{"title":"Changes in Nursing Practice Among Clinical Nurses After Experiencing a Patient Safety Incident: Partial Least Squares Structural Equation Modeling","authors":"Sunmi Kim, Seohee Jeong, Seok Hee Jeong","doi":"10.1155/jonm/1587897","DOIUrl":null,"url":null,"abstract":"<div>\n <p><b>Background:</b> 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.</p>\n <p><b>Methods:</b> 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.</p>\n <p><b>Results:</b> 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 (<i>B</i> = 0.07, <i>p</i> < 0.001). In the absence of a just culture, constructive changes decreased (<i>B</i> = −0.12, <i>p</i> < 0.001). The just culture negatively influenced defensive changes in nursing practice through second victim experience (<i>B</i> = −0.24, <i>p</i> < 0.001). The just culture negatively influenced defensive changes in nursing practice through second victim experience and avoidant coping (<i>B</i> = −0.10, <i>p</i> < 0.001). Without the just culture, defensive changes in nursing practice increased (<i>B</i> = 0.19, <i>p</i> < 0.001). The just culture reduced avoidant coping through second victim experience (<i>B</i> = −0.25, <i>p</i> < 0.001).</p>\n <p><b>Conclusions:</b> 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.</p>\n <p><b>Implications for Nursing Management:</b> 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.</p>\n </div>","PeriodicalId":49297,"journal":{"name":"Journal of Nursing Management","volume":"2025 1","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jonm/1587897","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Nursing Management","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/jonm/1587897","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MANAGEMENT","Score":null,"Total":0}
引用次数: 0
Abstract
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.
期刊介绍：
The Journal of Nursing Management is an international forum which informs and advances the discipline of nursing management and leadership. The Journal encourages scholarly debate and critical analysis resulting in a rich source of evidence which underpins and illuminates the practice of management, innovation and leadership in nursing and health care. It publishes current issues and developments in practice in the form of research papers, in-depth commentaries and analyses.
The complex and rapidly changing nature of global health care is constantly generating new challenges and questions. The Journal of Nursing Management welcomes papers from researchers, academics, practitioners, managers, and policy makers from a range of countries and backgrounds which examine these issues and contribute to the body of knowledge in international nursing management and leadership worldwide.
The Journal of Nursing Management aims to:
-Inform practitioners and researchers in nursing management and leadership
-Explore and debate current issues in nursing management and leadership
-Assess the evidence for current practice
-Develop best practice in nursing management and leadership
-Examine the impact of policy developments
-Address issues in governance, quality and safety
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