Kim Sunmi, Jeong Seohee, Jeong Seok Hee
Department of Nursing, College of Nursing, Woosuk University, Wanju-gun, Republic of Korea.
Medical Care Department, QI Team, Jeonbuk National University Hospital, Jeonju-si, Republic of Korea.
J Nurs Manag. 2025 Mar 4;2025:1587897. doi: 10.1155/jonm/1587897. eCollection 2025.
Nurses experiencing second victimization after a patient safety incident face challenges in developing effective coping strategies. Active coping can lead to constructive practice changes within a just culture. However, no theoretical model has yet tested the relationships among a just culture, second victim variables, coping strategies, and practice changes. A nationwide online survey was conducted using proportional quota sampling based on region, representing 0.7% of nurses in tertiary hospitals across various Korean regions as of August 2022. Partial least squares structural equation modeling (PLS-SEM) was used to develop the hypothesized model, determine the model fit, and test research hypotheses. Descriptive statistics, model fit, and path analysis were performed using SPSS and Smart-PLS. The final analysis included 461 clinical nurses. Six significant pathways were identified: A just culture positively influenced constructive changes in nursing practice through second victim experience and avoidant coping ( = 0.07, < 0.001). In the absence of a just culture, constructive changes decreased ( = -0.12, < 0.001). The just culture negatively influenced defensive changes in nursing practice through second victim experience ( = -0.24, < 0.001). The just culture negatively influenced defensive changes in nursing practice through second victim experience and avoidant coping ( = -0.10, < 0.001). Without the just culture, defensive changes in nursing practice increased ( = 0.19, < 0.001). The just culture reduced avoidant coping through second victim experience ( = -0.25, < 0.001). This study provides pathways to increase constructive nursing practice changes and decrease defensive nursing practice changes in nurses who have experienced a patient safety incident. The just culture needs to be established in a nursing practice setting and healthcare organizations. This study, using a representative sample through proportional quota sampling, provides reliable and valid evidence for nursing practice and healthcare organizations regarding the just culture, second victim experiences, and patient safety.
在患者安全事件后经历二次受害的护士在制定有效的应对策略方面面临挑战。积极应对可以在公正文化中带来建设性的实践变革。然而，尚无理论模型检验公正文化、二次受害变量、应对策略和实践变革之间的关系。2022年8月，基于地区采用比例配额抽样进行了一项全国性在线调查，代表了韩国各地区三级医院0.7%的护士。使用偏最小二乘结构方程模型（PLS-SEM）来构建假设模型、确定模型拟合度并检验研究假设。使用SPSS和Smart-PLS进行描述性统计、模型拟合和路径分析。最终分析纳入了461名临床护士。确定了六条显著路径：公正文化通过二次受害经历和回避应对对护理实践中的建设性变革产生积极影响（β = 0.07，p < 0.001）。在缺乏公正文化的情况下，建设性变革减少（β = -0.12，p < 0.001）。公正文化通过二次受害经历对护理实践中的防御性变革产生负面影响（β = -0.24，p < 0.001）。公正文化通过二次受害经历和回避应对对护理实践中的防御性变革产生负面影响（β = -0.10，p < 0.001）。没有公正文化，护理实践中的防御性变革增加（β = 0.19，p < 0.001）。公正文化通过二次受害经历减少回避应对（β = -0.25，p < 0.001）。本研究为经历过患者安全事件的护士增加建设性护理实践变革和减少防御性护理实践变革提供了路径。需要在护理实践环境和医疗保健组织中建立公正文化。本研究通过比例配额抽样使用代表性样本，为护理实践和医疗保健组织提供了关于公正文化、二次受害经历和患者安全的可靠有效证据。
