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Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses
Abstract
Background: Second victim experiences can affect the wellbeing of health care providers and compromise patient safety. Many factors associated with improved coping after patient safety event involvement are also components of a strong patient safety culture, so that supportive patient safety cultures may reduce second victim–related trauma. A cross-sectional survey study was conducted to assess the influence of patient safety culture on second victim–related distress.
Methods: The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC) and the Second Victim Experience and Support Tool (SVEST), which was developed to assess organizational support and personal and professional distress after involvement in a patient safety event, were administered to nurses involved in direct patient care.
Results: Of 358 nurses at a specialized pediatric hospital, 169 (47.2%) completed both surveys. Hierarchical linear regres sion demonstrated that the patient safety culture survey dimension nonpunitive response to error was significantly associated with reductions in the second victim survey dimensions psychological, physical, and professional distress (p < 0.001). As a mediator, organizational support fully explained the nonpunitive response to error–physical distress and nonpunitive response to error–professional distress relationships and partially explained the nonpunitive response to error–psychological distress relationship.
Conclusions: The results suggest that punitive safety cultures may contribute to self-reported perceptions of second victim–related psychological, physical, and professional distress, which could reflect a lack of organizational support. Reducing punitive response to error and encouraging supportive coworker, supervisor, and institutional interactions may be useful strategies to manage the severity of second victim experiences.
... Studies have found that the second victim experience is not limited to adverse events or sentinel events that cause serious harm to patients. It can also occur when a patient experiences a near miss that does not directly harm the patient [4,10]. Therefore, active support and prevention activities at the institutional level have been emphasized to prevent medical staff from second victim experience after a PSI [11]. ...
... This philosophy can be quanti ed through a speci c subscale in established patient safety culture assessment tools -namely, the non-punitive response to errors. Studies have indicated that a non-punitive response to errors can help diminish the distress experienced by nurses as second victims [8][9][10]. Consequently, it is anticipated that a JC can help mitigate SVEs among nurses [21]. ...
... Because of this balancing act, an organization's JC is necessary to provide a support system to reduce SVD experienced after a PSI [32]. Reducing punitive responses to PSIs and providing support through interactions with colleagues, supervisors, and the organization can help mitigate SVD [10]. In a study comparing the perception of JC among international nurses, it was found that nurses who received support after SVEs had a higher perception of JC than nurses who did not have experience as second victims [33]. ...
Background Second victim experiences of nurses are a critical issue in healthcare. In addition to causing psychological and emotional distress to nurses, second-victim experiences adversely affect organizational performance and overall patient safety. Purpose This study aimed to identify the effects of the perceived just culture of medical institutions on the second victim experiences of nurses after patient safety incidents. Methods This was a cross-sectional correlational study. Data were collected from 183 clinical nurses in tertiary general hospitals between December 28, 2022 and January 14, 2023 using an online self-report questionnaire. Data were analyzed using SPSS WIN 23.0 and AMOS 23.0 programs. Results The hypothesized model was found to be statistically fit (normed χ ² /df = 2.53; root mean square error of approximation = .09; comparative fit index = .99; Tucker-Lewis index = .97; normed fit index = .99). Eight hypothesized pathways were tested, of which five direct effects and three indirect effect pathways were statistically significant. Just culture had a significant effect on second victim distress (β = -0.29, p = .001) and demand for support (β = -0.65, p = .001). Second victim distress had a significant effect on demand for support (β = 0.14, p = .025) and negative work-related outcomes (β = 0.66, p = .001). Demand for support had a significant effect on negative work-related outcomes (β = 0.18, p = .010). Conclusions This study demonstrates that a just culture in medical institutions can ameliorate second victim experiences of nurses involved in patient safety incidents. Implementing systemic interventions to establish a just culture in medical institutions is a key imperative to mitigate second victim experiences and improve organizational performance.
... These symptoms include guilt, anger, shame, and, in some cases, concern about punishment, job loss, and litigation. The nal results of these symptoms are a decrease in job con dence and job satisfaction and an increase in stress in the second victim [11,12]. A study by Nydoo et al. (2020) showed that the effects of an adverse medical event for second victims of error are dire, and many of them experience feelings of sadness, guilt, and anxiety. ...
... In the context of the present study, there was a signi cant relationship between the phenomenon of second victims of errors and the management atmosphere of the department. Quillivan et al. (2016) stated that a nonreprimanding work culture provides an environment for nurses in which the physical and professional discomfort of nurses and the phenomenon of second victims are reduced by increasing the support of managers [12]. Ajri-Khameslou et al. (2021), regarding the effect of how managers deal with nurses' errors, point out that the presence of a punitive atmosphere in the organization, according to the majority of nurses, increases the nurse's anxiety and tension and ultimately increases the phenomenon of second victims of errors and the possibility of more errors [32]. ...
... In the context of the present study, there was a signi cant relationship between the phenomenon of second victims of errors and the management atmosphere of the department. Quillivan et al. (2016) stated that a nonreprimanding work culture provides an environment for nurses in which the physical and professional discomfort of nurses and the phenomenon of second victims are reduced by increasing the support of managers [12]. Ajri-Khameslou et al. (2021), regarding the effect of how managers deal with nurses' errors, point out that the presence of a punitive atmosphere in the organization, according to the majority of nurses, increases the nurse's anxiety and tension and ultimately increases the phenomenon of second victims of errors and the possibility of more errors [32]. ...
Background Errors not only affect patients as the primary victim but also have a negative impact on nurses as the secondary victim; therefore, understanding the reasons for the second victim's error, as well as the elements that contribute to this phenomenon, is critical for managing the mistake. The main purpose of this research was to determine the status of second victims of error and related factors in nurses. Methods This is an analytical-descriptive study conducted in Iran. five teaching hospitals affiliated with Ardabil University of Medical Sciences. The study's statistical population comprised all nurses working in the teaching hospitals of Ardabil city. A random sampling method was used. The data collection tool included a demographic characteristics questionnaire, a questionnaire on previous nursing error experience characteristics, and the Second Victim Experience and Support Tool. The collected data was analyzed in SPSS-16 software. Results The results obtained from this research showed that the average score of second victims of error among nurses participating in the study was 85.89 (10/17). Based on the results obtained, there was a significant relationship between the number of second victims of error phenomena with age (p < 0.01 and r = -0.179) and work experience (p < 0.01 and r = -0.156), the number of cases of errors in 12 previous months, having an error that resulted in injury in the last 12 months, the history of going to court, the way nursing errors were reported, and the way managers dealt with nurses' errors (p < 0.05). Conclusions The nurses under study had an average level of the phenomenon of second victims of error, and a set of individual and organizational factors were influential in the development of this phenomenon. Based on this, it was evident that there is a need to utilize the findings of this study to decrease the occurrence of second victims of errors.
... Promoting open discussions, support about events, and meaningful patient safety event feedback in the hospital environment could enhance the possibility of learning from mistakes and responding to errors in no punitive ways that may be beneficial for effectively coping with the second victim event (17,18). Conversely, a patient safety culture that encourages blame, criticism, silence, or stigmatization of patient safety events can intensify the physical and psychological distress in the second victim (19)(20)(21). ...
... It has been demonstrated that the second victim phenomenon in a non-supportive workplace could create a sense of hatred or feeling accused, victimized, judged, and embraced (14,34,35). Reducing punitive response to error and having encouraging, supportive coworkers, supervisors, and institutional interactions may be effective in the management of the second victim symptoms (21). In contrast with our findings, Joeste et al. reported that second victims received maximum support from their colleagues (36). ...
... When support from staff members against error is increased without any punitive response, the error-reporting rate is also increased. Consistent with our study, Quillivan et al. reported that punitive safety cultures may contribute to self-reported perceptions of the second victim-related psychological, physical, and professional distress, which could reflect a lack of organizational support (21). Supporting staff after safety events and informing other staff about errors reduce the incidence of errors. ...
... The studies included in the final analysis assessed SVS and organizational support across a variety of healthcare settings and professions, using both quantitative and qualitative approaches to measure provider experiences (Table 3, Appendix B). [5][6][7][8][9][10] The Second Victim Experience and Support Tool (SVEST) 5,9 (n = 2/6, 33.3%) and the Medically Induced Trauma Support Services Staff Support Survey (n = 2/6, 33.3%) 7,9 were the most commonly used tools to measure SVS experiences. Based on these studies, the presence of organizational support strategies were predictive of absenteeism and turnover. ...
... Of those support strategies offered, 2 studies generalized that those who identify as a SVs with greater awareness of resources available would predictably decrease absenteeism and intention to leave their occupation. 5,9 Reported in 5 of the articles, common symptoms of SVs were identified by healthcare providers, but most were afraid to report the incident and seek support due to litigation, fear of punishment, or stigma surrounding support. [5][6][7][8][9][10] Organizational Support Strategies Our findings indicated healthcare providers were either given or sought support methods after an adverse event. ...
... 5,9 Reported in 5 of the articles, common symptoms of SVs were identified by healthcare providers, but most were afraid to report the incident and seek support due to litigation, fear of punishment, or stigma surrounding support. [5][6][7][8][9][10] Organizational Support Strategies Our findings indicated healthcare providers were either given or sought support methods after an adverse event. They further reported that they believe organizational support after adverse patient events was or would be beneficial for minimizing SVS. ...
Purpose: Healthcare providers may experience critical incidents, medical errors, or other adverse patient events in their clinical practice.Providers that encounter such events can experience second victim syndrome (SVS), a condition where providers feel psychological, cognitive, or physical reactions rendering care in these instances. Organizational support may mediate the impacts of SVS after an adverse patient event. We conducted a scoping review to explore and synthesize the literature on the support strategies implemented by healthcare organizations for healthcare providers after adverse patient events. Methods: The initial search strategy yielded 244 articles, 84 of which were removed for duplication. The 3-person review team completed title and abstract screening, reference screening, and full-text review, reaching 2-person consensus for article inclusion at each phase. To be included in analysis, studies had to be conducted in the United States, include real or perceived outcomes of organizational support strategies for healthcare providers related to adverse patient events. During title and abstract screening, 144 articles did not meet inclusion criteria. The references of the remaining articles (n = 16) were screened and 6 articles were added to the review pool. Twenty-two articles were included in the full text analysis, 16 articles were removed for not meeting the inclusion criteria. Six articles were included in the final extraction and analysis. Results: The 6 studies assessed SVS and organizational support across a variety of healthcare work settings and professions. Findings indicated that healthcare providers believe organizational support after adverse patient events was or would be beneficial for minimizing SVS. They further demonstrated a discrepancy in the types of support strategies healthcare providers preferred or desired after an adverse event, as the level of agreement differed between sampled populations.Conclusion: Healthcare providers believe support from their organization is important after experiencing an adverse patient event, but support strategies may not be universal. Organizations should establish provider support systems for adverse events, but first need to assess provider preferences to implement the strategies most desired. As organizations develop their support systems, they should consider the interprofessional nature of their staffs to aid in collective support following an adverse event.
... Lack of organizational support leads to reduced patient safety and consequently, patient injury and injury to health care providers (Farokhzadian et al., 2018;Rinaldi et al., 2016). The second victim's mental, physical and occupational distress reflects a culture of punitive safety and a lack of organizational support (Burlison et al., 2017;Quillivan et al., 2016). ...
... According to Iranian nurses, support resources after patient safety events are mostly related to the supervisor and the institution. Unlike previous studies, colleague support and non-work-related support have a negligible effect on improving the condition of feeling like a second victim (Chen et al., 2019;Quillivan et al., 2016;Santana-Domínguez et al., 2021). In Iranian culture, due to the lack of nurses, absenteeism is almost impossible. ...
... The results of this study demonstrated that nurses in intensive care units and the emergency department endure psychological and physical distress after patient safety events, which is consistent with other studies (Quillivan et al., 2016;Zhang et al., 2019). However, the consequences of the second victim experience for Iranian nurses are different in some countries (Brunelli et al., 2021;Kim et al., 2020). ...
Aim:
This study was designed to characterize the psychometric properties of the Persian version of the Second Victim Experience and Support Instrument (P-SVEST).
Design:
This study was a methodological and cross-sectional study.
Methods:
The SVEST was back-translated into Persian and 10 experts assessed its content validity. Construct validity was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a total of 754 critical care and emergency nurses.
Results:
The results of exploratory factor analysis showed that the P-SVEST had four factors. These four factors accounted for 51.67% of the total variance. Also, these factors were confirmed by confirmatory factor analysis (root mean square error of approximation = (90%. confidence interval) = 0.058 [0.045, 0.071], goodness-of-fit index = 0.932, comparative fit index = 0.956, non-normal fit index = 0.918, incremental fit index = 0.957 and Tucker-Lewis index = 0.944). Coefficients of Cronbach's alpha, McDonald's omega, composite reliability and maximum reliability for all of the factors were >0.7, demonstrating satisfied internal consistency.
... However, some methods can help nurses recover and maintain their professional attitudes. For instance, stress symptoms can be alleviated by non-punitive work environments, open discussions of incidents, exchanges of incident-related information with co-workers, and constructive feedback from supervisors or organizations (Quillivan et al., 2016). Moreover, creating just cultures reduces distress following patient safety incidents, and combined with good leadership and management support, help nurses cope with guilt and shame (Schrøder et al., 2019). ...
... These findings corroborate a previous study wherein positive perceptions of organizational culture were found to alleviate physical, psychological, and professional distress, and enable effective coping mechanisms in response to patient safety incidents (Quillivan et al., 2016). ...
... Further, these findings agree with the results of Kim et al. (2017), wherein participants expressed the need for supervisor, institutional, and co-worker support. It is evident that support from co-workers, supervisors, and institutions, ameliorates the difficulties healthcare providers face after experiencing patient safety incidents and facilitates their return to work and everyday life (Quillivan et al., 2016). These findings suggest that nurses' working lives can be improved by timely providing them with strategic and systematic support from co-workers, supervisors, and administrative staff. ...
Aim:
We investigated the impact of patient safety incidents on the quality of nurses' work-related lives, based on the Culture-Work-Health model.
Design:
Descriptive correlational study.
Methods:
An online survey was administered between March 10 and 18, 2020 to 622 nurses in South Korea who had experienced patient safety incidents within the past year. Descriptive analysis was performed along with inferential statistics, including one-way ANOVA, correlation, and multiple linear regression (p < 0.05).
Results:
A multiple linear regression analysis was used to identify factors affecting participants' quality of work-related life. Significantly influential factors were resonant leadership, just culture, organizational support, organizational health, and overall work experience.
Conclusions:
Resonant leadership and culture positively affects nurses' quality of work-related life. Therefore, it is critical to evaluate nurses' perceptions of these factors and use these factors in creating administrative interventions to assist nurses in improving their work experiences.
... Patient safety culture is defined by WHO and Agency for Healthcare Research and Quality [66] as "the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum. " It included attitudes, perceptions, and values that employees have in relation to patient safety and focuses on the prevention of medical errors, surgical errors, healthcare-associated infections and sepsis, diagnosis errors, patient falls, venous thromboembolism, pressure ulcers, unsafe transfusion practices, patient misidentification and unsafe injection practices [49,67,68]. ...
... An organization's patient safety culture is the extent to which an organization/hospital supports and promotes a patient safety culture. Its features are managers' dedication to patient safety, manageable staff workloads, error reporting, teamwork, non-punitive policies, an open climate in the institute, and information exchange [49,67,68]. ...
Background
Creating a healthy and conducive nursing work environment is a universal global nursing concern. Work-Related Stress, global nursing and a public health problem that has continued to bedevil the world healthcare systems is of a particular interest. It has not only compromised the quality of patient care but also negatively impacted nurses’ quality of work life and adversely affected global healthcare management. Organizational culture is an important determinant of nurses’ work-related stress, yet it remains systematically under-researched. Despite a plethora of research on work-related stress in nursing environments, there are few dedicated systematic literature reviews, and this study aimed to fill this gap.
Objective
To determine the scientific evidence in the literature, on the impact of organizational culture on work-related stress among nurses and provide valuable insights to mitigation of work-related stress among nurses.
Design
A Systematic literature review.
Methods
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive literature search was conducted in major electronic databases, including PubMed, Scopus, Web of Science, Ovid Medline, Embase and CINAHL in July 2023. Studies that met the inclusion criteria set were screened using Rayyan and Covidence. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality and risk of bias.
Results
The search generated a total of 2,113 records, and 13 were included. Thematic analysis generated three main themes: types of organizational culture, organizational climate, and organizational politics, each with distinct effects on nurses’ work-related stress. We found overall that, positive organizational culture, positive organizational climate and positive organizational politics were consistently associated with nurse’s happiness and joy at the workplace and lower levels of work-related stress while negative organizational culture, climate and politics were strongly associated with nurses’ work-related stress.
Conclusions
This review underscores the crucial role of organizational culture in nursing work environments and its impact on nurses’ stress levels, offering valuable insights for the mitigation of work-related stress and the transformation of the nursing profession.
... • Blame culture [40][41][42] • Stigmatization of health care incidents [40][41][42] • Lack of sensitization of second victim support initiatives in health organizations strongly influences the organizational culture, often fostering a climate of silence concerning health care incidents and distressing situations [15,16,43]. ...
... • Blame culture [40][41][42] • Stigmatization of health care incidents [40][41][42] • Lack of sensitization of second victim support initiatives in health organizations strongly influences the organizational culture, often fostering a climate of silence concerning health care incidents and distressing situations [15,16,43]. ...
Background
Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs’ well-being and ultimately improve the quality of care and patient safety.
Objective
This study aims to describe and evaluate a multimodal training organized by the European Researchers’ Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs.
Methods
We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities.
Results
Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants’ satisfaction increased, particularly when adjusting the allocated time for the case studies’ discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team.
Conclusions
This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts.
... Esto resalta la importancia de trabajar en la cultura de seguridad y en la educación continua del personal. Varios autores señalan que, a mayor cultura de seguridad menores consecuencias en las SVS 14,31 . El apoyo institucional percibido refleja que las SVs sienten que la institución acompaña, pero no lo perciben en su entorno inmediato (colegas y supervisores) y en consecuencia lo buscan fuera del entorno laboral. ...
... Esta idea refuerza la necesidad de capacitar al personal en acciones de atención a la SV. De esta forma se fomenta una atmósfera positiva en la organización que facilita el afrontamiento y reduce los efectos en los profesionales 31 . ...
Introduction:
The second victims are those professionals who, when faced with a mistake, are traumatized, questioning their professional and personal skills. Knowledge of their experience allows institutions to understand the consequences of error in professionals to carry out care actions for the professionals involved, improving care security. The objective of this study is to characterize the phenomenon of second victims and to know the perceived support measures.
Method:
Cross-sectional descriptive observational quantitative study. Health professionals from five highly complex institutions participated through convenience sampling. The data collection instrument was the Second Victim Experience and Support Tool (SVEST) validated in Argentina, composed of impact dimensions (psychological, physical and professional skills) of support received (colleagues, supervisors, institutional and measures not related to the workplace) and two outcome dimensions (professional abandonment and absenteeism).
Results:
1134 professionals participated and 56% said they had made a mistake. The mean STEVS was 2.5, with the psychological impact dimension predominating (x = 3.4). As part of the support measures, professionals perceived greater support from family and friends (not related to work) (x = 3.1). The greater the impact, the lower the perception of support measures (Rho: -0.8, p = 0.047).
Discussion:
More than half of the professionals refer to being second victim with a significant psychological impact, who, despite working in institutions that have patient safety protocols, received support from nonwork-related environments.
... Esto resalta la importancia de trabajar en la cultura de seguridad y en la educación continua del personal. Varios autores señalan que, a mayor cultura de seguridad menores consecuencias en las SVS 14,31 . El apoyo institucional percibido refleja que las SVs sienten que la institución acompaña, pero no lo perciben en su entorno inmediato (colegas y supervisores) y en consecuencia lo buscan fuera del entorno laboral. ...
... Esta idea refuerza la necesidad de capacitar al personal en acciones de atención a la SV. De esta forma se fomenta una atmósfera positiva en la organización que facilita el afrontamiento y reduce los efectos en los profesionales 31 . ...
Resumen Introducción: Las segundas víctimas son aquellos profesionales que, ante un error, quedan traumatizados, cuestionándose sus habilidades profesionales y perso-nales. El conocimiento de su experiencia permite a las instituciones entender las consecuencias del error en los profesionales para realizar acciones de atención a los profesionales involucrados mejorando la seguridad de atención. El objetivo de este estudio es caracterizar el fenómeno de segundas víctimas y conocer las medidas de apoyo percibidas. Métodos: Estudio cuantitativo observacional descrip-tivo transversal. Participaron profesionales de la salud de cinco instituciones de alta complejidad a través de un muestreo por conveniencia. El instrumento de recogida de datos fue el Second Victim Experience and Support Tool (SVEST) validado en Argentina, compuesta por dimen-siones de impacto (psicológico, físico y de habilidades profesionales) de apoyo recibido (colegas, supervisores, institucional y medidas no relacionadas al ámbito la-boral) y dos dimensiones de resultado (abandono pro-fesional y ausentismo). Resultados: Participaron 1134 profesionales. El 56% manifestó haber cometido un error y completó el SVEST. La media del SVEST fue de 2.5 predominando la dimen-sión de impacto psicológico (x = 3.4). Como parte de las medidas de apoyo los profesionales percibieron mayor apoyo en familiares y amigos (x = 3.1). A mayor impacto menor percepción de las medidas de apoyo (Rho:-0.8, p = 0.047). Discusión: Más de la mitad de los profesionales re-fieren ser segundas víctimas con un impacto psicológico importante, los cuales, a pesar de trabajar en institu-ciones que cuentan con protocolos de seguridad del paciente, reciben el apoyo principalmente de entornos no relacionados al trabajo Palabras clave: segunda víctima, seguridad del pa-ciente, evento adverso, SVEST Abstract Second victim experience and support from health prof-fessionals
... Specifically, this relates to staff that do not deliver direct patient care, rating the patient safety grade higher than staff that deliver direct patient care [16]. This may be due to a perception of a punitive culture [11,[36][37][38][39]. ...
... Hence, a high performance and safety culture can enhance facilitating teamwork [44]. Consistent with our findings, emphasis must be placed on reducing punitive responses to error and having supportive supervisors to improve safety culture [11,36,38,39]. ...
Background: This study aims to investigate the patient safety culture at a sports medicine hospital and explore the quality of healthcare and associated factors. Methods: In a cross-sectional study design, the Hospital Survey on Patient Safety Culture (HSOPC) tool was administered online among staff at a sports medicine hospital in Doha, Qatar. Out of 898 staff who received an email invitation, 504 participated (56.1%). Results: The results showed that 48.0% of the staff rated the patient safety grade as excellent and 37.5% as very good, totaling 85.5%. Factors associated with excellent or very good patient safety grades were management support OR 4.7 95% CI (1.8 to 12.3); team communication OR 3.0 95% CI (1.4 to 6.3), supervisor action supporting patient safety OR 3.5 95% CI (1.7 to 7.0) and other items related to work area such as working together: OR 3.0 95% CI (1.2 to 7.6), helping out busy areas OR 2.5 95% CI (1.1 to 5.5) and having good procedures and systems: OR 2.8 95% CI (1.4 to 5.8). Conclusions: Addressing management support, enhancing communication, and cohesive work within the work area facilitates a culture of trust that improves patient safety grades.
... In fact, systemic faults or the breakthrough of infinitesimal errors, as in Reason's Swiss cheese model, are often overlooked [57,124,125]. Nevertheless, instilling a non-punitive culture would require a more welcoming atmosphere [27] and accommodate a more effective coping mechanism after experiencing PSI, which has been shown to halt the progress of second-victim distress or reduction in professional efficacy [126]. Effective coping mechanisms, as facilitated by the support triad, can be achieved by democratically discussing PSI on a neutral ground, and without judging remarks; this would result in healthcare reform or cultural transformation [4]. ...
... This was a cross-sectional study that had possibility of other confounding factors and limited power to analyze causality, but still provided a good description upon exploring second-victim circumstances in Malaysia. A further complex analysis, such as covariancebased structural equation modeling involving many latent constructs, longitudinal study, or causative multiple mediation model with other third variables such as moderation or covariates, could be exercised later to analyze more related variables (such as patient safety culture) [126,134,135]. Future studies could also choose a qualitative or mixed method approach that could perhaps better explain the suitable type of support. ...
Citation: Mohd Kamaruzaman, A.Z.; Ibrahim, M.I.; Mokhtar, A.M.; Mohd Zain, M.; Satiman, S.N.; Yaacob, N.M.
... Sleep disorders, eating disorders, concentration and memory disorders, alcohol and drug use, anxiety, post-traumatic stress disorder (PTSD), and even suicide attempts, have been associated with SVP as well [10][11][12][13][14]. Organizational support provided immediately following the event may help nurses and physicians recover more quickly and return to their previous level of professional functioning [15]. On the other hand, ignoring the unique needs of the 'second victim' may delay or prevent recovery, and lead to the provision of defensive or suboptimal treatment [15][16][17][18][19], since providers may doubt their clinical skills and professionalism [20][21][22] and consider leaving, or do leave, the profession [5,10,16,22]. ...
... Others felt that there should be a complete separation between the administrative role of the manager and the therapeutic needs of the provider. Recent research does support the need [19,26] that there be separation between management and proffered psychosocial support, by a nonbiased, confidential professional, trained to treat second victims. Health organizations need a referral mechanism to handle this situation that is confidential and respects providers' confidentiality. ...
Background
The ‘second victim’ phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health’s implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers’ perceptions of the ‘second victim’ occurrence.
Methods
A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the ‘second victim’. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of ‘second victim’, and identifying components of possible intervention programs and challenges to implementing those programs.
Results
Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager.
Conclusions
Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.
... Clinicians who were involved in errors or any patient safety incident are prone being second victims (Schroder et The Joint Commission, 2018). One study also highlighted that punitive safety cultures may contribute to self-reported perceptions of second victim-related psychological, physical, and professional distress, which could re ect from lack of organizational support (Quillivan et al., 2016). ...
... The emerging evidence of systematic reviews indicated that promoting a culture of safety as a patient safety strategy supports the potential e cacy of using interventions to promote safety culture, which includes second-victim support program (Busch et al., 2021;(Scott, 2015). Reducing punitive response to error and fostering supportive coworker, supervisor, and institutional interactions may be helpful techniques to manage the severity of second victim experiences (Quillivan et al., 2016;Shuangjiang et al., 2022;Scott, 2015). ...
Aim
Assess the impact of the second victim support program to the just culture perception of nurses.
Method
A descriptive, cross-sectional study using the validated Just Culture Assessment Tool (JCAT) conducted last November 2020 to December 2020 in a large referral hospital in the Middle East. The total response rate was 82%. The just culture perception of 212 staff nurses is presented through a dimension-level mean scores of each group based on the second-victim exposure (non-victims, second victims with support, and second victims without support).
Results
Results revealed that the second victim with the support group got the highest overall mean score (5.13 ± 0.13), while second victim with support and second-victim without support is (5.15 ± 0.10) and is (5.45 ± 0.11), respectively. ANOVA and Tukey HSD multiple comparisons test showed a significant difference in just culture mean scores between second victims with support and non-victims are significantly different at a 5% level of significance (p-value = 0.0386 < 0.005).
Conclusion
A better perceptual score of just culture was linked to perceived institutional support for second victims.
... Destaca-se que o acompanhamento pelo psicólogo foi o único recurso de suporte formal identificado pelos estudantes de enfermagem neste estudo. Segundo a literatura, a oferta deste suporte é limitada nos serviços de saúde, sobretudo por falha na identificação das possíveis segundas vítimas, intervenções de apoio insuficientes e ausência de uma cultura de segurança do paciente (20)(21)(22)(23) . Apesar do apoio entre colegas e professores durante o incidente ser considerado adequado para aliviar o sofrimento dos estudantes, eles reconhecem que há uma orientação limitada da instituição de ensino e da instituição de saúde (18) . ...
... A National Quality Forum, agência de pesquisa de cuidado em saúde e qualidade, e outras organizações de saúde recomendam que todas as organizações incorporem programas de apoio aos prestadores de serviço à saúde como segunda vítima (32) . Ressalta-se, portanto, que a responsabilidade pelo cuidado e bem-estar dos pacientes, familiares, profissionais de saúde e estudantes da instituição é das organizações de saúde (20,(31)(32) . ...
Objectives
to identify the support provided to nursing students after a patient safety incident.
Methods
qualitative study developed with 23 students attending an undergraduate nursing program in southern Brazil. Data were collected between September and November 2021 and submitted to textual discursive analysis using the Iramuteq software.
Results
the students reported that mainly classmates and professors of the practical courses provided support. The students showed no knowledge of organizational support or protocols available to students who become second victims of such incidents.
Final Considerations
the primary support sources available to nursing students involved in patient safety incidents were identified. Note that support provided to nursing students is still incipient both in Brazil and internationally. Hence, further studies are needed to address potential victims and support resources to mitigate this phenomenon.
Descriptors:
Students; Nursing; Patient Safety; Risk Management; Clinical Clerkship; Qualitative Research
... Destaca-se que o acompanhamento pelo psicólogo foi o único recurso de suporte formal identificado pelos estudantes de enfermagem neste estudo. Segundo a literatura, a oferta deste suporte é limitada nos serviços de saúde, sobretudo por falha na identificação das possíveis segundas vítimas, intervenções de apoio insuficientes e ausência de uma cultura de segurança do paciente (20)(21)(22)(23) . Apesar do apoio entre colegas e professores durante o incidente ser considerado adequado para aliviar o sofrimento dos estudantes, eles reconhecem que há uma orientação limitada da instituição de ensino e da instituição de saúde (18) . ...
... A National Quality Forum, agência de pesquisa de cuidado em saúde e qualidade, e outras organizações de saúde recomendam que todas as organizações incorporem programas de apoio aos prestadores de serviço à saúde como segunda vítima (32) . Ressalta-se, portanto, que a responsabilidade pelo cuidado e bem-estar dos pacientes, familiares, profissionais de saúde e estudantes da instituição é das organizações de saúde (20,(31)(32) . ...
Objectives:
to identify the support provided to nursing students after a patient safety incident.
Methods:
qualitative study developed with 23 students attending an undergraduate nursing program in southern Brazil. Data were collected between September and November 2021 and submitted to textual discursive analysis using the Iramuteq software.
Results:
the students reported that mainly classmates and professors of the practical courses provided support. The students showed no knowledge of organizational support or protocols available to students who become second victims of such incidents.
Final considerations:
the primary support sources available to nursing students involved in patient safety incidents were identified. Note that support provided to nursing students is still incipient both in Brazil and internationally. Hence, further studies are needed to address potential victims and support resources to mitigate this phenomenon.
... Almost 20% of the participants reported involvement in a PSI resulting in permanent harm or death of the patient. According to literature, these participants are particularly at risk for poor well-being and reduced professional functioning during their clinical experience from being involved in a PSI with such serious consequences; involvement in a PSI can have a serious impact on mental health, so it is important to recognize early SV symptoms [21][22][23]. The main perceived causes of the reported PSIs (distraction, procedural errors) were consistent with other similar studies [13,18]. ...
... As a consequence, they are less likely to report the feeling of working badly after a PSI. Seeking support is a common coping strategy for SVs [21]. This was confirmed by our results, where almost all of the participants talked to someone about the PSI, as expected, mainly with their colleagues [28]. ...
Background:
The term second victim (SV) describes healthcare professionals who remain traumatized after being involved in a patient safety incident (PSI). They can experience various emotional, psychological, and physical symptoms. The phenomenon is quite common; it has been estimated that half of hospital workers will be an SV at least once in their career. Because recent literature has reported high prevalence (>30%) among nursing students, we studied the phenomenon among the whole population of healthcare students.
Methods:
We conducted a cross-sectional study with an online questionnaire among nursing students, medical students, and resident physicians at the teaching hospital of the University of the Piemonte Orientale located in Novara, Italy. The study included 387 individuals: 128 nursing students, 174 medical students, and 85 residents.
Results:
We observed an overall PSI prevalence rate of 25.58% (lowest in medical students, 14.37%; highest in residents, 43.53%). Of these, 62.63% experienced symptoms typical of an SV. The most common temporary symptom was the feeling of working badly (51.52%), whereas the most common lasting symptom was hypervigilance (51.52%). Notably, none of the resident physicians involved in a PSI spoke to the patient or the patient's relatives.
Conclusion:
Our findings highlighted the risk incurred by healthcare students of becoming an SV, with a possible significant impact on their future professional and personal lives. Therefore, we suggest that academic institutions should play a more proactive role in providing support to those involved in a PSI.
... 5 In 2016, Quillivan et al demonstrated a significant positive association of peer support with the successful attainment of safety culture in units that encounter high levels of stress. 6 Peer support can be considered to be an evidence-based intervention to support the emotional wellbeing of workers. Despite this, there are barriers to providing workers with peer support in a health care institution. ...
Healthcare leaders are responsible for creating an environment where their staff can maintain their resilience and well-being. However, there is a crisis of burnout among healthcare workers. The resulting increased turnover, diminished morale and performance, safety risks, and decreased worker engagement produces a vicious cycle of burnout. A strategic intervention is needed that focuses on worker wellbeing. This paper describes how the Johns Hopkins Resilience In Stressful Events (RISE) peer support program has helped healthcare leaders support their workers and strengthen the resilience of their organization. It explains the crucial role that leaders play in the success of the program. RISE peer was established at Johns Hopkins Hospital in 2011 to provide timely peer support for stressful patient and work-related situations. RISE helps break the cycle of healthcare worker burnout by providing peer support for stresses at work 24 hours a day, 7 days a week. This program structure also supports leaders by sharing the responsibility of emotional support and by providing them with new skills to do their job in a way that generates personal and professional satisfaction. The program has been implemented globally in over 140 healthcare organizations. Leaders are essential to integrate support and serve as role models. Institutions that successfully launch peer support programs engage leaders to participate in program design, participate in the program themselves, and adapt the program to meet the needs of their staff and organization. Peer support programs broaden the base of support for all healthcare workers by providing an employee-focused resource. Implementation of a RISE support model demonstrates an institution’s commitment to the overall health of the people it employs. Operational integration of the model conveys a positive impact on resilience at all levels of the organization, especially in institutions that broadly engage organizational leaders.
... Frequently cited 'symptoms' include flashbacks, concentration issues, sleep disturbance and loss of self-confidence. Suggestion that second victims have an increased risk of developing burnout [16,17], post-traumatic stress disorder (PTSD) [18][19][20][21], a self-harming dependency on alcohol and drugs [22] and suicidal thoughts [23] focuses concern for affected practitioners' longer term psychological state. Numerous studies highlight the persistent emotional burden that adverse event involvement may inflict on healthcare practitioners. ...
Support that mitigates the detrimental impact of adverse events on human healthcare practitioners is underpinned by an understanding of their experiences. This study used a mixed methods approach to understand veterinary practitioners’ responses to adverse events. 12 focus groups and 20 interviews with veterinary practitioners were conducted and analysed using grounded theory principles. Experiencing stress, externalising facts and feelings, morally contextualising events and catalysing personal and professional improvements were identified as components of practitioners’ response. Natural language processing content analysis of posts regarding involvement in adverse events (n = 572) written by members of a veterinary member-only Facebook group was also performed, to categorise and count words within texts based on underlying meaning. Percentile scores of four summary variables along with relative frequency of function, psychological process and time orientation words used were recorded and compared with content analysis of posts where members discussed euthanasia (n = 471) and animal health certification (n = 419). Lower authenticity scores (reflecting lower honesty), differences in clout scores (reflecting dominance) and higher frequencies of moralisation, future focus, prosocial behaviour and interpersonal conflict were observed in the adverse event group compared to either comparison group. Analytical thinking scores (reflecting logical thinking) and frequencies of total, positive and negative emotion, anxiety, anger and cognitive processing words (reflecting debate) were not significantly different between the adverse events and euthanasia groups. Integration of findings confirmed and expanded inferences made in both studies regarding the emotionally detrimental impact of adverse events and the role that peer-to-peer mediated reflection and learning plays in mitigating pathologisation of responses in the aftermath of adverse events. Discordance in findings related to practitioners’ intentions and expressions of honesty suggest that work is needed to normalise open discussion about adverse events. Findings may be used to lever, and to inform, peer-to-peer support for practitioners in relation to veterinary adverse events.
... 28,29 To effectively address the emotional burden and aid in the reconciliation of errors, nurses need a structured support system or program to prevent the onset of the 2nd-victim phenomenon. 30,31 Providing psychological safety for nurses was established through "just culture" methods, which establish a nonpunitive approach to error investigation. 32 The concepts of just culture have been applied to healthcare settings and have been shown to improve patient safety. ...
OBJECTIVE
This study explored nurse leaders' perspectives and experiences in supporting nurses following a serious medical error.
BACKGROUND
Appropriate support is crucial for nurses following an error. Authentic leadership provides an environment of psychological safety and establishes a patient safety culture.
METHODS
A cross-sectional survey research design was conducted to determine nurse leader's (NLs') perspectives on supporting nurses following a medical error.
RESULTS
NL training on handling serious medical errors varied. NLs indicated experiencing a variety of formal support programs: peer support, education, error examination, employee assistance, and just culture. Following an error, NLs reported these interventions were helpful, including education/retraining, psychological safety, time off the unit, identifying system failures, nurse involvement in disclosure, and peer support.
CONCLUSION
This study illuminates how NLs support nurses following an error. It provides insight into the education of NLs on assisting nurses and the need to implement formal caregiver support programs.
... Evidence refers that supporting HCWs after a stressful event improves patient safety [14,15] and reduces avoidable costs [4]. Thus the importance of creating psychological safe environments, by strengthening the sense of safety to take interpersonal risks at work [16], will encourage supportive interactions such as SV programs [17]. ...
Objectives
To establish a consensus for evaluating second victims (SV) support interventions to facilitate comparison over time and across different organizations.
Methods
A three-phase qualitative study was conducted from June 2023 to March 2024. This consensus approach engaged members of the European Researchers Network Working on Second Victims. A nominal group technique and insights from a scoping review were used to create a questionnaire for Delphi Rounds. Indicators were rated 1–5, aiming for agreement if over 70% of participants rated an indicator as feasible and sensitive with scores above 4, followed by a consensus conference.
Results
From an initial set of 113 indicators, 59 were assessed online, with 35 advancing to the Delphi rounds. Two Delphi rounds were conducted, achieving response rates of over 60% and 80% respectively, resulting in consensus on 11 indicators for evaluating SV support programs. These indicators encompass awareness and activation, outcomes of SV support programs, as well as training offered by the institution.
Conclusion
This study presents a scoreboard for designing and monitoring SV support programs, as well as measuring standardized outcomes in future research.
... Failing to report errors in these high-turnover wards ultimately leads to a greater risk of adverse events and patient mortality. In particular, it is reported that there is a statistically significant relation between error disclosure to a nursing supervisor and its impact on the patient [19] and this hypothesis is supported by Quillivan et al. in 2016, too [19]. ...
Nursing errors significantly impact patient safety and care quality, necessitating effective error recognition and analysis techniques. The Taxonomy of Error, Root Cause Analysis, and Practice-Responsibility (TERCAP) tool aims to systematically classify and address nursing errors, though its application and usefulness remain uncertain. This systematic review provides an overview of nursing errors using the TERCAP instrument, evaluating its applicability, strengths, and opportunities for improvement. A comprehensive literature search was conducted across databases such as PubMed, CINAHL, and Scopus to identify studies employing the TERCAP tool for nursing error analysis. Inclusion criteria encompassed peer-reviewed articles, studies with quantitative or qualitative data, and English-language publications. Data were extracted and analyzed to assess the tool's validity, reliability, impact on patient outcomes, and integration into clinical practice. The review identified a limited number of studies utilizing the TERCAP instrument, indicating its early stage of implementation. Findings suggest that the TERCAP tool provides a structured approach to error categorization and root cause analysis, potentially benefiting patient safety. However, challenges such as inconsistency in tool use, integration issues with electronic health records, and the need for further validation were noted. Additionally, nurses' perceptions of the tool and training needs emerged as crucial factors influencing its effectiveness. The TERCAP tool shows promise in improving nursing error reporting and analysis. Nonetheless, further research is essential to confirm its reliability, optimize its integration into clinical workflows, and understand its long-term impact on patient outcomes and safety culture. Addressing these gaps will be crucial in harnessing the TERCAP tool's full potential to reduce nursing errors and enhance healthcare quality.
... Such interventions carry a risk of exacerbating the second victim phenomenon. It is therefore paramount to ensure the psychological safety of all individuals and teams involved during the trigger event [21]. ...
Simulation educators are often requested to provide multidisciplinary and/or interprofessional simulation training in response to critical incidents. Current perspectives on patient safety focus on learning from failure, success and everyday variation. An international collaboration has led to the development of an accessible and practical framework to guide the implementation of appropriate simulation-based responses to clinical events, integrating quality improvement, simulation and patient safety methodologies to design appropriate and impactful responses. In this article, we describe a novel five-step approach to planning simulation-based interventions after any events that might prompt simulation-based learning in healthcare environments. This approach guides teams to identify pertinent events in healthcare, involve relevant stakeholders, agree on appropriate change interventions, elicit how simulation can contribute to them and share the learning without aggravating the second victim phenomenon. The framework is underpinned by Deming’s System of Profound Knowledge, the Model for Improvement and translational simulation. It aligns with contemporary socio-technical models in healthcare, by emphasising the role of clinical teams in designing adaptation and change for improvement, as well as encouraging collaborations to enhance patient safety in healthcare. For teams to achieve this adaptive capacity that realises organisational goals of continuous learning and improvement requires the breaking down of historical silos through the creation of an infrastructure that formalises relationships between service delivery, safety management, quality improvement and education. This creates opportunities to learn by design, rather than chance, whilst striving to close gaps between work as imagined and work as done.
... According to a survey in a specialized pediatric hospital in the USA, 358 nurses who worked in direct contact with patients were interviewed, corroborating the thesis that punitive cultures can worsen the perception of those involved and cause more suffering. It is therefore important to reduce the punitive nature of responses involving errors and experiences of the second victim, culminating in positive implications for the well-being of the team and patient safety [14]. ...
Justification: Health professionals perform their duties in environments that require complex care, and avoiding possible complications is the main focus, however, given human fallibility, adverse events sometimes become inevitable, and when this occurs, the effects go far beyond the individual who suffered the damage directly, as there is an indirect effect on the health professionals involved, who are considered "second victims". Considering that the likelihood of these professionals suffering physical and psychosocial damage because of the harm caused to the patient is relatively high, it is essential that studies are developed to provide adequate support for these professionals. Objective: To review the national and international literature to identify existing notes on the support given to health professionals in the role of second victim. Results: 27 articles dated between 2011 and 2021 were analyzed. The country with the most publications was the United States of America, followed by Canada and Spain, and quantitative methods were prevalent. The studies identified important strategies, such as sensitivity, empathy and adequate support, effective communication, review of adverse events, social and emotional support in a trusting environment, individualized follow-up and a support network. By adopting these strategies, it is possible to provide effective and compassionate support, helping them to face and overcome the emotional and psychological challenges associated with adverse events or medical errors. Conclusions: In view of the impacts faced by healthcare professionals in the role of second victim, a sensitive approach to the issue is needed, and it is essential to recognize and address the emotional needs of professionals with support strategies, psychological support and resilience education programs. And so, promote a culture of safety in healthcare institutions, encouraging constant learning and welcoming a just culture.
... Research indicates that the extent of impact is negatively correlated with the perceived level of support, highlighting an inverse relationship [26]. Similarly, the safety culture within which professionals operate is significantly linked to the distress experienced by SVs [29]. ...
Objectives
When adverse events (AE) occur, there are different consequences for healthcare professionals. The environment in which professionals work can influence the experience. This study aims to explore the experiences of second victims (SV) among health professionals in Argentina.
Methods
A phenomenological study was used with in-depth interviews with healthcare professionals. Audio recordings and verbatim transcriptions were analyzed independently for themes, subthemes, and codes.
Results
Three main themes emerged from the analysis: navigating the experience, the environment, and the turning point. Subthemes were identified for navigating the experience to describe the process: receiving the impact, transition, and taking action.
Conclusion
SVs undergo a process after an AE. The environment is part of this experience. It is a turning point in SVs’ professional and personal lives. Improving the psychological safety (PS) environment is essential for ensuring the safety of SVs.
... The benefits to staff from the effects of interventions to improve safety culture are under-researched. 20 21 We conducted a systematic review of the literature to examine the evidence for interventions to improve hospital safety culture and staff outcomes. The research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; ...
Background
In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified?
Methods and analysis
We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects.
Results
We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units.
Discussion
This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.
... 12 Institutional support systems are increasingly being implemented in order to provide an immediate and empathic response to HCWs after stressful situations such as PSIs. Health organisations are recognising the importance of this type of support, due to its important impact on the organisational culture, 13 patient safety (PS) and quality of care [14][15][16] and also on the economic perspective. 17 It is well-established that poor HCWs' well-being has a strong influence on the reoccurrence of PSIs. ...
Objectives
This study aims to map and frame the main factors present in support interventions successfully implemented in health organisations in order to provide timely and adequate response to healthcare workers (HCWs) after patient safety incidents (PSIs).
Design
Scoping review guided by the six-stage approach proposed by Arksey and O’Malley and by PRISMA-ScR.
Data sources
CINAHL, Cochrane Library, Embase, Epistemonikos, PsycINFO, PubMed, SciELO Citation Index, Scopus, Web of Science Core Collection, reference lists of the eligible articles, websites and a consultation group.
Eligibility criteria for selecting studies
Empirical studies (original articles) were prioritised. We used the Mixed Methods Appraisal Tool Version 2018 to conduct a quality assessment of the eligible studies.
Data extraction and synthesis
A total of 9766 records were retrieved (last update in November 2022). We assessed 156 articles for eligibility in the full-text screening. Of these, 29 earticles met the eligibility criteria. The articles were independently screened by two authors. In the case of disagreement, a third author was involved. The collected data were organised according to the Organisational factors, People, Environment, Recommendations from other Audies, Attributes of the support interventions. We used EndNote to import articles from the databases and Rayyan to support the screening of titles and abstracts.
Results
The existence of an organisational culture based on principles of trust and non-judgement, multidisciplinary action, leadership engagement and strong dissemination of the support programmes’ were crucial factors for their effective implementation. Training should be provided for peer supporters and leaders to facilitate the response to HCWs’ needs. Regular communication among the implementation team, allocation of protected time, funding and continuous monitoring are useful elements to the sustainability of the programmes.
Conclusion
HCWs’ well-being depends on an adequate implementation of a complex group of interrelated factors to support them after PSIs.
... After patient safety incidents, second victims suffer from anxiety, fear, guilt, anger, and sleep disturbance. They may experience emotional distress including loss of confidence or decreased job satisfaction in their clinical practice (6,7). Most of the studies on unexpected or preventable medical errors indicate the requirement of supplementary support services for the healthcare professional affected by symptoms related to this undesirable condition (8). ...
... This is because mental health symptoms such as anxiety and depression differ between countries and regions [27]. Furthermore, these symptoms can be influenced by the organization's patient safety culture and the health of the work environment [28]. Third, the three SeViD studies integrated in the meta-analysis were categorized as involving healthcare professionals affiliated with ICUs or intermediate care units; thus, the prevalence of SVS may not strictly involve healthcare workers only in ICUs [13][14][15]. ...
Introduction
Patient safety incidents, including medical errors and adverse events, frequently occur in intensive care units, leading to a significant psychological burden on healthcare workers. This burden results in second victim syndrome, which impacts the psychological and psychosomatic well-being of these workers. However, a systematic review focusing specifically on this condition among intensive care unit healthcare workers is lacking. Therefore, we aimed to conduct a systematic review and meta-analysis to examine the occurrence of second victim syndrome among intensive care unit healthcare workers, including the types, prevalence, risk factors, and recovery time associated with this condition.
Methods
We conducted a comprehensive search of the MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi databases. The eligibility criteria encompassed retrospective, prospective, and cross-sectional studies and controlled trials, with no language restrictions. Data on the type, prevalence, risk factors, and recovery time of second victim syndrome were extracted and pooled. Prevalence estimates from the included studies were combined using a random-effects meta-analytic model.
Results
Of the 2,245 records retrieved, 16 potentially relevant studies were identified. Following full-text evaluation, five studies met the inclusion criteria and were included in the review. The findings revealed that 58% of intensive care unit healthcare workers experienced second victim syndrome. Frequent symptoms included guilt (12–68%), anxiety (38–63%), anger at self (25–58%), and lower self-confidence (7–58%). However, specific risk factors exclusive to intensive care unit healthcare workers were not identified in the review. Furthermore, approximately 20% of individuals took more than a year to recover or did not recover at all from the second victim syndrome.
Conclusions
Thus, this condition is prevalent among intensive care unit healthcare workers and may persist for extended periods, potentially exceeding a year. The risk factors for second victim syndrome in the intensive care unit setting are unclear and require further investigation.
... Second-victim pain includes both psychological and physical suffering and is influenced by a variety of factors, with patient safety culture being seen as the most important influencing factor, (Quillivan et al., 2016). Our country is a populous country facing the problem of tight medical resources and insufficient nursing staff allocation, and with the increasing demand for nursing care as society develops, nurses, faced with such a heavy workload, are at high risk for adverse nursing events. ...
Aim:
Exploring the influence of patient safety culture on nurses' pain and turnover intention the job as a second victim.
Design:
The study employed a cross-sectional design.
Methods:
From July 2020 to August 2020, a convenience sampling method was used to select 1525 clinical nurses from hospitals of different levels in Shandong Province as the research subjects, and the general data survey method, patient safety culture scale and the assessment entries on pain in the second victim experience and support scale, using a convenience sampling method.
Results:
Patient safety culture is an influencing factor that affects the second-victim pain and turnover intention. Among them, the non-punitive response to errors, open communication, cooperation between different departments, organizational learning and promotion has a statistically significant influence on the second-victim pain and turnover intention.
... An audit to understand the reason for lapses, without punishing the treating doctor will eventually dispel apprehensions about the protocol being a detriment for health care providers. Healthcare workers involved in an adverse patient event are akin to 'second victims' , after the patient themselves, and need to be supported as such (Quillivan et al., 2016). Finally, for the healthcare providers themselves, actively following the protocol-at the lower-facility end and at the higher-facility end-would be part of their commitment to the process. ...
Patient referral management is an integral part of clinical practice. However, in low-resource settings, referrals are often delayed. The World Health Organization categorizes three types of referral delays; delay in seeking care, in reaching care and in receiving care. Using two case studies of maternal referrals (from a low-resource state in India), this article shows how a culture of downstream blaming permeates referral practice in India. With no referral guidelines to follow, providers in higher-facilities evaluate the clinical decision-making of their peers in lower-facilities based on patient outcome, not on objective measures. The fear of punitive action for an unfavorable maternal outcome is a larger driving factor than patient safety. The article argues for the need to formulate an ecosystem where patient responsibility is shared across the health system. In conclusion, it discusses possible solutions which can bridge communication and information gap between referring facilities.
... Bu durum insan hatasının tamamen ortadan kaldırılabileceğini ve mükemmelliğin mümkün olmadığını ortaya koymaktadır (22,23). Potansiyel ikinci mağdurların tespit edilemediği, destek müdahalelerinin yetersiz olduğu ve HG kültürünün olmaması nedeniyle sağlık sistemlerinde profesyonellere yönelik desteklerin sınırlı olduğu vurgulanmıştır (1,24). Ülkemizde bu konuda sağlık çalışanlarına sunulan destek politikası maalesef bulunmamaktadır. ...
Objective: As a result of the negative events experienced, the patient becomes the first victim, while the healthcare provider becomes the second victim. This situation is frequently experienced in the operating room (OR) and intensive care unit (ICU). Our aim is to reveal the problems and experiences of the anesthesia personnel working in OR / ICU regarding the second victim phenomenon (SVP) and to propose solutions. Methods: The research was conducted with the qualitative research method. Focus group interviews were conducted with six volunteer healthcare personnel working in OR / ICU. The data was written down and thematic content analysis was done through MAXQDA 22. Results: 5 main themes and 21 subthemes were reached. These main themes can be counted as the frequency of experiencing SVP, the main problems, emotions/feelings, coping methods, and suggestions/requests. The anesthesia team encountered the SVP frequently and this could be due to medical, violent, or technical reasons. In this situation, they felt worthlessness, helplessness, injustice, anger, and aggression. In order to cope with the SVP, they use methods such as self-suggestion, taking a break, calming down, and sharing with colleagues. As suggestions, they demanded psychological, legal, technical, managerial, physiotherapy, peer, and academic support as well as free time, elimination of patient complaints, and increased hospital security. Conclusion: The operating room and intensive care units are the busiest departments, and the frequency of adverse events is very high. Some of the situations that cause to feel SVP are preventable problems. Being aware of what you feel and how to overcome it will increase the quality of health service delivery and reduce the burnout status of health workers. Keywords: Patient safety, anesthesia, critical care
... 19 This culture may negatively impact healthcare workers who are experiencing the second victim phenomenon. 20 Health organisations should be responsible for providing tools and training to support healthcare workers after an incident occurs during healthcare, thereby contributing to a learning environment and safer healthcare. 21 Most of the support strategies that have been internationally adopted are programmes and interventions. ...
Introduction
Health organisations should support healthcare workers who are physically and psychologically affected by patient safety incidents (second victims). There is a growing body of evidence which focuses on second victim support interventions. However, there is still limited research on the elements necessary to effectively implement and ensure the sustainability of these types of interventions. In this study, we propose to map and frame the key factors which underlie an effective implementation of healthcare worker support interventions in healthcare organisations when healthcare workers are physically and/or emotionally affected by patient safety incidents.
Methods and analysis
This scoping review will be guided by the established methodological Arksey and O’Malley framework, Levac and Joanna Briggs Institute (JBI) recommendations. We will follow the JBI three-step process: (1) a preliminary search conducted on two databases; (2) the definition of clear inclusion criteria and the creation of a list of search terms to be used in the subsequent running of the search on a larger number of databases; and (3) additional searches (cross-checking/cross-referencing of reference lists of eligible studies, hand-searching in target journals relevant to the topic, conference proceedings, institutional/organisational websites and networks repositories). We will undertake a comprehensive search strategy in relevant bibliographic databases (PubMed/MEDLINE, Embase, CINHAL, Web of Science, Scopus, PsycInfo, Epistemonikos, Scielo, Cochrane Library and Open Grey). We will use the Mixed Methods Appraisal Tool V.2018 for quality assessment of the eligible studies. Our scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews.
Ethics and dissemination
This study will not require ethical approval. Results of the scoping review will be published in a peer-review journal, and findings will be presented in scientific conferences as well as in international forums and other relevant dissemination channels.
Trial registration number
10.17605/OSF.IO/RQAT6.
Preprint from medRxiv available: doi: https://doi.org/10.1101/2022.01.25.22269846 .
Introduction: The second victims are the healthcare professionals involved in an unexpected adverse event in patient care. Aims: To apprehend the perception of healthcare managers regarding the assumptions related to the second victim and understand the strategies adopted by healthcare managers for the support and assistance of the second victim. Study Design: This is qualitative research. Place and Duration of Study: It was conducted in a healthcare institution in the southeastern region of São Paulo, Brazil over a period of two months. Methodology: The 12 participants were managerial professionals of the institution who responded to a semi-structured interview. The information was analyzed according to Bardin's theoretical framework. Results: The group of participants consists of managers with different levels of experience, contributing to a diversity of experiences in the field of work, with 83.33% having more than 10 years of professional training. The following categories were apprehended: Safety culture and professional practice, Management and the practice of support, and Healthcare managers and competencies in approaching the second victim. The study highlighted that the second victim management process depends on defining roles and proactive attitudes, involving managers and healthcare professionals, as well as preparing professionals to enhance patient safety and provide appropriate attention to the second victim. Conclusions: The results suggest, based on the meanings that were apprehended, that the experience of being actors involved in patient safety and adverse events related to the second victim is still in its early stages, and there are paradigms to be shattered and different concepts to be reflected upon. In addition, the institution should prepare its managers and senior management professionals to be welcoming, through continuing education.
Background: The second victim phenomenon and moral injury are acknowledged entities of psychological harm for healthcare providers. Both pose risks to patients, healthcare workers, and medical institutions, leading to further adverse events, economic burden, and dysfunctionality. Preceding studies in Germany and Austria showed a prevalence of second victim phenomena exceeding 53 percent among physicians, nurses, emergency physicians, and pediatricians. Using two German instruments for assessing moral injury and second victim phenomena, this study aimed to evaluate their feasibility for general practitioners and healthcare assistants. Methods: We conducted a nationwide anonymous online survey in Germany among general practitioners and healthcare assistants utilizing the SeViD (Second Victims in Deutschland) questionnaire, the German version of the Second Victim Experience and Support Tool Revised Version (G-SVESTR), and the German version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP). Results: Out of 108 participants, 67 completed the survey. In G-SVESTR, the collegial support items exhibited lower internal consistency than in prior studies, while all other scales showed good-quality properties. Personality traits, especially neuroticism, negatively correlated to age, seem to play a significant role in symptom count and warrant further evaluation. Multiple linear regression indicated that neuroticism, agreeableness, G-SVESTR, and G-MISS-HP were significant predictors of symptom count. Furthermore, moral injury partially mediated the relationship between second victim experience and symptom count. Discussion: The results demonstrate the feasible use of the questionnaires, except for collegial support. With respect to selection bias and the cross-sectional design of the study, moral injury may be subsequent to the second victim phenomenon, strongly influencing symptom count in retrospect. This aspect should be thoroughly evaluated in future studies.
Purpose: This study aimed to review second victim support programs to identify effective evidence-based strategies for supporting healthcare providers involved in patient safety incidents.Methods: A comprehensive review search was conducted, including a search of databases, gray literature, and a hand-search of related fields, with “second victim” as the main search term.Results: We reviewed nine second victim support programs, focusing on their development process, operating form, and performance. These were (a) Peer Support Services, (b) forYOU team, (c) YOU Matter, (d) Resilience in Stressful Events, (e) Clinician Peer Support Program, (f) SWADDLE, (g) Surgery Second Victim Peer Support Program, (h) Caring for the Caregiver, and (i) Code Lavender.Conclusion: Second victim support programs help solve the emotional problems of medical staff caused by patient safety incidents. Therefore, it is necessary to develop a second victim support program suitable for the medical environment in Korea.
Background:
Second victim describes the impact on health care professionals after an error causing preventable patient harm. However, to date, the impact of making errors in practice by nurses and/or nursing students is unclear.
Purpose:
To describe and understand what is known about nurses and nursing students as second victims.
Methods:
A scoping review was completed using three databases: CINAHL, Medline, and Proquest for the period between 2010 and 2022. A total of 23 papers underwent thematic analysis.
Discussion:
Three themes were identified: (a) Psychological distress and symptomatology, (b) Coping-response/reactions to errors, and (c) Seeking support and understanding.
Conclusion:
Nurses and nursing students' well-being and productivity levels can be negatively affected by inadequate team and organisational support. To improve team functioning, appropriate support mechanisms must be implemented to assist nurses who experience significant distress after making errors. Nursing leadership should prioritise improving support programs, assessing workload allocation, and increasing awareness amongst leaders of the potential benefits of providing support to second victims.
Today’s healthcare professionals encounter countless unprecedented challenges. Most individuals adjust well to the acute stressors faced while rendering care for clinically challenging cases/events. These professionals habitually display strong emotional defenses that allow them to move forward and complete the tasks at hand. Yet sometimes, the emotional effect is professionally/personally demanding, overwhelming the individual’s ability to cope well. Referred to as the second victim phenomenon, healthcare professionals can experience signs and symptoms of this emotional impact that may last days, weeks, months, or even longer. The second victim experience is one that no one wants to encounter, yet most clinicians have either suffered personally or witnessed colleagues experiencing the effects of this career insult. Sadly, when a second victim reaction occurs, most healthcare professionals are unsure of what they are experiencing. The immediate aftermath of a challenging clinical event can potentially produce a lack of self-forgiveness on the part of the involved care team member, diminished self-worth and value, and minimized self-compassion causing many individuals to suffer in silence and alone. To compound the intensity of their distress, most colleagues and healthcare institutions are uncertain about responding to or assisting, resulting in additional stress and worry for the suffering individual. This chapter provides an overview of current knowledge regarding the second victim phenomenon with insights into interventions that can impact successful recovery for the suffering healthcare professional.KeywordsSecondary traumatizationVicarious traumaOccupational burnout
Meeting with your risk manager is something that every physician should do. Proactively meeting with a risk manager can help you prepare for challenging situations. They can help define and clarify your institution’s policies and offer guidance about communicating with challenging patients and families. An understanding of these topics can help you set the foundation for providing safe quality care. After the seminal paper “To Err Is Human” by the Institute Of Medicine in 1999, patient safety quickly became an important attribute of our healthcare system. This chapter will address factors recommended for a robust safety culture, what happens when an event occurs, and how to understand both what went wrong and what went right. It also discusses the effect on clinicians and how to ease or prevent second-victim trauma.KeywordsRisk managementLitigationPatient safetyHigh reliabilityRCA
Background:
Respiratory therapists (RTs) work alongside allied health staff, nurses, and physicians during stressful and traumatic events that can be associated with emotional and physiological implications known as second victim (SV) experiences (SVEs). This study aimed to evaluate SVEs of RTs, including both positive and negative implications.
Methods:
RTs within a large academic health care organization across Minnesota, Wisconsin, Florida, and Arizona were asked to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool-Revised to assess SVEs as well as desired support services.
Results:
Of the RTs invited to participate, 30.8% (171/555) completed the survey. Of the 171 survey respondents, 91.2% (156) reported that they had been part of a stressful or traumatic work-related event as an RT, student, or department support staff member. Emotional or physiologic implications experienced by respondents as SVs included anxiety 39.1% (61/156), reliving of the event 36.5% (57/156), sleeplessness 32.1% (50/156), and guilt 28.2% (44/156). Following a stressful clinical event, 14.8% (22/149) experienced psychological distress, 14.2% (21/148) experienced physical distress, 17.7% (26/147) indicated lack of institutional support, and 15.6% (23/147) indicated turnover intentions. Enhanced resilience and growth were reported by 9.5% (14/147). Clinical and non-clinical events were reported as possible triggers for SVEs. Nearly half of respondents 49.4% (77/156) indicated feeling like an SV due to events related to COVID-19. Peer support was the highest ranked form of desired support following an SVE by 57.7% (90/156).
Conclusions:
RTs are involved in stressful or traumatic clinical events, resulting in psychological/physical distress and turnover intentions. The COVID-19 pandemic has had a significant impact on RTs' SVEs, highlighting the importance of addressing the SV phenomenon among this population.
Sağlık hizmet sunumu, hata payının ve istenmeyen olayların en az olması istenen hizmet sektörüdür. Ancak uygulanan tedaviler ve girişimler sırasında istenmeyen olayların meydana gelmesi kaçınılmazdır. Bu gibi durumlarda hasta ve hasta yakınları birincil mağdur (kurban) olarak adlandırılırken, bu gibi olayla karşılaşan sağlık çalışanı da ikinci mağdur (kurban) konumuna düşmektedir. Çeşitli faktörlerin etkisi ile ikinci mağdur olgusu yaşama sıklığı kişiden kişiye değişse de özellikle pandemiden dolayı yıpranmış ve tükenmiş sağlık çalışanları advers olaylara karşı daha hassas bir dönemde bulunmaktadır. Ameliyathane ve yoğun bakımlar ise yüksek mortalite ve morbidite oranı olan, yoğun çalışma temposuyla ve gece vardiyası ile çalışılan, aciliyetin ve hızlı karar vermenin gerektiği alanlardır. Bu alanda çalışan sağlık personelinin, sonu ölüme kadar giden advers olaylardan etkilenme ihtimali daha yüksektir. Avrupa ve Amerika’da pek çok tıp merkezi ikinci mağdur durumunda sağlık personelini desteklemek için politikalar geliştirmiştir. Ancak Türkiye’de bu konu hala bilinmemekte ve bu konuda herhangi bir yayın bulunmamaktadır. Bu derleme anestezi ve yoğun bakım alanında görev yapan sağlık personelinin ikinci mağdur konusundaki farkındalığını arttırmak için yazılmıştır
Background:
The increasing prevalence of moral distress in the stressful environment of the intensive care unit (ICU) provides grounds for nursing error and endangers patients' health, safety, and even life. One of the most important reasons for this distress is the treatment team's second victim syndrome (SVS), especially nurses, following errors in the treatment system.
Objectives:
The present study aimed to determine the relationship between moral distress and SVS in ICUs.
Research design:
This cross-sectional study involved a sample size of 96 ICU nurses working in hospitals affiliated with Tehran University of Medical Sciences, Iran, in the 2021-2022 period, who were selected via a simple random sampling method. Data were collected using the Demographic Questionnaire, the second victim experience and support tool (SVEST) and Moral Distress Scale-Revised (MDS-R). Descriptive statistics (percentage, frequency, mean, and SD) and analytical tests (Spearman correlation coefficient test, independent t-test, and ANOVA) were employed for data analysis.
Participants and research context:
This study used a sample size of 96 intensive care unit nurses working in hospitals affiliated to Tehran University of Medical Sciences selected by simple random sampling.
Ethical considerations:
The study obtained research ethics approval, and all participants were informed of the voluntary and anonymous nature of their participation.
Findings:
The results showed that 59.4% of nurses suffered a low level of moral distress, and 40.6% suffered from a moderate level of moral distress. The SVS score of 86.5% of the nurses was moderate. There was no significant and direct correlation between moral distress and SVS in nurses; however, there was a significant and inverse correlation between the moral distress intensity and SVS (p = 0.011).
Conclusion:
Despite no significant correlation between moral distress and SVS, these variables were at moderate levels. Accordingly, it is suggested to provide a proper ground for expressing morally stressful situations, counseling and training strategies to deal with moral distress, creating support resources for those suffering from SVS, and implementing empowerment programs.
Introducción: Las segundas víctimas son aquellos trabajadores de salud que están involucrados en un Evento Adverso (EA) y presentan afección física, emocional, psicológica y/o laboral. Para evitar estas afecciones, es importante recibir medidas de soporte. El objetivo de este artículo es determinar qué relación existe entre las consecuencias de un EA sobre las segundas víctimas y la calidad de las medidas de soporte percibidas en instituciones de salud públicas y privadas de la Región Metropolitana durante el segundo semestre del año 2018. Materiales y método: Estudio cuantitativo, exploratorio, descriptivo, correlacional y transversal. A través de una plataforma online se aplicó una encuesta sociodemográfica e instrumento SVEST que consta de nueve dimensiones relacionadas con consecuencias del EA y calidad del soporte percibido (α=0,826). Resultados: Muestra de 301 trabajadores de salud entre institución pública y privada, el 39,2% se involucró en un EA y de estos, el 73,0% manifestó ser Segunda Víctima. De estas segundas víctimas, 69,1% pertenece al sexo femenino y el 45,7% se desempeña como Profesional de Enfermería. Existe una relación negativa entre calidad de soporte percibido y consecuencia psicológica y laboral del EA (Público y Privado p
Introduction : Interventions designed to improve safety culture in hospitals foster organisational environments that prevent patient safety events and support organisational and staff learning when events do occur. A safety culture supports the required health workforce behaviours and norms that enable safe patient care, and the well-being of patients and staff. The impact of safety culture interventions on staff perceptions of safety culture and patient outcomes has been established. To-date, however, there is no common understanding of what staff outcomes are associated with interventions to improve safety culture and what staff outcomes should be measured.
Objectives : The study seeks to examine the effect of safety culture interventions on staff in hospital settings, globally.
Methods and Analysis : A mixed methods systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be conducted using the electronic databases of MEDLINE, EMBASE, CINAHL, Health Business Elite, and Scopus. Returns will be screened in Covidence according to inclusion and exclusion criteria. The mixed-methods appraisal tool (MMAT) will be used as a quality assessment tool. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials and non-randomised studies of interventions will be employed to verify bias. Synthesis will follow the Joanna Briggs Institute methodological guidance for mixed methods reviews, which recommends a convergent approach to synthesis and integration.
Discussion : This systematic review will contribute to the international evidence on how interventions to improve safety culture may support staff outcomes and how such interventions may be appropriately designed and implemented.
Jackie Jones, Linda Treiber, Rebeca Shabo, Christie Emerson, Susan Scott, Judy Smetzer, Mary Dolansky, Laura Madden, Bethany Robertson, and Ethel Santiago published a policy white paper entitled “Just Culture, Medication Error Prevention, and Second Victim Support: A Better Prescription for Preparing Nursing Students for Practice.” The white paper was created by a team of academic professional nursing faculty in Georgia along with expert consultants from the Institute for Safe Medication Practices (ISMP), University of Missouri, and Case Western Reserve University. Per the ISMP website, the white paper serves as a call to action to nursing programs to change the way they are preparing students for practice by:
· Creating a Just Culture within nursing programs
· Teaching nursing students about human fallibility and medication error prevention
· Establishing a second victim response team within nursing programs
It has been estimated that medical errors are the third highest‐ranking cause of death in the United States. A patient safety culture has been touted for many years as best practice to reduce medical error. While there is a general agreement of its importance, it has remained elusive for many. This study sought to learn how strengthening leadership skills within a health care organization could catalyze patient safety culture improvement. The research asked the following to gain an appreciation for that question: How does a leader ensure consistency in policies, practices, and protocols to create a patient safety culture? What attitudes, beliefs, and collective efficacy are needed to produce a patient safety culture? What leadership characteristics are needed to create a patient safety culture? The research participants were the employees who make up the patient safety department in a large academic health care system. Information was gathered to capture their view of leadership's role in patient safety culture and to gain knowledge relative to their individual experiences following a medical error.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objectives: Making a medical error can have serious implications for clinician well-being, affecting the quality and safety of patient care. Despite an advancing literature base, cross-country exploration of this experience is limited, and a paucity of studies has examined the coping strategies used by clinicians. A greater understanding of clinicians' responses to making an error, the factors that may influence these, and the various coping strategies used are all essential for providing effective clinician support and ensuring optimal outcomes. The objectives were therefore to investigate the following: a) the professional or personal disruption experienced after making an error, b) the emotional response and coping strategies used, c) the relationship between emotions and coping strategy selection, d) influential factors in clinicians' responses, and e) perceptions of organizational support. Methods: A cross-sectional, cross-country survey of 265 physicians and nurses was undertaken in 2 large teaching hospitals in the United Kingdom and the United States. Results: Professional and personal disruption was reported as a result of making an error. Negative emotions were common, but positive feelings of determination, attentiveness, and alertness were also identified. Emotional response and coping strategy selection did not differ because of location or perceived harm, but responses did appear to differ by professional group; nurses in both locations reported stronger negative feelings after an error. Respondents favored problem-focused coping strategies, and associations were identified between coping strategy selection and the presence of particular emotions. Organizational support services, particularly including peers, were recognized as helpful, but fears over confidentiality may prohibit some staff from accessing these. Conclusions: Clinicians in the United Kingdom and the United States experience professional and personal disruption after an error. A number of factors may influence clinician recovery; these factors should be considered in the provision of comprehensive support programs so as to improve clinician recovery and ensure higher quality, safer patient care.
Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims.
A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals.
A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio –OR- 1.1, 95% Confidence Interval –CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p = 0.019) and hospital (p = 0.019) settings.
Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon.
In communication-and-resolution programs (CRPs), health systems and liability insurers encourage the disclosure of unanticipated care outcomes to affected patients and proactively seek resolutions, including offering an apology, an explanation, and, where appropriate, reimbursement or compensation. Anecdotal reports from the University of Michigan Health System and other early adopters of CRPs suggest that these programs can substantially reduce liability costs and improve patient safety. But little is known about how these early programs achieved success. We studied six CRPs to identify the major challenges in and lessons learned from implementing these initiatives. The CRP participants we interviewed identified several factors that contributed to their programs' success, including the presence of a strong institutional champion, investing in building and marketing the program to skeptical clinicians, and making it clear that the results of such transformative change will take time. Many of the early CRP adopters we interviewed expressed support for broader experimentation with these programs even in settings that differ from their own, such as systems that do not own and control their liability insurer, and in states without strong tort reforms.
The term 'second victim' refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient-the 'first victim'. The aim of this study was to investigate how healthcare professionals are affected by their involvement in adverse events with emphasis on the organisational support they need and how well the organisation meets those needs.
21 healthcare professionals at a Swedish university hospital who each had experienced an adverse event were interviewed. Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo software for coding and categorisation.
Our findings confirm earlier studies showing that emotional distress, often long-lasting, follows from adverse events. In addition, we report that the impact on the healthcare professional was related to the organisation's response to the event. Most informants lacked organisational support or they received support that was unstructured and unsystematic. Further, the formal investigation seldom provided adequate and timely feedback to those involved. The insufficient support and lack of feedback made it more difficult to emotionally process the event and reach closure.
This article addresses the gap between the second victim's need for organisational support and the organisational support provided. It also highlights the need for more transparency in the investigation of adverse events. Future research should address how advanced support structures can meet these needs and provide learning opportunities for the organisation. These issues are central for all hospital managers and policy makers who wish to prevent and manage adverse events and to promote a positive safety culture.
Advancing a framework that links organizational culture, work organization conditions, and mental health, this article extends current stress models so as to capture the influence of an important dimension of the broader context in which individuals experience stress and strain. By so doing, this framework integrates distal organizational and proximal task-level characteristics and thereby provides a wider lens for studies of the workplace antecedents of occupational stress and psychological strain. We illustrate the workings of this occupational stress framework with a series of illustrative propositions that connect organizational culture to those work organization conditions that are associated with mental health. This theorizing may not only offer new perspectives for multilevel research in this area, but also may inform occupational health interventions that often fail to account for shared values, meanings, and beliefs. The integration of organizational culture into stress research puts a wide-angle lens on the situation.
Personal view p 812When I was a house officer another resident failed to identify the electrocardiographic signs of the pericardial tamponade that would rush the patient to the operating room late that night. The news spread rapidly, the case tried repeatedly before an incredulous jury of peers, who returned a summary judgment of incompetence. I was dismayed by the lack of sympathy and wondered secretly if I could have made the same mistake—and, like the hapless resident, become the second victim of the error.Strangely, there is no place for mistakes in modern medicine. Society has entrusted physicians with the burden of understanding and dealing with illness. Although it is often said that “doctors are only human,” technological wonders, the apparent precision of laboratory tests, and innovations that present tangible images of illness have in fact created an expectation of perfection. Patients, who have an understandable need to consider their doctors infallible, have colluded with doctors to deny the existence of error. Hospitals react to every error as an anomaly, for which the solution is to ferret out and blame an individual, with a promise that “it will never happen again.” Paradoxically, this approach has diverted attention …
The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings. The purpose of this study was to examine the multilevel psychometric properties of the survey.
Survey data from 331 U.S. hospitals with 2,267 hospital units and 50,513 respondents were analyzed to examine the psychometric properties of the survey's items and composites. Item factor loadings, intraclass correlations (ICCs), design effects, internal consistency reliabilities, and multilevel confirmatory factor analyses (MCFA) were examined as well as intercorrelations among the survey's composites.
Psychometric analyses confirmed the multilevel nature of the data at the individual, unit and hospital levels of analysis. Results provided overall evidence supporting the 12 dimensions and 42 items included in the AHRQ Hospital Survey on Patient Safety Culture as having acceptable psychometric properties at all levels of analysis, with a few exceptions. The Staffing composite fell slightly below cutoffs in a number of areas, but is conceptually important given its impact on patient safety. In addition, one hospital-level model fit indicator for the Supervisor/Manager Expectations & Actions Promoting Patient Safety composite was low (CFI = .82), but all other psychometrics for this scale were good. Average dimension intercorrelations were moderate at .42 at the individual level, .50 at the unit level, and .56 at the hospital level.
Psychometric analyses conducted on a very large database of hospitals provided overall support for the patient safety culture dimensions and items included in the AHRQ Hospital Survey on Patient Safety Culture. The survey's items and dimensions overall are psychometrically sound at the individual, unit, and hospital levels of analysis and can be used by researchers and hospitals interested in assessing patient safety culture. Further research is needed to study the criterion-related validity of the survey by analysing the relationship between patient safety culture and patient outcomes and studying how to improve patient safety culture.
Previous research has established health professionals as secondary victims of medical error, with the identification of a range of emotional and psychological repercussions that may occur as a result of involvement in error.2 3 Due to the vast range of emotional and psychological outcomes, research to date has been inconsistent in the variables measured and tools used. Therefore, differing conclusions have been drawn as to the nature of the impact of error on professionals and the subsequent repercussions for their team, patients and healthcare institution. A systematic review was conducted.
Data sources were identified using database searches, with additional reference and hand searching. Eligibility criteria were applied to all studies identified, resulting in a total of 24 included studies. Quality assessment was conducted with the included studies using a tool that was developed as part of this research, but due to the limited number and diverse nature of studies, no exclusions were made on this basis.
Review findings suggest that there is consistent evidence for the widespread impact of medical error on health professionals. Psychological repercussions may include negative states such as shame, self-doubt, anxiety and guilt. Despite much attention devoted to the assessment of negative outcomes, the potential for positive outcomes resulting from error also became apparent, with increased assertiveness, confidence and improved colleague relationships reported.
It is evident that involvement in a medical error can elicit a significant psychological response from the health professional involved. However, a lack of literature around coping and support, coupled with inconsistencies and weaknesses in methodology, may need be addressed in future work.
When patients experience unexpected events, some health professionals become "second victims". These care givers feel as though they have failed the patient, second guessing clinical skills, knowledge base and career choice. Although some information exists, a complete understanding of this phenomenon is essential to design and test supportive interventions that achieve a healthy recovery.
The purpose of this article is to report interview findings with 31 second victims. After institutional review board approval, second victim volunteers representing different professional groups were solicited for private, hour-long interviews. The semistructured interview covered demographics, participant recount of event, symptoms experienced and recommendations for improving institutional support. After interviews, transcripts were analyzed independently for themes, followed by group deliberation and reflective use with current victims.
Participants experienced various symptoms that did not differ by sex or professional group. Our analysis identified six stages that delineate the natural history of the second victim phenomenon. These are (1) chaos and accident response, (2) intrusive reflections, (3) restoring personal integrity, (4) enduring the inquisition, (5) obtaining emotional first aid and (6) moving on. We defined the characteristics and typical questions second victims are desperate to have answered during these stages. Several reported that involvement in improvement work or patient safety advocacy helped them to once again enjoy their work.
We now believe the post-event trajectory is largely predictable. Institutional programs could be developed to successfully screen at-risk professionals immediately after an event, and appropriate support could be deployed to expedite recovery and mitigate adverse career outcomes.
Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown.
To determine the association of fatigue and distress with self-perceived major medical errors among resident physicians using validated metrics.
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic, Rochester, Minnesota. Data were provided by 380 of 430 eligible residents (88.3%). Participants began training from 2003 to 2008 and completed surveys quarterly through February 2009. Surveys included self-assessment of medical errors, linear analog self-assessment of overall quality of life (QOL) and fatigue, the Maslach Burnout Inventory, the PRIME-MD depression screening instrument, and the Epworth Sleepiness Scale.
Frequency of self-perceived, self-defined major medical errors was recorded. Associations of fatigue, QOL, burnout, and symptoms of depression with a subsequently reported major medical error were determined using generalized estimating equations for repeated measures.
The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P = .002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P < .001). Subsequent error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P < .001; emotional exhaustion OR, 1.06; 95% CI, 1.04-1.08; P < .001; lower personal accomplishment OR, 0.94; 95% CI, 0.92-0.97; P < .001), a positive depression screen (OR, 2.56; 95% CI, 1.76-3.72; P < .001), and overall QOL (OR, 0.84 per unit increase; 95% CI, 0.79-0.91; P < .001). Fatigue and distress variables remained statistically significant when modeled together with little change in the point estimates of effect. Sleepiness and distress, when modeled together, showed little change in point estimates of effect, but sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression.
Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.
We examined how house officers coped with serious medical mistakes to gain insight into how medical educators should handle these situations. An anonymous questionnaire was mailed to 254 house officers in internal medicine asking them to describe their most important mistake and their response to it; 45% (N = 114) reported a mistake and completed the questionnaire. House officers experienced considerable emotional distress in response to their mistakes and used a variety of strategies to cope. In multivariate analysis, those who coped by accepting responsibility were more likely to make constructive changes in practice, but to experience more emotional distress. House officers who coped by escape-avoidance were more likely to report defensive changes in practice. For house officers who have made a mistake, we suggest that medical educators provide specific advice about preventing a recurrence of the mistake, provide emotional support, and help them understand that distress is an expected concomitant of learning from the experience.
Increasingly, healthcare organizations are becoming aware of the importance of transforming organizational culture in order to improve patient safety. Growing interest in safety culture has been accompanied by the need for assessment tools focused on the cultural aspects of patient safety improvement efforts. This paper discusses the use of safety culture assessment as a tool for improving patient safety. It describes the characteristics of culture assessment tools presently available and discusses their current and potential uses, including brief examples from healthcare organizations that have undertaken such assessments. The paper also highlights critical processes that healthcare organizations need to consider when deciding to use these tools.
The aim of this research was to examine the influence of medication errors on the mental state of the erring caregiver. In-depth interviews were conducted with 20 erring nurses. The data were analyzed using content analysis. The following categories were identified: "stress, pressure, and inattention," "responsibility," "the double fear," "I might get fired," "he who works, errs," waiting for the inquiry--"every day is like eternity," "absurdly, it got worse with time," and "following the event I learned my lessons." The emotional distress of several subjects was, across time, reminiscent of PTSD symptoms.
Trainees are exposed to medical errors throughout medical school and residency. Little is known about what facilitates and limits learning from these experiences.
To identify major factors and areas of tension in trainees' learning from medical errors.
Structured telephone interviews with 59 trainees (medical students and residents) from 1 academic medical center. Five authors reviewed transcripts of audiotaped interviews using content analysis.
Trainees were aware that medical errors occur from early in medical school. Many had an intense emotional response to the idea of committing errors in patient care. Students and residents noted variation and conflict in institutional recommendations and individual actions. Many expressed role confusion regarding whether and how to initiate discussion after errors occurred. Some noted the conflict between reporting errors to seniors who were responsible for their evaluation. Learners requested more open discussion of actual errors and faculty disclosure. No students or residents felt that they learned better from near misses than from actual errors, and many believed that they learned the most when harm was caused.
Trainees are aware of medical errors, but remaining tensions may limit learning. Institutions can immediately address variability in faculty response and local culture by disseminating clear, accessible algorithms to guide behavior when errors occur. Educators should develop longitudinal curricula that integrate actual cases and faculty disclosure. Future multi-institutional work should focus on identified themes such as teaching and learning in emotionally charged situations, learning from errors and near misses and balance between individual and systems responsibility.
Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations.
To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics.
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months.
Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures.
Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively).
Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.
Mediation models are widely used, and there are many tests of the mediated effect. One of the most common questions that researchers have when planning mediation studies is, "How many subjects do I need to achieve adequate power when testing for mediation?" This article presents the necessary sample sizes for six of the most common and the most recommended tests of mediation for various combinations of parameters, to provide a guide for researchers when designing studies or applying for grants.
To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors.
Prospective cohort study.
Three urban freestanding children's hospitals in the United States.
123 residents in three paediatric residency programmes.
Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month.
24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2).
Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their non-depressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.
Objectives:
Making a medical error can have serious implications for clinician well-being, affecting the quality and safety of patient care. Despite an advancing literature base, cross-country exploration of this experience is limited, and a paucity of studies has examined the coping strategies used by clinicians. A greater understanding of clinicians' responses to making an error, the factors that may influence these, and the various coping strategies used are all essential for providing effective clinician support and ensuring optimal outcomes.The objectives were therefore to investigate the following: a) the professional or personal disruption experienced after making an error, b) the emotional response and coping strategies used, c) the relationship between emotions and coping strategy selection, d) influential factors in clinicians' responses, and e) perceptions of organizational support.
Methods:
A cross-sectional, cross-country survey of 265 physicians and nurses was undertaken in 2 large teaching hospitals in the United Kingdom and the United States.
Results:
Professional and personal disruption was reported as a result of making an error. Negative emotions were common, but positive feelings of determination, attentiveness, and alertness were also identified. Emotional response and coping strategy selection did not differ because of location or perceived harm, but responses did appear to differ by professional group; nurses in both locations reported stronger negative feelings after an error. Respondents favored problem-focused coping strategies, and associations were identified between coping strategy selection and the presence of particular emotions. Organizational support services, particularly including peers, were recognized as helpful, but fears over confidentiality may prohibit some staff from accessing these.
Conclusions:
Clinicians in the United Kingdom and the United States experience professional and personal disruption after an error. A number of factors may influence clinician recovery; these factors should be considered in the provision of comprehensive support programs so as to improve clinician recovery and ensure higher quality, safer patient care.
Objectives:
Medical errors and unanticipated negative patient outcomes can damage the well-being of health care providers. These affected individuals, referred to as "second victims," can experience various psychological and physical symptoms. Support resources provided by health care organizations to prevent and reduce second victim-related harm are often inadequate. In this study, we present the development and psychometric evaluation of the Second Victim Experience and Support Tool (SVEST), a survey instrument that can assist health care organizations to implement and track the performance of second victim support resources.
Methods:
The SVEST (29 items representing 7 dimensions and 2 outcome variables) was completed by 303 health care providers involved in direct patient care. The survey collected responses on second victim-related psychological and physical symptoms and the quality of support resources. Desirability of possible support resources was also measured. The SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis.
Results:
Confirmatory factor analysis results suggested good model fit for the survey. Cronbach α reliability scores for the survey dimensions ranged from 0.61 to 0.89. The most desired second victim support option was "A respected peer to discuss the details of what happened."
Conclusions:
The SVEST can be used by health care organizations to evaluate second victim experiences of their staff and the quality of existing support resources. It can also provide health care organization leaders with information on second victim-related support resources most preferred by their staff. The SVEST can be administered before and after implementing new second victim resources to measure perceptions of effectiveness.
Nursing is a stressful occupation, even when compared with other health professions; therefore, it is necessary to advance our knowledge about the protective factors that can help reduce stress among nurses. The present study sought to investigate the associations among problem-solving skills and hardiness with perceived stress in nurses. The participants, 252 nurses from six private hospitals in Tehran, completed the Personal Views Survey, the Perceived Stress Scale, and the Problem-Solving Inventory. Structural Equation Modeling (SEM) was used to analyse the data and answer the research hypotheses. As expected, greater hardiness was associated with low levels of perceived stress, and nurses low in perceived stress were more likely to be considered approachable, have a style that relied on their own sense of internal personal control, and demonstrate effective problem-solving confidence. These findings reinforce the importance of hardiness and problem-solving skills as protective factors against perceived stress among nurses, and could be important in training future nurses so that hardiness ability and problem-solving skills can be imparted, allowing nurses to have more ability to control their perceived stress.
This descriptive, correlational study examined the responses and concerns of healthcare professionals about making medication errors and estimated patient harm from such errors. A systematic random sample of nurses, pharmacists, and physicians (N = 402) completed a self-report survey about a medication error they judged to be serious. Respondents were guilty, nervous, and worried about the error. They feared for the safety of the patient, disciplinary action, and punishment. A few subjects indicated that they never reported the errors. The most frequent symptoms associated with errors were neurologically based. The injury suffered by patients was not severe overall according to the harm scales. Weak correlations were found for the harm scales and responses and concerns. The authors suggest a supportive environment for the provider following an error and continuous quality improvement efforts to eliminate system-based errors.
Everything about health care is complex. There are complex care processes, complex health care technologies, complex patient needs and responses to therapeutic interventions, and complex organizations. There are tremendous opportunities and challenges in improving the quality and safety of health care, but the majority require purposeful redesign of health care organizations and processes. Organizations that are committed to high-quality and safe care will not place nurses at the “sharp end” of care, but will focus on system improvements. Recognizing the complexity of care and how several factors combine at a specific time and result in errors and adverse events, organizations, leaders, and clinicians will dedicate themselves to using data and evidence and to continuously improve the quality and safety of care, even when there are complex challenges.
When a patient is injured or dies during anesthesia care, both the family of the patient and the health care providers suffer. The family needs to know what happened. The family can benefit from personal contact with the involved physicians. Apology to the injured is very important. The health care providers must report adverse events. Systematic review of adverse events can provide improved patient safety. Mechanisms exist to support the health care providers recovering from these potentially devastating experiences, but useful support is often not immediately available.
The emotional toll of medical error is high for both patients and clinicians, who are often unsure with whom-and whether-they can discuss what happened. Although institutions are increasingly adopting full disclosure policies, trainees frequently do not disclose mistakes, and faculty physicians are underprepared to teach communication skills related to disclosure and apology. The authors developed an interactive educational program for trainees and faculty physicians that assesses experiences, attitudes, and perceptions about error, explores the human impact of error through filmed patient and family narratives, develops communication skills, and offers a strategy to facilitate bedside disclosures. Between spring 2007 and fall 2008, 154 trainees (medical students/residents) and 75 medical educators completed the program. Among learners surveyed, 62% of trainees and 88% of faculty physicians reported making medical mistakes. Of those, 62% and 78%, respectively, reported they did not apologize. While 65% of trainees said they would turn to senior doctors for assistance after an error, 26% were not sure where to get help. Just 20% of trainees and 21% of physicians reported adequate training to respond to error. Following the session, all of the faculty physicians surveyed indicated they felt better prepared to address and teach this topic. At a time of increased attention to disclosure, actual faculty and trainee practices suggest that role models, support systems, and education strategies are lacking. Trainees' widespread experience with error highlights the need for a disclosure curriculum early in medical education. Educational initiatives focusing on communication after harm should target teachers and students.
A unique rapid response system was designed to provide social, psychological, emotional, and professional support for health care providers who are "second victims"--traumatized as a result of their involvement in an unanticipated adverse event, medical error, or patient-related injury.