After an Adverse Event, Staff Needs Support

Tami Swartz , March 28, 2013

Vanhaecht also spoke with Medically Induced Trauma Support Systems, which has in place systematic support design for second victims. In December 2012, Vanhaecht also presented his findings at the IHI's annual forum.

"Although I had been working on quality in ­healthcare for years, a new world opened up for me after talking with these experts. It was clear that this ­phenomenon was not something new, but it was very clear that there was a lack of knowledge and evidence about second victims," he says.

Understanding the second victim

Second victims are defined by Scott 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.

Research is still revealing exactly how to help these providers. Many hospitals know that involving a ­second victim in a root cause analysis and following process ­redesign can help him or her find solace; meanwhile, the hospital has a goal to proactively work toward-avoiding the same event in the future. However, the study notes that while involvement can be quite helpful, without sufficient emotional ­support for the second victim, the process can be "­associated with heightened emotional stress."

Not surprisingly, if victims are suffering from posttraumatic stress, as evidence suggests, then much of the quality efforts could force the victim to relive the incident. The paper concludes that without proper support during this time, involvement in the correction process may backfire and further victimize this group.

Viewing an event as traumatizing and treating the person involved as suffering from trauma can help ­hospital leaders understand what the second victim is going through and how to help. For example, just like many other types of victims, these victims benefit from hearing and connecting with others who have been involved in a similar adverse event.

Common feelings of second victims include guilt, shame, fear, and loss of confidence. According to KU Leuven Research's website on second victims, many experience:

  • Post-traumatic stress
  • General stress symptoms
  • Anger
  • Insomnia
  • Nervousness
  • A deterioration in family life
  • Depression

"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," says Vanhaecht.

"In their ­personal lives we see symptoms like insomnia, general stress symptoms, anger, fear, ­nervousness, depression, substance use [alcohol and medication], and there are cases of suicides. The most known case is that of ­Kimberly Hiatt, a nurse from Seattle who committed suicide ­after accidentally ­giving a baby a fatal overdose." Hiatt's mistake came after a 24-year accident-free career. She was fired after the incident.

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