BackgroundHealthcare workers who find themselves entangled in unforeseen adverse patient events, medical errors, and/or patient-related injuries, experiencing trauma and victimization as a consequence of said incidents, are referred to as "second victims".ObjectıveThis study aims to validate and assess the reliability of the Turkish version of the Second Victim Experience and Support Tool-Revised (SVEST-R).MethodsThe methodological and cross-sectional study involved 400 physicians and nurses in an Edirne tertiary hospital of Turkey. The Turkish SVEST-R and a questionnaire were administered, assessing validity through factor analysis and content validity, and reliability through item-total score correlation, internal consistency, and test-retest methods.ResultsKaiser-Meyer-Olkin test (0.84) and Bartlett Test (p < 0.001) indicated adequate sampling for factor analysis. Exploratory Factor Analysis identified nine factors explaining 71.58% of total variance. Confirmatory Factor Analysis showed good fit (x2 = 976.95, x2/df = 2.3, CFI = 0.92, GFI = 0.87, RMSEA = 0.05). Cronbach's alpha was 0.85, signifying high internal consistency. Healthcare professionals' average T-SVEST-R score was 2.8 ± 0.5. Among independent variables, professional experience length significantly influenced T-SVEST-R score.ConclusıonsThe Turkish version of the Second Victim Experience Support Tool-Revised (T-SVEST-R) has been validated as a reliable scale.

This study aimed to examine the relationships between second-victim experience, resilience, and nurses' turnover intention.

The second-victim experience significantly affects nurses' psychological well-being in healthcare settings, leading to serious consequences. These psychological impacts can compromise patient care, clinical judgment, and confidence, ultimately jeopardizing patient safety and the quality of care. Support from organizations and colleagues is vital to alleviate the negative effects of these experiences. Addressing these factors can help develop targeted interventions to prevent adverse outcomes from second-victim experiences.

This cross-sectional correlational descriptive study collected data from secondary- and tertiary-care hospitals across 13 regions of Saudi Arabia, with 117 nurses participating. The Second-Victim Experience and Support Tool, Turnover Intention Scale, and Connor-Davidson Resilience Scale 25 were utilized to assess secondary-victim experiences, resilience, and turnover intention.

Local nurses reported higher second-victim experiences (M = 2.83, SD ± .42, p = .004) and turnover intention (M = 2.83, SD ±  .42, p = .012) but lower resilience scores (M = 12.43, SD ± 4.6, p = .03) compared with expatriate nurses. A significant positive correlation existed between second-victim-related distress and turnover intention. Conversely, a significant negative correlation existed between most second-victim-related variables (physical and psychological distress), supervisor support, and resilience. The regression model was significant (F [1, 115] = 73.13, p < .001, R2 = .389), with second-victim experience (β = 1.822, p < .001) significantly predicting turnover intention.

This study highlights the physical and psychological distress experienced by nurses, their turnover intentions, and resilience in response to second-victim experiences.

Health organizations should implement programs that assist nurses with overcoming trauma post adverse events and enhancing resilience, which may reduce their turnover intention in the profession.

This study aims to explore the negative emotions experienced by nurses following medication errors.

Mixed-method systematic review.

A systematic search was conducted in PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar for studies published in English between January 2013 and October 2024. The Joanna Briggs Institute critical appraisal tool was used to assess article quality and data were analysed through qualitative content analysis.

From 1619 screened studies, 19 were selected: 14 qualitative, 3 quantitative and 2 mixed-method. The negative emotions experienced by nurses, as second victims of medication errors, can be categorised into 8 groups: Fear, anger, disturbance, sadness, shame, guilt, low self-esteem and depression. Additionally, the following 11 types of fear were identified: Fear of judgement, disrespect, losing one's job, getting scolded and contempt, retaliation and punishment, reaction, consequences, disciplinary actions and lawsuits, patient's well-being, reporting a medication error and losing patient's/their families' trust. Furthermore, two types of shame were identified: Internal and external shame.

The negative emotions that nurses experience as second victims can persist long after the error occurs. It underscores the need for structured psychological support systems to foster a culture of 'responsibility without blame'.

Addressing nurses' emotional challenges as second victims enhances their well-being and improves global healthcare safety and quality.

These findings highlight the need for healthcare leaders and policymakers to implement interventions that foster a supportive, non-punitive workplace with the aim of improving the emotional well-being of nurses following medication errors.

The study adhered to PRISMA guidelines.

None.

Prospero code: CRD42023439304.

This study aimed to understand the lived experience of UK NHS doctors who encountered second victim phenomenon following an adverse event and the role that medical leadership played in their trajectory.

Semi-structured interviews were conducted with eight NHS doctors. Data were analysed using Interpretative Phenomenological Analysis (IPA).

There emerged three superordinate themes describing the impact on the doctor, the perceptions of colleagues and the leadership support received.

Although the small sample size is consistent with the chosen research methodology, it remains an acknowledged limitation. This study did not specifically aim to explore suicidality among NHS doctors; however, given the importance of this issue, further research is clearly warranted. While some protected characteristics were represented in the sample, they were not sufficiently prominent to influence the findings meaningfully. Consequently, there is scope to examine potential psychosocial differences among doctors. The first author's extensive NHS career may potentially introduce bias. Finally, future research should incorporate a longitudinal research design to assess the long-term impact of second victim phenomenon on doctors and the effectiveness of support interventions.

The paper makes three recommendations: (1) NHS organisations should establish locally led peer support or buddy programmes. Additionally, the organisation should strive to reduce psychological morbidity through candid and open discussions about prevalence. (2) When exhibiting signs of distress, burnout or other maladaptive coping strategies are observable, medical leaders should take compassionate and deliberate action. (3) Medical leaders must demonstrate collective responsibility for fostering cultures that learn from and support doctors in their darkest hour following an adverse event.

This study broadens the extant knowledge base regarding second victim phenomenon among doctors, particularly doctors in the NHS. A doctor's well-being and, consequently, patient safety are jeopardised by exposure to persistent, invisible distress. In the field of medicine, incivility, abusive supervision and poor organisational and team cultures exacerbate distress.

Providing support to second victims in workplaces is crucial for maintaining high-quality performance. Peer support approach has proven to be one of the most effective and well-accepted approaches. However, the specific competencies required for peer supporters remain unclear. This review aims to address this gap by identifying and categorising these competencies.

This scoping review examines the competencies (skills, attitudes and knowledge) needed to support workers where the pressure of their roles may lead to errors that could cause harm to others. In such situations, these individuals may experience intense feelings of responsibility, potentially impacting their ability to perform their duties. In the healthcare sector, these workers are commonly referred to as 'second victims'.

This review includes studies that define the competencies necessary for peer supporters assisting second victims in any industry. It covers all professional roles susceptible to human errors affecting people's well-being. The focus is on peer support and psychological first aid, encompassing relevant competencies, attitudes and knowledge for addressing safety-related incidents and workplace errors.

The scoping review was conducted following Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were identified through a comprehensive search of databases, including Embase, ProQuest, PsycINFO, PubMed, Scopus and Web of Science. References from eligible studies were also considered.

Data were extracted and categorised into competency domains through a standardised process. Two reviewers independently performed data extraction, with discrepancies resolved by consensus.

A total of 34 studies were included in the review. Across five identified domains, 91 specific and 30 general competencies were categorised. Additionally, the review identified 29 types of peer-based interventions designed to support professionals following incidents or stressful situations.

The findings underscore the need for well-defined competencies for peer supporters of second victims, emphasising training in communication, emotional support and role-specific knowledge. Tailoring peer support programmes to the professional context and industry-specific characteristics is essential for providing effective assistance.

The study aimed to investigate the experience of pathologists facing medical errors.

A qualitative study conducted with 18 pathologists in the Hauts-de-France region. Data were collected through semi-structured interviews and analyzed using grounded theory method.

Pathologists experienced three main stages after a diagnostic error: initial shock, re-mobilization, and enrichment. Most symptoms dissipated in the short term. Professional adjustments to prevent new errors were common. The term "second victim," referring to healthcare professionals affected by an error, was unfamiliar to participants. Most did not identify as "second victims," questioning the relevance of the term and emphasizing their responsibility in the error. To minimize errors, participants underlined the importance of communication, collaboration, and better working conditions. They called for ongoing training and improvement in managing medical errors, as well as increased recognition of the psychological impacts of such errors on healthcare professionals.

The results align with existing literature on other healthcare professionals. Currently, the term "second victim" is being questioned by some physicians and patient associations.

The study sheds light on pathologists' experience with medical errors, emphasizing the importance of prevention, communication, and support for affected healthcare professionals. Further quantitative research is needed to confirm these findings.

Prescribing errors (PEs) in hospital care lead to patient harm, prolonged hospital stays, readmissions, and mortality. Despite interventions that successfully target 'high risk' populations in trials, PE rates remain largely unchanged in real-world settings. Existing studies often focus narrowly on specific populations, overlooking the wider complexities of hospital-wide prescribing. This scoping review evaluates interventions for adult inpatients to identify knowledge gaps in how to reduce in-hospital PEs.

A systematic search of PubMed, EMBASE.com, and the Cochrane Library (inception to 13 December 2024) was conducted following PRISMA-ScR guidelines. Studies prospectively evaluating interventions reducing in-hospital PEs were eligible for inclusion; those focusing on specific drugs, wards or populations or lacking original data were excluded.

Fourteen studies met the inclusion criteria. Technological interventions, such as computerized order entry systems, accounted for 35.7% of the studies. Half addressed prescriber-related factors, such as inadequate drug knowledge and prescribing skills, while organizational factors were underexplored.

Current interventions fail to address the underlying complexities, leaving critical gaps to decrease in-hospital PEs. To achieve sustainable PE reductions and improve patient safety, a multidisciplinary approach, standardized reporting, organizational reform, and a Safety-II perspective are essential.

Although complications primarily affect patients, they also seem to cause repetitive trauma for surgeons. The concept of the "second victim" was introduced by Dr. A. Wu in 2000. This study aims to analyze the psychological impact of serious complications on metabolic and bariatric surgeons.

The target population included all metabolic and bariatric surgeons who are members of the Société Française et Francophone de Chirurgie de l'Obésité et Maladies Métaboliques (SOFFCO.MM). A questionnaire was developed by two surgeons, and refined by a group of psychologists.

A total of 130 participants completed the questionnaire. Serious adverse effect affected surgical practice and professional confidence in 41.3% of cases, and had negative repercussions at family level in 39.7% of respondents. These complications led to feelings of guilt, anxiety and sleep disorders (53.7%, 53.7%, 44.6%). Excessive workload, a macho culture and a lack of communication within the team were the main obstacles to seeking help (60.3%, 47.1%, 40.5%). Women and young surgeons (30-40 years) were more affected by complications in their surgical practice and self-confidence (p = 0.03 and p = 0.019). Neither regular physical activity nor meditation showed any significant benefit in mitigating these effects.

This study highlights the significant psychological burden that serious complications impose on metabolic and bariatric surgeons. Due to a lack of institutional support, surgeons often manage emotional distress privately rather than professionally. Urgent action is needed to implement comprehensive support systems.

In a culture of safety and risk management that seeks to prevent serious adverse events in healthcare environments, we rarely consider what the caregivers involved in these events experience. Studies of nurses show that they experience a range of feelings and sometimes symptoms similar to those found in post-traumatic shock. This text looks back at the experience of nurses as moral suffering, focusing on the offence of a healthcare system and the betrayal of a promise at the heart of the caring relationship.

Patient safety is a fundamental aspect of any healthcare system. We explore the development of patient safety both generally and in relation to dentistry over the past ten years. Other aspects of healthcare and various concepts are explained and described, including human factors, Safety I and Safety II, patient safety culture, managing patient safety incidents and the second victim concept, perfectionism and punishment myths, and hierarchy, along with wellbeing and support for practitioners. We bring together ten years of experience in patient safety related to dentistry and discuss this in the context of wider developments in patient safety, with reference to reports and policies that have influenced this field. We also include helpful resources and suggestions to allow readers to discover more about patient safety in dentistry, and to examine the safety culture in their own organisations. We finish this paper by contemplating on what the next decade might bring.

The aim of the study was to explore the impact of patient safety culture on nurses' negative work outcomes resulting from patient safety incidents, as well as the mediating roles of second victim support and distress.

A cross-sectional survey was conducted. The participants included 208 nurses, each with over a year of clinical experience, working in hospitals across South Korea.

Data were collected through self-reported questionnaires on general characteristics, patient safety culture, second victim support and distress, and negative work outcomes. The collected data were analyzed using descriptive statistics, the t-test, ANOVA, the Scheffé test, and Pearson correlation coefficients. Additionally, model 6 of Hayes' PROCESS macro and the Sobel test were employed to determine the mediating effect.

Mediation analysis revealed significant indirect effects of patient safety culture on the work outcomes experienced by nurses following patient safety incidents, mediated by second victim distress, after controlling for participants' marital status, position, and the severity of patient safety incidents.

This study demonstrates that in healthcare settings, patient safety culture that supports the second victim and alleviates second victim distress mitigates the negative work outcomes resulting from patient safety incidents. The findings highlight the significance of culturally sensitive support systems, particularly considering the diverse impacts on Korean nurses. Based on this study, healthcare leaders are recommended to develop strategies to support nurses and reduce their second victim distress, which can ultimately improve patient safety and the quality of nursing care.

The findings of this study can be used to develop strategies to support second victims in addressing their distress. Taking steps to alleviate the distress of second victims will help prevent negative work outcomes in nurses.

This study investigates the prevalence and contributory factors of mental health issues, including anxiety, depression, and insomnia, among resident physicians. Additionally, it endeavors to understand the complex characteristics of these issues across different demographic groups.

Using an online cross-sectional design, the study engaged resident physicians in Inner Mongolia, China, through convenience sampling. Questionnaires collected data on sociodemographic background, training details, and symptoms of depression, anxiety, and insomnia, assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI). Conduct latent class analysis on psychological issues using Mplus software. Analyze the related influencing factors of different group characteristics using a multivariate logistic regression model.

The study comprised 2891 resident physicians, revealing that 20.3% experienced moderate to severe anxiety, 19.72% had moderate to severe depression, and 9.6% faced moderate to severe insomnia. Latent class analysis identified three distinct mental health groups: a high anxiety-depression-insomnia group, a low anxiety-depression-healthy sleep group, and a moderate anxiety-mild depression-variable insomnia group. Factors such as training stage, professional accomplishments, self-reported medical errors, self-esteem, perceived stress, and social support were significantly associated with mental health issues, as identified by multivariate logistic regression.

The mental health problems among residents are prominent. By analyzing mental health status and influencing factors, residents can be categorized into different groups, allowing for more targeted interventions. These interventions may include stress management, communication skills training, crisis intervention, and the development of support systems, along with improvements to the work environment and a focus on humanistic care.

Safety-II is a new approach to patient safety that is characterised by learning from work that goes well, including learning from success and work-as-done. Practical tools to facilitate this learning are starting to emerge within healthcare patient safety practices. In absence of a systematic review of such learning tools, the aim of the study was to provide an overview of strategies and tools for healthcare professionals to learn from work that goes well in healthcare patient safety practices.

Registered in advance in PROSPERO, this systematic review has followed the PRISMA 2020 checklist. We searched eight databases in February 2023: Medline, Cinahl, Embase, PsycInfo, Cochrane Central, Web of Science, Scopus, and Google Scholar. Articles describing the development, implementation or evaluation of tools were included if they were (1) quantitative, qualitative, mixed-methods or white papers/commentaries (non-empirical), (2) available in English or Scandinavian language, (3) published between 2000 and February 2023, (4) developed or implemented in healthcare practices, (5) detailed in description and (6) preferably peer-reviewed. Articles were excluded if they primarily dealt with students, Functional Resonance Analysis Method (FRAM), appreciative inquiry and positive deviance. Articles were screened against eligibility criteria using Rayyan software. The Mixed Methods Appraisal Tool was used to assess the quality of the articles. The framework for resilience research was used to present and synthesise the results.

Out of 5298 records screened, 126 articles were retrieved for evaluation, and 22 articles were included, describing 16 unique tools. Five tools were not empirically evaluated. Most learning tools were aimed at healthcare professionals in hospitals units (68%), and were generally welcomed by healthcare professionals. Tools intended for learning across the organisation were second most frequent (23%), followed by tools intended for learning between hospitals (9%). Most studies focused on validating the tools' ability to provide insights into work-as-done, and their effect on staff wellbeing. Few studies focused on patient outcomes.

The review shows a growing number of practical Safety-II tools, which may help understand and learn from the constant adaptations made by healthcare professionals every day to keep patients safe.

PROSPERO: number CRD42022335758.

The functioning of emergency departments (ED) is considered an indicator of the effectiveness and efficiency of the healthcare system. In Germany, there is increasing pressure to improve emergency care. EDs are relatively autonomous organizational units that interact with other levels within and outside the hospital organization. Based on a model of organization-related care research, the current state of emergency care is described and barriers to and facilitators of change are discussed.A narrative review was used that includes literature sources on organizational impacts on the functioning of EDs. Publications were considered that, in addition to the interface perspective, have a relevance to the current state as well as to the proposed changes from the legislature and other actors. These were assigned to the respective organizational levels and (potential) effects were described. The macro-meso-micro model of organization-related health services research serves as a heuristic.Insufficient consideration of interdependencies and interfaces between organizational actors and levels of emergency care facilitates friction and hinders care innovation. At the macro level of the healthcare system, structures, responsibilities and financing are regulated, which significantly impact functioning at the meso and micro levels. At the meso-level of the hospital, the role of the ED is influenced by the difficulty of controlling patient flows and the lack of Diagnoses Related Groups (DRGs) to cover the costs for outpatient emergency care. The micro-level of the ED has to prioritize treatment and is confronted with the challenges of "exit blocks" when there are indications for patient transfer. Previous reform efforts did not take this organizational complexity into account.Reform proposals must take into account the organizational complexity and interests that arises from interfaces, interactions and stakeholder interests. Organization-related health services research can examine the contextual conditions that affect emergency care in order to derive recommendations for health care innovations.

ObjectivesIn line with the widespread acknowledgement of the harms which can be caused to healthcare staff through their role in adverse events and unexpected patient outcomes, so is there now acceptance of the role of staff peer support programs to support these 'second victims' in a non-clinical way. Here, we share reproduceable steps that any service might take in creating their own staff peer support program.MethodsWe outline the establishment of a program in a NSW health-service encompassing several hospitals and services, from initiation of the program, customising it to our local needs, engaging the broader health service, launching the program, and the ongoing maintenance required.ResultsDedicated resourcing and strong executive support have been essential to launch and maintain the program. Reaching all staff in a large organisation and building trust in the program's confidentiality have been the main challenges.ConclusionsStaff peer support programs, whilst early in their evidence, offer a way to provide practical, non-clinical support to staff harmed through adverse events in healthcare. Here, we offer methodology and learnings for all services to consider when implementing a localised program.

Disclosure of adverse events has become the expectation in medicine and is widely regarded as the appropriate path when medical errors occur. Although data are limited on adverse events in pediatrics, that they occur frequently is uncontested. Types and rates of errors vary depending on the care setting and patient population. Patients with complex medical conditions or from historically marginalized groups or minoritized communities likely suffer disparate health and safety outcomes. Systemic factors, including nonpunitive safety cultures and supportive environments within institutions, are essential to promoting disclosure. State laws protecting apologies from use in legal proceedings can also help to encourage open communication. Some states have adopted laws to advance disclosure, and governmental agencies provide materials encouraging open communication and early resolution after adverse events occur. Many programs emphasize the importance of supporting health care workers involved in adverse events. Shame, fear of professional and legal repercussions, and lack of training remain barriers to disclosure. Education for health care clinicians, support in health care settings, additional research on programs and disparities, and governmental and regulatory initiatives can support disclosure of adverse events.

The infection caused by the COVID-19 virus, with its high capacity for spread and transmission, reached the level of an international pandemic, affecting many people and resulting in a large number of deaths.

To analyse the experiences of nursing professionals caring for patients with COVID-19 during the early stages of the pandemic and the skills or coping strategies that they employed.

A qualitative study was carried out with an interpretative phenological design. Semistructured interviews were conducted with 20 nursing professionals working in emergency and critical care units, which were adapted to care for patients with symptoms of the disease, in public hospitals in Madrid, Spain. The data were analysed following, the Interpretive Phenomenological Analysis (IPA) of Smith et al. FINDINGS: Five themes were identified: "emotional brain training (EBT) to cope with great emotional stress", "material and sequential difficulties"; "an experience similar to a war that can cause burnout"; "Second Victim Syndrome (SVS), the emotional impact of witnessing trauma"; and "Surviving COVID-19 with overloads of energy and positivity".

Nursing professionals who cared for patients with Covid-19 during the first wave of the pandemic lived an experience in which they experienced a brain training of feelings, including sadness, impotence, fear, anger, pain and much worry. They also experienced a great feeling of suffering and guilt as in Second Victim Syndrome, in a situation similar to a war, due to the number of deaths caused by the virus, with all this resulting in a great overload of work. It is essential that these situations do not affect the mental health of these professionals in the dimensions that they did, and it is necessary to regain enthusiasm and motivation to provide comprehensive care for patients with COVID-19. Nursing professionals are not alone and need to be taken care of to respond to the chaos that can cause a pandemic, without ignoring the risks that it entails. They require specific training, which is necessary to provide them with proper security, and it is necessary to develop health and welfare policies, which will not be possible without first understanding their experiences.

Nurses commonly experience negative experiences after experiencing a patient safety event, triggering a domino effect on the nurses themselves, subsequent patients, and healthcare organisations, thus requires urgent attention.

To explore the mediating role of psychological capital and coping styles between neurotic personality and negative experiences of nurses' second victims, and to provide theoretical guidance for nursing administrators to develop targeted strategies to mitigate negative experiences of nurses' second victims.

In June-July 2023, a general information questionnaire, a neurotic personality subscale, the Chinese version of the Second Victim Experience and Support Scale, the Nurses' Psychological Capital Questionnaire, and the Coping Styles Questionnaire were used to conduct an online survey of 213 nurses' second victims and structural equation modelling was constructed to clarify the relationship between these elements.

Psychological capital and coping styles partially mediated the relationship between neurotic personality and negative experiences in the nurses' second victims, with a total indirect effect value of 0.203 and a total effect value of 0.303, for a mediating effect of 33.00%.

Neurotic personality and immature coping styles negatively predict the degree of negative experience, while psychological capital and mature coping styles positively predict the degree of negative experience. Psychological capital and coping styles play a partial mediating role between neurotic personality and negative experience.

After a patient safety incident, nursing managers can mitigate the negative experiences of nurses' second victims in patient safety incidents by reducing their neurotic personality tendencies, enhancing their level of psychological capital, and guiding them to adopt mature coping styles.

No patient or public contribution.

Physician burnout has become a public-health crisis. The need is dire for robust organizational solutions, focusing on reduction of specific stressors. The physician-specific Occupational Stressor Index (OSI) based on cognitive ergonomics can help. Individual-participant data (IPD) from different studies addressing physician burnout are lacking.

To perform IPD analysis regarding job stressors and their relation to physician burnout and to utilize the IPD results to inform a systematic review of the stressors that show an association with physician burnout, focusing on intervention studies.

PRISMA guidelines are followed for the IPD analysis and systematic review of intervention studies on the implicated stressors, taking the COVID-19 pandemic into consideration. The IPD analysis is performed on studies using the physician-specific OSI vis-à-vis burnout assessed by the Copenhagen Burnout Inventory (CBI). Odds ratios (OR) ± 95% confidence-intervals (CI) are reported, adjusting for age, gender and caring for patients with suspected COVID-19 infection.

Three studies fulfilled the inclusion criteria, providing complete IPD data for 95 physicians. Thirty-two (33.7%) physicians had total OSI scores >88, for which intervention is urgently needed. Unit-change in the total stressor burden assessed via OSI yielded OR = 1.11 (95%CI: 1.03-1.18) (p = 0.003) for personal burnout, OR = 1.17 (95%CI: 1.08-1.26) (p = 0.0001) for work-related burnout and OR = 1.07 (95%CI: 1.01-1.15) (p = 0.03) for patient-related burnout. Caring for patients with suspected COVID-19 infection showed significant multivariable results (p = 0.04) only for personal burnout. Twenty distinct work stressors revealed multivariable associations with CBI. Systematic examination via PUBMED, CINAHL and OVID Medline yielded 33 publications mitigating those stressors among physicians. Adequate staffing was pivotal. Clerical staff off-loaded administrative burden. Information-technology staff helped diminish interruptions, enhancing workflow. Cross-coverage reduced time constraints, ensured separate periods for non-clinical tasks, and ≥1 work-free day/week. Several interventions impacted physician burnout, as did recognition of physicians' efforts/achievements. Other OSI-identified stressors were insufficiently examined in intervention studies: e.g. vacation; appropriately-timed, cross-covered restbreaks; and counter-measures for emotionally-disturbing aspects of MD's work, particularly during the pandemic.

Further participatory-action research is needed in well-controlled intervention trials to alleviate physician burnout.

Communication and Resolution Programs' (CRP) favorable impact on professional liability claims continues to draw attention, but because they are deliberately aligned to advance the health system's mission rather than amelioration of litigation exposure, CRPs stand a better chance of delivering durable healthcare improvements than traditional responses to patient harm. CRP adherents employ focused investigations overseen by their own patient safety leader in order to engage patients with a principled response following unintended clinical outcomes. Focused on safety and unencumbered by litigation delays, CRP investigations are more apt than traditional responses to lay bare patient safety risks including professionalism challenges. Leaders, however, must be prepared to embrace and address hard-to-hear truths about dysfunctional systems or disruptive humans that threaten outcomes of care or clinical staff wellbeing.

To examine the prevalence of second-victim distress among nurses and the association of second-victim distress, organizational support, and interprofessional collaboration with posttraumatic growth.

Medical errors are unavoidable in healthcare; however, when acknowledged and shared, they offer healthcare professionals an opportunity to learn and grow. Second-victim distress arises from learning from mistakes but can be stressful for nurses, prompting some to leave the profession. Furthermore, poor management may foster a culture of reluctance to admit errors. Therefore, addressing nurses' distress is crucial for posttraumatic growth and, ultimately, patient safety.

The participants were 435 nurses working in general or tertiary hospitals who completed an online survey. This cross-sectional study followed the guidelines of the STROBE checklist. The collected data were analyzed using multiple regression analysis to determine significant factors influencing posttraumatic growth.

Physical distress, interprofessional collaboration, colleague support, institutional support, nonwork-related support, professional self-efficacy, and the position of charge nurse significantly influenced posttraumatic growth. The regression model explained 32.2% of posttraumatic growth with isolation emerging as the most influential factor.

Encouraging cooperation among healthcare professionals, mitigating physical distress, and providing organizational support are necessary to galvanize posttraumatic growth. Interprofessional medical collaboration and prevention of nurse isolation may be crucial for converting second-victim distress into posttraumatic growth.

Careful consideration of factors influencing posttraumatic growth is necessary to develop interventions that can enable nurses to overcome second-victim distress and achieve higher-level growth. If nurses can successfully transform second-victim distress into posttraumatic growth, it will ultimately have a positive impact on patient safety and the quality of nursing care.

In the aftermath of an adverse event, the first priority is to provide care for the patient, known as the first victim . However, the experiences of healthcare professionals (HCPs) involved in these events, known as "second victims", have been largely overlooked. This review aims to consolidate existing knowledge on second victim syndrome (SVS), explore its unique implications for neuro-ophthalmologists, and suggest support strategies to increase awareness and meet the needs of affected colleagues.

A comprehensive review of the literature was conducted using PubMed, analyzing peer-reviewed articles and reports on SVS across medical specialties. The review focused on the prevalence, risk factors, outcomes, and strategies for addressing SVS at both the individual and system-wide levels.

SVS is alarmingly prevalent among HCPs, with estimates ranging from 10% to 43%, and nearly half of all HCPs are expected to experience SVS at least once in their careers. Although direct evidence is lacking, neuro-ophthalmologists may be particularly vulnerable due to the complexity of their patients, frequent diagnostic challenges, and the risk of poor outcomes. Effective coping strategies include peer support at the institutional level, with an urgent need for healthcare systems to transition toward a "Just Culture" that fosters openness and collective learning.

Neuro-ophthalmologists are likely among several specialty fields suffering in silence following medical errors. To reduce these errors and optimize patient care, we must focus on enhancing support for the physicians involved. Sustainable improvements in healthcare require both targeted clinician support and comprehensive system-level changes to foster resilience and improve quality of care. Key efforts should include formal peer support programs, targeted educational initiatives, and a deliberate shift toward a "Just Culture." These initiatives are essential for fostering clinician resilience, promoting effective recovery, and ultimately improving the broader healthcare system and quality of care.

Patient safety incidents in paediatric radiology have profound impacts not only on the patient and their family, but also on the well-being and professional practice of healthcare professionals. These incidents, which range from procedural and diagnostic incidents to serious adverse events leading to harm or even death of the patient, may evoke feelings of distress, guilt, and anxiety among paediatric radiologists (in-training), ultimately affecting their confidence and ability to deliver high-quality care. Recognizing the importance of addressing these challenges, healthcare organizations should implement strategies to support professionals in coping with and learning from these incidents. By fostering a culture of open communication, providing access to peer support, and offering structured debriefing and educational opportunities, healthcare institutions can help mitigate the psychological toll of patient safety incidents and promote resilience among their staff. This article examines the multifaceted impacts of patient safety incidents on paediatric radiologists (in-training) and their staff and outlines effective approaches for handling these incidents to support professional well-being and enhance patient safety.

Second victim experiences of nurses are a critical issue in healthcare. In addition to causing psychological and emotional distress to nurses, second victim experiences can adversely affect organizational performance and overall patient safety.

This study aimed to determine effects of perceived just culture of medical institutions on second victim experiences of nurses after patient safety incidents.

This was a cross-sectional correlational study. Data were collected from 183 clinical nurses in tertiary general hospitals between December 28, 2022 and January 14, 2023 using an online self-report questionnaire. The questionnaire included items from Just Culture Assessment Tool (JCAT) and Korea-Second Victim Experience and Support Tool (K-SVEST). A hypothetical model was established and tested. Data were analyzed using SPSS WIN 23.0 and AMOS 23.0 programs.

The hypothesized model was found to be statistically fit (normed χ2 /df = 2.53; root mean square error of approximation = 0.09; comparative fit index = 0.99; Tucker-Lewis index = 0.97; normed fit index = 0.99). Eight hypothesized pathways were tested, of which five direct effect pathways and three indirect effect pathways were statistically significant. Just culture had a significant effect on second victim distress (β = -0.29, p = 0.001) and demand for support (β = -0.65, p = 0.001). Second victim distress had a significant effect on demand for support (β = 0.14, p = 0.025) and negative work-related outcomes (β = 0.66, p = 0.001). Demand for support had a significant effect on negative work-related outcomes (β = 0.18, p = 0.010).

This study demonstrated that a just culture in medical institutions could ameliorate second victim experiences of nurses involved in patient safety incidents. Implementing systemic interventions is a key imperative to establish a just culture in medical institutions, mitigate second victim experiences, and improve organizational performance.

Not applicable.

Incontrovertible evidence surrounds the need to support healthcare professionals after patient safety incidents (PSIs). However, what characterises effective organisational support is less clearly understood and defined. This review aims to determine what support healthcare professionals want for coping with PSIs, what support interventions/approaches are currently available and which have evidence for effectiveness.

Systematic research review with narrative synthesis.

Medline, Scopus, PubMed and Web of Science databases (from 2010 to mid-2021; updated December 2022), reference lists of eligible articles and Connected Papers software.

Empirical studies (1) containing information about support frontline healthcare staff want before/after a PSI, OR addressing (2) support currently available, OR (3) the effectiveness of support to help prevent/alleviate consequences of a PSI. Study quality was appraised using the Quality Assessment for Diverse Studies tool.

Ninety-nine studies were identified. Staff most wanted: peer support (n=28), practical support and guidance (n=27) and professional mental health support (n=21). They mostly received: peer support (n=46), managerial support (n=23) and some form of debrief (n=15). Reports of poor PSI support were common. Eleven studies examined intervention effectiveness. Evidence was positive for the effectiveness of preventive/preparatory interventions (n=3), but mixed for peer support programmes designed to alleviate harmful consequences after PSIs (n=8). Study quality varied.

Beyond peer support, organisational support for PSIs appears to be misaligned with staff desires. Gaps exist in providing preparatory/preventive interventions and practical support and guidance. Reliable effectiveness data are lacking. Very few studies incorporated comparison groups or randomisation; most used self-report measures. Despite inconclusive evidence, formal peer support programmes dominate. This review illustrates a critical need to fund robust PSI-related intervention effectiveness studies to provide organisations with the evidence they need to make informed decisions when building PSI support programmes.

CRD42022325796.

This study aimed to examine factors influencing psychological well-being and support among healthcare professionals involved in adverse event investigations, complaints, medical errors, and patient injuries from January 2020 to March 2022. The second-victim experience and support tool (SVEST) was used to assess second-victim experiences and support resources. Non-probability purposive sampling was employed, and data were collected through a Monkey Survey sent via email to around 150 clinicians (physicians, nurses, and pharmacists). A total of 100 responses were received. The inclusion criteria required participants to have been involved in adverse event investigations, complaints, medical errors, or patient-related injuries. The SVEST, with 29 items measured on a 5-point Likert scale, evaluated their perceptions of second-victim experiences and support resources. Institutional support was positively perceived by 55.0% of participants, with 52.0% feeling a range of coping resources was available. However, 31.0% felt their well-being was not adequately prioritized. Nonwork-related support was crucial, with 57.0% relying on friends and family. Professional self-efficacy was impacted, with 46.0% feeling inadequate and 39.0% experiencing self-doubt. Turnover intentions were notable, as 39.0% expressed a desire to leave patient care, and 34.0% considered quitting due to stress. This study highlights the need for targeted support systems to address second-victim experiences among healthcare professionals involved in adverse events. Enhancing institutional support, professional self-efficacy, and access to coping resources is crucial. Policymakers and healthcare leaders can help mitigate stress, decrease turnover intentions, and promote psychological resilience by fostering a supportive work environment and providing comprehensive resources, healthcare organizations can improve clinician well-being, reduce stress, and enhance patient care quality.

Background/Objectives: Despite the importance of the second victim phenomenon for healthcare systems, there is limited research on Italian healthcare providers. We assessed emotional distress in individuals impacted by an adverse event using the Withstand-PSY Questionnaire (WS-PSY-Q). Additionally, we aimed to identify potential risk factors for anxiety and depression. Methods: A cross-sectional online survey of 284 participants. Measures included the WS-PSY-Q, Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI-Y). Descriptive analyses and seemingly unrelated regression, jointly estimating anxiety and depression, were conducted using Stata (version 18). Results: Fifty-nine percent of the participants tested positive for anxiety (WS-PSY-Q anxiety subscale ≥ 16), thirty-seven percent for depression (WS-PSY-Q depression subscale ≥ 22), and thirty-five percent for both. In the final model, anxiety symptoms following the adverse event were associated with pre-event anxiety levels (p < 0.01), seeking psychological help (p < 0.05), self-perceived responsibility (p < 0.01), severity of the adverse event for the patient (p < 0.05), and punitive workplace climate (p < 0.05). Correlates of post-event depressive symptoms included pre-existing depression (p < 0.01), self-perceived responsibility (p < 0.01), severity of the impact of the adverse event (p < 0.01), punitive or neutral workplace climate (p < 0.05), and seeking psychological help (p < 0.01). Conclusions: This study adds to the growing understanding of the mental health difficulties that healthcare workers in Italy encounter after adverse events, addressing both individual and systemic risk factors. Proactive implementation of mental health measures for healthcare workers could foster their well-being after adverse events and promote a stronger, more just organizational culture.

There is a noticeable lack of information on iatrogenic error (IE)-related deaths in the United States. To address this, we conducted a retrospective analysis examining temporal, regional, urbanization, and age-related trends in IE-related mortality from 1999 to 2020.

Utilizing the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database, we identified crude and age-adjusted mortality rates (AAMR) per 100,000 persons. We calculated annual percentage changes (APCs) via the Joinpoint regression program.

From 1999 to 2020, a total of 531,792 IE-related deaths were reported, with an overall decline in mortality rates. From 2015 to 2020, an increase in AAMR by an APC of 17.19% was noted. Similar trends were seen in the 65-85+ age group from 2015 to 2020 (18.39%). The largest percentage increase in death rates occurred in Noncore metropolitan areas. Significant disparities were observed among states, with mortality rates ranging from 4.45 of 100,000 in Massachusetts and 10.43 of 100,000 in Mississippi. Other states with high AAMR values include New Mexico and Wyoming. In addition, the West census region demonstrated the greatest increase in APC in mortality rates (APC: 25.36%) from 2015 to 2020 followed by the South, Midwest, and lastly Northeast regions.

The data indicate a notable fluctuation in mortality rates over the years, underscoring the importance of targeted interventions to address the regional and age-specific disparities. Investigating the causes of mortality variations offers crucial opportunities to reduce IEs.

Healthcare adverse events (AEs) significantly impact professionals, often leading to emotional distress and lasting effects. This study investigates the impact of AEs on healthcare professionals in Romania, focusing on nurses to examine their experiences within the patient safety culture and the psychological consequences of AEs. With a limited body of research on patient safety, adverse events, and second victims (SVs) in Romania, this study addresses a crucial gap, highlighting the need for enhanced safety culture and support mechanisms for SVs.

A cross-sectional study in Romania targeted healthcare professionals, focusing on nurses. Utilizing online and onsite surveys facilitated by the Order of Nurses, Midwives, and Medical Assistants in Romania, data were collected between April and June 2022, exploring AEs and related experiences. Statistical analysis included chi-square tests, Student's t-tests, one-way ANOVA, and logistic regression, using SPSS version 29.0.

This study surveyed 995 nurses in Romania, primarily aged 31-50 (67.8%). Over half (57.9%) reported near-miss incidents, and 30.8% were aware of serious adverse events. Nurses over 50 scored higher on safety culture (20.98 vs. 20.45, p = .024) than younger nurses. Higher safety culture scores were associated with reduced negative emotional responses (e.g., guilt, anxiety, insomnia, tiredness) following AEs. Higher safety culture scores were associated with reduced negative emotional responses. Additionally, 88.9% of nurses showed interest in training for coping with adverse events, highlighting the need for supportive interventions in healthcare settings.

This study underscores the significant emotional and professional impact of AEs on nurses in Romania, highlighting ongoing challenges in healthcare environments. The positive perception of safety culture among nurses suggests a basis for improvement, while training needs underscore areas for intervention. Tackling the second victim phenomenon is crucial for maintaining patient safety.

Errors not only affect patients as the primary victim but also have a negative impact on nurses as the secondary victim; therefore, understanding the reasons for the second victim's error, as well as the elements that contribute to this phenomenon, is critical for managing the mistake. The main purpose of this research was to determine the status of second victims of error and related factors in nurses.

This is an analytical-descriptive study conducted in Iran. The study's statistical population comprised all nurses working in the five teaching hospitals of Ardabil city. A random sampling method was used. The data collection tool included a demographic characteristics questionnaire, a questionnaire on previous nursing error experience characteristics, and the Second Victim Experience and Support Tool. The collected data was analyzed in SPSS-16 software.

The results obtained from this research showed that the average score of second victims of error among nurses participating in the study was 85.89 (10/17). Based on the results obtained, there was a significant relationship between the number of second victims of error phenomena with age (p < 0.01 and r = -0.179) and work experience (p < 0.01 and r = -0.156), the number of cases of errors in 12 previous months, having an error that resulted in injury in the last 12 months, the history of going to court, the way nursing errors were reported, and the way managers dealt with nurses' errors (p < 0.05).

The nurses under study had an average level of the phenomenon of second victims of error, and a set of individual and organizational factors were influential in the development of this phenomenon. The second victim of error phenomenon was more prevalent among novice nurses, who tended to make more mistakes in a reprimanding work environment. Therefore, it is recommended that hospitals use a justice-oriented policy instead of a reprimand policy against nursing errors.

The objective of this study is to evaluate whether the nationwide establishment and institutionalization of a peer-support program, is economically justified given the potential positive effects on the Second Victim Phenomenon (SVP) among healthcare professionals in Germany.

A comprehensive methodological approach was employed, using data from the SeViD studies to assess the prevalence and duration of SVP among physicians and nurses in Germany. Economic impact assessments were conducted to estimate the potential cost savings associated with implementing a peer-support program.

The economic analysis reveals significant annual costs associated with SVP-induced absenteeism: approximately 1.56 billion euros for physicians and 1.87 billion euros for nurses. Implementing comprehensive peer-support programs could reduce these costs to approximately 0.85 billion (physicians) and 1.02 billion euros (nurses), respectively, demonstrating substantial potential economic benefits.

Investing in a structured peer-support program could yield annual savings exceeding 1.55 billion euros while enhancing workforce resilience and improving patient care. This underscores the economic rationale for scaling up peer support initiatives in healthcare settings.

In their care of terminally ill patients, palliative care physicians and oncologists are increasingly predisposed to physical and emotional exhaustion, or compassion fatigue (CF). Challenges faced by physicians include complex care needs; changing practice demands, and sociocultural contextual factors. Efforts to better understand CF have, however, been limited. We propose a systematic scoping review (SSR) to determine "What is known about theories of CF in physicians?".

Guided by the PRISMA-based Systematic Evidence-based Approach (SEBA) methodology, our SSR comprised searches for articles published between 1 January 2000 and 31 December 2023 on MEDLINE, EMBASE, PsycINFO, Wiley, CINAHL and Google Scholar databases. Both thematic and content analyses were carried out.

Of the 10 505 titles identified, 80 articles were included. 15 current theories of CF were evaluated, leading to two key domains: theories of CF and theories related to the costs of caring. Overall, theories of CF evolved from Figley's model with gradual encompassing of moral distress, vicarious trauma and burnout, alongside the inclusion of individual characteristics, decisioning and nous in later theories.

CF was found to be part of a wider cost of caring that links clinical experiences with self-concepts of personhood and identity. The Ring Theory of Personhood has been able to shed light on how physicians will respond to such experiences and is key to guiding physician support and the creation of nurturing working environments.

The second victim (SV) experience limits the performance of health and care workers and places patients at risk. Peer support is recognised as the most effective, feasible and acceptable intervention to mitigate its impact.

To define a set of success factors when designing interventions to support SVs in health and care facilities based on expertise in different European countries.

International collaboration involving countries with diverse cultures, structures and legal frameworks.

Qualitative research.

Focus groups involving a total of 43 participants were conducted in five countries. Prominent professionals in European peer support interventions were engaged. Analysis of common elements considered key to the success of these programmes was underscored.

Critical success factors for designing effective SV support interventions included the need for an occupational health approach, the establishment of a strong organisational safety culture, immediate psychological first aid, long-term resilience building, the engagement and training of peer supporters, the provision of adequate resources and ongoing support, the importance of leadership commitment and the necessity of tailoring interventions to the specific context and needs of each institution and country considering their diverse sociocultural and legal framework. The expected benefits included ensuring optimal patient care and reducing associated costs such as staff turnover and litigation.

Effective SV support interventions are essential for enhancing the resilience and performance of health and care workers, ultimately improving patient safety. By implementing tailored and well-resourced interventions, healthcare institutions can mitigate the negative impact of the SV phenomenon, promoting optimal care.

Patient safety is a priority for all healthcare systems. Despite this, too many patients still suffer harm as a consequence of healthcare. Furthermore, it has a significant impact on family members, professionals and healthcare institutions, resulting in considerable economic costs. The critically ill patient is particularly vulnerable to adverse events. Numerous safe practices have been implemented, acknowledging the influence of human factors on safety and the significance of the well-being of professionals, as well as the impact of critical episodes at hospital discharge on patients and their families. Training and engagement of professionals, patients and families are of paramount importance. Recently, artificial intelligence has demonstrated its ability to enhance clinical safety. This update on "Patient Safety" reviews all these aspects related to one of the most pivotal dimensions of healthcare quality.

Complications and poor outcomes are an inevitable part of sports medicine surgery. When building a practice, dealing with complications can be overwhelming and difficult to overcome. Establishing strong and transparent surgeon-patient relationships built on open communication and realistic expectations is fundamental to preemptive management of poor outcomes. When a complication occurs, careful action and appropriate treatment are imperative to ensure the best possible outcome. Patients who trust their surgeons are less likely to pursue medicolegal action. A complication can lead to self-doubt, anxiety, and depression. Surgeons should seek counsel from colleagues when dealing with complications and learn from their mistakes.

Anaesthetic training has always had patient safety as part of the curriculum. However, there is limited emphasis on what happens when things do not go to plan. Our aims were to understand the impact of involvement in patient safety incidents on anaesthetic trainees in our region, to describe the range of support currently offered and put forward suggestions for improvement.

An initial electronic survey was sent to all anaesthetic trainees in a single UK healthcare region to capture qualitative and quantitative information on patient safety incidents. After completing the questionnaire, participants were asked to consent to involvement in a semi-structured interview to provide a more detailed understanding of the impact of safety incidents. Data were analysed from the questionnaires and interview transcripts using descriptive statistics and thematic analysis.

Thirty-four completed questionnaires were analysed revealing 27 trainees had been involved in a patient safety incident. Ten semi-structured interviews were conducted and six themes were identified: team dynamics (including adequacy of staffing and supportive departmental culture); context of the event; reflex immediate support post-event; working environment pending completion of the investigation; personal impact (including physical and mental health); and suggestions for future support.

This study has shown the significant impact of safety incidents on anaesthetic trainees in one training region in the UK and highlights the importance of implementing early, tailored debriefs led by trained facilitators, the value of a supportive work environment and the need to raise awareness of system-based approaches to learning from incident investigations. Further research should guide the format and delivery of support for trainees to provide more helpful and timely interventions after patient safety incidents and reduce the risk of future harm to both patients and trainees.

Background: Caring for patients with substance use disorders (SUD) is held in low regard and many clinicians resist treating them. To address this situation, numerous research projects assessed training program gaps and professional attitudes. In contrast, this study explored the actual clinical difficulties that a variety of hospital-based professionals encounter when treating patients with SUD. Methods: Qualitative multiple method design including: (1) individual semi-structured interviews with SUD experts and educators; (2) video-elicited, cross self-confrontation interviews with clinicians working in a specialist addiction unit; (3) paired semi-structured interviews with clinicians working in non-specialist units. Participants were recruited within one university hospital. Data collected at stages (1) and (3) relied on an interview guide and were analyzed using conventional content analyses. Data collected at stage (2) consisted of discussions of video recorded clinical interviews and were analyzed based on a participatory approach. Results: Twenty-three clinicians from seven hospital units participated. Forty-four difficulties were reported that we classified into six categories: knowledge-based; moral; technical; relational; identity-related; institutional. We identified seven cross-category themes as key features of SUD clinical complexity: exacerbation of patient characteristics; multiplication of medical issues; hybridity and specificity of medical discipline; experiences of stalemate, adversity, and role reversal. Conclusions: Our study, providing a comprehensive analysis of the difficulties of caring for patients with SUD, reveals a highly challenging clinical practice for a diversity of healthcare providers. They represent a complementary approach to addressing resistance as an important feature of a complex clinical system, and valuable material to discussing professional preparedness.

Obstetrics and gynecology surgery is becoming increasingly complex because of an aging population with increasing rates of medical comorbidities and obesity. Complications are therefore common, and not only impact the patient but can also cause distress to the obstetrics and gynecology surgeon as a "second victim."

This study aimed to describe and quantify the range of effects of complications on obstetrics and gynecology surgeons, and assess sociodemographic, clinician, and practice factors associated with such impact.

A cross-sectional survey was developed on the basis of interviews with obstetrics and gynecology surgeons and a review of the literature. The survey assessed obstetrics and gynecology surgeons' demographic, clinical, and practice characteristics; estimated the number of complications per year and the impact of complications on distress, physical and mental health, sleep, and relationships; and explored strategies that obstetrics and gynecology surgeons used to cope with complications. Univariate logistic regression analyses were used to determine the association between obstetrics and gynecology surgeons' characteristics and complication consequences.

Overall, of 727 survey respondents, 431 (61%) were female, 384 (55%) were aged ≥50 years, almost half had worked as obstetrics and gynecology surgeons for ≥15 years (329 [45%]), and 527 (73%) reported completing <10 surgical procedures per week. Most (568 [78%]) reported <3 surgical complications per year, and most (472 [66%]) thought this was similar or less frequent compared with their colleagues. Complications caused most stress when they resulted in poor patient outcomes (653 [90%]), had severe patient consequences (630 [87%]), or were a result of surgeon error (627 [86%]). Complications impacted most obstetrics and gynecology surgeons' well-being and sleep. A greater proportion of those aged <50 years reported that their mental well-being (32 [10%]; P=.002) and sleep (130 [42%]; P=.03) were affected when a complication occurred. Female participants were also more likely to report that their physical health (14 [3%]; P≤.001), mental health (39 [9%]; P=.01), and sleep (183 [43%]; P≤.001) were affected. Current trainees (11 [10%]) and surgeons with <15 years of experience (25 [9%]) were more likely to experience mental well-being consequences compared with surgeons with ≥15 years of experience (12 [4%]; P=.01). Female participants reported less willingness to interact with colleagues when complications occurred (323 [75%]; P=.006), and surgeons with <15 years of training were less likely to report comfort in talking (221 [74%]; P=.03) and interacting with others (212 [74%]; P=.02).

The vast majority of obstetrics and gynecology surgeons experience a major impact on their health and well-being when one of their patients develops a complication. The degree and type of impact reported are similar to those observed in other surgical specialties. Future studies are needed to test interventions that alleviate the substantial impact and to follow obstetrics and gynecology surgeons longitudinally to understand the duration of the impact of complications.

Adverse events impact patients as primary victims including their families, while healthcare providers are impacted as second victims. These incidents have serious psychological and physical impacts on healthcare providers' quality of life and their ability to execute their jobs. As no studies have been conducted in the Middle East to explore the experiences of second victims among nurses, this study examined the relationship between nurses' second victim experiences, turnover and absenteeism.

Descriptive, correlational, cross-sectional study.

A convenience sample of 117 nurses was recruited from secondary- and tertiary-level hospitals across 13 regions in Saudi Arabia. The Second Victim Experience and Support Tool was used to assess second victim experiences and their impact on turnover and absenteeism.

Second victim trauma affected over half of the participants. 'The mental weight of my experience is exhausting' and 'My colleagues can be indifferent to the impact these situations have had on me' obtained the highest mean scores. Healthcare providers who stated that these situations had improved their quality of care were found to have the lowest scores. Second victim experiences had significant relationships with turnover and absenteeism. Further, healthcare providers' length of experience did not affect absenteeism, while second victim experiences significantly predicted absenteeism. Additionally, a strong relationship was observed between turnover and absenteeism. Overall, those with a second victim experience had a greater turnover intention.

The results underscore the physical and psychological distress that healthcare providers endure, increasing the likelihood of them leaving the profession. These problems are worsened by inadequate institutional support, emphasising the need for efforts to stabilise second victims and avoid unfavourable organisational outcomes.

The study adheres to the STROBE reporting guidelines.

No patient or public contribution.

Second victim syndrome (SVS) refers to the psychological trauma experienced by healthcare workers (HCWs) as a result of being involved in an adverse event (AE). Research on the prevalence of SVS and the support needed for HCWs who experience it is limited. A cross-sectional study was conducted at the Health Local Unit of Lecce, in Puglia, to identify the phenomenon of SVS among HCWs and recognize the forms of support received and desired. A validated questionnaire, IT-SVEST, was administered to doctors and nurses. The survey received responses from 250 HCWs, and 41% of respondents reported being involved in an AE that could cause SVS. Among the seven dimensions measuring the effects of the SVS and two outcome variables, the highest percentage of agreement was found for psychological distress (23.5%), followed by turnover intentions (19.8%) and physical distress (9.9%); 23.8% of the interviewees declared that they did not receive institutional support, and 9.9% identified help resources mostly in non-work-related support (9.9%), followed by supervisor support (9.3%). The multivariable binary logistic regression analysis showed a positive association between the occurrence of an AE and the medical doctor profession (OR = 4.267, p ≤ 0.0001), and affiliation to intensive care departments (OR = 5.133, p ≤ 0.0001) and male gender (OR = 2.069, p = 0.033). SVS is a serious problem that affects the entire health system, systematic surveys and appropriate institutional responses including formal support programs for affected HCWs are a priority.

Adverse medical events not only harm patients and families, but also have a significant negative impact on healthcare providers, with the potential to compromise future professional functioning. These "second victims" may need organizational support and rehabilitation to return to functionality.

We analyzed the validity of an adapted tool, the Second Victim Experience and Support Tool (SVEST), on a population in Israel, H-SVEST.

The H-SVEST was completed by 172 nurse participants working in a variety of patient care settings. All of the participants reported experiencing SVP. The H-SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis (CFA).

The CFA, when run on the initial model with 9 factors and 29 items, did not meet criteria for suitability of fit. After removing three items based on their low-factor loadings and the correlation, the model fit significantly improved with acceptable CFI, TLI, RMSEA, and SRMR. The final version included 26 items and 9 factors with Cronbach α values ranging from 0.66 to 0.94.

The H-SVEST demonstrates robust psychometric properties and valuable insights into the second victim experience in the Israeli context. Comparative analysis with other versions highlights potential cultural influences and areas for further investigation. Implementing this tool and developing evidence-based interventions based on its results can significantly improve the well-being and resilience of healthcare providers in Israel and other countries with diverse cultural populations.

In previous studies, surgical specialties accounted for most malpractice claims. The objective of the present study was to determine the risk for malpractice claims for physicians working in hospitals. A retrospective observational study using anonymized closed malpractice claims between 2007 up to 2021 from two Dutch insurers was carried out. Main outcomes involved claim volume & outcome, and the estimated annual risk (EAR) for a claim per year for the individual physician from all specialties. Sustained or settled claims were considered unfavorable for the physician (UOP). Surgical specialists, involving surgical specialties and specialties with surgical characteristics accounted for 77% (14,330/18,649) of the claims closed. Liability was denied in 51% of the claims (n = 9,487). The remaining claims were sustained (granted) (n = 4,600; 25%), settled (n = 3,444; 18%) or closed without decision (n = 1118; 6%). Surgeons faced an average EAR of 21.6% (range 6.5 - 28%) which was higher compared to colleagues from specialties with surgical characteristics (EAR 7.3%; range 2.9 - 10.1%) and non-surgical specialties (EAR 2.5%; range 0.9 - 4.4%). Surgical specialists received more claims than their non-surgical colleagues. Relative to specialty size, surgeons faced a higher risk for a claim in general, as well as for a claim with an unfavorable outcome.

Support that mitigates the detrimental impact of adverse events on human healthcare practitioners is underpinned by an understanding of their experiences. This study used a mixed methods approach to understand veterinary practitioners' responses to adverse events. 12 focus groups and 20 interviews with veterinary practitioners were conducted and analysed using grounded theory principles. Experiencing stress, externalising facts and feelings, morally contextualising events and catalysing personal and professional improvements were identified as components of practitioners' response. Natural language processing content analysis of posts regarding involvement in adverse events (n = 572) written by members of a veterinary member-only Facebook group was also performed, to categorise and count words within texts based on underlying meaning. Percentile scores of four summary variables along with relative frequency of function, psychological process and time orientation words used were recorded and compared with content analysis of posts where members discussed euthanasia (n = 471) and animal health certification (n = 419). Lower authenticity scores (reflecting lower honesty), differences in clout scores (reflecting dominance) and higher frequencies of moralisation, future focus, prosocial behaviour and interpersonal conflict were observed in the adverse event group compared to either comparison group. Analytical thinking scores (reflecting logical thinking) and frequencies of total, positive and negative emotion, anxiety, anger and cognitive processing words (reflecting debate) were not significantly different between the adverse events and euthanasia groups. Integration of findings confirmed and expanded inferences made in both studies regarding the emotionally detrimental impact of adverse events and the role that peer-to-peer mediated reflection and learning plays in mitigating pathologisation of responses in the aftermath of adverse events. Discordance in findings related to practitioners' intentions and expressions of honesty suggest that work is needed to normalise open discussion about adverse events. Findings may be used to lever, and to inform, peer-to-peer support for practitioners in relation to veterinary adverse events.