Moving on after critical incidents in health care. Second victims: A qualitative study of the experiences of nurses and midwives

Aims: The aims of this study were to gain a deeper understanding of the experiences of nurses and midwives who have been involved in a critical incident in a non-critical care area and to explore how they have ‘moved-on’ from the event. Background: It is irrefutable that health care is intrinsically risk-laden and perceived to be personally and professionally demanding for those who are employed within it. The term ‘second victim’ has been assigned to health care professionals who experienced emotional distress as a result of their involvement in critical incidents. Despite the recognition that critical incidents contribute to workrelated stress, strategies employed by nurses and midwives to move-on from their often traumatic experiences of these events in non-critical care settings were not widely reported. Research design: An interpretive descriptive design based on the scientific worldview of constructivism guided inductive inquiry to interpret the meaning of moving-on central to nurses and midwives who have lived through the impact of critical incidents. Methods: Purposive sampling was used to recruit 10 nurses and midwives to participate in the study. Data collection comprised of semi-structured interviews, memos and field notes. Data was concurrently collected and analysed with the data management software NVivo 11, to derive themes and patterns, which enabled the researcher and the study-participants to co-construct knowledge. A thematic analytical method stipulated a coherent analytical framework to evolve the emerging themes and transform the data into credible interpretive description findings. Findings: The findings revealed five main themes (1) initial emotional and physical response, (2) the aftermath, (3) long-lasting repercussions, (4) workplace support and (5) moving-on. Nurses and midwives experienced intense initial reactions and tumultuous emotions in the aftermath of the event and desired to share their burden. Various unsupportive workplace practices convoluted the reclamation of their professional competence, whilst adaptive strategies to promote physical and mental well-being enabled the participants to rise above the impact of critical incidents. Discussion: This study highlighted several issues fundamental to withstand and overcome the personally damaging and professionally destructive challenges associated with critical incidents. The discussion of findings revealed new insights into the significance of support and a generally optimistic outlook derived from a well-adjusted work-life balance. Future research is required to explore the perceived effectiveness of workplace practices, as well as the role of education. Relevance: This study presented an opportunity to shed light on the perceptions of ‘nurse and midwife-second victims’ within a range of non-critical care settings. Through their lens, the strategies they engaged in to move-on from the event were identified and their call for organisational and collegial support received a voice. Conclusion: This study explored how nurses and midwives moved-on following critical incidents in various clinical areas. The identification of adaptive strategies contributed to the existing body of knowledge surrounding this phenomenon. Findings have the potential to inform health care organisations with the aim to support others who experienced critical incidents in health care, as well as guide nursing and midwifery education programs to raise awareness of the potential effects associated with the impact of critical incidents

The impact of critical incidents on nurses and midwives: A systematic review

© 2020 John Wiley & Sons Ltd Aims: To synthesise the existing literature, which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment to move on from the event. Design: Systematic review and qualitative synthesis. Data sources: The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013–2018, and core authors and journals identified in the literature were manually investigated. Review methods: Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Results: A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta-synthesis by meta-aggregation. The 179 findings and sub-findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move on. Conclusion: This review illuminated that moving-on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce

Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims

Aims To gain a deeper understanding of nurses and midwives\u27 experiences following involvement in a critical incident in a non-critical care area and to explore how they have \u27moved-on\u27 from the event. Design An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving-on. Methods Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi-structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016–2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting guidelines. Results The findings revealed five main themes: Initial emotional and physical response, the aftermath, long-lasting repercussions, workplace support and moving-on. Conclusion This study shed light on the perceptions of nurses and midwives who lived through the impact of critical incidents. Through their lens, the strategies engaged in to move-on were identified and their call for organizational and collegial support received a voice