Second victim: after all, what is this?

Abstract

Healthcare professionals practice their activities daily with dedication and informed by science, and face several situations of excessively complex care. Nobel, courageous, and full of compassion, they increasingly want to save more lives, be useful; with the objective of achieving better results in care, they bravely face long working hours with no sleep, and are known as professionals that dedicate themselves constantly in work as in studies. Additionally, they have a method of working that requires physical disposition and agility in order to evaluate, diagnose, and care for their patients. Watching over the lives of others is the task of healthcare professionals. (1,2) One of the major objectives of all professionals is to avoid complications, focused on safety of patients and quality of care. Nevertheless, adverse events are a reality and likely with always be a part of the system, due to the universal nature of human fallibility and the complexity in which care is inserted. Adverse events can cause severe damage to the patient or death; thus, the patient is the "first victim" of these events. However, the victims of adverse events go way beyond a given individual. When they occur, there is an indirect effect on healthcare professionals, who are considered the "second victims". (2) The term "second victim" was used by Albert Wu, professor of health policies and management at the Johns Hopkins Bloomberg School of Public Health, in the year 2000, to describe the impact of adverse events on healthcare professionals. Some symptoms experienced by them have been described in literature and include psychological (shame, guilt, anxiety, sadness, and depression), and cognitive (dissatisfaction, exhaustion, secondary traumatic stress) symptoms, besides physical reactions, with a negative impact on their bodies. (2) It is probable that healthcare professionals directly involved in adverse events suffer emotional response reactions, which can lead to difficulty sleeping, guilt, lack of confidence, shame, anxiety, or reduced job satisfaction. If not treated, they may result in several consequences, including depression, emotional exhaustion, post-traumatic stress disorder, and suicidal ideation, according to a survey carried out by the American Society of Healthcare Risk Management, in 2015. (1-4) An analysis of 2013 in reference to healthcare professional as "second victims", and published in the Evaluation & the Health Professions, concluded that almost half of them experienced some impact, but few sought help. (2,3) A study conducted in 2017, based on professional interviews linked to the patient safety sector in intensive care hospitals in Maryland, United States, highlighted numerous barriers impeding physicians, nurses, and other healthcare professional from receiving help after the occurrence of How to cite this article:

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