BackgroundSecond victims are healthcare workers who experience emotional distress following patient adverse events. Studies indicate the need to develop organisational support programmes for these workers. The RISE (Resilience In Stressful Events) programme was developed at the Johns Hopkins Hospital to provide this support.ObjectiveTo describe the development of RISE and evaluate its initial feasibility and subsequent implementation. Programme phases included (1) developing the RISE programme, (2) recruiting and training peer responders, (3) pilot launch in the Department of Paediatrics and (4) hospital-wide implementation.MethodsMixed-methods study, including frequency counts of encounters, staff surveys and evaluations by RISE peer responders. Descriptive statistics were used to summarise demographic characteristics and proportions of responses to categorical, Likert and ordinal scales. Qualitative analysis and coding were used to analyse open-ended responses from questionnaires and focus groups.ResultsA baseline staff survey found that most staff had experienced an unanticipated adverse event, and most would prefer peer support. A total of 119 calls, involving ∼500 individuals, were received in the first 52 months. The majority of calls were from nurses, and very few were related to medical errors (4%). Peer responders reported that the encounters were successful in 88% of cases and 83.3% reported meeting the caller's needs. Low awareness of the programme was a barrier to hospital-wide expansion. However, over the 4 years, the rate of calls increased from ∼1–4 calls per month. The programme evolved to accommodate requests for group support.ConclusionsHospital staff identified the need for a multidisciplinary peer support programme for second victims. Peer responders reported success in responding to calls, the majority of which were for adverse events rather than for medical errors. The low initial volume of calls emphasises the importance of promoting awareness of the value of emotional support and the availability of the programme.

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Unanticipated patient adverse events can also have a serious negative impact on clinicians. The term second victim was coined to highlight the experience of health professionals with these events and the need to effectively support them. However, there is some controversy over use of the term second victim. This article explores terminology used to describe the professionals involved in adverse events and services to support them. There is a concern that use of the term victim may connote passivity or stigmatize involved clinicians. Some patient advocates are also offended by the term, believing that it deemphasizes the experience of patients and families. Despite this, the term is now coming into widespread use by clinicians and health care managers as well as policy makers. As the importance of emotional support for clinicians continues to gain visibility, the terminology surrounding it will undoubtedly change and evolve. At this time, it may be most appropriate to label this important phenomenon in a way that local leaders are comfortable with-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. Debate concerning the benefits and drawbacks to this terminology will enhance and further drive its evolution, while helping retain our industry's focus on the importance of developing and evaluating programs to support clinicians in need.

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Finally, some suggestions for facilitating the access process are discussed. They include the sensitive and appropriate application of research governance frameworks to social research - including studies within health care settings. Ethical considerations and adequate protection of children are vital but, the authors argue, wherever possible children themselves should be encouraged to decide whether or not to participate in research. In addition, unnecessarily complex access procedures may adversely affect research outcomes.

Objectives A peer-support program called Resilience In Stressful Events (RISE) was designed to help hospital staff cope with stressful patient-related events. The aim of this study was to evaluate the impact of the RISE program by conducting an economic evaluation of its cost benefit. Methods A Markov model with a 1-year time horizon was developed to compare the cost benefit with and without the RISE program from a provider (hospital) perspective. Nursing staff who used the RISE program between 2015 and 2016 at a 1000-bed, private hospital in the United States were included in the analysis. The cost of running the RISE program, nurse turnover, and nurse time off were modeled. Data on costs were obtained from literature review and hospital data. Probabilities of quitting or taking time off with or without the RISE program were estimated using survey data. Net monetary benefit (NMB) and budget impact of having the RISE program were computed to determine cost benefit to the hospital. Results Expected model results of the RISE program found a net monetary benefit savings of US $22,576.05 per nurse who initiated a RISE call. These savings were determined to be 99.9% consistent on the basis of a probabilistic sensitivity analysis. The budget impact analysis revealed that a hospital could save US $1.81 million each year because of the RISE program. Conclusions The RISE program resulted in substantial cost savings to the hospital. Hospitals should be encouraged by these findings to implement institution-wide support programs for medical staff, based on a high demand for this type of service and the potential for cost savings.

This paper reports on a two-year study exploring children's understandings of disability. It focuses on findings from interviews conducted with 24 children, aged 6 to19, who had disabled siblings, exploring their perceptions of impairment, disability and difference. Most were very aware of their sibling's impairment but the majority did not see that as making their siblings different. Where difference was perceived, this was sometimes attributed to their siblings' experience of disability-unequal treatment and the hostile attitudes of others. Most children saw their disabled sibling as holding various identities and their shared biographies, as members of the same family, may have taken precedence over any perceived differences.