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Berchtenbreiter K, Innes K, Watterson J, Nickson CP, Wong P. Intensive care unit nurses' perceptions of debriefing after critical incidents: A qualitative descriptive study. Aust Crit Care 2024; 37:288-294. [PMID: 37537123 DOI: 10.1016/j.aucc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU) nurses are exposed to critical incidents daily at their workplace, which may have long-term physical and psychological impacts. Despite the growing evidence supporting clinical debriefing in health care to prevent these impacts, a scarcity of literature exists to support its use in the adult intensive care setting. OBJECTIVES The objective of this study was to explore nurses' perceptions of clinical debriefing after critical incidents in an adult ICU. METHODS A qualitative descriptive design was utilised. Thematic analysis of data from individual semistructured interviews with six ICU nurses was undertaken. FINDINGS In this study, two themes were identified. Firstly, participants valued hot debriefing after critical incidents for the key reasons of having an opportunity to reflect on and learn from a critical incident and reduce normalisation of stressful situations. Secondly, when logistical factors such as communication, timing, and location were not considered, the attendance at debriefings was negatively influenced. Participants identified that ICU nurses commonly prioritised patient tasks over attending a debrief; therefore, teamwork and flexibility with logistics was crucial. CONCLUSIONS Hot debriefing, of a short duration and close to the time of the event, was valued and played an important role in staff wellbeing and self-care, contributing to preventing self-blame and normalisation of stressful situations. A clearer definition of the term along with greater recognition of types of events that could be considered critical incidents is required for staff support after critical incidents in the complex intensive care setting.
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Affiliation(s)
- Kristie Berchtenbreiter
- Alfred Health, 55 Commercial Road, Prahran, Victoria, 3004, Australia; Monash University, Monash Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Kelli Innes
- Monash University, Monash Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Jason Watterson
- Monash University, School of Public Health and Preventative Medicine, Wellington Road, Clayton, Victoria, 3800, Australia; Peninsula Health, 2 Hastings Rd, Frankston, VIC 3199 Australia.
| | - Christopher Peter Nickson
- Alfred Health, 55 Commercial Road, Prahran, Victoria, 3004, Australia; Monash University, School of Public Health and Preventative Medicine, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Pauline Wong
- Monash University, Monash Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia.
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Vikan M, Deilkås EC, Valeberg BT, Bjørnnes AK, Husby VS, Haugen AS, Danielsen SO. The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway. Patient Saf Surg 2024; 18:7. [PMID: 38374077 PMCID: PMC10877820 DOI: 10.1186/s13037-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. METHODS This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. RESULTS The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. CONCLUSIONS This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Ellen Ct Deilkås
- Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Berit T Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Ann K Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Vigdis S Husby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Department of Health Sciences Aalesund, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Arvid S Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Stein O Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
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Austin DM, Pauley G, Ferkins L. Establishing a Guide for Developing Organizational Support in Healthcare Following a Critical or Sentinel Event. QUALITATIVE HEALTH RESEARCH 2022; 32:1607-1619. [PMID: 35786094 DOI: 10.1177/10497323221111644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Health professionals require support and recognition to help manage the well-known impact of critical or sentinel events relating to patient care. The potential distress can be magnified or mitigated by the response of the organization and colleagues. However, strategies that are accessible, relevant, and effective in the aftermath of a poor outcome are not well established. Using an action research methodology, a support tool was collaboratively designed, developed, and evaluated in a maternity service of one organization and adapted to the mental health and addiction service in another. Four principles that are intrinsic to the establishment of support tools became apparent across the two settings. Through applying these criteria to the customization of the support tool, it became relevant within the new service setting, and an implementation guide for other organizations was created. Although undertaken pre-pandemic, insights derived from this study may benefit post-pandemic situations where the need for health professional support is even greater.
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Affiliation(s)
| | - Gerard Pauley
- 1410Auckland University of Technology, Wellington, New Zealand
| | - Lesley Ferkins
- 1410Auckland University of Technology, Wellington, New Zealand
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Santana-Domínguez I, González-De La Torre H, Verdú-Soriano J, Berenguer-Pérez M, Suárez-Sánchez JJ, Martín-Martínez A. Feelings of being a second victim among Spanish midwives and obstetricians. Nurs Open 2022; 9:2356-2369. [PMID: 35633515 PMCID: PMC9374404 DOI: 10.1002/nop2.1249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/05/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022] Open
Abstract
Aim The aim of this study was to determine the prevalence of feelings of being a second victim among midwives and obstetricians in Spain and to explore possible differences between the two professions. Design Cross‐sectional descriptive‐analytical observational study. Methods An online survey collecting several variables was administered throughout the Spanish territory. Spanish version of the Second Victim Experience and Support Tool (SVEST) was used. The data collection period was from May to December 2020. Results A total sample of 719 obstetricians and midwives were studied. There were significant differences between the two groups with respect to seven dimensions of SVEST: greater feelings of being a second victim among obstetricians in the dimensions physical distress/p ≤ .001, non‐work‐related support/p ≤ .001 and absenteeism/p ≤ .001 and greater feelings of being a second victim among midwives in the dimensions psychological distress/p ≤ .001, supervisor support/p = .011, professional self‐efficacy/p ≤ .001 and intention to change jobs/p ≤ .001.
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Affiliation(s)
- Irene Santana-Domínguez
- University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria-Canary Islands, Spain.,Canary Health Service. Obstetrics and Gynaecology Department, Gran Canaria Maternal and Infant University Hospital Complex, Canary Islands, Spain
| | - Héctor González-De La Torre
- Research Unit of Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Las Palmas de Gran Canaria-Canary Islands, Spain.,University of La Laguna (ULL)-Nursing Unit La Palma, Tenerife-Canary Islands, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante (UA), Alicante, Spain
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante (UA), Alicante, Spain
| | - Juan José Suárez-Sánchez
- University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria-Canary Islands, Spain.,Canary Health Service, Direction of Primary Care Gran Canaria, Canary Islands, Spain
| | - Alicia Martín-Martínez
- University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria-Canary Islands, Spain.,Canary Health Service. Obstetrics and Gynaecology Department, Gran Canaria Maternal and Infant University Hospital Complex, Canary Islands, Spain
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Buhlmann M, Ewens B, Rashidi A. Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims. J Adv Nurs 2022; 78:2960-2972. [PMID: 35451525 PMCID: PMC9543713 DOI: 10.1111/jan.15274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/19/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Aims To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non‐critical care area and to explore how they have 'moved‐on' from the event. Design An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving‐on. Methods Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi‐structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016–2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting guidelines. Results The findings revealed five main themes: Initial emotional and physical response, the aftermath, long‐lasting repercussions, workplace support and moving‐on. Conclusion This study shed light on the perceptions of nurses and midwives who lived through the impact of critical incidents. Through their lens, the strategies engaged in to move‐on were identified and their call for organizational and collegial support received a voice.
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Affiliation(s)
- Melanie Buhlmann
- School of Nursing & Midwifery, Edith Cowan University, Bunbury, Western Australia, Australia
| | - Beverley Ewens
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amineh Rashidi
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Choi EY, Pyo J, Ock M, Lee H. Profiles of second victim symptoms and desired support strategies among Korean nurses: A latent profile analysis. J Adv Nurs 2022; 78:2872-2883. [PMID: 35307876 DOI: 10.1111/jan.15221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 12/16/2022]
Abstract
AIMS To clarify second victim symptoms subgroups, explore the factors affecting profile membership and determine how desired support strategies differ between the subgroups. DESIGN A cross-sectional study using an online survey. METHODS A total of 378 Korean staff nurses directly involved in patient safety incidents were recruited between December 2019 and February 2020. Data analyses consisted of latent profile analysis, multinomial logistic regression and analysis of variance. RESULTS Three latent profiles were identified: 'mild symptoms', 'moderate symptoms' and 'severe symptoms'. Lower organizational support and higher non-work-related support were more likely to belong to the severe symptoms' profile. Incidents that caused temporary harm to the patient were more strongly associated with an increased likelihood of belonging to the moderate and severe symptoms profiles than no-harm events. Participants with severe symptoms agreed more with the usefulness of the support strategies than other participants; the usefulness of the psychological support strategies was rated particularly high. Participants in the mild and moderate symptoms groups agreed more strongly with the usefulness of coping strategies following patient safety incidents than psychological support. The strategy that all profiles considered the most useful was having the opportunity to take time away from clinical duties. CONCLUSION Tailored support should be provided to nurses with factors influencing the profile membership and subgroups of second victim symptoms. IMPACT This study confirmed the need to provide organizational support to nurses as second victims and provided valuable evidence for developing support programs tailored to the subgroups of second victim symptoms.
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Affiliation(s)
- Eun Young Choi
- College of Nursing, Sungshin Women's University, Seoul, Republic of Korea.,Ulsan Public Health Policy Institute, Ulsan, Republic of Korea
| | - Jeehee Pyo
- Ulsan Public Health Policy Institute, Ulsan, Republic of Korea.,Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsu Ock
- Ulsan Public Health Policy Institute, Ulsan, Republic of Korea.,Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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Jeong S, Jeong SH. [Effects of Second Victim Experiences after Patient Safety Incidents on Nursing Practice Changes in Korean Clinical Nurses: The Mediating Effects of Coping Behaviors]. J Korean Acad Nurs 2021; 51:489-504. [PMID: 34497257 DOI: 10.4040/jkan.21089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was investigated the mediating effect of coping behaviors in the relationship between the second victim experiences after patient safety incidents and the nursing practice changes. METHODS A cross-sectional survey was performed using structured questionnaires. Participants were 218 clinical nurses in general tertiary hospitals in South Korea. Data were collected through an online survey and snowball sampling from August 11 to September 6 2020. Data were analyzed using SPSS 23.0 program. A mediation analysis was performed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval. RESULTS The mean scores of second victim experiences was 3.41/5. Approach coping (β = .55, p < .001) and the avoidant coping (β = - .23, p = .001) showed mediation effects in the relationship between second victim experiences and constructive change in nursing practice. Avoidant coping (β = .29, p < .001) showed a mediation effect in the relationship between second victim experiences and defensive change in nursing practice. CONCLUSION Coping behaviors has a mediating effect on the relationship between second victim experiences and nursing practice changes. To ensure that nurses do not experience second victim, medical institutions should have a culture of patient safety that employs a systematic approach rather than blame individuals. They also need to develop strategies that enhance approach coping and reducing avoidant coping to induce nurses' constructive practice changes in clinical nurses in experiencing second victims due to patient safety incidents.
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Affiliation(s)
- Seohee Jeong
- Quality Improvement Team, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seok Hee Jeong
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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