Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses

Abstract

Background Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. Many factors associated with improved coping afer patient safety event involvement are also components of a strong patient safety culture, so that supportive patient safety cultures may reduce second victim–related trauma. A cross-sectional survey study was conducted to assess the influence of patient safety culture on second victim–related distress, in which associations among patient safety culture dimensions, organizational support, and second victim distress were investigated. Methods The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC) and the Second Victim Experience and Support Tool (SVEST), which was developed to assess organizational support and personal and professional distress after involvement in a patient safety event, were administered to nurses involved in direct patient care. Results Of 358 nurses, 155 (41%) responded, of whom 144 completed both surveys. Hierarchical linear regression demonstrated that the patient safety culture survey dimension nonpunitive response to errors was significantly associated with reductions in the second victim survey dimensions psychological, physical, and professional distress (p <.001). As a mediator, organizational support fully explained the nonpunitive response to errors–physical distress and nonpunitive response to errors–professional distress relationships and partially explained the nonpunitive response to error–psychological distress relationship. Conclusions A nonpunitive response to errors may mitigate the negative effects of involvement in a patient safety event by encouraging supportive interactions. Also, perceptions of second victim–related distress may be less severe when hospital cultures are characterized by nonpunitive response to errors. Reducing punitive response to error and encouraging supportive coworker, supervisor, and institutional interactions may be useful strategies to manage the severity of second victim experiences.

From organisational support to second victim‐related distress: Role of patient safety culture

“…Nurse turnover could result from second victim‐related distress and burnout, and the cost for the turnover is very high for health care organisations (Quillivan et al, ). In the present study, physical distress ( β = 0.919) had more effects on second victim‐related distress when compared to psychological ( β = 0.682) and professional self‐efficacy distress ( β = 0.394).…”

“…‘Second victim’ was first used in 2000 to call attention to trauma resulting when the physician who made medical errors (Wu, ). The prevalent rate of adverse events in patient care is about 10.4% to 46.8%, and almost all of the health care providers experienced second victim‐related distress, which may further compromise patient safety (Pratt & Jachna, ; Quillivan, Burlison, Browne, Scott, & Hoffman, ; Scott et al, ). The symptoms of second victim‐related distress include sleep disturbances (Chan, Khong, & Wang, ; Scott et al, ), guilty feelings and depressive symptoms (Chard, ; Ullstrom, Andreen Sachs, Hansson, Ovretveit, & Brommels, ), and burnout (Mira et al, ; Shanafelt et al, ); furthermore, these symptoms may lead to absenteeism and turnover intention (Burlison, Scott, Browne, Thompson, & Hoffman, ; Kable, Kelly, & Adams, ; Pak, ; Wu & Steckelberg, ).…”

“…Low institutional support after adverse events is very common (Pratt & Jachna, ); for example, a Belgian nationwide survey revealed that the majority of organisations punished the clinicians if they made any medical errors and would not provide supports for them (Vlayen, Hellings, Claes, Peleman, & Schrooten, ). Despite the literature, nonpunitive responses to errors have been found to be a significant predictor for less second victim‐related distress (Quillivan et al, ); to date, empirical evidence of the associations between second victim‐related distress, organisational support and patient safety culture is rare (Quillivan et al, ). A recent study in China found that health care staffs could not fully trust in the so‐called nonpunitive culture when they encountered an adverse event (Xu et al, ), and the consequence from this phenomenon is unknown.…”

“…In this model, patient safety culture is explained as the result of individual/organisational values and capabilities that have impact on the dedication to the safety management of an organisation (Nieva & Sorra, ). Organisational support is the level of support that individuals received from their workplace after the adverse event occurred, and second victim‐related distress is the distress experiences following adverse events (Quillivan et al, ). Findings from this study could help similar organisations in China and elsewhere have a better understanding of second victim distress and its consequences on staff nurses; furthermore, the study highlights the importance of organisational support.…”

The Tokyo Declaration on patient safety

“…Real progress demands a true partnership, a radical but essential shift in practice and culture in many healthcare settings. Partnership in safety should be extended to all stakeholders, including frontline staff—who have been described as the second victims of medical error 1920…”