Anestezi Ekibinin İkinci Mağdur Fenomeni Deneyimi: Odak Grup Çalışması

Amaç: Sağlık sisteminde yaşanan olumsuz olaylar neticesinde hasta birinci mağdur olurken, sağlık hizmeti veren kişi ikinci mağdur durumuna düşmektedir. Bu durum ameliyathane ve yoğun bakımda sıklıkla yaşanmaktadır. Amacımız ameliyathane ve yoğun bakımda görev yapan anestezi personelinin ikinci mağdur fenomenine (İMF) ilişkin yaşadıkları sorunları ve deneyimleri göz önüne sermek, çözüm önerilerini ortaya koymaktır. Yöntem: Araştırma nitel araştırma yöntemi ile yapılmıştır. Ameliyathane ve yoğun bakımda görev yapan altı adet gönüllü sağlık personeli ile derinlemesine odak grup görüşmesi yapılmıştır. Veriler yazıya dökülerek, MAXQDA 22 aracılığıyla tematik içerik analizi yapılmıştır. Bulgular: Araştırmanın sonucunda 5 ana tema ve 21 alt temaya ulaşılmıştır. Bu ana temalar İMF yaşanma sıklığı, yol açan sorunlar, duygular/hisler, başa çıkma yolları, öneriler/istekler olarak sayılabilir. Anestezi ekibi İMF ile sıklıkla karşılaştığını ve bunun medikal, şiddet veya teknik nedenli olabildiğini belirtmiştir. Bu durumda değersizlik, çaresizlik, haksızlığa uğramışlık, öfke ve agresiflik hissettiklerini belirttiler. İkinci mağdur fenomeni ile başa çıkmak için kendini telkin, mola vermek, alttan almak, akranlarına anlatmak gibi yöntemler kullanmaktalar. Öneri olarak psikolojik, hukuki, teknik, yönetimsel, fizyoterapi, akran ve akademisyen desteğinin yanı sıra serbest zaman, şikayetlerde eleme uygulanması ve hastane güvenliğinin artırılmasını talep ettiler. Sonuç: Ameliyathane ve yoğun bakımlar kesintisiz hizmet sunumunun verildiği en yoğun bölümler olup, olumsuz olay yaşanma sıklığı çok yüksektir. Sağlık personelinin İMF hissetmesine yol açan durumlardan bazıları önlenebilir sorunlardır. Ne hissettiğinin ve nasıl üstesinden geleceğinin bilincine varılması sağlık hizmet sunumunun kalitesini artıracak, sağlık çalışanlarındaki tükenmişlik durumunu azaltacaktır.

The Second Victim Phenomenon Experience of the Anesthesia Team: A Focus Group Study

Objective: As a result of the negative events experienced, the patient becomes the first victim, while the healthcare provider becomes the second victim. This situation is frequently experienced in the operating room (OR) and intensive care unit (ICU). Our aim is to reveal the problems and experiences of the anesthesia personnel working in OR / ICU regarding the second victim phenomenon (SVP) and to propose solutions. Methods: The research was conducted with the qualitative research method. Focus group interviews were conducted with six volunteer healthcare personnel working in OR / ICU. The data was written down and thematic content analysis was done through MAXQDA 22. Results: 5 main themes and 21 subthemes were reached. These main themes can be counted as the frequency of experiencing SVP, the main problems, emotions/feelings, coping methods, and suggestions/requests. The anesthesia team encountered the SVP frequently and this could be due to medical, violent, or technical reasons. In this situation, they felt worthlessness, helplessness, injustice, anger, and aggression. In order to cope with the SVP, they use methods such as self-suggestion, taking a break, calming down, and sharing with colleagues. As suggestions, they demanded psychological, legal, technical, managerial, physiotherapy, peer, and academic support as well as free time, elimination of patient complaints, and increased hospital security. Conclusion: The operating room and intensive care units are the busiest departments, and the frequency of adverse events is very high. Some of the situations that cause to feel SVP are preventable problems. Being aware of what you feel and how to overcome it will increase the quality of health service delivery and reduce the burnout status of health workers.

PDF

___

1. Zhang X, Li Q, Guo Y, Lee SY. From organisational support to second victim-related distress: Role of patient safety culture. J Nurs Manag 2019;27(8):1818-25.
2. Wu AW. Medical error: The second victim. BMJ 2000;320:726- 7.
3. Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Qual Saf Health Care 2009;18(5):325-30.
4. Mizrahi T. Managing medical mistakes: Ideology, insularity and accountability among internists-in-training. Soc Sci Med 1984;19(2):135-46.
5. Lander LI, Connor JA, Shah RK, Kentala E, Healy GB, Roberson DW. Otolaryngologists’ responses to errors and adverse events. Laryngoscope 2006;116(7):1114-20.
6. Choi EY, Pyo J, Ock M, Lee H. Second victim phenomenon after patient safety incidents among Korean nursing students: A cross-sectional study. Nurse Educ Today 2021;107:105115.
7. Busch IM, Moretti F, Purgato M, Barbui C, Wu AW, Rimondini M. Psychological and psychosomatic symptoms of second victims of adverse events: A systematic review and metaanalysis. J Patient Saf 2020;16(2):e61-74.
8. Lee W, Pyo J, Jang SG, Choi JE, Ock M. Experiences and responses of second victims of patient safety incidents in Korea: A qualitative study. BMC Health Serv Res 2019;19(1):100.
9. Dilshad RM, Latif MI. Focus group interview as a tool for qualitative research: An analysis. PJSS 2013;33(1):191-8.
10. Ayvat P. Experiences of anesthesiology and reanimation specialists in the COVID-19 pandemic: A focus group study. JARSS 2022;30(1):62-70.
11. Tekindal M, Attepe Özden S, Enes Gedik T, Ege A, Erim F, Agâh Tekindal M. Nitel araştırmaların raporlanmasında standartlar: SRQR kontrol listesinin Türkçe uyarlaması. OPUS International JSR 2021;18(42):5425–43.
12. Attepe Özden S, Tekindal M, Enes Gedik T, Ege A, Erim F, Agah Tekindal M. Nitel araştırmaların rapor edilmesi: COREQ kontrol listesinin türkçe uyarlaması. EJOSAT 2022;35:522-9.
13. Wolf ZR, Serembus JF, Smetzer J, Cohen H, Cohen M. Responses and concerns of healthcare providers to medication errors. Clin Nurse Spec 2000;14(6):278-87; quiz 288-90.
14. Rassin M, Kanti T, Silner D. Chronology of medication errors by nurses: Accumulation of stresses and PTSD symptoms. Issues Ment Health Nurs 2005;26(8):873-86.
15. Werthman JA, Brown A, Cole I, et al. Second victim phenomenon and nursing support: An integrative review. J Radiol Nurs 2021;40(12):139-45.
16. Harrison R, Lawton R, Perlo J, Gardner P, Armitage G, Shapiro J. Emotion and coping in the aftermath of medical error. J Patient Saf 2015;11(1):28-35.
17. Chan ST, Khong PCB, Wang W. Psychological responses, coping and supporting needs of healthcare professionals as second victims. Int Nurs Rev 2017;64(2):242-62.
18. Jones JH, Treiber LA. When nurses become the “second” victim. Nurs Forum 2012;47(4):286-91.
19. Carrillo I, Mira JJ, Vicente MA, et al. Design and testing of BACRA, a web-based tool for middle managers at health care facilities to lead the search for solutions to patient safety ıncidents. J Med Internet Res 2016;18(9):e257.
20. Mazor KM, Simon SR, Gurwitz JH. Communicating with patients about medical errors: A review of the literature. Arch Intern Med 2004;164(15):1690-7.
21. Manser T, Staender S. Aftermath of an adverse event: Supporting health care professionals to meet patient expectations through open disclosure. Acta Anaesthesiol Scand 2005;49(6):728-34.
22. Crigger NJ. Always having to say you’re sorry: An ethical response to making mistakes in professional practice. Nurs Ethics 2004;11(6):568-76.
23. Buhlmann M, Ewens B, Rashidi A. Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims. J Adv Nurs 2022;78(9):2960-72.
24. Quillivan RR, Burlison JD, Browne EK, Scott SD, Hoffman JM. Patient safety culture and the second victim phenomenon: Connecting culture to staff distress in nurses. Jt Comm J Qual Patient Saf 2016;42(8):377-84.
25. Anderson RA, McDaniel Jr RR. Managing health care organizations: Where professionalism meets complexity science. Health Care Manage Rev 2000;25(1):83-92.
26. Pratt SD, Jachna BR. Care of the clinician after an adverse event. Int J Obstet Anesth 2015;24(1):54-63.
27. Wu AW, Steckelberg RC. Medical error, incident investigation and the second victim: Doing better but feeling worse? BMJ Qual Saf 2012;21(4):267-70.
28. Burlison JD, Scott SD, Browne EK, Thompson SG, Hoffman JM. The second victim experience and support tool: Validation of an organizational resource for assessing second victim effects and the quality of support resources. J Patient Saf 2017;13(2):93-102.
29. Mira JJ, Carrillo I, Guilabert M, et al. The second victim phenomenon after a clinical error: The design and evaluation of a website to reduce caregivers’ emotional responses after a clinical error. J Med Internet Res 2017;19(6):e203.