The latest news of people dying during consultation in the emergency room of Anna-Laberge hospital can of course worry all future patients, but they also mask a reality experienced by the caregivers involved in this tragedy. We obviously consider deceased patients and their families as victims of an event which we will investigate and about which we will judge to be an additional situation for reviewing a culture of safety within establishments. We will therefore take lessons from the factors that have been singled out.
When you die in these circumstances after being received in triage by caregivers and placed on a severity scale according to clinical reasoning, it will not take more to define the situation as a class adverse event. I on the scale of accidents and incidents. These accidents and incidents are very numerous and call for a declaration, a disclosure, an investigation and perhaps more if lawyers and professional orders get involved.
To put it in figures, a report published in Quebec regarding the events occurring from 2019 to 2021 indicates a total annual number of 495,652 events for the years 2019-2020 and 442,725 events for the years 2020-2021 (Ministry of Health and Social Services, 2022). In 2018, 14.5% of them led to temporary consequences and 421 led to deaths. In 2020-2021, 16.7% resulted in temporary consequences and 517 resulted in deaths (Ministry of Health and Social Services, 2018).
In 2020-2022, these figures were still very high since we noted 16.4% of events with temporary consequences and 550 deaths. This means that despite multiple prevention approaches, an ever-improved safety culture and effective risk management, these events are increasing in number, just like those which lead to the death of people ‘we had to take care of it.
These events and their management have major effects in their wake. Among the people to be treated of course but also among the caregivers. When they are involved personally and as a unit, a range of feelings emerge and can last—feelings of hurt, shame, doubt, anger, guilt, and many other emotional manifestations.
This means first of all that the event consists of a major betrayal, that of caregivers who must normally respond to a caring promise and who have committed themselves by cultivating an ideal and a positive image of themselves. The social and symbolic representations that revolve around caregivers should not be neglected either, as they are described as angelic and superheroes.
In short, the accident marks a betrayal and a broken promise. The values of humanization, the depths of the caring relationship, the empathic and sympathetic forms of attention, the dispositions to presence, maintained, learned and incorporated during several years of training, would ultimately have been only decoys.
To see the victim and in this week’s case, the corpse and his grieving family, declare, disclose, appear in the media, be under investigation, is to not be able to escape this time from moral responsibility and sensitivity. If I recall this observation, it is because nurses and other caregivers encounter many other negligences in their daily lives. They left them in the closet, in the shadows, because they have become so common. The banality of evil is also in our healthcare environments and the moral anesthesia of caregivers is not far away as they are dispossessed of care and alienated by discourses and logics of services (services that can be divided, divided up, measurable, administrable).
Thus, one thing leads to another, from small wounds to small wounds, from minor betrayals to major betrayals, moral suffering sets in, and the previous feelings are common expressions of it. Sometimes and in serious events, caregivers experience post-traumatic shock, made up of incessant ruminations, reminiscences, nightmares and fears.
All these layers of caring chair are yet again affected by another betrayal, this time that of a system and an organization which are lacking in the work environment they produce. How many nurses enter work with a sinking heart knowing that something serious can or will inevitably happen, for one of their patients, for another, for themselves or for their colleague. This is felt, announced and shared with local managers who cannot do much other than encourage them, lend them a helping hand by taking their noses out of their paperwork, and support them in the face of a charge and a pace of work that distracts them from care and limits them to poor quality service.
A priori and knowing what is happening in emergency services, the betrayal of the system seems obvious, and the nurses or caregivers involved in these stories experience real offenses which only increase this moral suffering and make resignation or very likely work stoppage. We must also try to understand the lack of caregivers on this side!
So what will happen in the context of this tragedy in the emergency room at Anna-Laberge Hospital? We will certainly act to ensure that the teams “ventilate”, breathe, express themselves in a troubled time, filled with shame and anger. We will reach out to those offended with an employee assistance program that is often late and not at all specialized in dealing with adverse events. Because caregivers experience a feeling of bitterness and resentment in the face of the traitor, they will certainly turn away from him.
And what more can we say about this guilt and moral responsibility currently pending? Will one person’s error turn into an individual fault? Will the event management device place responsibility on the system, its administrators or on the caregivers?
Whatever the case, feelings and suffering are unavoidable at the moment, and actions must be taken to enable caregivers not to suffer from guilt for too long, so that they can regain their self-esteem and reconnect. with a promise of care that brings them to the doors of health institutions every day. Let us hope that we offer reparations for the first victims of the events, but that we also not forget to act towards these other parties, overwhelmed and offended by a system that we all know is adrift. .