How does just culture reduce negative work outcomes through second victim distress and demand for support in clinical nurses? A path analysis

• DOI: 10.1186/s12912-025-02685-x
• Publication Date: 2025-02-19T11:39:46Z
• Authors: Seohee Jeong; Sunmi Kim; Hyoung Eun Chang; Seok Hee Jeong
• Keywords: Patient safety; Research; RT1-120; Nurses; Organizational culture; Nursing; Medical error; Hospitals

BACKGROUND: Second victim experiences of nurses are a critical issue in healthcare. In addition to causing psychological and emotional distress to nurses, second victim experiences can adversely affect organizational performance and overall patient safety. PURPOSE: This study aimed to determine effects of perceived just culture of medical institutions on second victim experiences of nurses after patient safety incidents. METHODS: This was a cross-sectional correlational study. Data were collected from 183 clinical nurses in tertiary general hospitals between December 28, 2022 and January 14, 2023 using an online self-report questionnaire. The questionnaire included items from Just Culture Assessment Tool (JCAT) and Korea-Second Victim Experience and Support Tool (K-SVEST). A hypothetical model was established and tested. Data were analyzed using SPSS WIN 23.0 and AMOS 23.0 programs. RESULTS: The hypothesized model was found to be statistically fit (normed χ(2) /df = 2.53; root mean square error of approximation = 0.09; comparative fit index = 0.99; Tucker-Lewis index = 0.97; normed fit index = 0.99). Eight hypothesized pathways were tested, of which five direct effect pathways and three indirect effect pathways were statistically significant. Just culture had a significant effect on second victim distress (β = -0.29, p = 0.001) and demand for support (β = -0.65, p = 0.001). Second victim distress had a significant effect on demand for support (β = 0.14, p = 0.025) and negative work-related outcomes (β = 0.66, p = 0.001). Demand for support had a significant effect on negative work-related outcomes (β = 0.18, p = 0.010). CONCLUSIONS: This study demonstrated that a just culture in medical institutions could ameliorate second victim experiences of nurses involved in patient safety incidents. Implementing systemic interventions is a key imperative to establish a just culture in medical institutions, mitigate second victim experiences, and improve organizational performance. CLINICAL TRIAL NUMBER: Not applicable.