Exploring the Experiences and Support of Nurses as Second Victims After Patient Safety Events in China: A Mixed-Method Approach

Figures & data

Table 1 SVEST Scores of Participants (n=406)

Number Items	Total Scale Score	Item Mean Score
SVEST	65.61±11.47	2.73±0.48
Psychological distress (4 items)	15.48±3.74	3.87±0.94
Physical distress (3 items)	9.43±3.29	3.14±1.10
Practice distress (5 items)	15.74±4.97	3.18±0.99
Management support (7 items)	14.05±5.54	2.00±0.79
Colleague support (3 items)	6.55±2.38	2.18±0.79
Nonwork-related support (2 items)	4.35±1.93	2.18±0.96

Table 2 SVEST Scores of Nurses in Different Backgrounds Were Compared (n=406)

Variable	SVEST Score	Psychological Distress	Physical Distress	Practice Distress	Management Support	Colleague Support	Nonwork-Related Support
Gender
Female	65.51±11.30	15.57±3.71	9.45±3.26	15.79±4.94	13.92±5.51	6.49±2.35	4.29±1,90
Male	67.33±14.38	13.81±4.09	9.10±3.92	14.86±5.60	16.52±5.62	7.57±2.69	5.48±2.09
t	0.708	−2.113	−0.48	−0.834	2.106	2.033	2.762
P	0.48	0.035**	0.632	0.404	0.036**	0.043**	0.006**
Age
20–30	65.68±11.41	14.95±3.68	9.40±3.26	16.50±4.56	13,90±5.01	6.72±2.18	4.20±1.84
31–40	66.23±11.57	15.71±3.84	9.48±3.34	15.45±5.06	14.44±5.94	6.65±2.45	4.50±2.01
41–50	64.77±12.01	16.15±3.80	9.38±3.32	14.52±5.73	14.23±6.35	6.08±2.71	4.40±1.96
≥51	60.79±8.34	17.42±1.74	9.43±3.39	13.50±4.77	11.07±3.58	4.86±2.11	4.50±1.95
F	1.075	7.224	0.018	3.671	1.676	3.517	0.73
P	0.359	<0.001**	0.996	0.012**	0.171	0.015**	0.535
Marital status
Unmarried	66.34±11.63	14.85±3.93	9.51±3.16	16.64±4.88	14.10±4.79	6.99±2.29	4(3–6)^#
Married	15.82±3.61	15.82±3.61	9.36±3.40	15.12±4.95	13.95±5.90	6.27±2.39	4(3–6)^#
Divorced	17.00±2.45	17±2.45	10.43±1.90	18.72±4.19	16.71±7.48	7.00±2.83	3(2–5)^#
F/Z	2.481	3.731	0.429	5.816	0.468	4.409	1.322
P	0.085	0.025**	0.652	0.003**	0.635	0.013**	0.516
Education level
College degree or below	64.18±11.51	14.59±3.95	8.61±3.41	14.11±4.44	14.71±6.35	7.30±2.95	4.86±1.96
College degree	65.89±11.45	15.55±3.75	9.61±3.26	15.97±4.97	14.00±5.49	6.48±2.30	4.29±1.92
Master degree or above	63.07±12.04	16.71±2.34	7.5±2.85	15.21±5.94	13.42±4.22	5.86±2.07	4.36±1.99
F	0.788	2.068	4.368	2.813	0.409	2.929	1.737
P	0.455	0.128	0.013**	0.061	0.664	0.055	0.177
Monthly income (CNY)
<5000	67.37±12.23	14.72±4.03	9.54±3.27	16.38±4.91	14.99±5.76	7.12±2.50	4.62±1.61
5000–7000	65.13±12.08	15.20±3.95	9.85±3.51	15.97±5.03	13.75±5.50	6.45±2.41	4,01±1.86
7001–9000	66.25±10.03	15.91±3.44	9.24±3.05	15.73±4.54	14.32±5.44	6.47±2.11	4.58±1.89
>9000	64.39±11.25	16.08±3.35	8.84±3.13	14.87±5.33	13.75±5.54	6.36±2.48	4.49±2.22
F	1.058	2.415	1.917	1.406	1.079	1.613	2.850
P	0.367	0.066	0.126	0.241	0.358	0.186	0.039**
Unit types
Medical	66.06±10.64	15,90±3.72	9.72±3.44	16.46±5.22	13.59±5.63	6.32±2.35	4.07±1.88
Surgical	66.32±11.10	15.99±3.10	9.40±3.09	15.81±5.00	14.05±5.02	6.67±2.13	4.40±1.86
Obstetrics and gynecology	63.47±11.97	14.78±4.01	9.50±2.95	15.50±5.36	13.33±6.60	6.3±2.78	4.07±2.03
Operating room	65.54±11.15	15.92±3.92	10.06±3.34	15.60±4.13	13.00±5.83	6.68±2.41	4.28±2.1
Pediatrics	70.38±10.30	16.12±3.12	10.44±3.54	17.81±4.22	16.25±5.96	5.75±2.11	4.00±1.83
Emergency room	64.45±10.87	15.3±2.18	8.65±3.23	13.00±4.39	15.90±4.62	6.4±1.93	5.20±2.09
ICU	70.20±6.99	17.3±3.74	9.20±3.084	14.4±4.50	16.10±1.52	6.9±2.69	6.30±1.83
Others	63.69±13.47	13.96±4.36	8.69±3.49	15.35±5.11	14.42±5.79	6.85±2.68	4.42±1.76
F	1.197	2.418	1.326	1.779	2.985	0.706	2.595
P	0.303	0.027**	0.237	0.090	0.007**	0.667	0.013**
Length of working (years)
<5	67.23±10.73	15.25±3.59	9.85±3.08	17.48±3.08	13.98±4.98	6.60±2.15	4.09±1.63
5–10	64.58±12.18	14.92±3.89	9.01±3.52	15.20±4.70	14.33±5.57	6.76±2.45	4.38±2.06
11–15	66.29±10.81	16.00±3.87	9.59±3.30	15.36±4.98	14.07±6.06	6.71±2.40	4.55±2.09
16–20	63.56±12.86	15.16±3.49	8.5±2.90	14.06±5.22	14.97±5.50	6.34±2.24	4.53±1.76
>20	64.34±11.44	16.66±3.45	9.72±3.37	14.59±5.76	13.04±5.93	5.85±2.72	4.49±2.06
F	1.335	2.604	1.779	6.044	0.742	1.533	0.926
P	0.256	0.036**	0.132	<0.001**	0.564	0.192	0.449
Positional titles
Nurse	66.69±10.20	15.35±3.23	10.01±3.10	17.39±4.26	13.49±4.91	6.58±2.41	3.88±1.47
Senior nurse	64.77±12.67	14.59±4.26	9.14±3.53	15.42±4.98	14.28±5.83	6.93±2.41	4.41±2.06
Supervisor nurse	66.31±11.10	16.02±3.36	9.40±3.12	15.58±4.96	14.42±5.50	6.43±2.23	4.46±1.96
Co-chief nurse	65.97±10.73	16.42±3.91	9.79±3.45	14.76±5.76	12.85±6.00	5.61±2.59	4.55±2.03
Chief nurse	56±9.85	17.67±1.53	6.33±3.22	10.00±3.61	11.00±1.73	3(3–6.5)	5.67±1.53
F	1.192	3.858	1.606	3.570	1.039	2.481	1.702
P	0.314	0.022**	0.172	0.007*	0.387	0.043**	0.149
Hours worked per week in the last 3 months(h)
≤40	65.01±11.74	15.48±3.76	9.22±3.36	15.81±4.82	13.75±5.47	6.45±2.26	4.30±1.86
41–50	65.73±11.30	15.46±3.66	9.60±3.12	15.48±5.12	14.27±5.48	6.54±2.48	4.38±2.03
51–60	69.12±9.93	16.24±3.24	10.44±2.52	16.64±4.95	14.24±5.29	6.92±2.27	4.64±1.87
>60	69.12±11.05	12.83±6.40	8.5 (3.75–11.7)	16.67±7.06	18.33±9.22	8.5±3.89	4.5±1.76
F	1.174	1.349	1.451	0.504	1.498	1.676	0.252
P	0.319	0.258	0.228	0.680	0.215	0.172	0.860

Note: **<0.05, ^#M (IQR).

Table 3 The Correlation of SVEST, SCSSQ, and GAD-7 in the Study (N =406)

Variable	SVEST	Psychological Distress	Physical Distress	Practice Distress	Management Support	Colleague Support	Nonwork-Related Support	SCSSQ	Fatigue	Pain	Sleep Issues	Gastrointestinal Discomfort	GAD-7
SVEST	1
Psychological distress	0.451**	1
Physical distress	0.640**	0.583**	1
Practice distress	0.647**	0.446**	0.559**	1
Management support	0.588**	−0.245**	0.006	−0.044	1
Colleague support	0.243**	−0.436**	−0.303**	−0.145**	0.534**	1
Nonwork-related support	0.322**	−0.164**	−0.116*	−0.245	0.541**	0.412**	1
SCSSQ	0.444**	0.326**	0.479**	0.404**	0.091	−0.091	−0.005	1
Fatigue	0.434**	0.365**	0.477**	0.434**	0.052	−0.139**	−0.039	0.919**	1
Pain	0.375**	0.282**	0.418**	0.339**	0.079	−0.097	−0.006	0.913**	0.785**	1
Sleep issues	0.406**	0.309**	0.441**	0.345**	0.092	−0.075	−0.001	0.902**	0.844**	0.724**	1
Gastrointestinal discomfort	0.388**	0.224**	0.396**	0.346**	0.105*	−0.019	0.026	0.874**	0.697**	0.777**	0.680**	1
GAD-7	0.490**	0.323**	0.497**	0.469**	0.106*	−0.055	−0.11	0.693**	0.658**	0.620**	0.610**	0.614**	1

Note: **P<0.01; *P<0.05.

Table 4 Interviewees’ General Information (N = 8)

Number	Sex	Age	Education Level	Positional Titles	Length of Working (Years)	Unit Types	Professional Positions	Patient Safety Events
1	Female	27	College degree	Senior nurse	5	Medical	Clinical nurse	Patient Accidents (Falls/Suicide) Behavior (Unsuccessful puncture)
2	Female	28	College degree	Senior nurse	3	Others	Clinical nurse	Blood (Procedure error)
3	Female	45	Master degree	Chief nurse	24	Surgery	Nursing management	Medication (Procedure error) Clinical Process (Procedure error)
4	Female	30	Master degree	Supervisor nurse	7	Emergency	Clinical nurse	Patient Accidents (Pipe shedding) Medication (Procedure error)
5	Female	44	College degree	Supervisor nurse	24	Surgery	Clinical nurse	Blood (Procedure noncompliant)
6	Female	42	College degree	Supervisor nurse	20	Surgery	Clinical nurse	Patient Accidents (Falls) Medication (Procedure error)
7	Female	38	Master degree	Co-chief nurse	12	ICU	Nursing management	Patient Accidents (Unplanned extubation)
8	Female	26	Master degree	Nurse	1	Pediatrics	Clinical nurse	Medication (Procedure error)

Table 5 Open Coding Results

Category	Sub-Category	Main Concept
1. Nurses’ perceptions and needs for patient safety events	1.1 Cognitive deficit	The understanding of security incidents is superficial
	1.2 Need support	Hoping surroundings can provide emotional support due to the events
2. Psychological, physical and practice distress of nurses after patient safety events	2.1 Psychological distress	2.1.1 Anxiety after the events
		2.1.2 Fear after the events
	2.2 Physical distress	Temporary loss of sleep quality after the events
	2.3 Practice distress	2.3.1 More cautious at work after the events
		2.3.2 Professional wonder after the events
		2.3.3 Worry about career after the events
3. Nurses, and hospitals coping style after patient safety events	3.1 Nurses coping style	3.1.1 Talk to surrounding people after the events
		3.1.2 Self-focused behavioral coping after the events
	3.2 Hospital coping style	Positive coping style regarding the events