Relationship between patient safety culture and job burnout in Iranian nurses: Assessing the mediating role of second victim experience using structural equation modelling

Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions

AIMS

To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them.

DESIGN

A qualitative study using interviews.

METHODS

A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis.

RESULTS

The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture.

CONCLUSION

Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety.

IMPACT

Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work.

REPORTING METHOD

COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.

Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout

BACKGROUND

Patient and health care worker safety is an interconnected phenomenon. To date, few studies have examined the relationship between patient and worker safety, specifically with respect to work safety culture. Therefore, we examined patient safety culture, workplace violence (WPV), and burnout in health care workers to identify whether patient safety culture factors influence worker burnout and WPV.

METHODS

This cross-sectional study used secondary survey data sent to approximately 7,100 health care workers at a large academic medical center in the United States. Instruments included the Hospital Survey on Patient Safety Culture, a WPV scale measuring physical and verbal violence perpetrated by patients or visitors, and the Emotional Exhaustion scale from the Maslach Burnout Inventory.

FINDINGS

These analyses included 3,312 (47%) hospital staff who directly interacted with patients. Over half of nurse (62%), physician (53%), and allied health professional respondents (52%) reported experiencing verbal violence from a patient, and 39% of nurses and 14% of physicians reported experiencing physical violence from a patient. Burnout levels for nurses (2.67 ± 1.02) and physicians (2.65 ± 0.93) were higher than the overall average for all staff (2.61 ± 1.0). Higher levels of worker-reported patient safety culture were associated with lower odds of WPV (0.47) and lower burnout scores among workers (B = -1.02). Teamwork across units, handoffs, and transitions were dimensions of patient safety culture that also influenced WPV and burnout.

CONCLUSIONS/APPLICATION TO PRACTICE

Our findings suggest that improvements in hospital strategies aimed at patient safety culture, including team cohesion with handoffs and transitions, could positively influence a reduction in WPV and burnout among health care workers.

Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims

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.

Experience and support of Chinese healthcare professionals as second victims of patient safety incidents: A cross-sectional study

PURPOSE

To describe the experience and support of Chinese healthcare professionals as second victims of PSIs.

DESIGN AND METHODS

A cross-sectional study with anonymous online self-report questionnaires was adopted. A total of 1357 Chinese healthcare professionals participated in this study. The Chinese version of the Second Victim Experience and Support Tool (C-SVEST) was used to evaluate the experience of second victims and the quality of support resources. Descriptive and inferential statistics were employed to analyze the data.

FINDINGS

This study showed that 350 participants (25.8%) had been involved in PSIs during their careers. The majority of respondents who had experienced PSIs agreed they suffered more from psychological distress, followed by professional self-efficacy distress, and physical distress. Besides, they regarded colleague support and management support as the most desirable support. Statistically significant differences were reported in some items. First, compared with medical staff without professional titles, staff with professional titles suffered more from psychological distress but gained more support from colleagues.

PRACTICE IMPLICATIONS

The second victim phenomenon deserves further attention. The programs focusing on training qualified colleagues to provide emotional support should be developed, implemented, and evaluated. Moreover, it is necessary to build a better patient safety culture with nonpunitive responses and encourage the disclosure and reporting of PSIs.

Profiles of second victim symptoms and desired support strategies among Korean nurses: A latent profile analysis

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.

[Effects of Second Victim Experiences after Patient Safety Incidents on Nursing Practice Changes in Korean Clinical Nurses: The Mediating Effects of Coping Behaviors]

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.

Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes

A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers' wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.