Article

Health Care Workers as Second Victims of Medical Errors

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Abstract

"Second victims" are health care providers who are involved with patient adverse events and who subsequently have difficulty coping with their emotions. Growing attention is being paid to making system improvements to create safer health care and to the appropriate handling of patients and families harmed during the provision of medical care. In contrast, there has been little attention to helping health care workers cope with adverse events. The aim of the study was to emphasize the importance of support structures for second victims in the handling of patient adverse events and in building a culture of safety within hospitals. A survey was administered to health care workers who participated in a patient safety meeting. The total number of registered participants was 350 individuals from various professions and different institutions within Johns Hopkins Medicine. The first part of the survey was paper-based and the second was administered online. The survey results reflected a need in "second victim" support strategies within health care organizations. Overall, informal emotional support and peer support were among the most requested and most useful strategies. When there is a serious patient adverse event, there are always second victims who are health care workers. The Johns Hopkins Hospital has established a "Second Victims" Work Group that will develop support strategies, particularly a peer-support program, for health care professionals within the system.

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... Adicionalmente, este personal afronta sentimientos de culpa, rabia, depresión y miedo. De hecho, puede llegar a dudar de sus conocimientos, competencias, habilidades en su trabajo e incluso puede tomar la decisión de no seguir ejerciendo su profesión (29), (20), (26). ...
... En este sentido, los estudios han descrito mayor afectación en el personal de salud femenino que en el masculino, pues se sienten más culpables y preocupadas por su reputación (30), (31), (29), (32), (26), (19), (27). las consecuencias también se ven influenciadas por la respuesta del equipo de salud y el manejo institucional del evento adverso. ...
... las consecuencias también se ven influenciadas por la respuesta del equipo de salud y el manejo institucional del evento adverso. Otros elementos que influyen en la intensidad de la experiencia son la relación entre el paciente y el cuidador, haber vivido experiencias clínicas de eventos adversos previas, establecer algún tipo de conexión con el paciente como tener un miembro de la familia de la misma edad, entre otros (33), (29), (34), (26), (19), (35), (36). ...
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Los hospitales son instituciones seguras. Justamente esa seguridad es el reflejo de un sinnúmero de acciones llevadas a cabo desde las áreas administrativas, la infraestructura y, especialmente, desde las actividades relacionadas con el personal de salud. En este aspecto partimos de una base: el personal de salud tiene una gran vocación de servicio y siempre aspira a que las personas egresen de los hospitales “mejor que como llegaron”. Lo anterior tiene que ver con una de las premisas fundamentales inculcadas en su formación desde Hipócrates: primum non nocere (primero no hacer daño). Infortunadamente, esto no siempre ocurre debido a las mismas condiciones clínicas de las personas o algunas veces por hacer u omitir una acción que puede comprometer la seguridad del paciente.
... Studies included focused on participants in the healthcare setting involving nursing, 5,9 physician residents 7 and other healthcare professionals in the hospital setting. 6,8,10 All 6 studies originated in the United States (see Table 3, Appendix B). ...
... The studies included in the final analysis assessed SVS and organizational support across a variety of healthcare settings and professions, using both quantitative and qualitative approaches to measure provider experiences (Table 3, Appendix B). [5][6][7][8][9][10] The Second Victim Experience and Support Tool (SVEST) 5,9 (n = 2/6, 33.3%) and the Medically Induced Trauma Support Services Staff Support Survey (n = 2/6, 33.3%) 7,9 were the most commonly used tools to measure SVS experiences. Based on these studies, the presence of organizational support strategies were predictive of absenteeism and turnover. ...
... 5,9 Reported in 5 of the articles, common symptoms of SVs were identified by healthcare providers, but most were afraid to report the incident and seek support due to litigation, fear of punishment, or stigma surrounding support. [5][6][7][8][9][10] Organizational Support Strategies Our findings indicated healthcare providers were either given or sought support methods after an adverse event. They further reported that they believe organizational support after adverse patient events was or would be beneficial for minimizing SVS. ...
Article
Purpose: Healthcare providers may experience critical incidents, medical errors, or other adverse patient events in their clinical practice.Providers that encounter such events can experience second victim syndrome (SVS), a condition where providers feel psychological, cognitive, or physical reactions rendering care in these instances. Organizational support may mediate the impacts of SVS after an adverse patient event. We conducted a scoping review to explore and synthesize the literature on the support strategies implemented by healthcare organizations for healthcare providers after adverse patient events. Methods: The initial search strategy yielded 244 articles, 84 of which were removed for duplication. The 3-person review team completed title and abstract screening, reference screening, and full-text review, reaching 2-person consensus for article inclusion at each phase. To be included in analysis, studies had to be conducted in the United States, include real or perceived outcomes of organizational support strategies for healthcare providers related to adverse patient events. During title and abstract screening, 144 articles did not meet inclusion criteria. The references of the remaining articles (n = 16) were screened and 6 articles were added to the review pool. Twenty-two articles were included in the full text analysis, 16 articles were removed for not meeting the inclusion criteria. Six articles were included in the final extraction and analysis. Results: The 6 studies assessed SVS and organizational support across a variety of healthcare work settings and professions. Findings indicated that healthcare providers believe organizational support after adverse patient events was or would be beneficial for minimizing SVS. They further demonstrated a discrepancy in the types of support strategies healthcare providers preferred or desired after an adverse event, as the level of agreement differed between sampled populations.Conclusion: Healthcare providers believe support from their organization is important after experiencing an adverse patient event, but support strategies may not be universal. Organizations should establish provider support systems for adverse events, but first need to assess provider preferences to implement the strategies most desired. As organizations develop their support systems, they should consider the interprofessional nature of their staffs to aid in collective support following an adverse event.
... The latter of the two are recognised as the second victims of medical errors [13]. A second victim can be described as a health-care professional who is deeply affected and traumatised as a result of an adverse medical event [14]. The associated trauma of the adverse event has been shown to result in detrimental consequences to both the personal and professional life of the health-care professional [15]. ...
... emotional reactions and psychological distress, with symptoms associated with post-traumatic stress disorder (PTsD), have been reported by a variety of health-care professionals, including surgeons, physicians and registered nurses [16]. An estimated 50% of all health-care professionals experience symptomology of the second victim phenomenon (svP) at least once during their careers, and prevalence rates of the svP can be as high as 72.6% in some populations [14,17,18]. ...
... In the aftermath of an adverse medical event, the first and most apparent victim is the patient and the patient's family. However, involvement in or exposure to such an event may also have an immense impact on the health-care professional involved [14]. The health-care professional may experience extreme personal and professional distress, consequently becoming a second victim of trauma. ...
... Healthcare 2024, 12, 2046 2 of 16 victims' [1][2][3][22][23][24][25]; impede or even harm organizational learning and performance [8,[26][27][28]; increase defensive posturing and safety clutter [29]; worsen staff insularity and silence [30,31]; exacerbate inequalities across medical-competency hierarchies in healthcare organizations; and invite abuses of power [32]. Restorative practices, in contrast, have yielded demonstrable benefits for second-victim experiences in healthcare [33] for claims resolution, stakeholder inclusion, quality of recommendations, just outcomes, risk awareness, and organizational learning [6,[34][35][36][37]. ...
... A number of converging trends and developments are responsible for this. They include the growing acknowledgment of healthcare providers as second victims of clinical errors and incidents [1][2][3], which can lead to moral injury [4] and worse [5]; ethical innovations in our thinking about medical error and accountability [6,7]; data showing that honesty and disclosure are cheaper than denial and lawsuits [8]; and the realization that we cannot punish and threaten our way toward a safer healthcare system [9][10][11][12] but should be creating work climates of trust and openness [13][14][15][16]. Some of these insights have come on the back of highly public inquiries into the quality failings of healthcare [17]. ...
Article
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Background/Objectives: Restorative responses to staff involved in incidents are becoming recognized as a rigorous and constructive alternative to retributive forms of ‘just culture’. However, actually achieving restoration in mostly retributive working environments can be quite difficult. The conditions for the fair and successful application of restorative practices have not yet been established. In this article, we explore possible commonalities in the conditions for success across multiple cases and industries. Methods: In an exploratory review we analysed published and unpublished cases to discover enabling conditions. Results: We found eight enabling conditions—leadership response, leadership expectations, perspective of leadership, ‘tough on content, soft on relationships’, public and media attention, regulatory or judicial attention to the incident, second victim acknowledgement, and possible full-disclosure setting—whose absence or presence either hampered or fostered a restorative response. Conclusions: The enabling conditions seemed to coagulate around leadership qualities, media and judicial attention resulting in leadership apprehension or unease linked to their political room for maneuver in the wake of an incident, and the engagement of the ‘second victim’. These three categories can possibly form a frame within which the application of restorative justice can have a sustainable effect. Follow-up research is needed to test this hypothesis.
... It is well established that 60%-92% of HCWs experience the Second Victim Phenomenon (SVP) at least once in their careers [1,[7][8][9][10][11][12][13]. This phenomenon can have significant medium to long-term psychological and physical effects that impact their professional and personal lives [2,7,8,10]. ...
... It is well established that 60%-92% of HCWs experience the Second Victim Phenomenon (SVP) at least once in their careers [1,[7][8][9][10][11][12][13]. This phenomenon can have significant medium to long-term psychological and physical effects that impact their professional and personal lives [2,7,8,10]. ...
Article
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Objectives To establish a consensus for evaluating second victims (SV) support interventions to facilitate comparison over time and across different organizations. Methods A three-phase qualitative study was conducted from June 2023 to March 2024. This consensus approach engaged members of the European Researchers Network Working on Second Victims. A nominal group technique and insights from a scoping review were used to create a questionnaire for Delphi Rounds. Indicators were rated 1–5, aiming for agreement if over 70% of participants rated an indicator as feasible and sensitive with scores above 4, followed by a consensus conference. Results From an initial set of 113 indicators, 59 were assessed online, with 35 advancing to the Delphi rounds. Two Delphi rounds were conducted, achieving response rates of over 60% and 80% respectively, resulting in consensus on 11 indicators for evaluating SV support programs. These indicators encompass awareness and activation, outcomes of SV support programs, as well as training offered by the institution. Conclusion This study presents a scoreboard for designing and monitoring SV support programs, as well as measuring standardized outcomes in future research.
... Available data suggest that between 60% and 92% of HCWs become second victims at least once during their careers [10][11][12][13][14]. However, a large number of managers and HCWs do not know how to act after a patient safety incident or how to cope with the second victim phenomenon (SVP) in their health care institutions [15,16]. ...
... Addressing an adequate response to the SVP can reduce distress, the emotional burden of HCWs [7,11,17], and the financial impact stemming from avoidable health care incidents [18] and increase the quality of care and patient safety [19,20]. This support is key in reducing risks of future adverse events in the health care system and contributing to patient safety [19]. ...
Preprint
BACKGROUND Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs’ well-being and ultimately improve the quality of care and patient safety. OBJECTIVE This study aims to describe and evaluate a multimodal training organized by the European Researchers’ Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. METHODS We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. RESULTS Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants’ satisfaction increased, particularly when adjusting the allocated time for the case studies’ discussion ( P <.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team. CONCLUSIONS This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts.
... Available data suggest that between 60% and 92% of HCWs become second victims at least once during their careers [10][11][12][13][14]. However, a large number of managers and HCWs do not know how to act after a patient safety incident or how to cope with the second victim phenomenon (SVP) in their health care institutions [15,16]. ...
... Addressing an adequate response to the SVP can reduce distress, the emotional burden of HCWs [7,11,17], and the financial impact stemming from avoidable health care incidents [18] and increase the quality of care and patient safety [19,20]. This support is key in reducing risks of future adverse events in the health care system and contributing to patient safety [19]. ...
Article
Background Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs’ well-being and ultimately improve the quality of care and patient safety. Objective This study aims to describe and evaluate a multimodal training organized by the European Researchers’ Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. Methods We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. Results Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants’ satisfaction increased, particularly when adjusting the allocated time for the case studies’ discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team. Conclusions This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts.
... At least half of healthcare providers suffer from the effect of being an SV [13]. In fact, there is always an SV when a serious adverse event occurs [14]. Furthermore, misuse claims in hospitals are related to "surgical" or "infusion errors," while the majority of claims in outpatient care relate to "unnoticed" or "late diagnosis" [15]. ...
... This does not necessarily indicate that these healthcare providers did not experience trauma at work, however; it is evident that the trend exists. Comparatively, the study by Edrees et al. in 2011 reported that 46% (a total of 139 Johns Hopkins male nurses participated in the study) knew about the term and its definition [14]. There is one possible reason for this: healthcare professionals' trauma is not mentioned in Saudi medical schools and hospitals, which do not offer specialty training or support programs. ...
Article
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Background: A second victim (SV) is a healthcare worker who is traumatized by an unexpected adverse patient case, therapeutic mistake, or patient-associated injury that has not been anticipated. Often, the second victim experiences direct guilt for the harm caused to the patients. Healthcare organizations are often unaware of the emotional toll that adverse events can have on healthcare providers (HCPs) who can be harmed by the same incidents that harm their patients. Second victims (SVs) were present in 10.4% up to 43.3% of cases following an adverse event. Aim: This study aims to examine the second victim phenomenon among healthcare providers at Al-Ahsa hospitals, its prevalence, symptoms, associated factors, and support strategies. Methods: Four major public hospitals participated in this cross-sectional study. The study used the German standardized questionnaire "SeViD-I survey." The directors of the four hospitals sent invitations with links to participate to healthcare providers who had worked in their hospitals for over six months after completing their internship program. Results: More than one-quarter of the respondents (90 (28%)) have been victims of a second victim incident before; of those, 63 (70%) have had it once, 12 (13.3%) twice, and 15 (16.7) repeatedly. In our study, the risk factors for a second victim only appeared in the male gender and were statistically significant. Strong reactivation of situations outside of the workplace was reported in 36 (40%) participants. Thirty-five (38.9%) participants reported reactivating the situation on the job site. Twenty-eight (31%) participants reported aggressive psychosomatic reactions (headaches and back pain). In 28 (31.1%) participants, sleep problems or excessive sleep needs were pronounced. The median of feeling symptoms was 7.2. As for supporting strategies, 64 (71.1%) respondents considered emotional support and crisis management to be very helpful. Sixty-six (73.3%) respondents found a safe chance to be very helpful. Conclusion: The findings of this study indicate that healthcare providers in Al-Ahsa, Saudi Arabia, suffer from second victim traumatization at high rates. Several symptoms appear in the second victim, and most do not receive enough support.
... In general it treats the second victim as a person with a condition that requires e.g. short-term psychotherapy or psychosocial support, while clinical support (Level 5) treats the second victim as having a disease treatable with medication [32,42,44,48,52,67,73,76,93,94] and long-term psychotherapy [32,42,44,48,52,67,73,76,80,81,93,94]. Next to this, national and local initiatives exist that include several levels of support [37,49,50,54,56,57,64,69,73,81,86, (Supplementary File 7). ...
... In general it treats the second victim as a person with a condition that requires e.g. short-term psychotherapy or psychosocial support, while clinical support (Level 5) treats the second victim as having a disease treatable with medication [32,42,44,48,52,67,73,76,93,94] and long-term psychotherapy [32,42,44,48,52,67,73,76,80,81,93,94]. Next to this, national and local initiatives exist that include several levels of support [37,49,50,54,56,57,64,69,73,81,86, (Supplementary File 7). ...
Article
Full-text available
Background Insights around second victims (SV) and patient safety has been growing over time. An overview of the available evidence is lacking. This review aims to describe (i) the impact a patient safety incident can have and (ii) how healthcare professionals can be supported in the aftermath of a patient safety incident. Methods A literature search in Medline, EMBASE and CINAHL was performed between 1 and 2010 and 26 November 2020 with studies on SV as inclusion criteria. To be included in this review the studies must include healthcare professionals involved in the aftermath of a patient safety incident. Results In total 104 studies were included. SVs can suffer from both psychosocial (negative and positive), professional and physical reactions. Support can be provided at five levels. The first level is prevention (on individual and organizational level) referring to measures taken before a patient safety incident happens. The other four levels focus on providing support in the aftermath of a patient safety incident, such as self-care of individuals and/or team, support by peers and triage, structured support by an expert in the field (professional support) and structured clinical support. Conclusion The impact of a patient safety incident on healthcare professionals is broad and diverse. Support programs should be organized at five levels, starting with preventive actions followed by self-care, support by peers, structured professional support and clinical support. This multilevel approach can now be translated in different countries, networks and organizations based on their own culture, support history, structure and legal context. Next to this, they should also include the stage of recovery in which the healthcare professional is located in.
... The "second victim" phenomenon is common among health care workers including physicians with a prevalence that can be as high as 30-46% [18,19]. The phenomenon was reported among about 87% of surgical residents who experienced medical errors and were able to provide details of the event [14]. ...
... Our findings of a common occurrence of the "second victim" phenomenon among the participants in our study validates the increasing concern this is generating within the medical cycle due to the confirmed increase in the expression of "second victim" thoughts among physicians [18,19,22,23]. The responses of physicians, including surgical residents to medical errors are varied spanning the cognitive, emotional and behavioral domains [24] and can include guilt, fear, disappointment, sadness, self doubt, frustration and shock [11,20,21,25]. ...
Article
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Introduction The “second victim” phenomenon refers to the distress and other negative consequences that physicians experience when they commit medical error. There has been increasing awareness about this phenomenon and efforts are being made to address it. However, there is dearth of information about it in developing countries. This study explored the experiences of surgical resident doctors of the University College Hospital in Ibadan, Nigeria about the “second victim” phenomenon and the support they had following medical errors. Methods This is a phenomenology study in which qualitative data were obtained from interviews with 31 resident doctors across 10 surgical units/departments. Interviews were transcribed verbatim, and data were coded inductively. Data were analyzed using content analysis method. Themes and subthemes were generated using axial coding. The themes were then integrated using selective coding. Results There were 31 participants and 10(32.3%) were females. All had witnessed other physicians encountering medical errors while 28(90.3%) had been directly involved in medical errors. Most of the errors were at the inter-operative stage. Prolonged work hours with inadequate sleep were identified as major causes of most medical errors. The feelings following medical errors were all negative and was described as ‘stressful’. Most of the residents got support from their colleagues, mostly contemporaries following medical errors, and many viewed medical errors as a learning point to improve their practice. However, there was a general belief that the systemic support following medical errors was inadequate. Conclusion The “second victim” phenomenon was common among the study group with consequent negative effects. Normalizing discussions about medical errors, reduction of work hours and meticulous intraoperative guidance may reduce medical errors and its consequences on the surgical residents. Steps should be taken within the system to address this issue effectively.
... The emotional toll of these major adverse events on surgeons may be quite severe, and surgeons may become "second victims" of complications. 2,3 Preliminary studies have demonstrated profound emotional effects in physicians involved in serious adverse events, such as fear, shame, anger, embarrassment, humiliation, anxiety, depression, and acute stress disorders. 2,4,5 In fact, at the highest level, postoperative post-traumatic stress disorder (PTSD) may occur in up to 10% to 20% of health care workers. ...
... Indeed, health care professionals who are second victims may leave their profession and even turn to suicide, and it has been previously reported that almost one-half of the health care providers may experience at least one second victim experience during their professional careers, making it essential for the entire health care infrastructure to provide structured support mechanisms to mitigate psychological suffering and promote emotional healing for second victims. 3 Our study also sought to explore if vascular surgeons' ways of coping, their perceptions of the controllability of the incident, and their perceptions of the support mechanisms predicted their experience of acute traumatic stress in the aftermath of major complications. Most respondents indicated a need to take time away immediately after the concerning event as well as the desire to share their emotions with respected peers. ...
Article
Introduction Post-operative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons. Methods An anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics, practice type, and used imbedded validated measures to determine emotional responses to post-operative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant. Results The survey was distributed to 267 faculty at 128 institutions in the US and 10 institutions in Canada and completed by 65 participants (response rate: 32%). 20/65 (31%) identified as female and the total group had a mean age of 47±10.2. Most respondents (43/65, 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65, 69%) reporting the outcome of patient mortality. Of respondents, 20/65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year with 12/65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (p=0.0028); less likely to identify the complication as “expected” (p=0.048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs. 20%, p=0.008). In regard to support following major complications, most respondents (57/65, 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and sense of honor (66%). Gender differences persisted on multivariate analysis (p=0.016). Conclusion Emotional responses following major post-operative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers, with whom to discuss complications
... 3,4 In a recent study, 60% of providers reported having been a "second victim," and two-thirds of these providers felt anxious, depressed, and unable to perform their job after the adverse event. 5 Support to providers who suffer the "second victim" phenomenon is lacking at many healthcare organizations, 6 although there is improving awareness on the part of hospital administrators toward the phenomenon. 7 Helping providers cope with the sequelae of medical errors can improve the quality of care that those providers are able to provide. ...
... Healthcare organizations are starting to realize that the second victim phenomenon can impact the quality of patient care by decreasing physician job performance. 5 As a result, institutions are building their own second victim response teams. Scott et al describe their institutional response team to second victim crises as a three-tier system 19 : The first (most immediate) tier is local support, and consists of immediate reassurance and comfort from colleagues and supervisors. ...
Article
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Background:. The second victim phenomenon is the distress felt by healthcare providers after a medical error. Although the phenomenon is a significant risk factor for burnout, little has been written about it in surgery, especially among residents. Methods:. After institutional review board approval, a 27-question anonymous online survey was sent to plastic surgery residents throughout the United States, and to residents from all surgical specialties at our institution, for a total of 435 residents. Residents were asked to describe any adverse events they had experienced, and subsequent emotional sequelae. Results:. The survey was returned by 125 residents (response rate 28.7%), of whom 53 were plastic surgery residents (42.4%) and 72 were from other surgical specialties (57.6%). In total, 110 (88%) described having been part of a medical error. An estimated 74 residents (34 from plastic surgery, 40 from other surgical specialties) provided a detailed description of the event. Sixty-four of them (86.5%) had subsequent emotional sequelae, most commonly guilt, anxiety, and insomnia. Only 24.3% of residents received emotional support. They rated other residents as the most important source of support, followed by faculty members and then family/friends. Conclusions:. The second victim phenomenon seems to be common among surgical residents. The most important source of support for affected residents in our cohort was other residents. Given these findings, institutions should focus on fostering camaraderie among residents, building effective second victim response teams and training peer support specialists.
... To determine differences in desired support strategies for each profile, the percentage of responses with four points was calculated. This tool has been used to identify the need for support strategies, but its reliability has not been reported (Edrees et al., 2011). In our study, Cronbach's alpha for this tool was 0.86, indicating adequate reliability. ...
... Hopkins Hospital (Edrees et al., 2011) are typical examples of these support programs. Although empirical data on the effectiveness of these programs are lacking, research has highlighted their usefulness (Busch et al., 2021). ...
Article
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Aims To clarify second victim symptoms subgroups, explore the factors affecting profile membership and determine how desired support strategies differ between the subgroups. Design A cross‐sectional study using an online survey. Methods A total of 378 Korean staff nurses directly involved in patient safety incidents were recruited between December 2019 and February 2020. Data analyses consisted of latent profile analysis, multinomial logistic regression and analysis of variance. Results Three latent profiles were identified: 'mild symptoms', 'moderate symptoms' and 'severe symptoms'. Lower organizational support and higher non‐work‐related support were more likely to belong to the severe symptoms' profile. Incidents that caused temporary harm to the patient were more strongly associated with an increased likelihood of belonging to the moderate and severe symptoms profiles than no‐harm events. Participants with severe symptoms agreed more with the usefulness of the support strategies than other participants; the usefulness of the psychological support strategies was rated particularly high. Participants in the mild and moderate symptoms groups agreed more strongly with the usefulness of coping strategies following patient safety incidents than psychological support. The strategy that all profiles considered the most useful was having the opportunity to take time away from clinical duties. Conclusion Tailored support should be provided to nurses with factors influencing the profile membership and subgroups of second victim symptoms. Impact This study confirmed the need to provide organizational support to nurses as second victims and provided valuable evidence for developing support programs tailored to the subgroups of second victim symptoms.
... One reason to involve those affected in incident investigations is that it meets a democratic consumer right, and speaks to a restorative view of justice, whereby genuine attempts to rebuild trusting relationships are central (11)(12)(13). Evidence suggests that patients and their relatives, as well as staff, report physical, financial and/or emotional vulnerability following healthcare incidents (14)(15)(16)(17) and during investigations (18,19). Morrison et al., described investigations as a "painful journey; for most, a pain yet to heal" (20), resulting in outcomes such as poorer health, work absenteeism and difficulties contributing to society (21,22). ...
Article
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Background: There is a growing international policy focus on involving those affected by healthcare safety incidents, in subsequent investigations. Nonetheless, there remains little UK-based evidence exploring how this relates to the experiences of those affected over time, including the factors influencing decisions to litigate. Aims: We aimed to explore the experiences of patients, families, staff and legal representatives affected by safety incidents over time, and the factors influencing decisions to litigate. Methods: Participants were purposively recruited via (i) communication from four NHS hospital Trusts or an independent national investigator in England, (ii) relevant charitable organizations, (iii) social media, and (iv) word of mouth to take part in a qualitative semi-structured interview study. Data were analyzed using an inductive reflexive thematic approach. Findings: 42 people with personal or professional experience of safety incident investigations participated, comprising patients and families (n = 18), healthcare staff (n = 7), legal staff (n = 1), and investigators (n = 16). Patients and families started investigation processes with cautious hope, but over time, came to realize that they lacked power, knowledge, and support to navigate the system, made clear in awaited investigation reports. Systemic fear of litigation not only failed to meet the needs of those affected, but also inadvertently led to some pursuing litigation. Staff had parallel experiences of exclusion, lacking support and feeling left with an incomplete narrative. Importantly, investigating was often perceived as a lonely, invisible and undervalued role involving skilled "work" with limited training, resources, and infrastructure. Ultimately, elusive "organizational agendas" were prioritized above the needs of all affected. Conclusions: Incident investigations fail to acknowledge and address emotional distress experienced by all affected, resulting in compounded harm. To address this, we propose five key recommendations, to: (1) prioritize the needs of those affected by incidents, (2) overcome culturally engrained fears of litigation to re-humanize processes and reduce rates of unnecessary litigation, (3) recognize and value the emotionally laborious and skilled work of investigators (4) inform and support those affected, (5) proceed in ways that recognize and seek to reduce social inequities. KEYWORDS patient safety, patient involvement, staff involvement, healthcare harm, safety investigations, healthcare litigation, qualitative research.
... Therefore, it would be useful to introduce this concept to nurses before they practise in the profession. Although training courses and educational level are important factors, there are many other additional factors that could impact SVE, such as blame culture, personality traits, gender and relationship with patients and other professionals (Beck, LoGiudice, and Gable 2015;Edrees et al. 2011;Nevalainen, Kuikka, and Pitkälä 2014). ...
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Aim Adverse events impact patients as primary victims including their families, while healthcare providers are impacted as second victims. These incidents have serious psychological and physical impacts on healthcare providers' quality of life and their ability to execute their jobs. As no studies have been conducted in the Middle East to explore the experiences of second victims among nurses, this study examined the relationship between nurses' second victim experiences, turnover and absenteeism. Design Descriptive, correlational, cross‐sectional study. Methods A convenience sample of 117 nurses was recruited from secondary‐ and tertiary‐level hospitals across 13 regions in Saudi Arabia. The Second Victim Experience and Support Tool was used to assess second victim experiences and their impact on turnover and absenteeism. Results Second victim trauma affected over half of the participants. ‘The mental weight of my experience is exhausting’ and ‘My colleagues can be indifferent to the impact these situations have had on me’ obtained the highest mean scores. Healthcare providers who stated that these situations had improved their quality of care were found to have the lowest scores. Second victim experiences had significant relationships with turnover and absenteeism. Further, healthcare providers' length of experience did not affect absenteeism, while second victim experiences significantly predicted absenteeism. Additionally, a strong relationship was observed between turnover and absenteeism. Overall, those with a second victim experience had a greater turnover intention. Conclusions The results underscore the physical and psychological distress that healthcare providers endure, increasing the likelihood of them leaving the profession. These problems are worsened by inadequate institutional support, emphasising the need for efforts to stabilise second victims and avoid unfavourable organisational outcomes. Reporting Method The study adheres to the STROBE reporting guidelines. Patient or Public Contribution No patient or public contribution.
... The term "second victim" (SV) describes healthcare professionals who, through direct engagement or indirectly, are affected by adverse patient events, unintended healthcare mistakes, or patient harm that leads to emotional and psychological distress, including anxiety, self-directed anger, and fear of future errors [7,8,10]. These conditions are managed through employee support programs, designed as peer support, online or local leadership programs within the health organisation [11][12][13][14], consisting of preincident prevention and post-incident support tailored to context-speci c factors such as culture and organisational structure [15]. ...
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Background: The second victim phenomenon, denoting the harmful effects of patient safety incidents on healthcare practitioners, remains insufficiently examined within the pharmacy workforce. Aim: This study aimed to investigate the second victim phenomenon in community pharmacies across Serbia, examining its triggers, contexts, and effects on pharmacists’ health, well-being, and implications towards pharmaceutical care. Method: Thisconsensus study, involving 27 pharmacists with prior experience in the second victim phenomenon, employed the Nominal Group Technique in three groups. The final rank was calculated using the van Breda methodology, where the higher values present a higher impact. Statistical evaluation was applied to ascertain the distribution of events, investigate the potential relationships between event categories and patient outcomes, and determine the subsequent impact on pharmacists. Results: "Patient-centric anxiety" (6.8) was the top mental health issue, followed by "Personal responsibility and resilience" and "Future concerns and career aspirations" (6.0 each). The dominant support was "Colleague/Peer support" (5.3). Significant patient safety incidents were "Inadequate pharmaceutical service" (8.0) and "Wrong drug dispensed" (7.8). In community pharmacies, 63.0% of incidents involved dispensing errors, with "near misses" or "no harm incidents" at 33.3% each and "harmful incidents" at 25.9%. Transcripts indicate that lack of supervision, crowding, and storage issues led to errors, highlighting the need for better dispensing verification and pharmacist training. Conclusion: This study highlights the profound impact of the second victim phenomenon on pharmacists, which often stems from breaches in basic practice standards. Unmanaged, it worsens quality and safety in pharmaceutical care and severely threatens pharmacists' well-being.
... In the wake of the COVID-19 pandemic, healthcare organisations have increasingly faced employee burnout accompanied by staff turnover and a shortage of skilled personnel [1]. This situation has drawn increased attention to the physical and mental health and well-being of those providing healthcare services [2]. Numerous initiatives and research consortia have been established to study the impact of adverse treatment outcomes on the health of all healthcare professionals [3], [4]. ...
Conference Paper
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The COVID-19 pandemic and increased incidence of adverse events in healthcare have intensified global research into the impacts on healthcare professionals, including pharmacists. Recognizing the importance of business competencies such as communication, teamwork, and resilience, global regulations have highlighted these competencies to reduce staff turnover and enhance patient safety. In response, the pharmaceutical company Galenika A.D. Beograd developed "Galiverse," a mobile application to support its strategic pharmacy partners by providing an accessible tool for competency enhancement. The application content was created by a multidisciplinary team from two universities in Serbia based on a thorough review of the literature and guidelines for educational interventions in health. The content is accredited by the Health Council of Serbia. Since its launch in February 2023, the application has been adopted by 4,200 users, with 5,351 participating in accredited tests, achieving a 77.78% success rate. A total of 10,427 webinar views were also recorded. A survey revealed that 95.77% of users felt the application had improved their organisational, personal, and professional competencies, while 97.65% would recommend it to colleagues seeking development. The "Galiverse", which is aligned with regulatory requirements and ensures safe and reliable practices for the future, proved to be the most accessible tool for the development of business competencies among pharmacists in Serbia. Keywords: Business Competencies, Pharmacists, Mobile Application, Competency Framework, Professional Development.
... 31 Scenarios who may be helpful for faculty and health care learners include breaking bad news, high-risk-low-incidence clinical scenarios, and SVEs. Little evidence exists on the outcomes of the inclusion of SVE content in medical school or allied health educational curriculums, but surveys have consistently found limited awareness of the term SV. 2,[32][33][34] The specialty of nurse anesthesia developed an evidence-based 6-domain SV curriculum to define SV, highrisk situations, barriers for SVs, consequences of SVEs, evidence-based understanding and interventions frameworks, and support systems. 35 This framework can be translated to all health care professionals and included in the educational curriculum of any type of health care learner. ...
Article
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Objective To investigate the experience of medical and graduate learners with second victim experience (SVE) after medical errors or adverse patient outcomes, including impact on training and identification of factors that shape their postevent recovery. Patients and Methods The validated Second Victim Experience and Support Tool-Revised (SVEST-R), Physician Well-Being Index, and supplemental open-ended questions were administered to multidisciplinary health care learners between April 8, 2022, and May 30, 2022, across a large academic health institution. Open-ended responses were qualitatively analyzed for iterative themes related to impact of SVE on the training experience. Results Of the 206 survey respondents, 144 answered at least 1 open-ended question, with 62.1% (n=91) reporting at least 1 SVE. Participants discussed a wide range of SVEs and indicated that their postevent response was influenced by their training environment. Lack of support from supervisors and staff exacerbated high stress situations. Some trainees felt blamed and unsupported after a traumatic experience. Others emphasized that positive training experiences and supportive supervisors helped them grow and regain confidence. Learners described postevent processing strategies helpful to their recovery. Some, however, felt disincentivized from seeking support. Conclusion This multidisciplinary study of learners found that the training environment was influential in postevent recovery. Our findings support the need for the inclusion of education on SVEs and adaptive coping mechanisms as part of health care professional educational curriculums. Educators and health care staff may benefit from enhanced education on best practices to support trainees after stressful or traumatic patient events.
... (Goncharuk 2023).Research has shown that almost half of HCPs experience the impact as an SV at least one time in their career Ozeke (2019). Indeed, there are always SVs, when there is a serious patient adverse event, but mostly silent because of the fear of litigation and the absence of a welldefined reporting system (Edrees 2011). The effects specialists such as Surgeons, anesthesiologists, and Pediatrist were found to be most affected according to researchers (Han 2017).In hospitals, most of the malpractice assertions are related to "surgical" or "infusion errors", whereas for outpatient care, most assertions are related to "unnoticed" or "late diagnosis" ...
Article
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Purpose: This essay provides a comprehensive analysis of support programs for healthcare professionals following an adverse health event. Through the use of electronic health records, health information exchange, and interoperability with data standards, these programs aim to address the effects on second victims. Methodology: The methodology utilized includes a thorough review of the literature on the topic and presents key findings and implications for future research. Findings: Overall, these results highlight the importance of supporting healthcare professionals to improve patient outcomes and minimize negative impacts within the healthcare system. Unique contribution to theory, policy and practice: As healthcare evolves ceaselessly, we must cultivate an environment where the shaken can recover their footing. Collaborative efforts and advances can weave together a support structure sturdy enough to hold up all harmed by mishaps as second victims.
... There are a few notable instruments available to assess SVS [17,25,[54][55]; however, the most widely recognized is the Second Victim Experience and Support Tool (SVEST), published by Burlison in English [56]. The SVEST has been validated and translated into Korean [57], Iranian [58], Italian [59], Spanish (Argentina) [60], Chinese [61], Danish [62], and Spanish (Spain) [63]. ...
Article
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“Second victims” are defined as healthcare professionals who are traumatized physically, psychologically, or emotionally as a result of encountering any patient safety incidents. The Revised Second Victim Experience and Support Tool (SVEST-R) is a crucial instrument acknowledged worldwide for the assessment of the second victim phenomenon in healthcare facilities. Hence, the aim of this study was to evaluate the psychometric properties of the Malay version of the SVEST-R. This was a cross-sectional study that recruited 350 healthcare professionals from a teaching hospital in Kelantan, Malaysia. After obtaining permission from the original author, the instrument underwent 10 steps of established translation process guidelines. Pretesting of 30 respondents was performed before embarking on the confirmatory factor analysis (CFA) to evaluate internal consistency and construct validity. The analysis was conducted using the R software environment. The final model agreed for 7 factors and 32 items per the CFA’s guidelines for good model fit. The internal consistency was determined using Raykov’s rho and showed good results, ranging from 0.77 to 0.93, with a total rho of 0.83. The M-SVEST-R demonstrated excellent psychometric properties and adequate validity and reliability. This instrument can be used by Malaysian healthcare organizations to assess second victim experiences among healthcare professionals and later accommodate their needs with the desired support programs.
... Coping strategies following an error varied. Only a small minority of nurses have been reported to have sought professional help and/or disclose the error (Edrees et al., 2011;Scott et al., 2009). The most common coping approach was to remain silent. ...
Article
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In this project we used sequential qualitative, QUAL → qual (i.e., sequential qualitative mixed method-method design) to explore the experiences of 36 nurses involving 44 clinical errors. With the core QUAL component, we used content analysis to describe the context and develop a new taxonomy—Circumstances-of-Error. This compensates for limitations in the presently used scale, TERCAP, developed in 2002. The revised scale links error types with error causation, thus enabling the institution to identify problems within its system as well as personnel. Next, in the sequential qual component, we linked each type of error with the emotional impact experience by nurses involved in the process. A constructivist grounded theory with the post-error stages—Impact of the Error, Losing Competency and Reestablishing Competency—describes the emotional ramifications of the experience. Three types of responses were prevalent, somatic, angst, and mortification, which shattered the confidence of staff resulting in nurses leaving or transferring from the unit. In addition to the cost to patient safety, estimating the cost of errors must also include cost to professionals, staff in general, the institution, and to the profession.
... The knowledge of the term "Second Victim" (50.6%) was very high when compared to other studies in German-speaking countries [1,2,12], and was also slightly higher when compared to a study conducted by Edrees et al. at John Hopkins University (U.S.), where 46% of the participants were familiar with the term [15]. This can be interpreted as a positive development regarding the knowledge and acceptance of emotional or psychological distress (especially when traumatized during an adverse event) among health care workers. ...
Article
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Citation: Krommer, E.; Ablöscher, M.; Klemm, V.; Gatterer, C.; Rösner, H.; Strametz, R.; Huf, W.; Ettl, B. Second Abstract: (1) Background: The Second Victim Phenomenon (SVP) is widespread throughout health care institutions worldwide. Second Victims not only suffer emotional stress themselves; the SVP can also have a great financial and reputational impact on health care institutions. Therefore, we conducted a study (Kollegiale Hilfe I/KoHi I) in the Hietzing Clinic (KHI), located in Vienna, Austria, to find out how widespread the SVP was there. (2) Methods: The SeViD (Second Victims in Deutschland) questionnaire was used and given to 2800 employees of KHI, of which 966 filled it in anonymously. (3) Results: The SVP is prevalent at KHI (43% of the participants stated they at least once suffered from SVP), although less prevalent and pronounced than expected when compared to other studies conducted in German-speaking countries. There is still a need for action, however, to ensure a psychologically safer workspace and to further prevent health care workers at KHI from becoming psychologically traumatized.
... We hypothesized that, training experiences or support from colleagues and supervisors might be associated with growth, given that peer support system as well as organizational support system are known as the most useful strategy to help healthcare workers to effectively cope with a patient adverse event (Edrees et al., 2011;Seys et al., 2013). However, training experiences or support from colleagues and supervisors were not significantly associated with distress or growth in the current study. ...
Article
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Medical mishaps are well-known sources of distress. However, some mishaps may give medical professionals an opportunity to experience personal growth. We examined the associations between medical mishaps, second victim distress, and posttraumatic growth. A total of 157 physicians and 139 nurses completed a survey that included questions about mishaps, Second Victim Experience and Support Tool and the Posttraumatic Growth Inventory. Overall, 82.8% of the physicians and 48.9% of the nurses experienced at least one mishap. Lack of training, rumination, and impact of mishaps were associated with distress among nurses, whereas rumination, impact, and stressfulness were associated with distress among physicians. On the other hand, the impact of mishaps is the only factor that was associated with posttraumatic growth among nurses, whereas none with physicians. This study suggests that the posttraumatic growth from medical mishaps is not associated with the theory-driven event-related factors, and highlights the importance of further investigation.
... It is estimated that half of health professionals experience the second victim phenomenon at least once in their career. 9 Another study developed in Spain indicated that 6 out of 10 health professionals experienced the second victim phenomenon. 10 There is a growing body of evidence which focuses on understanding physical and psychological consequences experienced by healthcare professionals who are involved in a patient safety incident which causes serious or minor harm or even did not cause direct harm to the patient (near miss). ...
Article
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Introduction Health organisations should support healthcare workers who are physically and psychologically affected by patient safety incidents (second victims). There is a growing body of evidence which focuses on second victim support interventions. However, there is still limited research on the elements necessary to effectively implement and ensure the sustainability of these types of interventions. In this study, we propose to map and frame the key factors which underlie an effective implementation of healthcare worker support interventions in healthcare organisations when healthcare workers are physically and/or emotionally affected by patient safety incidents. Methods and analysis This scoping review will be guided by the established methodological Arksey and O’Malley framework, Levac and Joanna Briggs Institute (JBI) recommendations. We will follow the JBI three-step process: (1) a preliminary search conducted on two databases; (2) the definition of clear inclusion criteria and the creation of a list of search terms to be used in the subsequent running of the search on a larger number of databases; and (3) additional searches (cross-checking/cross-referencing of reference lists of eligible studies, hand-searching in target journals relevant to the topic, conference proceedings, institutional/organisational websites and networks repositories). We will undertake a comprehensive search strategy in relevant bibliographic databases (PubMed/MEDLINE, Embase, CINHAL, Web of Science, Scopus, PsycInfo, Epistemonikos, Scielo, Cochrane Library and Open Grey). We will use the Mixed Methods Appraisal Tool V.2018 for quality assessment of the eligible studies. Our scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. Ethics and dissemination This study will not require ethical approval. Results of the scoping review will be published in a peer-review journal, and findings will be presented in scientific conferences as well as in international forums and other relevant dissemination channels. Trial registration number 10.17605/OSF.IO/RQAT6. Preprint from medRxiv available: doi: https://doi.org/10.1101/2022.01.25.22269846 .
... En este mismo orden de ideas, el 72,5 % de los participantes del área hospitalaria en el estudio español manifestó haberse sentido víctima secundaria de un evento adverso en algún momento (9). Asimismo, en un estudio realizado en el Johns Hopkins Hospital en Estados Unidos, así lo manifestaron más de la mitad de los participantes (18). En el estudio Boston Intraoperative Adverse Event Surgeons Attitude (BISA), realizado en cirujanos de los Estados Unidos, se encontró que el 84 % de los participantes se habían sentido víctimas secundarias de un evento adverso en algún momento (10), lo que demuestra cuán común es el fenómeno, incluso en diferentes contextos clínicos y sociales. ...
Article
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Introducción. Los eventos adversos pueden causar daño al paciente y también afectar a los profesionales de la salud, lo que los convierte en segundas víctimas. Las intervenciones se han enfocado principalmente en los pacientes, pero poca atención se ha prestado a los profesionales de la salud, probablemente por falta de herramientas. Objetivo. Estimar la prevalencia de eventos adversos y describir sus manifestaciones en el personal asistencial, con el fin de evidenciar el fenómeno de las segundas víctimas en un hospital de alta complejidad. Materiales y métodos. Se hizo un estudio transversal analítico mediante una encuesta a 419 profesionales asistenciales de las áreas de hospitalización, urgencias y cirugía en un hospital de alta complejidad de Medellín en el 2019. Se estimó la frecuencia de eventos adversos, y se determinó su asociación con algunas variables laborales y demográficas. Resultados. El 93,1 % de los entrevistados conocía de casos de incidentes y el 79 %, de eventos adversos graves. El 44,4 % se había visto involucrado en un evento adverso, y el 99 % de estos expresaba sentirse como segunda víctima por experimentar dificultad para concentrarse, sentimientos de culpa, cansancio, ansiedad y dudas sobre sus decisiones. El 95 % quería recibir capacitación para afrontar las consecuencias de los eventos adversos y saber cómo informar al paciente. Conclusiones. Con frecuencia los profesionales de la salud se exponen a eventos adversos que pueden causarles emociones negativas como culpa, cansancio, ansiedad e inseguridad. La mayoría de los profesionales que participan en un evento adverso manifiestan sentimientos como segunda víctima. El informar al paciente sobre un evento adverso requiere preparación y la mayoría de los profesionales entrevistados pidió capacitación en el tema.
... It is estimated that half of health professionals experience the second victim phenomenon at least once in their career. 9 Another study developed in Spain indicated that 6 out of 10 health professionals experienced the second victim phenomenon. 10 There is a growing body of evidence which focuses on understanding physical and psychological consequences experienced by healthcare professionals who are involved in a patient safety incident which causes serious or minor harm or even did not cause direct harm to the patient (near miss). ...
Preprint
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Introduction Health organisations should support healthcare workers who are physically and psychologically affected by patient safety incidents (second victims). There is a growing body of evidence which focusses on second victim support interventions. However, there is still limited research on the elements necessary to effectively implement and ensure the sustainability of these types of interventions. In this study, we propose to map and frame the key factors which underlie an effective implementation of healthcare worker support interventions in healthcare organisations when healthcare workers are physically and/or emotionally affected by patient safety incidents. Methods and analysis This scoping review will be guided by the established methodological Arksey and O’Malley framework, Levac and Joanna Briggs Institute (JBI) recommendations. We will follow the JBI three-step process: (1) a preliminary search conducted on two databases; (2) the definition of clear inclusion criteria and the creation of a list of search terms to be used in the subsequent running of the search on a larger number of databases; and (3) additional searches (cross-checking/cross-referencing of reference lists of eligible studies, hand-searching in target journals relevant to the topic, conference proceedings, institutional/organisational websites and networks repositories). We will undertake a comprehensive search strategy in relevant bibliographic databases (Pubmed/Medline, Embase, CINHAL, Web of Science, Scopus, PsycInfo, Epistemonikos, Scielo, Cochrane Library and Open Grey). We will use the Mixed Methods Appraisal Tool (MMAT) 2018 version for quality assessment of the eligible studies. Our scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Ethics and dissemination This study will not require ethical approval. Results of the scoping review will be published in a peer-review journal and findings will be presented in scientific conferences as well as in international forums and other relevant dissemination channels. This protocol is registered on the Open Science Framework ( www.osf.io ): 10.17605/OSF.IO/WZSE9 Strengths and limitations of this study To our knowledge, this is the first scoping review to map and frame the different organisational, operational and contextual factors which underlie the implementation of health worker support programmes after the occurrence of a patient safety incident. This scoping review uses a rigorous and transparent method for mapping the available evidence. Given the broad focus of this scoping review, we don’t expect that eligible studies will show a direct relation between the key factors and the effectiveness of the implementation of the support interventions. For better interpretation of the results, we will provide a quality assessment of the included studies, although quality assessment is not mandatory to include in scoping reviews. We will involve key stakeholders as an additional source of information to complement the literature search.
... Nevertheless, these efforts need to be aimed specifically at developing guidelines for potential peer responders. Edrees et al. put forward some basic recommendations on the language to be used and avoided by the peer responder when meetings with the SV 30 . These guidelines, though useful, need to be complemented by training courses organised by each hospital. ...
Article
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Background and aim of study An effective and accessible first source of support for second victims (SV) is usually the colleagues themselves, who should have tools to help emotionally and detect the unusual course of a SV. The aim of this work is to assess health professionals’ perception of the phenomenon, as well as their capability to apply psychological first aid. Material and methods Observational descriptive study through online surveys answered anonymously. Participants were different health professionals from surgical area, mainly from a third-level hospital. Results 329 responses, 67 anaesthesiologists, 110 anaesthesiologists in training, 152 nurses. 78.4% had felt SV, more frequent among anaesthesiologists; however, 58% had never heard of the term. Guilt was the most frequent emotion. Residents were more afraid of judgmental colleagues and thought more about drop out their training. From those who sought help, most did it through a colleague, but most did not feel useful in helping a SV. 66% affirmed there is a still punitive, evasive or silent culture about medical incidents. Conclusions Despite the frequency of the phenomenon there is still lack of knowledge of the term SV. Impact of the phenomenon is heterogenous and changes based on experience and responsibility. Colleagues are the first source of emotional help but there is a lack of tools to be able to provide it. Institutions are urged to create training programs so that professionals can guarantee «psychological first aid».
... Many researchers have noted that second victim syndrome can progress to posttraumatic stress disorder (Paparella, 2011;Scott et al., 2008). There is also a recognition that SVS can be enduring, lasting for many years, which has contributed to comparisons to PTSD (Edrees et al., 2011;Pratt & Jachna, 2015). Importantly, PTSD is a fear-based disorder, where moral injury is a shame based disorder (Shay, 2014). ...
Article
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Purpose: This study examined the combined role psychological capital and social capital play in the severity of second victim syndrome experienced by registered nurses. Design: This research study was an ex post facto, cross-sectional, non-experimental survey design. Data were collected from October to December 2018. The study sample was composed of 1167 nurses recruited through 12 professional nursing associations in the United States. Methods: Self-report questionnaires were administered to measure psychological capital (Psychological Capital Questionnaire), social capital (Social Capital Outcomes for Nurses) and second victim syndrome (Second Victim Experience and Support Tool). Data cleaning and analysis of 1167 cases were conducted via SPSS v25 and structural equation modeling of 999 cases was conducted with AMOS v25. Findings: The SEM analysis demonstrated that psychological capital, on its own, had no effect on the severity of the second victim experience. Social capital, on its own, had a statistically significant relationship with second victim severity. The combined impact of social capital and psychological capital had a statistically significant effect on second victim severity. Conclusions: The results of this study have practical implications that include unit-based peer support programs and an increased focus on supportive workplace cultures. Programmatic efforts should also focus on social capital at the team level as well as the importance of building self-efficacy through increasing mastery experiences, modeling of behavior, social persuasion and monitoring one's physiological responses. Clinical relevance: These findings demonstrate the importance of social capital to mitigation of second victim experiences, while also demonstrating that psychological capital has no effect on second victim severity. Building social capital and collective efficacy are critical to mitigation of second victim syndrome.
Article
The second victim phenomenon, involving emotional and psychological distress after adverse events, is underexplored among pharmacy professionals. The validated Second Victim Experience and Support Tool measures these experiences and support options, with the improved version also assessing resilience. This study aimed to validate the Second Victim Experience and Support Tool-Revised, measure the second victim phenomenon, and present results among pharmacy professionals in Serbia. This cross-sectional study included 350 pharmacy professionals (MPharm and technicians). The questionnaire, with 9 factors and 35 statements, was translated and adapted following guidelines, and the content was validated by five experts. A pre-test with 30 participants ensured clarity, followed by Confirmatory Factor Analysis for construct validity and Cronbach's Alpha for reliability. Content validity was confirmed with item scores from 0.8 to 1 and a mean scale score of 0.83. Factor analysis identified 9 factors and 30 items (Chi-square = 545.6, degrees of freedom = 366, p < 0.001). The model fit was supported by a Root Mean Square Error of Approximation of 0.037, a Comparative Fit Index of 0.958, a Tucker-Lewis Index of 0.950, and a Standardised Root Mean Square Residual of 0.040. Reliability analysis showed a Cronbach's alpha of 0.88, with factor values from 0.60 to 0.90. Among participants, 49.5% feared future events, 47.4% felt exhausted, 22.6% considered quitting, 72.6% valued peer support, and 28.9% improved work quality. The Serbian resilience measuring tool is valid and reliable, effectively evaluating second victim experiences and support, with half of pharmacy professionals affected.
Article
Objectives Incontrovertible evidence surrounds the need to support healthcare professionals after patient safety incidents (PSIs). However, what characterises effective organisational support is less clearly understood and defined. This review aims to determine what support healthcare professionals want for coping with PSIs, what support interventions/approaches are currently available and which have evidence for effectiveness. Design Systematic research review with narrative synthesis. Data sources Medline, Scopus, PubMed and Web of Science databases (from 2010 to mid-2021; updated December 2022), reference lists of eligible articles and Connected Papers software. Eligibility criteria for selecting studies Empirical studies (1) containing information about support frontline healthcare staff want before/after a PSI, OR addressing (2) support currently available, OR (3) the effectiveness of support to help prevent/alleviate consequences of a PSI. Study quality was appraised using the Quality Assessment for Diverse Studies tool. Results Ninety-nine studies were identified. Staff most wanted: peer support (n=28), practical support and guidance (n=27) and professional mental health support (n=21). They mostly received: peer support (n=46), managerial support (n=23) and some form of debrief (n=15). Reports of poor PSI support were common. Eleven studies examined intervention effectiveness. Evidence was positive for the effectiveness of preventive/preparatory interventions (n=3), but mixed for peer support programmes designed to alleviate harmful consequences after PSIs (n=8). Study quality varied. Conclusions Beyond peer support, organisational support for PSIs appears to be misaligned with staff desires. Gaps exist in providing preparatory/preventive interventions and practical support and guidance. Reliable effectiveness data are lacking. Very few studies incorporated comparison groups or randomisation; most used self-report measures. Despite inconclusive evidence, formal peer support programmes dominate. This review illustrates a critical need to fund robust PSI-related intervention effectiveness studies to provide organisations with the evidence they need to make informed decisions when building PSI support programmes. PROSPERO registration number CRD42022325796.
Article
Background Healthcare workers who find themselves entangled in unforeseen adverse patient events, medical errors, and/or patient-related injuries, experiencing trauma and victimization as a consequence of said incidents, are referred to as “second victims”. Objectıve This study aims to validate and assess the reliability of the Turkish version of the Second Victim Experience and Support Tool-Revised (SVEST-R). Methods The methodological and cross-sectional study involved 400 physicians and nurses in an Edirne tertiary hospital of Turkey. The Turkish SVEST-R and a questionnaire were administered, assessing validity through factor analysis and content validity, and reliability through item-total score correlation, internal consistency, and test-retest methods. Results Kaiser-Meyer-Olkin test (0.84) and Bartlett Test (p < 0.001) indicated adequate sampling for factor analysis. Exploratory Factor Analysis identified nine factors explaining 71.58% of total variance. Confirmatory Factor Analysis showed good fit (x ² = 976.95, x ² /df = 2.3, CFI = 0.92, GFI = 0.87, RMSEA = 0.05). Cronbach's alpha was 0.85, signifying high internal consistency. Healthcare professionals’ average T-SVEST-R score was 2.8 ± 0.5. Among independent variables, professional experience length significantly influenced T-SVEST-R score. Conclusıons The Turkish version of the Second Victim Experience Support Tool-Revised (T-SVEST-R) has been validated as a reliable scale.
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Background : The second victim phenomenon, involving emotional and psychological distress after adverse events, is underexplored among pharmacy professionals. The validated Second Victim Experience and Support Tool measures these experiences and support options, with the improved version also assessing resilience. Aim : This study aimed to validate the Second Victim Experience and Support Tool-Revised, measure the second victim phenomenon, and present results among pharmacy professionals in Serbia. Method : This cross-sectional study included 350 pharmacy professionals (MPharm and technicians). The questionnaire, with 9 factors and 35 statements, was translated and adapted following guidelines, and the content was validated by five experts. A pre-test with 30 participants ensured clarity, followed by Confirmatory Factor Analysis for construct validity and Cronbach's Alpha for reliability. Results : Content validity was confirmed with item scores from 0.8 to 1 and an average scale score of 0.83. Factor analysis identified 9 factors and 30 items (Chi-square = 545.571, degrees of freedom = 366, p < 0.001). The model fit was supported by a Root Mean Square Error of Approximation of 0.037, a Comparative Fit Index of 0.958, a Tucker-Lewis Index of 0.950, and a Standardised Root Mean Square Residual of 0.040. Reliability analysis showed a Cronbach's alpha of 0.88, with factor values from 0.60 to 0.90. Among participants, 49.5% feared future events, 47.4% felt exhausted, 22.6% considered quitting, 72.6% valued peer support, and 28.9% improved work quality. Conclusion : The Serbian resilience measuring version effectively evaluates the second victim experience and support options among pharmacy professionals, showing good validity and reliability.
Article
The second victim phenomenon, denoting the harmful effects of patient safety incidents on healthcare practitioners, remains insufficiently examined within the pharmacy workforce. This study aimed to investigate the second victim phenomenon in community pharmacies, focusing on its triggers, impacts on pharmacists’ well-being, and effects on pharmaceutical care and safety. This consensus study with the Nominal Group Technique involved 27 community pharmacists in three equal groups. The final ranks of the statements scored by participants from 5 to 1 were recalculated using the Van Breda method, combining three distinct data sets with higher values for a higher impact on the output evaluated. Statistics were applied to ascertain event distribution and investigate the potential relationships between event categories and outcomes for patients and pharmacists. "Patient-centric anxiety" (6.8) was the top mental health issue, followed by "Personal responsibility and resilience" and "Future concerns and career aspirations" (6.0 each). The dominant support was "Colleague/Peer support" (5.3). The most frequent patient safety incidents were "Inadequate pharmaceutical service" (8.0) and "Wrong drug dispensed" (7.8). Most errors (63%) were dispensing failures, primarily wrong drug dispensed (44.4%). Of these, 50% were near misses, 25.0% caused no harm, and 16.7% had serious consequences. Field notes suggest contributing factors like inadequate supervision, crowding, and storage issues. This study revealed the second victim phenomenon among pharmacists, which potentially stems from breaches in practice standards. The impact on the quality and safety of pharmaceutical care and its influence on pharmacists’ well-being should be studied in further studies.
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Background: The second victim phenomenon is an incident that occurs after an adverse medical event; while the patient is the first victim of the incident, the nurses and healthcare personnel become the second victims because they feel ashamed after that. The present research aimed to investigate various dimensions of the second victim phenomenon among nurses in South Khorasan Province, Iran. Materials and Methods: The current research was a descriptive study. The sample selection method was multi-stage cluster randomization, including 200 nurses working in South Khorasan Province, Iran. The data was collected using a demographic questionnaire and the second victim experience and support tool (SVEST) and analyzed using SPSS version 21. Results: The scores of incidence of psychological distress (14.60), professional self-efficacy (9.42), supervisor support (15.97), institutional support (10.71), turnover intentions and absenteeism (13.35), non-work-related support (expected sources of support) (25.25) and the total score of second victim phenomenon (114.55) were higher than the expected average; but other scores including colleague support (8.56), family support (5.41), and physical distress (11.31) were significantly lower than the expected average (p<0.05). Conclusion: Medical errors cause negative emotional reactions and psychological distress among healthcare provideres turning them to the second victims of those errors. Timely and effective support from their institutions and other sources should be supplied in order to reduce the incidence of second victim phenomenon.
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Background and Objective The second victim (SV) phenomenon concerns health care workers (HCWs) whose involvement in a medical error, as well as non-error patient safety events, has affected their well-being. Its prevalence ranges from 10% to 75% and can predispose HCWs to burnout, increasing the probability of committing errors. The primary aim of our study was to determine the prevalence of HCWs involved in an adverse patient safety event in Friuli Venezia Giulia Region (Italy). The secondary aims were to use latent profile analysis to identify profiles of SVs and factors influencing profile membership, and to evaluate the relationship between the severity of symptoms and desired support options. Methods A cross-sectional survey through the Italian version of the Second Victim Experience and Support Tool tool was conducted in 5 local health authorities. Descriptive statistics were conducted for all variables. Associations and correlations were assessed with statistical tests, as appropriate. Latent profile analysis was based on the scores of dimensions measuring SVs’ symptoms. Factors affecting profile membership were assessed through multinomial logistic regression. Results A total of 733 HCWs participated. Of them, 305 (41.6%) experienced at least 1 adverse event. Among dimensions measuring SVs’ symptoms, psychological distress had the highest percentage of agreement (30.2%). Three latent profiles were identified: mild (58.7%), moderate (24.3%), and severe (17.0%) symptoms. Severe symptoms profile was positively associated with the agreement for extraoccupational support and negatively associated with the agreement for organizational support. A respected colleague with whom to discuss the details of the incident (78.7%) and free counseling outside of work (71.2%) were the support options most desired by HCWs. The severity of symptoms was directly associated with the desire for support strategies. Conclusions The prevalence of HCWs involved in adverse events is consistent with the literature. Three latent profiles have been identified according to SV symptoms, and the higher the severity of symptoms, the greater the reliance on extraoccupational support.
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Objectives In 2018, the Healing Emotional Lives of Peers (HELP) Program was implemented at Mayo Clinic Rochester to guide healthcare professionals (HCPs) after a second victim experience, such as adverse patient events or medical errors. The HELP program was expanded to all HCPs in response to the anticipated stressors of the COVID-19 pandemic. This article aims to describe the rapid expansion of the peer support program and evaluate the effectiveness of peer support provided to affected colleagues (ACs). Methods Quantitative data collected from workshop evaluations, activations, and associated metrics ( TPS Self-Assessment , Encounter Form , and AC Self-Assessment ) were summarized through standard descriptive statistics using SAS version 9.4 software. Open-ended responses were qualitatively analyzed for iterative themes about the HELP program and associated workshops. Results Between April 2020 and December 2021, 22 virtual workshops to train peer supporters were conducted with 827 attendees. Of these, 464 employees completed the workshop evaluation. A total of 94.2% rated the workshop as excellent or very good. Participants perceived the workshop to be highly effective and felt more prepared to support ACs. Between May 2020 and December 2021, 247 activations were submitted through the HELP Program’s intranet Web site and peer support was requested for 649 employees. Of the 268 TPS Self-Assessments , 226 (84.3%) felt that they provided helpful support to an AC. One hundred ACs evaluated support received, with 93% being “extremely” or “very satisfied.” Affected colleagues appreciated having a TPS provide judgment-free support. Conclusions The HELP Program promotes a culture of safety by helping HCPs process traumatic events. To effectively meet the needs of patients, healthcare organizations need to prioritize the well-being of their employees through interpersonal support.
Article
Background: It is thought that 50% of healthcare providers experience Second Victim Syndrome (SVS) in the course of their practice. The manifestations of SVS varies between individuals, with potential long-lasting emotional effects that impact both the personal lives and professional clinical practice of affected persons. Although surgeons are known to face challenging and high-stress situations in their profession, which can increase their vulnerability to SVS, majority of studies and reviews have focused squarely on nonsurgical physicians. Methods: This scoping review aimed to consolidate existing studies pertaining to a surgeon's experience with SVS, by broadly examining the prevalence and impact, identifying the types of responses, and evaluating factors that could influence these responses. The scoping review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Three databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception till March 19, 2023. Results: A total of 13 articles were eligible for thematic analysis based on pre-defined inclusion criteria. Effects of SVS were categorized into Psychological, Physical and Professional impacts, of which Psychological and Professional impacts were particularly significant. Factors affecting the response were categorized into complication type, surgeon factors and support systems. Conclusion: SVS adds immense psychological, emotional and physical burden to the individual surgeon. There are key personal, interpersonal and environmental factors that can mitigate or exacerbate the effects of SVS, and greater emphasis needs to be placed on improving availability and access to services to help surgeons at risk of SVS.
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Introduction assessing the ability to cope with regret can contribute to support strategies for health professionals. However, in Brazil only few instruments evaluate this ability in general. Objective this study aimed was to adapt and validate the Regret Coping Scale for Healthcare Professionals (RCS-HCP) to Brazilian Portuguese. Methods the instruments were translated, and the psychometric properties evaluated for validity and reliability. Three hundred and forty-one professionals participated, with an average age of 38.6 ± 9.2, and 87 participated in a retest survey 30 days later. Results exploratory factor analysis showed adequacy of the structure (KMO = 0.786) composed of three factors. In the confirmation, the performance was close to acceptable. Reliability was good for the maladaptive strategies (α = 0.834) and adequate for the problem-focused initiatives (α = 0.717), but slightly too low for adaptive strategies (α = 0.595). Test- retest showed lower than expected values, with a Spearman- Brown coefficient of 0.703. Conclusion the RCS-HCP scale showed satisfactory performance in relation to the properties evaluated.
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Background: Respiratory therapists (RTs) work alongside allied health staff, nurses, and physicians during stressful and traumatic events that can be associated with emotional and physiological implications known as second victim (SV) experiences (SVEs). This study aimed to evaluate SVEs of RTs, including both positive and negative implications. Methods: RTs within a large academic health care organization across Minnesota, Wisconsin, Florida, and Arizona were asked to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool-Revised to assess SVEs as well as desired support services. Results: Of the RTs invited to participate, 30.8% (171/555) completed the survey. Of the 171 survey respondents, 91.2% (156) reported that they had been part of a stressful or traumatic work-related event as an RT, student, or department support staff member. Emotional or physiologic implications experienced by respondents as SVs included anxiety 39.1% (61/156), reliving of the event 36.5% (57/156), sleeplessness 32.1% (50/156), and guilt 28.2% (44/156). Following a stressful clinical event, 14.8% (22/149) experienced psychological distress, 14.2% (21/148) experienced physical distress, 17.7% (26/147) indicated lack of institutional support, and 15.6% (23/147) indicated turnover intentions. Enhanced resilience and growth were reported by 9.5% (14/147). Clinical and non-clinical events were reported as possible triggers for SVEs. Nearly half of respondents 49.4% (77/156) indicated feeling like an SV due to events related to COVID-19. Peer support was the highest ranked form of desired support following an SVE by 57.7% (90/156). Conclusions: RTs are involved in stressful or traumatic clinical events, resulting in psychological/physical distress and turnover intentions. The COVID-19 pandemic has had a significant impact on RTs' SVEs, highlighting the importance of addressing the SV phenomenon among this population.
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Sağlık hizmet sunumu, hata payının ve istenmeyen olayların en az olması istenen hizmet sektörüdür. Ancak uygulanan tedaviler ve girişimler sırasında istenmeyen olayların meydana gelmesi kaçınılmazdır. Bu gibi durumlarda hasta ve hasta yakınları birincil mağdur (kurban) olarak adlandırılırken, bu gibi olayla karşılaşan sağlık çalışanı da ikinci mağdur (kurban) konumuna düşmektedir. Çeşitli faktörlerin etkisi ile ikinci mağdur olgusu yaşama sıklığı kişiden kişiye değişse de özellikle pandemiden dolayı yıpranmış ve tükenmiş sağlık çalışanları advers olaylara karşı daha hassas bir dönemde bulunmaktadır. Ameliyathane ve yoğun bakımlar ise yüksek mortalite ve morbidite oranı olan, yoğun çalışma temposuyla ve gece vardiyası ile çalışılan, aciliyetin ve hızlı karar vermenin gerektiği alanlardır. Bu alanda çalışan sağlık personelinin, sonu ölüme kadar giden advers olaylardan etkilenme ihtimali daha yüksektir. Avrupa ve Amerika’da pek çok tıp merkezi ikinci mağdur durumunda sağlık personelini desteklemek için politikalar geliştirmiştir. Ancak Türkiye’de bu konu hala bilinmemekte ve bu konuda herhangi bir yayın bulunmamaktadır. Bu derleme anestezi ve yoğun bakım alanında görev yapan sağlık personelinin ikinci mağdur konusundaki farkındalığını arttırmak için yazılmıştır
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Background: Physicians involved in adverse events may suffer from second victim syndrome and can experience emotional and physical distress long after the complication occurred. We sought determine the prevalence of second victim syndrome among surgeons at our children's hospital and evaluate any differences in how surgeons respond to adverse events based on their age, position, and gender. Methods: An anonymous 19-question questionnaire distributed via institutional emails linking to an anonymous Research Electronic Data Capture (REDCap) survey. Eligible participants included all surgeons and rotating surgical trainees at our hospital. Results: Of 64 faculty surgeons eligible to participate, 63 surveys were returned for a 98% completion rate. Ten additional surveys from surgical trainees were completed for a total of 73 participants. Eighty-four percent reported having had difficulty dealing with a poor outcome or unhappy patient/family. Speaking with a colleague was the most common coping strategy, reported by 82%. Fifty-six percent indicated they believed reporting a poor outcome would have negative ramifications for them. Younger surgeons were more likely to suppress their feelings following an adverse event, and trainees were less likely to advise their peers to speak to a superior about the event (p < 0.05). Conclusion: There is a high prevalence of second victim syndrome among surgeons at our children's hospital. There exist differences in ways that surgeons respond to adverse events based on age and position. Healthcare institutions should establish formal mechanisms of support to shift the culture towards one where help is actively sought and offered. Level of evidence: IV.
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Although acknowledged to be an ethical imperative for providers, disclosure following patient safety incidents remains the exception. The appropriate response to a patient safety incident and the disclosure of medical errors are neither easy nor obvious. An inadequate response to patient harm or an inappropriate disclosure may frustrate practitioners, dent their professional reputation, and alienate patients. The authors have presented a descriptive study on the comprehensive process for responding to patient safety incidents, including the disclosure of medical errors adopted at a large, urban tertiary care centre in the United States. In the first two years post-implementation, the "seven pillars" process has led to more than 2,000 incident reports annually, prompted more than 100 investigations with root cause analysis, translated into close to 200 system improvements and served as the foundation of almost 106 disclosure conversations and 20 full disclosures of inappropriate or unreasonable care causing harm to patients. Adopting a policy of transparency represents a major shift in organisational focus and may take several years to implement. In our experience, the ability to rapidly learn from, respond to, and modify practices based on investigation to improve the safety and quality of patient care is grounded in transparency.
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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. 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, hour-long 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. 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. 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.
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Personal view p 812When I was a house officer another resident failed to identify the electrocardiographic signs of the pericardial tamponade that would rush the patient to the operating room late that night. The news spread rapidly, the case tried repeatedly before an incredulous jury of peers, who returned a summary judgment of incompetence. I was dismayed by the lack of sympathy and wondered secretly if I could have made the same mistake—and, like the hapless resident, become the second victim of the error.Strangely, there is no place for mistakes in modern medicine. Society has entrusted physicians with the burden of understanding and dealing with illness. Although it is often said that “doctors are only human,” technological wonders, the apparent precision of laboratory tests, and innovations that present tangible images of illness have in fact created an expectation of perfection. Patients, who have an understandable need to consider their doctors infallible, have colluded with doctors to deny the existence of error. Hospitals react to every error as an anomaly, for which the solution is to ferret out and blame an individual, with a promise that “it will never happen again.” Paradoxically, this approach has diverted attention …
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The emotional toll of medical error is high for both patients and clinicians, who are often unsure with whom-and whether-they can discuss what happened. Although institutions are increasingly adopting full disclosure policies, trainees frequently do not disclose mistakes, and faculty physicians are underprepared to teach communication skills related to disclosure and apology. The authors developed an interactive educational program for trainees and faculty physicians that assesses experiences, attitudes, and perceptions about error, explores the human impact of error through filmed patient and family narratives, develops communication skills, and offers a strategy to facilitate bedside disclosures. Between spring 2007 and fall 2008, 154 trainees (medical students/residents) and 75 medical educators completed the program. Among learners surveyed, 62% of trainees and 88% of faculty physicians reported making medical mistakes. Of those, 62% and 78%, respectively, reported they did not apologize. While 65% of trainees said they would turn to senior doctors for assistance after an error, 26% were not sure where to get help. Just 20% of trainees and 21% of physicians reported adequate training to respond to error. Following the session, all of the faculty physicians surveyed indicated they felt better prepared to address and teach this topic. At a time of increased attention to disclosure, actual faculty and trainee practices suggest that role models, support systems, and education strategies are lacking. Trainees' widespread experience with error highlights the need for a disclosure curriculum early in medical education. Educational initiatives focusing on communication after harm should target teachers and students.
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A unique rapid response system was designed to provide social, psychological, emotional, and professional support for health care providers who are "second victims"--traumatized as a result of their involvement in an unanticipated adverse event, medical error, or patient-related injury.
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Background: In July 2006, a 16-year-old patient came to the hospital to deliver her baby. During the process of her care, an infusion intended exclusively for the epidural route was connected to the patient's peripheral intravenous line and infused by pump. The patient experienced cardiovascular collapse. A cesarean section resulted in the delivery of a healthy infant, but the medical team was unable to resuscitate the mother. The media attention surrounding the error accelerated through the national provider and safety community when the nurse was charged with a criminal offense. These events set in motion intense internal and external scrutiny of the hospital's medication and safety procedures. Root cause analysis (rca): To further understanding about latent systems gaps and process failure modes, an independent RCA of the event was conducted in June 2007. An external consultant team conducted a one-week evaluation of the medication use system and the organization's current environment, systems and processes, staffing patterns, leadership, and culture to help shape the recommended improvements. For each of the four proximate causes of the event, performance-shaping factors were identified. Although the hospital's organizational learning was painful, this event offered an opportunity for increasing organizational competency and capacity for designing and implementing patient safety. Structures and processes, including safety nets and fail-safe mechanisms, were implemented to promote safer behavioral choices for providers. Actions taken: The hospital took a number of clinical steps to improve the safety of medication administration, including removing the barriers to scanning medication bar codes, implementing consistent scanning-compliance tracking, and providing teamwork training for all nursing and physician staff practicing in the birth suites.
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Despite the best efforts of health care practitioners, medical errors are inevitable. Disclosure of errors to patients is desired by patients and recommended by ethicists and professional organizations, but little is known about how patients and physicians think medical errors should be discussed. To determine patients' and physicians' attitudes about error disclosure. Thirteen focus groups were organized, including 6 groups of adult patients, 4 groups of academic and community physicians, and 3 groups of both physicians and patients. A total of 52 patients and 46 physicians participated. Qualitative analysis of focus group transcripts to determine the attitudes of patients and physicians about medical error disclosure; whether physicians disclose the information patients desire; and patients' and physicians' emotional needs when an error occurs and whether these needs are met. Both patients and physicians had unmet needs following errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Physicians agreed that harmful errors should be disclosed but "choose their words carefully" when telling patients about errors. Although physicians disclosed the adverse event, they often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Patients also desired emotional support from physicians following errors, including an apology. However, physicians worried that an apology might create legal liability. Physicians were also upset when errors happen but were unsure where to seek emotional support. Physicians may not be providing the information or emotional support that patients seek following harmful medical errors. Physicians should strive to meet patients' desires for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors.
Looking at sentinel events along the continuum of patient safety
Joint Commission on Accreditation of Healthcare Organizations. Looking at sentinel events along the continuum of patient safety." Jt Comm Perspect. 2010; 30: 3-5.