After an Adverse Event, Staff Needs Support

Tami Swartz , March 28, 2013

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.

However, and perhaps not surprisingly, discussing the event with the patient is a different story. It is seen as a source of emotional stress for physicians.

Managers should discuss the event with the ­second ­victim as well; however, 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. Key phrases identified by the literature review as being helpful include:

"This has been difficult. Are you okay?"

"I believe in you."

"I cannot imagine what that might have been like for you. Can we talk about it?"

"You are a good nurse working in a very complex environment."

Being available to the second victim and knowing his or her whole story surrounding the event is crucial. A positive relationship with the patient or family involved can also be beneficial.

The organizational culture and behavior will affect how well the second victim overcomes his or her trauma. Open and confidential discussion with peers is crucial, as is the opportunity to have this conversation immediately after an event, before a provider leaves the clinical setting.

"Because of the impact of the AE on both the professional and personal life of these second victims, there can be additional victims who we must not forget," says ­Vanhaecht.

"These are, on the one hand, new patients who are in danger because of doubt in the second victims' skills and knowledge, creating a higher risk of other mistakes. Next to that, we must not forget the impact of the AE on the personal life of the second victim. The second victim's family, friends, and colleagues are also indirectly victimized and can be confronted with these negative effects."

Barriers to support

To begin with, having a culture of safety and transparency is crucial to ensuring a healthy environment in which your second victim can cope.

One study in the literature review found that physicians involved in an AE rarely saw a counselor or psychologist, and indicated that the most difficult part of the process was forgiving themselves.

"Also noted in the literature review as a barrier to overcoming second victim phenomena is the stigma of healthcare providers seeking mental health counseling," says Vanhaecht.

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