Promoting professional safety in addition to patient safety

The idea that those who work to guarantee life can cause harm or death to others seems to be paradoxical. I am talking about the professionals who work in health care and have as core values to provide care for others in an integrated and personalized manner with quality and safety. They are responsible to promote harm free care by following bioethical principles of respect for autonomy, beneficence, non-maleficence and justice by delivering care to those in need at times of vulnerability.¹ These professionals are trained to act with prudence and responsibility, advocate on behalf of patient and their families, help them to make decisions that involve their health, and to understand their disease pathways or impact of the treatment.

However, professionals who work to improve health, the art of health care and well-being can make mistakes during health assistances that may cause harmful consequences to patients, although their intention is always to act correctly.²

These adverse factors consequences are not minor. First, they affect patients, more precisely, those who were supposed to benefit from quality care and end up suffering a variety of harms. These harms, when not fatal, may increase the number of interventions and contribute to higher health care costs, increase feelings of uncertainty and lead to deterioration of relationship with professionals.³

Other consequences are related with legal actions, even more frequent, which end-up in significant financial compensations to victims or their relatives. These actions involve institutions directly and, more commonly, physicians who start to practice defensive medicine to avoid the thread of legal liability, however, as a consequence, they end-up exposing the patient to more procedures and new risks. In order to reduce health system related costs and promote patient safety, the American Board of Internal Foundation launched in 2011 the Choosing Wisely campaign. This campaign has been adopting in Brazil, since 2015 by engaging the medical societies in this discussion especially concerning what is needed or not for providing a safe and efficient care.⁴

However, as alerted by Dr. Mira in the previous editorial that introduces this subject, consequences for professionals directly involved in such adverse events may cause suffering including feeling as the worst professional in the world, inability to live with guilt of harming someone else, wishing to cry out, wishing to die, feeling pain, insomnia, weakness, feeling small, alone, and wishing to give up his/her profession and his/her own existence.² In general, these professionals are considered as sole responsible and little or nothing is done to help them. They are “second victims” and, unfortunately, Brazil lacks supporting programs as the one mentioned by Dr. Mira. In addition, few studies have been conducted on the subject or even the situation has received attention in terms of patient safety, exposition, and the punitive culture at institutions. The prevalence of professionals (around 50% to 70%) in the condition as “second victim” is alarming, requires further studies, and reveals the urgency of this discussion.⁵

The analysis of studies about adverse factors that affect patients revealed as the main causes the lack of structural conditions in the work environment, inadequate materials and equipment, insufficient employees in organization, work overload, tiring and professional stress, planning for error, lacks in processes, and communication problems. All these causes are preventable and avoidable and represent a risk for professionals and may weaken the care to be delivered.⁶

For this reason, organizations need to be committed with safety, learn with errors, analyze working process, and put patient, their family members, and also their employees first.

Referências

• ¹
  Coli RC, Anjos MF, Pereira LL. Postura dos enfermeiros de uma unidade de terapia intensiva frente ao erro: uma abordagem à luz dos referenciais bioéticos. Rev Lat Am Enfermagem. 2010;18(3):324–30.
• ²
  Bohomol E. Nurses as second victims: A Brazilian perspective. Nurs Health Sci. 2019 Jul 1. doi: 10.1111/nhs.12630
  » https://doi.org/10.1111/nhs.12630
• ³
  Pazinatto MM. A relação médico-paciente na perspectiva da Recomendação CFM 1/2016. Rev Bioet. 2019;27(2):234–43.
• ⁴
  Laguardia J, Martins MS, Castro IRS, Barcellos GB. Qualidade do cuidado em saúde e a iniciativa “Choosing Wisely”. 2016;10(1). http://dx.doi.org/10.29397/reciis.v10i1.1097
  » http://dx.doi.org/10.29397/reciis.v10i1.1097
• ⁵
  Mira JJ, Carrillo I, Lorenzo S, Ferrús L, Silvestre C, Pérez-Pérez P, et al.; Research Group on Second and Third Victims. The aftermath of adverse events in Spanish primary care and hospital health professionals. BMC Health Serv Res. 2015;15(1):151.
• ⁶
  De Freitas GF, Hoga LA, Fernandes MF, González JS, Ruiz MC, Bonini BB. Brazilian registered nurses’ perceptions and attitudes towards adverse events in nursing care: a phenomenological study. J Nurs Manag. 2011;19(3):331–8.

Publication Dates

• Publication in this collection
  10 Oct 2019
• Date of issue
  Sep-Oct 2019