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Powell MA, Walton AL, Scott SD. Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic. Int J Qual Stud Health Well-being 2024; 19:2355711. [PMID: 38758981 PMCID: PMC11104704 DOI: 10.1080/17482631.2024.2355711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim. METHODS A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles. RESULTS Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings. CONCLUSION Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.
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Affiliation(s)
- Melissa A. Powell
- School of Nursing, Duke University School of Nursing, Durham, NC, USA
| | | | - Susan D. Scott
- MU Health Care, University of Missouri Healthcare, Columbia, MO, USA
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2
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Talcott W, Covington E, Bazan J, Wright JL. The Future of Safety and Quality in Radiation Oncology. Semin Radiat Oncol 2024; 34:433-440. [PMID: 39271278 DOI: 10.1016/j.semradonc.2024.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The increasing complexity of radiation therapy treatment presents new potentials for error and suboptimal care. High-performing programs thus not only require adherence to, but also ongoing improvement of, key safety and quality practices. In this article, we review these practices including standardization, risk analysis, peer review, and maintenance of strong safety culture, while also describing recent innovations and promising future directions. We specifically highlight the growing role of artificial intelligence in radiation oncology, both as a tool to deliver safe, high-quality care and as a potential new source of safety challenges.
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Affiliation(s)
- Wesley Talcott
- Northwell Health Department of Radiation Oncology, New York, NY
| | | | - Jose Bazan
- City of Hope Comprehensive Cancer Center, Department of Radiation Oncology, Duarte, CA
| | - Jean L Wright
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD.
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3
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Gonzales PA, Coopersmith AS, Kaushik D, Lebares C, Malotte M, Taylor JM, Pierorazio PM. A mindful approach to complications: Brief review of the literature and practical guide for the surgeon. Urol Oncol 2024; 42:302-309. [PMID: 38845297 DOI: 10.1016/j.urolonc.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/18/2024] [Indexed: 07/27/2024]
Abstract
Patient complications and adverse outcomes are inherent to surgical practice and training. In addition to the impact on patients, there are profound and well-documented impacts of complications on surgeons, surgical trainees, and surgical teams. This manuscript reviews the literature regarding mindfulness-based practices and the associated mitigation of the adverse impact of complications. These mindfulness-based practices prepare surgeons for complications by improving mental and cognitive resilience facilitating more effective management of complications that avoids undue psychological and emotional stress. Practical recommendations are provided for the practicing surgeon from providers experienced in mindfulness-based training and preparation.
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Affiliation(s)
- Paul Adam Gonzales
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Ari S Coopersmith
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Dharam Kaushik
- Department of Urology, Houston Methodist, 6560 Fannin St # 2100, Houston, TX 77030
| | - Carter Lebares
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Michael Malotte
- UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Jennifer M Taylor
- Department of Urology, Baylor College of Medicine, 7200 Cambridge St Ste 10B, Houston TX 7703
| | - Phillip M Pierorazio
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine, 51 N. 39th Street, Suite 300 MOB, Philadelphia PA 19104.
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Norvell M, Connors CA, Wu AW. Confronting the inevitable: When a urologist feels like a second victim. Urol Oncol 2024; 42:315-318. [PMID: 38971673 DOI: 10.1016/j.urolonc.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/09/2024] [Indexed: 07/08/2024]
Abstract
There are many opportunities for urologists to be emotionally impacted, and possibly injured, in the regular course of their work. In particular, urologists are vulnerable to become Second Victims as a result of errors, adverse events, and distressing clinical events. This article reviews best practices that individuals, training programs, hospitals, and healthcare systems can implement to intentionally and programmatically mitigate the short and long-term effects on healthcare professionals.
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Affiliation(s)
- Matt Norvell
- Department of Spiritual Care and Chaplaincy, Johns Hopkins Hospital, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
| | - Cheryl A Connors
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD; Johns Hopkins Medicine, Baltimore, MD
| | - Albert W Wu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD; Johns Hopkins University School of Medicine, Johns Hopkins Medicine, Baltimore, MD.
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Scrimgeour G, Turner K. Hospital and departmental level strategies for managing the impact of adverse events on surgeons. Urol Oncol 2024; 42:310-314. [PMID: 38514276 DOI: 10.1016/j.urolonc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
Adverse events have a profound impact on surgeons. This impact extends to physical and mental health, psychological wellbeing, and professional performance. Surgeons are ill prepared for these consequences of adverse events and are under-supported when they inevitably occur. Here we review the data on how adverse events affect surgeons. We explore the efforts made to date to both prepare surgeons before and support them after such events and we make recommendations regarding how this should and could be done better.
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Affiliation(s)
- Gemma Scrimgeour
- Department of Urology, Royal Bournemouth Hospital, University Hospitals Dorset, Castle Lane East, Bournemouth, UK
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Prakash G, Peters CE, Badalato G, Hampson LA, Raman JD, Bagrodia A. Complications and Surgeon Health: Resources for individuals and institutions. Urol Oncol 2024; 42:296-301. [PMID: 38594152 DOI: 10.1016/j.urolonc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 04/11/2024]
Abstract
The emotional impact of surgical complications on urologists is a significant yet historically under-addressed issue. Traditionally, surgeons have been expected to cope with complications and their psychological effects in silence, perpetuating a culture of perfectionism and 'silent suffering.' This has left many unprepared to handle the emotional toll of adverse events during their training and early careers. Recognizing the gap in structured education on this matter, there is a growing movement to openly address and educate on the emotional consequences of surgical complications. This article underscores the importance of such educational initiatives in the mid-career phase, proposing strategies to promote surgeon health, and psychological safety. It advocates for utilizing Morbidity and Mortality conferences as platforms for peer support, learning from 'near miss' events, and encourages at least annual department-wide discussions to raise awareness and normalize the emotional challenges faced by surgeons. Furthermore, it highlights the role of formal peer support programs, acceptance and commitment therapy, and resilience training as vital tools for promoting surgeon well-being. Resources from various organizations, including the American Urological Association and the American Medical Association, are now available to facilitate these critical conversations. By integrating these resources and encouraging a culture of openness and support, the article suggests that the surgical community can better manage the inevitable emotional ramifications of complications, thereby fostering resilience and reducing burnout among surgeons.
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Affiliation(s)
- Gagan Prakash
- Tata Memorial Hospital, Department of Urology, Mumbai, India
| | - Chloe E Peters
- University of Washington, Department of Urology, Seattle WA
| | - Gina Badalato
- Columbia University, Department of Urology, New York, NY
| | - Lindsay A Hampson
- University of California, San Francisco, Department of Urology, California
| | - Jay D Raman
- Penn State Health, Department of Urology, Hershey PA
| | - Aditya Bagrodia
- University of California, San Diego, Department of Urology, La Jolla, CA; University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX.
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Strametz R, Mira JJ, Sousa P. The second victim phenomenon: comprehensive support and systemic change in healthcare. Int J Qual Health Care 2024; 36:0. [PMID: 39252590 DOI: 10.1093/intqhc/mzae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/04/2024] [Indexed: 09/11/2024] Open
Affiliation(s)
- Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - José Joaquin Mira
- Alicante-Sant Joan Healthcare District, Alicante, Spain
- Miguel Hernandez University, Elche, Spain
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA, University Lisbon, Lisbon, Portugal
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Powell MA, Oyesanya TO, Scott SD, Allen DH, Walton A. Traumatised Nurses' Desired Support Needs for Continued Recovery After the COVID-19 Pandemic: A Qualitative Descriptive Study Utilising Photovoice. J Adv Nurs 2024. [PMID: 39253764 DOI: 10.1111/jan.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/30/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024]
Abstract
AIMS The aims of this study were to describe the experiences of nurses in the aftermath of the COVID-19 pandemic and to explore nurses' current desired support needs. DESIGN This study used a qualitative descriptive design. METHODS This study was conducted in the Southeastern United States at an academic health system encompassing acute care hospitals and outpatient speciality clinics. Thirteen nurses were interviewed in August and September of 2023 in five small groups of two or three nurses. Photovoice was used for data collection and each nurse submitted two photographs. Data were analysed utilising conventional content analysis, with transcripts and photograph analysis occurring concurrently. RESULTS Three themes were identified: (1) organisational turmoil, (2) personal traumatisation and transitions and (3) striving for revival and renewal. A conceptual model illustrating the three themes and their relationships was developed to depict study findings. CONCLUSION Nurses were impacted by organisational factors, such as staffing issues and lack of support, and personally through psychological trauma that has remained challenging. Nurses found revival and renewal in their personal lives, but still desire continued improvement in organisational factors to enhance their well-being in ways not currently being addressed to allow for full recovery. Findings from this study are pertinent for healthcare organisations and leaders to develop organisational changes and mental health solutions to support nurse well-being. IMPLICATIONS FOR THE PROFESSION The prioritisation of nurse well-being is critical for the nursing profession and healthcare organisations. Organisational improvements and the implementation of support resources are urgently needed to aid in nurse recovery, nurse retention and to ensure patients receive quality care. IMPACT This study identified nurses' struggles 3 years after the beginning of the COVID-19 pandemic, highlighting the ongoing need to provide resources and interventions that support nurse well-being. Our findings offer nurses' descriptions of their experiences and support needs for organisations and healthcare leaders to consider in the future. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR) Checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Tolu O Oyesanya
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Susan D Scott
- Sinclair School of Nursing, University of Missouri Healthcare, Columbia, Missouri, USA
| | | | - AnnMarie Walton
- Duke University School of Nursing, Durham, North Carolina, USA
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Fall F, Hu YY, Walker S, Baertschiger R, Gaffar I, Saltzman D, Stylianos S, Shapiro J, Wieck M, Buchmiller T, Brandt ML, Tracy T, Heiss K, Berman L. Peer Support to Promote Surgeon Well-being: The APSA Program Experience. J Pediatr Surg 2024; 59:1665-1671. [PMID: 38272766 DOI: 10.1016/j.jpedsurg.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Peer support programs have evolved to train physicians to provide outreach and emotional first aid to their colleagues when they experience the inevitable challenge of a serious adverse event, whether or not it is related to a medical error. Most pediatric surgeons have experienced the trauma of a medical error, yet, in a survey of APSA membership, almost half said that no one reached out to them, and few were satisfied with their institution's response to the error. Thus, the APSA Wellness Committee developed an APSA-based peer support program to meet this need. METHODS Peer supporters were nominated by fellow APSA members, and the group was vetted to ensure diversity in demographics, practice setting, and seniority. Formal virtual training was conducted before the program went live in 2020. Trained supporters were surveyed 6 months after the program launched to evaluate their experiences with providing peer support. RESULTS 15 referrals were made in the first year, 60 % of which were self-initiated. Most referrals were for distress related to adverse events or toxic work environments (33 % each). While only about 25 % of trained supporters had provided formal support through the APSA program, more than 80 % reported using the skills to support colleagues and trainees within their own institutions. CONCLUSION Our experience in the first year of the APSA peer support program demonstrates the feasibility of building and maintaining a national program to provide emotional first aid by a professional society to expand the safety net for surgeons who are suffering.
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Affiliation(s)
- Fari Fall
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA; Department of General Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yue Yung Hu
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sarah Walker
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Reto Baertschiger
- Division of Pediatric Surgery, Department of Surgery, Dartmouth Health Children's Hospital, Lebanon, NH, USA
| | | | - Daniel Saltzman
- Department of Surgery, Division of Pediatric Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Steven Stylianos
- Division of Pediatric Surgery, Columbia University Vagelos College of Physicians & Surgeons and NYP-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jo Shapiro
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Minna Wieck
- Department of Pediatric Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA
| | - Terry Buchmiller
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mary L Brandt
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Thomas Tracy
- Executive Director, American Pediatric Surgical Association, East Dundee, IL, USA
| | - Kurt Heiss
- Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA; Department of General Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Bushuven S, Trifunovic-Koenig M, Klemm V, Diesener P, Haller S, Strametz R. The "Double Victim Phenomenon": Results From a National Pilot Survey on Second Victims in German Family Caregivers (SeViD-VI Study). J Patient Saf 2024; 20:410-419. [PMID: 39051764 DOI: 10.1097/pts.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Second-victim phenomena may lead to severe reactions like depression or posttraumatic disorder, as well as dysfunction and absenteeism. Medical error as a cause for second victims is not limited to professionals, as family caregivers care for millions of patients at home. It remains unclear whether these are first, second, or double victims in case of error. This explorative study investigated whether second victim effects and signs of moral injury are detectable in family caregivers and whether existing instruments are applicable in lay persons. METHODS In an open convenience sampling online survey, we recruited 66 German family caregivers. Propensity score matching was conducted to obtain a balanced sample of family caregivers and qualified nurses who took part in the previous study by adjusting for age and sex. The groups were compared regarding the German Version of the Second Victim Experience and Support Tool-Revised and the German version of the Moral Injury Symptom and Support Scale for Health Professionals. RESULTS Sixty-six caregivers participated, of whom 31 completed the survey. Of all, 58% experienced a second victim-like effect, 35% experienced a prolonged effect, and 45% reported to still suffer from it. In a matched sample (22 family caregivers and 22 nurses), no significant differences were observed between the groups. DISCUSSION Regarding the limitations of this pilot study, demanding for resampling in larger populations, we could show that second victim effects and moral injury are detectable in family caregivers by validated instruments and are not inferior to professionals' experiences. Concerning the demand for further studies, we confirmed the applicability of the testing instruments but with need for item reduction to lower response burden.
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Affiliation(s)
| | | | - Victoria Klemm
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, Rhein-Main University of Applied Sciences, Wiesbaden, Germany
| | - Paul Diesener
- Hegau Jugendwerk Gailingen, Health Care Association District of Constance, Gailingen, Germany, Health Care Association District of Constance
| | - Susanne Haller
- Elisabeth-Kuebler-Ross Academy Stuttgart, Hospice Stuttgart, Stuttgart, Germany
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, Rhein-Main University of Applied Sciences, Wiesbaden, Germany
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Johnson B, New L, Ballister M, Brown C, Scott S. Implementing a Peer Support Program for Second Victims. Am J Nurs 2024; 124:44-52. [PMID: 39185983 DOI: 10.1097/01.naj.0001050816.14247.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
ABSTRACT The second victim phenomenon describes the distress frequently experienced by health care providers after an unintentional medical error or unexpected adverse event. However, few health care institutions have initiatives that proactively address this phenomenon. The pilot project discussed in this article aimed to create a peer support program for health care providers experiencing the second victim phenomenon. The project team validated the need for such a program among health care providers in the perioperative departments of two facilities within a large health care organization in the southeastern United States. To do this, they used a survey, the Second Victim Experience and Support Tool. Among survey respondents in the two departments, 80% and 87.6% indicated a strong desire to discuss their emotional challenges with a respected peer colleague after a traumatic event. The project team then developed and implemented a peer support program in three phases to 1) educate staff across the facility on second victimization, 2) recruit and train volunteer peer supporters, and 3) launch the pilot program by embedding these peer supporters in the two perioperative departments. A survey completed by participants in the pilot program showed that 80% of respondents found the peer support extremely beneficial, 20% found it very beneficial, and 100% would recommend peer support to a colleague. This successful pilot project could inform the establishment of peer support programs at other institutions to assist health care providers experiencing the second victim phenomenon.
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Affiliation(s)
- Bernadette Johnson
- Bernadette Johnson is assistant professor, assistant program director, and clinical director of the Medical University of South Carolina (MUSC) Nurse Anesthesia Program, Charleston, SC. Luci New is assistant professor and associate director of clinical education in the Department of Academic Nursing, Wake Forest University School of Medicine, Winston-Salem, NC. Michele Ballister is a staff certified registered nurse anesthetist (CRNA) at the MUSC, Charleston, SC. Courtney Brown is a staff CRNA III at Novant Health Forsyth Medical Center, Winston-Salem, NC. Susan Scott is adjunct associate professor at the University of Missouri-St Louis, Columbia, MO. Contact author: Bernadette Johnson, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Guerra-Paiva S, Mira JJ, Strametz R, Fernandes J, Klemm V, Madarasova Geckova A, Knezevic B, Potura E, Buttigieg S, Carrillo I, Sousa P. Application and Evaluation of a Multimodal Training on the Second Victim Phenomenon at the European Researchers' Network Working on Second Victims Training School: Mixed Methods Study. JMIR Form Res 2024; 8:e58727. [PMID: 39213524 DOI: 10.2196/58727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs' well-being and ultimately improve the quality of care and patient safety. OBJECTIVE This study aims to describe and evaluate a multimodal training organized by the European Researchers' Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. METHODS We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. RESULTS Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants' satisfaction increased, particularly when adjusting the allocated time for the case studies' discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team. CONCLUSIONS This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts.
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Affiliation(s)
- Sofia Guerra-Paiva
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - José Joaquín Mira
- Alicante-Sant Joan Health District, Alicante, Spain
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Joana Fernandes
- NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
| | - Victoria Klemm
- Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University, Bratislava, Slovakia
| | - Bojana Knezevic
- Department for Quality Assurance and Improvement in Health Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Eva Potura
- Gesundheit Österreich GmbH, Bundesinstitut für Qualität im Gesundheitswesen, Vienna, Austria
| | - Sandra Buttigieg
- Department of Health Systems Management and Leadership, Faculty of Health Sciences,University of Malta, Malta, Malta
| | - Irene Carrillo
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Huang H, Liu T, Peng Y, Du X, Huang Q, Zhao Q, Xiao M, Luo Y, Zheng S. "Learn from Errors": Post-traumatic growth among second victims. BMC Public Health 2024; 24:2330. [PMID: 39198793 PMCID: PMC11350947 DOI: 10.1186/s12889-024-19738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
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.
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Affiliation(s)
- Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Tong Liu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ying Peng
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xingyao Du
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Huang
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yetao Luo
- Department of Nosocomial Infection Control, Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
| | - Shuangjiang Zheng
- Department of Medical Affairs, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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14
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Zhang C, Yang Z, Liang Y, Feng Y, Zhang X. A qualitative study of head nurses' experience in China: forced growth during patient safety incidents. BMC Nurs 2024; 23:592. [PMID: 39183276 PMCID: PMC11346293 DOI: 10.1186/s12912-024-02255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND In patient safety accidents, nurse managers are indirectly victimized by the pressures from many aspects and become the second victim. This study delves into the experiences of nurse managers in China, aiming to uncover their cognition and provide reference for relevant managers. METHODS A descriptive phenomenological approach was used to gain insight into the inner reality of nurse leaders' experiences and management perceptions of experiencing patient safety incidents. The data of 15 nurse leaders who experienced patient safety incidents in Bethune Hospital, Shanxi Province, China, were collected via face‒to‒face semi-structured interviews, and the data were analyzed via the 7-step analysis method of Colaizzi. RESULTS On the basis of the content of the interviews, three themes were identified, the emotional experience of experiencing patient safety events, role dilemmas, the obstruction and conceptual reshaping of nursing management. Eight subthemes as follows: physical and mental health-related symptoms due to passive coping and life and work disorder, self-relief, playing multiple roles with lack of role adjustment ability, blurred role positioning and initial signs of job burnout, event replay is impeded, Inaccurate analysis of safety incidents, subversion and remolding of the nursing management concept. Finally, it can be abstracted as "forced growth in patient safety events". CONCLUSION Patient safety incidents can lead to negative impacts, role dilemmas, and management confusion for head nurses, but they also promote purposeful rumination, meditation, and growth. Medical institutions should pay attention to special groups that are second victims of head nurses and construct a safety event support system for nurse leaders to improve the post-training and education system for nurse leaders, help them better adapt to their roles, break through their role dilemmas, improve their post-competence, and construct an effective safety event management system.
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Affiliation(s)
- Cuiling Zhang
- Department of Digestive Oncology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Ziyan Yang
- College of Nursing, Shanxi Medical University, Taiyuan, China
| | - Yali Liang
- Department of Digestive Oncology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong Feng
- College of Nursing, Shanxi University of Chinese Medicine, Taiyuan, China
| | - Xiaohong Zhang
- Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, NO. 99, Longcheng Street, Xiaodian District, Taiyuan, 030032, People's Republic of China.
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15
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Kassam AF, Axelrod DA, Geevarghese SK. Moral injury: An unspoken burden of transplant surgery. Am J Transplant 2024:S1600-6135(24)00498-2. [PMID: 39159721 DOI: 10.1016/j.ajt.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/20/2024] [Accepted: 08/11/2024] [Indexed: 08/21/2024]
Abstract
Moral injury in health care is characterized as the lasting psychological, biological, and social impact on providers that occurs following an adverse patient outcome. Moral injury can contribute to second victim syndrome and lasting psychological harm. Although many surgeons face moral injury due to patient acuity and the potential for intraoperative or postoperative complications, the transplant ecosystem compounds the impact of moral injury. Institutional blame placed on the transplant surgeon following a posttransplant death or graft loss is magnified by public reporting. Centers whose outcomes fall below threshold levels are subject to regulatory citation and financial loss. Moral injury can also result in risk aversion, limiting access to transplants for higher-risk candidates and reducing acceptance of marginal organs hurting donor families. Strategies to increase resilience, reduce accusation and blame, and focus on system quality improvement are vital to mitigate the impact of moral injury on transplant professionals. The transplant community must proactively work to reduce moral injury to protect surgeons, ensure access to life-saving transplant procedures, and avoid unnecessary organ offer declines.
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Affiliation(s)
- Al-Faraaz Kassam
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Axelrod
- Department of Surgery, Division of Organ Transplant, Organ Transplant Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| | - Sunil K Geevarghese
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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16
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Huang RR, Xie YS, Chen GR, Shu LZ, Ding XM, Pan SH. Development and evaluation of a second victim training course for nursing managers. NURSE EDUCATION TODAY 2024; 142:106357. [PMID: 39154593 DOI: 10.1016/j.nedt.2024.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/30/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Most nursing managers are not fully aware of second victims and may not be able to provide support. Moreover, there are relatively few training courses for nursing managers about second victims. AIM To describe the construction and evaluation of a second victim course for nursing managers. DESIGN A single-group pretest-posttest study design was used. SETTING A large comprehensive tertiary hospital with over 3000 beds in China. PARTICIPANTS Forty-nine nursing managers who met the inclusion and exclusion criteria participated in this training. Sixteen clinical frontline nurses who experienced adverse events within three months following the training were also invited. METHODS The course "Second Victim & Empathy Communication" was developed through a literature review and expert consultation and consisted of 4 unit modules: (1) adverse events & second victims, (2) the recovery trajectory of second victims, (3) second victim supportive resources, and (4) key strategies of empathy communication. A course evaluation questionnaire, an empathy communication questionnaire for nursing managers, a second victim evaluation questionnaire, and an open-ended question were used to measure the feasibility, acceptability and effectiveness of the course. RESULTS >97.96 % of the nursing managers were satisfied with the course, >97.96 % had learned new knowledge, and >95.92 % had changed their behavior and attitudes toward second victims. Their levels of empathetic communication differed significantly before and after training (t = -2.170, P = 0.035). Among these nursing managers, twenty-six participants provided positive and meaningful feedback and suggestions to the course by answering an open-ended question. A total of 66.6 % to 100 % of second victims were satisfied with the empathetic communication behavior exhibited by nursing managers. CONCLUSION The second victim training course is feasible and can be used for clinical training to enhance nursing managers' understanding of second victims and enhance their empathetic communication.
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Affiliation(s)
- Rong-Rong Huang
- Department of Burn and Plastic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yu-Sheng Xie
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Gui-Ru Chen
- Department of Infectious Diseases, The People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Aba Tibetan and Qiang Autonomous Prefecture, China.
| | - Ling-Zhi Shu
- Department of Nursing, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiao-Min Ding
- Department of Comprehensive Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shi-Hua Pan
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, China
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17
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Bostock IC, Antonoff MB. Wellness Strategies Among Bad Outcomes and Complications. Thorac Surg Clin 2024; 34:207-212. [PMID: 38944447 DOI: 10.1016/j.thorsurg.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Surgery of the chest is high stakes, and adverse events are common. Given the frequency and severity of such complications, cardiothoracic surgeons are at particularly high risk of becoming second victims. Even though our primary commitment as doctors is to take care of our patients, surgeons may fall into the emotional and intellectual trap of taking on the whole responsibility of a patient's poor outcome. This viewpoint may lead the physician to develop a heightened self-doubt, greater insecurity, and imposter syndrome, further affecting their ability to prevent complications and tackle difficult cases in the future.
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Affiliation(s)
- Ian C Bostock
- Department of Cardiothoracic Surgery, Medical University of South Carolina, 30 Courtenay Drive, Charleston, SC 29425, USA.
| | - Mara B Antonoff
- Division of Surgery, Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1489, Houston, TX 77030, USA
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18
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Luby AO, Chung KC. Shedding Light on Surgeons' Darkest Times: Coping with Errors and Stress in the Silos of a Silent Surgical Culture. Plast Reconstr Surg 2024; 154:261-264. [PMID: 39046835 DOI: 10.1097/prs.0000000000011412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Alexandra O Luby
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
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19
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Adams MA, Bevan C, Booker M, Hartley J, Heazell AE, Montgomery E, Sanford N, Treadwell M, Sandall J. Strengthening open disclosure in maternity services in the English NHS: the DISCERN realist evaluation study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-159. [PMID: 39185618 DOI: 10.3310/ytdf8015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. Objectives To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement. Design A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with study participants. A patient and public involvement strategy underpinned all study phases. Setting National recruitment (study phases 1 and 3); three English maternity services (study phase 2). Participants We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families. Results The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families' own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced. Limitations Research was conducted after the pandemic, with exceptional pressure on services. Case-study ethnography was of three higher performing services: generalisation from case-study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups. Conclusions We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study's findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research. Study registration This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Mary Ann Adams
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Charlotte Bevan
- The Stillbirth and Neonatal Death Charity (SANDS), London, UK
| | | | - Julie Hartley
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | | | - Elsa Montgomery
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
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20
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Catalán L, Alvarado-Peña J, Torres-Soto G, Lorca-Sepúlveda B, Besoain-Cornejo AM, Kappes M. Second victim phenomenon among healthcare students: A scoping review. Nurse Educ Pract 2024; 79:104094. [PMID: 39146810 DOI: 10.1016/j.nepr.2024.104094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/16/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
AIM This study aims to explore the "second victim" phenomenon in healthcare professions students following an adverse event. BACKGROUND In healthcare settings, adverse events affect not only patients but also the involved healthcare personnel, who experience a wide range of physical and psychological responses, a situation known as the second victim phenomenon. This phenomenon also extends to students in health-related professions during their clinical training, yet there needs to be more research specifically addressing this group. DESIGN A scoping review METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. In December 2023, we conducted a comprehensive database search in PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, Web of Science (WoS), Scopus and the Virtual Health Library (VHL). The review included original research studies of any design that focused on the second victim phenomenon among students, published in English, Spanish, German or Portuguese, with no restrictions on the publication date. The review was reported according to PRISMA-ScR guidelines. RESULTS Seven studies were selected, primarily involving nursing and medical students. Common triggers of the second victim phenomenon in students were medication errors, patient falls and procedural errors. Described symptoms ranged from emotional distress, such as stress and hypervigilance, to physical symptoms, like sleep disturbances. Among the factors that influenced how this "second victim" phenomenon manifested in students were the reactions of their peers and the lack of support from supervisors. Contrary to the three possible outcomes described for professionals as second victims (surviving, thriving, or leaving), students are only described with two: giving up or moving on. CONCLUSION The studies highlighted the crucial role of peer and supervisor support in managing such difficult situations. The results suggest that additional research is necessary in other healthcare disciplines. Educational and healthcare institutions should improve their preventive and management strategies to address the phenomenon's impact on students.
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Affiliation(s)
- Lucía Catalán
- Faculty of Healthcare Sciences, Nursing School, Universidad San Sebastián, Santiago, Chile; Faculty of Nursing, Universidad Andres Bello, Santiago, Chile.
| | | | | | | | - Ana-María Besoain-Cornejo
- Faculty of Medicine & Science, Chemistry and Pharmacy School, Universidad San Sebastián, Chile; Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Deu, Esplugues de Llobregat, Spain.
| | - María Kappes
- Faculty of Healthcare Sciences, Nursing School, Universidad San Sebastián, Puerto Montt, Chile.
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21
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Kupkovicova L, Skoumalova I, Madarasova Geckova A, Dankulincova Veselska Z. Medical Professionals' Responses to a Patient Safety Incident in Healthcare. Int J Public Health 2024; 69:1607273. [PMID: 39132384 PMCID: PMC11310029 DOI: 10.3389/ijph.2024.1607273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients' safety (e.g., silence). Five superiors' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.
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Affiliation(s)
- Lucia Kupkovicova
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University, Bratislava, Slovakia
| | - Ivana Skoumalova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Andrea Madarasova Geckova
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University, Bratislava, Slovakia
- Department of Health Psychology and Research Methodology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
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22
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Higgins KE, Vinson AE, Petrini L, Kotha R, Black SA. Embracing Failure: Nurturing Learning and Well-Being in Anesthesiology and Perioperative Medicine. Int Anesthesiol Clin 2024; 62:15-25. [PMID: 38785110 DOI: 10.1097/aia.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Failure, ubiquitous in life and medical practice, offers myriad opportunities for learning and growth alongside challenges to overall well-being. In this article, we explore the nature of failure, it's sources and impacts in perioperative medicine, and the specific challenges it brings to trainee well-being. With a deeper understanding of the societal, psychological and cognitive determinants and effects of failure, we propose solutions in order to harness the opportunities inherent in failures to create brave and supportive learning environments conducive to both education and well-being.
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Affiliation(s)
- K Elliott Higgins
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles
| | - Amy E Vinson
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Laura Petrini
- Department of Anesthesiology, University of Pennsylvania Perelman, School of Medicine
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Rohini Kotha
- Department of Anesthesiology and Oncologic Sciences, Morsani College of Medicine, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida
| | - Stephanie A Black
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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23
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Kappes M, Romero-Garcia M, Sanchez M, Delgado-Hito P. Coping trajectories of intensive care nurses as second victims: A grounded theory. Aust Crit Care 2024; 37:606-613. [PMID: 38360471 DOI: 10.1016/j.aucc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
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.
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Affiliation(s)
- Maria Kappes
- Faculty of Health Care Sciences, Universidad San Sebastian, Puerto Montt, Chile.
| | - Marta Romero-Garcia
- Fundamental and Clinical Nursing Department, Faculty of Nursing, University of Barcelona, Barcelona, Spain; IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Granvia, L'Hospitalet de Llobregat, Spain; International Research Project: HU-CI Project, Collado Villalba, Spain.
| | - Maria Sanchez
- Faculty of Health Care Sciences, Universidad San Sebastian, Puerto Montt, Chile.
| | - Pilar Delgado-Hito
- Fundamental and Clinical Nursing Department, Faculty of Nursing, University of Barcelona, Barcelona, Spain; IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Granvia, L'Hospitalet de Llobregat, Spain; International Research Project: HU-CI Project, Collado Villalba, Spain.
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24
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Albert-Galbis A, Pérez-Cañaveras RM, Vaismoradi M, Vizcaya-Moreno MF. The second victim phenomenon: A qualitative study among bachelor's degree nursing students within the clinical learning environment. Nurse Educ Pract 2024; 78:104038. [PMID: 38936299 DOI: 10.1016/j.nepr.2024.104038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
AIM This study explores and describes the second victim phenomenon in nursing students in association with the characteristics of the clinical learning environment and the clinical supervision process. DESIGN Qualitative design using conventional content analysis and summative content analysis approaches. METHODS From September 2022 to July 2023, in-depth semi-structured individual interviews were conducted with a purposive sample of 10 undergraduate nursing students. RESULTS Six main themes were developed: 'defining the physical and psychological responses after the most significant patient safety incident', 'analyzing the characteristics of patient safety incidents', 'creating a safe learning environment to provide the best care for patients', 'developing mentorship capabilities and qualities for an ideal follow up of students as a second victim', 'providing resources and integrating support structures to second victim nursing students during their clinical learning', and 'considering the cooperation and coordination between the health institution and the higher education institutions.' CONCLUSION Nursing students become second victims during their clinical placement. The clinical learning environment and mentoring characteristics influence the second victim experience.
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Affiliation(s)
| | - Rosa M Pérez-Cañaveras
- Clinical Nursing Research Group. Department of Nursing, Faculty of Health Sciences, University of Alicante, Spain
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway; Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
| | - M Flores Vizcaya-Moreno
- Clinical Nursing Research Group. Department of Nursing, Faculty of Health Sciences, University of Alicante, Spain.
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25
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Mahat S, Lehmusto H, Rafferty AM, Vehviläinen-Julkunen K, Mikkonen S, Härkänen M. Impact of second victim distress on healthcare professionals' intent to leave, absenteeism and resilience: A mediation model of organizational support. J Adv Nurs 2024. [PMID: 38896051 DOI: 10.1111/jan.16291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/21/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
AIMS To examine the relationship between the second victim distress and outcome variables, specifically: 'turnover intentions, absenteeism and resilience'. Furthermore, this study also assessed how organizational support mediates the relationship between second victim distress and outcome variables. DESIGN Cross-sectional survey. METHODS A cross-sectional survey study using regression and mediation analysis with bootstrapping was conducted among (n = 149) healthcare professionals in two university hospitals in Finland from September 2022 to April 2023 during different time periods. The Finnish version of the revised Second Victim Experience and Support Tool (FI-SVEST-R) was used to assess second victim distress, level of organizational support and related outcomes. RESULTS Psychological distress was the most frequently experienced form of reported second victim distress, and institutional support was the lowest perceived form of support by healthcare professionals. The study found second victim distress to have a significant association with work-related outcomes: turnover intention and absenteeism. However, no significant relationship was found with resilience. Mediation models with organizational support revealed a partially mediated relationship between second victim distress and work-related outcomes. CONCLUSIONS The findings from this study indicate that second victim experiences if not adequately addressed can lead to negative work-related outcomes such as increased job turnover and absenteeism. Such outcomes not only affect healthcare professionals but can also have a cascading effect on the quality of care. However, the mediating effect of organizational support suggests that if comprehensive support is provided, it is possible to mitigate the negative impact of the second victim phenomenon. IMPACT Raising awareness regarding the second victim phenomenon, promoting a culture of safety and shifting the paradigm from a blame to just culture helps in identifying the system flaws thus improving both patient and provider safety. REPORTING METHOD The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sanu Mahat
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Helena Lehmusto
- Jorvi Hospital, Helsinki University Hospital Pharmacy, Espoo, Finland
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Santtu Mikkonen
- Department of Environmental and Biological Sciences, Faculty of Science, Forestry and Technology, University of Eastern Finland, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Wellbeing Services County of North Savo, Research Centre for Nursing Science and Social and Health Management, Kuopio University Hospital, Kuopio, Finland
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26
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Roesner H, Neusius T, Strametz R, Mira JJ. Economic Value of Peer Support Program in German Hospitals. Int J Public Health 2024; 69:1607218. [PMID: 38939515 PMCID: PMC11208334 DOI: 10.3389/ijph.2024.1607218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
Objectives Acknowledging peer support as the cornerstone in mitigating the psychosocial burden arising from the second victim phenomenon, this study assesses the economic benefits of a Peer Support Program (PSP), compared to data of the Resilience In Stressful Events (RISE) program in the US, within the acute inpatient care sector in Germany. Methods Employing a Markov model, this economic evaluation analyzes the cost benefits, including sick day and dropout costs, over a 1-year period, comparing scenarios with and without the Peer Support Program from a hospital perspective. The costs were calculated as an example based on a hospital with 1,000 employees. The estimations are considered conservative. Results The anticipated outcomes demonstrate an average cost saving of €6,672 per healthcare worker participating in the Peer Support Program, leading to an annual budgetary impact of approximately €6,67 Mio. for the studied hospital. Conclusion The integration of a PSP proves economically advantageous for German hospitals, not only preserving financial resources but also reducing absenteeism, and mitigating turnover, thereby enhancing overall patient care.
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Affiliation(s)
- Hannah Roesner
- Hochschule RheinMain, Wiesbaden, Germany
- Miguel Hernández University of Elche, Elche, Spain
| | | | | | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
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Brunelli MV, Seisdedos MG, Maluenda Martinez M. Second Victim Experience: A Dynamic Process Conditioned by the Environment. A Qualitative Research. Int J Public Health 2024; 69:1607399. [PMID: 38939516 PMCID: PMC11208313 DOI: 10.3389/ijph.2024.1607399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
Objectives When adverse events (AE) occur, there are different consequences for healthcare professionals. The environment in which professionals work can influence the experience. This study aims to explore the experiences of second victims (SV) among health professionals in Argentina. Methods A phenomenological study was used with in-depth interviews with healthcare professionals. Audio recordings and verbatim transcriptions were analyzed independently for themes, subthemes, and codes. Results Three main themes emerged from the analysis: navigating the experience, the environment, and the turning point. Subthemes were identified for navigating the experience to describe the process: receiving the impact, transition, and taking action. Conclusion SVs undergo a process after an AE. The environment is part of this experience. It is a turning point in SVs' professional and personal lives. Improving the psychological safety (PS) environment is essential for ensuring the safety of SVs.
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Affiliation(s)
- Maria Victoria Brunelli
- Escuela de Enfermería, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina
| | - Mariana Graciela Seisdedos
- Departamento de Calidad y Seguridad del Paciente, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Maria Maluenda Martinez
- Escuela de Enfermería, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina
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Järvisalo P, Haatainen K, Von Bonsdorff M, Turunen H, Härkänen M. Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions. J Adv Nurs 2024; 80:2552-2565. [PMID: 38071607 DOI: 10.1111/jan.16013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIMS To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them. DESIGN A qualitative study using interviews. METHODS A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis. RESULTS The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture. CONCLUSION Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety. IMPACT Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work. REPORTING METHOD COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.
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Affiliation(s)
- Paula Järvisalo
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Haatainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Monika Von Bonsdorff
- Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Buchanan K, Ross C, Bloxsome D, Hocking J, Bayes S. Development of a Midwifery Student Peer Debriefing Tool: An interpretive descriptive study. NURSE EDUCATION TODAY 2024; 137:106167. [PMID: 38513304 DOI: 10.1016/j.nedt.2024.106167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Psychosocial traumatisation associated with giving birth, can occur in those present with the woman giving birth, a phenomenon known as vicarious trauma. It has been identified that there are currently no interventions available for midwifery students who have experienced vicarious trauma following difficult birth experiences. OBJECTIVE To explore whether the counselling intervention developed by Gamble et al. (2005), can be adapted for midwifery students to be appropriately and feasibly used as a counselling intervention with peers who have experienced midwifery practice-related vicarious trauma. DESIGN Interpretive descriptive methodology. SETTING This study was set at two Australian universities from which pre-registration midwifery courses are delivered. PARTICIPANTS The work of reviewing the original tool and adapting it for use by and with midwifery students associated with this project was conducted by a key stakeholder group of seven representative midwifery students and five midwifery academics. METHODS Ethics were approved. Data were collected via one face to face and two online conversations using the Microsoft Teams™ platform. Reflexive Thematic analysis were applied to revise the tool following each round of data collection and to finalise the adaptation of the intervention for its new intended purpose. RESULTS The Midwifery Student Peer Debriefing Tool is presented as a six-step intervention that guides the midwifery student through a process of debriefing with their peer. The feasibility of the tool resulted in an overarching theme labelled "I want this to mean something" and captures the therapeutic power of peer debriefing toward a meaningful outcome that fostered growth, and a deeper understanding of the profession. CONCLUSION Vicarious trauma is widely recognised as a core reason for midwives and midwifery students leaving the workforce. The peer debriefing tool helps midwifery students move through the process of recovering from adversity but also fostered learnings about midwifery practice and the profession.
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Affiliation(s)
- Kate Buchanan
- Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia; Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia.
| | - Carolyn Ross
- Australian Catholic University, 8 - 14 Brunswick St, Fitzroy VIC 3065, Australia.
| | - Dianne Bloxsome
- Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia.
| | - Jen Hocking
- Australian Catholic University, 8 - 14 Brunswick St, Fitzroy VIC 3065, Australia.
| | - Sara Bayes
- Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia; Australian Catholic University, 8 - 14 Brunswick St, Fitzroy VIC 3065, Australia; Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia.
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Zvonar I, Jauregui J, Welsh LA. Posttraumatic growth for long-term success: Organizational strategies for supporting residents after medical error. AEM EDUCATION AND TRAINING 2024; 8:e10991. [PMID: 38765710 PMCID: PMC11099761 DOI: 10.1002/aet2.10991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Ivan Zvonar
- Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Joshua Jauregui
- Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Laura A. Welsh
- Emergency Medicine at the Chobanian & Avedisian School of MedicineBoston UniversityBostonMassachusettsUSA
- Boston Medical Center Emergency Medicine Residency ProgramBostonMassachusettsUSA
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Gold P, Arshi A. Dealing With Complications as a Young Surgeon. Arthroplast Today 2024; 27:101419. [PMID: 39071839 PMCID: PMC11282428 DOI: 10.1016/j.artd.2024.101419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/30/2024] [Accepted: 04/28/2024] [Indexed: 07/30/2024] Open
Abstract
Rewarding and honorable, yet challenging and humbling, this is our chosen profession. No matter how robust of a residency and fellowship training we have had or how impactful our mentors have been, nothing can truly prepare us for dealing with complications as new attendings.
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Affiliation(s)
- Pete Gold
- Department of Adult Reconstuction, Panorama Orthopaedic and Spine Center, Golden, CO, USA
| | - Armin Arshi
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Bursch B, Ziv K, Marchese S, Aralis H, Bufford T, Lester P. Department of Anesthesiology Skilled Peer Support Program Outcomes: Second Victim Perceptions. Jt Comm J Qual Patient Saf 2024; 50:442-448. [PMID: 38556442 DOI: 10.1016/j.jcjq.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP. METHODS An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program. RESULTS There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement "I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again" at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01-15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9-22.5). CONCLUSION Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.
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Huang L, Riggan KA, Torbenson VE, Osborne AK, Chesak SS, Finney RE, Allyse MA, Rivera-Chiauzzi EY. Second Victim Experiences of Health Care Learners and the Influence of the Training Environment on Postevent Adaptation. Mayo Clin Proc Innov Qual Outcomes 2024; 8:232-240. [PMID: 38708189 PMCID: PMC11068502 DOI: 10.1016/j.mayocpiqo.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Objective To investigate the experience of medical and graduate learners with second victim experience (SVE) after medical errors or adverse patient outcomes, including impact on training and identification of factors that shape their postevent recovery. Patients and Methods The validated Second Victim Experience and Support Tool-Revised (SVEST-R), Physician Well-Being Index, and supplemental open-ended questions were administered to multidisciplinary health care learners between April 8, 2022, and May 30, 2022, across a large academic health institution. Open-ended responses were qualitatively analyzed for iterative themes related to impact of SVE on the training experience. Results Of the 206 survey respondents, 144 answered at least 1 open-ended question, with 62.1% (n=91) reporting at least 1 SVE. Participants discussed a wide range of SVEs and indicated that their postevent response was influenced by their training environment. Lack of support from supervisors and staff exacerbated high stress situations. Some trainees felt blamed and unsupported after a traumatic experience. Others emphasized that positive training experiences and supportive supervisors helped them grow and regain confidence. Learners described postevent processing strategies helpful to their recovery. Some, however, felt disincentivized from seeking support. Conclusion This multidisciplinary study of learners found that the training environment was influential in postevent recovery. Our findings support the need for the inclusion of education on SVEs and adaptive coping mechanisms as part of health care professional educational curriculums. Educators and health care staff may benefit from enhanced education on best practices to support trainees after stressful or traumatic patient events.
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Affiliation(s)
- Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | | | | | - Alayna K. Osborne
- Division of Community and Employee Engagement, Mayo Clinic Health System–Southwest Minnesota region, Mankato, MN
| | | | - Robyn E. Finney
- Department of Anesthesiology and Perioperative Medicine and Healing the Emotional Lives of Peers Program, Mayo Clinic, Rochester, MN
| | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo, q1Clinic, Rochester, MN
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
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Shao Y, Shan X, Li S, Zhang X, Chi K, Xu Y, Wei H. Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses. Nurs Res 2024; 73:E21-E30. [PMID: 38300627 DOI: 10.1097/nnr.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
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.
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Yaow CYL, Ng QX, Chong RIH, Ong C, Chong NZY, Yap NLX, Hong ASY, Tan BKT, Loh AHP, Wong ASY, Tan HK. Intraoperative adverse events among surgeons in Singapore: a multicentre cross-sectional study on impact and support. BMC Health Serv Res 2024; 24:512. [PMID: 38659030 PMCID: PMC11040834 DOI: 10.1186/s12913-024-10998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND It is known that many surgeons encounter intraoperative adverse events which can result in Second Victim Syndrome (SVS), with significant detriment to their emotional and physical health. There is, however, a paucity of Asian studies in this space. The present study thus aimed to explore the degree to which the experience of an adverse event is common among surgeons in Singapore, as well as its impact, and factors affecting their responses and perceived support systems. METHODS A self-administered survey was sent to surgeons at four large tertiary hospitals. The 42-item questionnaire used a systematic closed and open approach, to assess: Personal experience with intraoperative adverse events, emotional, psychological and physical impact of these events and perceived support systems. RESULTS The response rate was 57.5% (n = 196). Most respondents were male (54.8%), between 35 and 44 years old, and holding the senior consultant position. In the past 12 months alone, 68.9% recalled an adverse event. The emotional impact was significant, including sadness (63.1%), guilt (53.1%) and anxiety (45.4%). Speaking to colleagues was the most helpful support source (66.7%) and almost all surgeons did not receive counselling (93.3%), with the majority deeming it unnecessary (72.2%). Notably, 68.1% of the surgeons had positive takeaways, gaining new insight and improving vigilance towards errors. Both gender and surgeon experience did not affect the likelihood of errors and emotional impact, but more experienced surgeons were less likely to have positive takeaways (p = 0.035). Individuals may become advocates for patient safety, while simultaneously championing the cause of psychological support for others. CONCLUSIONS Intraoperative adverse events are prevalent and its emotional impact is significant, regardless of the surgeon's experience or gender. While colleagues and peer discussions are a pillar of support, healthcare institutions should do more to address the impact and ensuing consequences.
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Affiliation(s)
- Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| | - Ryan Ian Houe Chong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nicolette Zy-Yin Chong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole Li Xian Yap
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ashley Shuen Ying Hong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
- Singhealth Duke-NUS Global Health Institute, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States
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Rodriguez-Ruiz E, van Mol MMC, Latour JM, Fuest K. Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety. Med Intensiva 2024:S2173-5727(24)00061-4. [PMID: 38594110 DOI: 10.1016/j.medine.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.
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Affiliation(s)
- Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Joseph Maria Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; Curtin School of Nursing, Curtin University, Perth, Australia; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kristina Fuest
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ismaninger Str. 22, 81675 Munich, Germany
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Madan R, Das N, Patley R, Nagpal N, Malik Y, Math SB. Consequences of medical negligence and litigations on health care providers - A narrative review. Indian J Psychiatry 2024; 66:317-325. [PMID: 38778854 PMCID: PMC11107921 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_799_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
Medical professionals face high stress due to the type of work they do and the prolonged working hours. Frequent burnout results due to the challenging nature of their work. Added to the stress of work, malpractice lawsuits add to their burden. In India, most doctors work in compromised settings with poor infrastructure and manpower but are expected to follow the best practices. In court, they are judged with the Bolam and Bolitho tests being essential considerations. Several tragic incidents have been reported, including depression, anger issues, and even suicide deaths of healthcare professionals (HCPs) after accusations of negligence and subsequent inquiry. Such incidents demonstrate the multitude of challenges an HCP faces in day-to-day practice. It is crucial to find ways to tackle these problems and enhance the capacity of HCP to handle such demanding circumstances. Malpractice litigation can significantly impact the mental health of HCPs. It is common to experience emotional turmoil when faced with a lawsuit. Second victim syndrome (SVS) is a term used to describe a set of symptoms experienced by HCPs who make an error leading to injury to a patient. However, it also happens if he is traumatized by the consequences of violence during healthcare services or a lawsuit or defamation article in newspaper/social media. Following a litigation crisis in their career, many HCPs go through various stages of grief, including shock, denial, anger, bargaining, depression, and acceptance. At times, death by suicide of the HCPs is well known. SVS is known to profoundly affect the personal, family, economic, professional (defensive practice), and social life of HCPs. HCPs should accept the allegations of negligence as an occupational hazard and prepare for the eventual litigation at least once in a lifetime by knowing about the medical laws, HCP's rights, becoming aware of the emotional turmoil of the lawsuit, preparing to cope with the lawsuit, and seeking help from colleagues and indemnity insurance. Frequent training of the HCPs is strongly recommended to know about the changing laws and also to undergo periodic professional competence enhancement to reduce the incidents of errors amounting to medical negligence. Medical and hospital administration should debrief after any incident and conduct internal investigations to identify systemic flaws and prevent future recurrence, resolve issues within their control at their level, and manage media (mainstream and social media) appropriately. If established, a reporting system with online and offline services will ease the internal administrative investigation process and take appropriate, timely actions. During the crisis, HCPs should have adequate and appropriate insurance or indemnity coverage and mental health support systems.
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Affiliation(s)
- R Madan
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nileswar Das
- Department of Psychiatry, Goldman Sachs-NIMHANS Mental Health Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rahul Patley
- Department of Psychiatry, Goldman Sachs-NIMHANS Mental Health Program, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Neeraj Nagpal
- Managing Director, MLAG Indemnity, New Sunny Enclave, Mohali, Punjab, India
- Hope Gastrointestinal Diagnostic Clinic, New Sunny Enclave, Mohali, Punjab, India
| | - Yogender Malik
- Ethics and Medical Registration Board, National Medical Commission (NMC), Government of India, Sonipat, Haryana, India
- Forensic Medicine and Toxicology, Bhagat Phool Singh Government Medical College, Khanpur Kalan, Sonipat, Haryana, India
| | - Suresh B. Math
- Department Psychiatry, Forensic Psychiatry Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Choi SH, Yan TD, Misskey J, Chen JC. The Emotional Impact and Coping Mechanisms Following Adverse Patient Events Among Canadian Vascular Surgeons and Trainees. Vasc Endovascular Surg 2024; 58:294-301. [PMID: 37878392 DOI: 10.1177/15385744231209914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND This study's objective is to evaluate the emotional experiences, coping mechanisms, and support resources for Canadian vascular surgeons and trainees following an adverse patient event or near miss. METHODS This is a cross-sectional survey study of all Canadian Society for Vascular Surgery (CSVS) members from October to November 2021. We collected data on participant experiences with adverse events, their emotional responses, the coping mechanisms used, and their perceptions on available support resources. RESULTS The survey was sent to 233 CSVS members yielding 66 responses. The majority (77%) of respondents had experiences with adverse event causing serious patient harm. The most common negative experience following an adverse event included feelings of negativity towards oneself, general distress, and anxiety about potential for future errors. The most common coping mechanism was seeking advice from a mentor or close colleague. Peers (82%) and senior colleagues (59%) were the most preferred sources of support. Most of the respondents would reach out to a mentor if they had 1, but 30% reported no mentor or close colleague for support. CONCLUSION Adverse patient events and near misses have serious negative impact on the lives of Canadian vascular surgeons and trainees. Peers and senior colleagues are the most desired source for support, but this is not universally available. Organized efforts are needed to bring awareness in our vascular surgery community on the ubiquitous nature and detrimental effects of adverse events.
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Affiliation(s)
- Sally Hj Choi
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tyler D Yan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Misskey
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jerry C Chen
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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Bredenkamp K, Raschka MJ, Holmes A. A Review of Medication Errors and the Second Victim in Pediatric Pharmacy. J Pediatr Pharmacol Ther 2024; 29:100-106. [PMID: 38596421 PMCID: PMC11001212 DOI: 10.5863/1551-6776-29.2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/06/2023] [Indexed: 04/11/2024]
Abstract
The concept of the second victim, described as the sense of victimization of health care professionals following the exposure to a traumatic, unanticipated medical error, was first introduced in 2000 by Albert W. Wu. Since then, the concept has gained immense traction and inspired the generation of assistance programs for second victims. With most second victim occurrences resulting from medication errors, pediatric pharmacists are at a high risk of experiencing second victim phenomenon. Second victims may experience both psychological and physical symptoms of distress often akin to post-traumatic stress disorder. Typical trajectories for second victims, as well as typical support needs, have been previously described, with several organizations responding by creating formal programs designed to support their staff in the events of traumatic workplace experiences. Most support programs involve peer-to-peer support, group sessions, and programs designed to increase coping skills. Additional resources are available for health care workers who do not have formalized support programs at their institution, although these are limited. Despite these resources, institutions across the country have room for additional growth in their support of employees who become second victims to tragedy.
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Affiliation(s)
| | | | - Amy Holmes
- Department of Pharmacy (AH), Atrium Health Wake Forest Baptist, Winston-Salem, NC
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Wilkinson T, Ajjawi R, Mansouri S. Informal peer support for rural doctors. CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:55-62. [PMID: 38709015 DOI: 10.4103/cjrm.cjrm_16_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Practising medicine exposes physicians to emotionally difficult situations, which can be devastating, and for which they might be unprepared. Informal peer support has been recognised as helpful, although this phenomenon is understudied. Hence, it is important to develop a better understanding of the features of helpful informal peer support from the experiences of physicians who have successfully moved through such difficult events. This could lead to new and potentially more effective ways to support struggling physicians. METHODS Rural Canadian generalist physicians were interviewed. Using a hermeneutic phenomenological approach, data analysis was oriented towards understanding features of helpful informal peer support and the meanings that participants derived from the experience. RESULTS Eleven rural generalist physicians took part. Peer support prompted the processing of difficult emotional experiences, which initially seemed insurmountable and career-ending. Participants overcame feelings of emotional distress after even brief encounters of informal peer support. Most participants described the support they received as vitally important. After the peer support encounter, practitioners no longer thought of leaving medical practice and felt more able to handle such difficulties moving forward. CONCLUSIONS Informal peer support enabled recipients to move through an emotionally difficult experience. Empathy, shared vulnerability and connection were the part of the peer support encounter. In addition, the support offered benefits which are known to help physicians not only process emotionally difficult events but also to acquire 'post-traumatic growth'. Practitioners, healthcare leaders and medical educators all have roles to play in enabling the conditions for informal peer support to flourish. INTRODUCTION La pratique de la médecine expose les médecins à des situations émotionnellement difficiles, qui peuvent être dévastatrices, et auxquelles ils ne sont pas préparés. Le soutien informel par les pairs a été reconnu comme utile, même si ce phénomène est peu étudié. Il est donc important de mieux comprendre les caractéristiques du soutien informel par les pairs à partir des expériences de médecins qui ont réussi à traverser des événements aussi difficiles. Cela pourrait conduire à de nouvelles façons, potentiellement plus efficaces, de soutenir les médecins en difficulté. MTHODES Onze médecins généralistes canadiens ruraux ont été interrogés. En utilisant une approche phénoménologique herméneutique, l'analyse des données a été orientée vers la compréhension des caractéristiques du soutien informel utile par les pairs et des significations que les participants ont tirées de l'expérience. RSULTATS Le soutien des pairs a incité à vivre des expériences émotionnelles difficiles, qui semblaient au départ insurmontables et mettant fin à une carrière. Les participants ont surmonté leurs sentiments de détresse émotionnelle après même de brèves rencontres de soutien informel par leurs pairs. La plupart des participants ont décrit le soutien qu'ils ont reçu comme étant d'une importance vitale. Après la rencontre de soutien par les pairs, les praticiens ne pensaient plus à quitter la pratique médicale et SE sentaient plus capables de faire face à de telles difficultés à l'avenir. CONCLUSION Le soutien informel par les pairs a permis aux bénéficiaires de traverser une expérience émotionnellement difficile. L'empathie, la vulnérabilité partagée et la connexion faisaient partie de la rencontre de soutien par les pairs. En outre, le soutien a offert des avantages connus pour aider les médecins non-seulement à gérer des événements émotionnellement difficiles, mais également à acquérir une 'croissance post-traumatique'. Les praticiens, les dirigeants des soins de santé et les enseignants en médecine ont tous un rôle à jouer pour permettre aux conditions propices au soutien informel par les pairs de s'épanouir.
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Affiliation(s)
- Tandi Wilkinson
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Nelson, BC, Canada
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Burwood, Australia
| | - Shireen Mansouri
- Department of Family Practice, Faculty of Medicine, University of Calgary, Yellowknife, NT, Canada
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Methangkool E, Slade IR, Rangrass G, Harbell M. Best practices for addressing adverse event analysis: a scoping review. Int Anesthesiol Clin 2024; 62:16-25. [PMID: 38282451 DOI: 10.1097/aia.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Emily Methangkool
- Department of Anesthesiology, Olive View-UCLA Medical Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Ian R Slade
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Govind Rangrass
- Department of Anesthesiology, St. Louis University School of Medicine, St. Louis, Missouri
| | - Monica Harbell
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona
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Catalán L, Kappes M, Morgado G, Oliveira D. Ethical issues in research with second victims: A scoping review. Nurs Ethics 2024:9697330241238345. [PMID: 38476037 DOI: 10.1177/09697330241238345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Second victim is the name given to the healthcare personnel-most often a nursing professional-involved with the error that led to the adverse event to a patient and who, as a result, have experienced negative psychological effects. Research with second victims has increased over the years, however concerns exist with regards to the ethical risks imposed upon these individuals. AIM To explore the extent to which research with second victims of adverse events in healthcare settings adhere to ethical requirements. METHODS A scoping review was conducted following Arksey and O'Malley's methodological framework and using the following databases: PUBMED, Web of Science, and SCOPUS. Original research of any study design focused on second victims and published in English, Spanish, or Portuguese in 2014-2023 were included. A critical narrative approach was used to discuss the findings. ETHICAL CONSIDERATIONS The review followed ethical guidelines emphasizing accurate authorship attribution and truthful data reporting. RESULTS Fifteen studies using qualitative (n = 2), quantitative (n = 10), and mixed-method (n = 3) designs were included. Over half were not assessed by a research ethics committee, with questionable reasons given by the authors. One-third did not refer to having used an informed consent. In two studies, participants were recruited by their workplace superiors, which could potentially right to autonomy and voluntary participation. CONCLUSION Over half of the included studies with second victims did not comply with fundamental ethical aspects, with risk to inflict respect for individual autonomy, confidentiality, and of not causing any harm to participants. IMPLICATIONS FOR NURSING RESEARCH Healthcare personnel involved in adverse events are most often nursing professionals; therefore, any breach of ethics in research with this population is likely to directly affect their rights as research participants. We provide recommendations to promote better research practices with second victims towards safeguarding their rights as research participants.
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Affiliation(s)
| | | | | | - Déborah Oliveira
- Universidad Andres Bello
- Millennium Institute for Care Research (MICARE)
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Tang W, Xie Y, Yan Q, Teng Y, Yu L, Wei L, Li J, Chen Y, Huang X, Yang S, Jia K. Exploring the Experiences and Support of Nurses as Second Victims After Patient Safety Events in China: A Mixed-Method Approach. Risk Manag Healthc Policy 2024; 17:573-586. [PMID: 38501130 PMCID: PMC10944798 DOI: 10.2147/rmhp.s451766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
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.
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Affiliation(s)
- Wenzhen Tang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Yuanxi Xie
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Qingfeng Yan
- The Sanming Second Hospital, Sanming, Fujian Province, 366099, People’s Republic of China
| | - Yanjuan Teng
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Li Yu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Liuying Wei
- Nanning Fourth People’s Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Jinmei Li
- Wanxiu District Chengnan Community Health Service Center, Wuzhou, Guangxi Zhuang Autonomous Region, 543000, People’s Republic of China
| | - Yuhui Chen
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Xiaolin Huang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Shaoli Yang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Kui Jia
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
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Chong RIH, Yaow CYL, Chong NZY, Yap NLX, Hong ASY, Ng QX, Tan HK. Scoping review of the second victim syndrome among surgeons: Understanding the impact, responses, and support systems. Am J Surg 2024; 229:5-14. [PMID: 37838505 DOI: 10.1016/j.amjsurg.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND It is thought that 50% of healthcare providers experience Second Victim Syndrome (SVS) in the course of their practice. The manifestations of SVS varies between individuals, with potential long-lasting emotional effects that impact both the personal lives and professional clinical practice of affected persons. Although surgeons are known to face challenging and high-stress situations in their profession, which can increase their vulnerability to SVS, majority of studies and reviews have focused squarely on nonsurgical physicians. METHODS This scoping review aimed to consolidate existing studies pertaining to a surgeon's experience with SVS, by broadly examining the prevalence and impact, identifying the types of responses, and evaluating factors that could influence these responses. The scoping review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Three databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception till March 19, 2023. RESULTS A total of 13 articles were eligible for thematic analysis based on pre-defined inclusion criteria. Effects of SVS were categorized into Psychological, Physical and Professional impacts, of which Psychological and Professional impacts were particularly significant. Factors affecting the response were categorized into complication type, surgeon factors and support systems. CONCLUSION SVS adds immense psychological, emotional and physical burden to the individual surgeon. There are key personal, interpersonal and environmental factors that can mitigate or exacerbate the effects of SVS, and greater emphasis needs to be placed on improving availability and access to services to help surgeons at risk of SVS.
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Affiliation(s)
- Ryan Ian Houe Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Nicole Li Xian Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore; MOH Holdings Pte Ltd., Singapore.
| | - Hiang Khoon Tan
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore
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New L, Lambeth T. Second-Victim Phenomenon. Nurs Clin North Am 2024; 59:141-152. [PMID: 38272580 DOI: 10.1016/j.cnur.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
All in health care are at risk of involvement in adverse events. Oftentimes, the health care worker manifests physical, psychological, and professional effects and this is referred to as the second-victim phenomenon. Unmitigated recovery of a second victim can contribute to absenteeism, turnover intentions, burnout, and loss of joy and meaning in work. The preferred method of support among health care workers is a respected peer to provide emotional support. Health care organizations can contribute to a second victim's recovery by providing a culture of safety and diverse resources based on the needs of the individual.
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Affiliation(s)
- Luci New
- Department of Academic Nursing, Wake Forest University, School of Medicine, 525 Vine Street, Suite 230, Winston-Salem, NC 27101, USA.
| | - Tinisha Lambeth
- Department of Academic Nursing, Wake Forest University, School of Medicine, 525 Vine Street, Suite 230, Winston-Salem, NC 27101, USA
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Croke L. Support and Recovery Strategies for Second Victims. AORN J 2024; 119:P7-P10. [PMID: 38275256 DOI: 10.1002/aorn.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/27/2024]
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Bushuven S, Trifunovic-Koenig M, Bunz M, Weinmann-Linne P, Klemm V, Strametz R, Müller BS. Applicability and Validity of Second Victim Assessment Instruments among General Practitioners and Healthcare Assistants (SEVID-IX Study). Healthcare (Basel) 2024; 12:351. [PMID: 38338236 PMCID: PMC10855668 DOI: 10.3390/healthcare12030351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The second victim phenomenon and moral injury are acknowledged entities of psychological harm for healthcare providers. Both pose risks to patients, healthcare workers, and medical institutions, leading to further adverse events, economic burden, and dysfunctionality. Preceding studies in Germany and Austria showed a prevalence of second victim phenomena exceeding 53 percent among physicians, nurses, emergency physicians, and pediatricians. Using two German instruments for assessing moral injury and second victim phenomena, this study aimed to evaluate their feasibility for general practitioners and healthcare assistants. METHODS We conducted a nationwide anonymous online survey in Germany among general practitioners and healthcare assistants utilizing the SeViD (Second Victims in Deutschland) questionnaire, the German version of the Second Victim Experience and Support Tool Revised Version (G-SVESTR), and the German version of the Moral Injury Symptom and Support Scale for Health Professionals (G-MISS-HP). RESULTS Out of 108 participants, 67 completed the survey. In G-SVESTR, the collegial support items exhibited lower internal consistency than in prior studies, while all other scales showed good-quality properties. Personality traits, especially neuroticism, negatively correlated to age, seem to play a significant role in symptom count and warrant further evaluation. Multiple linear regression indicated that neuroticism, agreeableness, G-SVESTR, and G-MISS-HP were significant predictors of symptom count. Furthermore, moral injury partially mediated the relationship between second victim experience and symptom count. DISCUSSION The results demonstrate the feasible use of the questionnaires, except for collegial support. With respect to selection bias and the cross-sectional design of the study, moral injury may be subsequent to the second victim phenomenon, strongly influencing symptom count in retrospect. This aspect should be thoroughly evaluated in future studies.
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Affiliation(s)
- Stefan Bushuven
- Training Center for Emergency Medicine (NOTIS e.V), 78234 Engen, Germany;
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, 79106 Freiburg, Germany
- Institute for Medical Education, University Hospital, LMU Munich, 80539 Munich, Germany
| | - Milena Trifunovic-Koenig
- Training Center for Emergency Medicine (NOTIS e.V), 78234 Engen, Germany;
- Wiesbaden Institute for Healthcare Economics and Patient Safety (WiHelP), Wiesbaden Business School, RheinMain University of Applied Sciences, 65183 Wiesbaden, Germany; (V.K.); (R.S.)
| | - Maxie Bunz
- Institute of General Practice, University of Cologne, 50937 Cologne, Germany; (M.B.); (P.W.-L.); (B.S.M.)
| | - Patrick Weinmann-Linne
- Institute of General Practice, University of Cologne, 50937 Cologne, Germany; (M.B.); (P.W.-L.); (B.S.M.)
| | - Victoria Klemm
- Wiesbaden Institute for Healthcare Economics and Patient Safety (WiHelP), Wiesbaden Business School, RheinMain University of Applied Sciences, 65183 Wiesbaden, Germany; (V.K.); (R.S.)
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety (WiHelP), Wiesbaden Business School, RheinMain University of Applied Sciences, 65183 Wiesbaden, Germany; (V.K.); (R.S.)
| | - Beate Sigrid Müller
- Institute of General Practice, University of Cologne, 50937 Cologne, Germany; (M.B.); (P.W.-L.); (B.S.M.)
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Koželj A, Strauss M, Poštuvan V, Strauss Koželj A, Strnad M. Perception of Personal Participation of the Nurses in Resuscitation Procedures: A Qualitative Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:196. [PMID: 38399484 PMCID: PMC10890641 DOI: 10.3390/medicina60020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/18/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A qualitative approach by conducting semi-structured interviews was used, and a thematic data analysis of the recorded interviews was carried out. The collected data were transcribed verbatim, with no corrections to the audio recordings. The computer program ATLAS.ti 22 was used for the qualitative data analysis. Results: Eleven male registered nurses were interviewed, with an average of 18.5 years of experience working in a prehospital environment (max. 32/min. 9). A total of 404 min of recordings were analyzed, and 789 codes were found, which were combined into 36 patterns and 11 themes. As the most stressful situations, the interviewees pointed out the resuscitation of a child, familiar persons, conflicts with the environment, conflicts within the resuscitation team, nonfunctioning or insufficient equipment, complications during resuscitation, and resuscitating a person only for training. As positive effects, the interviewees cited successful resuscitations or their awareness that, despite an unsuccessful resuscitation, they did everything they could. Conclusions: Participation in these interventions has a specific positive or negative impact on the performers. The interviewees shared the opinion that they can cope effectively with the adverse or stressful effects of resuscitation. Yet, despite everything, they allow the possibility of subconscious influences of this intervention on themselves.
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Affiliation(s)
- Anton Koželj
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia;
| | - Maja Strauss
- Faculty of Health Sciences, University of Maribor, 2000 Maribor, Slovenia;
| | - Vita Poštuvan
- Slovene Center for Suicide Research, Andrej Marušič Institute, University of Primorska, 6000 Koper, Slovenia;
| | | | - Matej Strnad
- Emergency Department, University Clinical Centre Maribor, 2000 Maribor, Slovenia;
- Center for Emergency Medicine, Prehospital Unit, Community Healthcare Center, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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Gemmete JJ. Learning from medical errors. CVIR Endovasc 2024; 7:8. [PMID: 38197983 PMCID: PMC10781906 DOI: 10.1186/s42155-023-00406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Joseph J Gemmete
- Department of Radiology, Neurology, Neurosurgery, and Otolaryngology, University of Michigan Hospitals, UH B1D 328, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Adkins S, Alta'any R, Brar K, Kauser H, Hughbanks S, Rabah K, Flowers S. Medical Error: Using Storytelling and Reflection to Impact Error Response Factors in Family Medicine Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241272358. [PMID: 39149530 PMCID: PMC11325321 DOI: 10.1177/23821205241272358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 07/12/2024] [Indexed: 08/17/2024]
Abstract
I am a healer, yet sometimes I do more harm than good…David Hilfiker, 1984. Objectives Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error. Methods Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection. Results Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance. Conclusions Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.
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Affiliation(s)
- Sherry Adkins
- Rural Family Medicine Residency, Wright State University, Greenville, OH, USA
| | - Rahaf Alta'any
- Rural Family Medicine Residency, Wright State University, Greenville, OH, USA
| | - Kewaljit Brar
- Rural Family Medicine Residency, Wright State University, Greenville, OH, USA
| | - Humaira Kauser
- Rural Family Medicine Residency, Wright State University, Greenville, OH, USA
| | - Savannah Hughbanks
- School of Professional Psychology, Wright State University, Dayton, OH, USA
| | - Kelly Rabah
- Department of Faculty Affairs, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Stacy Flowers
- Family Medicine Residency, Wright State University, Dayton, Ohio, USA
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