Experiences of and support for nurses as second victims of adverse nursing errors: a qualitative systematic review
Authors: Cabilan C.J. , Kynoch Kathryn 
Published: September 2017

EXECUTIVE SUMMARY

Background
Second victims are clinicians who have made adverse errors and feel traumatized by the experience. The current published literature on second victims is mainly representative of doctors, hence nurses’ experiences are not fully depicted. This systematic review was necessary to understand the second victim experience for nurses, explore the support provided, and recommend appropriate support systems for nurses.

Objectives
To synthesize the best available evidence on nurses’ experiences as second victims, and explore their experiences of the support they receive and the support they need.

Inclusion criteria Participants
Participants were registered nurses who made adverse errors.

Phenomena of interest
The review included studies that described nurses’ experiences as second victims and/or the support they received after making adverse errors.

Context
All studies conducted in any health care settings worldwide.

Types of studies
The qualitative studies included were grounded theory, discourse analysis and phenomenology.

Search strategy
A structured search strategy was used to locate all unpublished and published qualitative studies, but was limited to the English language, and published between 1980 and February 2017. The references of studies selected for eligibility screening were hand-searched for additional literature.

Methodological quality
Eligible studies were assessed by two independent reviewers for methodological quality using a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI QARI).

Data extraction
Themes and narrative statements were extracted from papers included in the review using the standardized data extraction tool from JBI QARI.

Data synthesis
Data synthesis was conducted using the Joanna Briggs Institute meta-aggregation approach.

Results
There were nine qualitative studies included in the review. The narratives of 284 nurses generated a total of 43 findings, which formed 15 categories based on similarity of meaning. Four synthesized findings were generated from the categories: (i) The error brings a considerable emotional burden to the nurse that can last for a long time. In some cases, the error can alter nurses’ perspectives and disrupt workplace relations; (ii) The type of support received influences how the nurse will feel about the error. Often nurses choose to speak with colleagues who have had similar experiences. Strategies need to focus on helping them to overcome the negative emotions associated with being a second victim; (iii) After the error, nurses are confronted with the dilemma of disclosure. Disclosure is determined by the following factors: how nurses feel about the error, harm to the patient, the support available to the nurse, and how errors are dealt with in the past; and (iv) Reconciliation is every nurse's endeavor. Predominantly, this is achieved by accepting fallibility, followed by acts of restitution, such as making positive changes in practice and disclosure to attain closure (see “Summary of findings”).

Conclusion
Adverse errors were distressing for nurses, but they did not always receive the support they needed from colleagues. The lack of support had a significant impact on nurses’ decisions on whether to disclose the error and his/her recovery process. Therefore, a good support system is imperative in alleviating the emotional burden, promoting the disclosure process, and assisting nurses with reconciliation. This review also highlighted research gaps that encompass the characteristics of the support system preferred by nurses, and the scarcity of studies worldwide.