read the research carefully. answer from very good to very poor and support your answer "why"it's good or bad in order to answer each question on a side.

Our academic experts are ready and waiting to assist with any writing project you may have. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs.

GET A 40% DISCOUNT ON YOU FIRST ORDER

ORDER NOW DISCOUNT CODE >>>> WELCOME40

read the research carefully. answer from very good to very poor and support your answer “why”it’s good or bad in order to answer each question on a side.
Table 1. Guidelines for qualitative research appraisal – Answer and concisely support your answer to each of the following questions (as applicable to the chosen study)

Student Name:
Appraisal Criteria
Full APA citation of Article:
Phenomena/Problem and Aims:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
What is the phenomena/problem of interest?
Are the phenomena/problems clearly defined?
Do authors provide sufficient explanation of what is already known about the phenomena/problem?
Is the research placed in the context of what is already known about the phenomenon?
What is the justification for using qualitative methods?
What new knowledge is anticipated?
Research Design:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
What is the theoretical framework for the study?
What is the research design and is it clearly stated?
Does the research design provide a good fit with the research aims?
Is the study completed according to the processes described?
Sample and Setting:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
What is the larger target population for the study?
Describe the sample.
What type of sampling is used?
Are informants appropriate to inform the research?
How was the number of participants determined?
Data Collection:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
How were data collected?
Was the step-by-step procedures well-articulated and replicable?
Is saturation of data described?
How is protection of human subjects addressed?
Data Analysis:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
What methods are used to analyze data?
What criteria are used to determine data saturation?
How did researchers identify patterns in the data?
What strategies are used to analyze the data?
Describe how credibility, auditability and fittingness of the data are addressed.
Results:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
Are findings defined, coherent, and clearly delineated?
Are the findings well supported by the data and seem credible and authentic?
Have the authors adequately addressed outliers?
Do tables, figures, and/or illustrations neatly capture results?
Is the information in tables, figures, and/or illustrations consistent with the study findings in the text?

 

Discussion:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
Do the authors adequately state the implications of their findings?
Are the findings discussed in the context of what is already known about the phenomena/problem?
Are the limitations are noted appropriate and comprehensive?
Conclusion:
□      Very Good
□      Good
□      Adequate
□      Poor
□      Very Poor
Do the conclusions reflect the study’s findings?
What are the recommendations for future research?
What are the research’s implications for nursing?
Did you find the study relevant?
What audience would be most interested in the study and why?
What overall recommendations would you make from critiquing this study?

RESEARCH – QUALITATIVE
Exploring the experience of nurse practitioners who have
committed medical errors: A phenomenological approach
Romuald Delacroix, DNP, ARNP, FNP-C (Assistant Professor, Family Nurse Practitioner)
DNP Scholarly Project, The Catherine McAuley School of Nursing, Maryville University, St. Louis, Missouri
Keywords
Medical errors; medical mistakes; qualitative
research; phenomenology; “second victim”;
nurse practitioner; advanced practice nurse.
Correspondence
Romuald Delacroix, DNP, ARNP, FNP-C, The
Catherine McAuley School of Nursing, St. Louis,
19019, Silverbrook Dr, Tampa, FL 33647.
Tel: (813) 326–8522; Fax: 813-258-7214;
E-mail: Romdelacroix@gmail.com
Received: 1 January 2016;
revised: 8 March 2017;
accepted: 20 March 2017
doi: 10.1002/2327-6924.12468
Disclosure
The author has no competing interests to
declare.
Abstract
Background and purpose: To explore the experience of committing medical
error from the perspective of nurse practitioners (NPs). Overall, the purpose of
the study is to discern NPs’ behaviors, perceptions, and coping mechanisms in
response to having made a medical error.
Methods: Qualitative research based on two face-to-face audio-recorded
semistructured interviews with 10 NPs who had made medical errors in practice.
The analysis was guided by concepts in phenomenology.
Conclusions: During iterative analyses, four overarching themes were identified:
(a) The paradox of error victimization, (b) primacy of responsibility and
mindfulness, (c) yearning for forgiveness and a supportive other, and (d) coping
with a new reality is context dependent. The narratives strongly suggest that NPs
who err experience “second victim” phenomena.
Implications for practice: Reminiscing about the experience of living through
an error, NPs shared meaningful insights into their need for a safe environment
in which they could candidly share feelings, reflect on the experience, and ascertain
the etiology of the mistake. Debriefing in a formal manner might prevent
the development of permanent psychological injuries. Hence, inherent to the
care of “second victims” is the notion of co-workers’ fairness, compassion, and
recognition of appropriate caring responses that contribute to effective coping
and healing.
Introduction
Medical errors are an inevitable reality of a complex
and often chaotic healthcare system. After all, human beings
are fallible. Regrettably, the number and severity of
medical errors occurring in the United States is staggering
(Kohn, Corrigan, & Donaldson, 2000). Over the past
few decades, considerable numbers of patients have suffered
significant adverse events while being cared for in
hospitals and outpatient settings including 400,000 preventable
deaths and 4–8 million occurrences of serious
harm per year (Andel, Davidow, Hollander, & Moreno,
2012; Bishop, Ryan, & Casalino, 2011; James, 2013). Consequently,
the Institute of Medicine (IOM) called for the
entire nation to be vigilant against the very real possibility
of medical error (Kohn et al., 2000).
In addition to the potential deleterious effects on patients
and families, medical errors provoke intense emotional
responses in healthcare providers—responses that
threaten provider well-being and subsequent patient care
(Waterman et al., 2007). Dr. Albert Wu, former director
of the Agency of Healthcare Research and Quality
(AHRQ), published several influential papers on the effect
on medical errors on healthcare providers (Wu, 2000;
Wu, Cavanaugh, McPhee, Lo, & Micco, 1997). Wu (2000)
coined the term “second victim” to describe the anguish
felt by those clinicians who err. This term is appropriate
based on the substantial literature documenting healthcare
providers’ personal and professional angst following
incidents of errors (Bishop et al., 2011; Boyle, 2011;
Engel, Rosenthal, & Sutcliffe, 2006; Jones & Treiber, 2012;
Sandars & Esmail, 2003; Scott et al., 2009; Sirriyeh, Lawton,
Gardner, & Armitage, 2007; Waterman et al., 2007,
Wu, 2000). The relevant literature suggests that healthcare
providers who had made medical errors longed for an
opportunity to reflect on their experience with peers. This
debriefing might prevent the development of permanent
psychological injuries (Kroll, Singleton, & Collier, 2008).
Journal of the American Association of Nurse Practitioners 29 (2017) 403–409 403
C 2017 American Association of Nurse Practitioners
Experience of NPs who have committed errors R. Delacroix
Similar to physicians, and staff nurses, nurse practitioners
(NPs) practice within an unrealistic error-free imperative
largely as a result of the fact that the healthcare culture
holds individuals who err fully accountable (White
et al., 2008). Yet, most literature related to “second victim”
phenomena examines only physician and staff nurse
response (Boyle, 2011; Jones & Treiber, 2012; Scott et al.,
2009). Hence, it is fair to say there is little understanding
of how NPs respond to having made medical errors.
Therefore, there is a need to allow NPs to self-reflect, and
to better understand how making a medical error affects
NPs.
Aim
The purpose of this qualitative study is to better understand
the experience of NPs who err. The overarching research
questions included:
1. How do NPs who err perceive medical error?
2. How do medical errors affect NPs who err?
3. How do NPs who err cope after having made a
medical error?
To the author’s knowledge, this is the first study of its
kind to describe medical error experience from the NP
perspective.
Operational definition
A medical error is an unintentional act of commission or
omission in planning or executing patient care that could
or did contribute to unintended harm.
Design
An interpretive phenomenological approach was chosen
because the research questions sought to explore the experience
of committing medical error from the perspective
of NPs. This method is well suited to this study because
the aim of phenomenology is to uncover study participants’
perceptions, understandings, and perspectives of a
phenomenon (Polit & Beck, 2012).
Sample
A convenience sample of NPs who belong to the Tampa
Bay Advanced Practice Nurses Council (TBAPNC) was recruited
to participate in the study. TBAPNC is a professional
organization of NPs who live and/or practice in
Tampa Bay, Florida. There are approximately 200 members
from different specialties. No race, age, ethnicity, or
gender was excluded, but volunteers needed to meet the
following criteria:
1. hold a national NP certification;
2. have a history of having committed a medical error
while practicing as an NP.
Ethical considerations
The Institutional Review Board (IRB) at Maryville University,
St. Louis, Missouri, approved the Study in March
2015. Prior to interviews, a consent form was provided,
explained, and signed. Furthermore, participants were informed
of potential psychological risks associated with the
study and their right to withdraw at anytime.
Data collection
This study used two face-to-face in-depth semistructured
interviews as the primary source of data collection. The
semistructured interview guides were researcher developed
and reviewed by experts versed in phenomenology.
The interview guides were used to initiate conversation
and encourage dialogue.
A first interview on the meaning of error was designed
to elicit an account of the medical error and how the NP
appraised the experience. The second interview allowed
the participants to elaborate on their thoughts, feelings,
actions, and coping mechanisms after the event. Similar
interview guides have been used in several studies
that investigated medical errors committed by physicians,
residents, and nurses (Courvoisier, Agoritsas, Perneger,
Schmidt, & Cullati, 2011; Crigger & Meek, 2007; Engel
et al., 2006; Fischer et al., 2006; Kroll et al., 2008; Luk,
Ng, Ko, & Ung, 2008; Scott et al., 2009; Stetina, Groves, &
Pafford, 2005).
Data analysis
Because the foundation of a phenomenological study
likely lies within the narrative text (Pohlman, 2005), a
more in-depth discussion related to thematic analysis is
warranted. Thematic analysis involves an iterative process
of reading and re-reading across cases to identify meaningful
patterns, similarities, and differences among participants’
narratives (Polit & Beck, 2012). This iterative
process allows the researcher to identify inconsistencies
among conclusions drawn in earlier reads (Benner, 2001).
Rigor
As the instrument of analysis, reflection, and interpretation,
the researcher relied on a long commitment to
his daily practice of meditating that fosters self-awareness,
social attentiveness, and attention to the present moment.
Obviously, complete objectivity is impossible;
404
R. Delacroix Experience of NPs who have committed errors
nevertheless, these personal attributes mitigate potential
biases and researcher expectations through the process of
self-awareness also known as bracketing (Yin, 2011). Exemplars
or direct participant quotes were used to illustrate
similarities or differences among NPs’ experiences.
It is hoped that the exemplars deepen understanding and
heighten the validity of this study’s findings.
Participant characteristics
A convenience sample of ten NPs practicing in Florida
was identified and signed informed consent to participate.
The sample was predominantly female (90.0%), white
(80.0%), and middle-aged (70%). All participants held advanced
degrees; two (20.0%) were doctorally prepared.
On average, participants had 25 years of nursing experience,
including 12 years at the advanced practice level. The
majority (80.0%) of the participants were in family practice.
All 10 participants reported having committed medical
errors while practicing as NPs.
Thematic analysis
Four overarching themes emerged from the narratives.
While the themes are reported as discrete categories and
are presented as sequential phenomenon, there is a lot
of overlap within the themes. The narratives were categorized
by “best-fit” even though some oral accounts addressed
more than one theme simultaneously.
Theme I: The paradox of error victimization
Much like patients and families, NPs who committed errors
felt victimized (n = 10). This victimization was evidenced
by reports of fear and feelings of uncertainty. Fear
and uncertainty were experienced by all study participants
and are presented within two subthemes: (a) fear for the
patient’s welfare and (b) fearing an uncertain professional
future. The following discussion is presented accordingly.
Fear for the patient’s welfare. When the participants
realized a medical error had occurred, they engaged
in immediate information-seeking behavior to discern exactly
what transpired and to assess the seriousness of the
error and the potential negative effects on the patient. A
sentiment echoed by all is illustrated as follows:
“My priority after my supervisor told me I made a medical
error [selection of an incorrect antibiotic], well, my priority
was patient safety and efficacy of my choice.” Later on, in
the interview he added, “I asked the patient how was she
feeling, how did she respond to the medicine, and that was
my main concern.”
Fearing an uncertain professional future. Not
only did the participants worry about potential harmful
effects to patients, most (n = 9) also expressed feelings of
self-doubt, disappointment, and dread related to the possibility
of making future errors. Half of the participants
feared disciplinary action.
Illustrative of NP disappointment, one participant
explained:
“I felt incompetent. Maybe I felt like I had caused that patient
harm, that I had done something wrong.”
This last account also touches on participants’ sense of
fallibility. One NP portrayed this sentiment best by stating:
“I think that was the biggest eye opener for me, of all, that
I was fallible, and I never made a mistake and now here I
was, and made a huge one. It was shocking how simple it is
to make an error.”
Theme II: The primacy of responsibility
and mindfulness
Self-blame, taking responsibility, and mindfulness were
pervasive among the participants. This theme was divided
into three subthemes: (a) I am responsible, (b) acute reactions,
and (c) mindfulness.
I am responsible. Taking responsibility for medical
errors was a sentiment shared by most of the study participants
(n = 9), even when extrinsic factors such as their
hectic patient caseload, lack of trained supportive staff,
computerized system malfunctions, outdated standard operating
procedures, and patient’s confusion contributed to
the error.
Most (n = 9) viewed making an error as a personal lapse
in judgment and a professional failure, for which they held
themselves fully accountable. The following account illustrates
how deeply participants assumed responsibility for
having erred.
“I saw it so clearly, and I understood exactly what I had
done, and it was so clear how I had done it, but I just never
thought that I would do that. I didn’t understand how I
could’ve omitted that step [drug dosage miscalculation].”
The analysis also suggests mitigating factors that contribute
to error commission have little effect on NP
acceptance of responsibility. Again, most of the NPs
unequivocally accepted full responsibility for their error.
For example, one respondent confided:
“The situation would’ve happened regardless of who started
that medication, but that doesn’t change how you feel about
it. You still feel responsible for your patient. You want to
feel like you did the right thing for that patient, that is your
patient. Yes, I felt like it was my fault, I felt like I had caused
that patient harm, that I had done something wrong.”
Acute reactions. An analysis of participants’ response
to medical errors suggests NPs’ physical, emotional, and
405
Experience of NPs who have committed errors R. Delacroix
cognitive domains are impacted. For instance, some participants
(n = 6) experienced a paralyzing sense of panic
and doom, which manifested itself in physical reactions
such as “felt sick,” “felt like a punch to the stomach,” “feeling
flushed”, “sick to my stomach,” “difficulty breathing,”
“heart racing,” and “insomnia.” One NP recalled how the
medical error negatively affected her sleep pattern:
“I couldn’t sleep. I mean I couldn’t sleep. I had bad insomnia,
and then if I did manage to fall asleep, I had nightmares
about it, where oh it’s my subconscious telling me,
you screwed up girl, you should’ve not done this.”
Participants’ physical responses were short-lived. Their
emotional responses were not. For instance,
“I berated myself, I beat myself up. I’m like how could you
do that? Oh, my God. I really went after myself, I was very
hard on myself.”
Additionally, some (n = 6) recounted experiencing
cognitive impairments using term such as “rumination,”
“hyper-vigilance,” “worrying,” and “flash-backs.”
Mindfulness. Every participant reported heightening
attention during patient encounters. The need to be “fully
present in the moment with the patient” and to “pay really
close attention” to the patient was echoed by all.
Theme III: Yearning for forgiveness and a supportive
other
The theme “yearning for forgiveness and a supportive
other” was categorized in two subthemes: (a) nonsupportive
just culture and (b) seeking forgiveness and support.
Nonsupportive just culture. Although many participants
(n = 6) recalled that supervisors and organizations
reportedly have a “just culture” approach to addressing
medical errors, they also experienced environments in
which forgiveness, solace, and reassurance were not readily
forthcoming.
“I don’t think I learned anything about my employers. I
think I already knew how they were, and I thought that
was normal for them not to be supportive. I thought that
was typical, I didn’t think that was unusual. I hadn’t seen
them be supportive of anybody else. So, they didn’t blame
me, they didn’t shame me, but they didn’t support me.”
Most (n = 7) described impersonal, distant, and
business-like interactions with their supervisor as illustrated
by this NP’s comments:
“I’ll be honest, it’s a business. It’s healthcare but it’s a business,
and you’re the provider, and okay, an error is expected,
as part of their business plan. When it happens, well,
they want you to follow protocol, follow the process of error
reporting and that’s it. It does not include the human aspect
of the error, no emotional support, no follow through, no
follow-ups, they just make sure the provider deals with it
[error reporting], and move on. It is a little cold, right, but
that is the reality nowadays.”
Seeking forgiveness and support. Several participants
(n = 6) confided they actively yearned and searched
for forgiveness, support, and understanding. One sought
reassurance from trusted co-workers:
“I talked about it [medical error] with colleagues because no
one in my family is medical and probably wouldn’t understand
any of the things I was saying, but colleagues would
understand, so I did talk about it with colleagues, and it alleviated
a lot of the anxiety I was feeling.”
Theme IV: Coping with a new reality is context
dependent
Medical error was a catalyst for personal and professional
change among the participants (n = 9). Coping with
the experience of having erred was either constructive or
atypical in nature. Not surprisingly, coping was contextual
and depended on individual personality and organizational
culture. Hence, the theme “Coping with a New
Reality Is Context Dependent” can be divided into two
subthemes: (a) atypical changes and (b) constructive
changes.
Atypical coping. Participants reacted differently to
the effects medical errors had on their professional and
personal selves. Revelations from the interviewees uncovered
that many (n = 6) engaged in atypical coping strategies
to diminish signs and symptoms of stress without fully
addressing the real problem. Atypical changes included
obsessive behaviors, hyper-vigilance, avoidance, and discounting.
Some participants (n = 6) engaged in obsessivecompulsive
behaviors and hypervigilance to alleviate fear
and anxiety related to the possibility of making future
errors.
“So, I try to find ways to put things in place so I don’t make
the same mistake. You know I follow a strict process during
the patient encounter, try to be totally focused on the
patient. I won’t answer the phone when I am with a patient
now. I always cross-check my decision with Epocrates
[a medical diagnostic software], yes, I do more checks”
“My anxiety level of course has gone down over a period of
time, but I still double, triple check the chief complaint to
be addressed during the visit. [NP overlooked one patient’s
complaint, which led to a misdiagnosis.] The error has kind
of heightened my vigilance . . . it made me hyper-vigilant.”
Constructive coping. Participants (n = 9) reported
that the medical error offered a context for personal and
professional improvements including investigating the etiology
of the medical error, implementing actions designed
to prevent further error, and developing professional competence
both at the personal and organizational level.
Some (n = 8) described a concerted effort to gain deep
406
R. Delacroix Experience of NPs who have committed errors
understanding of their role related to the error and to
make practice modifications.
Several participants (n = 5) reported that errors provided
the impetus for acquiring new knowledge and enhancing
clinical competence: The following excerpt is from an NP
who committed a medication error.
“I certainly did read up on it [medication contraindication],
I did a lot of research on it and gained a lot of knowledge on
it, and I’m much more cautious [starting an elderly patient
on a new medication] when I do it, and I usually start at a
lower dose and titrate up, and keep in close contact with that
patient. I think the mistake was an educational moment.”
Discussion
NPs as “second victims”
Similar to patients, making a medical error negatively
affected NPs’ well-being and oftentimes left long-lasting
psychological scars. Overall, this evidence supports the notion
that medical errors result in psychological harm to patients
as well as caregivers (Gallagher, Waterman, Ebers,
Fraser, & Levinson, 2003; Jones & Treiber, 2012; Santomauro,
Kalkman, & Dekker, 2014; Scott et al., 2009;
Waterman et al., 2007). Clearly, the narratives strongly
suggest that NPs who err experience “second victim”
phenomena. This term has been described in the literature
as any:
Health care provider who [is] involved in an unanticipated
adverse patient event, in a medical error and/or a patient
related injury and become[s] victimized in the sense that
the provider is traumatized by the event. (Scott et al., 2009,
p. 326)
“Second victim” is an apropos description and one that
was substantiated in the narratives: NPs felt responsible for
the error, viewed themselves as having failed their patient,
and questioned their clinical competence as a primary care
provider.
Primacy of responsibility and mindfulness
Medical error proved to be a catalyst for intensifying
responsibility and personal and professional change, including
developing strategies designed to enhance a culture
of patient safety. Because responsibility and coping
involve intentioned cognitive awareness (Lazarus, 2000),
it is likely that mindfulness heightened NPs’ awareness and
coping responses. All NPs reflected mindfully on the effect
medical errors had on their professional and personal
selves. Out of this thoughtful self-examination, some insights
emerged.
First, the narratives dispel the myth of successful multitasking
to complete work in a timely manner. Research
has shown that although the brain is capable of rapidly
switching from one task to another, the mind remains
essentially a linear device incapable of performing two separate
conscious tasks simultaneously (Rosen, 2008). The
participants recognized that this inefficient back and forth
multitasking negatively affected their clinical decisionmaking
and contributed to the error. Consequently, the
NPs came to the realization that they needed “to pay attention”
and “be present in the moment.”
Another insight came about after participants faced their
own personal fallibility. Being human means to accept
one’s imperfections (Waterman et al., 2007), yet the narratives
strongly suggest that NPs have extremely high expectations
of themselves and regard medical errors as the result
of incompetence and carelessness. This phenomenon
has been well documented by others who characterize
healthcare providers as intolerant of error (Kroll et al.,
2008; White et al., 2008).
During the recovery process, some participants experienced
deep psychological turmoil as they attempted to reconcile
their infallible ideal self with their imperfect true
self. Prior evidence shows that the commission of a medical
error does indeed generate profound personal transformation
and life altering professional growth (Scott et al.,
2009).
Yearning for forgiveness and a supportive other
The narratives show that NPs were denied adequate
support and understanding from their organizations and
co-workers. This absence of forgiveness and support has
been corroborated by others who investigated the experience
of clinicians who erred (Jones & Treiber, 2012;
Karga, Kiekkas, Aretha, & Lemonidou, 2011; Schwappach
& Boluarte, 2008; Sirriyeh et al., 2007).
Reminiscing about the experience of living through an
error, participants shared meaningful insights into their
need for a safe environment in which they could candidly
share feelings, reflect on the experience, and ascertain the
etiology of the mistake. Participants also yearned for reassurance,
comfort, and understanding from colleagues.
Unfortunately, co-workers and managers were often emotionally
unavailable.
Coping with error is context dependent
How one copes with error is contextual, and error context
is influenced by an exchange of interactions including
meaning assignment, individual perception, professional
and personal relationships, and organizational culture
(Sirriyeh et al., 2007). This intermingling of contexts affects
the emotional healing and professional recovery of
healthcare providers who err (Leape, 2009).
407
Experience of NPs who have committed errors R. Delacroix
Implications and recommendations
Practice
The American Nurses Association (ANA) code of ethics
(1984) provides guidelines for the ethical responsibilities
of the nursing profession. In addition to commitment
to patient welfare, the nursing professional code urges
nurses to establish relationships with coworkers based
on fairness, compassion, and honesty. In short, nurses
should strive to protect colleagues’ sense of self and professional
integrity (ANA, 1984; Corey, Corey & Callanan,
2011).
Inherent to the care of “second victims” is the notion of
co-workers’ fairness, compassion, and recognition of appropriate
caring responses that contribute to effective coping
and healing. Nurses must be cognizant that “second
victims” need significant and timely support after a medical
error.
As professionals who are taught and socialized to provide
individualized care, nurses should have deep-rooted
principles and convictions to care about others, including
colleagues who err. Regrettably, several of the participants
experienced suffering in isolation, a phenomenon reported
in previous studies (Scott et al., 2009; Waterman et al.,
2007). Moreover, this study found that adequate collegial
emotional support is often lacking, and systems’ businesslike
methods to investigate and mitigate errors do nothing
to help “second victims.”
The narratives underscore the importance of developing
a just culture. Foundational to emotional healing is
an adequate, reassuring, and supportive response (Scott
et al., 2009). Nearly a decade after Wu (2000) introduced
and conceptualized the term “second victim,” Dr. Denham
(2007), former chairman of the Leapfrog NQF (National
Quality Forum), stressed the need for an institutional response
to address the needs of healthcare providers who
err. He suggested five rights to which “second victims”
should be entitled following an unintentional error. He
recorded them under the acronym TRUST.
1. Treatment: Those who err should be treated fairly.
2. Respect: Those who err should not be named,
blamed, and shamed.
3. Understanding: Understand the need to assist “second
victims” in coping.
4. Support: Every institution should create a “second
victim” rapid response team.
5. Transparency: Healthcare organizations should foster
a culture of openness so “second victims” have
the opportunity to seek and understand the epidemiology
of the medical error, and find healing
by contributing to the establishment of a culture of
safety (Denham, 2007).
Research
As many as half of all healthcare providers will experience
“second victim” phenomena during their professional
lives (Edrees, Paine, Feroli, & Wu, 2011). Yet,
there is a paucity of studies that investigate the NP experience.
Most of the literature related to “second victim” phenomena
examines the physician and staff nurse response
(Boyle, 2011; Jones & Treiber, 2012; Scott et al., 2009).
This study provides a foundation for further investigations
designed to better understand the experience of NPs
who err.
Education
Dissemination of this study’s results will promote
awareness of “second victim” need and the inadequate
support network currently in place. Formally educating
NPs on “second victim” phenomena is important to assure
appropriate response and effective support. This, of course,
means that faculty must be well versed about “second
victim” phenomena and its implications. Curricular content
on patient safety, errors, quality improvement, and
“second victim” phenomena including awareness about
the very possibility of future errors, error disclosure, and
constructive coping mechanisms should be developed and
integrated within professional nursing curricula.
Strength and limitations
Although there is a growing body of research on
how medical errors affect physicians and staff nurses,
none have investigated the experience of NPs who err.
Hence, the primary strength of this study is its characterization
of the medical error experience from the NP
perspective.
Another strength of this study is its methodology that
facilitates new insights into unique human responses. An
interpretive phenomenological approach was chosen because
the research questions sought to explore the experience
of committing medical errors from the perspective of
NPs. Although the NPs assigned unique meaning to error,
they reported similar experiences, emotional and physical
responses, coping patterns, and self-reconciliation trajectories
consistent with those described in other qualitative
and quantitative investigations.
This study has several limitations. Although a series
of two interviews provided time for the participants to
narrate their experience involving medical error, two
interviews might not have provided sufficient time to
establish rapport with study participants who may not
feel comfortable recounting personal and professional
experiences. Hence, a longitudinal design using multiple
408
R. Delacroix Experience of NPs who have committed errors
interviews would likely yield far richer, more in-depth
information capable of elucidating the lived experience
of NPs who have made medical errors. Additionally,
even though qualitative findings can be transferable
to other settings, they cannot be extended to a larger
population.
References
American Nurses Association Committee on Ethics. (1984). Codes of ethics for
nurses. Retrieved from www.nursingworld.org/codeofethics
Andel, C., Davidow, S., Hollander, M., & Moreno, D. (2012). The economics of
health care quality and medical errors. Journal of Health Care Finance, 39(1),
39–50.
Benner, P. (2001). The phenomenon of care. In S. K. Toombs (Ed.), Handbook of
phenomenology and medicine (pp. 351–369). Netherlands: Kluwer Academic
Publishers.
Bishop, T. F., Ryan, A. M., & Casalino, L. P. (2011). Paid malpractice claims for
adverse events in inpatient and outpatient settings. Journal of the American
Medical Association, 305, 2427–2431. doi:10.1001/jama.2011.813.
Boyle, D. J. (2011). How medical errors affect physicians emotionally. Academy
of Orthoepedic Surgeons Now, 5(11), 41–45.
Corey, G., Corey, M., & Callanan, P. (2011). Issues and ethics in the helping
professions (8th ed.). Pacific Grove, CA: Brooke/Cole Publishing Cie.
Courvoisier, D., Agoritsas, T., Perneger, T., Schmidt, R., & Cullati, S. (2011).
Regrets associated with providing healthcare: Qualitative study of
experiences of hospital-based physicians and nurses. PloS One, 6(8),
1–6.
Crigger, N., & Meek, V. (2007). Toward a theory of self-reconciliation following
mistakes in nursing practice. Journal of Nursing Scholarship, 39(2), 177–183.
doi:0.1111/j.1547-5069.2007.00164.x
Denham, C. R. (2007). TRUST: The five rights of the second victim. Journal of
Patient Safety, 3(2), 107–119.
Edrees, H. H., Paine, L. A., Feroli, E. R., & Wu, A. W. (2011). Healthcare
workers as second victims of medical errors. Polskie Archiwum Medycyny
Wewnetrznej, 121(4), 101–108.
Engel, K. G., Rosenthal, M., & Sutcliffe, K. M. (2006). Residents’ responses to
medical error: Coping, learning, and change. Academic Medicine, 81(1), 86–93.
doi:10.1097/00001888-200601000-00021
Fischer, M., Mazor, K., Baril, J., Alper, E., DeMarco, D., & Pugnaire, M. (2006).
Learning from mistakes. Journal of General Internal Medicine, 5, 419–423.
doi:10.1111/j.15251497.2006.00420.x
Gallagher, T., Waterman, A., Ebers, A., Fraser, V., & Levinson, W. (2003).
Patients’ and physicians’ attitudes regarding the disclosure of medical errors.
Journal of the American Medical Association, 289(8), 1001–1007.
James, J. T. (2013). A new, evidence-based estimate of patient harms associated
with hospital care. Journal of Patient Safety, 9(3), 122–128.
Jones, J., & Treiber, L. (2012). When nurses become the “second victim.”
Nursing Forum, 47(4), 286–291. doi:10.1111/j.1744-6198.2012.00284.x
Karga, M., Kiekkas, P., Aretha, D., & Lemonidou, C. (2011). Changes in nursing
practice: Associations with responses to and coping with errors. Journal of
Clinical Nursing, 20(20/21), 3246–3255. doi:10.1111/j.1365-2702.2011.
03772.x
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a
safer health system. Washington, DC: National Academies Press.
Kroll, L., Singleton, A., & Collier, J. (2008). Learning not to take it seriously:
Junior doctors’ accounts of error. Medical Education, 42, 982–990.
Lazarus, R. S. (2000). Evolution of a model of stress, coping, and discrete
emotions. In V. H. Rice (Ed.), Handbook of stress, coping, and health: Implications
for nursing research, theory, and practice (pp. 195–222). Thousand Oaks, CA:
Sage.
Leape, L. L. (2009). Errors in medicine. Clinica Chimica Acta, 404(1), 2–5.
Luk, L., Ng, W., Ko, K., & Ung, V. (2008). Nursing management of medication
errors. Nursing Ethics, 15(1), 28–39.
Pohlman, S. (2005). The primacy of work and fathering preterm infants:
Findings from an interpretive phenomenological study. Advances in Neonatal
Care, 5(4), 204–216.
Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence
for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer.
Rosen, C. (2008). The myth of multitasking. New Atlantis, 20, 105–110.
Sandars, J., & Esmail, A. (2003). The frequency and natures of medical error in
primary care: Understanding the diversity across studies. Family Practice,
20(3), 231–236. doi:10.1093/fampra/cmg301
Santomauro, C. M., Kalkman, C. J., & Dekker, S. (2014). Second victims,
organizational resilience and the role of hospital administration. Journal of
Hospital Administration, 3(5), 95–103. Retrieved from https://doi.org/10.5430/
jha.v3n5p95
Schwappach, D. L., & Boluarte, T. A. (2008). The emotional impact of medical
error involvement on physicians: A call for leadership and organizational
accountability. Swiss Medical Weekly, 139(1), 1–7.
Scott, S., Hirschinger, L., Cox, H., McCoig, M., Brandt, J., & Hall, L. (2009). The
natural history of recovery for healthcare provider “second victim” after
adverse patient events. Quality & Safety in Health Care, 18(5), 325–330.
doi:10.1136/qshc.2009.032870
Sirriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2007). Coping with
medical error: A systematic review of papers to assess the effects of
involvement in medical errors on healthcare professionals’ psychological
well-being. Quality & Safety in Health Care, 19(6), 35–43. doi:10.1136/qshc.
2009.035253
Stetina, P., Groves, M., & Pafford, L. (2005). Managing medication errors.
MEDSURG Nursing, 14(3), 174–178.
Waterman, A. D., Garbutt, J., Hazel, E., Dunagan, W. C., Levinson, W., Fraser,
V. J., & Gallagher, T. H. (2007). The emotional impact of medical errors on
practicing physicians in the United States and Canada. Joint Commission
Journal on Quality and Patient Safety, 33(8), 467–476.
White, A. A., Gallagher, T. H., Krauss, M. J., Garbutt, J., Waterman, A. D.,
Dunagan, W. C., . . . Larson, E. B. (2008). The attitudes and experiences of
trainees regarding disclosing medical errors to patients. Academic Medicine,
83(3), 250–256.
Wu, A. (2000). Medical error: The second victim. British Medical Journal, 320,
726–727.
Wu, A., Cavanaugh, T., Mcphee, S., Lo, B., & Micco, G. (1997). To tell the truth.
Journal of General Internal Medicine, 12(12), 770–775.
Yin, R. K. (2011). Qualitative research from start to finish. New York: Guilford Press.
409

Our academic experts are ready and waiting to assist with any writing project you may have. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs.

GET A 40% DISCOUNT ON YOU FIRST ORDER

ORDER NOW DISCOUNT CODE >>>> WELCOME40

 

 

Posted in Uncategorized