Changes in Nursing Practice Among Clinical Nurses After Experiencing a Patient Safety Incident: Partial Least Squares Structural Equation Modeling

Background: 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. Methods: 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. Results: 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 (B = 0.07, p < 0.001). In the absence of a just culture, constructive changes decreased (B = -0.12, p < 0.001). The just culture negatively influenced defensive changes in nursing practice through second victim experience (B = -0.24, p < 0.001). The just culture negatively influenced defensive changes in nursing practice through second victim experience and avoidant coping (B = -0.10, p < 0.001). Without the just culture, defensive changes in nursing practice increased (B = 0.19, p < 0.001). The just culture reduced avoidant coping through second victim experience (B = -0.25, p < 0.001). Conclusions: 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. Implications for Nursing Management: 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.