The "Double Victim Phenomenon": Results From a National Pilot Survey on Second Victims in German Family Caregivers (SeViD-VI Study).

INTRODUCTION: Second-victim phenomena may lead to severe reactions like depression or posttraumatic disorder, as well as dysfunction and absenteeism. Medical error as a cause for second victims is not limited to professionals, as family caregivers care for millions of patients at home. It remains unclear whether these are first, second, or double victims in case of error. This explorative study investigated whether second victim effects and signs of moral injury are detectable in family caregivers and whether existing instruments are applicable in lay persons. METHODS: In an open convenience sampling online survey, we recruited 66 German family caregivers. Propensity score matching was conducted to obtain a balanced sample of family caregivers and qualified nurses who took part in the previous study by adjusting for age and sex. The groups were compared regarding the German Version of the Second Victim Experience and Support Tool-Revised and the German version of the Moral Injury Symptom and Support Scale for Health Professionals. RESULTS: Sixty-six caregivers participated, of whom 31 completed the survey. Of all, 58% experienced a second victim-like effect, 35% experienced a prolonged effect, and 45% reported to still suffer from it. In a matched sample (22 family caregivers and 22 nurses), no significant differences were observed between the groups. DISCUSSION: Regarding the limitations of this pilot study, demanding for resampling in larger populations, we could show that second victim effects and moral injury are detectable in family caregivers by validated instruments and are not inferior to professionals' experiences. Concerning the demand for further studies, we confirmed the applicability of the testing instruments but with need for item reduction to lower response burden.

Applicability and Validity of Second Victim Assessment Instruments among General Practitioners and Healthcare Assistants (SEVID-IX Study).

BACKGROUND: The second victim phenomenon and moral injury are acknowledged entities of psychological harm for healthcare providers. Both pose risks to patients, healthcare workers, and medical institutions, leading to further adverse events, economic burden, and dysfunctionality. Preceding studies in Germany and Austria showed a prevalence of second victim phenomena exceeding 53 percent among physicians, nurses, emergency physicians, and pediatricians. Using two German instruments for assessing moral injury and second victim phenomena, this study aimed to evaluate their feasibility for general practitioners and healthcare assistants. METHODS: We conducted a nationwide anonymous online survey in Germany among general practitioners and healthcare assistants utilizing the SeViD (Second Victims in Deutschland) questionnaire, the German version of the Second Victim Experience and Support Tool Revised Version (G-SVESTR), and the German version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP). RESULTS: Out of 108 participants, 67 completed the survey. In G-SVESTR, the collegial support items exhibited lower internal consistency than in prior studies, while all other scales showed good-quality properties. Personality traits, especially neuroticism, negatively correlated to age, seem to play a significant role in symptom count and warrant further evaluation. Multiple linear regression indicated that neuroticism, agreeableness, G-SVESTR, and G-MISS-HP were significant predictors of symptom count. Furthermore, moral injury partially mediated the relationship between second victim experience and symptom count. DISCUSSION: The results demonstrate the feasible use of the questionnaires, except for collegial support. With respect to selection bias and the cross-sectional design of the study, moral injury may be subsequent to the second victim phenomenon, strongly influencing symptom count in retrospect. This aspect should be thoroughly evaluated in future studies.

Application and Evaluation of a Multimodal Training on the Second Victim Phenomenon at the European Researchers' Network Working on Second Victims Training School: Mixed Methods Study.

BACKGROUND: Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs' well-being and ultimately improve the quality of care and patient safety. OBJECTIVE: This study aims to describe and evaluate a multimodal training organized by the European Researchers' Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. METHODS: We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. RESULTS: Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants' satisfaction increased, particularly when adjusting the allocated time for the case studies' discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team. CONCLUSIONS: This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts.

Second Victim Phenomenon in an Austrian Hospital before the Implementation of the Systematic Collegial Help Program KoHi: A Descriptive Study.

(1) Background: The Second Victim Phenomenon (SVP) is widespread throughout health care institutions worldwide. Second Victims not only suffer emotional stress themselves; the SVP can also have a great financial and reputational impact on health care institutions. Therefore, we conducted a study (Kollegiale Hilfe I/KoHi I) in the Hietzing Clinic (KHI), located in Vienna, Austria, to find out how widespread the SVP was there. (2) Methods: The SeViD (Second Victims in Deutschland) questionnaire was used and given to 2800 employees of KHI, of which 966 filled it in anonymously. (3) Results: The SVP is prevalent at KHI (43% of the participants stated they at least once suffered from SVP), although less prevalent and pronounced than expected when compared to other studies conducted in German-speaking countries. There is still a need for action, however, to ensure a psychologically safer workspace and to further prevent health care workers at KHI from becoming psychologically traumatized.

Second Victims among Austrian Pediatricians (SeViD-A1 Study).

(1) Background: The second victim phenomenon (SVP) plays a critical role in workplace and patient safety. So far, there are limited epidemiological data on the SVP in German-speaking countries. Some studies have been carried out in Germany, but so far, no quantitative studies have been carried out in Austria examining the prevalence, symptom load and preferred support measures for second victims (SVs). This study therefore examines the SVP among Austrian pediatricians. (2) Methods: A nationwide, cross-sectional and anonymous online study was conducted using the SeViD questionnaire (Second Victims in Deutschland) including the Big Five Inventory-10 (BFI-10). Statistical analysis included binary-logistic and multiple linear regression with the bootstrapping, bias-corrected and accelerated (BCa) method based on 1000 bootstrap samples. (3) Results: Of 414 Austrian pediatricians, 89% self-identified as SVs. The main cause of becoming an SV was the unexpected death or suicide of a patient. High neuroticism and extraversion values as well as working in outpatient care positively correlated with having experienced the SVP. A preferred support strategy was access to legal counseling. (4) Conclusions: Austrian pediatricians have the highest SVP prevalence measured with the SeViD questionnaire. Further research should focus on prevention strategies and intervention programs.

Second Victims among German Emergency Medical Services Physicians (SeViD-III-Study).

BACKGROUND: Patient care in the prehospital emergency setting is error-prone. Wu's publications on the second victim syndrome made very clear that medical errors may lead to severe emotional injury on the caregiver's part. So far, little is known about the extent of the problem within the field of prehospital emergency care. Our study aimed at identifying the prevalence of the Second Victim Phenomenon among Emergency Medical Services (EMS) physicians in Germany. METHODS: Web-based distribution of the SeViD questionnaire among n = 12.000 members of the German Prehospital Emergency Physician Association (BAND) to assess general experience, symptoms and support strategies associated with the Second Victim Phenomenon. RESULTS: In total, 401 participants fully completed the survey, 69.1% were male and the majority (91.2%) were board-certified in prehospital emergency medicine. The median length of experience in this field of medicine was 11 years. Out of 401 participants, 213 (53.1%) had experienced at least one second victim incident. Self-perceived time to full recovery was up to one month according to 57.7% (123) and more than one month to 31.0% (66) of the participants. A total of 11.3% (24) had not fully recovered by the time of the survey. Overall, 12-month prevalence was 13.7% (55/401). The COVID-19 pandemic had little effect on SVP prevalence within this specific sample. CONCLUSIONS: Our data indicate that the Second Victim Phenomenon is very frequent among prehospital emergency physicians in Germany. However, four out of ten caregivers affected did not seek or receive any assistance in coping with this stressful situation. One out of nine respondents had not yet fully recovered by the time of the survey. Effective support networks, e.g., easy access to psychological and legal counseling as well as the opportunity to discuss ethical issues, are urgently required in order to prevent employees from further harm, to keep healthcare professionals from leaving this field of medical care and to maintain a high level of system safety and well-being of subsequent patients.

Self-Stigmatization of Healthcare Workers in Intensive Care, Acute, and Emergency Medicine.

This quantitative study examines whether employees in the fields of intensive care or acute and emergency medicine experience psychological distress because of their daily work. In addition, it was examined if self-stigmatization tendencies can significantly influence the willingness to seek help, and therefore psychological problems are not being treated adequately. These problems lead to various difficulties in professional and private contexts and ultimately endanger patient safety. From May to June 2021, an online questionnaire survey was conducted. This questionnaire combined two validated measuring instruments (PHQ-D and SSDS). To ensure high participation, the departments of anesthesia and/or intensive care medicine in 68 German hospitals were contacted, of which 5 responded positively. A total of 244 people participated in the questionnaire survey. On average, depressive symptoms were of mild severity. At the same time, self-stigmatization regarding depressive symptoms was high. These results highlight the practical need to prepare staff who work in the field of intensive care or acute and emergency medicine at the early onset for potentially traumatic and emotionally demanding events during their university education or studies. Adequate, evaluated, and continuously available support services from the psychosocial field should become an integral part of every staff care structure.

Second Victims in Intensive Care-Emotional Stress and Traumatization of Intensive Care Nurses in Western Austria after Adverse Events during the Treatment of Patients.

BACKGROUND: The second victim phenomenon is common among nurses in intensive care units. Apart from quantitative studies, little is known about individual cases among those high-risk groups. This study evaluates the natural history and cause of second victim traumatization in Western Austria for the first time to tailor specific intervention. METHODS: A total of 20 guided interviews were conducted with intensive care nurses in Western Austria. All interviews were transcribed and analyzed with MAXQDA software. Evaluation followed the structuring qualitative content analysis scheme according to Kuckartz. RESULTS: The most frequent symptoms of the second victim phenomenon reported were feelings of guilt and problems with falling asleep. Coping with the second victim phenomenon was accomplished by conversations in private as well as among work colleagues. CONCLUSIONS: Intensive care nurses are exposed to many exceptional situations which have a high likelihood of resulting in second victim traumatization. As proximal psychosocial support is considered to be a main source of coping, wide-spread implementation of effective psychosocial peer support programs ought to be applied by medical organizations. Patient safety measures such as proactive and reactive clinical risk management (e.g., CIRS) should be linked to second victim support.

Self-Assessment and Learning Motivation in the Second Victim Phenomenon.

INTRODUCTION: The experience of a second victim phenomenon after an event plays a significant role in health care providers' well-being. Untreated; it may lead to severe harm to victims and their families; other patients; hospitals; and society due to impairment or even loss of highly specialised employees. In order to manage the phenomenon, lifelong learning is inevitable but depends on learning motivation to attend training. This motivation may be impaired by overconfidence effects (e.g., over-placement and overestimation) that may suggest no demand for education. The aim of this study was to examine the interdependency of learning motivation and overconfidence concerning second victim effects. METHODS: We assessed 176 physicians about overconfidence and learning motivation combined with a knowledge test. The nationwide online study took place in early 2022 and addressed about 3000 German physicians of internal medicine. Statistics included analytical and qualitative methods. RESULTS: Of 176 participants, 83 completed the assessment. Analysis showed the presence of two overconfidence effects and in-group biases (clinical tribalism). None of the effects correlated directly with learning motivation, but cluster analysis revealed three different learning types: highly motivated, competent, and confident "experts", motivated and overconfident "recruitables", and unmotivated and overconfident "unawares". Qualitative analysis revealed four main themes: "environmental factors", "emotionality", "violence and death", and "missing qualifications" contributing to the phenomenon. DISCUSSION: We confirmed the presence of overconfidence in second victim management competencies in about 3% of all persons addressed. Further, we could detect the same three learning motivation patterns compared to preceding studies on learning motivation in other medical competencies like life support and infection control. These findings considering overconfidence effects may be helpful for safety managers, medical teachers, curriculum developers and supervisors to create preventive educational curricula on second victim recognition and management.