A sequential exploratory mixed methods study of midwives’ experiences after making an error in clinical practice.

Introduction

Maternity services are under scrutiny in the United Kingdom. The experiences and support needs of midwives in England who had made errors in practice, and the potential impact on practice and safety were unknown until this study was conducted. This thesis explores the experiences of midwives who had made errors, framing experiences through the lens of the second victim.

Methods

A narrative literature review provides a foundational overview of the current literature and determines the significance of the matter of safety in healthcare and more specifically the context of safety and errors in midwifery practice. The establishment of a gap in the extant research lay the groundwork for the research and the main methodologies previously used in the research were explored and this determined and justified a focused research proposal and this research.

A two-phase sequential exploratory mixed methods study was conducted. The first phase included a qualitative descriptive study utilising semi-structured face to face interviews with midwives who had experienced making an error in practice using purposive sampling. Thematic data analysis with an inductive approach was used to analyse the data. The second phase employed a questionnaire based on the first phase to a wider sample of midwives in England. Descriptive and inferential statistics were used to analyse data using SPSS version 25.0.

Results

Using the data generated from the study (phase 1, 15 midwives and phase 2, 513 midwives), the midwife as a second victim was established and a support mechanism for midwives was generated. The findings of this study provide essential insights into midwives’ experiences following errors in clinical practice, with implications for clinicians, providers, managers, and policy makers to improve safety in healthcare in England. Midwives experience the second victim phenomenon following the making of an error which was unknown previously, experiencing both physical and psychological symptoms. Midwives’ experience is bound up with self-blame, blame from others and perceived blame. Frameworks that describe the experiences and support required to recover from being a second victim midwife, have been developed.

Conclusion

The study provides a view of the experiences of midwives in England following making an error in practice, locating midwives as professionals who can become second victims. It showed insights into the emotional and professional impact of errors on midwives. The findings highlighted the need to address the blame and symptoms in midwives following errors that could impact safety. It shows the necessity for a new model of support for midwives that is grounded in the evidence.