Coping trajectories of intensive care nurses as second victims: A grounded theory.

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.

Segundas víctimas: calidad de soporte percibido y su relación con las consecuencias del evento adverso / Second victims: perceived support quality and its relationship with the consequences of the adverse event

INTRODUCCIÓN: Las segundas víctimas son aquellos trabajadores de salud que están involucrados en un Evento Adverso (EA) y presentan afección física, emocional, psicológica y/o laboral. Para evitar estas afecciones, es importante recibir medidas de soporte. El objetivo de este artículo es determinar qué relación existe entre las consecuencias de un EA sobre las segundas víctimas y la calidad de las medidas de soporte percibidas en instituciones de salud públicas y privadas de la Región Metropolitana durante el segundo semestre del año 2018. MATERIALES Y MÉTODO: Estudio cuantitativo, exploratorio, descriptivo, correlacional y transversal. A través de una plataforma online se aplicó una encuesta sociodemográfica e instrumento SVEST que consta de nueve dimensiones relacionadas con consecuencias del EA y calidad del soporte percibido (α=0,826). RESULTADOS: Muestra de 301 trabajadores de salud entre institución pública y privada, el 39,2% se involucró en un EA y de estos, el 73,0% manifestó ser Segunda Víctima. De estas segundas víctimas, 69,1% pertenece al sexo femenino y el 45,7% se desempeña como Profesional de Enfermería. Existe una relación negativa entre calidad de soporte percibido y consecuencia psicológica y laboral del EA (Público y Privado p<0,05) y un aumento del riesgo de tener consecuencias graves al recibir una baja calidad de soporte (OR=3,8; IC 95% 1.32-11.47). DISCUSIÓN: Es de gran importancia conocer este fenómeno y entregar medidas de soporte adecuadas a la Segunda Víctima, para disminuir el impacto físico, psicológico, emocional y/o laboral que conlleva involucrarse en un EA. (AU)

INTRODUCTION: The second victims are those health workers who are involved in an Adverse Event (AE) and display physical, emotional, psychological and / or work-related symptoms. To avoid these conditions, it is important to receive supportive measures. The objective of this arti-cle is to determine the relationship between the consequences of an AE on the second victims and the quality of the support measures received in public and private health institutions of the Metropolitan Region during the second semester of 2018. MATERIALS AND METHOD: Quantitative, exploratory, descriptive, correlational and transversal study. Through an online platform, a sociodemographic survey and SVEST instrument was conducted, consisting of 28 items on the Likert scale (1-5) and nine dimensions related to the consequences of the AE and the quality of the perceived support (α = 0.826). RESULTS: Of a sample of 301 health workers in public and private institution, 39.2% were invol-ved in an EA and of these, 73.0% manifested symptoms of Second Victims. Of these second victims, 69.1% were female and 45.7% worked in the Nursing Profession. There is a negative relationship between the quality of perceived support and the psychological and occupational consequence of AD (Public and Private p <0.05) and an increased risk of having serious con-sequences when receiving low quality of support (OR=3,8; IC 95% 1.32-11.47) DISCUSSIONS: It is of great importance to recognize this phenomenon and deliver adequate su-pport measures to the Second Victim, in order to reduce the physical, psychological, emotional and / or work impact involved in being involved in an AD. (AU)

Nursing students' errors in clinical learning. Qualitative outcomes in Mixed Methods Research.

OBJECTIVE: to analyze factors associated with nursing students' errors during clinical learning, and their perceptions regarding these events and the opportunity for learning and development provided by them. METHOD: Convergent Mixed Method design according Creswell and Clark. Qualitative dimension included face to face and internet interviews. Data analysis followed Miles and Huberman method. RESULTS: Nursing student's errors were revealed according to their perceptions. They occurred in all phases of the nursing process and in transversal skills. Errors were acknowledged as learning and developmental opportunities. FINAL CONSIDERATIONS: Students acknowledged their errors and ascribe to themselves reasons and what could have prevented what happened. Mixed Method was a very adequate design to study phenomena. Qualitative dimension was essential to reveal and achieve the objectives. Suggestions founded on the findings are presented.

Nursing students' errors in clinical learning. Qualitative outcomes in Mixed Methods Research / Erros dos estudantes de enfermagem em aprendizagem clínica. Resultados qualitativos em investigação de métodos mistos / Errores de los estudiantes de enfermería en aprendizaje clínico. Resultados cualitativos en investigación de métodos mixtos

ABSTRACT Objective: to analyze factors associated with nursing students' errors during clinical learning, and their perceptions regarding these events and the opportunity for learning and development provided by them. Method: Convergent Mixed Method design according Creswell and Clark. Qualitative dimension included face to face and internet interviews. Data analysis followed Miles and Huberman method. Results: Nursing student's errors were revealed according to their perceptions. They occurred in all phases of the nursing process and in transversal skills. Errors were acknowledged as learning and developmental opportunities. Final considerations: Students acknowledged their errors and ascribe to themselves reasons and what could have prevented what happened. Mixed Method was a very adequate design to study phenomena. Qualitative dimension was essential to reveal and achieve the objectives. Suggestions founded on the findings are presented.

RESUMO Objetivo: analisar fatores associados aos erros dos estudantes de enfermagem durante a aprendizagem clínica e as suas perceções destes eventos constituírem oportunidade de aprendizagem e de desenvolvimento. Método: Investigação com desenho de Métodos Mistos de acordocom Creswell e Clark. A dimensão qualitativa incluiu entrevistas presenciais e pela internet. A análise de dados seguiu o método de Miles e Huberman. Resultados: Os erros dos estudantes foram revelados Segundo as suas perceções em todas as fases do processo de enfermagem e nas competências transversais. Os erros foram reconhecidos como oportunidades de aprendizagem e de desenvolvimento. Considerações finais: Os estudantes reconheceram o seus erros e atribuíram a sim mesmos as razões e o que teria prevenido a sua ocorrência. O Método Misto foi um desenho adequado para estudar o fenómeno. A dimensão qualitativa foi essencial para revelar e alcançar o objetivo. São apresentadas sugestões alicerçadas nos resultados.

RESUMEN Objetivo: analizar los factores asociados a los errores de los estudiantes de enfermería durante el aprendizaje clínico y sus percepciones con respecto a estos eventos y la oportunidad de aprendizaje y desarrollo que proporcionan. Método: Diseño de método mixto convergente según Creswell y Clark. La dimensión cualitativa incluyó entrevistas presenciales y por internet. El análisis de los datos siguió el método de Miles y Huberman. Resultados: Los errores de los estudiantes de enfermería fueron revelados de acuerdo a sus percepciones. Ocurrieron en todas las fases del proceso de enfermería y en habilidades transversales. Los errores fueron reconocidos como oportunidades de aprendizaje y desarrollo. Consideraciones finales: los estudiantes reconocieron sus errores y se atribuyeron las razones y lo que pudría haber evitado lo que sucedió. El método mixto fue un diseño muy adecuado para estudiar los fenómenos. La dimensión cualitativa fue esencial para revelar y lograr los objetivos. Se presentan sugerencias fundamentadas en los hallazgos.

The Function of Disclosing Medical Errors: New Cultural Challenges for Physicians.

A general consensus has been reached in health care organizations that the disclosure of medical errors can be a very powerful way to improve patients and physicians well-being and serves as a core component to high quality health care. This practice strongly encourages transparent communication with patients after medical errors or unanticipated outcomes. However, many countries, such as Brazil, do not have a culture of disclosing harmful errors to patients or standards emphasizing the importance of disclosing, taking responsibility, apologizing, and discussing the prevention of recurrences. Medical error is not discussed or approached during medical school. The stigma of error has a strong connection with value judgments, and emotional support for physicians does not exist. This paper suggests that open communication with the patient is essential. Guidance about error disclosure from health care organizations would be helpful for quality and patient safety and for health care professionals in countries like Brazil.

Incidents reporting: barriers and strategies to promote safety culture.

OBJECTIVE: The purpose was to identify the barriers of underreporting, the factors that promote motivation of health professionals to report, and strategies to enhance incidents reporting. METHOD: Group conversations were carried out within a hospital multidisciplinary team. A mediator stimulated reflection among the subjects about the theme. Sixty-five health professionals were enrolled. RESULTS: Complacency and ambition were barriers exceeded. Lack of responsibility about culture of reporting was the new barrier observed. There is a belief only nurses should report incidents. The strategies related to motivation reported were: feedback; educational intervention with hospital staff; and simplified tools for reporting (electronic or manual), which allow filling critical information and traceability of management risk team to improve the quality of report. CONCLUSION: Ordinary and practical strategies should be developed to optimize incidents reporting, to make people aware about their responsibilities about the culture of reporting and to improve the risk communication and the quality of healthcare and patient safety.

Burnout in anesthesiology / Burnout em anestesiologia

Abstract Background and objectives Burnout is a chronic condition caused by high levels of stress and anesthesiology is a stressful medical specialty with more vulnerability to burnout. The aim of this study is to review the characteristics and impact of burnout in anesthesiology. Contents In this review, the stressors and risk factors, manifestations, assessment, complications, management and prevention of burnout as well as the inconsistent research found in the state-of-art are approached. Conclusions Anesthesiologists are in a high-risk group to develop burnout, with different manifestations and consequences such as suicide or medical errors. Although there is no specific treatment yet, there are a lot of helpful measures to cope this condition. Prevention is considered an important step in order to reduce the prevalence of burnout.

Resumo Justificativa e objetivos Burnout é uma condição crônica de esgotamento causada por níveis altos de estresse e a anestesiologia é uma especialidade médica estressante com maior vulnerabilidade ao burnout. O objetivo deste estudo foi revisar as características e o impacto do burnout em anestesiologia. Conteúdo Nesta revisão, são abordados os estressores e fatores de risco, manifestações, avaliação, complicações, manejo e prevenção do burnout, bem como as pesquisas inconsistentes encontradas no estado da arte. Conclusões Os anestesiologistas estão em um grupo de alto risco para desenvolver burnout, com diferentes manifestações e consequências, como suicídio ou erros médicos. Embora ainda não haja tratamento específico, existem muitas medidas úteis para lidar com essa condição. A prevenção é considerada um passo importante para reduzir a prevalência de burnout.

Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort.

BACKGROUND: The disrespect and abuse of women during the process of childbirth is an emergent and global problem and only few studies have investigated this worrying issue. The objective of the present study was to describe the prevalence of disrespect and abuse of women during childbirth in Pelotas City, Brazil, and to investigate the factors involved. METHODS: This was a cross-sectional population-based study of women delivering members of the 2015 Pelotas birth cohort. Information relating to disrespect and abuse during childbirth was obtained by household interview 3 months after delivery. The information related to verbal and physical abuse, denial of care and invasive and/or inappropriate procedures. Poisson regression was used to evaluate the factors associated with one or more, and two or more, types of disrespectful treatment or abuse. RESULTS: A total of 4275 women took part in a perinatal study. During the three-month follow-up, we interviewed 4087 biological mothers with regards to disrespect and abuse. Approximately 10% of women reported having experienced verbal abuse, 6% denial of care, 6% undesirable or inappropriate procedures and 5% physical abuse. At least one type of disrespect or abuse was reported by 18.3% of mothers (95% confidence interval [CI]: 17.2-19.5); and at least two types by 5.1% (95% CI: 4.4-5.8). Women relying on the public health sector, and those whose childbirths were via cesarean section with previous labor, had the highest risk, with approximately a three- and two-fold increase in risk, respectively. CONCLUSIONS: Our study showed that the occurrence of disrespect and abuse during childbirth was high and mostly associated with payment by the public sector and labor before delivery. The efforts made by civil society, governments and international organizations are not sufficient to restrain institutional violence against women during childbirth. To eradicate this problem, it is essential to 1) implement policies and actions specific for this type of violence and 2) formulate laws to promote the equality of rights between women and men, with particular emphasis on the economic rights of women and the promotion of gender equality in terms of access to jobs and education.

Cuidando de um filho com diagnóstico de paralisia cerebral: sentimentos e expectativas / Taking care of a child diagnosed with cerebral palsy: feelings and expectations / Cuidar a un niño com diagnóstico de parálisis cerebral: sentimientos y expectativas

Este estudo objetivou compreender a experiência da maternidade em mulheres que são mães de um filho com diagnóstico de Paralisia Cerebral. Participaram 26 mães, que responderam a uma entrevista semiestruturada. A Análise Textual Qualitativa da entrevista resultou nas categorias: "o momento do diagnóstico"; "a percepção em relação à maternidade"; "preocupações, dificuldades e desejos" e "expectativas para o futuro". Elas atribuíram a causa da Paralisia Cerebral ao erro médico ou à negligência dos profissionais da saúde durante o pré-parto e o parto, à precariedade de recursos do hospital ou à própria responsabilidade. Entre as preocupações, estão o temor de adoecer e morrer, a falta de capacitação de profissionais da saúde, o receio de que o filho sofra algum tipo de exclusão na escola e a necessidade de promover o máximo de autonomia. Quanto às dificuldades, elas apontaram que o transporte público para locomoção dos seus filhos, as situações em que o filho não é bem aceito ou sofre preconceitos, as críticas recebidas em relação ao cuidado exercido e a falta de respeito por parte das pessoas nas ruas. Quanto às expectativas sobre o futuro, as mães salientaram a aspiração de poder trabalhar, voltar a estudar, investir no cuidado pessoal e dispor de momentos de lazer. O exercício da maternidade requer constante adaptação às necessidades de cuidado do filho com paralisia cerebral, é explícita a importância do apoio familiar e da orientação que as mães recebem dos profissionais da saúde

This study aimed at understanding the maternity experience for women who are mothers of a child diagnosed with cerebral palsy. Twenty-six mothers answered a semi-structured interview. The qualitative textual analysis of the interview resulted in the following categories: "the diagnosis moment"; "the perception of motherhood"; "worries, difficulties and aspirations" and "expectations for the future". The interviewed mothers attributed the cause of Cerebral Palsy to medical error or to the negligence of health professionals during the pre-labor and labor phases, to the precariousness of resources in thehospital, or to their own fault. Among the concerns, the fear of becoming sick and dying, the lack of qualified health professionals, the worry that their child will suffer some kind of exclusion at school, and the need to promote the maximum autonomy possible. As for the difficulties, they mentioned public transportation for their children's locomotion, the situations in which their child is not well accepted or suffers with prejudice, the criticisms towards the way that they care for their children and the lack of respect from some people on the streets. Concerning the future expectations, the mothers revealed that they would like to be able to work, to go back to school, to invest in their personal care, and to be able to have leisure time. The results indicate that motherhood requires constant adaptation to the needs of the child with cerebral palsy and highlight the importance of family support and the advising that mothers receive from health professionals.

Este estudio tuvo como objetivo comprender la experiencia de la maternidad en las mujeres que son madres de un niño diagnosticado con parálisis cerebral. Se recolectaron los datos por intermedio de la aplicación de entrevista semiestructurada y la evaluación de la función motora gruesa. Participaron 26 madres que respondieron a una entrevista semiestructurada. Un análisis textual de la entrevista cualitativa resultó en las categorías: "El momento del diagnóstico"; "La percepción de la maternidad"; "Las preocupaciones, problemas y deseos" y "las expectativas para el futuro". Ellos atribuyeron la causa de la parálisis cerebral a un error o negligencia médica de los profesionales de la salud durante el preparto y el trabajo de parto, la precariedad de los recursos hospitalarios o de poseer responsabilidad. Entre las preocupaciones son el miedo a la enfermedad y la muerte, la falta de formación de los profesionales de la salud, el temor de que el niño sufre algún tipo de exclusión de la escuela y la necesidad de promover la máxima independencia. En cuanto a las dificultades, señalaron que el transporte público para el transporte de sus hijos, las situaciones en las que el niño no es bien aceptado o perjudicado, críticas recibidas en relación con el cuidado ejercido y la falta de respeto por parte de la gente en las calles. Lo que les gustaría hacer y no pueden por falta de tiempo, las madres destacaron la aspiración atrabajar, volver a la escuela, invertir en el cuidado personal y tener tiempo de ocio. Los resultados indican que el ejercicio de la maternidad requiere una adaptación constante a las necesidades de cuidado infantil, y explican la importancia del apoyo familiar y orientación que las madres reciben de los profesionales de la salud.

How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience.

Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one's own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure.

O erro médico e o respeito às vítimas / Medical malpractice and the respect for victims

O erro médico advém de uma conduta profissional inadequada, capaz de produzir dano à vida ou agravo à saúde de outrem, por ação ou omissão. Essa situação tem se tornado cada vez mais comum no cenário brasileiro e o respeito e consideração às vítimas ficam ignorados. Dessa maneira, este estudo tem objetivo de identificar de que modo os profissionais envolvidos com o erro levam em consideração a pessoa da vítima enquanto ser humano. Foi utilizada entrevista semiestruturada realizada com cada uma das 12 pessoas que passaram pela situação do erro médico. Verificou-se que as vítimas se sentem desrespeitadas e sem direitos, quando acometidas pelo erro. Os médicos responsáveis se mostraram pouco disponíveis a ajudar e, menos ainda, a assumirem que erraram, reforçando uma relação desgastada. O estigma do erro médico no Brasil tem uma forte ligação com os juízos de valores impostos, dificultando sua aceitação para a vítima e profissionais.

Medical malpractice results from an inadequate professional conduct leading to damage to somebody´s life or health, due to some action or omission. Such a situation has become more and more common in the Brazilian scenario, and the respect and the concern for the victims are ignored. Thus, this study aims at identifying the ways the professionals involved in malpractice take the victim as a human being into consideration. An individual semi structured interview was performed with twelve individuals who had suffered malpractice. It was found out that the victims feel disrespected and deprived of rights, when they go through such a situation. Doctors didn't show willingness to help, nor they assumed the responsibility for their malpractice, which reinforces a impaired relationship. In Brazil the stigma of malpractice has a strong connection with imposed value judgments, which makes it more difficult to be accepted by both the victim and the professionals.

Brazilian registered nurses' perceptions and attitudes towards adverse events in nursing care: a phenomenological study.

AIM: To describe the perceptions and attitudes of registered nurses (RNs) towards adverse events (AEs) in nursing care. BACKGROUND: The professionals' subjective perspectives should be taken into account for the prevention of AEs in care settings. METHOD: Schütz's social phenomenology was developed. Interviews were conducted with nine Intensive Care Unit RNs. RESULTS: The following five descriptive categories emerged: (1) the occurrence of AEs is inherent to the human condition but provokes a feeling of insecurity, (2) the occurrence of AEs indicates the existence of failures in health care systematization, (3) the professionals' attitudes towards AEs should be permeated by ethical principles; (4) the priority regarding AEs should be the mitigation of harm to patients, and (5) decisions regarding the communication of AEs were determined by the severity of the error. CONCLUSIONS: The various subjective perspectives related to the occurrence of AEs requires a health care systematization with a focus on prevention. Ethical behaviour is essential for the patients' safety. IMPLICATIONS FOR NURSING MANAGEMENT: Activities aimed at the prevention of AEs should be integrated jointly with both the professionals and the health care institution. A culture of safety, not punishment, and improvement in the quality of care provided to patients should be priorities.

El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad / Hospital clinical safety from the patient's point of view: Validation of a safety perception questionnaire

Background: Approximately 10 percent of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. Aim: To determine the perception on clinical safety among patients discharged from a hospital. Material and methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency Results: The questionnaire was answered by 384 patients, yielding a response rate of 29 percent. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10 percent) reported a possible adverse event. In 19 cases (5.8 percent), it was due to medication errors and in 19 (6.1 percent), to surgical procedures. In seven cases (2.3 percent), both errors coincided (2.3 percent). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.

[Hospital clinical safety from the patient's point of view: validation of a safety perception questionnaire]. / El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad.

BACKGROUND: Approximately 10% of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. AIM: To determine the perception on clinical safety among patients discharged from a hospital. MATERIAL AND METHODS: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency. RESULTS: The questionnaire was answered by 384 patients, yielding a response rate of 29%. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10%) reported a possible adverse event. In 19 cases (5.8%), it was due to medication errors and in 19 (6.1%), to surgical procedures. In seven cases (2.3%), both errors coincided (2.3%). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). CONCLUSIONS: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.