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Baas MAM, Stramrood CAI, Molenaar JE, van Baar PM, Vanhommerig JW, van Pampus MG. Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns). BMC Psychiatry 2024; 24:286. [PMID: 38627649 PMCID: PMC11022402 DOI: 10.1186/s12888-024-05678-3] [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: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support. METHODS In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5). RESULTS The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient. CONCLUSIONS The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.
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Affiliation(s)
- Melanie A M Baas
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, 9700 RB, Groningen, PO box 30.001, The Netherlands
| | - Claire A I Stramrood
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Beval Beter, 1000 AH, Amsterdam, PO box 345, The Netherlands
| | - Jolijn E Molenaar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Petra M van Baar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands.
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Fitzgerald K, Knight J, Valji K. Enhancing your practice: debriefing in interventional radiology. CVIR Endovasc 2024; 7:12. [PMID: 38227127 DOI: 10.1186/s42155-023-00412-8] [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: 09/10/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024] Open
Abstract
LEARNING OBJECTIVES Review the history of debriefing and provide an Interventional Radiologist (IR) specific framework for leading an effective debrief. BACKGROUND A debrief is often regarded as a meeting with persons who were involved in a stressful, traumatic and/or emotionally challenging situation to review processes, communicate concerns or gather feedback. The goals of these sessions can be for learning/quality improvement (QI) or psychological/emotional support, or a mix of both. Debriefing after tough situations has become a standard tool of many medical specialties, such as surgery, critical care and emergency medicine, with specialty specific literature available. However, there is a paucity of Interventional Radiology specific literature available for debriefing techniques. CLINICAL FINDINGS/PROCEDURE DETAILS We will review the history and types of debriefing and why a debrief could be considered. We will provide a framework for leading a successful debrief in Interventional Radiology. CONCLUSION Debriefing can be a useful tool for learning and QI as well as psychological or emotional support after a challenging or tough situation. Debriefing can address multiple variables and can stylistically be tailored to suit specific needs. IRs have an opportunity to take a leadership role in debriefing, providing comfort and quality improvement through communication and support.
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Affiliation(s)
- Kara Fitzgerald
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA.
| | - Jesse Knight
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA
| | - Karim Valji
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA
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Busch IM, Mazzi MA, Berti L, Wu AW, Cosci F, Marinelli V, Moretti F, Rimondini M. Screening Second Victims for Emotional Distress: Assessment of the Clinimetric Properties of the WITHSTAND-PSY Questionnaire. Psychother Psychosom 2023; 92:399-409. [PMID: 38118426 PMCID: PMC10794969 DOI: 10.1159/000535006] [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] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/31/2023] [Indexed: 12/22/2023]
Abstract
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.
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Affiliation(s)
- Isolde Martina Busch
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Loretta Berti
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Marinelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of General and Pancreatic Surgery, University of Verona, Verona, Italy
| | - Francesca Moretti
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Movement Sciences, University of Verona, Verona, Italy
| | - Michela Rimondini
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
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Abreu T, Freysteinson WM, Clutter P, Aulbach R. Demystifying the experience of participating in a root cause analysis: A hermeneutic phenomenological study. Appl Nurs Res 2023; 74:151746. [PMID: 38007246 DOI: 10.1016/j.apnr.2023.151746] [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: 12/12/2022] [Revised: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
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.
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Affiliation(s)
- Tamu Abreu
- Nelda C. Stark College of Nursing, Texas Woman's University, USA.
| | | | - Paula Clutter
- Nelda C. Stark College of Nursing, Texas Woman's University, USA
| | - Rebecca Aulbach
- Nelda C. Stark College of Nursing, Texas Woman's University, USA
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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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Krogh TB, Mielke-Christensen A, Madsen MD, Østergaard D, Dieckmann P. Medical students' experiences, perceptions, and management of second victim: an interview study. BMC Med Educ 2023; 23:786. [PMID: 37875909 PMCID: PMC10598910 DOI: 10.1186/s12909-023-04763-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The term second victim describes a healthcare professional who has been involved in an adverse event and feels wounded by the event. The effects of this experience differ. It can present as second victim syndrome, describing a wide range and degree of emotional and behavioural responses. Studies show that medical students can also experience second victim. The aim of this study was to elucidate medical students' experiences, perceptions, and management of second victim and second victim syndrome and to describe possible learning needs around these issues. METHODS Thirteen medical students and two recent medical graduates participated in semi-structured focus group interviews. The interviews lasted 1.5-2 h and were audiotaped, transcribed, and analysed using Braun and Clarke's six-step approach for thematic analysis. RESULTS Four main themes were identified: contributing factors; current coping strategies; perception of own requirements and learning needs; wishes for the future healthcare system. Students' behavioural and emotional response to dilemmas were affected by stakeholders and practices embedded in the healthcare system. Students described patient-injury and unexpected events as triggers for second victim, but also harmful interactions with individuals and feelings of self-blame. Students' coping centred around their network, formal offers, and separation of personal- and work-life. Students sought a clear definition of second victim and a desire for role-models. Students' wished to learn how to handle feeling like a burden to others, managing waiting time after patient complaints, and learning how to help second victims recover. Students emphasized the importance of the healthcare organisation understanding students' needs and providing them relevant support. CONCLUSION Students experience second victim as described in the literature. Students' emotional responses were caused by classical second victim triggers, but also other triggers in the educational environment: harmful interactions and self-blame. Although some triggers differ from the second victim definition, these different triggers should be considered equally serious and acknowledged. We must aim to prepare students for future adverse events and emotional responses. The health organisation and healthcare professionals must support students' mental well-being and contribute to ideal conditions for students' professional development and management of second victim as future physicians.
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Affiliation(s)
- Tobias Browall Krogh
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark.
| | - Anne Mielke-Christensen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
| | - Marlene Dyrløv Madsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
- Department of Quality and Health Technology, University Stavanger, Stavanger, Norway
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
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Pacutova V, Geckova AM, de Winter AF, Reijneveld SA. Opportunities to strengthen resilience of health care workers regarding patient safety. BMC Health Serv Res 2023; 23:1127. [PMID: 37858175 PMCID: PMC10588085 DOI: 10.1186/s12913-023-10054-0] [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: 07/21/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic endangered the quality of health care and the safety of patients and health care workers (HCWs). This provided challenges for HCWs' resilience and for hospital management and probably increased risks for patient safety incidents (PSI). HCWs may also have experienced psychological consequences as second victims of PSI, but evidence on this is lacking. Therefore, we mapped HCWs' experiences with PSI during the second wave of COVID-19, the associations of these experiences with the hospital management of patient safety culture and HCWs' interests in receiving further training. METHODS We obtained data from 193 HCWs working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire developed in direct collaboration with them. We measured PSI experiences as various HCWs' experiences with near miss and adverse events and the hospital management of patient safety culture using indicators such as risk of recurrence, open disclosure and second victim experiences. For analysis, we used logistic regression models adjusted for age and gender of the HCWs. RESULTS One-third of the hospital HCWs had experienced PSI; these were more likely to expect adverse events to recur (odds ratio, OR = 2.7-3.5). Regarding the hospital management of patient safety culture, the HCWs' experiencing openly disclosed PSI was associated with one negative outcome, i.e. conflicts among colleagues (OR = 2.8), and one positive outcome, i.e. patients' acceptance of their explanation and apologies (OR = 2.3). We found no associations for any other essential domains after disclosure. PSI experiences were strongly associated with psychological indicators of second victimhood, such as sadness, irritability, anxiety and depression (OR = 2.2-4.3), while providing support was not. The majority of the HCWs would like to participate in the suggested trainings (83.4%). CONCLUSION HCWs with PSI experiences reported poor hospital management of the patient safety culture, which might reflect they missed the opportunities to strengthen their resilience, especially during the COVID-19 pandemic.
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Affiliation(s)
- Veronika Pacutova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, Kosice, 040 11, Slovakia.
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9713, Netherlands.
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, Kosice, 040 11, Slovakia
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9713, Netherlands
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University Bratislava, Bratislava, 821 05, Slovakia
| | - Andrea F de Winter
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9713, Netherlands
| | - Sijmen A Reijneveld
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9713, Netherlands
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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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Li X, Che CC, Li Y, Wang L, Chong MC. The mediating role of coping styles in the relationship between second victim experience and professional quality of life among nurses: a cross-sectional study. BMC Nurs 2023; 22:312. [PMID: 37700282 PMCID: PMC10496327 DOI: 10.1186/s12912-023-01473-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Studies have shown that second-victim experiences could increase risks of the compassion fatigue while support from individuals and organisations is most often protection. However, the risk for poor compassion satisfaction and increased compassion fatigue in nurses aroused by adverse events remains an underestimated problem, meanwhile, litter known about the role of positive and negative coping styles among nurses suffering from adverse events. This study aims to investigate the effect of second-victim experiences on the professional quality of life among nurses and to determine the mediating role of coping styles in the relationship between second-victim experiences and professional quality of life. METHODS Multistage sampling was used to recruit registered nurses from Hunan province in China. Registered nurses who identified themselves as experiencing adverse events from nine tertiary hospitals were included in this study. Participants were recruited to complete a survey on the second victim experience and support tool, the simplified coping style questionnaire, and the professional quality of life scale. The stress coping theory was used to develop the framework in this study. The structural equation modelling approach was used for conducting the mediating effects analysis via IBM SPSS Statistics 26.0 and Mplus 8.3. RESULTS In total, 67% (n = 899) of nurses reported a second victim experience during their careers. In a bivariate analysis, both second-victims experiences and coping styles were significantly associated with their professional quality of life. The results showed that the effects of second victim experiences on their professional quality of life were fully mediated by coping styles. A total of 10 significantly indirect pathways were estimated, ranging from -0.243 to 0.173. CONCLUSIONS Second-victim experiences are common among nurses in this study. Since the mediating effects of coping styles were clarified in this study, it is imperative to promote the perception of negative coping styles and encourage nurses to adopt more positive coping styles with adequate support systems.
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Affiliation(s)
- Xizhao Li
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ling Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Cohen R, Sela Y, Nissanholtz-Gannot R. Addressing the second victim phenomenon in Israeli health care institutions. Isr J Health Policy Res 2023; 12:30. [PMID: 37667398 PMCID: PMC10476320 DOI: 10.1186/s13584-023-00578-5] [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: 04/04/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
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.
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Affiliation(s)
- Rinat Cohen
- Department of Health System Management, School of Health Science, Ariel University, Ariel, Israel
- Nursing Department, Ramat Gan Academic College, Ramat Gan, Israel
- Rishon Le Zion, Israel
| | - Yael Sela
- Nursing Department, Ruppin Academic College, Emek-Hefer, Israel
| | - Rachel Nissanholtz-Gannot
- Department of Health System Management, School of Health Science, Ariel University, Ariel, Israel
- Smokler Center for Health Policy Research, Meyers JDC-Brookdale Institute, Jerusalem, Israel
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Seys D, Panella M, Russotto S, Strametz R, Joaquín Mira J, Van Wilder A, Godderis L, Vanhaecht K. In search of an international multidimensional action plan for second victim support: a narrative review. BMC Health Serv Res 2023; 23:816. [PMID: 37525127 PMCID: PMC10391912 DOI: 10.1186/s12913-023-09637-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/03/2023] [Indexed: 08/02/2023] Open
Abstract
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.
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Affiliation(s)
- Deborah Seys
- Department Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Leuven, Belgium.
- Department Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Sophia Russotto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - José Joaquín Mira
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Astrid Van Wilder
- Department Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lode Godderis
- Department Public Health and Primary Care, KU Leuven, Leuven, Belgium
- External Service for Prevention and Protection at Work, IDEWE, Heverlee, Belgium
| | - Kris Vanhaecht
- Department Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Quality, University Hospitals Leuven, 3000, Leuven, Belgium
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Härkänen M, Pineda AL, Tella S, Mahat S, Panella M, Ratti M, Vanhaecht K, Strametz R, Carrillo I, Rafferty AM, Wu AW, Anttila VJ, Mira JJ. The impact of emotional support on healthcare workers and students coping with COVID-19, and other SARS-CoV pandemics - a mixed-methods systematic review. BMC Health Serv Res 2023; 23:751. [PMID: 37443003 DOI: 10.1186/s12913-023-09744-6] [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: 02/24/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Pandemics such as COVID-19 pose threats to the physical safety of healthcare workers and students. They can have traumatic experiences affecting their personal and professional life. Increasing rates of burnout, substance abuse, depression, and suicide among healthcare workers have already been identified, thus making mental health and psychological wellbeing of the healthcare workers a major issue. The aim of this systematic review is to synthesize the characteristics of emotional support programs and interventions targeted to healthcare workers and students since the onset of COVID-19 and other SARS-CoV pandemics and to describe the effectiveness and experiences of these programs. METHOD This was a mixed method systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review was registered on PROSPERO [CRD42021262837]. Searches were conducted using Medline, CINAHL, PsycINFO, Cochrane Library, and Scopus databases. The COVIDENCE systematic review management system was used for data selection and extraction by two independent reviewers. The JBI (Joanna Briggs Institute) critical appraisal tools were used to assess the quality of selected studies by two additional reviewers. Finally, data extraction and narrative analysis were conducted. RESULTS The search retrieved 3161 results including 1061 duplicates. After screening, a total of 19 articles were included in this review. Participants in studies were nurses, physicians, other hospital staff, and undergraduate medical students mostly working on the front-line with COVID-19 patients. Publications included RCTs (n = 4), quasi-experimental studies (n = 2), cross-sectional studies (n = 6), qualitative interview studies (n = 3), and systematic reviews (n = 4). Most (63.4%) of the interventions used online or digital solutions. Interventions mostly showed good effectiveness (support-seeking, positive emotions, reduction of distress symptoms etc.) and acceptance and were experienced as helpful, but there were some conflicting results. CONCLUSION Healthcare organizations have developed support strategies focusing on providing emotional support for these healthcare workers and students, but it is difficult to conclude whether one program offers distinct benefit compared to the others. More research is needed to evaluate the comparative effectiveness of emotional support interventions for health workers.
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Affiliation(s)
- Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Yliopistoranta 1c, Kuopio, Finland
| | - Adriana López Pineda
- Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain
| | - Susanna Tella
- LAB University of Applied Sciences, Lappeenranta, Finland
| | - Sanu Mahat
- Department of Nursing Science, University of Eastern Finland, Yliopistoranta 1c, Kuopio, Finland
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Matteo Ratti
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Reinhard Strametz
- Wiesbaden Business School of RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernández University, Elche, Spain
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College, London, UK
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - José Joaquín Mira
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain.
- Health Psychology Department, Miguel Hernández University, Elche, Spain.
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Sahay A, McKenna L. Nurses and nursing students as second victims: A scoping review. Nurs Outlook 2023; 71:101992. [PMID: 37302259 DOI: 10.1016/j.outlook.2023.101992] [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: 06/24/2022] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Second victim describes the impact on health care professionals after an error causing preventable patient harm. However, to date, the impact of making errors in practice by nurses and/or nursing students is unclear. PURPOSE To describe and understand what is known about nurses and nursing students as second victims. METHODS A scoping review was completed using three databases: CINAHL, Medline, and Proquest for the period between 2010 and 2022. A total of 23 papers underwent thematic analysis. DISCUSSION Three themes were identified: (a) Psychological distress and symptomatology, (b) Coping-response/reactions to errors, and (c) Seeking support and understanding. CONCLUSION Nurses and nursing students' well-being and productivity levels can be negatively affected by inadequate team and organisational support. To improve team functioning, appropriate support mechanisms must be implemented to assist nurses who experience significant distress after making errors. Nursing leadership should prioritise improving support programs, assessing workload allocation, and increasing awareness amongst leaders of the potential benefits of providing support to second victims.
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Affiliation(s)
- Ashlyn Sahay
- School of Nursing and Midwifery, Central Queensland University, Mackay, QLD, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia.
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Mahat S, Rafferty AM, Vehviläinen-Julkunen K, Härkänen M. Negative emotions experienced by healthcare staff following medication administration errors: a descriptive study using text-mining and content analysis of incident data. BMC Health Serv Res 2022; 22:1474. [PMID: 36463187 PMCID: PMC9719256 DOI: 10.1186/s12913-022-08818-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident. METHOD This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data. RESULTS Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error. CONCLUSION Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice.
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Affiliation(s)
- Sanu Mahat
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1c, Kuopio, Finland
| | - Anne Marie Rafferty
- grid.13097.3c0000 0001 2322 6764King’s College London: Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK
| | - Katri Vehviläinen-Julkunen
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Kuopio, Yliopistonranta 1, 70210 Finland ,grid.410705.70000 0004 0628 207XKuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Marja Härkänen
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1c, Kuopio, Finland
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Cho DB, Lee W, Cha JM, Kim JH, Kim J, Kang SB, Eun CS. Second Victim Experience and Perception Discordance of the Colonoscopic Perforation. Dig Dis Sci 2022; 67:2857-65. [PMID: 34283361 DOI: 10.1007/s10620-021-07107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/09/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Perforation is the most serious adverse event of colonoscopy, but rarely considered from the view of colonoscopists' second victim experience and perception discordance between colonoscopists and patients. AIMS We aimed to evaluate colonoscopists' second victim experience and the perception discordance between colonoscopists and patients for the colonoscopic perforation. METHODS A survey for colonoscopic perforation was performed for the colonoscopists and outpatients who visited the university hospital between February 1, 2020, and April 30, 2020. The questionnaire included questions regarding colonoscopists' satisfaction for the intervention strategies offered to patients and patient-colonoscopist perception on colonoscopic perforation. A modified Korean version of the "Second Victim Experience and Support Tool (K-SVEST)" was used to assess the second victim experiences and supportive resources for the colonoscopists. RESULTS Survey results from 160 colonoscopists and 165 patients were analyzed. The colonoscopists' satisfaction scores were higher for strategies related to sufficient explanation, empathy, courteous listening, and monetary compensation. The scores of the K-SVEST for the second victim experience were highest in psychological distress, followed by loss of professional self-efficacy, colleague support, physical distress, non-work-related support, institutional support, and turnover intentions/absenteeism. Significant patient-colonoscopist discordance was noted for the same colonoscopic perforation scenario on the judgment of medical error, health professionals' apology, monetary compensation, and criminal penalties for the colonoscopists. CONCLUSIONS Colonoscopists can suffer emotionally and physically from the second victim experience after colonoscopic perforation. In addition, the significant patient-colonoscopist discordance should be considered to make a better communication for the colonoscopic perforation.
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Ben Saida I, Grira S, Toumi R, Ghodhbani A, Ennouri E, Meddeb K, Ben Saad H, Boussarsar M. North-African doctors as second victims of medical errors: a cross sectional survey. BMC Psychiatry 2022; 22:411. [PMID: 35718779 PMCID: PMC9208235 DOI: 10.1186/s12888-022-04049-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Physicians involved in medical errors (MEs) can experience loss of self-esteem and negative psychological experiences. They are called "second victims" of the ME. AIMS To i) describe the profile, the types and the severity of MEs, and ii) explore the psychological impact on "second victims" to better understand how they cope. METHODS It was a cross sectional retrospective study conducted from March to August 2018. All physicians working at Farhat Hached and Sahloul University hospitals were asked to complete a questionnaire about their possible MEs. The impact of MEs was evaluated using the Impact of Event Scale-Revised (IES-R) (scoring, 0-88) (subscales ranges; intrusion, (0-32); avoidance, (0-32); hyperarousal, (0-24)). The diagnosis of post-traumatic stress disorder (PTSD) was made when the total IES-R score exceeded 33. The coping strategies were evaluated using Ways of Coping Checklist Revised (WCC-R) scale (scoring, problem-focused, (10-40); emotion focused, (9-36); seeking social support, (8-32)). RESULTS Among 393 responders, 268(68.2%) reported MEs. Wrong diagnosis (40.5%), faulty treatment (34.6%), preventive errors (13.5%) and faulty communication (6.4%) were the main frequent types of MEs. The most common related causes of MEs were inexperience (47.3%) and job overload (40.2%). The physicians' median (range) score of the IES-R was 19(0-69). According to the IES-R score, the most frequent psychological impacts were median (range): intrusion, 7(0-28) and avoidance symptoms, 7(0-24). PTSD symptoms affected 23.5% of physicians. Female sex and serious MEs were identified as predictors of PTSD. On the WCC-R check list, coping was balanced between the three coping strategies median (range), problem focused, 28.5(10-40); emotion-focused, 24(9-36) and seeking social support 21(8-32). CONCLUSION There is a relatively high impact of ME within these North-African university hospital physicians. Coping was balanced within different three strategies as reported worldwide. Physicians adopted more likely constructive changes than defensive ones.
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Affiliation(s)
- Imen Ben Saida
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Sabil Grira
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Radhouane Toumi
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Amani Ghodhbani
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Emna Ennouri
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Khaoula Meddeb
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Helmi Ben Saad
- grid.7900.e0000 0001 2114 4570University of Sousse, Faculty of Medicine of Sousse, 4000 Sousse, Tunisia ,grid.412791.80000 0004 0508 0097Farhat Hached University Hospital, Laboratory of Physiology and Functional Explorations, Research Laboratory “Heart Failure”, LR12SP09, 4000 Sousse, Tunisia
| | - Mohamed Boussarsar
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia. .,Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure", LR12SP09, 4000, Sousse, Tunisia.
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Marr R, Goyal A, Quinn M, Chopra V. Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News and World Report Honor Roll Hospitals. BMC Health Serv Res 2021; 21:1330. [PMID: 34895225 PMCID: PMC8665707 DOI: 10.1186/s12913-021-07315-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals. Methods We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Telephone interviews were recorded, transcribed, and de-identified. To allow identification of both quantitative and qualitative themes that unified or distinguished programs with SVPs from each other, a content analysis approach was used. Results Of the Top 20 UNSWR hospitals, nineteen individuals with knowledge of or involvement in SVPs were identified. One individual represented two hospital systems for the same institution. Thirteen representatives agreed to participate, 12 declined, and 5 did not respond. One individual who initially agreed to participate did not attend the interview. Among twelve representatives interviewed, 10 reported establishment of SVPs at their hospitals between 2011 and 2016. Most program representatives reported that participants sought support voluntarily. Four domains were identified in the qualitative analysis: (a) identification of need for Second Victim Program (SVP); (b) challenges to program viability; (c) structural changes following SVP creation, and (d) insights for success. Driving SVP creation was the need support medical providers following a traumatic patient event. Poor physician participation due to the stigma associated with seeking support was commonly reported as a challenge. However, acceptance of the mission of SVPs, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. To ensure success, participants suggested training a variety of volunteers and incorporating SVPs within quality improvement processes. Conclusions In this convenience sample, programs for healthcare providers that experience psychosocial or emotional trauma from clinical care were uncommon. Variation in structure, performance, and measures of success among SVPs was observed. A systematic approach to evaluating SVPs is needed to help inform institutions of how to best serve their second victims. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07315-1.
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Affiliation(s)
- Ruby Marr
- Division of Hospital Medicine, Michigan Medicine, University of Michigan, MI, Ann Arbor, USA.
| | - Anupama Goyal
- Division of Hospital Medicine, Michigan Medicine, University of Michigan, MI, Ann Arbor, USA
| | - Martha Quinn
- School of Public Health, University of Michigan, MI, Ann Arbor, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, MI, Ann Arbor, USA
| | - Vineet Chopra
- Division of Hospital Medicine, Michigan Medicine, University of Michigan, MI, Ann Arbor, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, MI, Ann Arbor, USA
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Choi EY, Pyo J, Ock M, Lee H. Second victim phenomenon after patient safety incidents among Korean nursing students: A cross-sectional study. Nurse Educ Today 2021; 107:105115. [PMID: 34481312 DOI: 10.1016/j.nedt.2021.105115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 07/12/2021] [Accepted: 08/24/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Perfectionism in the medical field turns healthcare professionals into second victims of patient safety incidents. They suffer physically and psychologically, which makes them consider changing occupations. Nursing students may also have similar negative experiences during clinical practice. OBJECTIVE To describe the second victim phenomenon among nursing students after patient safety incidents during their clinical practice. DESIGN A descriptive cross-sectional study using an online questionnaire. SETTING AND PARTICIPANTS Fourth-year nursing students (n = 354) who encountered patient safety incidents directly or indirectly during clinical practice. Participants were recruited through convenience and snowball sampling methods using personal contacts, professional networks, and online platforms. METHODS The questionnaire addressed the characteristics of patient safety incidents, and physical and psychological responses after the most significant patient safety incident. Descriptive statistics and a chi-square test were performed for data analysis. RESULTS Of the participants, 22.6% were directly involved in patient safety incidents and 77.4% had indirectly encountered patient safety incidents, such as witnessing incidents with colleagues or other healthcare professionals. After patient safety incidents, of those, 67.8% experienced shock at the time of the incident, 47.2% feared experiencing a similar incident, and 28.2% were still affected although time had passed. Additionally, 26.3% reported experiencing long-term embitterment; of them, 7.3% were experiencing severe embitterment. Furthermore, 31.9% and 27.1% of the students experienced sleeping and eating difficulties, respectively, and these rates were higher when incidents were encountered directly rather than indirectly. CONCLUSIONS Nursing students may become second victims of patient safety incidents during clinical practice. Therefore, nursing education institutions need to develop comprehensive support strategies to help nursing students cope with experiencing the second victim phenomenon.
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Affiliation(s)
- Eun Young Choi
- Department of Nursing, Graduate School of Chung-Ang University, Republic of Korea; Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jeehee Pyo
- Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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Magaldi M, Perdomo JM, López-Baamonde M, Chanzá M, Sanchez D, Gomar C. Second victim phenomenon in a surgical area: Online survey. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:504-512. [PMID: 34764069 DOI: 10.1016/j.redare.2020.11.007] [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] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/05/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND AIM OF STUDY An effective and accessible first source of support for second victims (SV) is usually the colleagues themselves, who should have tools to help emotionally and detect the unusual course of a SV. The aim of this work is to assess health professionals' perception of the phenomenon, as well as their capability to apply psychological first aid. MATERIAL AND METHODS Observational descriptive study through online surveys answered anonymously. Participants were different health professionals from surgical area, mainly from a third-level hospital. RESULTS 329 responses, 67 anaesthesiologists, 110 anaesthesiologists in training, 152 nurses. 78.4% had felt SV, more frequent among anaesthesiologists; however, 58% had never heard of the term. Guilt was the most frequent emotion. Residents were more afraid of judgmental colleagues and thought more about drop out their training. From those who sought help, most did it through a colleague, but most did not feel useful in helping a SV. 66% affirmed there is a still punitive, evasive or silent culture about medical incidents. CONCLUSIONS Despite the frequency of the phenomenon there is still lack of knowledge of the term SV. Impact of the phenomenon is heterogenous and changes based on experience and responsibility. Colleagues are the first source of emotional help but there is a lack of tools to be able to provide it. Institutions are urged to create training programs so that professionals can guarantee «psychological first aid».
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Affiliation(s)
- M Magaldi
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain; Grupo de Simulación SimClínic, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J M Perdomo
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain; Grupo de Simulación SimClínic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M López-Baamonde
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain; Grupo de Simulación SimClínic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Chanzá
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, Spain
| | - D Sanchez
- Asistencia médica integral, Teladoc Health, Barcelona, Spain
| | - C Gomar
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain; Grupo de Simulación SimClínic, Hospital Clínic de Barcelona, Barcelona, Spain
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Finney RE, Czinski S, Fjerstad K, Arteaga GM, Weaver AL, Riggan KA, Allyse MA, Long ME, Torbenson VE, Rivera-Chiauzzi EY. Evaluation of a Second Victim Peer Support Program on Perceptions of Second Victim Experiences and Supportive Resources in Pediatric Clinical Specialties Using the Second Victim Experience and Support Tool (SVEST). J Pediatr Nurs 2021; 61:312-317. [PMID: 34500175 DOI: 10.1016/j.pedn.2021.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pediatric healthcare professionals (HCPs) may experience events that lead to psychological distress or second victim experiences (SVEs). This project evaluates the impact of a newly implemented peer support program on SVEs and perceptions of supportive resources among pediatric HCPs. DESIGN AND METHODS A second victim (SV) peer support program was implemented in the pediatric inpatient and intensive care units in September 2019. Multidisciplinary HCPs in these units were invited to participate in an anonymous survey that included the Second Victim Experience and Support Tool before and one-year after implementation. The survey assessed HCPs' SVEs, desired support, and perceptions of the peer support program. RESULTS 52.0% (194/373) completed the pre-implementation survey, and 43.9% (177/403) completed the post-implementation survey. At both timepoints, participants reported SV-related psychosocial distress, physical distress, or low professional self-efficacy; the most desired support was 'a respected peer to discuss the details of what happened'. Following implementation of the peer support program, HCPs were significantly more likely to have heard of the term 'second victim' (51.8 vs. 74.0%; p < 0.001) and to have felt like there were adequate resources to support SVs (35.8% vs. 89.1%; p < 0.001). In the post-implementation survey, most respondents indicated a likelihood to use the program for themselves (65.7%) or colleagues (84.6%) after involvement in future traumatic clinical events. CONCLUSIONS Implementation of a peer support program significantly influenced awareness and perceptions of support available for SV-related distress. PRACTICE IMPLICATIONS Peer support programs should be implemented to help HCPs navigate SVEs and decrease SV-related turnover intentions.
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Affiliation(s)
- Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States of America.
| | - Scott Czinski
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States of America
| | - Kelly Fjerstad
- Department of Nursing, Mayo Clinic Rochester, MN, United States of America
| | - Grace M Arteaga
- Pediatric Critical Care Medicine, Mayo Clinic Rochester, MN, United States of America
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic Rochester, MN, United States of America
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic Rochester, MN, United States of America
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic Rochester, MN, United States of America
| | - Margaret E Long
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, United States of America
| | - Vanessa E Torbenson
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, United States of America
| | - Enid Y Rivera-Chiauzzi
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, United States of America
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Tejedor-Romero L, Vinuesa-Sebastián MM, Aranaz-Andrés JM. [Healthcare workers in intensive care units as second victims of SARS-CoV-2: results of a survey]. J Healthc Qual Res 2021; 37:162-168. [PMID: 34836842 PMCID: PMC8554072 DOI: 10.1016/j.jhqr.2021.10.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
Introducción La epidemia por el virus SARS-CoV-2 ha generado una situación extraordinaria en la asistencia sanitaria de nuestro país. La enorme sobrecarga de trabajo a la que han estado expuestos los profesionales sanitarios, la importante carga emocional, las situaciones estresantes y el miedo al contagio propio y de sus familiares, entre otros aspectos, han podido tener consecuencias en los profesionales, convirtiéndolos en segundas víctimas. El objetivo de este estudio es conocer la sobrecarga emocional de los trabajadores de áreas de pacientes críticos por SARS-CoV-2 en un hospital terciario de la Comunidad de Madrid. Materiales y métodos Estudio descriptivo transversal, realizado mediante la cumplimentación voluntaria por parte de los profesionales de áreas de cuidados críticos de un cuestionario adaptado a partir de la Escala de Estrés Agudo «EASE COVID-19», consistente en 10 preguntas cerradas tipo Likert a las que se añadieron cuatro preguntas: sexo, categoría profesional, si trabajan habitualmente en áreas de críticos y el sacrificio en sus rutinas. Los datos se recogieron en julio de 2020, para evaluar el impacto de la primera ola. Se realizó una descripción de los datos y se analizó la asociación entre las variables y la respuesta emocional. Resultados Un 54% de los encuestados mostró buen ajuste emocional. Lo que más preocupó a los participantes fue la posibilidad de contagiar a sus familiares. Los colectivos con puntuaciones medias más altas fueron los enfermeros, técnicos en cuidados auxiliares de enfermería (TCAE) y celadores, mostrando ajuste emocional el 100% de los médicos, sin encontrarse diferencias por sexo. El 60% de los participantes modificó su rutina familiar, siendo los médicos internos residentes (MIR) los que presentaron mayor porcentaje. Conclusiones La crisis sanitaria vivida ha convertido a los profesionales sanitarios en segundas víctimas del SARS-CoV-2. Su detección es fundamental para ofrecerles los recursos y ayuda necesaria para garantizar su bienestar emocional, eliminando barreras y ayudándoles a salir reforzados.
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Affiliation(s)
- Laura Tejedor-Romero
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario de La Princesa, Madrid, España.
| | - María Mercedes Vinuesa-Sebastián
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario de La Princesa, Madrid, España; Departamento de Calidad, Hospital Universitario de La Princesa, Madrid, España
| | - Jesús María Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal; IRYCIS. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Magaldi M, Perdomo JM, López-Baamonde M, Chanzá M, Sanchez D, Gomar C. Second victim phenomenon in a surgical area: online survey. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(20)30320-0. [PMID: 34006368 DOI: 10.1016/j.redar.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF STUDY An effective and accessible first source of support for second victims (SV) is usually the colleagues themselves, who should have tools to help emotionally and detect the unusual course of a SV. The aim of this work is to assess health professionals' perception of the phenomenon, as well as their capability to apply psychological first aid. MATERIAL AND METHODS Observational descriptive study through online surveys answered anonymously. Participants were different health professionals from surgical area, mainly from a third-level hospital. RESULTS 329 responses, 67 anaesthesiologists, 110 anaesthesiologists in training, 152 nurses. 78.4% had felt SV, more frequent among anaesthesiologists; however, 58% had never heard of the term. Guilt was the most frequent emotion. Residents were more afraid of judgmental colleagues and thought more about drop out their training. From those who sought help, most did it through a colleague, but most did not feel useful in helping a SV. 66% affirmed there is a still punitive, evasive or silent culture about medical incidents. CONCLUSIONS Despite the frequency of the phenomenon there is still lack of knowledge of the term SV. Impact of the phenomenon is heterogenous and changes based on experience and responsibility. Colleagues are the first source of emotional help but there is a lack of tools to be able to provide it. Institutions are urged to create training programs so that professionals can guarantee «psychological first aid».
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Affiliation(s)
- M Magaldi
- Servicio de Anestesiología y Reanimación. Hospital Clínic de Barcelona, Barcelona, España; Grupo de Simulación SimClínic. Hospital Clínic de Barcelona, Barcelona, España.
| | - J M Perdomo
- Servicio de Anestesiología y Reanimación. Hospital Clínic de Barcelona, Barcelona, España; Grupo de Simulación SimClínic. Hospital Clínic de Barcelona, Barcelona, España
| | - M López-Baamonde
- Servicio de Anestesiología y Reanimación. Hospital Clínic de Barcelona, Barcelona, España; Grupo de Simulación SimClínic. Hospital Clínic de Barcelona, Barcelona, España
| | - M Chanzá
- Servicio de Anestesiología y Reanimación. Parc de Salut Mar, Barcelona, España
| | - D Sanchez
- Asistencia médica integral. Teladoc Health, Barcelona, España
| | - C Gomar
- Servicio de Anestesiología y Reanimación. Hospital Clínic de Barcelona, Barcelona, España; Grupo de Simulación SimClínic. Hospital Clínic de Barcelona, Barcelona, España
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24
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Van Slambrouck L, Verschueren R, Seys D, Bruyneel L, Panella M, Vanhaecht K. Second victims among baccalaureate nursing students in the aftermath of a patient safety incident: An exploratory cross-sectional study. J Prof Nurs 2021; 37:765-770. [PMID: 34187676 DOI: 10.1016/j.profnurs.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/09/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND A patient safety incident (PSI) is considered to have an impact on nursing students. Healthcare professionals often feel personally responsible for the unexpected patient outcome and feel as though they have failed their patient. In this way they may become second victims of the incident. Little is known about possible initiatives from hospitals or teaching institutions regarding the support of their students involved in a PSI. AIM The study aims to examine the prevalence, symptoms and support in the aftermath of a PSI in baccalaureate nursing students. METHODS A cross-sectional study in four teaching institutions for baccalaureate education across eleven campuses in Belgium. Students completed an online survey between February 2018 and March 2018. RESULTS About one in three (38.4%) students were involved in a PSI during their clinical experience. Of these, 84.7% experienced second victim symptoms. Most common symptoms were hypervigilance (65.7%), stress (42.5%) and doubting knowledge and skills (40.6%). Besides negative effects, the PSI also led to a more positive attitude. Students expect most support and room for open discussion from staff nurses (80.8%). CONCLUSION Nursing students may already become second victims during their education. PSIs have a major impact on their performance and personal life. Students have the right for a decent treatment, respect, understanding and compassion, support, transparency and the opportunity to contribute to improving procedures. Teaching institutions should therefore bear the responsibility to prepare students of the probability of the occurrence of PSIs during their clinical experience.
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Affiliation(s)
- Louis Van Slambrouck
- Department of Quality Management, AZ Delta Hospital, Roeselare, Belgium; Healthcare Department, VIVES University of Applied Sciences, Belgium.
| | | | - Deborah Seys
- Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Italy
| | - Kris Vanhaecht
- Department of Public Health and Primary Care - Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
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25
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Abstract
OBJECTIVE Health-care professionals (HCPs) who are involved in an unanticipated adverse patient event, a medical error or a patient-related injury can become second victims. Being a second victim can lead to various symptoms, affecting the well-being of HCPs and possible turnover intentions or absenteeism. An increasing number of hospitals have implemented a second-victim support programme. To achieve unique insights into what works and what does not work in second-victim support programmes, HCPs' perceptions are needed. The aim of this study was to translate the Second Victim Experience and Support Tool (SVEST) into Danish and test the psychometric properties of the Danish version (D-SVEST). METHODS The SVEST self-administered questionnaire was translated into Danish following the World Health Organization's guidelines. Assessments of the content validity, construct validity and internal consistency were performed based on 171 participants. RESULTS The study demonstrated that the D-SVEST is content valid and fits the a priori defined structure. Yet, four items revealed unacceptable factor loadings (<0.4) and item-rest correlations <0.3. All Cronbach's alpha estimates for these five dimensions exceeded 0.70. The dimensions on colleague and institutional support did not contribute to the validity. CONCLUSIONS In conclusion, the D-SVEST is considered relevant and valid for measuring second-victim experiences and the adequacy of support resources. However, we recommend a modification of items 9 and 25 to enhance the measurement scale in a Danish context. The D-SVEST can be used by health-care management at Danish hospitals.
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Affiliation(s)
- Tine Knudsen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Denmark
| | - Charlotte Abrahamsen
- Research Unit for User Perspectives, Institute of Public Health, University of Southern Denmark, Denmark
| | - Jan S Jørgensen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Denmark
| | - Katja Schrøder
- Research Unit for User Perspectives, Institute of Public Health, University of Southern Denmark, Denmark
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26
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Strametz R, Koch P, Vogelgesang A, Burbridge A, Rösner H, Abloescher M, Huf W, Ettl B, Raspe M. Prevalence of second victims, risk factors and support strategies among young German physicians in internal medicine (SeViD-I survey). J Occup Med Toxicol 2021; 16:11. [PMID: 33781278 PMCID: PMC8005860 DOI: 10.1186/s12995-021-00300-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Second victims, defined as healthcare team members being traumatised by an unanticipated clinical event or outcome, are frequent in healthcare. Evidence of this phenomenon in Germany, however, is sparse. Recently, we reported the first construction and validation of a German questionnaire. This study aimed to understand this phenomenon better in a sample of young (<= 35 years) German physicians. METHODS The electronic questionnaire (SeViD-I survey) was administered for 6 weeks to a sample of young physicians in training for internal medicine or a subspecialty. All physicians were members of the German Society of Internal Medicine. The questionnaire had three domains - general experience, symptoms, and support strategies - comprising 46 items. Binary logistic regression models were applied to study the influence of various independent factors on the risk of becoming a second victim, the magnitude of symptoms and the time to self-perceived recovery. RESULTS The response rate was 18% (555/3047). 65% of the participants were female, the mean age was 32 years. 59% experienced second victim incidents in their career so far and 35% during the past 12 months. Events with patient harm and unexpected patient deaths or suicides were the most frequent key incidents. 12% of the participants reported that their self-perceived time to full recovery was more than 1 year or have never recovered. Being female was a risk factor for being a second victim (odds ratio (OR) 2.5) and experiencing a high symptom load (OR 2). Working in acute care was promoting a shorter duration to self-perceived recovery (OR 0.5). Support measures with an exceptionally high approval among second victims were the possibility to discuss emotional and ethical issues, prompt debriefing/crisis intervention after the incident and a safe opportunity to contribute insights to prevent similar events in the future. CONCLUSION The second victim phenomenon is frequent among young German physicians in internal medicine. In general, these traumatic events have a potentially high impact on physician health and the care they deliver. A better understanding of second victim traumatisations in Germany and broad implementation of effective support programs are warranted.
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Affiliation(s)
- Reinhard Strametz
- Wiesbaden Business School, RheinMain University of Applied Sciences, Bleichstraße 44, 65183, Wiesbaden, Germany
| | - Peter Koch
- Centre of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Anja Vogelgesang
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Amie Burbridge
- Department of Acute Medicine, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, England
| | - Hannah Rösner
- Wiesbaden Business School, RheinMain University of Applied Sciences, Bleichstraße 44, 65183, Wiesbaden, Germany
| | - Miriam Abloescher
- Karl Landsteiner Institute for Clinical Risk Management, Wolkersbergenstraße 1, 1130, Vienna, Austria.,Clinic Hietzing, Vienna Healthcare Group, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Wolkersbergenstraße 1, 1130, Vienna, Austria.,Clinic Hietzing, Vienna Healthcare Group, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Brigitte Ettl
- Karl Landsteiner Institute for Clinical Risk Management, Wolkersbergenstraße 1, 1130, Vienna, Austria.,Clinic Hietzing, Vienna Healthcare Group, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Matthias Raspe
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany.
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Abstract
Burnout in healthcare has been increasingly recognized over the past few decades and has recently been accepted as a recognized diagnosis by the World Health Organization. By choice, we have sought careers where unfortunately both the stakes and the chances for error are high. When a serious safety event occurs, our patients (and their families) become the first victims. Those of us in healthcare, however, can become traumatized when a poor or unanticipated adverse outcome occurs, leading to morbidity and/or mortality, and where one personally bears the responsibility. This leads to the provider becoming the "second victim (SV)". Awareness of burnout and the SV syndrome by ourselves, peers, and the institutions and organizations in which we work is paramount to our understanding of the plight of the provider and averting significant human and fiscal consequences.
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Affiliation(s)
- Martin A Koyle
- University of Toronto, Department of Surgery and Institute of Healthcare Policy Management and Evaluation, Division of Urology, Hospital for Sick Children, 555 University Ave, M-299, Toronto, M5G1X8, Ontario, Canada.
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Christoffersen L, Teigen J, Rønningstad C. Following-up midwives after adverse incidents: How front-line management practices help second victims. Midwifery 2020; 85:102669. [PMID: 32120330 DOI: 10.1016/j.midw.2020.102669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/21/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe how front-line managers of maternity wards provide support to midwives as second victims in the aftermath of an adverse incident. DESIGN A qualitative study using critical incident technique and a content analytic approach of semi-structured in-depth interviews. SETTING Maternity wards in 10 Norwegian hospitals with more than 200 registered births annually were included in the study. PARTICIPANTS A purposeful sample of 33 midwives with more than two years' working experience described 57 adverse incidents. FINDINGS Maternity ward managers utilised four types of practices to support midwives after critical incidents: management, transformational leadership, distributed leadership and laissez-faire leadership. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The study shows that proactive managers who planned for how to handle critical incidents provided midwives with needed individual support and learning. Proactive transformational leadership and delegating roles for individual support should be promoted when assisting second victims after critical incidents. Managers can limit the potential harm to second victims by preparing for the eventuality of a crisis and institute follow-up practices.
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Affiliation(s)
- Line Christoffersen
- Oslo Business School at Oslo Metropolitan University, Ellen Gleditschs hus, Pilestredet 35, 0166 Oslo, Norway.
| | - Janne Teigen
- Telemark Hospital Trust, Ulefossvegen 55, 3710 Skien, Norway.
| | - Chris Rønningstad
- Oslo Business School at Oslo Metropolitan University, Ellen Gleditschs hus, Pilestredet 35, 0166 Oslo, Norway.
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29
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Strametz R, Schneider T, Pitz A, Raspe M. Survival-Day @ Wiesbaden business school - evaluation of a short-term educational intervention to reduce work-associated health risks during nursing internships of students in health care economics. J Occup Med Toxicol 2019; 14:30. [PMID: 31827574 PMCID: PMC6894114 DOI: 10.1186/s12995-019-0251-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2013 RheinMain University launched its bachelor's degree program Health Care Economics requiring each student to participate in a mandatory two-month nursing internship. A preliminary risk assessment revealed serious risks for both students and patients and had to be addressed by appropriate measures such as mandatory systematic safety training for each student. METHODS A short-term educational intervention named "Survival-Day" was designed to minimize risks related to nursing internships of students. This intervention consists of six 45-min-units with theoretical input (2 units) and hands-on training (4 units) imparting basic knowledge and skills in CPR, hand hygiene and handling of masks and protective gowns, prevention of needle stick injuries, fire protection and firefighting. Performance of CPR was assessed using computerized manikins. Acceptance, necessity and usability were assessed anonymously by standardized written questionnaires after completion of nursing internships. RESULTS 462 students have completed the Survival-Day until January 2019. CPR performance showed acceptable adherence rates to guideline recommendations (mean 78.8%, SD ±22.6%). The majority of students performed aseptic health care activities (66%), treated patients with multi-resistant pathogens (62%) and disposed sharp instruments such as blood-contaminated needles (76%). According to students' self-reports about these hazardous activities, less than 50% of these students received adequate safety training at nursing facilities. However, no sentinel events such as needle stick injuries or students becoming second victim have been reported. CONCLUSION Our study reveals severe discrepancies between legal obligation of nursing facilities to ensure safety instructions for nursing interns and initial training as perceived by this group. Mandatory initial training before conduction of hazardous tasks was mainly covered by our short-term educational intervention (Survival-Day). Regarding responsibility for their students a preliminary safety instruction program like the Survival-Day should be considered for all educational institutions sending students to nursing internships unless mandatory and sufficient safety trainings for nursing interns can be guaranteed by nursing facilities.
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Affiliation(s)
- Reinhard Strametz
- Wiesbaden Business School, RheinMain University of Applied Sciences, Bleichstraße 44, 65183 Wiesbaden, Germany
| | - Thomas Schneider
- St. Josefs-Hospital Wiesbaden GmbH, Quality Management, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Andreas Pitz
- University of Applied Science Mannheim, Professor of Social Law, Straßburger Ring 45, 68229 Mannheim, Germany
| | - Matthias Raspe
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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30
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Abstract
Critical care clinicians involved serious adverse events may experience a constellation of distressing emotions that may interfere with home and work life. Offering support after a serious adverse event may restore a clinician's ability to cope with the event, reestablish emotional balance and assist a clinician to function capably in the workplace and at home. A description of a care for the caregiver program implementation at a 10-hospital health system provides a roadmap to implement this program in other hospitals and health systems.
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Affiliation(s)
- Crystal L Morales
- High Reliability and Safety, Medstar Institute for Quality and Safety, 3007 Tilden Street, Northwest, Suite 5N, Washington, DC 20008, USA
| | - Mary-Michael Brown
- Nursing Practice Innovation, Medstar Health, 10980 Grantchester Place, 6101, Columbia, MD 21044, USA.
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Bratu I, Heiss K, Mueller C, Winthrop A, Blair G, Moulton CA. Canadian Association of Pediatric Surgeons' state of wellness. J Pediatr Surg 2019; 54:891-4. [PMID: 30782439 DOI: 10.1016/j.jpedsurg.2019.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
The following is a summary of the fourth Ein Panel Debate Session from the 50th Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) held in Toronto, ON, from September 26-29, 2018. The session focused on surgeon well-being at different stages of career: role of mentorship at the start of career, second victim syndrome, litigation stress syndrome, and retirement. Using Maslach Burnout Inventory Survey, CAPS members were presented their wellness scores as a group compared to other health care providers. The power of surgical culture in influencing decision making and judgment was explored. A culture shift toward vulnerability and transparency is possible and more suitable to expert practice and surgeon wellness.
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Kaur AP, Levinson AT, Monteiro JFG, Carino GP. The impact of errors on healthcare professionals in the critical care setting. J Crit Care 2019; 52:16-21. [PMID: 30951924 DOI: 10.1016/j.jcrc.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/25/2018] [Revised: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Medical errors occur at high rates in intensive care units (ICUs) and have great consequences. The impact of errors on healthcare professionals is rarely discussed. We hypothesized that issues regarding blame and guilt following errors in the ICU exist and may be dependent on type of practitioner, level of experience, and error type. MATERIALS AND METHODS An online survey was conducted of members of a large critical care medical society addressing three clinical scenarios of procedural, diagnostic and treatment errors. RESULTS Nine hundred one practitioners responded. In all scenarios, negative feeling after medical errors occurred in all practitioners regardless of experience or field. Surgeons and anesthesiologists showed higher negative responses after procedural errors while internal medicine and emergency medicine practitioners had higher negative responses after diagnostic errors. Survey respondents identified multiple ways to address these adverse feelings, including debriefing with the medical team (68%), talking with colleagues (68%) and discussing with patients and families (36%). CONCLUSIONS In critical care, blame and guilt after medical errors are common and affect all providers. Critical care practitioners have identified methods which may help mitigate adverse feeling after medical errors, including debriefing and talking with colleagues. Hospitals may benefit from developing these types of strategies after medical errors.
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Affiliation(s)
- Amanpreet P Kaur
- Division of Pulmonary and Critical Care Medicine, Warren Alpert Medical School at Brown University, Providence, RI, United States of America
| | - Andrew T Levinson
- Division of Pulmonary and Critical Care Medicine, Warren Alpert Medical School at Brown University, Providence, RI, United States of America
| | | | - Gerardo P Carino
- Division of Pulmonary and Critical Care Medicine, Warren Alpert Medical School at Brown University, Providence, RI, United States of America.
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Dukhanin V, Edrees HH, Connors CA, Kang E, Norvell M, Wu AW. Case: A Second Victim Support Program in Pediatrics: Successes and Challenges to Implementation. J Pediatr Nurs 2018; 41:54-9. [PMID: 29395793 DOI: 10.1016/j.pedn.2018.01.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE While there is growing attention to making health care safer, there has been less emphasis on helping health care workers to cope with stressful patient related events (these workers are commonly referred to as second victims). We used the RISE (Resilience In Stressful Events) peer support program at the Johns Hopkins Hospital as a case study for evaluating effectiveness, and identifying barriers to addressing the needs of second victims. DESIGN AND METHODS The study used a mixed-method approach that included: 1) quantitative analysis of surveys of health care workers in the Department of Pediatrics before RISE implementation and four years after, and 2) content analysis of open-ended commentaries about respondents' experience with seeking second victim support, as well as feedback on RISE. RESULTS Survey response rates were 22.4% and 23.3% respectively. Quantitative analysis showed that respondents at the later time point were more likely to contact an organizational support structure, and had greater awareness of the availability of support. Respondents were very likely (93%) to recommend RISE to others. Content analysis identified barriers to using RISE: overcoming blame culture, need to promote the initiative, and need for more staff time to handle adverse events. Respondents reported varied preferences for the support format and specific support interventions. CONCLUSIONS The mixed-method approach allowed a comprehensive evaluation of RISE and provided some evidence for its effectiveness in supporting pediatric health care workers. PRACTICE IMPLICATIONS The findings suggest an important role of organizational culture in second victim support program implementation and evaluation.
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Baas MAM, Scheepstra KWF, Stramrood CAI, Evers R, Dijksman LM, van Pampus MG. Work-related adverse events leaving their mark: a cross-sectional study among Dutch gynecologists. BMC Psychiatry 2018; 18:73. [PMID: 29566667 PMCID: PMC5863895 DOI: 10.1186/s12888-018-1659-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Health care professionals who are frequently coping with traumatic events have an increased risk of developing a posttraumatic stress disorder. Research among physicians is scarce, and obstetrician-gynecologists may have a higher risk. Work-related traumatic events and posttraumatic stress disorder among obstetricians-gynecologists and the (desired) type of support were studied. METHODS A questionnaire was emailed to all members of the Dutch Society of Obstetrics and Gynaecology, which included residents, attending, retired and non-practicing obstetricians-gynecologists. The questionnaire included questions about personal experiences and opinions concerning support after work-related events, and a validated questionnaire for posttraumatic stress disorder. RESULTS The response rate was 42.8% with 683 questionnaires eligible for analysis. 12.6% of the respondents have experienced a work-related traumatic event, of which 11.8% met the criteria for current posttraumatic stress disorder. This revealed an estimated prevalence of 1.5% obstetricians-gynecologists with current posttraumatic stress disorder. 12% reported to have a support protocol or strategy in their hospital after adverse events. The most common strategies to cope with emotional events were: to seek support from colleagues, to seek support from family or friends, to discuss the case in a complication meeting or audit and to find distraction. 82% would prefer peer-support with direct colleagues after an adverse event. CONCLUSIONS This survey implies that work-related events can be traumatic and subsequently can lead to posttraumatic stress disorder. There is a high prevalence rate of current posttraumatic stress disorder among obstetricians-gynecologists. Often there is no standardized support after adverse events. Most obstetrician-gynecologists prefer peer-support with direct colleagues after an adverse event. More awareness must be created during medical training and organized support must be implemented.
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Affiliation(s)
- Melanie A. M. Baas
- Department of Obstetrics and Gynecology, OLVG, PO box 95500, 1090 HM Amsterdam, The Netherlands
| | - Karel W. F. Scheepstra
- Department of Obstetrics and Gynecology, OLVG, PO box 95500, 1090 HM Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Claire A. I. Stramrood
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, PO Box 85500, 3508GA Utrecht, The Netherlands
| | - Ruth Evers
- Talmor, Andreas Bonnstraat 20hs, 1091AZ Amsterdam, The Netherlands
| | - Lea M. Dijksman
- Department of Research and Epidemiology, OLVG, PO box 95500, 1090 HM Amsterdam, The Netherlands
- Department of Research and Epidemiology, St. Antoniusziekenhuis, PO Box 2500, 3430EM Nieuwegein, The Netherlands
| | - Maria G. van Pampus
- Department of Obstetrics and Gynecology, OLVG, PO box 95500, 1090 HM Amsterdam, The Netherlands
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Mark L, Lester L, Cover R, Herzer K. A Decade of Difficult Airway Response Team: Lessons Learned from a Hospital-Wide Difficult Airway Response Team Program. Crit Care Clin 2018; 34:239-251. [PMID: 29482903 DOI: 10.1016/j.ccc.2017.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 11/17/2022]
Abstract
A decade ago the Difficult Airway Response Team (DART) program was created at The Johns Hopkins Hospital as a multidisciplinary effort to address airway-related adverse events in the nonoperative setting. Root cause analysis of prior events indicated that a major factor in adverse patient outcomes was lack of a systematic approach for responding to difficult airway patients in an emergency. The DART program encompasses operational, safety, and educational initiatives and has responded to approximately 1000 events since its initiation, with no resultant adult airway-related adverse events or morbidity. This article provides lessons learned and recommendations for initiating a DART program.
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Affiliation(s)
- Lynette Mark
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine Multidisciplinary Airway Programs, Difficult Airway Response Team (DART) Program, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine Multidisciplinary Airway Programs, Difficult Airway Response Team (DART) Program, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Laeben Lester
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine Multidisciplinary Airway Programs, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Emergency Medicine, Johns Hopkins Medicine Multidisciplinary Airway Programs, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Renee Cover
- Johns Hopkins Health System Legal Department, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Kurt Herzer
- Oscar Health, 219 Withers Street, Brooklyn, NY 11211, USA
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Abstract
The third victim phenomenon refers to a system-wide organizational response to a serious untoward event in health care settings. The objective of this report is to describe possible measurable correlates of this phenomenon. A serious incident on one unit in the hospital is described. Utilization of constant observation and rate of discharge in the aftermath throughout the hospital were assessed. There was a hospital-wide uptick in conservative decision making following the serious incident, exemplified by an increase in the utilization of constant observation and decreased rate of discharges. These findings lend support to the validity of the concept of the third victim phenomenon and underscore the imperative for a coherent leadership response to prevent damage to institutional core values, morale, and reputation. Systematic investigation of this phenomenon and its potential effects on clinical practice in the aftermath of serious incidents is warranted.
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Affiliation(s)
- Mark J Russ
- New York-Presbyterian Hospital/Westchester Division, Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, 10605, USA.
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Abstract
The critical arm of improvement and change comes after events are identified and classified. Getting and making things right when things go wrong defines a successful safety program. This article reviews the important tasks that should be familiar to any team approaching a serious event on an obstetrics unit. Root cause analysis is a critical, but often misunderstood, tool for dissecting the contributing factors leading to an adverse event. Successful root cause analyses have a standardized approach that result in meaningful action plans. Disclosure to the patient of the event and error, if applicable, is a new concept that is gaining traction in medicine. The review of a structured disclosure program can help programs adopt a method that has successfully gained the trust of patients and families with very few complications. Second victim support through coordinated debriefing of the individuals and teams who worked during the event is a final important measure that is important to prevent burnout or identification and classification is just the beginning to having a systematic approach to adverse events. The critical arm to improvement and change comes in the analysis and response to these events, which includes root cause analysis, corrective action plans, error disclosure, and second victim support.
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Affiliation(s)
- Christian M Pettker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale New Haven Hospital, 333 Cedar St, P.O. Box 208063, New Haven, CT 06520-8063.
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Abstract
Rational choice theory says that operators and others make decisions by systematically and consciously weighing all possible outcomes along all relevant criteria. This paper first traces the long historical arm of rational choice thinking in the West to Judeo-Christian thinking, Calvin and Weber. It then presents a case study that illustrates the consequences of the ethic of rational choice and individual responsibility. It subsequently examines and contextualizes Rasmussen's legacy of pushing back against the long historical arm of rational choice, showing that bad outcomes are not the result of human immoral choice, but the product of normal interactions between people and systems. If we don't understand why people did what they did, Rasmussen suggested, it is not because people behaved inexplicably, but because we took the wrong perspective.
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Affiliation(s)
- Sidney W A Dekker
- Griffith University, Safety Science Innovation Lab., Macrossan Building N16 Room 2.21, 170 Kessels Road, Nathan Campus, QLD 4111, Australia.
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Panella M, Rinaldi C, Leigheb F, Donnarumma C, Kul S, Vanhaecht K, Di Stanislao F. The determinants of defensive medicine in Italian hospitals: The impact of being a second victim. ACTA ACUST UNITED AC 2016; 31 Suppl 2:20-5. [PMID: 27373579 DOI: 10.1016/j.cali.2016.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 01/27/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear. OBJECTIVE To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians. DESIGN, SETTING AND PARTICIPANTS A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event. RESULTS A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians' experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty. CONCLUSIONS Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine.
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Affiliation(s)
- M Panella
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - C Rinaldi
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
| | - F Leigheb
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - C Donnarumma
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - S Kul
- Center for Applied Medical Statistics. University of Gaziantep, Gaziantep, Turkey
| | - K Vanhaecht
- Center for Health Services and Nursing Research, School of Public Health, University of Leuven, Leuven, Belgium
| | - F Di Stanislao
- Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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Van Gerven E, Deweer D, Scott SD, Panella M, Euwema M, Sermeus W, Vanhaecht K. Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study. ACTA ACUST UNITED AC 2016; 31 Suppl 2:34-46. [PMID: 27106771 DOI: 10.1016/j.cali.2016.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/05/2016] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES When a patient safety incident (PSI) occurs, not only the patient, but also the involved health professional can suffer. This study focused on this so-called "second victim" of a patient safety incident and aimed to examine: (1) experienced symptoms in the aftermath of a patient safety incident; (2) applied coping strategies; (3) the received versus needed support and (4) the aspects that influenced whether one becomes a second victim. MATERIALS AND METHODS Thirty-one in-depth interviews were performed with physicians, nurses and midwives who have been involved in a patient safety incident. RESULTS The symptoms were categorized under personal and professional impact. Both problem focused and emotion focused coping strategies were used in the aftermath of a PSI. Problem focused strategies such as performing a root cause analysis and the opportunity to learn from what happened were the most appreciated, but negative emotional responses such as repression and flight were common. Support from colleagues and supervisors who were involved in the same event, peer supporters or professional experts were the most needed. A few individuals described emotional support from the healthcare institution as unwanted. Rendered support was largely dependent on the organizational culture, a stigma remained among healthcare professionals to openly discuss patient safety incidents. Three aspects influenced the extent to which a healthcare professional became a second victim: personal, situational and organizational aspects. CONCLUSION These findings indicated that a multifactorial approach including individual and emotional support to second victims is crucial.
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Affiliation(s)
- E Van Gerven
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - D Deweer
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - S D Scott
- Patient Safety and Risk Management, University of Missouri Health Care, Columbia, MO, USA
| | - M Panella
- Amadeo Avogadro University of Eastern Piedmont, Faculty of Medicine, Novara, Italy
| | - M Euwema
- Occupational & Organizational Psychology and Professional Learning, KU Leuven, Leuven, Belgium
| | - W Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; University Hospitals Leuven & Flemish Hospital Network - KU Leuven, Leuven, Belgium.
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Abstract
Improving quality of care logically involves optimizing the duty-readiness and well-being of the healthcare provider. Medical errors and poor outcomes adversely impact the involved providers, especially surgeons, as well as the patients and their families. Unfortunately our current system does little to support these "second victims" who experience various degrees of emotional and psychological stresses including confusion, loss of confidence, and debilitating anxiety. These factors contribute to the alarmingly high rates of professional "burnout," substance abuse, and suicide of healthcare providers as well as increase the likelihood of subsequent medical errors. Mindful efforts to improve the healthcare culture and develop personal support systems can help surgeons become more resilient, provide higher quality patient care, and have longer productive professional lives. Institutional support systems are also necessary to assist "second victims" to recover from the impact of an adverse patient event.
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Affiliation(s)
- Louis M Marmon
- Division of General and Thoracic Pediatric Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Ave, NW, Washington, District of Columbia 20010.
| | - Kurt Heiss
- Division of Pediatric Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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