Complications: Second Victim

Coping trajectories of intensive care nurses as second victims: A grounded theory

A qualitative study that provides evidence of the institutional support required by intensive care unit (ICU) nurses as second victims of adverse events (AEs).

BACKGROUND

The phenomenon of second victims of AE in healthcare professionals can seriously impact professional confidence and contribute to the ongoing occurrence of AEs in hospitals.

OBJECTIVES

The objective of this study was to describe the coping trajectories of second victims among nurses working in ICUs in public hospitals in Chile.

METHODS

Conducting qualitative research through the grounded theory method, this study focused on high-complexity hospitals in Chile, using theoretical sampling. The participants consisted of 11 nurses working in ICUs. Techniques used included in-depth interviews conducted between March and May 2023, as well as a focus group interview. Analysis, following the grounded theory approach proposed by Strauss and Corbin, involved constant comparison of data. Open, axial, and selective coding were applied until theoretical data saturation was achieved. The study adhered to reliability and authenticity criteria, incorporating a reflexive process throughout the research. Ethical approval was obtained from the ethics committee, and the study adhered to the consolidated criteria for reporting qualitative research.

RESULTS

From the interviews, 29 codes were identified, forming six categories: perception of support when facing an AE, perception of helplessness when facing an AE, initiators of AE, responses when facing an AE, professional responsibility, and perception of AE. The perception of support when facing an AE emerged as the main category, determining whether the outcome was stagnation or overcoming of the phenomenon after the AE.

CONCLUSIONS

For the coping process of ICU nurses following an AE, the most crucial factor is the support from colleagues and supervisors.

Psychosocial impact of surgical complications and the coping mechanisms among surgeons in Uganda and Eastern Democratic Republic of the Congo

We aimed to assess the psychosocial impact from postoperative complications on the surgical workforce and the coping mechanisms they use following these complications in Uganda and Eastern Democratic Republic of the Congo (DRC). This was a cross-sectional multi-center study conducted from first February 2022 to 31st March 2022 in the preselected main teaching hospitals of Uganda and Eastern DRC. We surveyed the surgical workforce (practicing surgeons, Obstetrician-Gynecologists, and residents in surgery/ Obstetrics-Gynecology) who had experienced postoperative complications in their career. Data was analysed using SPSS version 23. One hundred ninety-eight participants responded to the questionnaire. Worry about patient and reputation were the commonest psychological impacts in 54.0% and 45.5% of the participants respectively. Majority of the participants (55.1%) used positive coping mechanisms with a positive impact on their practice (94.4%). Being a female doctor (AOR = 2.637, CI 1.065-6.533, P = 0.036), worrying about reputation (AOR = 3.057, CI = 1.573-5.939, P = 0.001) and guilt after a complication (AOR = 4.417, CI = 2.253-8.659, P = <0.001) were predictors of a negative coping mechanism. Postoperative surgical complications continue to cause a huge psychological impact on the operating doctors in Uganda and the Eastern DRC. Female doctors, those that worry about the reputation and those that feel guilty following a complication should be given more support and guidance by peers when surgical complications occur to their patients.

Learning from experience: a qualitative study of surgeons' perspectives on reporting and dealing with serious adverse events

INTRODUCTION

In surgery, serious adverse events have effects on the patient journey, the patient outcome and may constitute a burden to the surgeon involved. This study aims to investigate facilitators and barriers to transparency around, reporting of and learning from serious adverse events among surgeons.

METHODS

Based on a qualitative study design, we recruited 15 surgeons (4 females and 11 males) with 4 different surgical subspecialties from four Norwegian university hospitals. The participants underwent individual semistructured interviews and data were analysed according to principles of inductive qualitative content analysis.

RESULTS AND DISCUSSION

We identified four overarching themes. All surgeons reported having experienced serious adverse events, describing these as part of 'the nature of surgery'. Most surgeons reported that established strategies failed to combine facilitation of learning with taking care of the involved surgeons. Transparency about serious adverse events was by some felt as an extra burden, fearing that openness on technical-related errors could affect their future career negatively. Positive implications of transparency were linked with factors such as minimising the surgeon's feeling of personal burden with positive impact on individual and collective learning. A lack of facilitation of individual and structural transparency factors could entail 'collateral damage'. Our participants suggested that both the younger generation of surgeons in general, and the increasing number of women in surgical professions, might contribute to 'maturing' the culture of transparency.

CONCLUSION AND IMPLICATIONS

This study suggests that transparency associated with serious adverse events is hampered by concerns at both personal and professional levels among surgeons. These results emphasise the importance of improved systemic learning and the need for structural changes; it is crucial to increase the focus on education and training curriculums and offer advice on coping strategies and establish arenas for safe discussions after serious adverse events.

Only eye study 3 (OnES 3): a qualitative study into how surgeons approach surgery in patients with only one seeing eye

OBJECTIVE

Performing surgery on an 'only eye' patient is considered high stakes. The purpose of this study is to explore the process of only eye surgery from the perspective of ophthalmic surgeons and improve both patient and surgeon experience.

DESIGN, SETTING AND PARTICIPANTS

A cohort of 76 Australian consultant ophthalmologists, divided into three focus groups, were recruited via online webinar to participate in a guided focus group discussion about only eye surgery. Qualitative data regarding participant experience of performing only eye surgery were collected in audio and text form. Thematic analysis was conducted to identify patterns in the data.

MAIN OUTCOME MEASURE

Identification of themes relevant to only eye surgery.

RESULTS

Five overarching themes relevant to only eye surgery were identified: (1) differences in the surgical decision-making process; (2) differences in the approach to consent, (3) implementation of additional risk reduction strategies, (4) value of having colleagues to discuss and plan surgery with and (5) psychological challenges. A divergent theme was identified: (6) that all surgery, only eye or not, should be treated the same.

CONCLUSIONS

This study identifies challenges associated with clinical management of only eye patients across their surgical journey. A conceptual framework to guide surgeons when managing only eye patients is provided which has potential to promote a more unified approach to treating this high-stakes cohort.

Surgeon's guilt after postoperative complication

Surgery is an art, surgical dilemmas are not mathematical problems with rigid, straight cut solutions and the human mind/body is not a perfect science. In such a scenario, unexpected, sudden complications can happen during surgery. While better diagnostic and advanced techniques in surgery, have minimised surgical errors to a great extent, with the risk of post-operative death being as low as 3.6% now, still when complications due occur, the surgeon faces a huge backlash not only from the patient relatives, but from his peers, the hospital management, the social and print media. The surgeon also fears violent retribution, not just consumer issues but a threat of arrest and legal battles. All these make a surgeon the "second victim" in the event of a post-operative complication, leading to changes in practice behaviour, emotional turmoil and even serious mental issues like depression and suicide. In this era of instant judgement by a largely unregulated social media, it is urgently required to address this issue and provide appropriate strength/support to the surgical fraternity.

Anastomotic Leak: Toward an Understanding of Its Root Causes

BACKGROUND

When an anastomotic leak is discussed at a typical surgical morbidity and mortality conference, it is often presented as a due to an error in surgical technique involving ischemia, tension, or device failure. Here we assert that without direct visual analysis of the leak site and its tissue histology, an ex post facto claim that an anastomotic leak is due to an error in surgical technique remains speculative.

METHODS

The arguments and rationale used to conclude that an anastomotic leak is due to an error in surgical technique are critically reviewed and assessed for their validity.

RESULTS

No case series or literature exists in which a root cause analysis has been carried out with visual and tissue level evidence to determine the root cause(s) of an anastomotic leak.

CONCLUSIONS

At the individual case level, declaring that an anastomotic leak is due to an error in surgical technique without clear and compelling evidence either visually and/or at the tissue level to substantiate such a claim remains speculative.