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Error in Intensive Care: Psychological Repercussions and Defense Mechanisms Among Health Professionals

Laurent, Alexandra PhD; Aubert, Laurence MSc; Chahraoui, Khadija PhD; Bioy, Antoine PhD; Mariage, André PhD; Quenot, Jean-Pierre MD, PhD; Capellier, Gilles MD, PhD

doi: 10.1097/CCM.0000000000000508
Clinical Investigations

Objective: To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error.

Design: Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis.

Setting: Two ICUs in the teaching hospitals of Besançon and Dijon (France).

Subjects: Fourteen professionals in intensive care (20 physicians and 20 nurses).

Interventions: None.

Measurements and Main Results: We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of error in ICU. The interviews were transcribed and analyzed thematically by three experts. In the month following the error, the professionals described feelings of guilt (53.8%) and shame (42.5%). These feelings were associated with anxiety states with rumination (37.5%) and fear for the patient (23%); a loss of confidence (32.5%); an inability to verbalize one’s error (22.5%); questioning oneself at a professional level (20%); and anger toward the team (15%). In the long term, the error remains fixed in memory for many of the subjects (80%); on one hand, for 72.5%, it was associated with an increase in vigilance and verifications in their professional practice, and on the other hand, for three professionals, it was associated with a loss of confidence. Finally, three professionals felt guilt which still persisted at the time of the interview. We also observed different defense mechanisms implemented by the professional to fight against the emotional load inherent in the error: verbalization (70%), developing skills and knowledge (43%), rejecting responsibility (32.5%), and avoidance (23%). We also observed a minimization (60%) of the error during the interviews.

Conclusions: It is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional’s capacity to acknowledge and disclose his/her error and to learn from it.

Supplemental Digital Content is available in the text.

1Laboratory of psychology EA 3188, University of Franche-Comte, Besancon, France.

2Laboratory LPPM EA 4452, University of Bourgogne, Dijon, France.

3Intensive Care Units, Teaching Hospital, Dijon, France.

4Intensive Care Units, Teaching Hospital, Besançon, France.

5Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

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Supported, in part, by grants from the French Intensive Care Society (SRLF) and the region of Franche-Comté.

Dr. Laurent, Ms. Aubert, Dr. Chahraoui, Dr. Bioy, Dr. Mariage, Dr. Quenot, and Dr. Capellier’s institutions received grant support from SRLF Société de réanimation en langue française.

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