Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses

Jt Comm J Qual Patient Saf. 2016 Aug;42(8):377-86. doi: 10.1016/s1553-7250(16)42053-2.


Background: Second victim experiences can affect the wellbeing of health care providers and compromise patient safety. Many factors associated with improved coping after patient safety event involvement are also components of a strong patient safety culture, so that supportive patient safety cultures may reduce second victim-related trauma. A cross-sectional survey study was conducted to assess the influence of patient safety culture on second victim-related distress.

Methods: The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC) and the Second Victim Experience and Support Tool (SVEST), which was developed to assess organizational support and personal and professional distress after involvement in a patient safety event, were administered to nurses involved in direct patient care.

Results: Of 358 nurses at a specialized pediatric hospital, 169 (47.2%) completed both surveys. Hierarchical linear regres sion demonstrated that the patient safety culture survey dimension nonpunitive response to error was significantly associated with reductions in the second victim survey dimensions psychological, physical, and professional distress (p < 0.001). As a mediator, organizational support fully explained the nonpunitive response to error-physical distress and nonpunitive response to error-professional distress relationships and partially explained the nonpunitive response to error-psychological distress relationship.

Conclusions: The results suggest that punitive safety cultures may contribute to self-reported perceptions of second victim-related psychological, physical, and professional distress, which could reflect a lack of organizational support. Reducing punitive response to error and encouraging supportive coworker, supervisor, and institutional interactions may be useful strategies to manage the severity of second victim experiences.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Physiological
  • Adaptation, Psychological
  • Adult
  • Attitude of Health Personnel*
  • Cross-Sectional Studies
  • Female
  • Hospitals, Pediatric
  • Humans
  • Male
  • Medical Errors / prevention & control
  • Nursing Staff, Hospital / psychology*
  • Organizational Culture*
  • Quality Improvement
  • Safety Management*
  • Social Support
  • Stress, Psychological / diagnosis*
  • United States
  • United States Agency for Healthcare Research and Quality