Healthcare professionals aim to provide the absolute best care within extraordinarily complex healthcare systems
Keeping patients safe is a huge priority; but sometimes things will go wrong says Sarah De Biase, of the Yorkshire Humber Improvement Academy.
The ‘second victim’ phenomenon
A ‘second victim’ is a healthcare professional who has experienced a significant professional or personal impact because of their involvement in a patient safety incident (PSI).
The term acknowledges that the first ‘victims’ of a PSI are the patient and their family and carers; whilst recognising the potential for serious impact on the physical, mental and psychological wellbeing of the staff involved.
Why support second victims?
The impact of being involved in a PSI for a healthcare professional can be multidimensional. Physical, mental and psychological wellbeing are all typically compromised1. The impact of causing harm can include disturbing memories, anxiety, anger, remorse, self-punishment, distress, acute stress disorder and even suicidal ideation. Reduced professional confidence is common; individuals may make defensive changes to their practice. Distress after being involved in patient safety incidents is also significantly associated with sickness absence, burnout and intentions to leave healthcare altogether resulting in economic consequences for the healthcare organisations where they work.
Supporting staff to heal and recover after a PSI will help prevent enduring or lasting consequences for the individual and their employer; enabling learning to gain wisdom and action to improve patient safety.
What support should be available?
An organisation’s support model should include:
- a supportive working environment which facilitates adaptive coping
- rapid and appropriate responses in the immediate aftermath of a PSI to help reduce the severity/duration of stress experienced and prevent longer-term consequences
- individualised support for those experiencing severe and/or longer-term consequences.
Types of support may include:
- education for all staff on the impact of PSIs
- peer support and/or support from line management
- support to process incidents, for example rapid response teams
- information and guidance on what to expect after involvement in a PSI
- enhanced support where indicated, for example psychological therapy via staff wellbeing or occupational health teams; specialist mental health referral from line managers.
Support from Line Managers:
Having a one-to-one briefing after the incident with a trusted colleague, who was also going through a very similar situation, made me feel I was not alone. I was offered the rest of the day off to process what had happened and seek comfort from my family. I was offered further time off too and although I didn’t take up this offer, knowing it was there if I needed it was helpful.
A transparent learning culture:
‘In some ways, being able to speak with the patient’s family and explain to them I had done the best that I could in the situation that I was in, was comforting. Speaking to the family again at a later date, helped me achieve a sense of closure - knowing that the family were also on their way to accepting what had happened.’
Sources of support
Support is only possible if the ‘second victim’ phenomenon and its consequences are acknowledged.
As a workforce, we need to have an understanding of the serious implications which may follow involvement in a PSI for the healthcare employee. Help raise the profile of ‘second victim’ phenomenon in your own organisation and advocate for improved support for staff before and after involvement in a PSI.
The CSP wishes to bring your attention the Second Victim Support website – from the Yorkshire & Humber (Y&H) Quality and Safety Research Group and the Y&H Improvement Academy. The website brings together research which highlights issues ‘second victims’ face, and describes best-practice interventions which can help alleviate the impact on second victims.
Second Victim Support would also like to hear from any healthcare professional able to share their experiences of second victim phenomenon through anonymised case study.
In the UK, Samaritans can be contacted 24 hours a day, 365 days a year on 116 123 or on email at jo@samaritans.org. Other international helplines can be found here at Befrienders Worldwide.
The Enquiries Team is the first point of contact for all CSP enquiries.
1Sirriyeh R, Lawton R, Gardner P, & Armitage G. (2010). Coping with medical error: A systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Quality & Safety in Health Care, 19(6), E43.
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