{"title":"临床护士在经历病人安全事件后护理实践的变化：偏最小二乘结构方程模型","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":"{\"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}","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
摘要
背景：护士在患者安全事件后经历第二次受害，在制定有效的应对策略方面面临挑战。积极应对可以在公正的文化中带来建设性的实践变化。然而，目前还没有理论模型检验公正文化、第二受害者变量、应对策略和实践变化之间的关系。方法：采用基于地区的比例配额抽样，在全国范围内进行在线调查，截至2022年8月，占韩国各地区三级医院护士的0.7%。采用偏最小二乘结构方程模型（PLS-SEM）建立假设模型，确定模型拟合，检验研究假设。使用SPSS和Smart-PLS进行描述性统计、模型拟合和路径分析。结果：共纳入临床护士461名。发现了六个显著途径：公正文化通过第二受害者体验和回避应对正向影响护理实践的建设性变化(B = 0.07, p <；0.001)。在缺乏公正文化的情况下，建设性变化减少(B = - 0.12, p <；0.001)。公正文化通过第二受害者经历对护理实践中的防御变化产生负向影响(B = - 0.24, p <；0.001)。公正文化通过第二受害者经历和回避应对对护理实践中的防御变化产生负向影响(B =−0.10,p <；0.001)。没有公正文化，护理实践中的防御改变增加(B = 0.19, p <；0.001)。公正文化通过第二受害者经历减少回避应对(B = - 0.25, p <；0.001)。结论：本研究为经历过患者安全事件的护士提供了增加建设性护理实践改变和减少防御性护理实践改变的途径。对护理管理的启示：公正文化需要在护理实践环境和医疗保健组织中建立。本研究通过比例配额抽样，采用代表性样本，为护理实践和医疗机构提供有关公正文化、第二受害者经历和患者安全的可靠有效证据。
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.
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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