, the "seven pillars" process led to more than 2,000 incident reports annually, more than 100 investigations, close to 200 system improvements and 106 disclosure conversations. Read more

Hall L, Johnson JA, Watt I, Tsipa A, O’Connor DB.

A review of 46 studies aims to determine whether there is an association between health care professionals’ wellbeing and burnout with patient safety. Read more

Shapiro J, Galowitz P.

The Center for Professionalism and Peer Support at Brigham and Women's Hospital redesigned the peer support program in 2009. The program was one of the first of its kind; over 25 national and international programs have been modeled off of it. This perspective describes its origin, structure, and basic workings. Read more

Martens JA, Van Gerven E, Lannoy K, et al.

A quantitative, cross-sectional study of six psychiatric hospitals in Belgium looks at the impact of adverse events on physicians and nurses. About one in eight respondents considered quitting their job, and almost 18% declared that due to the impact of the event, they believed that the quality of the administered care was affected for longer than one month. Read more