The natural history of recovery for the healthcare provider "second victim" after adverse patient events

Abstract

Background: When patients experience unexpected events, some health professionals become ''second victims''. These care givers feel as though they have failed the patient, second guessing clinical skills, knowledge base and career choice. Although some information exists, a complete understanding of this phenomenon is essential to design and test supportive interventions that achieve a healthy recovery. Methods: The purpose of this article is to report interview findings with 31 second victims. After institutional review board approval, second victim volunteers representing different professional groups were solicited for private, hourlong interviews. The semistructured interview covered demographics, participant recount of event, symptoms experienced and recommendations for improving institutional support. After interviews, transcripts were analyzed independently for themes, followed by group deliberation and reflective use with current victims. Results: Participants experienced various symptoms that did not differ by sex or professional group. Our analysis identified six stages that delineate the natural history of the second victim phenomenon. These are (1) chaos and accident response, (2) intrusive reflections, (3) restoring personal integrity, (4) enduring the inquisition, (5) obtaining emotional first aid and (6) moving on. We defined the characteristics and typical questions second victims are desperate to have answered during these stages. Several reported that involvement in improvement work or patient safety advocacy helped them to once again enjoy their work. Conclusions: We now believe the post-event trajectory is largely predictable. Institutional programs could be developed to successfully screen at-risk professionals immediately after an event, and appropriate support could be deployed to expedite recovery and mitigate adverse career outcomes. BACKGROUND

Supporting involved health care professionals (second victims) following an adverse health event: A literature review

“…Scott et al (2008) suggest that immediate support should be provided to the clinician following the adverse event and that the time between the adverse event and support is crucial. A trusting relationship between the involved health care provider and the individual that is providing support is important (Schelbred et al, 2007;Scott et al, 2009). Family members, friends and colleagues seem to provide more support than managers and physicians (Wolf et al, 2000).…”

“…Frequently, second victims feel personally responsible for the unexpected patient outcomes and feel as though they have failed their patient, and feel doubts about their clinical skills and knowledge base" (Scott et al, 2009;Scott et al, 2010). As many as half of all health care providers have experienced the second victim phenomenon during their professional careers (Edrees et al, 2011).…”

“…The third and final step in the search strategy was an external review of the identified articles by three experts in the area of the second victim phenomenon: SS (published the definition of second victim and described a six-stage recovery trajectory) (Scott et al, 2009), JC (first author of the Institute for Healthcare Improvement (IHI) white paper) (Conway et al, 2010) and AW (initially introduced the term second victim) (Wu, 2000).…”

Nurses' experiences with errors in nursing

“…This concept has subsequently been translated to nursing practice (Jones, & Treiber, 2012;Scott et al, 2009). Scott et al (2009) defined the second victim as: "healthcare providers who … become traumatized by the [error].…”

“…As 'second victims,' individuals were affected in both their personal and professional lives (Schelbred & Nord, 2007) and/or experienced serious long-term emotional consequences . After being involved in an error, many nurses neither received the support they needed nor knew where to find such support (Scott et al, 2009;Waterman et al, 2007). Most health care institutions did not have 18 adequate support systems in place to assist staff with coping and adapting after an error (Gallagher et al, 2003;Schwappach & Boluarte, 2008).…”