Summary of "Modulo 5.3 - Gestionar segundas victimas"

Summary of Key Wellness Strategies, Self-Care Techniques, and Productivity Tips from “Modulo 5.3 - Gestionar segundas victimas”

This module focuses on managing the care and support of second victims—healthcare professionals involved in adverse or sentinel events that cause patient harm. It highlights the emotional and professional impact on these individuals and outlines strategies for organizational and personal support to promote recovery and maintain patient safety.

Key Concepts and Definitions

Second Victim: A healthcare professional involved in an adverse event who experiences trauma, remorse, anxiety, and moral distress. This can impact their well-being and future patient care.
First Victim: The patient harmed by the adverse event.
Third Victim: The healthcare organization affected by the event.

Emotional and Psychological Impact on Second Victims

Feelings include guilt, anger, fear, denial, loss of self-esteem, distrust, and isolation.
Physical symptoms: hyperventilation, muscle tension, disrupted sleep, hypertension.
High prevalence of post-traumatic stress disorder (PTSD) and frustration among second victims.
Risk of career abandonment or leaving the profession without adequate support.

Natural Recovery Stages for Second Victims (Susan Scott’s Model)

Chaos and Accident Response: Initial shock, confusion, and emotional overwhelm.
Intrusive Thoughts: Obsessive re-evaluation of the event, feelings of incompetence.
Restoring Personal Integrity: Trying to manage rumors, fear of judgment.
Enduring the Inquisition: Anxiety about reporting, fear of job loss, legal consequences.
Seeking Emotional Support: Recognizing the need for help and accessing support.
Moving Forward: Possible outcomes include surviving, overcoming, or leaving the profession.

Risk Factors for Becoming a Second Victim

Severity of the adverse event.
Self-blame and internal attribution.
Lack of organizational support.
Hierarchical work environments.
Gender (female professionals at higher risk).
Heavy clinical workload (>70-75% clinical time).
Close professional relationship with the patient involved.

Protective Factors

Support from family and institution.
Positive patient safety culture.
Good relationships with patients.
Ability to tolerate uncertainty and adverse outcomes.

Adaptive vs. Maladaptive Coping Strategies

Adaptive Problem-Focused:
- Analyze and understand the event.
- Seek solutions and improve practices.
Maladaptive Problem-Focused:
- Avoidance, denial, externalizing blame.
Adaptive Emotional-Focused:
- Accept responsibility.
- Apologize and seek social support.
- Maintain emotional control.
Maladaptive Emotional-Focused:
- Denial, minimization.
- Substance abuse or self-medication.

Organizational Strategies and Support Programs

Support programs should be:

Rapidly implemented (within hours or days).
Voluntary and confidential.
Provide emotional first aid, not therapy.
Include peer support from trained colleagues.
Facilitate escalation to professional help if needed (psychologists, social workers, spiritual care).

Three-Tiered Support Model (Susan Scott)

Local support: Immediate comfort and assessment by peers and supervisors (resolves ~60% cases).
Trained peer support: Structured debriefing and involvement in event analysis (~30% cases).
Professional referral: Psychological or psychiatric intervention (~10% cases).

Ethical and Cultural Considerations

Promote a culture of safety emphasizing quality improvement and error reduction.
Emphasize fair treatment, respect, empathy, compassion, transparency, and opportunities for professional growth (acronym: TRAS).
Implement open disclosure policies involving:
- Honest communication with patients and families.
- Apology and explanation of the event.
- Discussion of consequences and preventive measures.
Most patients (86%) accept apologies, improving relationships and trust.

Summary Takeaway

Healthcare workers involved in errors are also victims who need healing and support. Addressing their emotional and professional needs is an ethical imperative that enhances patient safety, improves organizational culture, and sustains the healthcare workforce.

Presenters / Sources Mentioned

Albert Wu
Susan Scott
Hilfiker (1984)
Christensen (1992)
Dean (2007)
Brian Goldman
Australian Commission on Quality and Safety in Health Care
Lander, Wolf (researchers on second victim prevalence and impact)

This summary encapsulates the strategies and methodologies for managing second victims, emphasizing emotional support, organizational culture, and ethical responsibility in healthcare.