June FY 21

[clawry]

This month's journal article is titled Second Victim: A Traumatic Experience. This article has been submitted by Monica Douglas, CRNA. This article discusses the potential physical and psychological symptoms of second victimhood that may have deleterious effects on patient care. Recognizing the important aspects during various stages of recovery will help guide effort to develop a supportive and compassionate recovery program for nurse anesthetists after catastrophic patient events. The second victim phenomenon can be a life altering experience that leaves a permanent imprint on the nurse anesthetist. 

Please answer the following questions after reviewing the article:

1.  Have you been involved in a case that involved or resulted in an adverse event?


2.  What type of support, or self-care techniques, do you utilize to support your well-being while working in such a high stress environment?


Here is a link to the article.

[clawry]

1. Have you been involved in a case that involved or resulted in an adverse event?

I recently had an aspiration event in GI. It was horrible because we intubated the patient and they still aspirated. The GI doc was very aggressive going in and out multiple times trying to place esophageal stents high up in the esophagus. I believe that the scope got caught up on the ETT and misplaced it enough that the patient aspirated. It was very frustrating because as soon as I came back to the room, mu attending anesthesiologist had already brought the next patient back who I knew nothing about because I was told that the patient was going to another room so I could catch up on charting, etc.

2. What type of support, or self-care techniques, do you utilize to support your well-being while working in such a high stress environment?

I try to take time off to get away and destress. I talk to other CRNAs for support. I try to exercise when I get a chance and spend time with my family.

[kels]

Yes I have been involved in a case that resulted in an adverse event . Like Cathy, I also make sure I take time off from work and talk to fellow CRNAs. Days when adverse event occur I think we should all be allowed either a little extra time and space to decompress from the event and or the opportunity to go home early . I also have an amazing family and amazing friends who I am able to lean on when days get tough .

[aileenm4]

1. I have also been involved in adverse events, not just my own but even being involved with other colleagues adverse event when trying to help is super stressful
2. I utilize my close collegues at work to talk out the case, learn form the case. We do have an amazing RISE program thatbis available to us during any stressful events. I believe debriefing is super important with the team involved

[Ben Waldbaum]

1. Have you been involved in a case that involved or resulted in an adverse event?
I have not had an serious long term adverse outcomes

2. What type of support, or self-care techniques, do you utilize to support your well-being while working in such a high stress environment?
Personally I’m concerned about possible lack of institutional support and a rush to blame if such an event would occur. This would only make the trauma that much worse. I remember growing up, and a colleague of my father had an adverse event resulting in the death of a young patient. The institutional support was inadequate and the provider committed suicide. Insitutions need to support their providers, especially those who have long track records of excellence. I’m not sure how I personally would cope with a serious adverse event but certainly would rely on my family and trusted colleagues.

[Anne McNulty]

1. Yes , I have been involved in an adverse event case. The longer you work in this profession, the more likely it will occur, especially in an setting with high risk patients like JHU. (2) I talk to other colleagues and rely on my family support and faith. Programs such as Rise may be beneficial to staff that have no family nearby for support. Aspiration will occur in endoscopy and business will continue as usual with production pressure in full force. Organizational support will not come to you. Learn from the event and let it go.

[nanci]

1. Have you been involved in a case that involved or resulted in an adverse event?
Yes I have been involved with a case that involved an adverse event- the worst was in ENDO at this institution.

2. What type of support, or self-care techniques, do you utilize to support your well-being while working in such a high stress environment?
I really rely on my family and talking to colleagues for support especially after any out of the ordinary events that happen working in such a high stress environment as we do. After the first adverse event the production pressure to continue and do the next case was astonishing to me and I couldn't believe they wanted us all to simply continue on, albiet in a clean different room (as if that was all that was necessary). The Institution did not support me, the system did not have enough staff to relieve me, and the production pressure I was feeling was almost as bad as the adverse event. During the darkest of hours in ones professional career everything is magnified, the sense of loss, of own self-esteem, reputation, professional stability, shock, confusion, emotional turmoil, what if's, vulnerability.........and then there is the we are bringing back the next patient are you ready yet, "let's go let's go let's go"? There are many ways to report an adverse event yet when and if anyone reaches out to you it is not to see how you are or if one is coping, it is more about how to fill out the paperwork correctly- sadly the institution does not prioritize its employees with compassion nor with second victim assistance. Self-care ever so important to continue on and move forward. I would say that taking time off would be a type of supportive self care that I engage in yet we all know with the low PAR levels taking time off is not always achievable. Hopefully the staffing levels will increase so that we can look out for each other more regularly and at the least relieve a colleague after an adverse event and give that colleague some time to decompress. Realizing it is a business, good business is also about taking care of your employees.

[Monica Douglas, CRNA]

1. Have you been involved in a case that involved or resulted in an adverse event?

I was involved in a case that involved an adverse event, but I was not in agreement with the Attending's anesthetic plan for that specific patient. Long story short, the Attending attempted to perform a GYN procedure without an IV on a patient with a history of IVDA. As expected, the patient did not tolerate the procedure, and the patient was tearfully pleading for the surgeon to stop. I was so emotionally distraught that I filed a HERO complaint. However, the HERO complaint did not lesson the amount of guilt that I experienced and it lasted for some time.

2. What type of support, or self-care techniques, do you utilize to support your well-being while working in such a high stress environment?

To support my physical and emotional health, I practice meditation and yoga several times per week. Unfortunately, if we are involved in a case that results in an adverse effect, we are unable to care for ourselves in the immediate moments following the event, due to staffing needs and high turnover demands. As a result, it is critical that we find ways to support our physical and emotional health outside of the work environment so that we can function optimally in our chosen profession.

[Amy Swank]

Thank you - What an important topic! I wish this was posted at the beginning of the academic year so that perhaps a larger number of CRNAs could read this article and hopefully learn from it.

If you can, fellow CRNAs- please check out the lecture that is offered through the AANA's CRNA Knowledge Network. It is the Jan Stewart Memorial Lecture: Another Day of Surgery - Lessons at the Sharp End of Care (2018). I cannot recommend this one highly enough. Warning: you will stop your car, stop chopping your vegetables, and be blown away. (and earn a couple CEUs too).

1. I have been involved in a couple of cases that have resulted in an adverse event. The one here - of course, was in Endo - such a sick patient population. The patient coded, but survived and went to the ICU. I had thought that here at such a prestigious medical center, there would be some sort of debriefing after the event, or a protocol in place to check in, and see how the team was faring, but no.
The other patient had an event in the recovery room, a PE, long after I had left for home. He had had a remote history of blood clots that he failed to disclose during his H and P.
Like they say: it's not a matter of IF, it is a matter of WHEN. Please be kind to yourselves and others when it happens.

2. I try to get exercise, get outside (the mountains have the best healing powers), love up my dogs and family, and spend time with good friends, & focus on what I can be grateful for - even during some dark times this past year.

[jessica switzman]

Thank you for sharing a very important topic. AANA has a wealth of information and support as does RISE at Hopkins.

1. I have been involved in a case with an adverse event; which I will never forget. One patient woke up fine and actually thanked me that she wasn't nauseated and then began to have trouble breathing as we left the IR suite. I immediately returned to the IR suite and the Anesthesia Machine/ Equipment instead of getting on the elevator; turns out she had a tracheal tear. The intubation was with a glide scope, easy and not traumatic and she was fully awake, reversed and following commands when extubated. We had to reverse the heprin and the pt later had a stroke.

2. I spoke with the chair of my department, the doc I was working with and a counselor at Hopkins which all helped. I don't believe RISE was set up when this happened. Regarding self-care, my super power is exercise; walking, biking, stretching and pilates. I love to spend time in nature and lucky to have good friends and a supportive family.