There’s no question that the patients and families who suffer, or potentially suffer, from sentinel events are the primary victims.
But it’s the healthcare worker — in our case, the nurse — who faces a painful and moral crisis. Nursing is dedicated to treating and healing patients. When we have unintentionally caused harm, we are second victims. Second victims experience significant distress after a sentinel event.
How do we pick up the pieces?
By realizing we are not alone. By learning about the healing process after a sentinel event. And by getting help through Critical Incident Stress Management.
Consistent themes in second victims
In this important study, published in Quality and Safety in Health Care in 2009, 31 eligible healthcare providers were interviewed about their experience as second victims; or those who were traumatized after an unexpected adverse event, medical error and/or patient injury. Approximately one-third were physicians, one-third nurses, and one-third categorized as “other healthcare providers.” Researchers found consistent themes throughout the interviews that demonstrated a common trajectory of recovery for second victims across the board, regardless of healthcare role, sex of the subject and degree of experience.
- 35-50% of participants reported physical symptoms such as fatigue, disturbance of sleep, rapid heart rate and breathing, increased blood pressure, and muscle tension.
- 65-77% of participants reported psychological symptoms including frustration, decreased job satisfaction, anger, extreme sadness, difficulty concentrating, flashbacks, loss of confidence and grief.
- Other feelings such as remorse, repetitive/intrusive memories, return to work anxiety and second guessing of career.
- Chaos and accident response: A period of internal and external turmoil, wherein the provider may be trying to manage a potentially unstable patient, respond to rapid inquiry and self-reflect on the recent events
- Intrusive reflections: Consists of “haunting re-enactments,” questioning of adequacy, and isolating the self. Judging past action after the fact.
- Restoring personal integrity: Categorized by seeking support of a co-worker, supervisor or other support person. Common feelings include uncertainty about who to turn to that might understand, strong doubts about professional future and concerns that trust has been irrevocably broken. Difficulty moving forward when faced with negative responses and/or gossip.
- Enduring the inquisition: Facing institutional investigation and worries about repercussions.
- Obtaining emotional first aid: Participants struggled with knowing who to turn to, faced barriers to confiding in family and friends due to HIPAA laws. While some reported receiving support from coworkers, the majority was found to be insufficient for the second victim’s needs.
- Moving on: Many found it difficult to move on entirely. May consist of changing careers or moving to a new unit or facility (dropping out), or of sticking with it but remaining with a degree of internal struggle and turmoil (surviving), or changed the way in which they practiced and/or worked with making a practice change (thriving).
Interested in developing a critical incident stress management program at your institution? Check out these resources for more information, guidelines and training seminars:
- American Association for Nurse Anesthetists (AANA), Guidelines for Critical Incident Stress Management
- CISM: Critical Incident Stress Management, Peer Support Training Seminars
- International Critical Incident Stress Foundation, Courses and Conferences Around the Country
Have you ever been involved in a sentinel event? How did you cope emotionally and professionally? Did your institution have a critical incident stress management program? If not, do you wish it had?
*Scott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Quality and Safety in Health Care, 18(5), 325-330.