Interprofessional staff working in the emergency department (ED) are exposed to repetitive traumatic adverse events throughout their careers, resulting in decreased physical and mental health of the provider. Critical Incident is the term used to refer to the particular circumstance that can result in feelings of distress such as tension, anxiety or pressure (Wuthnow et al., 2016). Stress, burnout, compassion fatigue and Post Traumatic Stress Disorder are often manifested by increased sick days, reduced job performance and job satisfaction, greater staff turnover, and lower quality of patient care (Lavoie et al., 2011).
Peer support describes a relationship between people who have a common lived experience. Types of peer support fall along a spectrum ranging from informal support to formal peer support within a structured organizational setting. Informal peer support occurs when colleagues who notice the similarity of their lived experience, listen to and support each other. Peer support within a clinical setting can involve programs where peer support workers offer opportunity for a supportive, empowering relationship (Mental Health of Canada, 2012). Talking with colleagues about a critical incident has been identified as an important coping mechanism, as it helps alleviate self doubt and isolation – features common after exposure to an adverse event (Chan et al., 2016).
Trillium Health Partners Credit Valley Hospital is an urban community hospital that has a visit volume of 100000+ annually. In 2017 it was realized that there were challenges to facilitate staff attendance to critical incident debriefings, particularly on night shift and on weekends. When debriefs were offered, they were poorly attended, and there was limited follow up for staff after the debriefing. Senior Nursing Staff, Nursing Leadership, and the ED Physician group had realized that challenges existed in which strategies were available to support the psychological health of emergency department staff after a Critical Incident.
Nursing Champions approached leadership with a mandate to create a Peer Support Group. Manager Janet Cadigan, Clinical Leader Jackie Rodricks, and Interprofessional ED team members came together, to create the ED Peer Support Group as researched and described in the literature. Technology was utilized to create a WhatsApp™ group connecting all peer support members. A distribution group was created using Trillium Health Partners email to allow for notification and communication among peer support members. Staff were consulted and given an opportunity to ‘opt out’ of the distribution list. No ‘opt out ‘ requests were received, indicating that the program was a priority for staff.
The process to initiate Peer Support is as follows. Every shift the charge nurse (CN), completes a shift report that includes the question, “Is peer support required?” If yes, the names of the team members involved are noted. The event that triggers a critical incident can vary from person to person, therefore peer support is initiated anytime staff indicate that they would like follow up, as well as for significant adverse events. The manager and clinical leader receive the CN report and initiate the fan out on WhatsApp™, notifying the peer support team that an event has occurred and peer support is required. Peer support members then refer to their corporate email for details of the event, and communicate via WhatsApp™ to identify which member is contacting which staff person involved in the incident. If allied health are involved in the incident, they are contacted as well. Initial contact can be via phone call or text utilizing staff fan out lists within 24 hours of the event. A second follow up contact is initiated at the 72 hour mark. The Peer Support Group does not provide counseling. Rather, they provide an opportunity to talk and check in. If the staff member requires more assistance, the peer support member immediately contacts the manager, and the manager reaches out to the staff member directly.
The Peer support program has been initiated at least monthly since it began, and on occasion several times a month to respond to critical incidents experienced in the emergency department by staff. Feedback from staff who have received a contact from the Peer Support Group has been positive. A brief survey was given to 30 staff members who had received a Peer Support contact after a critical incident. All 30 agreed or strongly agreed to the following questions: “I feel it was helpful having a peer connect with me after a critical incident,” and “I feel like the peer support team cared about me and was willing to listen to my feelings.”
Peer Support has now become part of our ED culture. It is introduced in our departmental orientation of new staff. Peer support does not replace formal debriefing or Employee Assistance Plan (EAP), but has been a successful addition that has heightened the awareness of acute and cumulative stress putting in place a safeguard of care for ourselves, each other, and our ED family.
This article was submitted by the emergency department team at Trillium Health Partners.