The impact of surgical complications on obstetricians' and gynecologists' well-being and coping mechanisms as second victims

BACKGROUND

Obstetrics and gynecology surgery is becoming increasingly complex because of an aging population with increasing rates of medical comorbidities and obesity. Complications are therefore common, and not only impact the patient but can also cause distress to the obstetrics and gynecology surgeon as a "second victim."

OBJECTIVE

This study aimed to describe and quantify the range of effects of complications on obstetrics and gynecology surgeons, and assess sociodemographic, clinician, and practice factors associated with such impact.

STUDY DESIGN

A cross-sectional survey was developed on the basis of interviews with obstetrics and gynecology surgeons and a review of the literature. The survey assessed obstetrics and gynecology surgeons' demographic, clinical, and practice characteristics; estimated the number of complications per year and the impact of complications on distress, physical and mental health, sleep, and relationships; and explored strategies that obstetrics and gynecology surgeons used to cope with complications. Univariate logistic regression analyses were used to determine the association between obstetrics and gynecology surgeons' characteristics and complication consequences.

RESULTS

Overall, of 727 survey respondents, 431 (61%) were female, 384 (55%) were aged ≥50 years, almost half had worked as obstetrics and gynecology surgeons for ≥15 years (329 [45%]), and 527 (73%) reported completing <10 surgical procedures per week. Most (568 [78%]) reported <3 surgical complications per year, and most (472 [66%]) thought this was similar or less frequent compared with their colleagues. Complications caused most stress when they resulted in poor patient outcomes (653 [90%]), had severe patient consequences (630 [87%]), or were a result of surgeon error (627 [86%]). Complications impacted most obstetrics and gynecology surgeons' well-being and sleep. A greater proportion of those aged <50 years reported that their mental well-being (32 [10%]; P=.002) and sleep (130 [42%]; P=.03) were affected when a complication occurred. Female participants were also more likely to report that their physical health (14 [3%]; P≤.001), mental health (39 [9%]; P=.01), and sleep (183 [43%]; P≤.001) were affected. Current trainees (11 [10%]) and surgeons with <15 years of experience (25 [9%]) were more likely to experience mental well-being consequences compared with surgeons with ≥15 years of experience (12 [4%]; P=.01). Female participants reported less willingness to interact with colleagues when complications occurred (323 [75%]; P=.006), and surgeons with <15 years of training were less likely to report comfort in talking (221 [74%]; P=.03) and interacting with others (212 [74%]; P=.02).

CONCLUSION

The vast majority of obstetrics and gynecology surgeons experience a major impact on their health and well-being when one of their patients develops a complication. The degree and type of impact reported are similar to those observed in other surgical specialties. Future studies are needed to test interventions that alleviate the substantial impact and to follow obstetrics and gynecology surgeons longitudinally to understand the duration of the impact of complications.

Demystifying the experience of participating in a root cause analysis: A hermeneutic phenomenological study

AIM

This study aimed to explore registered nurses' experience participating in a root cause analysis (RCA) meeting because of their involvement in an adverse event.

BACKGROUND

An RCA is the most common strategy used by organizations for adverse event investigations. Nursing healthcare professionals directly involved in an adverse event may be asked to participate in the RCA. However, no studies were found in the literature on their experience.

METHODS

Semi-structured audio-taped interviews were held with 13 registered nurses who participated in an RCA. Ricoeur's hermeneutic phenomenology guided data analysis.

RESULTS

Two structural elements represented the world of the nurses: 1) Learning about an RCA, and 2) being on the other side of the RCA table. Three phenomenological themes emerged: 1) anticipatory and embodied fear, 2) to speak or not to speak, 3) the aftermath.

CONCLUSION

Nurses desire RCA education to assist in understanding and support from nurse leaders throughout the process. Healthcare organizations must create a safe and collaborative environment to empower nurses to speak up and have their voices heard during the RCA process.

IMPLICATIONS FOR NURSING LEADERS

Nurses want to participate in RCA meetings. However, leaders must demystify the RCA process for nurses through education and training.

Psychometric properties of the Persian version of the Second Victim Experience and Support Instrument

AIM

This study was designed to characterize the psychometric properties of the Persian version of the Second Victim Experience and Support Instrument (P-SVEST).

DESIGN

This study was a methodological and cross-sectional study.

METHODS

The SVEST was back-translated into Persian and 10 experts assessed its content validity. Construct validity was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a total of 754 critical care and emergency nurses.

RESULTS

The results of exploratory factor analysis showed that the P-SVEST had four factors. These four factors accounted for 51.67% of the total variance. Also, these factors were confirmed by confirmatory factor analysis (root mean square error of approximation = (90%. confidence interval) = 0.058 [0.045, 0.071], goodness-of-fit index = 0.932, comparative fit index = 0.956, non-normal fit index = 0.918, incremental fit index = 0.957 and Tucker-Lewis index = 0.944). Coefficients of Cronbach's alpha, McDonald's omega, composite reliability and maximum reliability for all of the factors were >0.7, demonstrating satisfied internal consistency.

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.

Effects of Mindfulness Meditation on Doctors' Mindfulness, Patient Safety Culture, Patient Safety Competency and Adverse Event

OBJECTIVE

This study investigated the effects of mindfulness meditation on doctors' mindfulness, patient safety culture, patient safety competency, and adverse events.

METHODS

We recruited 91 doctors from a hospital in China and randomized them to mindfulness meditation group (n = 46) and a waiting control group (n = 45). The mindfulness meditation group underwent an 8-week mindfulness meditation intervention, while the control group underwent no intervention. We measured four main variables (mindfulness, patient safety culture, patient safety competency, and adverse event) before and after the mindfulness meditation intervention.

RESULTS

In the experimental group, mindfulness, patient safety culture and patient safety competency were significantly higher compared with those of the control group. In the control group, there were no significant differences in any of the three variables between the pre-test and post-test. Adverse events in the experimental group were significantly lower than in the control group.

CONCLUSIONS

The intervention of mindfulness meditation significantly improved the level of mindfulness, patient safety culture and patient safety competency. During the mindfulness meditation intervention, the rate of adverse events in the meditation group was also significantly lower than in the control group. As a simple and effective intervention, mindfulness meditation plays a positive role in improving patient safety and has certain promotional value.

The Mindful Path to Nursing Accuracy: A Quasi-Experimental Study on Minimizing Medication Administration Errors

Achieving error-free health care is critically vital and includes freedom from the occurrence of medication errors, which, as yet, is an unrealized goal in the United States. The purpose of this study was to minimize or potentially eliminate medication errors by adding training in mindfulness thinking to the current system protocol. The goal of this quantitative, quasi-experimental study was to determine whether training nurses in mindfulness thinking founded on the Dossey Integral Theory changed the frequency and severity of medication administration errors. Data analysis included the following steps: recording of data using the NCC MERP (National Coordinating Council for Medication Error Reporting) instrument, statistical analysis using paired t test, and a logistical interpretation of descriptive statistics. An error reduction of 73.3% between pre- and posttraining mean for the experimental group was observed. This study may add to the limited body of research related to mindfulness and the resultant reduction in medication errors.

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.