Jonathan D. Burlison

The Second Victim Experience and Support Tool: Validation of an Organizational Resource for Assessing Second Victim Effects and the Quality of Support Resources.

Objectives Medical errors and unanticipated negative patient outcomes can damage the well-being of health care providers. These affected individuals, referred to as “second victims,” can experience various psychological and physical symptoms. Support resources provided by health care organizations to prevent and reduce second victim–related harm are often inadequate. In this study, we present the development and psychometric evaluation of the Second Victim Experience and Support Tool (SVEST), a survey instrument that can assist health care organizations to implement and track the performance of second victim support resources. Methods The SVEST (29 items representing 7 dimensions and 2 outcome variables) was completed by 303 health care providers involved in direct patient care. The survey collected responses on second victim–related psychological and physical symptoms and the quality of support resources. Desirability of possible support resources was also measured. The SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis. Results Confirmatory factor analysis results suggested good model fit for the survey. Cronbach &agr; reliability scores for the survey dimensions ranged from 0.61 to 0.89. The most desired second victim support option was “A respected peer to discuss the details of what happened.” Conclusions The SVEST can be used by health care organizations to evaluate second victim experiences of their staff and the quality of existing support resources. It can also provide health care organization leaders with information on second victim–related support resources most preferred by their staff. The SVEST can be administered before and after implementing new second victim resources to measure perceptions of effectiveness.

Comparison of Three ADHD Screening Instruments in College Students of Varying Cognitive Ability

Objective: To assess three of the better known screeners for Attention Deficit/Hyperactive Disorder (ADHD) and review the relationship between ADHD and cognitive ability. Method: The three ADHD screeners were administered to 111 college students enrolled in a college Introductory Psychology class, on whom ACT scores and total course performance were also available. As a measure of cognitive ability, the Wonderlic Personnel Test (Wonderlic, Inc., 2000) was also administered. Furthermore, self-report data were available from participants who had been diagnosed with ADHD. The three screeners were the Adult ADHD Self-Report Scale (ASRS) (Kessler et al., 2005), the Conners’ Adult ADHD Rating Scale—Self-Report: Long Version (CAARS) (Conners, Erhardt, & Sparrow, 1999), and the Brown ADD Scales (Brown, 1996). Results: The results are discussed in terms of the scales’ reliability, as well as their relationship to academic aptitude, class performance, and their ability to identify self-reported ADHD diagnoses. Conclusion: All three screeners exhibited acceptable reliability levels. Criterion validity was demonstrated by the relationship between the CAARS’s inattention subscale and self-reported cases of ADHD. Criterion validity was also seen in the relationship found between the CAARS’s hyperactivity/restlessness subscale and the total course performance even after controlling for cognitive ability. Contrary to past research cognitive ability exhibited a weak but significant relationship with a few screeners and screener subscales.

Risk screening for ADHD in a college population: is there a relationship with academic performance?

Objective:The present study examines the relationship between self-reported levels of ADHD and academic outcomes, as well as aptitude. Method: A total of 523 college students took the Adult Self-Report Scale–Version 1.1 (ASRS-V1.1), and their scores were compared with course performance and ACT (American College Test) composite scores. Results: The measure identified 70 students (13.4%) as being in the “highly likely” category for an ADHD diagnosis. Course exam and ACT scores for the 70 “highly likely” students were statistically identical to the remaining 453 students in the sample and the 77 students identified as “highly unlikely” as well. Only 4 of the “highly likely” 70 students were registered with the university’s Office of Student Disability Services as having been diagnosed with ADHD. Conclusions: The ASRS-V1.1 failed to discriminate academic performance and aptitude differences between ADHD “highly likely” and “highly unlikely” individuals. The use of self-report screeners of ADHD is questioned in contexts relating ADHD to academic performance.

Development of the just culture assessment tool: measuring the perceptions of health-care professionals in hospitals.

Objectives Given the growing support for establishing a just patient safety culture in health-care settings, a valid tool is needed to assess and improve just patient safety culture. The purpose of this study was to develop a measure of individual perceptions of just culture for a hospital setting. Methods The 27-item survey was administered to 998 members of a health-care staff in a pediatric research hospital as part of the hospital’s ongoing patient safety culture assessment process. Subscales included balancing a blame-free approach with accountability, feedback and communication, openness of communication, quality of the event reporting process, continuous improvement, and trust. The final sample of 404 participants (40% response rate) included nurses, physicians, pharmacists, and other hospital staff members involved in patient care. Confirmatory factor analysis was used to test the internal structure of the measure and reliability analyses were conducted on the subscales. Results Moderate support for the factor structure was established with confirmatory factor analysis. After modifications were made to improve statistical fit, the final version of the measure included 6 subscales loading onto one higher-order dimension. Additionally, Cronbach &agr; reliability scores for the subscales were positive, with each dimension being above 0.7 with the exception of one. Conclusions The instrument designed and tested in this study demonstrated adequate structure and reliability. Given the uniqueness of the current sample, further verification of the JCAT is needed from hospitals that serve broader populations. A validated tool could also be used to evaluate the relation between just culture and patient safety outcomes.

The Effects of the Second Victim Phenomenon on Work-related Outcomes: Connecting Self-reported Caregiver Distress to Turnover Intentions and Absenteeism

OBJECTIVES Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim-related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes. METHODS A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression. The tool assesses organizational support, distress due to patient safety event involvement, and work-related outcomes. RESULTS Second victim distress was significantly associated with turnover intentions (P < 0.001) and absenteeism (P < 0.001), while controlling for the effects of demographic variables. Organizational support fully mediated the distress-turnover intentions (P < 0.05) and distress-absenteeism (P < 0.05) relationships, which indicates that perceptions of organizational support may explain turnover intentions and absenteeism related to the second victim experience. CONCLUSIONS Involvement in patient safety events and the important role of organizational support in limiting caregiver event-related trauma have been acknowledged. This study is one of the first to connect second victim distress to work-related outcomes. This study reinforces the efforts health care organizations are making to develop resources to support their staff after patient safety events occur. This study broadens the understanding of the negative effects of a second victim experience and the need to support caregivers as they recover from adverse event involvement.

A Multilevel Analysis of U.s. Hospital Patient Safety Culture Relationships With Perceptions of Voluntary Event Reporting

Objectives Patient safety events offer opportunities to improve patient care, but, unfortunately, events often go unreported. Although some barriers to event reporting can be reduced with electronic reporting systems, insight on organizational and cultural factors that influence reporting frequency may help hospitals increase reporting rates and improve patient safety. The purpose of this study was to evaluate the associations between dimensions of patient safety culture and perceived reporting practices of safety events of varying severity. Methods We conducted a cross-sectional survey study using previously collected data from The Agency for Healthcare Research and Quality Hospital Survey of Patient Safety Culture as predictors and outcome variables. The dataset included health-care professionals in U.S. hospitals, and data were analyzed using multilevel modeling techniques. Results Data from 223,412 individuals, 7816 work areas/units, and 967 hospitals were analyzed. Whether examining near miss, no harm, or potential for harm safety events, the dimension feedback about error accounted for the most unique predictive variance in the outcome frequency of events reported. Other significantly associated variables included organizational learning, nonpunitive response to error, and teamwork within units (all P < 0.001). As the perceived severity of the safety event increased, more culture dimensions became significantly associated with voluntary reporting. Conclusions To increase the likelihood that a patient safety event will be voluntarily reported, our study suggests placing priority on improving event feedback mechanisms and communication of event-related improvements. Focusing efforts on these aspects may be more efficient than other forms of culture change.