Essay: “Identifying Barriers to Support Nurses as Second Victims of Medical Errors: A Qualitative Study



RESEARCH

Please cite this paper as: [Mokhtari Z, Hosseini MA, Khankeh H, Fallahi-Khoshknab M,Nikbakht Nasrabadi A. Barriers to Support Nurses as Second Victim of Medical Errors :A Qualitative Study]

Corresponding Author:

Name: Mohammad Ali Hosseini

Address: Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Koodakyar St, Daneshjoo Ave, Evin, Tehran, Iran

Email address: mahmaimy2020@gmail.com.

Abstract

Background

Given the inevitability of medical errors and their impact on health workers, providing support to those who suffer is vital for their physical and mental recovery. Identifying the barriers to obtaining support is imperative in this regard.

Aims

The current study was conducted to identify the barriers impeding the provision of support to nurses as second victims of nursing errors in clinical settings within Iran.

Methods

This qualitative study was conducted on 18 nurses. The subjects were selected through the purposive sampling method, and data were collected using in-depth and semi-structured interviews. The data were analysed using methods as described by Graneheim and Lundman. The research context included the general and specialized departments of hospitals in Tehran, Iran, during 2017.

Results

 According to the results, mismanagement, oppressive and non-supportive environments, inadequate information, and the lack of supportive laws were the main barriers to supporting nurses.

Conclusion

Training nurses about the second victim phenomenon is recommended as well as the methods to manage the effects of this phenomenon, the supportive resources, and legal issues.

Word count: [1951]

Figures and Tables: [1]

Key Words

Barriers, Social Support, second victim, Qualitative Research, nursing error

What this study adds:

1. What is known about this subject?

Second victim supporting is a moral and professional necessity.

2.  What new information is offered in this study?

In this study, the experiences of nurses after error about barriers to support were identified.

3. What are the implications for research, policy, or practice?

The results of this research can help managers formulate plans to support nurses as second victims of an error

Background

The occurrence of medical errors in complicated therapeutic environments is inevitable (1). The human outcomes of nursing errors are important and have many negative consequences for healthcare providers (2). The psychological reactions to these errors in the literature are called the "second victim" phenomenon (3-5). The phenomenon of the second victim is a devastating phenomenon beyond the individual level (6, 7). Most second victims struggle with their personal and professional problems alone (8). Since there is a lot of evidence about the emotional distress of second victims (9). The care and support of the second victim is a professional and ethical imperative (9, 10).

Institutions may wish to help second victims but there are various barriers, such as a lack of knowledge toward the involvement of nurses (11). It seems that there are unknown effective factors in the inappropriate supporting of nurses as second victims of medical errors. Descriptive studies allow carrying out in-depth analysis and understanding the phenomena by using various methods of data collecting, as well as analysing the events, values, and norms from the perspective of participants (12). This study aims to explain the barriers to supporting nurses as second victims of medical errors.

Method

This qualitative study was conducted using a conventional content analysis approach (13). It was conducted on 18 nurses in public and private hospitals in Tehran.

The subjects were selected through the purposive sampling method and continued until data saturation was reached. After obtaining written informed consent, all the interviews were conducted in private and using Persian. Data collection was performed using semi-structural interviews.

At the interviews questions like “What barriers have you experienced to support nurses after an error as a second victim?” and “Were the nurses supported after the error?” were asked.

The MAXQDA software was used to facilitate the categorization of qualitative data. After typing the interviews and the reviews of the transcripts, extract codes were named.

These codes were categorized based on similarities and differences and they were interpreted within the context of the general transcripts in which they were combined to create a main category. The four criteria of transferability, dependability, credibility, and conformability were used to increase the rigor base on Lincoln and Guba's.

Results

The analysis of the data revealed 4 themes (Table 1). The participants perceived mismanagement as a barrier to receiving support after an error.

The lack of human resources and their distribution in shifts, the employment of newly arrived and inexperienced pastors without training, and the lack of proper equipment were among the factors that made nurses feel that they were not receiving support from the organization. “The beds and their fences in the ward are broken”, Participant 5.

 As a result of mismanagement, managers used conservative and passive approaches in dealing with nurses. “I wanted to schedule a meeting to have a word but he avoided me and booked me when the ship had sailed”, Participant 9.

The lack of a systematic support program was seen as a barrier to obtaining support. “They do not have any plan and everything is based on their personality”, Participant 12.

Nurses, as second victims, are treated unfairly. Moreover, they are disrespectful to the authorities and show aggressive behaviour.  

“You do not merit be a nurse”, Participant 6.

Other barriers to support nurses as second victims included the oppressive and non-supportive atmosphere. In this atmosphere, the organization has an individual approach to the error. Furthermore, it is believed that the error is unacceptable. “Is it possible for a good nurse to make a mistake?”, Participant 7.

The nurses’ needs, problems, and expectations are unknown for others and this ignorance is a barrier to supporting the involved nurses.

“Nobody knows what was happened to us”, Participant 2.

The involved nurses were unaware of the minor sources of support. The weakness of rules and lack of legal sanctions are the barriers for the involved nurses to be supported. Other barriers to supporting the nurses, as second victims, include the lack of special rules, contradiction of hospital guidelines against legal materials, and insufficient enforcement of legal previsions.

“The circulars in the hospital are in contradiction with the law that protects the nurse after the error”, Participant 15.

Discussion

According to the results of the current study, managers were not responsible for supporting nurses .The management of healthcare is important in supporting nurses because it plays a crucial role in workforce planning, providing adequate equipment, assessing needs, and enforcing supportive rules. The oppressive and non-supportive atmosphere in healthcare centers was considered as another barrier to supporting the involved nurses.

Organizational culture affects the development and maintenance of an attitude towards the answer to errors, the management of errors, and the protection of the second victim (14). The idea of just culture has been introduced with the goal of a more dynamic approach than the punitive culture that was intended to eliminate the negative effect of the punitive culture (15). The second victim phenomenon was unknown to nurses and the organization, and nobody cared about the problems of nurses; therefore, it was determined as a barrier to supporting them. According to the results of the study conducted by Rivera, more than one- third of the subjects (36%) were not aware of the concept of the second victim (16).  

As the results of this study indicated, the nurses were ill-informed about the law in relation to their occupation. In a study conducted by Hu et al. in 2011, 72 percent of the participants tended to be supported to cope with legal issues (17).

The limitation of this study is that most of the nurses approached are working in the field of treatment. The obtained results are, therefore, not transferable to the nurses who provide healthcare services in other sectors, such as families and schools.

Conclusion

It is to be hoped that we could take a step forward in promoting nursing support by using these results. It is recommended that senior nursing leaders in therapeutic centers should follow the just culture model in healthcare in order to improve the safety of patients and support the second victim of error.

References

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ACKNOWLEDGEMENTS

We thank all those who participated in the study.

PEER REVIEW

Not commissioned. Externally peer reviewed.

CONFLICTS OF INTEREST

The authors declare that they have no competing interests.

FUNDING

The University of Social Welfare and Rehabilitation Sciences

ETHICS COMMITTEE APPROVAL

This study was approved by the Ethics Committee of Tehran University of Social Welfare and Rehabilitation Sciences with No. IR.USWR.REC.1394.384

Figures and Tables

Table 1: Main themes and subthemes of Barriers to Supporting for Nurses as Second Victims of Medical Errors

Main themes Subthemes

Mismanagement Inadequate Staffing and other Resources

Incuriosity to the fate of staff and patients

Sovereignty of taste rather than strategy

Oppressive and non-supportive atmosphere Insulting and punishment atmosphere

False beliefs

Insecure mental atmosphere

Inadequate information Inadequate information about the effect of the error on the nurses.

Inadequate information of nurses about the supportive sources.

Lack of supportive law Weakness of the rules

Unknown rules