Relationship between patient safety culture and job burnout in Iranian nurses: Assessing the mediating role of second victim experience using structural equation modelling
Hossein Habibzadeh PhD
School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
Search for more papers by this authorRahim Baghaei PhD
Patient Safety Research Centre, Urmia University of Medical Sciences, Urmia, Iran
Search for more papers by this authorCorresponding Author
Fardin Ajoudani PhD Student
School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
Correspondence
Fardin Ajoudani, School of Nursing and Midwifery, Nazloo Campus of Urmia University of Medical Sciences, Sero Road, Urmia, Iran.
Email: [email protected]
Search for more papers by this authorHossein Habibzadeh PhD
School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
Search for more papers by this authorRahim Baghaei PhD
Patient Safety Research Centre, Urmia University of Medical Sciences, Urmia, Iran
Search for more papers by this authorCorresponding Author
Fardin Ajoudani PhD Student
School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
Correspondence
Fardin Ajoudani, School of Nursing and Midwifery, Nazloo Campus of Urmia University of Medical Sciences, Sero Road, Urmia, Iran.
Email: [email protected]
Search for more papers by this authorFunding information
Current study was supported financially by Urmia University of Medical Sciences, grant number: 1398.431.
Abstract
Aim
The study examined the mediating effect of the second victim experience between safety culture and burnout in Iranian nurses.
Methods
A convenience sample of 298 nurses from five teaching hospitals of Urmia participated in the study. Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and The Second Victim Experience and Support Tool were used to measure the major variables. We adopted structural equation modelling to examine the hypotheses.
Results
Safety culture was significantly associated with second victim experience and burnout (p < .01). Second victim experience had a partial mediating role on the relationship between safety culture and burnout (p < .01). The mediating model including major variables showed satisfactory fitness (χ2/df = 2.11, p < .01, Comparative Fit Index = 0.94, root-mean-square error of approximation = 0.062).
Conclusions
Establishing a safety culture is crucial for decreasing job burnout, and second victim experience has an intervening role clarifying how high level of safety culture reduces burnout.
Implications for Nursing Management
Managers should plan to promote safety culture and provide sufficient support to staff involved in the patient safety incident, which could reduce staff burnout.
REFERENCES
- Aboneh, E. A., Stone, J. A., Lester, C. A., & Chui, M. A. (2020). Evaluation of patient safety culture in community pharmacies. Journal of Patient Safety, 16(1), e18–e24. https://doi.org/10.1097/PTS.0000000000000245
- Ajoudani, F., Baghaei, R., & Lotfi, M. (2019). Moral distress and burnout in Iranian nurses: The mediating effect of workplace bullying. Nursing Ethics, 26(6), 1834–1847. https://doi.org/10.1177/0969733018779210
- Akbari, R., Ghafar Samar, R., Kiany, G.-R., & Eghtesadi, A.-R. (2011). Factorial validity and psychometric properties of Maslach burnout inventory–The Persian version. Knowledge Health, 6(3), 1–8.
- Al Ma'mari, Q., Sharour, L. A., & Al Omari, O. (2020). Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. British Journal of Nursing, 29(1), 28–34. https://doi.org/10.12968/bjon.2020.29.1.28
- Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.
- Arab, M., Moghri, J., Akbari Sari, A., & Rahimi Forooshani, A. (2013). Patient safety culture status in general hospitals affiliated to Tehran University of Medical Sciences. Hakim Research Journal, 16(3), 243–250.
- Azami-Aghdash, S., Azar, F. E., Rezapour, A., Azami, A., Rasi, V., & Klvany, K. (2015). Patient safety culture in hospitals of Iran: A systematic review and meta-analysis. Medical Journal of the Islamic Republic of Iran, 29, 251.
- Azizi, L., Feyzabadi, Z., & Salehi, M.(2008). Exploratory and confirmatory factor analysis of maslach burnout inventory among tehran universitys employees. Psychological Studies, 4(3), 73–92.
- Bartlett, J. E., Kotrlik, J., & Higgins, C. (2001). Organizational research: Determining appropriate sample size in survey research appropriate sample size in survey research. Information Technology, Learning, and Performance Journal, 19(1), 43–50.
- Brunelli, M. V., Estrada, S., & Celano, C. (2018). Cross-cultural adaptation and psychometric evaluation of a Second Victim Experience and Support Tool (SVEST). Journal of Patient Safety, [publish, Ahead of Print]. https://doi.org/10.1097/PTS.0000000000000497 [Epub ahead of print].
- Buddeberg-Fischer, B., Klaghofer, R., Stamm, M., Siegrist, J., & Buddeberg, C. (2008). Work stress and reduced health in young physicians: Prospective evidence from Swiss residents. International Archives of Occupational and Environmental Health, 82(1), 31–38. https://doi.org/10.1007/s00420-008-0303-7
- Burlison, J. D., Scott, S. D., Browne, E. K., Thompson, S. G., & Hoffman, J. M. (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
- Chard, R. (2010). How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors. AORN Journal, 91(1), 132–145. https://doi.org/10.1016/j.aorn.2009.06.028
- Chassin, M. R., & Loeb, J. M. (2013). High-reliability health care: Getting there from here. The Milbank Quarterly, 91(3), 459–490. https://doi.org/10.1111/1468-0009.12023
- 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-SVEST). Journal of Nursing Management, 27(7), 1416–1422. https://doi.org/10.1111/jonm.12824
- Dyrbye, L. N., & Shanafelt, T. D. (2011). Physician burnout: A potential threat to successful health care reform. JAMA, 305(19), 2009–2010. https://doi.org/10.1001/jama.2011.652
- El Hechi, M. W., Bohnen, J. D., Westfal, M., Han, K., Cauley, C., Wright, C., … Kaafarani, H. M. A. (2019). 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
- Gottlieb, L. N., Gottlieb, B., & Shamian, J. (2012). Principles of strengths-based nursing leadership for strengths-based nursing care: A new paradigm for nursing and healthcare for the 21st century. Nursing Leadership, 25(2), 38–50. https://doi.org/10.12927/cjnl.2012.22960
10.12927/cjnl.2012.22960 Google Scholar
- Hellings, J., Schrooten, W., Klazinga, N., & Vleugels, A. (2007). Challenging patient safety culture: Survey results. International Journal of Health Care Quality Assurance, 20(7), 620–632. https://doi.org/10.1108/09526860710822752
- Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513–524. https://doi.org/10.1037//0003-066x.44.3.513
- Hu, L.-T., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453. https://doi.org/10.1037/1082-989X.3.4.424
- Joint, Commission (2015). Comprehensive accreditation manual for hospitals (CAMH): The Official Handbook. Retrieved from http://www.jcrinc.com/Accreditation-Manuals
- 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. https://doi.org/10.1097/PTS.0000000000000466
10.1097/PTS.0000000000000466 Google Scholar
- Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout engagement. JONA: the Journal of Nursing Administration, 36(5), 259–267. https://doi.org/10.1097/00005110-200605000-00019
- Lewis, E. J., Baernholdt, M., & Hamric, A. B. (2013). Nurses' experience of medical errors: An integrative literature review. Journal of Nursing Care Quality, 28(2), 153–161. https://doi.org/10.1097/NCQ.0b013e31827e05d1
- Moghri, J., Ghanbarnezhad, A., Moghri, M., Rahimi Forooshani, A., Akbari Sari, A., & Arab, M. (2012). Validation of Farsi version of hospital survey on patient Safety culture questionnaire, using confirmatory factor analysis method. Journal of Hospital, 11(2), 19–30.
- 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, https://doi.org/10.1111/jonm.12920
- Mossburg, S. E., & Dennison, C. H. (2018). The association between professional burnout and engagement with patient safety culture and outcomes: A systematic review. Journal of Patient Safety, [Published Ahead-of-Print]. https://doi.org/10.1097/PTS.0000000000000519
- Prapanjaroensin, A., Patrician, P. A., & Vance, D. E. (2017). Conservation of resources theory in nurse burnout and patient safety. Journal of Advanced Nursing, 73(11), 2558–2565. https://doi.org/10.1111/jan.13348
- 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), 377–384. https://doi.org/10.1016/s1553-7250(16)42053-2
- Rezaei, S., Karami Matin, B., Hajizadeh, M., Soroush, A., & Nouri, B. (2018). Prevalence of burnout among nurses in Iran: A systematic review and meta-analysis. International Nursing Review, 65(3), 361–369. https://doi.org/10.1111/inr.12426
- Rochefort, C. M., & Clarke, S. P. (2010). Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing, 66(10), 2213–2224. https://doi.org/10.1111/j.1365-2648.2010.05376.x
- Salar, A. R., Zare, S., Miandoab, N. Y., & Jafari, H. (2016). Job burnout rate among Zahedan University of medical sciences staff. Biology and Medicine, 8(5), 1–4. https://doi.org/10.4172/0974-8369.1000309
10.4172/0974-8369.1000309 Google Scholar
- Sangi-Haghpeykar, H., Ambani, D., & Carson, S. (2009). Stress, workload, sexual well-being and quality of life among physician residents in training. International Journal of Clinical Practice, 63(3), 462–467. https://doi.org/10.1111/j.1742-1241.2008.01845.x
- 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. BMJ Quality & Safety, 18(5), 325–330. https://doi.org/10.1136/qshc.2009.032870
- Sharp, L., Rannus, K., Olofsson, A., Kelly, D., Oldenmenger, W. H., & group, E. R. (2019). Patient safety culture among European cancer nurses—An exploratory, cross-sectional survey comparing data from Estonia, Germany, Netherlands, and United Kingdom. Journal of Advanced Nursing, 75(12), 3535–3543. https://doi.org/10.1111/jan.14177
- Shorofi, A., Jafari, H., Lolaty, H. A., Cherati, J. Y., & Karimzadeh, M. (2016). Nurse burnout and patient satisfaction with nursing care at dialysis and cardiac care units. Journal of Critical Care Nursing, 9(1), 1013. https://doi.org/10.17795/ccn-5102
10.17795/ccn-5102 Google Scholar
- Sørskår, L. I. K., Abrahamsen, E. B., Olsen, E., Sollid, S. J., & Abrahamsen, H. B. (2018). Psychometric properties of the Norwegian version of the hospital survey on patient safety culture in a prehospital environment. BMC Health Services Research, 18(1), 784. https://doi.org/10.1186/s12913-018-3576-x
- Van Bogaert, P., van Heusden, D., Timmermans, O., & Franck, E. (2014). Nurse work engagement impacts job outcome and nurse-assessed quality of care: Model testing with nurse practice environment and nurse work characteristics as predictors. Frontiers in Psychology, 5, 126–136. https://doi.org/10.3389/fpsyg.2014.01261
- Van Gerven, E., Vander Elst, T., Vandenbroeck, S., Dierickx, S., Euwema, M., Sermeus, W., … Vanhaecht, K. (2016). Increased risk of burnout for physicians and nurses involved in a patient safety incident. Medical Care, 54(10), 937–943. https://doi.org/10.1097/MLR.0000000000000582
- Vifladt, A., Simonsen, B. O., Lydersen, S., & Farup, P. G. (2016). The association between patient safety culture and burnout and sense of coherence: A cross-sectional study in restructured and not restructured intensive care units. Intensive & Critical Care Nursing, 36, 26–34. https://doi.org/10.1016/j.iccn.2016.03.004
- Vogus, T. J., Ramanujam, R., Novikov, Z., Venkataramani, V., & Tangirala, S. (2020). Adverse events and burnout: the moderating effects of workgroup identification and safety climate. Medical Care, 58(7), 594–600. https://doi.org/10.1097/mlr.0000000000001341
- Waterman, A. D., Garbutt, J., Hazel, E., Dunagan, W. C., Levinson, W., Fraser, V. J., & Gallagher, T. H. (2007). The emotional impact of medical errors on practicing physicians in the United States and Canada. The Joint Commission Journal on Quality and Patient Safety, 33(8), 467–476. https://doi.org/10.1016/s1553-7250(07)33050-x
- Wu, A. W. (2000). Medical error: The second victim: The doctor who makes the mistake needs help too. BMJ, 320(4), 726–727. https://doi.org/10.1136/bmj.320.7237.726
- 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