Presentation
Development of BONE Break: A Hot Debrief Tool to Reduce Second Victim Syndrome in Nurses
SessionAdverse Events (HE2)
DescriptionIn 2018, the Joint Commission urged health care organizations to develop a strategy and/or program to support second victims immediately following an adverse event. This interest has been amplified as the COVID-19 pandemic increased clinician workload leading to more adverse events. As such, managers of inpatient units started to look for tools that could be used to help preserve the psychological well-being of their staff. Many second victim programs utilize a designated team of peer responders that provide support to providers following an adverse event. Other systems lean on the employee assistance program to provide this support. A literature search was conducted to explore existing tools that would meet the needs of the units. However, none were found that focused directly on second victim syndrome in nurses. Subsequently, using suggestions from research about mitigating the effects of second victim, nurse leaders and research staff developed BONE Break.
BONE Break is a structured, hot debriefing tool specifically designed to be used by a team of nurses within the same unit following an adverse event with the focus on immediate peer-to-peer support and emotional first aid to mitigate potential symptoms of second victim syndrome. The tool consists of four stages. During each stage, debrief participants are asked to reflect on the adverse event and offer peer support in a nonjudgmental way.
Buoy/Break: Nurses took a silent break or short pause to allow for space then reflected on the statement, “You are a good nurse working in a very complex environment.” Peers offered support using phrases such as “I cannot imagine what that must have been like for you. Can we talk about it?”
Open-up: Nurses invited each other to talk about the adverse event that had just occurred: “This has to be difficult. Are you okay?” and “How are you doing after the event?”
Needs: Nurses assessed what each other needed following the adverse event: “What do you need to be able to be successful in return to work right now?” They offered each other affirmations surrounding those needs: “I believe in you.”
Exit/Evaluate: Nurses discussed the effectiveness of the debriefing before returning to the floor.
Prior to implementation, we developed an educational presentation for nurses who would facilitating the BONE Breaks with other staff which included a teach-back model. Nurses were also provided with a small card with the BONE Break outlined to use as a guide.
The implementation of BONE Break has been fairly easy. Because it was developed “in-house,” its use matched the culture of the units it was being implemented on. The positive staff rapport with unit leadership also aided in the ease of implementation. These two factors led to an initial buy-in from charge nurses. This buy-in increased through the education provided to them as it explained how BONE Break could be helpful without being burdensome or interrupting the unit’s workflow. BONE Break is still being used regularly on the two units where it was original implemented. It is also now being used in a handful of other units within the hospital as well as another medical center in the same metro area. Other clinics and hospitals within the health system have also shown interest in implementing BONE Break. The goal is to implement BONE Break in more units and disseminate the tool widely as an easy tool to use that supports the psychological safety of all healthcare workers. As more units gain interest in BONE Break, we plan to conduct an impact study that allows us to compare control and intervention units from baseline and over time. As BONE Break continues to be implemented across our hospital, health system, and metro area, unit and department leadership champion the dissemination of the tool and its usefulness for preventing second victim syndrome.
BONE Break is a structured, hot debriefing tool specifically designed to be used by a team of nurses within the same unit following an adverse event with the focus on immediate peer-to-peer support and emotional first aid to mitigate potential symptoms of second victim syndrome. The tool consists of four stages. During each stage, debrief participants are asked to reflect on the adverse event and offer peer support in a nonjudgmental way.
Buoy/Break: Nurses took a silent break or short pause to allow for space then reflected on the statement, “You are a good nurse working in a very complex environment.” Peers offered support using phrases such as “I cannot imagine what that must have been like for you. Can we talk about it?”
Open-up: Nurses invited each other to talk about the adverse event that had just occurred: “This has to be difficult. Are you okay?” and “How are you doing after the event?”
Needs: Nurses assessed what each other needed following the adverse event: “What do you need to be able to be successful in return to work right now?” They offered each other affirmations surrounding those needs: “I believe in you.”
Exit/Evaluate: Nurses discussed the effectiveness of the debriefing before returning to the floor.
Prior to implementation, we developed an educational presentation for nurses who would facilitating the BONE Breaks with other staff which included a teach-back model. Nurses were also provided with a small card with the BONE Break outlined to use as a guide.
The implementation of BONE Break has been fairly easy. Because it was developed “in-house,” its use matched the culture of the units it was being implemented on. The positive staff rapport with unit leadership also aided in the ease of implementation. These two factors led to an initial buy-in from charge nurses. This buy-in increased through the education provided to them as it explained how BONE Break could be helpful without being burdensome or interrupting the unit’s workflow. BONE Break is still being used regularly on the two units where it was original implemented. It is also now being used in a handful of other units within the hospital as well as another medical center in the same metro area. Other clinics and hospitals within the health system have also shown interest in implementing BONE Break. The goal is to implement BONE Break in more units and disseminate the tool widely as an easy tool to use that supports the psychological safety of all healthcare workers. As more units gain interest in BONE Break, we plan to conduct an impact study that allows us to compare control and intervention units from baseline and over time. As BONE Break continues to be implemented across our hospital, health system, and metro area, unit and department leadership champion the dissemination of the tool and its usefulness for preventing second victim syndrome.
Event Type
Oral Presentations
TimeMonday, March 312:37pm - 3:00pm EDT
LocationHarbour C
Hospital Environments (HE)