Experiences of and support for nurses as second victims of adverse nursing errors: a qualitative systematic review

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.

Clinical nurses' work-life balance prediction due to patient safety incidents using classification and regression tree analysis: a secondary data analysis

BACKGROUND

Patient safety incidents lead to performance difficulties for nurses when providing nursing practice. This affects work-life balance and causes second and third-victimization. This study predicts factors affecting clinical nurses' work-life balance due to patient safety incidents using classification and regression tree analysis techniques.

METHODS

This study was a secondary analysis of data from a cohort research project, which used a descriptive survey for data collection. Participants comprised 372 nurses. Data were collected using SurveyMonkey, a mobile-based survey software solution, from January to September 2021. Data included the general characteristics of clinical nurses, second damage, second damage support, third damage, and work-life balance. The specific variables included in the analysis chosen through rigorous Lasso analysis form the foundation for predicting work-life balance. Variables with low explanatory power were excluded, thereafter, the variables selected by Lasso were analyzed with a classification and regression tree model to predict work-life balance.

RESULTS

A regression tree was applied to predict work-life balance using seven variables-education level, marital status, position, physical distress, second-victim support, turnover intentions, and absenteeism (selected through Lasso analysis). After pruning, at tree size four, when turnover intentions were < 4.250, physical distress < 2.875, and second-victim support < 2.345, the predicted work-life balance was 3.972. However, when turnover intentions were < 4.250, physical distress < 2.875, and second-victim support ≥ 2.345, then the predicted work-life balance was 2.760.

CONCLUSIONS

This study's insights offer crucial groundwork for crafting targeted workforce risk management strategies and fostering a conducive organizational culture to mitigate nursing occupational stress, potentially curbing the recurrence of patient safety incidents and improving nursing practice while enhancing patient outcomes. Future research should explore second and third victim experiences across various healthcare settings globally to understand their impact on WLB and patient safety outcomes.

Second Victim Symptoms and Desired Support Strategies Among Italian Health Care Workers in Friuli-Venezia Giulia: Cross-Sectional Survey and Latent Profile Analysis

BACKGROUND AND OBJECTIVE

The second victim (SV) phenomenon concerns health care workers (HCWs) whose involvement in a medical error, as well as non-error patient safety events, has affected their well-being. Its prevalence ranges from 10% to 75% and can predispose HCWs to burnout, increasing the probability of committing errors. The primary aim of our study was to determine the prevalence of HCWs involved in an adverse patient safety event in Friuli Venezia Giulia Region (Italy). The secondary aims were to use latent profile analysis to identify profiles of SVs and factors influencing profile membership, and to evaluate the relationship between the severity of symptoms and desired support options.

METHODS

A cross-sectional survey through the Italian version of the Second Victim Experience and Support Tool tool was conducted in 5 local health authorities. Descriptive statistics were conducted for all variables. Associations and correlations were assessed with statistical tests, as appropriate. Latent profile analysis was based on the scores of dimensions measuring SVs' symptoms. Factors affecting profile membership were assessed through multinomial logistic regression.

RESULTS

A total of 733 HCWs participated. Of them, 305 (41.6%) experienced at least 1 adverse event. Among dimensions measuring SVs' symptoms, psychological distress had the highest percentage of agreement (30.2%). Three latent profiles were identified: mild (58.7%), moderate (24.3%), and severe (17.0%) symptoms. Severe symptoms profile was positively associated with the agreement for extraoccupational support and negatively associated with the agreement for organizational support. A respected colleague with whom to discuss the details of the incident (78.7%) and free counseling outside of work (71.2%) were the support options most desired by HCWs. The severity of symptoms was directly associated with the desire for support strategies.

CONCLUSIONS

The prevalence of HCWs involved in adverse events is consistent with the literature. Three latent profiles have been identified according to SV symptoms, and the higher the severity of symptoms, the greater the reliance on extraoccupational support.

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.

Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim

Objective: To describe the support received by the second victim in falls suffered by hospitalized adult patients from the nursing team’s perspective. Materials and Methods: This is an exploratory and descriptive study with a qualitative approach, conducted in a large general hospital in the southern region of Brazil. Data collection was carried out through semi-structured interviews with 21 nursing professionals (seven nurses and fourteen nursing technicians) selected by random sampling, who worked in the inpatient units where falls occurred with a level of harm ranging from moderate to severe during March and May of 2020. The data were submitted to content analysis from July to August of the same year. Results: On the one hand, from the nursing team’s perspective, support for the second victim was considered incipient by the hospital institution. On the other, participants highlighted the support received by their families and peers in the work environment. The study followed the guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). Conclusions: An institutional flow of support for the second victim needs to be formalized to mitigate the repercussions on staff.

Distress, support and psychological resilience of psychiatric nurses as second victims after violence: A cross-sectional study

AIM

The aim is to explore the impact of violence and psychological resilience on psychiatric nurses as second victims.

BACKGROUND

Workplace violence is a public health concern, seriously influencing medical staff's physical and mental health. However, few pieces of research have concentrated on psychiatric nurses as second victims.

METHOD

The socio-demographic data, violence-related data, psychological resilience scale, the Chinese version of the Second Victim Experience and Support Tool were applied to conduct a cross-sectional survey on nurses from psychiatric hospitals. The multiple linear regression model identified significant variables associated with violence-related injury and resilience.

RESULTS

A total of 683 nurses completed the survey, of whom 88.3% were women. The average scores of the second victims' experience and support, support and distress were 3.45 ± 0.43, 3.71 ± 0.57 and 3.19 ± 0.67, respectively. Physical violence, psychological violence, psychological influence and nursing work environment were positively correlated with the experience and support of the second victims, and innocuous violence was a negative factor, which explains 20.6% of the variation. Moreover, physical injury, nursing work environment, resilience restructuring, physical violence, psychological violence, psychological impact and disagreement about the existence of violence explained 14.8% of the distress. The innocuous violence, psychological violence and nursing work environment explained 46.2% of the support.

CONCLUSIONS

Our findings suggest that nurses who are second victims after the violence mainly suffer from severe psychological distress and receive the least support for the same.

IMPLICATION FOR NURSING MANAGEMENT

The study provides clues to help nursing managers' emphasis on the distress and support of second victims and provides targeted intervention based on the relevant factors and these results. The article is a cross-sectional study of psychiatric nurses, which has been approved by the ethics committee of the hospital before the survey. All the nurses who participated in the survey have been informed and agreed.

Feelings of being a second victim among Spanish midwives and obstetricians

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.

Perceptions of Nurses Who Are Second Victims in a Hospital Setting

BACKGROUND

Second victims (SVs) are health care workers traumatized by unanticipated, adverse patient events. These experiences can have personal and professional effects on SVs. Research indicates that SVs experience inadequate support following adverse events.

PURPOSE

To determine the prevalence of nurses who identified as SVs and their awareness and use of supportive resources.

METHODS

A convenience sample of nurses was surveyed, and SV responses were compared with those who did not identify as a SV. Responses were analyzed using nonparametric methods.

RESULTS

One hundred fifty-nine (44.3%) of 359 participants identified as SVs. There was a significant relationship between work tenure and SVs (P = .009). A relationship was found between SVs and awareness and use of support resources, with debriefing being the preferred method after an event.

CONCLUSIONS

Adverse events trigger emotional trauma in SVs who require administrative awareness, support, and follow-up to minimize psychological trauma in the clinical nurse.

[Second victims: Perceived support quality and its relationship with the consequences of the adverse event]

INTRODUCTION

Second victims are health workers who have been involved in an adverse event (AE), or have been injured by physical, emotional, psychological and/or work conditions. To avoid these conditions, it is important to receive supportive measures.

OBJECTIVE

To determine the relationship between the consequences of an AE on the second victims and quality support measures perceived from public and private health institutions of the Metropolitan Region of Chile during the second semester of 2018.

MATERIALS AND METHOD

Quantitative, exploratory, descriptive, correlational and cross-sectional study, convenience sample type. Through an online platform, a questionnaire with sociodemographic variables and the Second Victim Experience and Support Tool (SVEST) instrument were applied, which consists of 9dimensions related to consequences of AE and quality of perceived support.

RESULTS

There were 301 health workers from public and private institutions, 39.2% were involved in an AE and of these, 73.0% manifested themselves in second victim; 69.1% was female sex and 45.7% work as a nursing professional. There is a negative relationship between the quality of perceived support and the psychological and occupational consequence of AE (public and private; p<0.05) and an increased risk of having serious consequences when receiving low quality of support (OR=3.8, 95% CI: 1.32-11.47).

CONCLUSIONS

It is very important to know this phenomenon and deliver adequate support measures to the second victim, in order to reduce the physical, psychological, emotional and/or work impact involved in being involved in an AE.

Organizational Interventions to Support Second Victims in Acute Care Settings: A Scoping Study

OBJECTIVES

Health care providers that experience harm after adverse events have been termed "second victims." Our objective was to characterize the range and context of interventions to support second victims in acute care settings.

METHODS

We performed a scoping study using Arksey and O'Malley's process. A library scientist searched PubMed, Cumulative Index of Nursing and Allied Health, EMBASE, and Cochrane Central Register of Controlled Trials in September 2017, and updated the search in November 2018. We sought gray literature (Canadian Electronic Library, Proquest and Scopus) and searched reference lists of included studies. Stakeholder organizations and authors of included studies were contacted. Two reviewers independently reviewed titles and abstracts and extracted data. A qualitative approach was used to categorize the context and characteristics of the 22 identified interventions.

RESULTS

After screening 5634 titles and abstracts, 173 articles underwent full-text screening. Twenty-two interventions met the criteria and were categorized as providing peer support (n = 8), proactive education (n = 6), or both (n = 8). Programs came from Canada (n = 2), Spain (n = 2), and the United States (n = 18). A specific traumatic event triggered the development of 5 programs. Some programs used a standard definition of second victims, (n = 6), whereas other programs had a broader scope (n = 12). Confidentiality was explicitly assured in 9 peer support programs. Outcome measures were often not reported.

CONCLUSIONS

This is a new area of study with little qualitative data from which to determine whether these programs are effective. Many programs had a similar design, based on the structure proposed by the same small group of experts in this new field. Concerns about potential legal proceedings hinder documentation and study of program effectiveness.

A Transactional "Second-Victim" Model-Experiences of Affected Healthcare Professionals in Acute-Somatic Inpatient Settings: A Qualitative Metasynthesis

BACKGROUND

"Second victims" are healthcare professionals traumatized by involvement in significant adverse events. Associated burdens, e.g., guilt, can impair professional performance, thereby endangering patient safety. To date, however, a model of second victims' experiences toward a deeper understanding of qualitative studies is missing. Therefore, we aimed to identify, describe, and interpret these experiences in acute-somatic inpatient settings.

METHODS

This qualitative metasynthesis reflects a systematic literature search of PubMed, CINAHL, and PsycINFO, extended by hand searches and expert consultations. Two researchers independently evaluated qualitative studies in German and English, assessing study quality via internationally approved criteria. Results were analyzed inductively and aggregated quantitatively.

RESULTS

Based on 19 qualitative studies (explorative-descriptive: n = 13; grounded theory: n = 3; phenomenology: n = 3), a model of second-victim experience was drafted. This depicts a multistage developmental process: in appraising their situation, second victims focus on their involvement in an adverse event, and they become traumatized. To restore their integrity, they attempt to understand the event and to act accordingly; however, their reactions are commonly emotional and issue focused. Outcomes include leaving the profession, surviving, or thriving. This development process is alternately modulated by safety culture and healthcare professionals.

CONCLUSIONS

For the first time, this model works systematically from the second-victim perspective based on qualitative studies. Based on our findings, we recommend integrating second victims' experiences into safety culture and root-cause analyses. Our transactional model of second-victim experience provides a foundation for strategies to maintain and improve patient safety.

The combined effect of psychological and social capital in registered nurses experiencing second victimization: A structural equation model

PURPOSE

This study examined the combined role psychological capital and social capital play in the severity of second victim syndrome experienced by registered nurses.

DESIGN

This research study was an ex post facto, cross-sectional, non-experimental survey design. Data were collected from October to December 2018. The study sample was composed of 1167 nurses recruited through 12 professional nursing associations in the United States.

METHODS

Self-report questionnaires were administered to measure psychological capital (Psychological Capital Questionnaire), social capital (Social Capital Outcomes for Nurses) and second victim syndrome (Second Victim Experience and Support Tool). Data cleaning and analysis of 1167 cases were conducted via SPSS v25 and structural equation modeling of 999 cases was conducted with AMOS v25.

FINDINGS

The SEM analysis demonstrated that psychological capital, on its own, had no effect on the severity of the second victim experience. Social capital, on its own, had a statistically significant relationship with second victim severity. The combined impact of social capital and psychological capital had a statistically significant effect on second victim severity.

CONCLUSIONS

The results of this study have practical implications that include unit-based peer support programs and an increased focus on supportive workplace cultures. Programmatic efforts should also focus on social capital at the team level as well as the importance of building self-efficacy through increasing mastery experiences, modeling of behavior, social persuasion and monitoring one's physiological responses.

CLINICAL RELEVANCE

These findings demonstrate the importance of social capital to mitigation of second victim experiences, while also demonstrating that psychological capital has no effect on second victim severity. Building social capital and collective efficacy are critical to mitigation of second victim syndrome.

Patient Safety Silence and Safety Nursing Activities: Mediating Effects of Moral Sensitivity

Among the factors that threaten patient safety and quality of care due to the diversification and complication of hospital environments, nurses play a pivotal role regarding patient safety in the clinical setting. This study investigates the mediating effects of moral sensitivity on the relationship between nurses’ patient safety silence and safety nursing activities and contributes to developing strategies. Nurses (n = 120) employed for at least one year in two university hospitals in Korea between 1 September and 30 October 2020 participated in the study. Data were analyzed using t-test, Pearson’s correlation coefficients, and multiple regression using the SPSS/WIN 22.0 program. Additionally, the mediating effects were analyzed using Baron and Kenny’s method and bootstrapping. Safety nursing activities were significantly negatively correlated with patient safety silence and significantly positively correlated with moral sensitivity. Patient safety silence was significantly negatively correlated with moral sensitivity. Moral sensitivity partially mediated the relationship between patient safety silence and safety nursing activities. There is a need to develop and implement individualized ethical programs that enhance moral sensitivity in nurses to promote patient safety nursing activities.

Associations of job demands and patient safety event involvement on burnout among a multidisciplinary group of pediatric hematology/oncology clinicians

BACKGROUND

Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs).

METHODS

A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The National Aeronautics and Space Administration Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post hoc analyses evaluated open-response comments for burnout factors.

RESULTS

Burnout prevalence was 33%, 20%, 34%, and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs, respectively (N = 481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs and APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups and MDs), effort (inpatient nurses and MDs), and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration.

CONCLUSIONS

All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources versus individual-level factors as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians.

Preserving nurses' professional dignity: Six evidence-based strategies

AIM

This study aimed to develop and refine strategies for preserving nurses' professional dignity.

BACKGROUND

Professional dignity is a non-negotiable nursing professional value. It should at all times be respected because of the worthiness of nurses as professional human beings. They are at the centre of healthcare societies. Their worth and contributions to the health of others should be acknowledged and preserved.

METHODS

Descriptive qualitative research was conducted during the development of the strategies while applying the principles of strategic navigation. The process was guided by the findings of the initial phase of the study and contextualised literature. Focus group discussions were held with healthcare professionals for the refinement of the strategies in two private hospitals in South Africa.

FINDINGS

The strategies unfolded multiple possibilities to value nurses' professional dignity. These were pathways for respecting, appreciating and supporting nurses; honouring nurses' desire to hold the well-being of patients in the highest regard; supporting nurses in fulfilling their professional roles; enabling nurses to take pride in themselves and the nursing profession; supporting nurses in demanding and complex circumstances and supporting nurses in coping with humiliating workplace experiences.

CONCLUSION

Strategies to ensure successful outcomes in preserving nurses' professional dignity were developed and refined. The professional dignity experiences that mattered most were presented.

IMPLICATIONS FOR NURSING/HEALTH POLICY

Valuing nurses' professional dignity promotes respect and support for nurses and their desire to prioritise patient-centred care, contributing to improved nursing practice and nurses' confidence to assert their professional dignity. Preserving nurses' professional dignity is a necessity in healthcare. It should be affirmed in equal standing in nursing codes of conduct, nursing curriculums and healthcare policies.

Secondary Traumatic Stress Among Labor and Delivery Nurses

PURPOSE

To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system.

STUDY DESIGN AND METHODS

Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked.

RESULTS

N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support.

CLINICAL IMPLICATIONS

This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.

Coping strategies in health care providers as second victims: A systematic review

AIM

To analyze personal and organizational strategies described in the literature for dealing with the second victim phenomenon among healthcare providers.

BACKGROUND

The second victim phenomenon involves many associated signs and symptoms, which can be physical, psychological, emotional, or behavioral. Personal and organizational strategies have been developed to deal with this phenomenon.

MATERIALS AND METHODS

A systematic review was carried out in PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO, Science Direct, and Cumulative Index to Nursing and Allied Health Literature databases, searching for evidence published between 2010 and 2019 in Spanish, English, German, and Portuguese.

RESULTS

Seven hundred and eighty-three articles were identified. After eliminating duplicates, applying inclusion and exclusion criteria and critical analysis tools of the Joanna Briggs Institute, 16 research articles were included: 10 quantitative studies (design: descriptive, correlational, systematic, or integrative review) and six qualitative studies (descriptive, systematic review). There are several different personal and organizational strategies for dealing with the second victim phenomenon. Among these, peer support and learning from adverse events are highly valued. In personal strategies stands out the internal analysis of the adverse event that the professional performs to deal with the generated negative feelings. In organizational strategies, the most valued are second victim support programs with rapid response teams and made up of peers.

CONCLUSIONS

The main organizational coping strategies for tackling this phenomenon are online programs in countries such as the United States, Spain, and other European countries. Formal evaluation of these programs and research is required in Latin America.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Adequately coping with the second victim phenomenon allows health professionals and organizations to learn from adverse events. Furthermore, by supporting health professionals who suffer from the second victim phenomenon, the organization takes care of its most valuable resource, its human capital. This contributes toward building a culture of healthcare quality in organizations, which will reduce adverse events in the future.

Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis

Background

Health care workers (HCWs) are at high risk of occupational injuries and approximately 10–15% of patients are affected by an adverse event during their hospital stay. There is scarce scientific literature about how HCWs manage these risks in practice and what support they need. This knowledge is needed to improve safety for patients and HCWs. This study explores HCWs’ experiences of workplace incidents that led to injury or posed a risk of patient and worker injury, with focus on HCWs’ emotions and actions.

Methods

This study employed a qualitative design using the critical incident technique. Semi-structured individual interviews were held with 34 HCWs from three regions in Sweden. Data were analysed using inductive category development.

Results

Altogether 71 workplace incidents were reported. The analysis of two dimensions – the emotions HCWs feel and the actions team members and managers take when a workplace incident occurs – yielded two categories each: Anxiety during the incident, Persistent distress after the incident, Team interplay for safety actions and Support and ratification from managers and colleagues. Health care workers risked their own safety and health to provide patient safety. Teamwork and trustful relationships were critical for patient and worker safety. Support and validation from colleagues and managers were important for closure; unsatisfactory manager response and insufficient opportunities to debrief the incident could lead to persistent negative emotions. Participants described insecurity and fear, sadness over being injured at work, and shame and self-regret when the patient or themselves were injured. When the workplace had not taken the expected action, they felt anger and resignation, often turning into long-term distress.

Conclusions

Work situations leading to injury or risk of patient and worker injury are emotionally distressing for HCWs. Team interplay may facilitate safe and dynamic practices and help HCWs overcome negative emotions. Organizational support is imperative for individual closure. For safety in health care, employers need to develop strategies for active management of risks, avoiding injuries and providing support after an injury.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06517-x.

Nurses as 'second victims' to their patients' suicidal attempts: A mixed-method study

AIMS AND OBJECTIVES

To understand the effects of patients' suicidal attempts and events on nurses' second victim symptoms and to explore the association between these experiences and nurse absenteeism and turnover.

BACKGROUND

The term 'second victim' is when a healthcare professional expresses psychological symptom following adverse patient event. This has been previously shown to be associated with absenteeism and higher staff turnover.

DESIGN

A mixed-methods study with a sequential exploratory approach.

METHODS

A qualitative approach was used for nurses to relate their experiences of their patients' suicidal attempts. A cross-sectional quantitative study was conducted in 150 nurses who worked in internal departments. The Second Victim Experience and Support Tool was used to substantiate and measure second victim related distress of nurses who treated suicidal patients. The qualitative data were analysed by a constant comparative analysis method. The analytic analysis of the quantitative study included Pearson's correlations and hierarchical linear regression model to assess the explanatory variables to absenteeism and staff turnover. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies.

RESULTS

The qualitative part identified three themes and nine sub-themes, including the new variable 'sense of being alone'. The quantitative part of the study found that nurses expressed a medium level of second victim related distress. After controlling for demographic variables, second victim distress and the sense of being alone following patients' suicidal events may explain nurse absenteeism and turnover.

CONCLUSIONS

Nurses who experience suicidal attempts of their patients react as second victims. These symptoms lead to nurse absenteeism and turnover.

RELEVANCE TO CLINICAL PRACTICE

Nurses who experience suicidal attempts of their patients need treatment and support as second victims, the same as in any other medical adverse event. The nursing leadership should emotionally support these nurses and prevent consequential staff organisational problems.

Strategies to support health professionals in the condition of second victim: scoping review

OBJECTIVE

To map and analyze the knowledge produced about strategies aimed at promoting support to health professionals in the condition of second victim.

METHOD

Scoping review, developed in portals, databases and academic websites, whose inclusion criteria were articles and materials indexed in the respective search sites, between January 2000 and December 2019, in Portuguese, English and Spanish. The findings were summarized and analyzed based on descriptive statistics and narrative synthesis.

RESULTS

A total of 64 studies were included, 100% international; 92.2% in English and 50% from secondary research. The support strategies were grouped into four categories and most of the studies referred to the use of the forYOU, Medically Induced Trauma Support Services and Resilience in Stressful Events programs and the interventions represented, through dialogue with peers, family, friends and managers.

CONCLUSION

Support strategies for the second victim are pointed out in international studies and mostly developed through programs/services and interventions. It is recommended to develop studies to learn about the phenomenon and to structure feasible support strategies in Brazilian health organizations.

Inpatient Suicide Second Victim Experience and Support Tool: Psychometric properties of a scale for nurses who experienced inpatient suicide at Chinese general hospitals

This study describes a psychometric scale, the Inpatient Suicide Second Victim Experience and Support Tool, for evaluating physical and psychological distress with a focus on resources for supporting the needs of nursing professionals. Our study defines "second victim" as a nurse who experiences inpatient suicide while on shift. We conducted a cross-sectional study among non-psychiatric nurses to examine the psychometrics of the scale. A total of 731 participants were recruited from eight Chinese general hospitals for this research. Data were analyzed by exploratory factor analysis and confirmatory factor analysis to examine the reliability and validity of the scale. The results indicated adequate indices resulting in 21 items. The final structure for the scale was categorized into five domains: psychosomatic distress, support from family and friends, work-related support, organizational support, and professional self-efficacy. The total variance explained was 69.06%. Cronbach's alpha was 0.869 overall, and ranged from 0.626 to 0.914 for the five dimensions. The test-retest reliability of 0.792 for the entire scale was also acceptable. The scale shows promise for use by healthcare organizations to identify second victims and promote necessary organizational support interventions in Chinese hospitals.

Experiences and responses of nursing students as second victims of patient safety incidents in a clinical setting: A mixed-methods study

AIM

To investigate the degree of second victim syndrome among nursing students in clinical practice and determine the rehabilitation process.

BACKGROUND

Empirical evidence suggests that health care providers who are considered second victims suffer from various difficulties. Nursing students in a clinical setting could be potential second victims, but few studies have quantitatively investigated the experiences and explored their response processes.

METHODS

A mixed-methods design was used. A questionnaire was sent to nursing students via a link to an electronic survey, and a semi-structured interview was conducted to explore their response process as second victims.

RESULTS

The quantitative results showed that nursing students in the clinical setting suffered second victim-related distress and that the most significant influences were psychological distress and professional efficacy. Four stages of rehabilitation experiences emerged from the qualitative data.

CONCLUSION

Being a second victim for nursing students in a clinical setting is psychological suffering, and although they can be expected to recover, an impact on professional efficacy is inevitable.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers must be aware that nursing students in a clinical setting might experience difficult situations after patient safety incidents and that developing appropriate programmes to support at-risk students is important.

The Second Victim Phenomenon: How Are Midwives Affected?

Perinatal care providers are likely to encounter adverse events such as intrapartum emergencies, traumatic births, or maternal or fetal deaths. As a result of being directly or indirectly involved in an adverse event, health care providers can be considered second victims. The experience of the second victim phenomenon can lead to significant physical, psychological, and psychosocial sequelae that can negatively impact the provider's personal and professional life for either a short or long duration of time. When health care providers experience an adverse event, they may manifest symptoms of guilt, shame, blame, flashbacks, nightmares, insomnia, isolation, helplessness, and hopelessness, thereby becoming the second victim. Following an adverse event, health care providers who experience second victim phenomenon experience stages of recovery that influence subsequent professional and personal well-being. Persons who experience the second victim phenomenon can incorporate self-care behaviors to assist with recovery. Health care organizations have a responsibility to implement efficacious support programs that promote the provider's recovery and a return to safe and full function in the workplace.

A cross-sectional survey on nurses' second victim experience and quality of support resources in Singapore

AIM

The study aimed to investigate nurses' second victim experience and quality of support resources in Singapore.

BACKGROUND

The second victim phenomenon, broadly described as the suffering of providers including nurses in the face of a clinical error, is often overlooked.

METHODS

A cross-sectional questionnaire survey was adopted. A total of 1,163 nurses from an acute public hospital in Singapore took part in the study. The Second Victim Experience and Support Tool (SVEST) was employed to assess experience of second victims and the quality of support resources.

RESULTS

The study results showed that nurses experienced second victim-related physical, psychological and professional distress. About 31.8% of the participants had turnover intentions, while 9.3% had absenteeism following an error. Nurses who are younger and less experienced were more likely to experience greater second victim response. Among the support options, peer support was rated as the most desirable.

CONCLUSION

Nurses, being at the forefront of care delivery, are especially susceptible to being a casualty of the second victim phenomenon.

IMPLICATIONS FOR NURSING MANAGEMENT

Acknowledging the second victim phenomenon, together with a strong organizational support, is essential in alleviating the trauma and assisting nurses with reconciliation in the aftermath of an unanticipated error.

The PEST Model: A Quality Improvement Project to Reduce Self-extubation in the Intensive Care Unit

BACKGROUND

Self-extubation is an adverse patient event that can lead to severe complications. Gaps in clinical practice from the lack of nursing awareness and decision making capacity have often resulted in cases of preventable self-extubation. Review of current evidence suggests that initiatives to support nursing clinical decision making can help prevent adverse patient events such as self-extubation.

AIMS

The aim of this study was to reduce the incidence of self-extubation by 50% in a cardiology intensive care unit over 1 year.

METHODS

A quality improvement project was undertaken with a PEST model of nursing care introduced from January 2017 to December 2017 in the cardiology intensive care unit to guide nursing staff to assess and render appropriate interventions along patient domains such as pain, endotracheal tube securement, sedation, and tie to prevent incidences of self-extubation.

RESULTS

Incidences of self-extubation have reduced to 5 cases in 2017, reflecting a 50% improvement from 10 cases in 2016.

CONCLUSIONS

Formalizing practice standards into an easy-to-remember mnemonics or framework can improve patient outcomes. Policy makers must be aware that initiatives to facilitate decision making can improve patient safety.

Supporting staff who are second victims after adverse healthcare events

Healthcare delivery is challenging and complex, At some point, most healthcare professionals, including nurses, will be directly or indirectly involved in adverse events, such as medication errors, patient safety incidents, witnessing adverse events and near misses. While the patient is considered the first and most important 'victim' of such events, the healthcare professional involved is often considered the 'second victim'. Second victims often experience negative psychological effects due to the event, may feel they have failed the patient and can doubt their clinical skills and knowledge base. This may lead to absenteeism and their leaving their profession. This article explores the concept of healthcare professionals as second victims, as well as the effects of adverse events on these individuals, their managers and healthcare organisations. It also details the investigation process, the healthcare professional's legal and professional responsibilities after an adverse event, and the resources and services available to support second victims.

Reducing the Second Victim Phenomenon: Healing Our Healers With Caritas Coaching

The second victim phenomenon is one in which nurses and other health care providers use dysfunctional mechanisms, such as anger, projection of blame, or drugs and/or alcohol, to cope with serious mistakes in the absence of a healthier means for healing. The main purpose of this article is to provide evidence and practices that support the need for caring organizational support systems following serious adverse clinical events. Recommendations are provided on key elements of programs to prevent the prevalence, symptoms, and impact of the second victim phenomenon on our health care professionals, our patients, and our health care system.

Ethical leadership, nursing error and error reporting from the nurses’ perspective

Background:

Nursing errors endanger patient safety, and error reporting helps identify errors and system vulnerabilities. Nursing managers play a key role in preventing nursing errors by using leadership skills. One of the leadership approaches is ethical leadership.

Aim:

This study determined the level of ethical leadership from the nurses’ perspective and its effect on nursing error and error reporting in teaching hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Research design:

This was a cross-sectional descriptive study.

Participants and research context:

A total of 171 nurses working in medical-surgical wards were selected through random sampling. Data collection was carried out using “ethical leadership in nursing, nursing errors and error reporting” questionnaires. Data were analyzed with SPSS20 using descriptive and analytical statistics.

Ethical considerations:

This study was approved by the Ethics Committee for Medical Research. Ethical considerations such as completing informed consent form, ensuring confidentiality of information, explaining research objectives, and voluntary participation were observed in the present study.

Findings:

The results showed that the level of nursing managers’ ethical leadership was moderate from the nurses’ point of view. The highest and the lowest levels were related to the power-sharing and task-oriented dimensions, respectively. There was a significant relationship between nursing managers’ level of ethical leadership with error rates and error reporting.

Conclusion:

The development of ethical leadership approach in nursing managers reduces error rate and increases error reporting. Programs designed to promote such approach in nursing managers at all levels can help reduce the level of error rate and maintain patient safety.

Second victims in health care: current perspectives

Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient's quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then find themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.

Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer

BACKGROUND

Laparoscopic abdominoperineal resection (APR) for low rectal cancer (LRC) is performed worldwide. However, APR involves technical difficulties and often causes intractable perineal complications. Therefore, a novel and secure technique during APR is required to overcome these critical issues. Although the usefulness of the endoscopic trans-anal approach has been documented, no series of the endoscopic trans-perineal approach during laparoscopic APR for LRC has been reported.

METHODS

Trans-perineal minimally invasive surgery (TpMIS) has been used during laparoscopic APR in our institution since April 2014. TpMIS is defined as an endoscopic trans-perineal approach using a single-port device and laparoscopic instruments. In this study, we retrospectively evaluated 50 consecutive patients with LRC who underwent laparoscopic APR at our institution from February 2011 to June 2017 and compared the outcomes of the patients who underwent TpMIS [trans-perineal APR (TpAPR) group, n = 21] versus the conventional trans-perineal approach (conventional group, n = 29). We investigated our experiences with TpMIS in detail and evaluated the safety and utility of TpMIS for patients with LRC. Moreover, major features and difficulties of TpMIS were examined from a surgical viewpoint.

RESULTS

Intraoperative blood loss (median (range) 55 (10-600) vs. 120 (20-1650) ml) and severe perineal wound infection (Clavien-Dindo grade 3, 0 vs. 5 cases) were significantly lower in the TpAPR than conventional group. TpMIS led to a shortened hospital stay (median (range), 14 (10-74) vs. 23 (10-84) days), and neither mortality nor conversion to open surgery occurred in the TpAPR group.

CONCLUSIONS

Magnified visualization via endoscopy provided more accurate dissection and less blood loss during surgery. Minimal skin incisions enabled a reduction in postoperative perineal complications, and consequently shortened the hospital stay. TpMIS during laparoscopic APR is safe and beneficial for patients with LRC.

Nature of nursing errors and their contributing factors in intensive care units

BACKGROUND

Errors tend to be multifactorial and so learning from nurses' experiences with them would be a powerful tool toward promoting patient safety.

AIM

To identify the nature of nursing errors and their contributing factors in intensive care units (ICUs).

METHODS

A semi-structured interview with 112 critical care nurses to elicit the reports about their encountered errors followed by a content analysis.

RESULTS

A total of 300 errors were reported. Most of them (94·3%) were classified in more than one error category, e.g. 'lack of intervention', 'lack of attentiveness' and 'documentation errors': these were the most frequently involved error categories. Approximately 40% of reported errors contributed to significant harm or death of the involved patients, with system-related factors being involved in 84·3% of them. More errors occur during the evening shift than the night and morning shifts (42·7% versus 28·7% and 16·7%, respectively). There is a statistically significant relation (p ≤ 0·001) between error disclosure to a nursing supervisor and its impact on the patient.

CONCLUSIONS

Nurses are more likely to report their errors when they feel safe and when the reporting system is not burdensome, although an internationally standardized language to define and analyse nursing errors is needed. Improving the health care system, particularly the managerial and environmental aspects, might reduce nursing errors in ICUs in terms of their incidence and seriousness.

RELEVANCE TO CLINICAL PRACTICE

Targeting error-liable times in the ICU, such as mid-evening and mid-night shifts, along with improved supervision and adequate staff reallocation, might tackle the incidence and seriousness of nursing errors. Development of individualized nursing interventions for patients with low health literacy and patients in isolation might create more meaningful dialogue for ICU health care safety.