参与患者安全事件后的心理影响与恢复：一项重复测量分析
Psychological impact and recovery after involvement in a patient safety incident: a repeated measures analysis.
作者信息
Van Gerven Eva, Bruyneel Luk, Panella Massimiliano, Euwema Martin, Sermeus Walter, Vanhaecht Kris
机构信息
KU Leuven-University of Leuven Institute for Healthcare Policy, Leuven, Belgium.
Faculty of Medicine, University of Eastern Piedmont Amedeo Avogadro, Vercelli, Italy.
出版信息
BMJ Open. 2016 Aug 31;6(8):e011403. doi: 10.1136/bmjopen-2016-011403.
OBJECTIVE
To examine individual, situational and organisational aspects that influence psychological impact and recovery of a patient safety incident on physicians, nurses and midwives.
DESIGN
Cross-sectional, retrospective surveys of physicians, midwives and nurses.
SETTING
33 Belgian hospitals.
PARTICIPANTS
913 clinicians (186 physicians, 682 nurses, 45 midwives) involved in a patient safety incident.
MAIN OUTCOME MEASURES
The Impact of Event Scale was used to retrospectively measure psychological impact of the safety incident at the time of the event and compare it with psychological impact at the time of the survey.
RESULTS
Individual, situational as well as organisational aspects influenced psychological impact and recovery of a patient safety incident. Psychological impact is higher when the degree of harm for the patient is more severe, when healthcare professionals feel responsible for the incident and among female healthcare professionals. Impact of degree of harm differed across clinicians. Psychological impact is lower among more optimistic professionals. Overall, impact decreased significantly over time. This effect was more pronounced for women and for those who feel responsible for the incident. The longer ago the incident took place, the stronger impact had decreased. Also, higher psychological impact is related with the use of a more active coping and planning coping strategy, and is unrelated to support seeking coping strategies. Rendered support and a support culture reduce psychological impact, whereas a blame culture increases psychological impact. No associations were found with job experience and resilience of the health professional, the presence of a second victim support team or guideline and working in a learning culture.
CONCLUSIONS
Healthcare organisations should anticipate on providing their staff appropriate and timely support structures that are tailored to the healthcare professional involved in the incident and to the specific situation of the incident.
目的
探讨影响医生、护士和助产士因患者安全事件产生心理影响及恢复的个人、情境和组织方面的因素。
设计
对医生、助产士和护士进行横断面回顾性调查。
地点
33家比利时医院。
参与者
913名参与过患者安全事件的临床医生（186名医生、682名护士、45名助产士）。
主要观察指标
采用事件影响量表回顾性测量安全事件发生时的心理影响，并与调查时的心理影响进行比较。
结果
个人、情境以及组织方面的因素均会影响患者安全事件的心理影响及恢复情况。当对患者的伤害程度更严重、医护人员认为自己对该事件负有责任以及女性医护人员中，心理影响更大。不同临床医生中，伤害程度的影响存在差异。更乐观的专业人员心理影响较低。总体而言，随着时间推移，影响显著降低。这种效应在女性以及认为自己对事件负有责任的人中更为明显。事件发生的时间越久，影响降低得越显著。此外，更高的心理影响与采用更积极的应对和计划应对策略有关，与寻求支持的应对策略无关。给予的支持和支持文化会降低心理影响，而责备文化则会增加心理影响。未发现与卫生专业人员的工作经验和恢复力、是否存在第二受害者支持团队或指南以及是否在学习型文化中工作有关。
结论
医疗保健机构应预期为其员工提供适当且及时的支持结构，这些结构应根据参与事件的医护人员以及事件的具体情况进行量身定制。
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