A Study On Nurses’ Experience,Support Status And Influencing Factors As Secondary Victims In Nursing Adverse Events

ObjectiveThrough the questionnaire survey in nursing adverse events as the second victim after experience and support the status quo,analysis of demographic data,adverse events,the hospital nurse patient safety culture and support for the next victim experience.In addition,qualitative research was used to explore the psychological experience and coping strategies of nurses as secondary victims in nursing adverse events.The results of this study provide a theoretical basis for medical institutions and nursing managers to improve their attention and support to nurses who are secondary victims of adverse nursing events and to develop perfect support strategies.Methods1.From July 2020 to Decembert 2020,convenience sampling was used to investigate the secondary victim experience,support status and influencing factors of nurses in 38 hospitals of different levels in Shandong Province.A total of 1525 nurses who experienced adverse nursing events were selected as the research objects,and SPSS23.0 was used for data collection,entry and analysis.2.Phenomenological research method was used to conduct semi-structured in-depth interviews with 23 nurses who experienced nursing adverse events,and data analysis was conducted according to Colaizzi phenomenological seven-step analysis method.Results1.Collected,3665 questionnaires,3420 valid questionnaires,the effective rate was 93.32%.Among the 3420 valid questionnaires,44.59%(1525 positive cases)of nurses had experienced adverse nursing events at work,among which,the number and proportion of positive cases in tertiary hospitals,secondary hospitals and primary hospitals were 1045 cases(46.67%),340 cases(37.86%)and 140 cases(49.47%),respectively.There was no statistical significance in the proportion of second victims among different hospitals(P>0.05).2.Nurses’experience as secondary victims and support status score:86.34 overall;The scores of each dimension:psychological pain 15.44±3.18,physical pain 13.08±4.02,occupational self-efficacy 12.09±2.74,colleague support 10.58±2.04,superior support 10.21±2.56,organization support 8.38± 1.86,non-work related support 4.76± 1.54,turnover intention 6.54± 1.93,absence 5.27±1.87.Nurses as the secondary victims of nursing adverse events are seriously troubled and receive insufficient support,which is particularly significant in tertiary hospitals.Compared with the level 2 hospitals(P=0.038)and the level 1 hospitals(P=0.033),the secondary victims of nurses in the level 3 hospitals had higher distress level and less support.There was no statistical significance between secondary hospitals and primary hospitals(P>0.05).3.In different age,nature of work unit,position,working hours per week,at a recent experiences the level of adverse events,the patients’ families whether understanding or matching degree of responsibility,adverse events,whether experienced department/large/nursing level analysis to discuss or report,the hospital can effective investigation and handling,hospitals have to medical staff have a support system,whether the experience the different levels of punishment,such as hospital patient safety culture indicators and the second victim between experience and support level is relevant(P<0.05).There was a significant relationship between the safety culture of hospital patients and the total scores and dimensions of the second victim’s experience and support level(P<0.01).4.Linear regression analysis results show that the place the unit type,working hours per week,and whether family members,and errors in the non punitive reaction,department and the expectation of regulators to promote safe operation,which all indoor teamwork,succession and change one’s major,hospital managers support for patient safety and the errors in the communication and feedback,organizational learning and continuous improvement,open communication is the second victim experience and support of the main influencing factors.5.Four themes were obtained through qualitative interviews:the second victim experienced significant negative psychological experience,but still had positive psychological experience,positive coping strategies and negative coping strategies.Conclusions1.The proportion of nurses as second victims in 10 prefecture-city medical institutions in Shandong province was.44.59%,which was lower than the international level and basically the same as the domestic situation.2.Nurses in nursing adverse events as the second victim of serious,get support,it is especially significant in tertiary hospital.Compared with the level 2 and level 1 hospitals,the secondary victims of nurses in the level 3 hospitals had higher pain level and less support.There was no difference between secondary and primary hospitals.3.The second victim’s painful experience and support level is influenced by many factors,working hours per week,family members whether to cooperate,whether through punishment,hospital patient safety culture is the main influence factors.4.In the case of insufficient support for the status quo,nurses as secondary victims still have positive psychological experience and positive coping strategies.Based on the above conclusions,the following suggestions are proposed:1.Flexible deployment,reasonable shift arrangement,reduce the safety risks caused by unreasonable working hours per week.2.Hospital administrators should face up to the second victim phenomenon,establish the second victim evaluation mechanism and methods,and provide formal and effective organizational support and professional psychological counseling.3.Improve the patient safety culture in non-punitive hospitals,reduce punitive reactions to errors,and encourage supportive colleagues,supervisors,and institutional interactions.