The Crossroads of Wellness and Second Victim Syndrome: Identifying Factors that Alter the Pathway of Caregiver Recovery Following an Unanticipated Adverse Patient Outcome

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery. Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The Impact of Event Scale-Revised (IES-R) was used as a measure of the stress a provider senses following a traumatic event. The Second Victim Experience and Support Tool (SVEST) was used to assess the medical provider’s emotional response and level of institutional support in response to an adverse clinical event. Results: Analysis of SVEST vs. IES-R demonstrated that respondents with greater self-perception of personal distress reported increased psychological (p=0.0008) and physical (p=0.0015) distress. Respondents who reported higher HRLSI scores had a greater perception that non-work-related support (p=0.04) such as family support was inadequate; however, these respondents were less likely to perceive institutional support (p=0.04) as inadequate. The results indicate that caregivers with more perceived life stresses believe that they do not have strong non-work-related support services, which is a known protective factor; thus, they may perceive any institutional support as more adequate. Conclusion: This study suggests that personal life risk factors, institutional support, and non-work related support may play an important role in the development of SVS and the perception of stress and wellness in the setting of SVS

Does NAFTA (North American Free Trade Agreement) Chapter 19 make a difference? Dispute settlement and the incentive structure of U.S./Canada unfair trade petitions

NAFTA Chapter 19 sets up bilateral review panels to replace the domestic judicial appeals process of resolving disputes among NAFTA members over the enforcement of unfair trade laws. In principle, such panels can change the incentive structure of filing unfair trade law petitions by reducing the likelihood of an affirmative finding of injurious unfair trade. Using data from U.S. and Canadian unfair trade petition filings, empirical tests show support for this hypothesis. However, a more comprehensive settlement of conflicts will require progressive legal integration, including an extension of national treatment measures to alleged "unfair trade" that is not currently envisaged under the NAFTA. Copyright 2000 Western Economic Association International.