Factors influencing negative outcomes for nurses who experience patient safety incidents: An integrative review

Abstract

Aim: To synthesize evidence on factors influencing negative outcomes following patient safety incidents.

Background: Patient safety incidents affect not only patients and families but also healthcare workers (second victims) and institutions (third victims). Nurses are at risk due to stressful environments and direct patient care, leading to defensive practices, job turnover, and errors. Identifying these factors and developing support strategies are crucial.

Methods: This integrative review followed Whittemore and Knafl's method, guided by the middle-range theory of nurses' psychological trauma. Seven databases (PubMed, CINAHL, PsycINFO, Cochrane Library, KISS, KMbase, and RISS) were searched for English and Korean articles from 2014 to 2023. Study quality was evaluated using Joanna Briggs Institute tools, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

Results: A review of 24 cross-sectional studies from the United States and China revealed factors such as genetic/biological (e.g., gender and age), environmental (e.g., work experience and organizational support), and psychological (e.g., distress and coping). Nonpunitive cultures reduced negative emotions, while high harm and preventable incidents increased negative impacts, mitigated by spirituality. These findings underscore the need for targeted interventions and supportive policies.

Conclusion: Multidimensional support strategies are necessary to improve nurses' working environments and patient care quality. Further research should explore additional mitigating factors and third victim studies.

Implications for nursing policy: This review highlights the need for global mental health strategies and supportive organizational cultures for nurses. Addressing punitive environments and systemic factors through policy changes can improve nurse well-being and patient care quality. Creating safer environments not only benefits nurses but also enhances the quality and safety of patient care, ultimately driving the provision of better healthcare services.

Keywords: Health service management; clinical errors; nursing; patient safety; stress; workforce issues.

FIGURE 1

PRISMA flow diagram of the screening process.