公正文化如何通过临床护士的二次受害者痛苦和支持需求来减少负面工作结果？一项路径分析。

How does just culture reduce negative work outcomes through second victim distress and demand for support in clinical nurses? A path analysis.

作者信息

Jeong Seohee, Kim Sunmi, Chang Hyoung Eun, Jeong Seok Hee

机构信息

QI Team, Jeonbuk National University Hospital, Jeonju, Republic of Korea.

College of Nursing, Woosuk University, 443, Samnye-ro, Samnye-eup, Wanju- Gun, Jeonbuk-do, 55338, Republic of Korea.

出版信息

BMC Nurs. 2025 Feb 19;24(1):192. doi: 10.1186/s12912-025-02685-x.

DOI:10.1186/s12912-025-02685-x

PMID:39972453

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11837672/

Abstract

BACKGROUND

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.

PURPOSE

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

METHODS

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.

RESULTS

The hypothesized model was found to be statistically fit (normed χ /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).

CONCLUSIONS

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.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

护士的“二次受害者”经历是医疗保健领域的一个关键问题。“二次受害者”经历不仅会给护士带来心理和情绪困扰，还会对组织绩效和整体患者安全产生不利影响。

目的

本研究旨在确定医疗机构的公正文化认知对患者安全事件后护士“二次受害者”经历的影响。

方法

这是一项横断面相关性研究。于2022年12月28日至2023年1月14日期间，使用在线自填问卷从三级综合医院的183名临床护士中收集数据。该问卷包括公正文化评估工具（JCAT）和韩国“二次受害者”经历与支持工具（K-SVEST）中的项目。建立并测试了一个假设模型。使用SPSS WIN 23.0和AMOS 23.0程序对数据进行分析。

结果

发现假设模型在统计学上拟合良好（标准化χ²/df = 2.53；近似均方根误差 = 0.09；比较拟合指数 = 0.99；塔克 - 刘易斯指数 = 0.97；标准化拟合指数 = 0.99）。测试了八条假设路径，其中五条直接效应路径和三条间接效应路径在统计学上具有显著性。公正文化对“二次受害者”困扰（β = -0.29，p = 0.001）和支持需求（β = -0.65，p = 0.001）有显著影响。“二次受害者”困扰对支持需求（β = 0.14，p = 0.025）和负面工作相关结果（β = 0.66，p = 0.001）有显著影响。支持需求对负面工作相关结果（β = 0.18，p = 0.010）有显著影响。