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Caring for the Caregiver

Most health care providers adjust well to the multitude of demands encountered during an unexpected or traumatic clinical event. Providers often have strong emotional defenses that carry them through and let them "get the job done." Yet sometimes the emotional aftershock (or stress reaction) can be difficult. Signs and symptoms of this emotional aftershock may last a few days, a few weeks, a few months, or longer.

Second victims are "healthcare providers who are involved in an unanticipated adverse patient event, medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event."

Frequently, second victims...

  • Feel personally responsible for the unexpected patient outcomes
  • Feel as though they have failed the patient
  • Second-guess their clinical skills
  • Second-guess their knowledge base

Second Victim Fast Facts

  • Each second victim (even those involved in the same event) will have unique experiences and needs
  • Regardless of job title, providers respond in predictable manners. The six stages of second victim recovery explain how the second victim is impacted by the clinical event
  • There are some events that are high risk for inducing a second victim  response
  • First tendency of providers is self isolation
  • Providers tend to 'worry' in a predictable pattern
  • Sometimes the entire team is impacted by a clinical event

Recovery Stages

New Panel

Second victim healing and recovery occurs in a predictable manner.

Six stages of second victim recovery have been identified as:

  1. Chaos and Accident Response
  2. Intrusive Reflections
  3. Restoring Personal Integrity
  4. Enduring the Inquisition
  5. Obtaining Emotional First Aid
  6. Moving On
    • Dropping out
    • Surviving
    • Thriving 

Triggering has been defined as reliving the initial event when an external stimulus, such as a similar clinical situation is presented. Triggering may occur at any time following the event by a random number of variables that the second victim encounters.

Different factors have been described as triggering fresh memories of an old event. Examples of common triggers are taking care of a patient in the exact location of the original event, similar name or similar diagnosis/treatment of the original patient. When the memory is triggered, similar physical or psycological symptoms may return.

Triggering frequently occurs throughout the various stages of recovery and can also be referred to as "tripping."

High Risk Scenarios

There are many different types of clinical events which can evoke a second victim response. Examples of high risk situations that may induce a stress response include the following:

  • Patient who 'connects' to health care professional's own family.
  • Unanticipated clinical event involving a pediatric patient
  • Unexpected patient death
  • Preventable harm to patient
  • Multiple patients with bad outcomes within a short period of time within one clinical area
  • Long term care relationship with patient death
  • Clinician experiencing his or her first patient death
  • Failure to detect patient deterioration in timely manner
  • Death in a young adult patient
  • Notification of pending litigation plans
  • Community high-profile patient/event
  • Health care professional who experienced needle stick exposure with high-risk patient
  • Death of a staff member or spouse of a staff member

Common Second Victim Responses

Predictable Patterns of Worrying

Patient
  • Is the patient/family okay?
  • What have they been told?
  • How did they respond?
Me
  • Will I be fired? (Nursing and allied health professionals)
  • Will I be sued? (Medical staff)
  • Will I lose my license? (All professional groups)
Peers
  • What will my colleagues think?
  • Will I ever be trusted again?
  • Will I still be a respected member of my team?
Next Steps
  • Who will be contacting me to discuss the case?
  • If a law suit does happen, when will I know?  How will I hear about it?
  • What do I need to do?
Common Phrases heard from Second Victims
  • "I had a sickening realization of what happened."
  • "I don't deserve to be a doctor."
  • "This will change the way I come to work from now on."
  • "This has been a career changing event."
  • "I'm going to check out my options at Wal-Mart. I can't mess that up!"
  • "I came to work today to help someone, not to hurt them."
  • "This is a turning point in my career."
  • "This event shook me to my core. I'll never be the same again."
Signs and Symptoms Suggestive of a Second Victim Response

Second victims experience many different physical and psychosocial symptoms. These symptoms are normal reactions to an abnormal and unanticipated patient event or outcome.

Common reactions reported by second victims:

Physical Symptoms:

  • Sleep disturbances
  • Difficulty concentrating
  • Eating disturbances
  • Headache
  • Fatigue
  • Nausea/vomiting
  • Diarrhea
  • Rapid heart rate
  • Rapid breathing
  • Muscle tension

Psychological Symptoms:

  • Isolation
  • Frustration
  • Fear
  • Uncomfortable returning to work
  • Anger and irritability
  • Depression
  • Extreme sadness
  • Self doubt
  • Flashbacks
  • Feeling numb

Resources

MU publications

  • Scott, S.D. The second victim phenomenon: A harsh reality of health care professions [Perspective]. AHRQ WebM&M [serial online]. May 2011.
  • Scott, S.D., Hirschinger, L.E., McCoig, M.M., Cox, K.R., Hahn-Cover, K., & Hall, L.W. (2011) The second victim. In M.A. DeVita, K. Hillman, & R. Bellomo (Eds.). Textbook of rapid response systems (pp. 321-330). New York, NY: Springer.
  • Brandt, J., Cox, K.R., Hall, L.W., Hirschinger, L.E. McCoig, M.M. and Scott, S.D. (2010). Second victims: Mitigating the impact on health care team members following an adverse clinical event. American Journal of Medical Quality Supplement, 25 (2):27S.
  • Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M.M., Hahn-Cover, K., Epperly, K.M., Hall, L.W. (2010). Caring for our own: Developing a systemwide second victim rapid response team. Journal on Quality and Patient Safety, 36(5), 233-240.
  • Hall, L.W., Hahn-Cover, K., Scott, S.D. (2010). The human side of medical errors. The Virtual Lecture Hall, Medical Directions, Inc.; Computerized CME Learning Module.
  • Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M.M., Brandt, J., & Hall, L.W. (2009). The natural history of recovery for the health care provider 'second victim' after adverse patient events. Quality Safety in Health Care, 18, 325-330.
  • Scott, S.D., Hirschinger, L.E. & Cox, K.R. (2008) Sharing the load: Rescuing the healer after trauma. RN, 71. 38-43.

National references

MU Awards and Recognitions

  • Anthem Blue Shield Central Region Hospital Quality Successful Practice Award (2009)
  • HOPE Award given by Medically Induced Trauma Support Services (MITSS) (2009) (MITSS) newsletter

Contact the forYOU team

We are available anytime day or night via our pager 573-397-0044. You can also contact us through email.