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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:S1036-7314(24)00006-7. [PMID: 38360471 DOI: 10.1016/j.aucc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Yehene E, Asherman A, Goldzweig G, Simana H, Brezner A. Secondary traumatic stress among pediatric nurses: Relationship to peer-organizational support and emotional labor strategies. J Pediatr Nurs 2024; 74:92-100. [PMID: 38029691 DOI: 10.1016/j.pedn.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Even though the cost of caring is acknowledged in multiple helping professions, research into secondary traumatic stress in pediatric nursing remains limited. This study aimed to determine the prevalence of secondary traumatic stress among pediatric nurses and examine its correlation with demographics, perceived organizational support, peer support, and emotional labor strategies. DESIGN AND METHODS A total of 186 nurses working in a pediatric hospital completed questionnaires addressing secondary traumatic stress, perceived organizational support, peer support, and emotional labor strategies. Through correlational and mediation analyses, we explored the relationships between the study variables. RESULTS Approximately 77.8% of the pediatric nurses surveyed exhibited moderate to severe secondary traumatic stress. Notably, the level of secondary traumatic stress did not correlate with demographic variables. Increased peer support was significantly associated with a heightened use of all emotional labor strategies (surface acting, deep acting, and natural expression) and with elevated levels of secondary traumatic stress. However, surface acting was the sole mediator of this relationship. Conversely, greater perceived organizational support correlated with decreased levels of surface acting and secondary traumatic stress, with surface acting serving as the mediator. CONCLUSIONS Pediatric nurses are greatly impacted by secondary traumatic stress. Enhancing organizational support and carefully assessing peer support can reduce this, by decreasing nurses' need to suppress or feign genuine emotions. PRACTICE IMPLICATIONS To enhance nurses' psychological well-being, healthcare institutions should raise awareness of secondary traumatization and foster a supportive organizational environment that prioritizes effective team emotional support and evaluates collegial emotional labor.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, the Academic College of Tel Aviv - Yaffo, Israel; Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.
| | - Adi Asherman
- School of Behavioral Sciences, the Academic College of Tel Aviv - Yaffo, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, the Academic College of Tel Aviv - Yaffo, Israel
| | - Hadar Simana
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Amichai Brezner
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
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Rivera-Chiauzzi EY, Huang L, Osborne AK, Musch AA, Berkland BE, Meyer AT, Vitek SM, Wieneke KC, Allyse MA, Riggan KA, Finney RE. Rapid Expansion of the Healing Emotional Lives of Peers Program During COVID-19: A Second Victim Peer Support Program for Healthcare Professionals. J Patient Saf 2024; 20:28-37. [PMID: 37966348 DOI: 10.1097/pts.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
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.
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Affiliation(s)
| | - Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Alayna K Osborne
- Division of Community and Employee Engagement, Mayo Clinic Health System-Southwest Minnesota Region, Mankato
| | | | | | - Anne T Meyer
- Department of Human Resources-Employee Well-Being
| | | | | | | | | | - Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Morley G, Sankary LR. Nurturing moral community: A novel moral distress peer support navigator tool. Nurs Ethics 2023:9697330231221220. [PMID: 38149497 DOI: 10.1177/09697330231221220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward "solution." Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, rather than evidencing identification of the "right" course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient's values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action.
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Affiliation(s)
- Georgina Morley
- Nursing Ethics Program, Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System
| | - Lauren R Sankary
- Neuroethics Program, Center for Bioethics, Neurological Institute, Cleveland Clinic Health System
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Finney RE, Jacob AK. Peer Support and Second Victim Programs for Anesthesia Professionals Involved in Stressful or Traumatic Clinical Events. Adv Anesth 2023; 41:39-52. [PMID: 38251621 DOI: 10.1016/j.aan.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
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.
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Affiliation(s)
- Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Adam K Jacob
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Pérez-Solà V, Ayuso JL, Borrás-Murcia C, Elices M, Campillo M, Giner L, González-Pinto A, Guija JA, Navío M, Palao D, Saiz P. Second victim experience in Spanish psychiatrists coping with patient suicide: A call for postvention. Span J Psychiatry Ment Health 2023:S2950-2853(23)00111-4. [PMID: 38008184 DOI: 10.1016/j.sjpmh.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/25/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Losing a patient by suicide may lead to psychological distress and mid/long-term personal and professional consequences for psychiatrists, becoming second victims. MATERIAL AND METHODS The validated Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire and a 30-item questionnaire created ad-hoc was administered online to psychiatrists from all over Spain to evaluate how patient suicide affects mental health professionals. RESULTS Two hundred ninety-nine psychiatrists participated in the survey, and 256 completed the SVEST-E questionnaire. The results of the SVEST-E questionnaire revealed a negative impact of suicide on emotional and physical domains, although this seemed not to lead to work absenteeism. Most respondents desired peer support from a respected colleague and considered institutional support, although desirable, lacking. Almost 70% of surveyed stated that an employee assistance program providing free counseling to employees outside of work would be desirable. The ad-hoc questionnaire showed that up to 88% of respondents considered some suicides unavoidable, and 76% considered the suicide unexpected. Almost 60% of respondents reported no changes in the approach of patients with suicidal ideation/behavior, after losing a patient. However, up to 76% reported performing more detailed clinical evaluations and notes in the medical record. Up to 13% of respondents considered leaving or changing their job or advancing retirement after losing a patient by suicide. CONCLUSIONS After a patient's suicide, psychiatrists often suffer the feelings of second victim, impacting personal and professional areas. The study results indicate the need for postvention strategies to mitigate the negative impact of patient suicide.
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Affiliation(s)
- Víctor Pérez-Solà
- Instituto de Neuropsiquiatría y Adicciones (INAD), Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain; Spanish Foundation of Psychiatry and Mental Health (Fundación Española de Psiquiatría y Salud Mental, FEPSM), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - José Luis Ayuso
- Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Matilde Elices
- Instituto de Neuropsiquiatría y Adicciones (INAD), Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Maite Campillo
- Psychiatry Department, Instituto de Neuropsiquiatría y Adicciones (INAD), Centre Emili Mira, Parc de Salut Mar, Barcelona, Spain
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Spain
| | - Ana González-Pinto
- Spanish Foundation of Psychiatry and Mental Health (Fundación Española de Psiquiatría y Salud Mental, FEPSM), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; University Hospital of Araba, BIOARABA, UPV/EHU, Vitoria, Spain
| | | | - Mercedes Navío
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Madrid Mental Health Regional Office, Hospital 12 de Octubre, Madrid, Spain
| | - Diego Palao
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Mental Health, University Hospital Parc Taulí, Unitat Mixta de Neurociència Traslacional I3PT-INc-UAB, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Pilar Saiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
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Kappes M, Delgado-Hito P, Contreras VR, Romero-García M. Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations. Nurs Crit Care 2023; 28:1022-1030. [PMID: 37614030 DOI: 10.1111/nicc.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Abstract
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.
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Affiliation(s)
- Maria Kappes
- 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: Proyecto HU-CI, Collado Villalba, Spain
| | | | - Marta Romero-García
- 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: Proyecto HU-CI, Collado Villalba, Spain
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Dato Md Yusof YJ, Ng QX, Teoh SE, Loh CYL, Xin X, Thumboo J. Validation and use of the Second Victim Experience and Support Tool questionnaire: a scoping review. Public Health 2023; 223:183-192. [PMID: 37672831 DOI: 10.1016/j.puhe.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Patient safety incidents can impact not only patients and families but also healthcare providers, who may experience negative emotions and symptoms, such as anxiety, guilt, stress, and loss of confidence. To identify and support these "second victims," a screening tool called the Second Victim Experience and Support Tool (SVEST) has been developed. This scoping review aims to map our current knowledge of the SVEST in terms of its scope of use, validation and limitations. STUDY DESIGN Scoping review. METHODS In accordance with the framework outlined by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews, we conducted a literature search in MEDLINE, CINAHL, Cochrane Library, SCOPUS, Embase and PsycINFO databases from database inception up till 1 March 2023. RESULTS A total of 31 studies were reviewed. The SVEST has been cross-culturally adapted from English into other languages. The SVEST has been successfully used in different contexts and with various healthcare professionals, including doctors, nurses, allied health professionals, midwives and pharmacists. The tool has been used to assess the impact of second victim experiences and the effectiveness of support interventions in addressing the phenomenon. Validity assessment of translated versions of SVEST in the reviewed studies revealed good content validity in most cases, although some studies did not report clear values for scale-level Content Validity Index. On the whole, SVEST is generally a reliable and valid tool, although further refinements and modifications may improve its validity and reliability. CONCLUSIONS The review highlights the significance of SVEST as a crucial resource for healthcare providers and organisations that prioritise well-being and safety in health care. It also underscores the importance of recognising the needs of second victims and offering them appropriate interventions to manage the aftermath of adverse events.
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Affiliation(s)
- Y J Dato Md Yusof
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Q X Ng
- Health Services Research Unit, Singapore General Hospital, Singapore.
| | - S E Teoh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C Y L Loh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - X Xin
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - J Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
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