Remembering the Second Victim (Part 2 of 3)

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In our last posting, we began to look at the research behind the second victims of an adverse event at a healthcare organization. These second victims are, of course, the providers, Tami Swartz explains in the February 2013 issue of Patient Safety Monitor and reprinted on the HealthLeaders Media site. The research cited established that healthcare organizations must provide emotional support as soon as the adverse event occurs or risk the impact of the AE on the second victim having negative consequences in the future.

Today, let’s look at what it takes for an organization to provide that emotional support, an area that still requires further research and knowledge.

According to Swartz, researcher Sue Scott of the University of Missouri defines second victims “as healthcare providers involved in an unanticipated adverse patient event, medical error, and/or patient-related injury who become victimized in the sense that the provider is ­traumatized by the event. Some suffer posttraumatic stress disorder.”

The first idea an organization might have is to include the second victim in a root-cause analysis or a process redesign that will help prevent a specific AE in the future. While this might help some second victims, Swartz writes, “…without sufficient emotional support for the second victim, the process can be ‘associated with heightened emotional stress,’” especially if the second victims are experiencing posttraumatic stress. These “quality efforts could force the victim to relive the incident.”

Rather than viewing the AE as a strictly procedural necessity, leaders should instead view it as traumatic and see the second victims as suffering from trauma and realize that they’re probably feeling guilt, anger, nervousness, shame, depression, fear, and loss of confidence. She adds that like the other victims, second victims need to hear and connect with others.

For example, Kimberly Hiatt was a Seattle nurse with a spotless 24-year record. However, she gave a baby a fatal overdose and was fired for her mistake. Soon thereafter, she committed suicide.

Kris Vanhaecht, M.D., R.N., MSc, Ph.D., leader of Health Services Research Group, School of Public Health, KU Leuven, ­University of ­Leuven, Belgium, co-author of a study titled “Supporting involved healthcare professionals (second victims) following an adverse health event: A literature review,” told Swartz, “The reactions of second victims have two sides: professional and personal. The professional impact is a change in behavior within the team, feeling unsafe among team members, behaving differently toward other patients and family members, burnout, and very ­importantly, doubt about their knowledge and skills, and this increases the risk of additional failures.”

Swartz notes, “Second victims who openly discuss an adverse event with colleagues often find doing so stress relieving; ­however, rarely are they so open for fear of tarnishing their professional reputation. It can be therapeutic for second victims to have a safe space to discuss the event, in which what they say remains confidential.”

Discussing mistakes and AEs with colleagues are one thing, however, she warns. Making them talk to the patient or patients affected by those incidents is another and can prove to be an additional “source of emotional stress.”

Finally, managers should be open to discussing the AE with the second victim. Swartz writes, “Talking in and of itself is not enough. Managers need to recognize what types of communication would be most beneficial to the discussion. Sharing an event they experienced themselves can be helpful, and conveying to the ­second victim that they are trusted and supported by the ­manager and organization is helpful as well.”

In our third and final posting on this subject, we’ll take a look at what Swartz calls the “barriers to support.”

-by Pete Fernbaugh

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