How does just culture reduce negative work outcomes through second victim distress and demand for support in clinical...

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.

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

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.

The hypothesized model was found to be statistically fit (normed χ² /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).

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.

Not applicable.