second victims also scored more negatively on the assessment of the safety culture of the institution, than those who did not know a second victim. Thus, the authors concluded this dichotomy could have significant repercussions on the overall culture of the institution. Leaders can take away from this the need to assess the gaps in perceived second victim support and to improve the institutional structure of support, which may help with overall increase in the support of a safety culture (Sexton, Adair, Profit, Milne, McCulloh, Scott, and Frankel, 2021). Should the error be disclosed to the patient or family? Traditionally, patients and families were not made aware of the error unless it was obvious. Healthcare systems traditionally had a deny and defend strategy in hope of providing limited information to the family and denying fault. However, this has changed (Agency for Healthcare Research and Quality [AHRQ], 2019). This is in direct contrast to patient-centered care. Now a number of institutions have adopted the philosophy of “communication and response.” This philosophy emphasizes early disclosure of adverse events, appropriate investigations (and letting the patient and family know the institution is investigating the event), changes to mitigate the chances of the event happening again, and, if care was inappropriate, financial compensation. Research has demonstrated this approach has led to a decrease in malpractice lawsuit and lower litigation costs. How the adverse event is disclosed to the patient and/or family needs to be handled thoughtfully and with sensitivity to avoid alienating the patient and/or family. State legislatures have supported this change in the culture of healthcare with more than 33 states having laws that preclude some or all information contained in the disclosure from being used in a malpractice lawsuit (AHRQ, 2019). Self-Assessment Quiz Question #8 Taylor makes a medication error. He forgets to scan the patient’s identification before administering the medication. There was no harm to the patient. He submits a report in the hospital’s reporting system. In a just culture, should there be any consequences, and if so, what should they be? a. No consequences, since he reported the failure to scan. b. No consequences, since there was no harm to the patient. c. Yes, this is an at-risk behavior and coaching would be appropriate. d. Yes, this is a reckless behavior, and he should be written up. legal jeopardy is important. Also understanding what a “just culture” is and is not, will help the nurse in their care. Finally, the best interest of the patient is every nurse’s primary goal and responsibility. • Gai,Y. & Pachamanova, D. (2019). Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research19 (837) https://doi. org/10.1186/s12913-019-4645-5 • International Council of Nurses. (2022). Definition of Nursing https://www.icn.ch/nursing- policy/nursing-definitions • Jun, J., & Ihm, R. (2021). The federal rule of civil procedure 37(e) and achieving uniformity of case law on sanctions for esi spoliation: Focusing on the “intent to deprive” culpability under rule 37(e)(2). Catholic University Law Review, 70(2),177-200. https://heinonline.org/ HOL/Page?handle=hein.journals/cathu70&div=13&g_sent=1&casa_token=4x6Nm-STWdA AAAAA:3glLBuJh8y2lFifleddL86MdLFUPhwR2cko0dU9bqaG9xGh13lHO3KTR5YTDe3rD9M L7efBl&collection=journals • National Council of State Boards of Nursing (NCSBN). (n.d.a). Requirements for eNLC https://www.ncsbn.org/NLC_ULRs.pdf • National Council of State Boards of Nursing (NCSBN). (n.d.b.) eNLC Fats facts https://www. ncsbn.org/NLC_Fast_Facts.pdf • National Council of State Boards of Nursing. (2018a). A nurse’s guide to the use of social media; https://www.ncsbn.org/NCSBN_SocialMedia.pdf • National Council of State Boards of Nursing. (2018b). A nurse’s guide to substance use disorder in nursing. https://www.ncsbn.org/SUD_Brochure_2014.pdf • National Council of State Boards of Nursing. (2018c). NCSBN Welcomes you to the Nursing Profession. https://www.ncsbn.org/New_Nurse-Booklet-Web.pdf • National Council of State Boards of Nursing. (NCSBN). (2021). The Interstate Commission of Nurse Licensure Compact Administrators: Final rules. https://www.ncsbn.org/ FinalRulesadopted81120clean_ed.pdf • National Council of State Boards of Nursing. (2022a). Initial Review of complaint https:// www.ncsbn.org/1616.htm#:~:text=The%20BON%20is%20called%20into,fraud%2C%20 positive%20criminal%20background%20checks • National Council of State Boards of Nursing. (2022b). Board Action https://www.ncsbn. org/673.htm#:~:text=Boards%20of%20Nursing%20(BON)%20take,objective%20is%20 not%20time%2Dlimited
or not, and depending on the severity of the error (Sexton, Adair, Profit, Milne, McCulloh, Scott and Frankel, 2021). White and Delacroix, in their integrative review of the research, describe a six-stage recovery process which most second victims go through. The six stages are: 1. Chaos and accident response, where the medical error is first detected and usually involves an acute stress response. 2. Intrusive reflections, where those who err experience a period of self-isolation and rumination regarding the event. 3. Restoring personal integrity, in which healthcare providers are haunted by intrusive thoughts regarding the error and its impact on their personal and professional self. 4. Enduring the inquisition, where second victims worry about legal and professional repercussions. 5. Obtaining emotional first aid for those who err to seek emotional support from trusted family members, friends, and/or colleagues. 6. Moving on by either dropping out, surviving, and/or thriving (White and Delacroix, 2022 p7). A healthy recovery after a medical error is highly grounded in the individual’s coping skills and self-forgiveness (White and Delacroix, 2022). What also assists with second victim recovery is support from the employing institution. According to the findings in the White and Delacroix article, the second victim needs 1) fair treatment; 2) respect; 3) institutional understanding of their need for assistance in coping with the experience; 4) institutional support; and 5) transparency as the institution fosters a culture of openness to aid in the healing process (White and Delacroix, 2020, p8). This finding was also supported in a research study published after White and Delacroix’s publication. Sexton, et al in 2021 published their findings examining the perception of institutional support for second victims (Sexton, Adair, Profit, Milne, McCulloh, Scott, and Frankel, 2021). They examined cross sectional data from 13,040 healthcare workers across 440 work settings within one academic health system (Sexton, Adair, Profit, Milne, McCulloh, Scott and Frankel, 2021). Forty- three percent of the registered nurses surveyed (the largest group within the respondents with an n=3,367) were aware of a second victim (Sexton, Adair, Profit, Milne, McCulloh, Scott, and Frankel, 2021). But of those nurses, only 31% felt the institution actually provided support for second victims. (Sexton, Adair, Profit, Milne, McCulloh, Scott and Frankel, 2021). The study also demonstrated that those who felt there was poor support for Conclusion Nurses have faced legal and ethical dilemmas for many years. It is the obligation of each nurse to practice within the scope and standards of practice as established by NPAs and within ethical codes of conduct. Understanding what could place a nurse in Agency for Health Care Research and Quality (AHRQ). (2019). PSNet- Patient Safety Network Disclosure of Errors. https://psnet.ahrq.gov/primer/disclosure-errors • American Association of Critical Care Nurses (AACN). (2019). AACN Scope and standards for progressive and critic care nursing practice. Aliso Viejo, CA. American Association of Critical Care Nursing. • American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association. • American Nurses Association. (2021b). Recognition of a nursing specialty, approval of a specialty nursing scope of practice, acknowledgement of specialty nursing standards of practice and affirmation of focused practice competencies. https://www.nursingworld. org/~49d755/globalassets/practiceandpolicy/scope-of-practice/3sc-booklet-2021-june.pdf • American Nurses Association. (2021a). Scope and standards of practice . Silver Spring, MD: American Nurses Association. • Bahr, S, J., Bang, J., Yakusheva, O., Bobay, K. L., Krejci, J., Costa, L., Hughes, Ronda, R. G., Hamilton, M., Siclovan, D. M., & Weiss, M.E. (2020). Nurse Continuity at Discharge and Return to Hospital, Nursing Research : 69(3) p 186-196 doi: 10.1097/ NNR.0000000000000417 • Brown, L. (2018). Nurses and Marijuana. Your Nurse Attorney https://yournurseattorney. com/nurses-and-marijuana/ • References • California Legislative Information. (n.d.) BUSINESS AND PROFESSIONS CODE – BPC DIVISION 2. HEALING ARTS [500 – 4999.129] ( Division 2 enacted by Stats. 1937, Ch. 399). CHAPTER 6. Nursing [2700 – 2838.4] ( Chapter 6 repealed and added by Stats. 1939, Ch. 807. ) ARTICLE 2. Scope of Regulation [2725 – 2742] ( Article 2 added by Stats. 1939, Ch. 807.) https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&divisi on=2.&title=&part=&chapter=6.&article=2. • Eng, D. M. & Schweikart, S. J. (2020). Why accountability sharing in health care organization cultures means patients are probably safer. American Medical Associations Journal of Ethics . 22(9) E779-783. www.doi: 10.1001/amajethics.2020.779.
Page 105
EliteLearning.com/Nursing
Book Code: ANCCUS2423
Powered by FlippingBook