Scott S D, Hirschinger L E, Cox K R, McCoig M, Brandt J, Hall L W
Office of Clinical Effectiveness, University of Missouri Health System, One Hospital Drive, 1W-29, Columbia, MO 65212, USA.
Qual Saf Health Care. 2009 Oct;18(5):325-30. doi: 10.1136/qshc.2009.032870.
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.
当患者遭遇意外事件时，一些医疗专业人员会成为“二次受害者”。这些护理人员感觉自己让患者失望了，开始质疑自己的临床技能、知识储备和职业选择。尽管已有一些相关信息，但全面了解这一现象对于设计和测试能实现健康康复的支持性干预措施至关重要。
本文旨在报告对31名二次受害者的访谈结果。在获得机构审查委员会批准后，招募了代表不同专业群体的二次受害者志愿者进行为时一小时的私下访谈。半结构化访谈涵盖人口统计学信息、参与者对事件的描述、所经历的症状以及对改善机构支持的建议。访谈结束后，独立分析访谈记录以提取主题，随后进行小组讨论并与当前的受害者进行反思性交流。
参与者经历了各种症状，且这些症状在性别或专业群体上并无差异。我们的分析确定了六个阶段，这些阶段描绘了二次受害者现象的自然发展过程。它们分别是：（1）混乱与事故反应阶段；（2）侵扰性反思阶段；（3）恢复个人完整性阶段；（4）忍受审查阶段；（5）获得情感急救阶段；（6）继续前行阶段。我们明确了二次受害者在这些阶段迫切希望得到解答的特征和典型问题。有几位参与者表示，参与改进工作或患者安全倡导活动帮助他们再次享受工作。
我们现在认为事件后的轨迹在很大程度上是可预测的。可以制定机构项目，以便在事件发生后立即成功筛查出有风险的专业人员，并提供适当的支持以加速康复并减轻不良职业后果。
