Concept Review: Second Traumatization and the Role of a Perioperative Advanced Practice Nurse

Abstract

Trauma is inherent in the lived experience of perioperative clinicians. The human cost of these experiences remains, however the hum, mostly unrecognized and shrouded within the Operating Room (OR). Second traumatization describes the phenomenon that clinicians are vulnerable to personal and professional destabilization following exposure to a critical event. Events can include: a medical error, traumatic case, or unanticipated patient outcome. While this phenomenon has been recognized in a variety of disciplines, including nursing, medicine, social work, and psychology it has received limited attention in the perioperative context. A concept review of second traumatization is necessary to understand the experiences of perioperative clinicians caring for victims of critical events.

This paper examines two intersecting concepts: vicarious traumatization and second victimization.

Vicarious traumatization is a concept coined by psychologists to address the phenomenon that individuals working with victims of trauma can absorb disruptive psychological effects that can persist over time.

Second victimization was originally proposed by a physician and used to describe situations in which clinicians suffer due to their perception of perpetuating an adverse event through a medical error. Over time the concept of second victimization has expanded to include not only those who might feel at fault but also any clinician involved in the adverse event.

Although these concepts originated from discipline specific research, both are pertinent to the high-risk, emergency, and interdisciplinary elements of OR care. Considering both victimization and traumatization allows for the development of an overarching understanding of the concept of second traumatization in perioperative contexts.

The purpose of this paper is to present a concept review of second traumatization. The intention of a concept review is to utilize pertinent literature to analyze, define, develop and evaluate a concept which is relevant to the nursing profession. While many frameworks exist for concept analysis, Rodger’s Evolutionary Method considers the contextual elements and growth of a concept, recognizing that it adapts in different circumstances. By defining second traumatization my hope is that it will allow nurses to recognize the phenomenon in practice and engage in initiatives in an effort to mitigate harm.