Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources

Assessment of a patient safety culture: a nationwide cross-sectional study comparing public and private hospitals in Kuwait

BACKGROUND

Several international health bodies advocate measuring patient safety culture within an organisation as an effective strategy for sustainably improving safety. This study aims to assess and compare patient safety culture across public and private hospitals in Kuwait.

METHODS

A cross-sectional study was conducted utilising the Hospital Survey of Patient Safety Culture. The questionnaire was distributed among clinical staff in public general and private hospitals. Data analysis using Microsoft Excel and SPSS 23 (α level = 0.05) provided an overview of participant characteristics and patient safety culture scores. A model for predicting the determinants of patient safety culture score was constructed from a regression analysis.

RESULTS

A total of 890 questionnaires were distributed equally between the public and private sectors. The overall response rate was 94.9%. Assessment of the positive percentage of patient safety culture showed that nationally, five composites were areas of strength: "Teamwork within Units" (87.2%), "Organizational Learning-Continuous Improvement" (87.5%), "Management Support for Patient Safety" (77.8%), "Feedback & Communication about Error" (75.8%) and "Teamwork across Units" (75.0%). Private hospitals showed these same areas of strength, whereas public hospitals had fewer. Private hospitals scored statistically significant higher positive percentages than public hospitals in most of the composites. Benchmarking against a 2015 study in Kuwait indicates that the positive percentages of six composites increased at the national level, whereas four remained the same. "Staffing" and "Non-punitive response to errors" were strikingly low.

CONCLUSION

In this first national study to assess patient safety culture in public and private hospitals in Kuwait, many areas of safety culture had improved. However, some areas require special attention, although causality cannot be inferred, which is a limitation of the study's design. A comparison between the two sectors revealed differences in the patient safety culture, which might be relevant to the guidelines governing them. Policymakers should set unified guidelines governing staffing in both sectors and devise intervention strategies to develop a culture that establishes learning from adverse events and supports patient safety, incorporating a just culture and whistle-blower protection. In academia, Kuwait University should incorporate patient safety and quality-of-care topics into its curricula.

Traumatised Nurses' Desired Support Needs for Continued Recovery After the COVID-19 Pandemic: A Qualitative Descriptive Study Utilising Photovoice

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.

Caring for Each Other: An Evaluation of a Peer Support Program for Nurses and Health Care Workers

BACKGROUND

Human errors, workplace violence, and community events can impact nurses and other health care workers' (HCW) overall well-being. Peer support programs have shown a positive impact on care teams by focusing on second victim mitigation and support.

PURPOSE

To determine the type of events and resource needs for a peer support program.

METHODS

This program evaluation piloted a 6-month peer support program and gathered prospective data on the volume, type, and length of debriefing events.

RESULTS

During the pilot, 192 referrals were made to the peer support program. This included 102 programmatic responses. These data supported the development of a business plan for ongoing program development.

CONCLUSIONS

Peer support programs play a critical role in health care organizations by helping nurses and other HCWs manage the physical and emotional aspects of the work and the environment in which care is provided.

Disclosure of Adverse Events in Pediatrics: Policy Statement

Disclosure of adverse events has become the expectation in medicine and is widely regarded as the appropriate path when medical errors occur. Although data are limited on adverse events in pediatrics, that they occur frequently is uncontested. Types and rates of errors vary depending on the care setting and patient population. Patients with complex medical conditions or from historically marginalized groups or minoritized communities likely suffer disparate health and safety outcomes. Systemic factors, including nonpunitive safety cultures and supportive environments within institutions, are essential to promoting disclosure. State laws protecting apologies from use in legal proceedings can also help to encourage open communication. Some states have adopted laws to advance disclosure, and governmental agencies provide materials encouraging open communication and early resolution after adverse events occur. Many programs emphasize the importance of supporting health care workers involved in adverse events. Shame, fear of professional and legal repercussions, and lack of training remain barriers to disclosure. Education for health care clinicians, support in health care settings, additional research on programs and disparities, and governmental and regulatory initiatives can support disclosure of adverse events.

An Exploration of Safety Culture, Second Victim Phenomenon and Negative Work Outcomes in Health Care Settings

PURPOSE

The aim of the study was to explore the impact of patient safety culture on nurses' negative work outcomes resulting from patient safety incidents, as well as the mediating roles of second victim support and distress.

DESIGN

A cross-sectional survey was conducted. The participants included 208 nurses, each with over a year of clinical experience, working in hospitals across South Korea.

METHODS

Data were collected through self-reported questionnaires on general characteristics, patient safety culture, second victim support and distress, and negative work outcomes. The collected data were analyzed using descriptive statistics, the t-test, ANOVA, the Scheffé test, and Pearson correlation coefficients. Additionally, model 6 of Hayes' PROCESS macro and the Sobel test were employed to determine the mediating effect.

RESULTS

Mediation analysis revealed significant indirect effects of patient safety culture on the work outcomes experienced by nurses following patient safety incidents, mediated by second victim distress, after controlling for participants' marital status, position, and the severity of patient safety incidents.

CONCLUSIONS

This study demonstrates that in healthcare settings, patient safety culture that supports the second victim and alleviates second victim distress mitigates the negative work outcomes resulting from patient safety incidents. The findings highlight the significance of culturally sensitive support systems, particularly considering the diverse impacts on Korean nurses. Based on this study, healthcare leaders are recommended to develop strategies to support nurses and reduce their second victim distress, which can ultimately improve patient safety and the quality of nursing care.

CLINICAL RELEVANCE

The findings of this study can be used to develop strategies to support second victims in addressing their distress. Taking steps to alleviate the distress of second victims will help prevent negative work outcomes in nurses.

How does just culture reduce negative work outcomes through second victim distress and demand for support in clinical nurses? A path analysis

BACKGROUND

Second victim experiences of nurses are a critical issue in healthcare. In addition to causing psychological and emotional distress to nurses, second victim experiences can adversely affect organizational performance and overall patient safety.

PURPOSE

This study aimed to determine effects of perceived just culture of medical institutions on second victim experiences of nurses after patient safety incidents.

METHODS

This was a cross-sectional correlational study. Data were collected from 183 clinical nurses in tertiary general hospitals between December 28, 2022 and January 14, 2023 using an online self-report questionnaire. The questionnaire included items from Just Culture Assessment Tool (JCAT) and Korea-Second Victim Experience and Support Tool (K-SVEST). A hypothetical model was established and tested. Data were analyzed using SPSS WIN 23.0 and AMOS 23.0 programs.

RESULTS

The hypothesized model was found to be statistically fit (normed χ2 /df = 2.53; root mean square error of approximation = 0.09; comparative fit index = 0.99; Tucker-Lewis index = 0.97; normed fit index = 0.99). Eight hypothesized pathways were tested, of which five direct effect pathways and three indirect effect pathways were statistically significant. Just culture had a significant effect on second victim distress (β = -0.29, p = 0.001) and demand for support (β = -0.65, p = 0.001). Second victim distress had a significant effect on demand for support (β = 0.14, p = 0.025) and negative work-related outcomes (β = 0.66, p = 0.001). Demand for support had a significant effect on negative work-related outcomes (β = 0.18, p = 0.010).

CONCLUSIONS

This study demonstrated that a just culture in medical institutions could ameliorate second victim experiences of nurses involved in patient safety incidents. Implementing systemic interventions is a key imperative to establish a just culture in medical institutions, mitigate second victim experiences, and improve organizational performance.

CLINICAL TRIAL NUMBER

Not applicable.

The impact of second-victim syndrome on staff well-being and practice

This study aimed to examine factors influencing psychological well-being and support among healthcare professionals involved in adverse event investigations, complaints, medical errors, and patient injuries from January 2020 to March 2022. The second-victim experience and support tool (SVEST) was used to assess second-victim experiences and support resources. Non-probability purposive sampling was employed, and data were collected through a Monkey Survey sent via email to around 150 clinicians (physicians, nurses, and pharmacists). A total of 100 responses were received. The inclusion criteria required participants to have been involved in adverse event investigations, complaints, medical errors, or patient-related injuries. The SVEST, with 29 items measured on a 5-point Likert scale, evaluated their perceptions of second-victim experiences and support resources. Institutional support was positively perceived by 55.0% of participants, with 52.0% feeling a range of coping resources was available. However, 31.0% felt their well-being was not adequately prioritized. Nonwork-related support was crucial, with 57.0% relying on friends and family. Professional self-efficacy was impacted, with 46.0% feeling inadequate and 39.0% experiencing self-doubt. Turnover intentions were notable, as 39.0% expressed a desire to leave patient care, and 34.0% considered quitting due to stress. This study highlights the need for targeted support systems to address second-victim experiences among healthcare professionals involved in adverse events. Enhancing institutional support, professional self-efficacy, and access to coping resources is crucial. Policymakers and healthcare leaders can help mitigate stress, decrease turnover intentions, and promote psychological resilience by fostering a supportive work environment and providing comprehensive resources, healthcare organizations can improve clinician well-being, reduce stress, and enhance patient care quality.

Anxiety and Depression and Related Risk Factors in Italian Healthcare Providers Involved in Adverse Events

Background/Objectives: Despite the importance of the second victim phenomenon for healthcare systems, there is limited research on Italian healthcare providers. We assessed emotional distress in individuals impacted by an adverse event using the Withstand-PSY Questionnaire (WS-PSY-Q). Additionally, we aimed to identify potential risk factors for anxiety and depression. Methods: A cross-sectional online survey of 284 participants. Measures included the WS-PSY-Q, Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI-Y). Descriptive analyses and seemingly unrelated regression, jointly estimating anxiety and depression, were conducted using Stata (version 18). Results: Fifty-nine percent of the participants tested positive for anxiety (WS-PSY-Q anxiety subscale ≥ 16), thirty-seven percent for depression (WS-PSY-Q depression subscale ≥ 22), and thirty-five percent for both. In the final model, anxiety symptoms following the adverse event were associated with pre-event anxiety levels (p < 0.01), seeking psychological help (p < 0.05), self-perceived responsibility (p < 0.01), severity of the adverse event for the patient (p < 0.05), and punitive workplace climate (p < 0.05). Correlates of post-event depressive symptoms included pre-existing depression (p < 0.01), self-perceived responsibility (p < 0.01), severity of the impact of the adverse event (p < 0.01), punitive or neutral workplace climate (p < 0.05), and seeking psychological help (p < 0.01). Conclusions: This study adds to the growing understanding of the mental health difficulties that healthcare workers in Italy encounter after adverse events, addressing both individual and systemic risk factors. Proactive implementation of mental health measures for healthcare workers could foster their well-being after adverse events and promote a stronger, more just organizational culture.

Peer Support Targeting the Second Victim Phenomenon: Implementation and Outcomes

The second victim phenomenon profoundly impacts clinicians and compromises care. Peer support is a preferred and practical resource, yet accounts of successful initiatives are scarce. Our findings revealed an urgent need: 20% of clinicians experienced emotionally distressing work events in the past month, 88% observed affected colleagues, but only 20% felt adequate support was available. In response, we quickly launched a scalable, evidence-based peer support program with peer-to-peer and online resources to safeguard clinician well-being. Over three months, trained peers facilitated 33 support encounters related to adverse events and personal issues, including bullying. An online platform designed to destigmatize mental health and normalize second victimhood received over 100 visits. Post-implementation, 77% reported timely, adequate support, and awareness of the term "second victim" doubled. This cost-effective, rapid rollout enhanced the perceptions of support and fostered a caring culture among clinicians. Our transferable approach offers a proactive solution for all healthcare disciplines to support second victims, mitigate burnout, and enhance suicide prevention efforts.

Validation of the Turkish version of the second victim experience and support tool- revised (T-SVEST-R)

BACKGROUND

Healthcare workers who find themselves entangled in unforeseen adverse patient events, medical errors, and/or patient-related injuries, experiencing trauma and victimization as a consequence of said incidents, are referred to as "second victims".

OBJECTIVE

This study aims to validate and assess the reliability of the Turkish version of the Second Victim Experience and Support Tool-Revised (SVEST-R).

METHODS

The methodological and cross-sectional study involved 400 physicians and nurses in an Edirne tertiary hospital of Turkey. The Turkish SVEST-R and a questionnaire were administered, assessing validity through factor analysis and content validity, and reliability through item-total score correlation, internal consistency, and test-retest methods.

RESULTS

Kaiser-Meyer-Olkin test (0.84) and Bartlett Test (p < 0.001) indicated adequate sampling for factor analysis. Exploratory Factor Analysis identified nine factors explaining 71.58% of total variance. Confirmatory Factor Analysis showed good fit (x2 = 976.95, x2/df = 2.3, CFI = 0.92, GFI = 0.87, RMSEA = 0.05). Cronbach's alpha was 0.85, signifying high internal consistency. Healthcare professionals' average T-SVEST-R score was 2.8 ± 0.5. Among independent variables, professional experience length significantly influenced T-SVEST-R score.

CONCLUSIONS

The Turkish version of the Second Victim Experience Support Tool-Revised (T-SVEST-R) has been validated as a reliable scale.

Assessing safety culture and second victim experience following adverse events among Romanian nurses: a cross-sectional study

BACKGROUND

Healthcare adverse events (AEs) significantly impact professionals, often leading to emotional distress and lasting effects. This study investigates the impact of AEs on healthcare professionals in Romania, focusing on nurses to examine their experiences within the patient safety culture and the psychological consequences of AEs. With a limited body of research on patient safety, adverse events, and second victims (SVs) in Romania, this study addresses a crucial gap, highlighting the need for enhanced safety culture and support mechanisms for SVs.

METHODS

A cross-sectional study in Romania targeted healthcare professionals, focusing on nurses. Utilizing online and onsite surveys facilitated by the Order of Nurses, Midwives, and Medical Assistants in Romania, data were collected between April and June 2022, exploring AEs and related experiences. Statistical analysis included chi-square tests, Student's t-tests, one-way ANOVA, and logistic regression, using SPSS version 29.0.

RESULTS

This study surveyed 995 nurses in Romania, primarily aged 31-50 (67.8%). Over half (57.9%) reported near-miss incidents, and 30.8% were aware of serious adverse events. Nurses over 50 scored higher on safety culture (20.98 vs. 20.45, p = .024) than younger nurses. Higher safety culture scores were associated with reduced negative emotional responses (e.g., guilt, anxiety, insomnia, tiredness) following AEs. Higher safety culture scores were associated with reduced negative emotional responses. Additionally, 88.9% of nurses showed interest in training for coping with adverse events, highlighting the need for supportive interventions in healthcare settings.

DISCUSSION

This study underscores the significant emotional and professional impact of AEs on nurses in Romania, highlighting ongoing challenges in healthcare environments. The positive perception of safety culture among nurses suggests a basis for improvement, while training needs underscore areas for intervention. Tackling the second victim phenomenon is crucial for maintaining patient safety.

Key elements for designing effective second victim support interventions: a focus group study in European clinical settings

BACKGROUND

The second victim (SV) experience limits the performance of health and care workers and places patients at risk. Peer support is recognised as the most effective, feasible and acceptable intervention to mitigate its impact.

OBJECTIVE

To define a set of success factors when designing interventions to support SVs in health and care facilities based on expertise in different European countries.

SETTING

International collaboration involving countries with diverse cultures, structures and legal frameworks.

DESIGN

Qualitative research.

METHOD

Focus groups involving a total of 43 participants were conducted in five countries. Prominent professionals in European peer support interventions were engaged. Analysis of common elements considered key to the success of these programmes was underscored.

RESULTS

Critical success factors for designing effective SV support interventions included the need for an occupational health approach, the establishment of a strong organisational safety culture, immediate psychological first aid, long-term resilience building, the engagement and training of peer supporters, the provision of adequate resources and ongoing support, the importance of leadership commitment and the necessity of tailoring interventions to the specific context and needs of each institution and country considering their diverse sociocultural and legal framework. The expected benefits included ensuring optimal patient care and reducing associated costs such as staff turnover and litigation.

CONCLUSION

Effective SV support interventions are essential for enhancing the resilience and performance of health and care workers, ultimately improving patient safety. By implementing tailored and well-resourced interventions, healthcare institutions can mitigate the negative impact of the SV phenomenon, promoting optimal care.

Translation, Adaptation, and Validation of the Japanese Version of Second Victim Experience and Support Tool-Revised

OBJECTIVE

Healthcare workers involved in, and negatively affected by, patient safety incidents are referred to as second victims. The Second Victim Experience and Support Tool-Revised (SVEST-R) can reveal the second victim's degree of negative experiences and the desirability of the support options. However, a Japanese version of the SVEST-R (J-SVESTR) has not yet been developed. This study aimed to translate and adapt the SVEST-R into Japanese and validate its psychometric properties.

METHODS

We performed forward and back translations of the SVEST-R and evaluated its clarity and content validity. Subsequently, we administered a cross-sectional questionnaire survey to evaluate the construct validity, internal consistency, and retest reliability of the J-SVESTR.

RESULTS

The J-SVESTR was finalized with clarity and content validity supported by a pilot test and an expert panel. In total, 224 healthcare workers responded to the J-SVESTR survey. The 9 factors and 35 items model indicated an acceptable fit (χ 2 / df = 1.811, root mean square error of approximation = 0.060, comparative fit index = 0.871, Tucker-Lewis index = 0.854, standardized root mean squared residual = 0.077). Cronbach's α values ranged from 0.68 to 0.85. The intraclass correlation coefficients ranged from 0.63 to 0.87.

CONCLUSIONS

The J-SVESTR retained 9 factors and 35 items, with no item changes from the original. The psychometric properties of the J-SVESTR are acceptable. The J-SVESTR can help investigate the actual situation and desired support options for second victims in Japan.

Understanding the Second Victim Phenomenon Among Healthcare Workers in an Italian Hospital

Second victim syndrome (SVS) refers to the psychological trauma experienced by healthcare workers (HCWs) as a result of being involved in an adverse event (AE). Research on the prevalence of SVS and the support needed for HCWs who experience it is limited. A cross-sectional study was conducted at the Health Local Unit of Lecce, in Puglia, to identify the phenomenon of SVS among HCWs and recognize the forms of support received and desired. A validated questionnaire, IT-SVEST, was administered to doctors and nurses. The survey received responses from 250 HCWs, and 41% of respondents reported being involved in an AE that could cause SVS. Among the seven dimensions measuring the effects of the SVS and two outcome variables, the highest percentage of agreement was found for psychological distress (23.5%), followed by turnover intentions (19.8%) and physical distress (9.9%); 23.8% of the interviewees declared that they did not receive institutional support, and 9.9% identified help resources mostly in non-work-related support (9.9%), followed by supervisor support (9.3%). The multivariable binary logistic regression analysis showed a positive association between the occurrence of an AE and the medical doctor profession (OR = 4.267, p ≤ 0.0001), and affiliation to intensive care departments (OR = 5.133, p ≤ 0.0001) and male gender (OR = 2.069, p = 0.033). SVS is a serious problem that affects the entire health system, systematic surveys and appropriate institutional responses including formal support programs for affected HCWs are a priority.

The RISE (Resilience in Stressful Events) Peer Support Program: Creating a Virtuous Cycle of Healthcare Leadership Support for Staff Resilience and Well-Being

Healthcare leaders are responsible for creating an environment where their staff can maintain their resilience and well-being. However, there is a crisis of burnout among healthcare workers. The resulting increased turnover, diminished morale and performance, safety risks, and decreased worker engagement produces a vicious cycle of burnout. A strategic intervention is needed that focuses on worker wellbeing. This paper describes how the Johns Hopkins Resilience In Stressful Events (RISE) peer support program has helped healthcare leaders support their workers and strengthen the resilience of their organization. It explains the crucial role that leaders play in the success of the program. RISE peer was established at Johns Hopkins Hospital in 2011 to provide timely peer support for stressful patient and work-related situations. RISE helps break the cycle of healthcare worker burnout by providing peer support for stresses at work 24 hours a day, 7 days a week. This program structure also supports leaders by sharing the responsibility of emotional support and by providing them with new skills to do their job in a way that generates personal and professional satisfaction. The program has been implemented globally in over 140 healthcare organizations. Leaders are essential to integrate support and serve as role models. Institutions that successfully launch peer support programs engage leaders to participate in program design, participate in the program themselves, and adapt the program to meet the needs of their staff and organization. Peer support programs broaden the base of support for all healthcare workers by providing an employee-focused resource. Implementation of a RISE support model demonstrates an institution's commitment to the overall health of the people it employs. Operational integration of the model conveys a positive impact on resilience at all levels of the organization, especially in institutions that broadly engage organizational leaders.

H-SVEST: Validation and Adaptation of the Hebrew Version of the Second Victim Experience and Support Tool

BACKGROUND

Adverse medical events not only harm patients and families, but also have a significant negative impact on healthcare providers, with the potential to compromise future professional functioning. These "second victims" may need organizational support and rehabilitation to return to functionality.

OBJECTIVES

We analyzed the validity of an adapted tool, the Second Victim Experience and Support Tool (SVEST), on a population in Israel, H-SVEST.

METHODS

The H-SVEST was completed by 172 nurse participants working in a variety of patient care settings. All of the participants reported experiencing SVP. The H-SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis (CFA).

RESULTS

The CFA, when run on the initial model with 9 factors and 29 items, did not meet criteria for suitability of fit. After removing three items based on their low-factor loadings and the correlation, the model fit significantly improved with acceptable CFI, TLI, RMSEA, and SRMR. The final version included 26 items and 9 factors with Cronbach α values ranging from 0.66 to 0.94.

CONCLUSION

The H-SVEST demonstrates robust psychometric properties and valuable insights into the second victim experience in the Israeli context. Comparative analysis with other versions highlights potential cultural influences and areas for further investigation. Implementing this tool and developing evidence-based interventions based on its results can significantly improve the well-being and resilience of healthcare providers in Israel and other countries with diverse cultural populations.

Understanding veterinary practitioners' responses to adverse events using a combined grounded theory and netnographic natural language processing approach

Support that mitigates the detrimental impact of adverse events on human healthcare practitioners is underpinned by an understanding of their experiences. This study used a mixed methods approach to understand veterinary practitioners' responses to adverse events. 12 focus groups and 20 interviews with veterinary practitioners were conducted and analysed using grounded theory principles. Experiencing stress, externalising facts and feelings, morally contextualising events and catalysing personal and professional improvements were identified as components of practitioners' response. Natural language processing content analysis of posts regarding involvement in adverse events (n = 572) written by members of a veterinary member-only Facebook group was also performed, to categorise and count words within texts based on underlying meaning. Percentile scores of four summary variables along with relative frequency of function, psychological process and time orientation words used were recorded and compared with content analysis of posts where members discussed euthanasia (n = 471) and animal health certification (n = 419). Lower authenticity scores (reflecting lower honesty), differences in clout scores (reflecting dominance) and higher frequencies of moralisation, future focus, prosocial behaviour and interpersonal conflict were observed in the adverse event group compared to either comparison group. Analytical thinking scores (reflecting logical thinking) and frequencies of total, positive and negative emotion, anxiety, anger and cognitive processing words (reflecting debate) were not significantly different between the adverse events and euthanasia groups. Integration of findings confirmed and expanded inferences made in both studies regarding the emotionally detrimental impact of adverse events and the role that peer-to-peer mediated reflection and learning plays in mitigating pathologisation of responses in the aftermath of adverse events. Discordance in findings related to practitioners' intentions and expressions of honesty suggest that work is needed to normalise open discussion about adverse events. Findings may be used to lever, and to inform, peer-to-peer support for practitioners in relation to veterinary adverse events.

Development of a Facility-Level Second Victim Syndrome Peer-Mentor Program: Program Design and Future Directions

Background

Despite efforts to prevent errors, studies show that iatrogenic, or health care-related, errors continue to occur. Understandably, these errors, which can range in severity from near-misses to serious harm, can be devastating for the health care professionals involved, creating a potential second set of victims, in addition to the patient(s) that were harmed directly. Studies show that individuals struggling with second-victim syndrome (SVS) can be at increased risk for depression, burnout, and poor work performance. However, programs designed to develop peer mentors to support individuals struggling with SVS are poorly described.

Methods

Following a review of the literature, our team designed a program that involved training for leaders to serve as mentors and provide ongoing emotional support to their staff. Mentorship training included a 90 to 120-minute training, involvement in monthly mentoring meetings, and materials and training on potential support modalities, such as journaling, aromatherapy, walking paths, and other stress relief activities.

Results

Thirty SVS peer mentors at our facility completed the training, with plans to expand to 50 SVS peer mentors by the end of 2025. Plans to expand the program to other facilities, add additional metrics, and evaluate both mentor and staff outcomes are underway.

Conclusion

The mentor training program was designed to support health care professionals experiencing SVS and build support for colleagues through the development of mentors to help with psychological support. Additional research on the short- and long-term outcomes for facilities implementing similar SVS peer-mentoring programs is needed.

Premenstrual Syndrome and the Attitudes Toward Seeking Professional Psychological Help Among College Students in Oman

Background

This study examines the relationship between premenstrual syndrome (PMS) and the attitude toward seeking professional psychological help among Omani college students.

Method

This study used a cross-sectional design with a convenience sampling approach. The date was issued between January and March 2024. A sample of 601 undergraduate female students completed the study questionnaires, including (1) a sociodemographic questionnaire, (2) the Premenstrual Syndrome Scale and (3) the attitude toward seeking professional psychological distress scale.

Results

The study included 601 eligible participants of age 18-29 years who were mostly single (83.7%) and living on campus (68.6%). PMS prevalence was high at 87.9%, with a mean score of 109.4, indicating low severity for most (62.1%). Participants generally had positive attitudes toward seeking psychological help (41.6% high willingness). A linear regression showed a positive link between PMS severity and help-seeking attitudes.

Conclusion

This study highlights a significant association between the experiences of PMS and attitudes toward seeking professional psychological help among Omani female undergraduate students. With a high prevalence of PMS reported, the findings suggest that cultural factors and support systems play crucial roles in shaping these attitudes. The positive inclination toward seeking help indicates a growing awareness of mental health issues within this demographic. Enhancing mental health services and fostering supportive environments in educational settings can further empower students to address PMS-related challenges.

The European Researchers' Network Working on Second Victim (ERNST) Policy Statement on the Second Victim Phenomenon for Increasing Patient Safety

Background

The second victim phenomenon refers to the emotional trauma healthcare professionals experience following adverse events (AEs) in patient care, which can compromise their ability to provide safe care. This issue has significant implications for patient safety, with AEs leading to substantial human and economic costs.

Analysis

Current evidence indicates that AEs often result from systemic failures, profoundly affecting healthcare workers. While patient safety initiatives are in place, the psychological impact on healthcare professionals remains inadequately addressed. The European Researchers' Network Working on Second Victims (ERNST) emphasizes the need to support these professionals through peer support programs, systemic changes, and a shift toward a just culture in healthcare settings.

Policy Options

Key options include implementing peer support programs, revising the legal framework to decriminalize honest errors, and promoting just culture principles. These initiatives aim to mitigate the second victim phenomenon, enhance patient safety, and reduce healthcare costs.

Conclusion

Addressing the second victim phenomenon is essential for ensuring patient safety. By implementing supportive policies and fostering a just culture, healthcare systems can better manage the repercussions of AEs and support the wellbeing of healthcare professionals.

Second Victims in Industries beyond Healthcare: A Scoping Review

The second victim phenomenon (SVP) refers to workers negatively impacted by involvement in unanticipated adverse events or errors. While this phenomenon has been extensively studied in healthcare since its acknowledgment over 20 years ago, its presence and management in other high-risk industries have remained unclear. We conducted a scoping review aiming to map the SVP in non-healthcare industries, as well as to explore the available interventions or support programs addressed to help second victims (SVs). A total of 5818 unique records were identified and, after the screening process, 18 studies from eight sectors were included. All industries acknowledged the existence of the SVP, though many did not use a specific term for defining the SV. Similarities in psychological and emotional consequences were found across sectors. Support strategies varied, with the aviation sector implementing the most comprehensive programs. Self-care and peer support were the most reported interventions, while structured clinical support was not mentioned in any industry. Our review highlighted a lack of standardized terminology and industry-specific, evidence-based support interventions for the SVP outside of healthcare. Healthcare appears to be at the forefront of formally recognizing and addressing the SVP, despite traditionally learning from other high-reliability industries in safety practices. This presents opportunities for reciprocal learning and knowledge transfer between healthcare and other high-risk sectors.

Peer Support to Promote Surgeon Well-being: The APSA Program Experience

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.

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

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.

Psychological distress and attitudes toward seeking professional psychological help among Omani nurses: Strategies for nursing practice

BACKGROUND

This study investigated the psychological distress and attitudes toward seeking professional psychological help among Oman's nurses, highlighting the importance of changing negative attitudes toward mental health among healthcare professionals. Nurses face difficult circumstances and serve as role models. Creating supportive environments can improve treatment quality and public awareness and reduce social stigma, ultimately contributing to better care and quality of life.

MATERIALS AND METHODS

This study used a cross-sectional design with a convenience sampling approach. A sample of 205 nurses working in Oman completed the study questionnaires, including a sociodemographic questionnaire, the attitude toward seeking professional psychological distress scale, and the Kessler Psychological Distress Scale. The survey was distributed between May and June 2023.

RESULT

The study found that most participants had moderate psychological distress (43.22%, n = 67) and a low attitude toward seeking professional psychological help (66.67%, n = 48). There were significant differences in distress based on gender (P < 0.001), marital status (P < 0.001), and working department (F = 3.140, P = 0.004), while attitude had significant differences based on gender (P < 0.001) and marital status (P < 0.001). The study also found no significant correlation between psychological distress and attitudes toward seeking help among Oman's nurses (T (1, 204) = 0.019, P = 0.985), with a r2 of 0.005.

CONCLUSION

Nurses must be trained to handle stress and job strain from terminally ill patients, complex cases, and difficult situations. They should prioritize psychological assistance as a sign of strength and self-awareness as it demonstrates stability and self-awareness in nursing. This can be promoted by obtaining education, enhancing healthcare accessibility, and providing a support system.

Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association

The psychological safety of health care workers is an important but often overlooked aspect of the rising rates of burnout and workforce shortages. In addition, mental health conditions are prevalent among health care workers, but the associated stigma is a significant barrier to accessing adequate care. More efforts are therefore needed to foster health care work environments that are safe and supportive of self-care. The purpose of this brief document is to promote a culture of psychological safety in health care organizations. We review ways in which organizations can create a psychologically safe workplace, the benefits of a psychologically safe workplace, and strategies to promote mental health and reduce suicide risk.

Registered nurses' emotional responses to medication errors and perceived need for support: A qualitative descriptive analysis

AIMS

To identify the contributing factors behind the second victim phenomenon, describe the emotional responses of nurses after medication errors, assess the support received by them after errors and recognize the need for a suitable support program for second victims.

DESIGN

Qualitative descriptive design.

METHODS

Eleven in-depth semi-structured interviews were conducted among registered nurses studying advanced degrees at a University in Finland during November 2021-April 2022. Data were analysed using thematic analysis.

RESULTS

The study results revealed four themes with various sub-themes which included: contributing factors behind the second victim phenomenon; emotional responses of nurses after error; support received by nurses; and the desired need for a support program for second victims. The severity of the error and the negative work environment acted as catalysts for the second victim phenomenon among nurses. A "bitter aftermath" of emotions and a sense of insufficient support added further risk to already stressed and anxious nurses.

CONCLUSIONS

This study identifies the early exploratory and enduring impact of memories associated with medication errors, some of them haunting nurses for long periods of time. Further, the need for support at different levels is highlighted to reduce the impact of negative emotions generated among nurses after medication errors.

IMPLICATIONS FOR THE PROFESSION

Through the lens of this study, it has been possible to identify contributing factors behind the second-victim phenomenon and enduring symptoms that make nurses vulnerable to becoming second victims of medication incidents.

IMPACT

This study addresses the aftermath effect of medication errors from the perspective of nurses involved with such incidents. It provides valuable insights for healthcare managers and nurse leaders to establish a just and blame-free culture in healthcare organizations and help emotionally traumatized nurses cope effectively after error.

REPORTING METHOD

The research adheres to Consolidated criteria for reporting qualitative research (COREQ) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Impact of second victim distress on healthcare professionals' intent to leave, absenteeism and resilience: A mediation model of organizational support

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.

Department of Anesthesiology Skilled Peer Support Program Outcomes: Second Victim Perceptions

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.

Unveiling the hidden struggle of healthcare students as second victims through a systematic review

BACKGROUND

When healthcare students witness, engage in, or are involved in an adverse event, it often leads to a second victim experience, impacting their mental well-being and influencing their future professional practice. This study aimed to describe the efforts, methods, and outcomes of interventions to help students in healthcare disciplines cope with the emotional experience of being involved in or witnessing a mistake causing harm to a patient during their clerkships or training.

METHODS

This systematic review followed the PRISMA guidelines and includes the synthesis of eighteen studies, published in diverse languages from 2011 to 2023, identified from the databases MEDLINE, EMBASE, SCOPUS and APS PsycInfo. PICO method was used for constructing a research question and formulating eligibility criteria. The selection process was conducted through Rayyan. Titles and abstracts of were independently screened by two authors. The critical appraisal tools of the Joanna Briggs Institute was used to assess the risk of bias of the included studies.

RESULTS

A total of 1354 studies were retrieved, 18 met the eligibility criteria. Most studies were conducted in the USA. Various educational interventions along with learning how to prevent mistakes, and resilience training were described. In some cases, this experience contributed to the student personal growth. Psychological support in the aftermath of adverse events was scattered.

CONCLUSION

Ensuring healthcare students' resilience should be a fundamental part of their training. Interventions to train them to address the second victim phenomenon during their clerkships are scarce, scattered, and do not yield conclusive results on identifying what is most effective and what is not.

Scoping review of the second victim syndrome among surgeons: Understanding the impact, responses, and support systems

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.

Effectiveness of a preceptors' social support program to aid novice nurses' error experience on preceptors' skill and novice nurses' perception of social support: A quasi-experimental study

AIM

To evaluate the effectiveness of the preceptors' social support program (PSSP) on preceptors' social support skill-supportive relationships and post-error support-and novice nurses' perception of received social support.

METHODS

This study employed a quasi-experimental pretest-posttest design with a control group of a non-random assigned sample of 47 preceptors and novice nurses and an intervention group of 48 each. Intervention group preceptors received training in building supportive relationships skill and post-error support skills three times in the PSSP over 7 months. Preceptors' social support skill and novice nurses' perception of received social support were measured as primary outcomes. Data were collected at baseline (T0), 1 month after the second session (T1), and 1 month after the last session (T2) and analyzed.

RESULTS

No significant differences in demographics or scores were shown at baseline (T0). Preceptors in the intervention group showed significantly better supportive relationships (T2, 101.6 ± 9 vs. 96.9 ± 7.6, 95% CI [0.95, 8.42], p = .015) and better performance of post-error support (T2, 67.6 ± 5 vs. 62 ± 6.5, 95% CI [2.78, 8.32], p < .001). Intervention group preceptors' social support skill increased or remained stable, while it decreased over time in the control group. Novice nurses in the intervention group received significantly better supportive relationships and post-error support from preceptors (T2, median 112 vs. 101, p = .007; 70.5 vs. 65, p = .028, respectively).

CONCLUSIONS

The PSSP improved preceptors' supportive relationship skills and post-error support performance, leading to novice nurses' perceptions of better supportive relationships and receiving greater post-error support.

Nurse Leader Attitudes and Beliefs Regarding Medical Errors

OBJECTIVE

This study aimed to explore nurse leader attitudes and beliefs about medical errors.

BACKGROUND

The perfectibility model suggests errors are avoidable if nurses are trained and follow safety guidelines. This impacts how nurse leaders approach medical errors. Nurse leaders (NLs) may be the first person to whom a nurse reports an error. Leaders support nurses through the investigation process and subsequent recovery.

METHODS

A cross-sectional quantitative study was conducted to determine NL attitudes toward medical errors using the Medical Error Attitude Scale (MEAS).

RESULTS

MEAS scores were high in all categories. Medical error perception was significant for NLs with institutional support programs and when compared with job titles. Medical error approach and perception were significant for NLs with direct reports who had committed a medical error.

CONCLUSION

This study provides insight into NLs' views on medical errors, awareness of NLs who have had nurses involved in medical errors, and formal caregiver support programs.

Rapid Expansion of the Healing Emotional Lives of Peers Program During COVID-19: A Second Victim Peer Support Program for Healthcare Professionals

OBJECTIVES

In 2018, the Healing Emotional Lives of Peers (HELP) Program was implemented at Mayo Clinic Rochester to guide healthcare professionals (HCPs) after a second victim experience, such as adverse patient events or medical errors. The HELP program was expanded to all HCPs in response to the anticipated stressors of the COVID-19 pandemic. This article aims to describe the rapid expansion of the peer support program and evaluate the effectiveness of peer support provided to affected colleagues (ACs).

METHODS

Quantitative data collected from workshop evaluations, activations, and associated metrics ( TPS Self-Assessment , Encounter Form , and AC Self-Assessment ) were summarized through standard descriptive statistics using SAS version 9.4 software. Open-ended responses were qualitatively analyzed for iterative themes about the HELP program and associated workshops.

RESULTS

Between April 2020 and December 2021, 22 virtual workshops to train peer supporters were conducted with 827 attendees. Of these, 464 employees completed the workshop evaluation. A total of 94.2% rated the workshop as excellent or very good. Participants perceived the workshop to be highly effective and felt more prepared to support ACs. Between May 2020 and December 2021, 247 activations were submitted through the HELP Program's intranet Web site and peer support was requested for 649 employees. Of the 268 TPS Self-Assessments , 226 (84.3%) felt that they provided helpful support to an AC. One hundred ACs evaluated support received, with 93% being "extremely" or "very satisfied." Affected colleagues appreciated having a TPS provide judgment-free support.

CONCLUSIONS

The HELP Program promotes a culture of safety by helping HCPs process traumatic events. To effectively meet the needs of patients, healthcare organizations need to prioritize the well-being of their employees through interpersonal support.

Workplace violence in radiology: results of a systematic review

BACKGROUND

Workplace violence (WPV) is a growing issue in health care with far-reaching consequences for health workers' physical and psychological well-being. While some medical specialities like emergency medicine have always been considered at higher risk for WPV, several studies have also reported its occurrence in radiology.

AIMS

This systematic review aimed to comprehensively synthesize the types of WPV in radiology, its psychological impact, and the underlying risk and protective factors.

METHODS

We searched five electronic databases (PubMed, Web of Science Core Collection, Scopus, PsycINFO and CINAHL) and additional literature, including grey literature, and established weekly search alerts. Two reviewers independently conducted all methodological steps, involving a third reviewer in case of disagreement.

RESULTS

Of the 12 205 retrieved records, 103 full-text articles were evaluated, and 15 studies were included. Across studies, verbal aggression, sexual harassment (mostly against women) and physical violence were experienced by up to 100%, 85% and 46% of health workers, respectively. Perpetrators were patients and patients' caregivers, followed by co-workers. Victims suffered from various psychological symptoms, such as anxiety (22%-54%), fear (6%-39%), depression (32%) and repeated disturbing memories (21%). Risk factors included female gender, understaffing, worker inexperience, poor communication and lengthy waiting times. Social support and security personnel presence were among the identified protective factors.

CONCLUSIONS

Health workers are at high risk of experiencing WPV in the radiological setting, with a strong psychological impact. Radiological departments should create a safe healthcare environment that actively manages the identified risk factors and offers psychological support to affected workers.

Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping review

OBJECTIVES

This study aims to map and frame the main factors present in support interventions successfully implemented in health organisations in order to provide timely and adequate response to healthcare workers (HCWs) after patient safety incidents (PSIs).

DESIGN

Scoping review guided by the six-stage approach proposed by Arksey and O'Malley and by PRISMA-ScR.

DATA SOURCES

CINAHL, Cochrane Library, Embase, Epistemonikos, PsycINFO, PubMed, SciELO Citation Index, Scopus, Web of Science Core Collection, reference lists of the eligible articles, websites and a consultation group.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Empirical studies (original articles) were prioritised. We used the Mixed Methods Appraisal Tool Version 2018 to conduct a quality assessment of the eligible studies.

DATA EXTRACTION AND SYNTHESIS

A total of 9766 records were retrieved (last update in November 2022). We assessed 156 articles for eligibility in the full-text screening. Of these, 29 earticles met the eligibility criteria. The articles were independently screened by two authors. In the case of disagreement, a third author was involved. The collected data were organised according to the Organisational factors, People, Environment, Recommendations from other Audies, Attributes of the support interventions. We used EndNote to import articles from the databases and Rayyan to support the screening of titles and abstracts.

RESULTS

The existence of an organisational culture based on principles of trust and non-judgement, multidisciplinary action, leadership engagement and strong dissemination of the support programmes' were crucial factors for their effective implementation. Training should be provided for peer supporters and leaders to facilitate the response to HCWs' needs. Regular communication among the implementation team, allocation of protected time, funding and continuous monitoring are useful elements to the sustainability of the programmes.

CONCLUSION

HCWs' well-being depends on an adequate implementation of a complex group of interrelated factors to support them after PSIs.

Screening Second Victims for Emotional Distress: Assessment of the Clinimetric Properties of the WITHSTAND-PSY Questionnaire

INTRODUCTION

Adverse events (AEs) are a leading cause of patient morbidity and mortality, greatly impacting healthcare providers' well-being (second victim (SV) phenomenon). Since it is not accurately captured by existing psychometric instruments, we developed a clinimetric instrument for assessing SVs' emotional distress before and after an AE.

METHODS

Content validity and clinical utility of the WITHSTAND-PSY Questionnaire (WS-PSY-Q) were examined using cognitive interviews. Rasch analysis (n = 284) was applied for clinimetric assessment (i.e., construct, concurrent, and clinical validity, internal consistency), considering two crucial psychological facets of the SV phenomenon (1st: emotional impact of the AE, 2nd: current emotional state).

RESULTS

The Rasch partial credit model was used. The 1st facet demonstrated overall acceptable clinimetric properties with the subscale anxiety meeting clinimetric threshold values (e.g., all items with ordered thresholds, Loevinger's coefficient h ≥ 0.40; Person Separation Reliability Index (PSI) = 0.7). The 2nd facet showed overall better clinimetric properties for both subscales (e.g., h ≥ 0.40, PSI = 0.82 and 0.79, respectively; receiver operating characteristic area of 0.80 and 0.86, respectively). For both datasets, item fit statistics, except those for item 19, were within the critical range (z-score < ±2.5), and meaningful differential functioning analysis was observed for only 4 (out of 24) items. Local dependency was not observed, except for two item couples in the depression subscales.

CONCLUSIONS

The WS-PSY-Q is the first clinimetric tool assessing SVs' emotional distress. It should be regarded as part of the armamentarium used by clinicians to assess in-depth healthcare providers' psychological reactions in the aftermath of an AE to mitigate burnout and allostatic overload.

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

AIM

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS FOR NURSING LEADERS

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

Peer Support and Second Victim Programs for Anesthesia Professionals Involved in Stressful or Traumatic Clinical Events

Modern anesthetic care is very safe, but stressful and traumatic clinical events may occur. When they occur, anesthesia professionals are vulnerable to second victim experiences, resulting in significant and long-lasting psychological and emotional consequences if not addressed. Peer support can help anesthesia professionals cope with the negative effects of second victim experiences.

Factors Influencing Professional Identity of Psychiatric Nurses as Second Victims: A Cross-Sectional Study

The current study aimed to explore the status and influencing factors of professional identity among psychiatric nurses as second victims in China by using a cross-sectional design. We investigated 291 psychiatric nurses from two psychiatric hospitals. Participants were asked to complete a demographic questionnaire, Second Victim Experience and Support Scale, Multidimensional Health Locus of Control Scale, and Professional Identity Scale for Nurses. Scores of professional identity of psychiatric nurses as second victims were moderate. Regression analysis showed that the second victim experience and support and internal control were significant predictors, explaining 34.2% of the variance in professional identity. Identifying risk factors related to the professional identity of psychiatric nurses as second victims will help managers take timely preventive measures to improve the awareness of the self-health responsibility of psychiatric nurses and reduce the adverse effects of patient safety incidents to enhance their professional identity. [Journal of Psychosocial Nursing and Mental Health Services, 61(12), 47-54.].

Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations

BACKGROUND

Health professionals can be 'second victims' of adverse patient events. Second victimhood involves a series of physical and psychological signs and symptoms of varying severity and is most prevalent among nurses and women and in intensive care units (ICUs). Previous research has described personal and organizational coping strategies.

AIM

The objective of this research is to determine the prevalence of second victimhood, focusing on psychological distress, among Chilean adult intensive care nurses and its relationship with the support provided by their organizations.

STUDY DESIGN

A descriptive, correlational and cross-sectional study was conducted in seven intensive care units of Chilean hospitals.

RESULTS

Of a sample of 326 nurses, 90.18% reported having been involved in an adverse event and 67% reported psychological distress resulting from the adverse event. Embarrassment was the most prevalent psychological symptom (69%). Only 2.8% reported that their organization had an action plan for professionals in the event of a serious adverse event. Participants who had spent longer working in an ICU reported more support from their organization around adverse events.

CONCLUSION

Two-thirds of Chilean adult intensive care unit nurses report psychological stress following an adverse event. These results should be assessed internationally because second victims have major implications for the well-being of health professionals and, therefore, for retention and the quality of care.

RELEVANCE TO CLINICAL PRACTICE

Critical care leaders must actively promote a safe environment for learning from adverse events, and hospitals must establish a culture of quality that includes support programmes for second victims.

Second victim syndrome in intensive care unit healthcare workers: A systematic review and meta-analysis on types, prevalence, risk factors, and recovery time

INTRODUCTION

Patient safety incidents, including medical errors and adverse events, frequently occur in intensive care units, leading to a significant psychological burden on healthcare workers. This burden results in second victim syndrome, which impacts the psychological and psychosomatic well-being of these workers. However, a systematic review focusing specifically on this condition among intensive care unit healthcare workers is lacking. Therefore, we aimed to conduct a systematic review and meta-analysis to examine the occurrence of second victim syndrome among intensive care unit healthcare workers, including the types, prevalence, risk factors, and recovery time associated with this condition.

METHODS

We conducted a comprehensive search of the MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi databases. The eligibility criteria encompassed retrospective, prospective, and cross-sectional studies and controlled trials, with no language restrictions. Data on the type, prevalence, risk factors, and recovery time of second victim syndrome were extracted and pooled. Prevalence estimates from the included studies were combined using a random-effects meta-analytic model.

RESULTS

Of the 2,245 records retrieved, 16 potentially relevant studies were identified. Following full-text evaluation, five studies met the inclusion criteria and were included in the review. The findings revealed that 58% of intensive care unit healthcare workers experienced second victim syndrome. Frequent symptoms included guilt (12-68%), anxiety (38-63%), anger at self (25-58%), and lower self-confidence (7-58%). However, specific risk factors exclusive to intensive care unit healthcare workers were not identified in the review. Furthermore, approximately 20% of individuals took more than a year to recover or did not recover at all from the second victim syndrome.

CONCLUSIONS

Thus, this condition is prevalent among intensive care unit healthcare workers and may persist for extended periods, potentially exceeding a year. The risk factors for second victim syndrome in the intensive care unit setting are unclear and require further investigation.

Addressing the second victim phenomenon in Israeli health care institutions

BACKGROUND

The 'second victim' phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health's implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers' perceptions of the 'second victim' occurrence.

METHODS

A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the 'second victim'. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of 'second victim', and identifying components of possible intervention programs and challenges to implementing those programs.

RESULTS

Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager.

CONCLUSIONS

Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.

In search of an international multidimensional action plan for second victim support: a narrative review

BACKGROUND

Insights around second victims (SV) and patient safety has been growing over time. An overview of the available evidence is lacking. This review aims to describe (i) the impact a patient safety incident can have and (ii) how healthcare professionals can be supported in the aftermath of a patient safety incident.

METHODS

A literature search in Medline, EMBASE and CINAHL was performed between 1 and 2010 and 26 November 2020 with studies on SV as inclusion criteria. To be included in this review the studies must include healthcare professionals involved in the aftermath of a patient safety incident.

RESULTS

In total 104 studies were included. SVs can suffer from both psychosocial (negative and positive), professional and physical reactions. Support can be provided at five levels. The first level is prevention (on individual and organizational level) referring to measures taken before a patient safety incident happens. The other four levels focus on providing support in the aftermath of a patient safety incident, such as self-care of individuals and/or team, support by peers and triage, structured support by an expert in the field (professional support) and structured clinical support.

CONCLUSION

The impact of a patient safety incident on healthcare professionals is broad and diverse. Support programs should be organized at five levels, starting with preventive actions followed by self-care, support by peers, structured professional support and clinical support. This multilevel approach can now be translated in different countries, networks and organizations based on their own culture, support history, structure and legal context. Next to this, they should also include the stage of recovery in which the healthcare professional is located in.

Nurses' Silence: Understanding the Impacts of Second Victim Phenomenon among Israeli Nurses

INTRODUCTION

The 'second victim' phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims' natural history of recovery model predicts stages of the phenomenon from AE occurrence until the 'moving on' stage and serves as a suitable structure for many organizational support programs worldwide.

PURPOSE

Using the second victims' natural history of recovery model to examine the impact of the SVP on Israeli nurses, with a specific focus on the organizational support they felt they required compared with the support they felt that they had received from their organizations.

METHODS

Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced the SVP. The interviews were recorded subject to the interviewees' consent, transcribed, and analyzed using thematic content analysis.

FINDINGS

Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of the type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but, despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of the SVP as a valid response to an AE, a perceived lack of legitimacy to receive organizational support, and personal barriers that accompany the phenomenon.

CONCLUSIONS

Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient, and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of the general organizational policy to improve the quality of care and patient safety.

Mediating role of psychological distress in the associations between medical errors, adverse events, suicidal ideation and plan among operating room nurses in China: a cross-sectional study

OBJECTIVES

Medical errors (MEs) and adverse events (AEs) both had long-term impacts on healthcare professionals. Studies investigated the associations between MEs, AEs, psychological distress and suicidal behaviours among healthcare professionals. The aim of the current study was to explore the mediating role of psychological distress in the relationship between MEs/AEs and suicidal ideation/suicide plan among operating room nurses in China.

DESIGN

A cross-sectional study.

SETTING

The survey was conducted between December 2021 and January 2022 in China.

PARTICIPANTS

A total of 787 operating room nurses completed the questionnaires in China.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were MEs and AEs. Secondary outcome measures were psychological distress and suicidal behaviours.

RESULTS

The results showed that 22.1% of operating room nurses were involved in MEs, while 13.9% of operating room nurses were involved in AEs. The associations between suicidal ideation (OR=1.10, p<0.001), suicide plan (OR=1.07, p<0.01) and psychological distress were significant. The associations between suicidal ideation (OR=2.76, 95% CI=1.53 to 4.97, p<0.01), suicide plan (OR=2.80, 95% CI=1.20 to 6.56, p<0.05) and MEs were significant. The associations between suicidal ideation (OR=2.27, 95% CI=1.17 to 4.40, p<0.05), suicide plan (OR=2.92, 95% CI=1.19 to 7.18, p<0.05) and AEs were significant. The psychological distress mediated the relationship between MEs/AEs and suicidal ideation/suicide plan.

CONCLUSION

There were positive associations between MEs, AEs and psychological distress. Moreover, MEs and AEs were also positively associated with suicidal ideation and suicide plan. As expected, psychological distress played an important role in the relationship between MEs/AEs and suicidal ideation/suicide plan.

Use of the Revised Second Victim Experience and Support Tool to Examine Second Victim Experiences of Respiratory Therapists

BACKGROUND

Respiratory therapists (RTs) work alongside allied health staff, nurses, and physicians during stressful and traumatic events that can be associated with emotional and physiological implications known as second victim (SV) experiences (SVEs). This study aimed to evaluate SVEs of RTs, including both positive and negative implications.

METHODS

RTs within a large academic health care organization across Minnesota, Wisconsin, Florida, and Arizona were asked to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool-Revised to assess SVEs as well as desired support services.

RESULTS

Of the RTs invited to participate, 30.8% (171/555) completed the survey. Of the 171 survey respondents, 91.2% (156) reported that they had been part of a stressful or traumatic work-related event as an RT, student, or department support staff member. Emotional or physiologic implications experienced by respondents as SVs included anxiety 39.1% (61/156), reliving of the event 36.5% (57/156), sleeplessness 32.1% (50/156), and guilt 28.2% (44/156). Following a stressful clinical event, 14.8% (22/149) experienced psychological distress, 14.2% (21/148) experienced physical distress, 17.7% (26/147) indicated lack of institutional support, and 15.6% (23/147) indicated turnover intentions. Enhanced resilience and growth were reported by 9.5% (14/147). Clinical and non-clinical events were reported as possible triggers for SVEs. Nearly half of respondents 49.4% (77/156) indicated feeling like an SV due to events related to COVID-19. Peer support was the highest ranked form of desired support following an SVE by 57.7% (90/156).

CONCLUSIONS

RTs are involved in stressful or traumatic clinical events, resulting in psychological/physical distress and turnover intentions. The COVID-19 pandemic has had a significant impact on RTs' SVEs, highlighting the importance of addressing the SV phenomenon among this population.