EVALUATING COPING RESPONSES OF PEDIATRIC ONCOLOGY NURSES AS SECOND VICTIMS
Background: Medication administration is a task centrally embedded in nursing practice thereby placing nurses at significant risk for experiencing errors and becoming second victims to the error events. Although a systematic literature review established that nurses experience emotional, physical, psychological distress effects following error events, there is limited evidence describing nurses’ coping behaviors upon experiencing medication errors. Coping is identified as a person’s continual process of cognitively and behaviorally attempting to deal with internal and external sources of stress. Classification of coping responses include (a) adaptive or problem-focused coping, in which the aim is to solve the problem or alter the source of stress, and (b) maladaptive or emotion-focused coping, which aims to manage or mitigate the emotional distress caused by the source of stress.
Methods: This study employed a descriptive, non-experimental, quantitative survey instrument comprised of (a) the 28-item Brief COPE inventory to assess participants’ coping responses to medication error events, and (b) a list of ten support mechanisms available within the clinical site. Of the 115 direct-care pediatric oncology nurses employed in a Rocky Mountain region tertiary care facility, 82 were invited to participate in the study and 66 completed the survey instrument (80.5% response rate). Data was analyzed using descriptive and correlational statistics for coping responses and preferred support interventions.
Results: Nurses’ adaptive coping responses prevail over maladaptive reactions. The majority of participants report using adaptive and problem-focused coping responses when faced with stressful situations, such as medication errors, by using Active Coping, Planning, Use of Instrumental Support, Acceptance, and Positive Reframing. Conversely, participants report using maladaptive and emotion-focused coping mechanisms less frequently in the form of Venting, Self-Distraction, Substance Use, Behavioral Disengagement, and Denial. Participants report minimal use of Humor as a coping response, which may be attributed to its close alignment with other maladaptive coping mechanisms such as Denial and Venting. Participants identify timely and empathetic conversations with peers (71%), family (58%), and supervisors (26%) as optimal sources of emotional and psychological support following medication error events. Participants’ preference to talk about their medication errors with family as a source of emotional and psychological support is supported through a slightly positive, statistically significant correlation with Use of Emotional Support as a coping response (r = .24, p = .05).
Implications: Nurses’ coping abilities relate to their perceptions of the medication error experience and their subsequent emotional and physical reactions. Nurses as second victims to medication errors are at risk for experiencing distress effects leading to burnout and job turnover. Understanding pediatric oncology nurses’ coping behaviors can facilitate nurse leaders in providing effective post-event support for nurses as second victims.