Remembering the Second Victim (Part 3 of 3)

by on

In our previous post, we continued our look at the second victim involved in an adverse event, the provider, and explored ways in which a healthcare organization can provide emotional support for those victims.

But what are some of the barriers to that support? And what kind of a design can you institute for your organization that will effectively address the needs of second victims?

An article by Tami Swartz in the February 2013 issue of Patient Safety Monitor and also reprinted on the HealthLeaders Media site detailed a study titled “Supporting involved healthcare professionals (second victims) following an adverse health event: A literature review” that compiled research on the subject of second victims. This study listed several barriers to providing the emotional support a second victim might need.

Not surprisingly, many of these barriers are psychological. In fact, one of the pieces of research cited in the study found that second victims “rarely saw a counselor or psychologist,” even though many “indicated that the most difficult part of the process was forgiving themselves.” To add to the complexity of these barriers, those who needed some sort of mental health counseling never pursued it because of the “stigma” around healthcare providers seeking it.

Another barrier involves the group persecution that can result from the second victim’s failure. Swartz explains, “Most AEs are a result of system failures, and most of the time more than one professional is involved in such an event. While healthcare is working toward a team model, there is frequently one person who made the final human contribution to an event, and he or she can become victimized despite several people taking part in the patient’s care.”

Sometimes, however, no one person can be blamed, especially with care teams. If a patient dies on the surgery table, the entire team can be traumatized. Co-author of the study 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, recommends “a rapid response team style for support in such events.”

Knowing that second victims need this kind of emotional support can empower organizations to develop their own “support design,” Swartz states. The design must be comprehensive, though, applying to all potential second victims. According to research, sixty percent of second victims need “immediate support…follow-up support that involved staff specifically trained in second-victim trauma and follow-up was necessary for 30 percent; and 10 percent needed support that included outside professional counseling.”

She adds that immediate emotional support from colleagues is especially needed for nurses, whereas morbidity and mortality meetings that focus on “identifying errors” can be most effective with physicians. Medical and nursing students who witnessed or were involved in the event should also be included in the design.

Finally, to make the support design as effective as possible, there needs to be an awareness on the part of department managers “of the organization system for handling errors, especially regarding second victims.”

Much of this is admittedly trial and error. As Swartz acknowledges, “The literature shows no consensus for how to effectively ­support second victims or how best to design a ­support ­program. Some hospitals have begun to integrate emotional ­support in their root cause analysis, but some experts believe that this should be handled as a ­separate function.”

Nevertheless, it’s vital for hospitals to have some protocol or support design in place for second victims. Hospitals would be advised to implement the recommendations set forth by the IHI, known as the Respectful Management of Serious Clinical Events.

What are your thoughts on these last three posts? How do you handle adverse events at your organization? What are some of the most effective means that you have used to provide emotional support to second victims?

-by Pete Fernbaugh

VN:F [1.9.7_1111]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.7_1111]
Rating: 0 (from 0 votes)

Leave a Comment

Previous post:

Next post: