Second-victim Experience and Support Desire Among Nurses Working at Regional Levels in China

The current status of nurses' psychological experience as second victims during the reconstruction of the course of event after patient safety incident in China: a mixed study

BACKGROUND

Patient safety incidents are unavoidable and nurses, as parties involved, become second victims due to the incident itself and the way it is handled. In China, reconstructing the course of events is a crucial step in the aftermath of the incident; however, its impact on the emotional well-being of the second victim remains unclear.

PURPOSE

The purpose of this study is to gain insight into the psychological experiences and current conditions of nurses who act as second victims during the process of reconstructing the sequence of events. Additionally, the study aims to provide justifications for supporting these individuals.

METHODS

An exploratory mixed research method was adopted to understand the emotional experience of the second victim when reconstructing the passage of the incident through qualitative research. Fourteen nurses with experience as second victims were selected for semi-structured interviews using purposive sampling according to the maximum difference sampling strategy. Through quantitative research, we explored the negative psychology and support needs of the second victims when they reverted to the incident, and a self-developed questionnaire (the Cronbach's alpha coefficient was 0.895) was used to survey 3,394 nurses with experiences as second victims in 11 tertiary hospitals in Shanxi Province.

RESULTS

In the qualitative part of the study, the emotional experience of the second victim's reconstruction of the course of events after a patient safety incident could be categorized into 3 themes: negative views as initial psychological impact, avoidance as part of psychological impact, and expectations and growth in overcoming negative psychological impact. The quantitative part of the study revealed that the emotions of guilt and self-blame accounted for the highest percentage after a patient safety incident. The second victim presented a high score of 39.58 ± 5.45 for support requirements.

CONCLUSION

This study provides a better understanding of the true emotional experiences and the need for support of the second victim in the process of reconstructing the course of events. Following a patient safety incident, nursing administrators and healthcare institutions should consider the adverse psychological effects on the second victim, prioritize their support needs during the incident's reconstruction, create a positive safety culture, and reduce the risk of secondary victimization for these individuals.

"Learn from Errors": Post-traumatic growth among second victims

BACKGROUND

Second victims, defined as healthcare providers enduring emotional and psychological distress after patient safety incidents (PSIs). The potential for positive transformation through these experiences is underexplored but is essential for fostering a culture of error learning and enhancing patient care.

OBJECTIVE

To explore the level and determinants of post-traumatic growth (PTG), applying the stress process model.

METHODS

The study was conducted at a tertiary general hospital in Chongqing, China. A descriptive, cross-sectional study design was used. A total of 474 s victims were included. An online survey was conducted in November 2021 to assess various factors related to the second victim experience. These factors included PSIs (considered as stressors), coping styles, perceived threats, and social support (acting as mediators), as well as the outcomes of second victim syndrome (SVS) and PTG. Statistical description, correlation analysis, and structural equation modeling were utilized for the data analysis. A p-value ≤ 0.05 was considered to indicate statistical significance.

RESULTS

The participants reported moderate distress (SVS = 2.84 ± 0.85) and PTG (2.72 ± 0.85). The total effects on SVS of perceived threat, negative coping, social support, positive coping, and PSIs were 0.387, 0.359, -0.355, -0.220, and 0.115, respectively, accounting for 47% of the variation in SVS. The total effects of social support, positive coping, and PSIs on PTG were 0.355, 0.203, and - 0.053, respectively, accounting for 19% of the variation in PTG.

CONCLUSIONS

The study provides novel insights into the complex interplay between perceived threats, coping styles, and social support in facilitating PTG among second victims. By bolstering social support and promoting adaptive coping strategies, the adverse effects of PSIs can be mitigated, transforming them into opportunities for resilience and growth, and offering a fresh perspective on managing PSIs in healthcare settings.

Barriers and Facilitators to Coping with Second Victim Experiences: Insights from Nurses and Nurse Managers

Background

Second victim experiences have long-term impacts on the personal and professional well-being of nurses. Individual-centered support is necessary to help nurses cope with the various stages of the second victim experience.

Objectives

To explore personal and workplace factors that facilitate or hinder coping styles for second victim experiences from the perspectives of both frontline nurses and nurse managers.

Design

This was a descriptive qualitative study that incorporated semistructured interviews.

Methods

Purposive sampling was employed to enlist a total of eight nurses and seven nurse managers selected from five tertiary hospitals located in Hunan Province, China. The study participants included nurses who had suffered second victim experiences and nurse managers who had grappled with their nurses' second victim experiences. The data were transcribed verbatim and analysed using thematic analysis.

Results

The analysis revealed four main themes that influenced nurses' ability to cope with second victim experiences: source of emotional trauma, personal factors, job stress, and support system. In contrast, emotional trauma from patients and relatives, negative personal traits, shadows from the second victim experience, and unsupportive workplace environments were obstacles to coping with second victim experiences.

Conclusion

The study highlights facilitators and barriers that nurses cope with second victim experiences, providing insight to develop targeted interventions that support nurses and mitigate the negative impacts of second victim experiences. A comprehensive approach is more effective in supporting nurses in coping with second victim experiences, improving patient safety, and enhancing the quality of care.

Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses

BACKGROUND

Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources.

OBJECTIVES

The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes.

METHODS

A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables.

RESULTS

There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses.

DISCUSSION

The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

Exploring the Experiences and Support of Nurses as Second Victims After Patient Safety Events in China: A Mixed-Method Approach

AIM

To investigate the current status of experience and support of nurses as second victims and explore its related factors in nurses.

DESIGN

A sequential, explanatory, mixed-method study was applied.

METHODS

A total of 406 nurses from seven tertiary hospitals in China were chosen as participants between September to October 2023. The Chinese version of the Second Victim Experience and Support Questionnaire (SVEST), Somatic Complaints of Sub-health Status Questionnaire (SCSSQ) and Generalized Anxiety Disorder (GAD-7) were applied to collect quantitative data. Eight nurses were selected for a qualitative study through in-depth interviews. Through interpretive phenomenological analysis, the interview data were analysed to explore the experience and support of nurses as second victims.

RESULTS

Practice distress (15.74 ± 4.97) and psychological distress (15.48 ± 3.74) were the highest dimensions, indicating Chinese nurses experienced second victim-related practice and psychological distress. Nurses with different gender, age, education, marital status, income, working hours, professional titles, and unit types have different levels of second victim-related experience and support (p < 0.05). In addition, the score of SVEST was positively associated with SCSSQ (r = 0.444) and GAD-7 (r = 0.490) (p < 0.05). This qualitative study found that the experience and support of nurses as second victims included nurses' perceptions and needs for patient safety events; psychological, physical and practice distress of nurses; and nurses and hospitals coping style after patient safety events.

DISCUSSION

Our findings suggest that nurses who are second victims of patient safety events experience severe practice and psychological distress, indicating that nursing managers should pay attention to psychological and practice distress of nurses after patient safety events and provide effective preventive measures.

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.