Workplace Blame and Related Concepts: An Analysis of Three Case Studies

Translation and validation study of the Indonesian version of the practice environment scale of the nursing work index

Objectives

This study aimed to translate and validate the Practice Environment Scale - Nursing Work Index (PES-NWI) among nurses in Indonesia.

Methods

A scale translation and cross-sectional validation study was conducted. The English version was translated into Indonesian, which involved five steps: forward translation, compare the translation, backward translation, compare the translation, and pilot testing with a dichotomous scale (clear or unclear). Thirty inpatient department nurses were involved in checking readability and understandability. A cross-sectional study was conducted from August to October 2022 at 17 hospitals across Indonesia, involving 350 nursing professionals. The validity test included structural validity and convergent validity. The internal consistency reliability was tested by Cronbach's α coefficient, item-total correlation, and composite reliability.

Results

Confirmatory factor analysis (CFA) showed an acceptable fit. The correlation of all dimensions was between 0.70 and 0.88, and all items had item loading higher than 0.6. Convergent validity of each dimension ranged from 0.61 to 0.74, internal consistencies with Cronbach's α coefficient was 0.97, corrected item-to-total correlation ranged from 0.62 to 0.85, and composite reliability of each dimension was higher than 0.89.

Conclusions

Good homogeneity and construct validity have been demonstrated for the Indonesian version of the PES-NWI, nursing management can use it to measure the work environment.

Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic review of prevalence, contributory factors, and interventions

BACKGROUND

Nurses have been identified as an occupational group at increased risk of suicide. This systematic review examines the prevalence of, and factors influencing, suicide and related behaviours among nurses and midwives (PROSPERO pre-registration CRD42021270297).

METHODS

MEDLINE, PsycINFO, and CINAHL were searched. Articles published from 1996 onwards exploring suicidal thoughts and behaviours among nurses and midwives were included. Quality of included studies was assessed. Articles were subjected to narrative synthesis informed by suicide data examined, study design, and quality. PRISMA guidelines were followed.

RESULTS

A total of 100 studies were eligible for inclusion in the review. Articles examining suicide exclusively among midwives were absent from the literature. Several studies confirmed that nursing professionals, especially female, are at increased risk of suicide, particularly by self-poisoning. Factors contributing to risk include psychiatric disorders, alcohol and substance misuse, physical health problems, and occupational and interpersonal difficulties. In studies of non-fatal suicidal behaviours, including during the COVID-19 pandemic, psychiatric, psychological, physical and occupational factors were contributory. There has been little investigation of interventions for prevention of suicide in nurses.

LIMITATIONS

Only articles published in English language were reviewed.

CONCLUSIONS

The findings highlight the risk of suicide in nurses. They also show a combination of factors contribute to suicide and non-fatal suicidal behaviour in nurses, with psychiatric, psychological, physical health, occupational and substance misuse (especially alcohol) problems being particularly important. The limited evidence regarding prevention measures indicates a major need to develop primary and secondary interventions for this at-risk occupational group, for example, education regarding enhancing wellbeing and safe alcohol use, alongside accessible psychological support.

Systematic scoping review on moral distress among physicians

BACKGROUND

Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.

METHODS

A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.

RESULTS

A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.

CONCLUSIONS

Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.

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.

Action after Adverse Events in Healthcare: An Integrative Literature Review

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.

Creating a Care for the Caregiver Program in a Ten-Hospital Health System

Critical care clinicians involved serious adverse events may experience a constellation of distressing emotions that may interfere with home and work life. Offering support after a serious adverse event may restore a clinician's ability to cope with the event, reestablish emotional balance and assist a clinician to function capably in the workplace and at home. A description of a care for the caregiver program implementation at a 10-hospital health system provides a roadmap to implement this program in other hospitals and health systems.

Curated Collection for Educators: Five Key Papers About Second Victim Syndrome

Second victim syndrome (SVS) is defined as the psychological or emotional suffering of healthcare workers as a result of a patient adverse, or near miss, event. Initially thought to be related to medical error, we now recognize that SVS can result from a much wider range of circumstances including adverse pediatric patient events, unanticipated deaths, or patients well known to the provider. Residents are particularly susceptible to SVS yet relatively little is written about this topic targeted at their educators. Since educators are positioned to help recognize and guide learners through the experience, this paper targets that reader audience. In this article, we identify and summarize five key papers relevant to educators interested in learning more about SVS as it relates to learners. We identified an extensive list of papers relevant to SVS via online discussions within the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. The Faculty Incubator is a digital community of practice providing professional development for educators. This list was augmented by an open call on Twitter seen by over 2000 people and yielding a list of 31 papers. We then conducted a three-round modified Delphi process within the authorship group, which included both junior and senior clinician educators, to identify the most impactful papers for educators interested in SVS. The three-round modified Delphi process ranked all papers submitted for review and used iterative rounds to select the five highest-rated papers for inclusion in this article. The group then summarized each of the five papers with specific consideration for junior faculty educators and faculty developers with an interest in SVS in learners. The five papers featured in this article serve as a key reading list for educators across specialties interested in SVS and our commentary provides context for medical educators using the articles.

Psychological impact and recovery after involvement in a patient safety incident: a repeated measures analysis

OBJECTIVE

To examine individual, situational and organisational aspects that influence psychological impact and recovery of a patient safety incident on physicians, nurses and midwives.

DESIGN

Cross-sectional, retrospective surveys of physicians, midwives and nurses.

SETTING

33 Belgian hospitals.

PARTICIPANTS

913 clinicians (186 physicians, 682 nurses, 45 midwives) involved in a patient safety incident.

MAIN OUTCOME MEASURES

The Impact of Event Scale was used to retrospectively measure psychological impact of the safety incident at the time of the event and compare it with psychological impact at the time of the survey.

RESULTS

Individual, situational as well as organisational aspects influenced psychological impact and recovery of a patient safety incident. Psychological impact is higher when the degree of harm for the patient is more severe, when healthcare professionals feel responsible for the incident and among female healthcare professionals. Impact of degree of harm differed across clinicians. Psychological impact is lower among more optimistic professionals. Overall, impact decreased significantly over time. This effect was more pronounced for women and for those who feel responsible for the incident. The longer ago the incident took place, the stronger impact had decreased. Also, higher psychological impact is related with the use of a more active coping and planning coping strategy, and is unrelated to support seeking coping strategies. Rendered support and a support culture reduce psychological impact, whereas a blame culture increases psychological impact. No associations were found with job experience and resilience of the health professional, the presence of a second victim support team or guideline and working in a learning culture.

CONCLUSIONS

Healthcare organisations should anticipate on providing their staff appropriate and timely support structures that are tailored to the healthcare professional involved in the incident and to the specific situation of the incident.

Exploring Distress Caused by Blame for a Negative Patient Outcome

OBJECTIVE

The aim of this study was to explore blame-related distress (B-RD).

BACKGROUND

No research exists describing the incidence and characteristics of consequences of blame.

METHODS

Survey research was used to explore the incidence, characteristics, and consequences of the distress caused by blame in the workplace.

RESULTS

B-RD is prevalent among intensive care and oncology staff. Participants reported an organizational impact to B-RD in terms of staff morale, turnover, and employee health. Management, physicians, and peers were the most frequently cited source of blame.

CONCLUSIONS

A proposed model is described to relate blame to other similar constructs.