Table 5

Emergent themes from focus group

ThemesMain findingsDescriptive quote
Peer responder training and educationPFA:
  • PFA concepts were helpful and easy to relate to ‘active listening’, therapeutic listening and medicine's ‘do no harm’

  • Benefitted from role-play exercises

Opportunities for improvement:
Create a second victim-focused curriculum, given that PFA focused on disaster and relief workers as opposed to clinicians working a hospital setting
The biggest takeaway I got from the PFA training was the active listening and the do no harm
I think a lot of the experiences that this type of training is modeled after is military, firefighters, police—in which I have experience with emergency medicine and firefighting—you are either completely bored or there is maximum stress; there is no real in between. And so decompressing or having an encounter after a police officer was short, I think that is a much richer field to encounter. We have significant stresses in the hospital on a daily basis, but hey are not the same kind of thing. They are things that build over a period of time and then they acutely explode in someone's face. How do you mold the training to the environment we are in, which is not a disaster-based experience?
Peer Responder Meetings:
  • Meetings were helpful to gain information and share insight with peers

  • Benefitted from the activities, including the role-play scenarios

  • Case studies/interactions from other peer responders were also helpful, especially stories related to ‘non-ideal’ scenarios, such as anger from a family member

Opportunities for improvement:Second victim stories were too de-identified and would like to hear more details about the event
Hearing about how the [second victim] calls that have been handled was helpful.
Sometimes getting more details on the event that happened would allow me to say—this is how I would have done as a responder or this is how I would have handled it. And even if that opens up the discussion: this is the situation we have faced and ask others ‘what would you have said’ and what are some of the things you would say to that staff member. Then, the team can go through a debrief to discuss the response.
The articles [current events] that we have gotten about nurse x, y, z who has gone through something, committed suicide, or got fired from her job; I think those are so powerful and they make us see how important this programme is
RISE debriefings:
  • Encouraged therapeutic listening

  • Helpful to hear other peer responders’ experiences

  • Debriefing process is very streamlined

  • Support received from the peer responders is very helpful

Opportunities for improvement:
Difficult to relate some of the second victim cases since the details of the event are de-identified
I like to hear about what is going on with other second victims and it makes you think about—if that person came to me, how would I respond to them?
I think the debriefings are fabulous! I think that it's really important for those who respond to have a place to process and get support from their peers and get the validation that they did well, and they didn't do any harm. And hearing how others responded is more training
Emotional distress as a peer responderOpportunities for improvement:
  • Insufficient training for providing group support as opposed to one-on-one support

  • Anxiety around not following up with a second victim or a unit after an interaction

What we did not take into account [when responding to second victims] are prior stress levels
When I did a group debriefing, it was very anxiety-producing because I had no idea what I was walking in to. I took one of my nurses with me and she sat with me for support and it ended up being fine
I would have trouble with not following up with the second victim after responding to them. And when you're a provider, you make a change in any patient's system, you follow up and make sure that that change was effective. And not having that opportunity to see if the ‘patient’ [second victim] is doing better as result, feels incomplete
Confidence in responding to a second victim(s)Strengths:
  • Different levels of confidence in responding to second victims

  • More confident since they provided support as part of their current role

  • More confident due to prior clinical training

Opportunities for improvement:
More comfortable in responding to second victims (one-on-one) as opposed to responding to an group
From my very first day in nursing school, active and therapeutic listening was a very big part of the nursing model. Most of us who have made it through nursing degrees are skilled at that already. As a provider, what cements my ability to do something well is to be able to do it time and time again
Training as a provider in general, is that you take from each portion of your training pieces that you will apply throughout your career. One thing I learned from my psychiatry rotation is the idea of therapeutic, thoughtful, and provocative listening. Thinking about events in the media through therapeutic listening is something I do now more than I do before
We are also getting a lot of requests for group debriefs
One thing that we did not get in any of our trainings was how to handle a group debriefing. And I think everybody would like that
It's interesting to see that there is a disparity in the responders in their own assessment in their ability to respond to a different group of people [responding to residents would be different than responding to nurses, for instance]
Recommendations for training
  • Develop a mechanism to gather background information on event prior to interacting with second victim

  • Provide more training on how to respond to groups

  • Include content that is relevant to clinicians in hospital settings as opposed to PFA for relief workers

  • Helpful for group debriefings to be less nurse-oriented and include an interdisciplinary approach

  • Develop a debriefing mechanism to share the background of the event so that peers understand how the peer responder responded

  • Develop a list of key phrases peer responders can use in their interactions with second victims

The role-play script helped me organize what I was saying [when responding to the second victim], which was like a map that tells me to start with this and do this
The role-playing helped people to feel more at ease
Having the RISE binder and documents made me feel more secure [when responding to a second victim]
  • PFA, Psychological First Aid; RISE, Resilience In Stressful Events.