Second victims are practitioners involved in an incident that (potentially) harms or kills somebody else, and for which they feel personally responsible. Professional culture and the psychology of blame (and shame) influence how second victims are viewed and dealt with. This paper reviews the status of second victimhood in healthcare -both its symptomatology and organizational responses. Then it considers the problematic nature of "human error" in healthcare and sets this against the psychological backdrop of healthcare professions, seeking cultural-historical explanations in assumptions of actor autonomy and professional identity. It concludes by drawing links between the psychological resilience of the individual practitioners involved in an incident and the resilience of an organization's safety culture.
Vibrotactile displays have been trialled in a variety of cognitively demanding domains, including healthcare. Previous work suggests that vibrotactile displays can be used to inform clinicians of patient status, particularly when the displays are alarm-style alerts in surgical or critical care. The goal of the present study is to evaluate how well a common measure of patient well-being-pulse oximetry-can be communicated via an upper-arm vibrotactile prototype. Pulse oximetry includes two important vital signs: heart rate and oxygen saturation. Two displays were tested in a between-subjects design: (1) the Separated display presented heart rate first, followed by oxygen saturation; and (2) the Integrated display communicated both vital signs simultaneously. Participants identified five ranges of heart rate and three levels of oxygen saturation with very high accuracy (>90%), regardless of display type. Although participants' identification accuracy improved marginally with practice, their initial high level of performance was achieved with minimal training. Findings will inform a broader program of research in which we aim to test whether vibrotactile displays might be useful as a part of multi-modal patient monitoring.
Objectives: Interruptions occur frequently in the intensive care unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know whether interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. The aim of the study was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions.
Methods:We conducted a prospective controlled trial in a high-fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepared and administered intravenous medications for a patient manikin. Nurses received either 3 (n = 35) or 12 (n = 35) scenario-relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinical errors and procedural failures committed by each nurse.
Results:The rate ratio of clinical errors committed by nurses who received 12 interruptions compared with nurses who received 3 interruptions was 2.0 (95% confidence interval = 1.41-2.83, P < 0.001). The rate ratio of procedural failures committed by nurses who received 12 interruptions compared with nurses who were interrupted 3 times was 1.2 (95% confidence interval = 1.05-1.37, P = 0.006).Conclusions: More workplace interruptions during medication preparation and administration lead to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicate.
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