‘Second victims’ and calling a boat a boat

I’ve lost count of the number of scratchy NHS related tweet exchanges I’ve had with certain human factor fanatics over the past three years. Blooming tedious and always brings in the flying monkey types who don’t engage or discuss but just retweet the too often cultish, Stepford Wifey, non speak.

Sigh.

On a vaguely related note, there has been ongoing discussion over the past two days around ‘no blame’ cultures and accountability. I’ve kind of tried not to get involved but every now and again words like ‘witch hunts’, ‘equal parties’ and the like make me chip in. Earlier today the concept of ‘second victims’ cropped up. Second what…?

Blimey. Turns out there is a body of research around health professionals being ‘second victims’ when a patient is harmed. A concept introduced 16 years ago in the BMJ by AW Wu and apparently uncritically accepted as a ‘thing’. The US based paper shared earlier has the following findings and conclusion around the impact of ‘adverse patient events’:

2vic

Six stages that conveniently sidestep any engagement with responsibility or accountability. What is astonishing – in this paper, I’m sure in the broader ‘second victim’ literature and in the twitter discussions I’ve been involved in or followed as a lurker – is the cosy, untouchable, (sadly too often smug) portrayal of healthcare professionals’ working practice being beyond scrutiny. No accountability (or heaven forbid, criminal prosecutions), here thank you. Move along now. We’re doing our holier than thou, extra special work. If anything goes wrong, we need help to start to enjoy our work again.

And zip all reflection about those  left brutalised by the death of their child, parent, grandparent, family member or friend…

The fakery and indulgence around this second victim nonsense is laid bare in the conclusion of the article where the authors state:

Regardless of sex, professional background or years of experience, all participants in our study easily recalled the immediate and ongoing impact of their specific career jolting event.

A career jolting event is nothing like experiencing the preventable death of a loved one. Please don’t ever pretend it is.

L1022338-2

Tama on vene [translation from Finnish: this is the boat].

Postscript: I’m not ignoring or denying that healthcare staff may/must be devastated by the death or serious harm of a patient here. It simply ain’t comparable to the experiences of families.

29 thoughts on “‘Second victims’ and calling a boat a boat

  1. Stinks. What about the real second victims like those young dudes who have witnessed things in units, poor treatment of fellow patients or the young people who were present on the unit when Connor died and observed some things what support did they have, and families who felt they were not informed to be able to support them.

  2. It is good to see these issues being discussed here. One consistent theme that I observed in the north Wales mental health services as things began to completely unravel was the framing of the staff as being the people who were really traumatised. The callous treatment, brutality and inhumanity being dished out to the patients was ignored – even when so many of them killed themselves that it showed up in national statistics as an outlier – whilst there was more and more discussion about the welfare of the staff. (There was actually a staff welfare issue in that the one whistleblower in the service and members of his team were being subjected to extreme workplace bullying, but that wasn’t the issue being discussed.) Intimately tied up with discussions of staff welfare were discussions of ‘threatening behaviour’ from patients – yet the concept of ‘threat’ was being used in a very elastic way, in so far as many such ‘incidents’ consisted of distressed psychotic people shouting or swearing. The picture painted by the service was of dedicated staff having to deal with dangerous criminals-in-the-making. The reality was very different – indeed there were a number of allegations from patients of violent behaviour towards them from staff. These incidents were not reported to the police or investigated – yet patients were prosecuted by the service for far less. When patients killed themselves, as Frannie above suggests, there was no support forthcoming at all to other patients – yet I found a journal article authored by three mental health professionals from north west Wales (where the service was seriously in crisis) discussing the emotions of nursing staff after patient suicides. Interestingly this paper stressed that staff have to accept that some patients ‘choose’ to kill themselves – whilst it may well be difficult to prevent suicide in certain cases, one cannot help but notice such a conclusion being drawn by people employed in a service that had an astronomically high suicide rate and wonder to what degree this comment was defensive. Such callous thinking spilt over into staff practices – on one ward in the acute mental health unit in Bangor one patient was particularly distressed after another patient whom he’d grown close to absconded and killed himself. In the wake of this patient’s death a staff nurse commented to his friend ‘well I think that he wanted to die’. The patient found this comment particularly offensive as the man who had killed himself had been expressing extreme distress regarding conditions on the ward, the oppressive and intimidating behaviour of the staff and had also been particularly troubled by the serious side effects that he was experiencing from the anti-psychotics that he was being forcibly injected with. None of these issues had been addressed – and his suicide was quite simply and quite easily dismissed by the staff. Staff in this unit became so well known for partaking of discussions regarding their own welfare in the face of patient neglect that one patient observed that the staff seemed to spend most of their time ‘ministering to each other’.

  3. First of all I wish to express my deepest sympathy for your loss. I am a health care profesdional but first and foremost I am a woman with a loving family and no pain I have ever felt after the loss of another life could ever compare with that of losing a loved one.
    However. I set out each day to do my JOB ( It is not a calling it is a job we are not ministering angels) to the best of my ability and give 100% to what I do.I am not holier than thou and I am no better than the next person doing whatever job they do. However the very nature of what we do makes us vulberable, our mistakes potentially have devastating effects on peoples lives that is why we are burdened with the expectation that we are superheros. We are not we are ordinary individuals doing a job that is glorified when it goes well but vilified when unfortunate consequences lead to tragedy. I dont believe any one in any profession sets out on thier way to work to injure harm or offend anyone. We are all capable of making a mistake or a misjudgement as I said it is all the more tragic where human or any life is at risk because of this.
    We do feel genuine pain when we see suffering, pain, anxiety, death, bereavement. We are not above feeling guilty, embarassed even responsible.
    This concept is not meant to cover up what has happened. It is to show the true face of the people looking after the health and well being of our loved ones. We are not super heroes, we never said we are, that is a public perception which serves only to raise public expectation. We all deserve to be cared for by responsible, knowledgable, well trained caring professionals, after all we are all potential patients. More importantly so are our families, but we are human, capable of errors and misjudgement.
    Our mistakes are not covered up. We go through internal and external scrutiny when a serious incident occurs. Please rest assured we are punished. We may not be publicly hung out to dry but we are held accountable and rightly so, for our mistakes. Investigations are held and fail safes put in place to minimise the risk of the same mistake occuring. During all of this we feel the pain of the loss of someone we cared for. Very much.
    Little comfort to family and friends I know. I dont want to diminish the effects of any loss to anyone. Nothing can heal that pain or stem the flow of anger and sense of betrayal you must feel after you have left you precious loved one in our care and the unbelievable happen.
    I have been in the nursing professon for 38 years. I care as much now as I did when I started out. I care about my patients greatly but I also care passionately for my profession.
    I dont know what was going on in that unit but it would appear that there were grave problems. Alleged behaviours and attitudes that are not supported or upheld by our code of conduct or our professional ethos. I cant account for what happened or how others conduct themselves. I can however assure you that we are not all the same.

    • I think everyone contributing to this blog understands that you are indeed ‘not all the same’ and we accept that there are healthcare professionals such as yourself who absolutely do their best and never go to work intending to harm or offend anyone. But your comments do not account for abusive staff – they exist, I have met them. And I have been involved in a case where the actions of abusive staff were most definitely ‘covered up’ for a number of years, with disasterous consquences. And dysfunctional services and units do exist – and staff trying to do a good job also suffer greatly in those services and units. It is good to hear the view of a healthcare professional who is articulating the distress and hurt that is felt by good staff in the face of service failure – but please don’t deny the existence of less well motivated staff.

      • I am in no way denying there are some staff who let down the very people we are paid to care for. I was merely trying to reassure that we are not all corrupt, uncaring self gratified, jumped up, primadonnas. Most of us are hardworking caring professional people who want to uphold high standards.
        I was in no way implying either that imagining something so awful happening could ever replicate actually going through what you are. I would never assume such arrogance.

  4. Lesley

    We have all met more good nurses and doctors than the other sort. The other sort destroy/have destroyed – our lives.

    And imagining something that has happened to some one else….is not nearly close to how it really is…

    You will have read the poem written in the 1980’s by an old lady at the end of her life begging nurses to ‘see me’. To see her a woman – a woman who has lived a long and varied life. A nurse then wrote an identical poem – in same style – about the pressure and penalties of nursing. I always thought the nurse missed the old ladies point.

    My father died from undiagnosed TB in a horrible ward full of old men.
    The old men were all lovely. One of the senior nurses treated them without any respect at all..and they just smiled at each other. They had seen it all in their long lives. And it reminded me of the old ladies poem.

    My dad caught TB in hospital from the oxygen things (the ones with tubes up nose) that we had seen being passed directly from patient to patient.

    Consultant treated him for dust – dad was a stone mason and the consultant also called him ‘the pigeon man’ because he had pigeons. I have the last letter dad wrote to me two hours before he died..he drowned. He said (my name) ‘they are treating me for dust but it not..it is something else’…It was – it was ….it was TB.

    He had to have a Post Mortem (which leaves it’s own nightmares) We were told when results came – cause was – TB – undiagnosed and my dad ‘should not have died’.

    We did not complain..we were too exhausted with grief and anger.

    That strong broad shouldered wise man – my dad – with the grizzled weather beaten face and that amazing thatch of wiry still brown hair – (he told his grandchildren his hair was glued in with cement) ……hair that he would wet and put under his cap (his bunnet – Scottish) to flatten on special occasions. My children used to love to watch it dry to normal state- almost immediately. Made my dad smile. Should not have died.

    Many more of us do not complain..than do..far too many of us go away to grieve and miss our loved one….forever.

    And we only have to read Sara’s blog…to see how bloody hard it is to get accountability..or justice.

    I did not even try.

    I failed him.

    • you didn’t fail him and I didn’t fail my daughter. I gave up when my health gave out, your Dad my daughter, they loved us and understand. You do what you can for as long as you can ,no bugger is handing out emotional first aid to families and individuals and it is a herculean task to achieve accountability via the PHSO and GMC/NMC just as you state.

  5. personally feel the GMC offers ample arse covering using’ only human’ after all. There are no unfortunate consequences and no tragedies, just wholly preventable deaths and harm caused. There is only one victim, that being the person deprived of their life or who suffers harm. Anyone bound by love to that person suffers devastation through loss .
    Health professionals portrayed as second victim to the patient, never, indulgent nonsense. First in line to be held accountable yes.

  6. I do take your point Lesley – when the Hergest Unit in Bangor that I was referring to above was established it had some excellent staff who gave an awful lot of very distressed people a lot of help. The uncaring staff were in the minority – but something awful happened in that the bad staff seemed to somehow gain a lot of power and they came to dominate the Unit and set a highly punitive, confrontational tone. I was an outpatient there throughout this time and I literally watched as nearly all the good staff left – and then two psychiatrists committed suicide. One can only imagine what it must have been like working there. But even after the deaths of the two psychiatrists (and numerous patients), no-one intervened or even investigated – it was obvious even to patients observing that the least that could have been done was to split up the highly dysfunctional teams of staff who were the subject of numerous patient complaints. Even that didn’t happen. In fact no action was taken at all until a series of major public scandals resulted in the whole Health Board being put into special measures. The Welsh Govt team running the Health Board concerned are now desperately trying to address the very serious problems in the Unit in Bangor – I suspect that this is far too little too late and that the Unit is irretrievable. For a start, its reputation is so toxic that no-one will work there. There has been a great deal of suffering and misery in that Unit on the part of both patients and staff – it could all have been avoided if during the years that the Unit was sliding into chaos patients and whistleblowers had been listened to. But there really was a major cover-up – we were silenced by every means that the NHS could employ.

  7. Lesley, it looks that nothing ever happened to you or your family in the hands of a bad professional. You are a nurse providing a service to public. The people on the other side of fence, who suffered in hands of professionals have a different point of view. I have had a terrible experience, where a nurse lied to prove her point. She went as far as damaging my health by continuous bullying and lying. I could do nothing, she was protected by army of colleagues just like her.” We only human” fraise means a loss of life or similar consequence. You know when you wrong and when bad and inhuman practises are being implemented on patients and their families.
    Your fraise is meaningless.

  8. Suzannne you assume wrongly. I have my own personal experience that I hoose not to disclose.
    I joined the conversation to try to give a balanced view of HCP’s from the perspective of someone with no agenda othet than to reassure that there are honest caring professional nurses and doctors working to serve our patients in the manner they deserve.
    I have been patronised by the group and made to feel like a bit of an idiot.I feel my contribution has served to do the opposite of what I intended and I dont wish to fan the flames any more.
    I am therefore going to wish you all well and have my last word. We are not all corrupt and by attempting to vilify the nursing and medical profession as a whole you are serving no purpose than to feed your frustration and anger. Individuals are responsible not the entire HCP population. Name them and bring them to account. Use the NMC. The CQC. Exercise your right as a member of the public to raise your concerns about the conduct and practices of them as individuals. Please dont tar us all with the same brush.

    • Lesley my last words read the Serious Case Review against Surrey Adult Social Services with regard to Gloria Foster. And also the CQC on Surrey’s children’s services.

  9. Dear Lesley,
    i have followed this exchange with interest. I suspect that the problem may lie in those very bodies you mention – the NMC, CQC, and I would add the GMC. In Sara’s case they have totally failed to address her well substantiated concerns that people are not being held to account. And no one, but no one, could have tried harder than her (and her family). If she cannot achieve this, then the channels you mention are useless, and this does fan the flames which you have felt licking at your ankles following your well meant comment. And this does undermine confidence in the system, and the people who work in it. And we are all the poorer for it,

    Jan

    • Actually, there are families trying really hard, who we don’t read about, as they fight alone without individual websites (so we are not all in the public domain), just to clarify.
      What Sara has done is to publicly expose dysfunctional systems while she shares the personal side of her experience, and I’m glad to add my blog to hers.
      These systems, for example even CQC as mentioned by Lesley, do bare minimum regulating, as things have to be obviously criminal before they speak.
      CQC didn’t deal with a complaint re my son when under the MHA even, though they say they do deal with MHA-related complaints – so how will ATUs improve? If we get it right in one sort of place, it will have a positive effect all round.
      Inspectors vary in integrity too, as well as nurses or medics or social workers.
      All of us know good nurses and psychiatrists – thank God for them.
      But the rotten apples need to be dealt with.

    • perceived financial irregularities are very newsworthy I realise and guaranteed the hounds went in and locked on which appears to have accomplished what the previous media coverage just couldn’t which is sad . But with the resignation there must be a welcome sense of relief all round that there will be a fresh CEO acting for patients and staff so new beginnings hopefully. I will be watching this space re KP’s curious advisory role ? that is a whole new story I imagine.

      • SHFT and the new CE – plus –

        Ghost of Christmas past – Ms Percy – on same/higher (?) salary as CE. Ms Percy with full confidence and ”full support” of Tim the chairman

        Picture …the untidy rush – plus a bit of a squash – on new CE’s chair..

        Pity the new CE and her poor staff – perhaps Ms Percy should resign to protect them from media… again.

        The poor patients ?

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