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Action after Adverse Events in Healthcare: An Integrative Literature Review

Department of Nursing Science/Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
South Karelia Social and Health Care District, 53130 Lappeenranta, Finland
Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
Faculty of Health Care & Social Services, LAB University of Applied Sciences, 53850 Lappeenranta, Finland
Research Center for Child Psychiatry, University of Turku, 20500 Turku, Finland
Clinical Development, Education and Research Unit of Nursing (CDERUN), Kuopio University Hospital, 70210 Kuopio, Finland
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(13), 4717;
Received: 7 May 2020 / Revised: 23 June 2020 / Accepted: 24 June 2020 / Published: 30 June 2020
Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed. View Full-Text
Keywords: patient safety; adverse events; first victims; second victims; third victims; management patient safety; adverse events; first victims; second victims; third victims; management
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Liukka, M.; Steven, A.; Vizcaya Moreno, M.F.; Sara-aho, A.M.; Khakurel, J.; Pearson, P.; Turunen, H.; Tella, S. Action after Adverse Events in Healthcare: An Integrative Literature Review. Int. J. Environ. Res. Public Health 2020, 17, 4717.

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