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The field of healthcare quality and safety has been informed by the study of Human Factors contributing to adverse events. Hitherto, much of the study of Human Factors has been focused on a narrow lens of human error, identifying cognitive-based or knowledge-based errors and cognitive processes such as loss of situational awareness contributing to error. While these factors are important, this narrow approach fails to consider the complexity of relational and systemic factors that also contribute to adverse events. We aimed to explore the relational and systemic human factors, including shared clinician attitudes and behavior, that contribute to serious adverse patient events in a public health setting. The study, set in a metropolitan local health district in New South Wales, Australia, was conducted using a retrospective qualitative multi-incident content analysis design. Serious adverse event reviews (SAER) over 6 months (2022-2023) were subject to qualitative content analysis until data saturation was reached. Data saturation reached at 20 reports. Emergent themes related to human factors in serious adverse events included: (i) delays and inertia-with a subtheme of inertia of ageism; (ii) "All-or-nothing" approach to end-of-life care and planning; (iii) communication lapses; and (iv) implementation gap between standards and practice. Error-based incidents accounted for only 35% of the serious adverse events examined. The sample studied involved mostly (65%) male patients, with a mean age of 69 (70% aged >65), managed across the gamut of specialties, with the most common incident being the management of acutely deteriorating patients. In conclusion, there is more to Human Factors in adverse events than cognitive or knowledge-based error. While identifying and correcting errors is absolutely essential, we need adjunctive "soft measures" to address clinical attitudes, behaviors, and relationships in health care, particularly in increasingly complex, fraught, and stressful health care environments., (© 2024 The Author(s). Journal of Healthcare Risk Management published by Wiley Periodicals LLC on behalf of American Society for Health Care Risk Management.)

Burnout has become a significant occupational concern for resident physicians, primarily attributed to chronic workplace stressors, inadequate work-life balance, high expectation from attending staffs, steep learning curve, and limited patient care experience. The study aimed to investigate the prevalence and associated factors of burnout in medical residents. This cross-sectional study was conducted online questionnaire of all specialists in a university hospital from September to October 2022. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. The data collection encompassed information on socio-demographics, working conditions, psychiatric issues, and medical errors as potential predictive variables. To analyze the association between these factors and burnout, a confounder summary score model was employed in four separate models utilizing multivariable logistic regression. A total of 238 participants, the average age of participants was 28.1 years (SD 2.7), and 56.2% of them were female. Weekly working hours averaged 75 (SD 21.8). Burnout prevalence was 46.3%. This prevalence was characterized by high levels of emotional exhaustion (57.1%) and depersonalization (36.1%), along with low levels of personal accomplishment (52.4%). Summary of association in each domain with burnout were as follow: demographic determinants, (adjusted odds ratio (aOR) 2.80, 95% CI 1.68-4.64), working conditions (aOR 2.97, 95% CI 1.54-5.71), psychiatric determinants (aOR 2.47, 95% CI 1.77-3.45) medical errors (aOR 2.14, 95% CI 1.05-4.34). Medical residency training programs should provide a supportive system that actively monitors and addresses depressive symptoms. Implementing preventive measures, such as increasing pay rates, can play a role in mitigating burnout., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Surawattanasakul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Over the last decade attention has grown to give patients and next of kin (P/N) more substantial roles in adverse event investigations. Adverse event investigations occur after adverse events that resulted in death or severe injury. Few studies have focused on patient perspectives on their involvement in such investigations. The present study sets out to investigate how P/N and patient representatives (client councils and the Patient Federation Netherlands) view the involvement of P/N in adverse event investigations, particularly whether and why they want to involved, and how they want to shape their involvement., Methods: The study features qualitative data on three levels: interviews with P/N (personal), focus groups with representatives of client councils (institutional), and an interview with the Patient Federation Netherlands (national). Researchers used inductive, thematic analysis and validated the results through data source triangulation., Results: The initiative taken by the hospitals in this study provided P/N with the space to feel heard and a position as legitimate stakeholder. P/N appreciated the opportunity to choose whether and how they wanted to be involved in the investigation as stakeholders. P/N emphasized the need for hospitals to learn from the investigations, but for them the investigation was also part of a more encompassing relationship. P/N's views showed the inextricable link between the first conversation with the health care professional and the investigation, and the ongoing care after the investigation was finalized. Hence, an adverse event investigation is part of a broader experience when understood from a patient perspective., Conclusions: An adverse event investigation should be considered as part of an existing relationship between P/N and hospital that starts before the investigation and continues during follow up care. It is crucial for hospitals to take the initiative in the investigation and in the involvement of P/N. P/N motivations for involvement can be understood as driven by agency or communion. Agentic motivations include being an active participant by choice, while communion motivations include the need to be heard., (© 2024. The Author(s).)

Since the publication of the Institute of Medicine's landmark report on medical errors in 2000, a large number of safety programs have been implemented in American hospitals. Concurrently, there has been a dramatic increase in the rate of burnout among physicians. Although there are many unrelated causes of burnout (eg, loss of autonomy), and multiple safety programs that are applauded by physicians (eg, The Safe Motherhood Initiative), other programs created in the name of safety improvements may be contributing to physician distress. In this piece, we review several of those programs, describe their limitations and costs to physician well-being, and discuss the manner in which they might be modified to retain their benefits while mitigating the burdens they place on physicians., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Medical errors are among the most important factors that threaten patient safety. Therefore, nurses' perspectives and experiences about medical errors are important for this manner., Aims: The aim of this study was to determine in depth the perspectives and experiences of nurses related to how they define medical error, as well as its causes, management and reporting., Design: This descriptive, exploratory study involved a qualitative design., Methods: A total of 15 clinical nurses from eleven provinces were reached by snowball sampling method. In the study, nurses' perspectives on medical errors were obtained through semistructured in-depth online interviews conducted based on phenomenological methods. Descriptive analysis was used in the analysis of the data obtained from the interviews. The research was conducted following the COnsolidated criteria for REporting Qualitative checklist., Results: The resulting 26 codes were categorized under seven themes: "Definition of medical error", "Experience of medical errors", "Frequency of medical errors", "Causes of medical errors", "Reporting of medical errors", "Medical error approach" and "Prevention of medical errors"., Conclusions: The results show that it is still necessary to increase the awareness of nurses about medical errors and the importance of error reporting. In addition, it reveals the need for leadership to eliminate the negative approach to medical errors and shows that nurse managers should be empowered accordingly., Implications for Nursing Practice and Policy: It is the first step of quality and safe care to reveal nurses' perspectives on medical errors, their thoughts about medical errors and their experiences about errors in their institutions. In this study, nurses' knowledge, opinions and experiences regarding medical errors were revealed in this qualitative study. Therefore, this study offers important clues to nursing services, hospital managers and policy makers for clinical and institutional arrangements., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Objectives: Preventable adverse events (PAEs) occur across the healthcare spectrum; and, unfortunately, errors, adverse events, and PAEs are common in pediatric care. Historically, the role of disclosure of PAEs to patients and their families occurred between the dyad of physician and patient, with physicians assuming the responsibility of disclosure. In recent years, a trend toward a multidisciplinary team-based approach has emerged in some institutions, yet the role of pediatric nurses within the team disclosing a PAE is not fully understood. Given the unique relationship between pediatric nurses and their patients and their families, it is essential to understand does the literature tell us about the role of pediatric nurses during PAE disclosure?, Methods: The Arksey and O'Malley scoping review method guided this study protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework guided reporting., Results: The final sample included five articles for synthesis: none reported or described a specific role for pediatric nurses during PAE disclosure., Conclusions: There is a gap in the literature on the role of pediatric nurses during PAE disclosure. Two themes emerged from this review: the use of a team-based approach to disclosure, and the need to provide emotional support to the pediatric patient and their family. There is a need for additional investigation into the role of pediatric nurses as part of a team-based disclosure process and how pediatric nurses currently provide, or desire to provide, emotional support to the patient and their family., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: This study aims to determine the effects of perceived organizational support on attitudes toward medical errors in surgical nurses., Background: Nurses exhibit high performance in a work environment that supports, satisfies, and motivates them. Organizational support is one of the factors affecting the work environments of nurses. A strong nursing and hospital leadership supports the daily professional practices and well-being of nurses and is important in creating a positive work environment for nurses., Materials and Methods: The population of this cross-sectional study was composed of nurses (N = 414) in the surgical clinics of the Turgut Özal Medical Center. To reach the necessary sample size, the purposive sampling method, which is a nonprobability sampling method, was used. The data were collected using a personal information form, the Perceived Organizational Support Scale and the Scale of Attitudes toward Medical Errors., Results: It was determined that 91.1% of the participants had positive attitudes toward the importance and reporting of medical errors and moderate perceived organizational support (3.04 ± 0.67). The organizational support perceived by the participants did not have a statistically significant effect on their attitudes toward medical errors (β = 0.015; p = 0.865). The multiple linear regression model established in the study revealed that education level and previous medical error status were significant predictors of the attitudes of the participants toward medical errors., Conclusion: It was determined that surgical nurses had positive attitudes toward the importance and reporting of medical errors and moderate perceived organizational support levels, and perceived organizational support did not significantly affect attitudes toward medical errors in surgical nurses., Implications for Nursing Practice and Health Policy: In this study, it was determined that the perceived organizational support levels of surgical nurses did not have a significant effect on their attitudes toward medical errors. Assuming that adequate organizational support will reduce medical error rates, it is considered important to develop and implement policies to increase organizational support levels. Likewise, the use of safety reporting systems should be expanded to reduce medical error rates, reports should be used only to prevent and reduce risks, and systems and strategies should be developed instead of blaming individuals. In addition to the reporting of confirmed medical errors to ensure patient safety, the reporting of so-called "near misses" is also very important. For this reason, institutional support should be provided regarding the importance of "near miss" events in error reporting. Necessary practices should be provided to identify, report, correct, and prevent these events., (© 2023 International Council of Nurses.)

Background: The emotional impact of medical errors on patients may be long-lasting. Factors associated with prolonged emotional impacts are poorly understood., Methods: The authors conducted a subanalysis of a 2017 survey (response rate 36.8% [2,536/6,891]) of US adults to assess emotional impact of medical error. Patients reporting a medical error were included if the error occurred ≥ 1 year prior. Duration of emotional impact was categorized into no/short-term impact (impact lasting < 1 month), prolonged impact (> 1 month), and especially prolonged impact (> 1 year). Based on their reported experience with communication about the error, patients' experience was categorized as consistent with national disclosure guidelines, contrary to guidelines, mixed, or neither. Multinomial regression was used to examine associations between patient factors, event characteristics, and organizational communication with prolonged emotional impact (> 1 month, > 1 year)., Results: Of all survey respondents, 17.8% (451/2,536) reported an error occurring ≥ 1 year prior. Of these, 51.2% (231/451) reported prolonged/especially prolonged emotional impact (30.8% prolonged, 20.4% especially prolonged). Factors associated with prolonged emotional impact included female gender (adjusted odds ratio 2.1 [95% confidence interval 1.5-2.9]); low socioeconomic status (SES; 1.7 [1.1-2.7]); physical impact (7.3 [4.3-12.3]); no organizational disclosure and no patient/family error reporting (1.5 [1.03-2.3]); communication contrary to guidelines (4.0 [2.1-7.5]); and mixed communication (2.2 [1.3-3.7]). The same factors were significantly associated with especially prolonged emotional impact (female, 1.7 [1.2-2.5]; low SES, 2.2 [1.3-3.6]; physical impact, 6.8 [3.8-12.5]; no disclosure/reporting, 1.9 [1.2-3.2]; communication contrary to guidelines, 4.6 [2.2-9.4]; mixed communication, 2.1 [1.1-3.9])., Conclusion: Prolonged emotional impact affected more than half of Americans self-reporting a medical error. Organizational failure to communicate according to disclosure guidelines after patient-perceived errors may exacerbate harm, particularly for patients at risk of health care disparities., (Copyright © 2024 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Background: Peer support programs have evolved to train physicians to provide outreach and emotional first aid to their colleagues when they experience the inevitable challenge of a serious adverse event, whether or not it is related to a medical error. Most pediatric surgeons have experienced the trauma of a medical error, yet, in a survey of APSA membership, almost half said that no one reached out to them, and few were satisfied with their institution's response to the error. Thus, the APSA Wellness Committee developed an APSA-based peer support program to meet this need., Methods: Peer supporters were nominated by fellow APSA members, and the group was vetted to ensure diversity in demographics, practice setting, and seniority. Formal virtual training was conducted before the program went live in 2020. Trained supporters were surveyed 6 months after the program launched to evaluate their experiences with providing peer support., Results: 15 referrals were made in the first year, 60 % of which were self-initiated. Most referrals were for distress related to adverse events or toxic work environments (33 % each). While only about 25 % of trained supporters had provided formal support through the APSA program, more than 80 % reported using the skills to support colleagues and trainees within their own institutions., Conclusion: Our experience in the first year of the APSA peer support program demonstrates the feasibility of building and maintaining a national program to provide emotional first aid by a professional society to expand the safety net for surgeons who are suffering., Competing Interests: Conflicts of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose of this research was to explore the incidence, characteristics and consequences of blame-related distress and its relationship to moral distress. An instrument was created and validated and a conceptual model proposed for relating blame to similar constructs among clinical staff working in acute care.

Background: Previous research suggests that medico-legal complaints often arise from various factors influencing patient dissatisfaction, including medical errors, physician-patient relationships, communication, trust, informed consent, perceived quality of care, and continuity of care. However, these findings are not typically derived from actual patients' cases. This study aims to identify factors impacting the interpersonal dynamics between physicians and patients using real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints., Methods: We conducted a retrospective study using data from closed medical regulatory authority complaint cases from the Canadian Medical Protective Association (CMPA) between January 1, 2015, and December 31, 2020. The study population included patients who experienced sepsis and survived, with complaints written by the patients themselves. A multi-stage standardized thematic analysis using Braun and Clarke's approach was employed. Two researchers independently coded the files to ensure the reliability of the identified codes and themes., Results: Thematic analysis of 50 patient cases revealed four broad themes: (1) Ethics in physician's work, (2) Quality of care, (3) Communication, and (4) Healthcare system/policy impacting patient satisfaction. Key sub-themes included confidentiality, honesty, patient involvement, perceived negligence, perceived lack of concern, active engagement and empathy, transparency and clarity, informed consent, respect and demeanor, lack of resources, long wait times, and insufficient time with physicians., Conclusions: This study identifies and categorizes various factors impacting relational issues between physicians and patients, aiming to increase patient satisfaction and reduce medico-legal cases. Improving physicians' skills in areas such as communication, ethical practices, and patient involvement, as well as addressing systemic problems like long wait times, can enhance the quality of care and reduce medico-legal complaints. Additional training in communication and other skills may help promote stronger relationships between physicians and patients., (© 2024. The Author(s).)

Background: Second victims, defined as healthcare providers enduring emotional and psychological distress after patient safety incidents (PSIs). The potential for positive transformation through these experiences is underexplored but is essential for fostering a culture of error learning and enhancing patient care., Objective: To explore the level and determinants of post-traumatic growth (PTG), applying the stress process model., Methods: The study was conducted at a tertiary general hospital in Chongqing, China. A descriptive, cross-sectional study design was used. A total of 474 s victims were included. An online survey was conducted in November 2021 to assess various factors related to the second victim experience. These factors included PSIs (considered as stressors), coping styles, perceived threats, and social support (acting as mediators), as well as the outcomes of second victim syndrome (SVS) and PTG. Statistical description, correlation analysis, and structural equation modeling were utilized for the data analysis. A p-value ≤ 0.05 was considered to indicate statistical significance., Results: The participants reported moderate distress (SVS = 2.84 ± 0.85) and PTG (2.72 ± 0.85). The total effects on SVS of perceived threat, negative coping, social support, positive coping, and PSIs were 0.387, 0.359, -0.355, -0.220, and 0.115, respectively, accounting for 47% of the variation in SVS. The total effects of social support, positive coping, and PSIs on PTG were 0.355, 0.203, and - 0.053, respectively, accounting for 19% of the variation in PTG., Conclusions: The study provides novel insights into the complex interplay between perceived threats, coping styles, and social support in facilitating PTG among second victims. By bolstering social support and promoting adaptive coping strategies, the adverse effects of PSIs can be mitigated, transforming them into opportunities for resilience and growth, and offering a fresh perspective on managing PSIs in healthcare settings., (© 2024. The Author(s).)

Background: Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed., Objective: To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment., Methods: Mixed-methods analysis of responses to the Massachusetts Medical Errors Recontact survey with participants reporting a medical error within the past 5 years. The survey consisted of forty closed and open-ended questions examining adverse medical events and their consequences. Respondents were asked whether they felt 'that the doctors abandoned or betrayed you or your family'. Open-ended responses were analysed with a coding schema by two clinician coders., Results: Of the 253 respondents, 34.5% initially and 20% persistently experienced abandonment. Perceived abandonment could be traced to interactions before (18%), during (34%) and after (45%) the medical mishap. Comprehensive post-incident communication reduced abandonment for patients staying with the provider associated with the mishap. However, 68.4% of patients perceiving abandonment left their original provider; for them, post-error communication did not increase the probability of resolution. Abandonment accounted for half the post-event loss of trust in clinicians., Limitations: Survey-based data may under-report the impact of perceived errors on vulnerable populations. Moreover, patients may not be cognizant of all forms of adverse events or all sequelae to those events. Our data were drawn from a single state and time period., Conclusion: Addressing the deleterious impact of persisting abandonment merits attention in programmes responding to patient safety concerns. Enhancing patient engagement in the aftermath of an adverse medical event has the potential to reinforce therapeutic alliances between patients and their subsequent clinicians., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: This study aims to explore the "second victim" phenomenon in healthcare professions students following an adverse event., Background: In healthcare settings, adverse events affect not only patients but also the involved healthcare personnel, who experience a wide range of physical and psychological responses, a situation known as the second victim phenomenon. This phenomenon also extends to students in health-related professions during their clinical training, yet there needs to be more research specifically addressing this group., Design: A scoping review METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework. In December 2023, we conducted a comprehensive database search in PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, Web of Science (WoS), Scopus and the Virtual Health Library (VHL). The review included original research studies of any design that focused on the second victim phenomenon among students, published in English, Spanish, German or Portuguese, with no restrictions on the publication date. The review was reported according to PRISMA-ScR guidelines., Results: Seven studies were selected, primarily involving nursing and medical students. Common triggers of the second victim phenomenon in students were medication errors, patient falls and procedural errors. Described symptoms ranged from emotional distress, such as stress and hypervigilance, to physical symptoms, like sleep disturbances. Among the factors that influenced how this "second victim" phenomenon manifested in students were the reactions of their peers and the lack of support from supervisors. Contrary to the three possible outcomes described for professionals as second victims (surviving, thriving, or leaving), students are only described with two: giving up or moving on., Conclusion: The studies highlighted the crucial role of peer and supervisor support in managing such difficult situations. The results suggest that additional research is necessary in other healthcare disciplines. Educational and healthcare institutions should improve their preventive and management strategies to address the phenomenon's impact on students., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: The aim of the current research is to determine nursing students' levels of altruism, attitudes towards medical errors and the effect of altruism on attitudes towards medical errors., Background: Nursing students should be aware of medical errors and have an attitude towards correcting them. Professional values play an essential role in changing, shaping and developing attitudes in nursing students. Altruism is one of the most important determining professional values in students' professional success and development of attitudes towards different situations., Desing: This study is a descriptive and cross-sectional study., Methods: The research was conducted in the Nursing Department of a state university in Turkey and the study population consisted of 2nd, 3rd and 4th year nursing students (N=375) who were continuing their education and clinical practice in the spring semester of the 2022-2023 academic year. The study was completed with 321 students. The data were collected online using the information form, the Altruism Scale and the Scale of Attitudes Towards Medical Errors via Google Forms between 01 and 31 May 2023. Data were analysed using descriptive statistics, Independent-Samples t-test, One-Way ANOVA test, Pearson's correlation analysis and simple linear regression., Results: Students had a mean score of 69.68 (range 40-98) on the Altruism Scale and 3.82 (range 2.38-4.56) on the Scale of Attitudes Towards Medical Errors. A significant, very weak positive correlation was found between the Altruism Scale and the total mean scores of the Attitudes Towards Medical Errors Scale (p=0.001). Altruism was found to have a significant effect on attitude towards medical errors (p=0.001). The explanatory power of the regression model was 0.101 and altruism explained 10.1 % of the students' attitudes towards medical errors scores., Conclusions: Students have positive attitudes towards medical errors, high awareness of the importance of medical errors and error reporting and above average levels of altruism. Altruism has a positive effect on attitudes towards medical errors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Answering calls in the literature, we developed and introduced an evidence-based tool for surgeons facing errors in the operating room: the STOPS framework (stop, talk to you team, obtain help, plan, succeed). The purpose of this research was to assess the impact of presenting this psychological tool on resident coping in the operating room and the related outcome of burnout while examining sex differences., Methods: In a natural experiment, general surgery residents were invited to attend 2 separate educational conferences regarding coping with errors in the operating room. Three months later, all residents were asked to fill out a survey assessing their coping in the operating room, level of burnout, and demographics. We assessed the impact of the educational intervention by comparing those who attended the coping conferences with those who did not attend., Results: Thirty-five residents responded to the survey (65% response rate, 54% female respondents, 49% junior residents). Our hypothesized moderated mediation model was supported. Sex was found to moderate the impact of the STOPS framework-female residents who attended the coping educational conference reported higher coping self-efficacy, whereas attendance had no statistically significant impact on male levels of coping self-efficacy. In turn, higher coping self-efficacy was associated with lower levels of burnout., Conclusion: Our results suggest that there is evidence of efficacy in this instruction-female residents presented this material report higher levels of coping in the operating room compared to those who did not receive the framework. Further, increase in coping ability was associated with reduced levels of burnout for both genders., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Understanding nursing students' perceptions of dishonesty and their attitudes towards medical errors is crucial for nurse educators., Objectives: This study aimed to examine the relationship between nursing students' perceptions of dishonesty and their attitudes towards medical errors., Design: This study is descriptive and correlational research. The sample size consisted of 230 nursing students in a Department of Nursing at Kırşehir Ahi Evran University Faculty of Health Sciences in Turkey during the 2022-2023 academic year. The data was collected between May 15-31, 2023., Results: A statistically significant correlation was observed between the total score of the Nursing Student Perceptions of Dishonesty Scale, and the Medical Errors Attitude Scale (p < 0.05). There was a positive and weak correlation between the MEAS scale score and the cheating (r = 0.284, p < 0.05), sabotage (r = 0.275, p < 0.05), perjury (r = 0.308, p < 0.05), non-compliance (r = 0.309, p < 0.05), and stealing (r = 0.359, p < 0.05) sub dimension score, and a positive and very weak correlation between the MEAS score and the sub dimension of not my problem score (r = 0.182, p < 0.05). The perceptions of dishonesty explain 15 % of the attitude towards medical errors (F = 4.563, p < 0.001)., Conclusions: In this study, a significant relationship was observed between nursing students' perceptions of dishonesty and their attitudes towards medical errors. Specifically, as the perception of dishonesty increased, there was a positive change in attitudes towards medical errors. These results offer nurse educators valuable insights into the impact of academic dishonesty on the development of medical error attitudes among student nurses throughout their nursing education and beyond., Competing Interests: Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients' safety (e.g., silence). Five superiors' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Kupkovicova, Skoumalova, Madarasova Geckova and Dankulincova Veselska.)

Objective: Safe patient care can help reduce treatment costs, morbidity, and mortality. This study aimed to assess dentists' perceptions of patient safety culture and related factors in the Eastern region of Saudi Arabia., Methods: This cross-sectional study used a sample of 271 dental professionals working in private and public dental hospitals and clinics in the Eastern region of Saudi Arabia. The Safety Attitude Questionnaire (SAQ), a validated tool consisting of 36 items on a 5-point Likert scale, was used to assess dentists' perceptions of patient safety culture. The score of SAQ ranges from 0 to 100 and a cut-off ≥ 75 is considered a positive attitude toward patient safety culture., Results: There were 53.9% males and 46.1% females in the study with a mean age of 35.56 ± 6.87 years. Almost half of the participants (52%) attended a course on patient safety and 22.1% experienced medical error in the last month. The mean score of the SAQ of the sample was 65.14 ± 13.03 and the patient safety score was significantly related to the marital status (P = 0.041), attendance of patient safety course (P < 0.001), and experience of medical error (P = 0.008). The highest mean score (73.27 ± 20.11) was for the job satisfaction domain, followed by the safety climate domain (67.69 ± 16.68), and working conditions domain (66.51 ± 20.43). About one-quarter of the participants (22.5%) demonstrated positive attitudes toward patient safety culture. Multiple logistic regression analysis showed that dental professionals who attended a patient safety course were 4.64 times more likely to demonstrate positive attitudes toward patient safety than those who did not attend a course (P < 0.001)., Conclusion: This study showed that patient safety culture was significantly related to the attendance of safety courses, marital status, and experiencing medical error. About one out of four dental professionals demonstrated a positive attitude towards patient safety culture which was significantly associated with the attendance of the safety course., (© 2024. The Author(s).)

A qualitative study that provides evidence of the institutional support required by intensive care unit (ICU) nurses as second victims of adverse events (AEs)., Background: The phenomenon of second victims of AE in healthcare professionals can seriously impact professional confidence and contribute to the ongoing occurrence of AEs in hospitals., Objectives: The objective of this study was to describe the coping trajectories of second victims among nurses working in ICUs in public hospitals in Chile., Methods: Conducting qualitative research through the grounded theory method, this study focused on high-complexity hospitals in Chile, using theoretical sampling. The participants consisted of 11 nurses working in ICUs. Techniques used included in-depth interviews conducted between March and May 2023, as well as a focus group interview. Analysis, following the grounded theory approach proposed by Strauss and Corbin, involved constant comparison of data. Open, axial, and selective coding were applied until theoretical data saturation was achieved. The study adhered to reliability and authenticity criteria, incorporating a reflexive process throughout the research. Ethical approval was obtained from the ethics committee, and the study adhered to the consolidated criteria for reporting qualitative research., Results: From the interviews, 29 codes were identified, forming six categories: perception of support when facing an AE, perception of helplessness when facing an AE, initiators of AE, responses when facing an AE, professional responsibility, and perception of AE. The perception of support when facing an AE emerged as the main category, determining whether the outcome was stagnation or overcoming of the phenomenon after the AE., Conclusions: For the coping process of ICU nurses following an AE, the most crucial factor is the support from colleagues and supervisors., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The fear of clinical errors among healthcare workers (HCW) is an understudied aspect of patient safety. This study aims to describe this phenomenon among HCW and identify associated socio-demographic, professional, burnout and mental health factors., Methods: We conducted a nationwide, online, cross-sectional study targeting HCW in France from May to June 2021. Recruitment was through social networks, professional networks, and email invitations. To assess the fear of making clinical errors, HCW were asked: "During your daily activities, how often are you afraid of making a professional error that could jeopardize patient safety?" Responses were collected on a 7-point Likert-type scale. HCW were categorized into "High Fear" for those who reported experiencing fear frequently ("once a week," "a few times a week," or "every day"), vs. "Low Fear" for less often. We used multivariate logistic regression to analyze associations between fear of clinical errors and various factors, including sociodemographic, professional, burnout, and mental health. Structural equation modeling was used to explore how this fear fits into a comprehensive theoretical framework., Results: We recruited a total of 10,325 HCW, of whom 25.9% reported "High Fear" (95% CI: 25.0-26.7%). Multivariate analysis revealed higher odds of "High Fear" among males, younger individuals, and those with less professional experience. High fear was more notable among physicians and nurses, and those working in critical care and surgery, on night shifts or with irregular schedules. Significant associations were found between "High Fear" and burnout, low professional support, major depressive disorder, and sleep disorders., Conclusions: Fear of clinical errors is associated with factors that also influence patient safety, highlighting the importance of this experience. Incorporating this dimension into patient safety culture assessment could provide valuable insights and could inform ways to proactively enhance patient safety., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Boyer, Wu, Fernandes, Tran, Brousse, Nguyen, Yon, Auquier, Lucas, Boussat and Fond.)

Importance: Adverse patient events are inevitable in surgical practice., Objectives: To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient., Design, Setting, and Participants: In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system., Main Outcomes and Measures: The personal impact of adverse patient events, current coping mechanisms, and desired forms of support., Results: Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing., Conclusions and Relevance: In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.

Introduction: Successful breast cancer outcomes can be jeopardised by adverse events. Understanding and integrating patients' and doctors' perspectives into care trajectories could improve patient safety. This study assessed their views on, and experiences of, medical error and patient safety., Methods: A cross-sectional, quantitative 20-40 item questionnaire for patients attending Cork University Hospital Cancer Centre and breast cancer doctors in the Republic of Ireland was developed. Domains included demographics, medical error experience, patient safety opinions and concerns., Results: 184 patients and 116 doctors completed the survey. Of the doctors, 41.4% felt patient safety had deteriorated over the previous five years and 54.3% felt patient safety measures were inadequate compared to 13.0% and 27.7% of patients respectively. Of the 30 patients who experienced medical errors/negligence claims, 18 reported permanent or long-term physical and emotional effects. Forty-two of 48 (87.5%) doctors who experienced medical errors/negligence claims reported emotional health impacts. Almost half of doctors involved in negligence claims considered early retirement. Forty-four patients and 154 doctors didn't experience errors but reported their patient safety concerns. Doctors were more concerned about communication and administrative errors, staffing and organisational factors compared to patients. Multiple barriers to error reporting were highlighted., Conclusion: This is the first study to assess patients' and doctors' patient safety views and medical error/negligence claims experiences in breast cancer care in Ireland. Experience of medical error/negligence claims had long-lasting implications for both groups. Doctors were concerned about a multitude of errors and causative factors. Failure to embed these findings is a missed opportunity to improve safety., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess Lebanese medical students' attitudes towards patient safety and medical error disclosure., Methods: This was a cross-sectional study involving medical students from seven different medical schools in Lebanon. The participants completed the Attitudes to Patient Safety Questionnaire (APSQ-III) online, which consists of 26 items across nine key patient safety domains. Items were scored from 1 (strongly disagree) to 5 (strongly agree). Demographic data were also collected., Results: Of the 549 students enrolled in the study, 325 (59%) were female and 224 (41%) were male. More than half (287, 52%) were aged between 20 and 22 years and 95% were Lebanese. The overall attitude of students towards patient safety was positive (3.59 ± 0.85) with the most positive attitudes in the domains of ' Team functioning' followed by ' Working hours as an error cause' . More positive attitudes were perceived among male students in the domains of ' Professional incompetence as an error cause' and ' Disclosure responsibility' whereas more positive attitudes were seen in female students in the domain of ' Working hour as an error cause' . Older medical students had more positive attitudes in the domain of ' Team functioning' than younger students., Conclusion: Medical students in Lebanon had an overall positive attitude towards patient safety. These findings may be used to guide improvements in patient safety education and enhance patient-centred care in medical institutions in Lebanon., Competing Interests: Declaration of conflicting interestsThe authors declare that there are no conflicts of interest

Background: Better understanding of the factors that influence patients to make a financial claim for compensation is required to inform policy decisions. This study aimed to assess the relative importance of factors that influence those who have experienced a patient safety incident (PSI) to make a claim for compensation., Method: Participants completed an online discrete choice experiment (DCE) involving 10 single profile tasks where they chose whether or not to file a claim. DCE data were modelled using logistic, mixed logit and latent class regressions; scenario analyses, external validity, and willingness to accept were also conducted., Results: A total of 1029 participants in the United Kingdom responded to the survey. An appropriate apology and a satisfactory investigation reduced the likelihood of claiming. Respondents were more likely to claim if they could hold those responsible accountable, if the process was simple and straightforward, if the compensation amount was higher, if the likelihood of compensation was high or uncertain, if the time to receive a decision was quicker, and if they used the government compensation scheme. Men are more likely to claim for low impact PSIs., Discussion and Conclusions: The actions taken by the health service after a PSI, and people's perceptions about the probability of success and the size of potential reward, can influence whether a claim is made. Results show the importance of giving an appropriate apology and conducting a satisfactory investigation. This stresses the importance around how patients are treated after a PSI in influencing the clinical negligence claims that are made., (© 2024. The Author(s).)

Background: It is known that many surgeons encounter intraoperative adverse events which can result in Second Victim Syndrome (SVS), with significant detriment to their emotional and physical health. There is, however, a paucity of Asian studies in this space. The present study thus aimed to explore the degree to which the experience of an adverse event is common among surgeons in Singapore, as well as its impact, and factors affecting their responses and perceived support systems., Methods: A self-administered survey was sent to surgeons at four large tertiary hospitals. The 42-item questionnaire used a systematic closed and open approach, to assess: Personal experience with intraoperative adverse events, emotional, psychological and physical impact of these events and perceived support systems., Results: The response rate was 57.5% (n = 196). Most respondents were male (54.8%), between 35 and 44 years old, and holding the senior consultant position. In the past 12 months alone, 68.9% recalled an adverse event. The emotional impact was significant, including sadness (63.1%), guilt (53.1%) and anxiety (45.4%). Speaking to colleagues was the most helpful support source (66.7%) and almost all surgeons did not receive counselling (93.3%), with the majority deeming it unnecessary (72.2%). Notably, 68.1% of the surgeons had positive takeaways, gaining new insight and improving vigilance towards errors. Both gender and surgeon experience did not affect the likelihood of errors and emotional impact, but more experienced surgeons were less likely to have positive takeaways (p = 0.035). Individuals may become advocates for patient safety, while simultaneously championing the cause of psychological support for others., Conclusions: Intraoperative adverse events are prevalent and its emotional impact is significant, regardless of the surgeon's experience or gender. While colleagues and peer discussions are a pillar of support, healthcare institutions should do more to address the impact and ensuing consequences., (© 2024. The Author(s).)

Background: Despite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops., Methods: Data collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines., Results: We identified four main themes: "Providers agree on the value of disclosure of a medical error to the patient"; "Emotional challenges of disclosure of medical error to patients"; "The medico-legal discourse challenges transparency"; and "Providers and patients call for a change in the culture regarding disclosure of medical errors". Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties., Conclusion: The study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers., (© 2024. The Author(s).)

All in health care are at risk of involvement in adverse events. Oftentimes, the health care worker manifests physical, psychological, and professional effects and this is referred to as the second-victim phenomenon. Unmitigated recovery of a second victim can contribute to absenteeism, turnover intentions, burnout, and loss of joy and meaning in work. The preferred method of support among health care workers is a respected peer to provide emotional support. Health care organizations can contribute to a second victim's recovery by providing a culture of safety and diverse resources based on the needs of the individual., Competing Interests: Disclosure The authors have no commercial associations that might pose a conflict of interest in connection with this work., (Copyright © 2023 Elsevier Inc. All rights reserved.)

To investigate clinical nurses' perception of adverse event risk and to analyze its influencing factors. A proportional stratified random sampling method was applied to recruit nurses from a hospital in Shiyan City, Hubei Province, China. The Nursing Adverse Event Risk Perception Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout scale was used to investigate 1084 nurses. Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors. The scores of the Nurses' Risk Perception of Adverse Nursing Event Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout Scale were 14.98 ± 5.39, 52.57 ± 10.00, 88.98 ± 21.08, 56.42 ± 5.03, 30.90 ± 21.49, respectively. According to the correlation analysis, nurses' perception of adverse nursing events was positively correlated with the sense of organizational support (r = .457, P  < .01), head nurses' leadership behavior (r = .348, P  < .01), and nurse safety behavior (r = .457, P  < .01), and negatively correlated with the level of burnout (r = -.384, P  < .01). According to the Regression analysis, nurses' departments (β = .226, P  < .001), daily working hours (β = 1.122, P  < .001), adverse events experience (β = -1.505, P  < .001), organizational support (β = .105, P  < .001), head nurses' leadership behavior (β = .072, P  < .001), and burnout (β = -.052, P  < .001) held an influence on nurses' risk perception of adverse nursing event. These factors explained 42.5% of the total variation. Nurses' risk perception of adverse nursing events needs to be improved. Nursing managers need to strengthen organizational support for nurses, change the leadership behavior of nurse managers, reduce nurses' burnout, improve nurses' risk perception of adverse nursing events, prevent adverse events, and ensure patient safety., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Anesthesia professionals experience events resulting in psychological and physiologic implications, known as second victim experiences (SVEs). This study evaluated the impact of a peer support program on anesthesia providers' SVEs. In July 2018, a departmental peer support program was implemented. All anesthesia professionals were invited to participate in a survey, including the Second Victim Experience and Support Tool (SVEST), which evaluated SVEs and desired support, preimplementation of the program. The survey was repeated two years after program implementation. A total of 57.9% (348/601) completed the preimplementation survey; 37.6% (231/614) completed the postimplementation survey. The median SVEST scores for psychological distress (3.0 vs 2.8, P = .04) and institutional support (3.0 vs 2.3, P < .001) were significantly lower on the postimplementation survey, indicating more favorable responses. For both assessments, the most desired support option was a 'respected peer to discuss the details of what happened.' Postimplementation, 84.9% (191/225) agreed the program enhanced departmental support, 93.2% (207/222) agreed the program considered professionals' well-being, and 81.7% (183/224) agreed the program contributed to a culture of safety. A total of 99.1% (213/215) would recommend the peer support program to others. Implementation of a peer support program significantly influenced anesthesia professionals' SVE-related psychologic distress and perception of adequate institutional support., Competing Interests: Name: Marina Pelikan, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Robyn E. Finney, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Adam Jacob, MD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

Purpose: As a competency of Canadian postgraduate education, residents are expected to be able to promptly disclose medical errors and assume responsibility for and take steps to remedy these errors. How residents, vulnerable through their inexperience and hierarchical team position, navigate the highly emotional event of medical error is underexplored. This study examined how residents experience medical error and learn to become responsible for patients who have faced a medical error., Method: Nineteen residents from a breadth of specialties and years of training at a large Canadian university residency program were recruited to participate in semistructured interviews between July 2021 and May 2022. The interviews probed their experience of caring for patients who had experienced a medical error. Data collection and analysis were conducted iteratively using a constructivist grounded theory method with themes identified through constant comparative analysis., Results: Participants described their process of conceptualizing error that evolved throughout residency. Overall, the participants described a framework for how they experienced error and learned to care for both their patients and themselves following a medical error. They outlined their personal development of understanding error, how role modeling influenced their thinking about error, their recognition of the challenge of navigating a workplace environment full of opportunities for error, and how they sought emotional support in the aftermath., Conclusions: Teaching residents to avoid making errors is important, but it cannot replace the critical task of supporting them both clinically and emotionally when errors inevitably occur. A better understanding of how residents learn to manage and become responsible for medical error exposes the need for formal training as well as timely, explicit discussion and emotional support both during and after the event. As in clinical management, graded independence in error management is important and should not be avoided because of faculty discomfort., (Copyright © 2023 by the Association of American Medical Colleges.)

Background: The rate of mistakes and near misses in clinical medicine remains staggering. The tendency to cover up mistakes is rampant in "name-blame-shame" cultures. The need for safe forums where mistakes can be openly discussed in the interest of patient safety is evident. Following a comprehensive review of the literature, a semi-structured weekly conference, named "mistake of the week" (MOTW), was introduced, enabling physicians to voluntarily discuss their mistakes and near-misses. The MOTW is intended to encourage cultural change in how physicians approach, process, accept and learn from their own and their peers' mistakes. This study seeks to assess if physicians appreciate, benefit from and are motivated to participate in MOTW., Methods: Physicians and medical students of the I. and II. Medizinische Klinik at the Academic Teaching Hospital Klinikum Konstanz (Germany) were eligible to participate voluntarily. Four groups of physicians (n=3-6) and one group of medical students (n=5) volunteered to participate in focus group interviews, which were videotaped, transcribed and analyzed., Results: The following success factors are crucial for dealing with and voluntarily disclosing mistakes and near-misses: 1. Exemplification ("follow the boss's lead"), 2. Fixed time slots and a clear forum, 3. Reporting mistakes without fear of penalty or punishment, 4. A trusting working atmosphere. The key effects of the MOTW approach are: 1. People report their mistakes more, 2. Relief, 3. Psychological safety, 4. Lessons learned/errors (potentially) reduced., Discussion: The MOTW conference models an ideal forum to mitigate hierarchy and promote a sustainable organizational dynamic in which mistakes and near misses can be discussed in an environment free from "name-blame-shame", with the ultimate goal of potentially improving patient care and safety., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Job-related psychosocial factors have a substantial effect on the occurrence of adverse events among healthcare professionals., Objective: An analytical and descriptive survey was conducted to evaluate the relationship between the occurrence of patient safety incidents and psychological factors., Methods: The study sample consisted of 177 nurses who were asked about patient safety events over six months. Repetitive patient safety incidents were selected by examining medical records and interviewing specialists. Also, psychological factors were assessed using job content questionnaire (JCQ)., Results: Repetitive patient safety incidents were involved medication administration error, pressure ulcer and skin-muscular injuries, patient falls, inability to CPR patients, blood transfusion reactions, and death due to human error. The findings showed that 92 participants (52%) had at least one case of patient safety incident. Among patient safety incidents, medication administration error and death due to human error had the highest and lowest repletion, respectively. Nurses training, job insecurity and peer support were significant predictors of different aspects of patient safety (p < 0.05)., Conclusion: Proper collaboration between new and experienced nurses can have a significant impact to reduce patient safety incidents. In addition, nursing training can be a good way to understand risk points in medical errors.

Background: Making a medical error is a uniquely challenging psychosocial experience for clinicians. Feelings of personal responsibility, coupled with distress regarding potential or actual patient harm resulting from a mistake, create a dual burden. Over the past 20 years, experiential accounts of making an error have provided evidence of the associated distress and impacts. However, theory-based psychosocial support interventions to improve both individual outcomes for the involved clinicians and system-level outcomes, such as patient safety and workforce retention, are lacking. There is a need for evidence-based ways to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts. Such interventions play a role within wider programs of health professional support. We sought to address this by developing a testable, psychosocial model of clinician recovery after error based on recent evidence., Methods: Systematic review methodology was used to identify studies published between January 2010 and June 2021 reporting experiences of direct involvement in medical errors and/or subsequent recovery. A narrative synthesis was produced from the resulting articles and used as the basis for a team-based qualitative approach to model building., Results: We identified 25 studies eligible for inclusion, reporting evidence primarily from experiences of doctors and nurses. The identified evidence indicates that coping approach, conversations (whether they occur and whether they are perceived to be helpful or unhelpful), and learning or development activities (helpful, unhelpful or absent) may influence the relationship between making an error and both individual clinician outcomes of emotional impact and resultant practice change. Our findings led to the development of the Recovery from Situations of Error Theory model, which provides a preliminary theoretical basis for intervention development and testing., Conclusions: The Recovery from Situations of Error Theory model is the first testable psychosocial model of clinician recovery after making a medical error. Applying this model provides a basis to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts and to support the replication of interventions that work across services and health systems toward constructive change. Such interventions may be embedded into the growing body of peer support and employee support programs internationally that address a diverse range of stressful workplace experiences., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Aims: To clarify second victim symptoms subgroups, explore the factors affecting profile membership and determine how desired support strategies differ between the subgroups., Design: A cross-sectional study using an online survey., Methods: A total of 378 Korean staff nurses directly involved in patient safety incidents were recruited between December 2019 and February 2020. Data analyses consisted of latent profile analysis, multinomial logistic regression and analysis of variance., Results: Three latent profiles were identified: 'mild symptoms', 'moderate symptoms' and 'severe symptoms'. Lower organizational support and higher non-work-related support were more likely to belong to the severe symptoms' profile. Incidents that caused temporary harm to the patient were more strongly associated with an increased likelihood of belonging to the moderate and severe symptoms profiles than no-harm events. Participants with severe symptoms agreed more with the usefulness of the support strategies than other participants; the usefulness of the psychological support strategies was rated particularly high. Participants in the mild and moderate symptoms groups agreed more strongly with the usefulness of coping strategies following patient safety incidents than psychological support. The strategy that all profiles considered the most useful was having the opportunity to take time away from clinical duties., Conclusion: Tailored support should be provided to nurses with factors influencing the profile membership and subgroups of second victim symptoms., Impact: This study confirmed the need to provide organizational support to nurses as second victims and provided valuable evidence for developing support programs tailored to the subgroups of second victim symptoms., (© 2022 John Wiley & Sons Ltd.)

Background: Medical errors have an impact on veterinary patient safety. Studies in human medicine suggest that students can help prevent medical errors. However, there are no studies that address the role of veterinary students in patient safety., Methods: An electronic survey was distributed to incoming final-year (IFY) and outgoing final-year (OFY) students at the Washington State University College of Veterinary Medicine. Response data were compared between class year groups with a Fisher's exact test and Mann-Whitney U test., Results: The response rate was 26.8% (70/261). Most respondents (85.7%) reported being present during a medical error, and 60% reported causing a medical error. The OFY group indicated lower agreement with documenting an error in the patient record and whether all errors should be disclosed. The IFY group felt more distress surrounding potential errors and sequential career implications. Compared with the IFY group, the OFY group agreed more that errors occur frequently in veterinary medicine and disagreed more that hospital staffing is adequate to ensure patient safety. Open responses recognised a need for communication training and identified that the OFY group regarded errors more actionably, whereas the IFY group viewed errors more emotionally., Conclusion: Most veterinary students will experience medical errors prior to graduation, but some lack clarity around appropriate disclosure and documentation. Additional training on medical errors and error disclosure should be provided to veterinary students., (© 2022 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Objective: To investigate the steps faculty surgeons take upon experiencing intraoperative error and synthesize these actions to offer a framework for coping with errors., Background: While intraoperative errors are inevitable, formal training in error recovery is insufficient and there are no established curricula that teach surgeons how to deal with the intraoperative error. This is problematic because insufficient error recovery is detrimental to both patient outcomes and surgeon psychological well-being., Methods: We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with faculty surgeons from 3 hospitals. Surgeons described recent experiences with intraoperative error. Interviews were transcribed and coded. Analysis allowed for development of themes regarding responses to errors and coping strategies., Results: Twenty-seven surgeons (30% female) participated. Upon completion of the analysis, themes emerged in 3 distinct areas: (1) Exigency, or a need for training surgical learners how to cope with intraoperative errors, (2) Learning, or how faculty surgeons themselves learned to cope with intraoperative errors, and (3) Responses, or how surgeons now handle intraoperative errors. The latter category was organized into the STOPS framework: Intraoperative errors could produce STOPS: Stop, Talk to your Team, Obtain Help, Plan, Succeed., Conclusions and Relevance: This study provides both novel insight into how surgeons cope with intraoperative errors and a framework that may be of great use to trainees and faculty alike., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Perforation is the most serious adverse event of colonoscopy, but rarely considered from the view of colonoscopists' second victim experience and perception discordance between colonoscopists and patients., Aims: We aimed to evaluate colonoscopists' second victim experience and the perception discordance between colonoscopists and patients for the colonoscopic perforation., Methods: A survey for colonoscopic perforation was performed for the colonoscopists and outpatients who visited the university hospital between February 1, 2020, and April 30, 2020. The questionnaire included questions regarding colonoscopists' satisfaction for the intervention strategies offered to patients and patient-colonoscopist perception on colonoscopic perforation. A modified Korean version of the "Second Victim Experience and Support Tool (K-SVEST)" was used to assess the second victim experiences and supportive resources for the colonoscopists., Results: Survey results from 160 colonoscopists and 165 patients were analyzed. The colonoscopists' satisfaction scores were higher for strategies related to sufficient explanation, empathy, courteous listening, and monetary compensation. The scores of the K-SVEST for the second victim experience were highest in psychological distress, followed by loss of professional self-efficacy, colleague support, physical distress, non-work-related support, institutional support, and turnover intentions/absenteeism. Significant patient-colonoscopist discordance was noted for the same colonoscopic perforation scenario on the judgment of medical error, health professionals' apology, monetary compensation, and criminal penalties for the colonoscopists., Conclusions: Colonoscopists can suffer emotionally and physically from the second victim experience after colonoscopic perforation. In addition, the significant patient-colonoscopist discordance should be considered to make a better communication for the colonoscopic perforation., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues., Competing Interests: Name: Michael Neft, PhD, DNP, MHA, RN, CRNA, FNAP, FAANA, FAAN Contribution: As lead author, Dr Neft designed and carried out the review and worked with co-authors regarding the synthesis, writing, rewriting, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Kathleen Sekula, PhD, PMHCNS, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Rick Zoucha, PhD, PMHCNS-BC, CTN-A, FAAN Contribution: This author made contributions to the writing, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Mary Ellen Smith Glasgow, PhD, RN, ACNS-BC, ANEF, FAAN Contribution: This author made contributions to the conception, synthesis, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Maria Van Pelt, PhD, CRNA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Ann Mitchell, PhD, RN, AHN-BC, FIAAN, FAAN Contribution: This author made contributions to the final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Background: Until the onset of the new millennium, the focus of medicine in general and patient safety in particular was the patient. In the past two decades, the well-being of the clinician is becoming more apparent in the professional literature. This article will focus on the physician who shows signs of distress, depression and burnout, or even trauma. This is the second victim of a medical error or adverse event., Methods: The author will review the literature of the past decade dealing with this phenomenon, often related to as a syndrome, in day-to-day routine and at a pandemic and emergency situation. I will start by the definition and description of symptoms of the syndrome, then move on to its scope, risk factors and various sources., Conclusions: I will conclude by describing the situation in Israel and provide some practical tools that have proved efficient for confronting the phenomenon., Discussion: The author will focus on the four origins of stress leading to the syndrome: the physical-psychological, institutional-cultural, cognitive and moral. I will emphasize the latter, which deserves further exploration given the evidence to its significant contribution to stress and trauma of health professionals. I will then discuss the interventions and tools suggested and implemented for support of the second victim in relation to the four origins.

Objectives: Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians., Methods: This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval., Results: Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%)., Conclusions: The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Health information technologies (HITs) are widely employed in healthcare and are supposed to improve quality of care and patient safety. However, so far, their implementation has shown mixed results, which might be explainable by understudied psychological factors of human-HIT interaction. Therefore, the present study investigates the association between the perception of HIT characteristics and psychological and organizational variables among 445 healthcare workers via a cross-sectional online survey in Germany. The proposed hypotheses were tested using structural equation modeling. The results showed that good HIT usability was associated with lower levels of techno-overload and lower IT-related strain. In turn, experiencing techno-overload and IT-related strain was associated with lower job satisfaction. An effective error management culture at the workplace was linked to higher job satisfaction and a slightly lower frequency of self-reported medical errors. About 69% of surveyed healthcare workers reported making errors less frequently than their colleagues, suggesting a bias in either the perception or reporting of errors. In conclusion, the study's findings indicate that ensuring high perceived usability when implementing HITs is crucial to avoiding frustration among healthcare workers and keeping them satisfied. Additionally healthcare facilities should invest in error management programs since error management culture is linked to other important organizational variables., (© 2021. The Author(s).)

Background: Prior work has identified intraoperative and postoperative coping strategies among surgeons and has demonstrated surgical errors to have a significant impact on patient outcomes and physicians. Little research has considered which coping strategies are most common among surgeons and if there exist coping strategy differences among sex or training level., Methods: An electronic survey was distributed to surgical faculty and trainees at 3 institutions. Variables included coping techniques after making an error in the operating room. Participants were asked to report the effectiveness of their overall coping strategy., Results: A total of 168 participants (56% male, 45% faculty) experienced an operative error and answered questions regarding coping strategies. The only coping strategy significantly associated with positive ratings of coping effectiveness was, upon error, taking a step back and taking time to think and act (r = 0.17; P = .024). There were differences between men and women in both intra and postoperative coping strategies. Men (mean = 3.69/5, standard error = .09) viewed their overall coping strategy as more effective than women (mean = 3.38/5, standard error = .09), t(158.86) = 2.47; P = .015., Conclusion: Although both male and female surgeons reported making errors in the operating room, differences exist in the strategies surgeons use to cope with these mistakes, and strategies differ in their ratings of effectiveness., (Copyright © 2021 Elsevier Inc. All rights reserved.)