A Qualitative Study on Support-Seeking Among Chinese Head Nurses: Explorations Under the Authority Role

A Qualitative Study on Support-Seeking Among Chinese Head Nurses: Explorations Under the Authority Role | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Qualitative Study on Support-Seeking Among Chinese Head Nurses: Explorations Under the Authority Role Cuiling Zhang, Jun Liang, Yali Liang, Tianshu Jiang, Xiaohong Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8851480/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Head nurses are often confronted with multifaceted challenges when managing patient safety incidents. However, the ways in which they navigate the process of seeking support remain insufficiently explored. This study explores Chinese head nurses’ support-seeking experiences during incident management, aiming to clarify their dilemmas and inform supportive strategies. Method A descriptive phenomenological design, following Colaizzi’s method, was employed. Purposive sampling was used to recruit 15 head nurses from Shanxi Bethune Hospital, all with direct experience in managing patient safety incidents. Data were collected through in-depth, semi-structured face-to-face interviews until thematic saturation was achieved. The analysis rigorously adhered to Colaizzi’s seven-step framework to ensure a faithful exploration of participants’ lived experiences. Result Based on the interview content, three themes and eleven sub-themes were identified: Theme 1: Multiple Constraints Under the Authority Role (Sub-themes: Conflicting perceptions of responsibility in the head nurse role; Overburdening emotional labour induced by the authority role; Shared vulnerability under pressure); Theme 2: The Contradictory Evolution of Support-Seeking Practices (Sub-themes: Urgent seeking of professional and logistical support; Seeking emotional support through virtual peer communities; Silent seeking of upward support; Emerging digital support seeking); Theme 3: Multidimensional Support System Needs Amid Silence (Sub-themes: Multidimensional safeguarding needs; Efficient cross-departmental collaboration needs; AI-empowered decision support needs). These findings were ultimately summarised as “Explorations Under the Authority Role.” Conclusion This study found that head nurses’ support-seeking behaviour following safety incidents evolves through contradictory stages, wherein an urgent need for support coexists with a state of silent upward support-seeking. In response to these findings, we appealed to healthcare institutions to establish communication management platforms incorporating peer-based emotional support mechanisms, develop multidimensional management training programmes utilising virtual reality scenario simulations, and advance the intelligentisation of safety incident management systems alongside third-party professional intervention. These measures may foster a systematic support framework to safeguard nursing managers when addressing safety incidents. Head Nurse Patient Safety Incident Support-Seeking Nursing Management Qualitative Research Background Patient safety incidents (PSIs) exhibit a high incidence rate across global healthcare systems, affecting about 10% of hospitalised patients, with 15% of these incidents resulting in serious harm [ 1 ]. Scholar Wu [ 2 ] first termed patients and their families harmed in safety incidents as primary victims in 2000, while healthcare professionals who suffer psychological trauma due to professional responsibility and emotional involvement were designated as secondary victims. As frontline clinical managers, head nurses serve both as the “primary responsible parties” for incident response and as the “direct bearers” of trauma [ 3 ]. Qualitative research by Chinese scholar Zhang [ 3 ] on head nurses as secondary victims revealed widespread anxiety following PSIs, yet effective support was seldom sought. According to role boundary theory [ 4 ], healthcare organisations’ expectations for head nurses to exercise “authoritative leadership” create a structural conflict with their individual emotional needs, compelling them to conceal stress and anxiety to maintain professional authority [ 5 ]. If unaddressed, this contradiction triggers cascading negative effects from the individual to the system. Long-term emotional suppression among head nurses significantly heightens the risk of post-traumatic stress disorder (PTSD) and occupational burnout, impairing decision-making capacity and mental wellbeing [ 6 ]. Concurrently, emotional isolation may erode team cohesion, exacerbate a “culture of silence,” and increase turnover rates. Estimates indicate that head nurse turnover stands at 5.8% in the UK, 12.8% in the US, and as high as 15–25% in Asian nations such as Indonesia and South Korea [ 7 – 11 ]. If unchecked, this high attrition directly compromises patient safety. Frequent turnover in nursing management creates gaps in clinical expertise, inconsistent implementation of quality control standards, and decreased team cohesion. Such managerial instability translates into potential risks for patient care quality, including weakened supervision of nursing processes, reduced adherence to safety protocols, and lower efficiency in responding to adverse events. This ultimately fosters a vicious cycle of psychological trauma, talent attrition, and safety vulnerabilities. The global Patient Safety Action Network explicitly incorporated “second victim psychological support” into healthcare institution accreditation standards in 2021, mandating the establishment of non-punitive incident reporting systems (IPSAN, 2021) [ 12 ]. China’s health authorities have likewise advocated “attention to healthcare workers’ occupational mental health” [ 13 ], yet practical implementation still lacks specialised support programmes for managers. This disconnect between policy and practice urgently requires empirical research to uncover head nurses’ genuine needs, thereby informing institutional improvement. This study therefore employs a qualitative, descriptive phenomenological approach using face-to-face semi-structured interviews to explore head nurses’ authentic inner experiences when seeking support following patient safety incidents. The findings are intended to inform further support provision for head nurses. Participants and Methods Purposeful Sampling Purposeful sampling was employed, using a maximum variation strategy to select head nurses from Shanxi Bethune Hospital in China as research participants. Inclusion criteria were defined as: (1) head nurses whose departments had experienced patient safety incidents; (2) head nurses willing and able to fully articulate their genuine experiences and feelings; (3) nurses who signed an informed consent form. Exclusion criteria included: (1) head nurses from non-clinical departments; (2) head nurses currently undergoing further training. The sample size followed the principle of information saturation, whereby interviews continued until no new themes emerged. Ultimately, 15 head nurses completed the interviews. Data Collection Methodology As the experiences, attitudes, and support-seeking needs of head nurses as secondary victims are abstract and difficult to quantify, qualitative research was considered the most appropriate approach for exploring intrinsic experiences, attitudes, and beliefs. Accordingly, qualitative methods were employed to understand head nurses’ authentic inner experiences of seeking support after patient safety incidents. Data were collected using semi-structured interviews. Drawing upon a review of recent literature on secondary victim experiences in patient safety incidents and head nurses’ support-seeking behaviours, combined with cognitive behavioural theory, stress and coping theory, and social support theory [ 14 – 19 ], an interview outline was developed. This outline underwent pre-interview testing, and modifications were made based on preliminary findings to finalise the interview guide. The semi-structured outline was developed specifically for this study. The full outline is available as a supplementary file (see Supplementary File 1: Interview Outline). The study was conducted by two researchers: a ward manager who had personally experienced a patient safety incident and a senior nurse responsible for analysing and organising patient safety incident data at the hospital. Both researchers had prior involvement in patient safety incident management, had published related papers [ 3 ], and had participated in qualitative research workshops. Prior to conducting interviews, the first author, acting as the researcher, explained the study objectives and confidentiality commitments to participants. Following informed consent, demographic data collection and interviews were conducted. Identifiers were substituted for real names to ensure data anonymity. Interviews were conducted face-to-face in quiet and comfortable private rooms. Mobile phones were used to record interviews, supplemented by notes and field observations. Interview duration ranged from 30 to 60 min, with an average of 45 min. The interview outline included the following questions: (1) Please recall a patient safety incident you personally experienced. Describe your handling process and inner feelings at the time. (2) Following the incident, whom or which channels did you approach for assistance? Why did you consider these the most appropriate options? (3) What concerns might you have had when seeking support? Could you illustrate these with specific examples? (4) Have you ever expressed stress during departmental meetings or similar settings, and how did such expression affect your working relationships? (5) If asked to design a support system for nursing managers, what features would genuinely address your pain points? Data Analysis Methodology Data analysis employed Colaizzi’s phenomenological approach [ 20 ], and, considering the impact of language translation on coding accuracy, interviews were coded in Chinese. Within 24 h after each interview, one researcher transcribed the audio recordings into text, while another researcher conducted cross-checking. Two researchers then performed independent coding. Through careful and repeated reading of the transcripts, combined with field notes taken during the interviews, they gained an overall familiarity with the research content. Subsequently, the transcripts were read sentence by sentence, and recurring expressions relevant to head nurses’ support-seeking experiences were extracted into Word documents to prepare for further coding. Recurring sentences were coded to construct meaning units. All meaning units were examined and synthesised into preliminary themes (sub-themes). Each preliminary theme was defined and described with reference to original statements. Similar preliminary themes were compared and integrated into final themes. These themes were then returned to the interviewees for verification of authenticity; if discrepancies arose, the process reverted to the initial step. To ensure coding consistency, cross-checking was conducted after independent coding. The coding results of the two researchers were compared, and discussions were held to resolve discrepancies and reach consensus. If consensus could not be achieved, a third researcher was invited to assist in resolving coding differences by providing neutral perspectives and recommendations. After completion of all coding procedures, the data were translated into English using specialised software and subsequently refined by an expert with English editing experience. Results General Characteristics of Study Participants A total of 15 head nurses (3 males and 12 females) participated in this study, and the general characteristics of the participants are presented in Table 1 . General participant information disclosures have been anonymised and obtained with participants' written informed consent before the publication. Table 1 General information on the study participants ( n = 15) Number Gender Age Education attainment Title Years of Management Experience N1 Female 35–40 Undergraduate Associate Chief 5 N2 Female 40–45 Undergraduate Associate Chief 17 N3 Female 50–55 Undergraduate Associate Chief 14 N4 Female 40–45 Undergraduate Associate Chief 6 N5 Female 40–45 Undergraduate Supervisor 6 N6 Male 35–40 Undergraduate Supervisor 1 N7 Female 40–45 Undergraduate Associate Chief 20 N8 Female 40–45 Postgraduate Associate Chief 13 N9 Female 40–45 Undergraduate Associate Chief 4 N10 Female 35–40 Undergraduate Associate Chief 3 N11 Female 40–45 Undergraduate Associate Chief 5 N12 Female 45–50 Postgraduate Associate Chief 2 N13 Male 40–45 Postgraduate Supervisor 5 N14 Male 40–45 Undergraduate Supervisor 5 N15 Female 35–40 Undergraduate Supervisor 4 Key Themes Analysis of the interview data yielded three themes and eleven sub-themes. The experiences and needs of head nurses as secondary victims seeking support after patient safety incidents were synthesised into the overarching theme “Explorations Under the Authority Role,” as shown in Table 2 . Table 2 Thematic coding of head nurses' support-seeking experiences following safety incidents Themes Subthemes Units Multiple Constraints Under the Authority Role Conflicted Perceptions of Responsibility Making it feel as though everything is my fault as if the entire department's affairs are your responsibility the head nurse is often held accountable Authority Role Inducing Exhaustive Emotional Labour I must maintain emotional stability I generally do not display my stress only adds to others' burdens Shared Vulnerability Under Pressure hope my stress can serve as motivation for nurses helping nurses understand and empathise The Contradictory Evolution of Support-Seeking Practices The Urgent Reality of Professional and Logistical Support Seeking contacted numerous places Consult the head nurse and physicians of the Nephrology ICU Consult with the respiratory nurse manager and physician For review by the ICU Head Nurse Seeking Emotional Support from Virtual Peer Communities Exchanging ideas in a WeChat group Codenames, private complaints (Nursing Department) The Status Quo of Silent Upward Support-Seeking realized I may not have expressed myself very clearly Considering direct requests for assistance as bypassing proper channels meeting them makes me feel rather intimidated focused on assigning blame Emergence of Digital Support-Seeking chat with Deepseek posted anonymously on Zhihu website seeking advice scroll through videos Multidimensional Support System Needs Amid Silence Multidimensional Support System Needs Clear problem feedback mechanisms and processes are required Requires an open, inclusive safety culture (environment) Third-party involvement may prove beneficial Assist in reconstructing incident sequences Requirements for Efficient Cross-Departmental Collaboration no buck-passing Complete the (assistance application) right by the bedside immediately activate relevant personnel support. AI-Empowered Decision Support Requirements AI systems analysing and guiding All regulations are uniformly categorized within a single mini-program A repository of successful case solutions would be beneficial system could provide key information Theme 1: The Multiple Constraints Under the Authority Role As team leaders, head nurses face substantial pressure. Multiple factors contribute to ambiguity regarding responsibility attribution during incidents. At the same time, role expectations requiring them to remain composed, professional, and authoritative prompt head nurses to regulate their emotions excessively to align with managerial norms, thereby intensifying emotional labour depletion. Under such pressure, head nurses tend to prioritise building emotional connections with nurses to strengthen the organizational safety climate. Conflicted Perceptions of Responsibility in the Head Nurse Role When confronting safety incidents, head nurses are required to manage the situation and assume managerial responsibility. However, interviews indicated that even in incidents not directly related to nursing practice, patients and families often direct blame toward the head nurse. Coupled with misunderstanding from physicians and healthcare management bodies, this situation creates a practical dilemma in which the boundaries of head nurses’ responsibility become blurred, resulting in conflicted perceptions of accountability. N4: This also relates to our management practices, indicating inadequacies in oversight. Doctors lack understanding, which makes it feel as though everything is my fault. N5: While doctors may also be at fault, this still falls within your core responsibilities. As the person in this role, you must fulfil these duties; you cannot simply refuse. N9: Whether you are on duty or off, as if the entire department's affairs are your responsibility. N11: When adverse events occur, patients' families naturally blame towards the head nurse. Even in severe liability incidents where nursing may bear little or no direct responsibility, the head nurse is often held accountable. Authority Role Inducing Exhaustive Emotional Labour Several interviewees reported varying degrees of pronounced personal stress following patient safety incidents. Nevertheless, given their role as head nurses, they tended to refrain from displaying such stress in public contexts. N3: I must maintain emotional stability. The responsibilities of a head nurse are extremely heavy, and I also need to protect the nurses. N6: Everyone experiences pressure. Talking about it openly solves nothing and only adds to others’ burdens. N10: I generally do not show my stress, because if the head nurse constantly expresses it, the nurses will have even less motivation to remain positive. Shared Vulnerability Under Pressure Regarding stress management among head nurses as secondary victims, some interviewees indicated that, under intense pressure, they deliberately choose to disclose their stress to nurses. They believed that this approach could help establish emotional connections with nursing staff and thereby improve the organisational safety culture. N1: I hope my stress can also motivate nurses to standardise their operational practices. It is meant to encourage them and serve as a reminder that similar incidents should not recur. N2: I share some of my stress by talking about my own experiences. This helps nurses understand and empathise. N5: Appropriately revealing stress to build resonance with nurses serves one purpose: to show that we are all on the same front line. N8: I think it can promote a sense of mutual empathy among us. Theme 2: The Contradictory Evolution of Support-Seeking Practices The complex dilemmas encountered by head nurses when managing patient safety incidents often generate multiple unmet support needs. Interviews revealed that their support-seeking behaviours evolve in an internally contradictory manner: during the incident response phase, emphasis is placed on professional and resource-based support; during the stress adaptation phase, attention shifts toward emotional support; yet during the system improvement phase, behaviours show a notable transition from proactive expression to strategic silence. At the same time, the interviews indicated emerging trends toward artificial intelligence-based support-seeking methods, driven by ongoing digital advancements. The Urgent Reality of Professional and Logistical Support Seeking To achieve rapid problem resolution and stabilise patients and families, most interviewees reported actively seeking support from relevant specialists. N2: We summoned the neurosurgery consultant for assessment, coordinated with logistics, and contacted medical services. We contacted numerous departments. Eventually, we reached the senior on-call officer and even the president on duty. N3: After the incident, I consulted head nurses and doctors from Nephrology and the Critical Care ICU regarding possible consequences for the patient. N9: I consulted both the head nurse and doctors from the respiratory department. After finalizing the video script, I first showed it to the respiratory head nurse. Following filming, I then asked both the respiratory head nurse and the ICU head nurses to assist with the review. Seeking Emotional Support from Virtual Peer Communities When confronting and managing patient safety incidents, ward managers may find limited understanding and support within their departmental work environment. As a result, ward managers in similar roles and situations tend to seek communication with peers, with virtual peer communities serving as relatively safe emotional outlets. N2: We all have our own small groups where we exchange ideas with each other. N12: A few of us younger ones set up a WeChat group called “Gripe Squad” to offer advice when needed. N13: We use coded language among ourselves to vent privately and release tension. The Status Quo of Silent Upward Support-Seeking Constrained by traditional perceptions and after weighing costs against benefits, most head nurses as secondary victims indicated that they would not seek support from senior management or would discontinue such attempts. N5: There may be reservations, such as whether I have expressed myself clearly enough, and I might also worry about disturbing the manager. N8: The manager might interpret directly requesting assistance from the Nursing Department as bypassing the chain of command. N12: I simply could not bring myself to seek support from management. Honestly, meeting them makes me feel intimidated, so I prefer to avoid them. N4: Some managers place me under immense pressure because they tend to reprimand you. N10: Management might conclude that the ward manager is failing in their duties, resulting in reprimands or formal criticism. N13: Most managers focus primarily on assigning blame, and few provide genuine help or support. Seeking assistance feels futile. N13: Leaving a negative impression could jeopardise my future promotion opportunities. Emergence of Digital Support-Seeking With advances in the AI era, nursing supervisors are moving beyond traditional communication methods and experimenting with large-scale data platforms to seek support. N3: Now we have Deepseek. I occasionally chat with it, and it is quite helpful. N6: I once posted anonymously on the Zhihu website to seek advice, which allowed me to see others’ suggestions. N13: I scroll through videos and give likes to good advice or relatable content, but I rarely comment because I worry about others seeing it. N14: Occasionally, I consult the literature, as it is quick and reliable. Theme 3: Multidimensional Support System Requirements Beneath the Silence Among the interviewed head nurses, experiences in managing patient safety incidents, ranging from feedback channels to organisational support systems, generated related suggestions and perspectives. These were summarised as multidimensional safeguards, seamless communication and collaboration across hospital departments, and expectations for AI-driven, evidence-based nursing decision support to provide more rational recommendations. Multidimensional Support System Needs Managing patient safety incidents often requires multi-departmental coordination and multidimensional safeguards. These include hospital safety culture and issue feedback mechanisms or processes, logistics departments, third-party insurance providers, and information technology platforms. N6: Clear problem feedback mechanisms and processes are required. N7: An open and inclusive safety culture is needed. N8: Third-party involvement may be beneficial in resolving these issues. N10: Assistance is needed to reconstruct incident sequences, facilitate analysis, and identify improvement pathways while maintaining confidentiality. N11: Purchasing insurance coverage is advisable, along with support from the hospital’s legal department. Requirements for Efficient Cross-Departmental Collaboration Cross-departmental coordination during incident management is often characterised by inefficiency and repetitive communication. The interviewed head nurses expressed a clear need for more efficient cross-departmental collaboration. N2: Immediate feedback is essential, without buck-passing that leaves us repeatedly negotiating over the same issue. N9: Could I complete the assistance application right at the bedside? It is a very simple procedure. N13: Overly complex procedures should be avoided. When issues arise, a single phone call or system click should immediately activate relevant personnel support. AI-Empowered Decision Support Requirements Traditional management decisions rely heavily on the fragmented personal experience of ward managers, which may lead to biased or inaccurate judgements. With the increasing application of AI, ward managers expressed a desire to use intelligent platforms that integrate scientific management tools with evidence-based expertise to support patient safety incident management. N1: Given the current level of AI development, could AI systems analyse problems and guide resolution in the next step? N5: All regulations and newly issued directives could be categorised and integrated into a single application, enabling ward managers to access and implement them easily. N8: A repository of successful case solutions would be particularly valuable, allowing direct application of prior experiences. N9: Such a system could provide key information for continuous review and learning, enabling access to knowledge when support is needed. N10: The electronic system should incorporate continuous online supervision functions. Discussion Research indicates that ward head nurses encounter multiple difficulties and challenges during patient safety incidents. In response to their urgent yet often unspoken need for support, this study proposes potential systematic improvement strategies for consideration by healthcare management. Establishing A Multifaceted Support System for Head Nurses as Secondary Victims, Balancing Emotional Counselling with Managerial Support This study found that head nurses who experience patient safety incidents as secondary victims are prone to excessive emotional regulation behaviours, particularly emotional labour burnout, which in turn increases emotional exhaustion. Previous research has documented role overload and role conflict among head nurses arising from their multiple responsibilities [ 21 ]. This is consistent with the present findings. Accordingly, senior management should prioritise addressing the emotional constraints faced by head nurses as secondary victims. Hospital administrators are encouraged to recognise their emotional exhaustion, foster a non-blaming organisational culture, streamline reporting procedures, and provide emotional support through structured peer support systems. Current peer support systems for secondary victimisation among nurses primarily emphasise emotional reassurance and stress relief for frontline clinical nurses, while failing to offer equivalent emotional release and management stress-coping support at the head nurse managerial level [ 22 ]. China’s hospital governance structure places nursing departments in a unified command position over head nurses across clinical departments. This hierarchical management system imposes substantial pressure on head nurses and may contribute to a “silent” response toward nursing department management [ 23 ]. This study further found that head nurses tend to alleviate emotional stress through virtual peer communication. The peer effect can transform individual risks into collective consensus through a process of “de-individualisation” [ 24 ]. This peer effect may be leveraged in nursing management by establishing a formal communication body for head nurses, mediated by a third-party agent. Through peer-to-peer interaction, a collective cognitive consensus among head nurses can be formed efficiently, after which the third party can engage in upward communication with the Nursing Department, thereby achieving upward communication management through a collective bargaining mechanism. Developing A Virtual Reality-Based Scenario Training and Emergency Response Enhancement Programme for Head Nurse Management In China, head nurses are predominantly selected from among clinical nursing specialists, and most have not received systematic or standardised training in management, psychology, or organisational studies that matches the demands of their role [ 25 , 26 ]. This background often results in role confusion and misalignment when confronting patient safety incidents. For example, head nurses frequently concentrate on operational details rather than optimising management processes or analysing the root causes of adverse events. When cross-departmental collaboration is required, they may also fail to clearly distinguish their responsibilities from those of other functional departments, thereby devoting excessive attention to matters beyond their remit. Concurrently, The Development Plan for China’s Nursing Profession (2021 – 2025) emphasises strengthening management training for nursing administrators to enhance managerial philosophy and capability [ 27 ]. Therefore, targeted training for head nurses is essential to improve their management competencies in addressing safety incidents. For instance, Qi et al. [ 28 ] developed a training curriculum for head nurses based on transformational leadership. Components such as emotional and stress management, effective communication, and role management may better equip head nurses to manage safety incidents. Given that the head nurse role integrates both clinical expertise and managerial responsibility, traditional training programmes have largely focused on theoretical knowledge. A review of relevant literature reveals a lack of immersive training in advanced managerial competencies, including decision-making, communication, and resource allocation in complex clinical scenarios [ 28 , 29 ]. In recent years, virtual reality technology has been widely applied in clinical skills training and has demonstrated clear advantages in enhancing procedural skills, emergency response capacity, and team collaboration [ 30 , 31 ]. When managing safety incidents, head nurses require strengthened emergency response capabilities. It is therefore recommended that management establish a scenario simulation database and conduct emergency coordination training across diverse scenarios using virtual reality technology. This approach may enhance head nurses’ rapid decision-making under pressure, cross-departmental collaboration skills, and psychological resilience. Calling for Full-Process Intelligent Management of Patient Safety Incidents and the Establishment of a Third-Party Professional Handling Agency The head nurses interviewed in this study expressed the expectation that, with continued digital advancement, the entire process of reporting patient safety incidents and conducting decision analysis could be automated. This would involve streamlined reporting through intelligent submission systems to reduce manual data entry burdens, with incidents automatically identified and forwarded to relevant management departments. To address knowledge gaps within nursing specialities and nursing management, participants expressed interest in using evidence-based AI-driven intelligent decision support systems to assist decision-making. At present, intelligent information development in nursing mainly focuses on medication management, nursing assessment documentation, and health education. Intelligent systems related to patient safety incidents remain largely limited to reporting and preliminary statistics and lack a comprehensive decision support repository that provides theoretical analysis of incident-related factors and corresponding improvement recommendations [ 32 ]. During interviews, head nurses indicated that such a system could facilitate rapid analysis and response. For non-specialist issues arising in patient safety incidents, participants also expressed a desire to draw on international experience by establishing third-party handling agencies. These agencies would possess multidisciplinary expertise, extensive legal knowledge, and systematic attribution management approaches. After an incident, the head nurse would evaluate its severity and complexity to determine whether third-party involvement is warranted. The agency would then assume responsibility for patient reassurance and communication, compensation coordination, logistical discussions, and management decision support, thereby facilitating effective resolution. Conclusion This study aims to examine the lived experiences and perceptions of head nurses regarding support-seeking during patient safety incidents, with the objective of identifying key challenges and informing potential systemic improvement strategies for healthcare management. Limitations The respondents in this study were limited to a single Grade III Class A public hospital in Shanxi, China, which may restrict sample representativeness and generalisability. Future studies could incorporate multi-centre and multi-level hospitals to capture a broader range of perspectives. In addition, the research scope may be expanded to include support providers such as nursing departments and hospital logistics departments, thereby offering further reference points for understanding head nurses’ support-seeking from diverse viewpoints. Declarations Ethics approval and consent to participate This study was approved by the Ethics Review Committee of Bethune Hospital, Shanxi, China (YXLL-2023–244) and was conducted in accordance with the Declaration of Helsinki. All methods were implemented in compliance with recommended guidelines and regulations. The purpose and significance of the research were explained to participants, and interviews were conducted only after written informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding No funding support was provided by any institution. Author Contribution All authors conceptualized the study and developed the interview guides.Cuiling Zhang designed interview outline and conducted the data collection.Tianshu Jiang, Jun Liang and Yali Liang conducted the data analysis and interpretation, aswell as drafted and revised the manuscript. Xiaohong Zhang provided critical revisions for important intellectual content. All authors reviewed and approved the manuscript. Acknowledgements Not applicable. Data Availability To access the data in this study, please contact the corresponding author. References World Health Organization. Patient safety. 2020. https://www.who.int/news-room/fact-sheets/detail/patient-safety . Accessed 6 Sep 2020. Wu AW. Medical error: The second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320:726–7. Zhang C, Yang Z, Liang Y, Feng Y, Zhang X. 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Issues Ment Health Nurs. 2025;46:2–11. Xiong K, Li J, Yang L, Zhao P, Zhang Y, Feng Z, et al. Evaluating an AI-VR escape room for disaster nursing education: A quasi-experimental study. Nurse Educ Pract. 2025;88:104529. Shen Z, Zhong Z, Ding S, Qiao L, Zhang Q. Research progress on informationization of nursing management in China. Chin J Nurs. 2020;55:397–400. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1InterviewOutline.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 17 Mar, 2026 Editor assigned by journal 16 Mar, 2026 Editor invited by journal 16 Feb, 2026 Submission checks completed at journal 14 Feb, 2026 First submitted to journal 14 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8851480","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607696805,"identity":"aa018e2b-ca2b-4faf-ae32-850588f6a8cf","order_by":0,"name":"Cuiling Zhang","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Cuiling","middleName":"","lastName":"Zhang","suffix":""},{"id":607696806,"identity":"2a5283fc-20bc-4339-b8ef-fa34ac92d604","order_by":1,"name":"Jun Liang","email":"","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Liang","suffix":""},{"id":607696807,"identity":"71ef5f36-3090-4c5c-acba-7cfa194a7634","order_by":2,"name":"Yali Liang","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yali","middleName":"","lastName":"Liang","suffix":""},{"id":607696808,"identity":"43805818-302e-48f1-b1a6-4c5847a32a44","order_by":3,"name":"Tianshu Jiang","email":"","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tianshu","middleName":"","lastName":"Jiang","suffix":""},{"id":607696809,"identity":"5a59f87d-d007-4032-8c57-0636d743bb85","order_by":4,"name":"Xiaohong Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYFACHgZmhgoJHnn2xsYHH4jXcsZGxrDncLPhDKK1MLal2TDcSG+T5iBGg/yM3GPSBWyHeRhnPmyQZmCwk9NtIKCFsedcsvEMnsM87NKJDcYFDMnGZgcIaGFm7zF8zCMBtGV2YkPyDIYDidsIaWFj5jE4DEIMNw82AEkitPCAbUlI42G4wdjYTJQWCZ4zxsYzDtjwGPYkNjPOMCDCL/IzcsykC/9J2MuzH3/+40OFnRxBLWjAgDTlo2AUjIJRMApwAADVRT3u9EqC0AAAAABJRU5ErkJggg==","orcid":"","institution":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xiaohong","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-02-11 12:09:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8851480/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8851480/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105005089,"identity":"616a77ad-0d93-4b06-bbc4-0fcfad1eb7b8","added_by":"auto","created_at":"2026-03-19 18:09:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1162993,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8851480/v1/84a15b4a-35c1-49eb-9417-d18b63dde4e9.pdf"},{"id":105005085,"identity":"afa1c547-14c1-4481-b850-cb4b353c028f","added_by":"auto","created_at":"2026-03-19 18:09:54","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15919,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1InterviewOutline.docx","url":"https://assets-eu.researchsquare.com/files/rs-8851480/v1/a94213e53fb5ff25bbd29a26.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Qualitative Study on Support-Seeking Among Chinese Head Nurses: Explorations Under the Authority Role","fulltext":[{"header":"Background","content":"\u003cp\u003ePatient safety incidents (PSIs) exhibit a high incidence rate across global healthcare systems, affecting about 10% of hospitalised patients, with 15% of these incidents resulting in serious harm [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Scholar Wu [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] first termed patients and their families harmed in safety incidents as primary victims in 2000, while healthcare professionals who suffer psychological trauma due to professional responsibility and emotional involvement were designated as secondary victims. As frontline clinical managers, head nurses serve both as the \u0026ldquo;primary responsible parties\u0026rdquo; for incident response and as the \u0026ldquo;direct bearers\u0026rdquo; of trauma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Qualitative research by Chinese scholar Zhang [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] on head nurses as secondary victims revealed widespread anxiety following PSIs, yet effective support was seldom sought. According to role boundary theory [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], healthcare organisations\u0026rsquo; expectations for head nurses to exercise \u0026ldquo;authoritative leadership\u0026rdquo; create a structural conflict with their individual emotional needs, compelling them to conceal stress and anxiety to maintain professional authority [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. If unaddressed, this contradiction triggers cascading negative effects from the individual to the system. Long-term emotional suppression among head nurses significantly heightens the risk of post-traumatic stress disorder (PTSD) and occupational burnout, impairing decision-making capacity and mental wellbeing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Concurrently, emotional isolation may erode team cohesion, exacerbate a \u0026ldquo;culture of silence,\u0026rdquo; and increase turnover rates. Estimates indicate that head nurse turnover stands at 5.8% in the UK, 12.8% in the US, and as high as 15\u0026ndash;25% in Asian nations such as Indonesia and South Korea [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. If unchecked, this high attrition directly compromises patient safety. Frequent turnover in nursing management creates gaps in clinical expertise, inconsistent implementation of quality control standards, and decreased team cohesion. Such managerial instability translates into potential risks for patient care quality, including weakened supervision of nursing processes, reduced adherence to safety protocols, and lower efficiency in responding to adverse events. This ultimately fosters a vicious cycle of psychological trauma, talent attrition, and safety vulnerabilities.\u003c/p\u003e \u003cp\u003eThe global Patient Safety Action Network explicitly incorporated \u0026ldquo;second victim psychological support\u0026rdquo; into healthcare institution accreditation standards in 2021, mandating the establishment of non-punitive incident reporting systems (IPSAN, 2021) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. China\u0026rsquo;s health authorities have likewise advocated \u0026ldquo;attention to healthcare workers\u0026rsquo; occupational mental health\u0026rdquo; [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], yet practical implementation still lacks specialised support programmes for managers. This disconnect between policy and practice urgently requires empirical research to uncover head nurses\u0026rsquo; genuine needs, thereby informing institutional improvement.\u003c/p\u003e \u003cp\u003eThis study therefore employs a qualitative, descriptive phenomenological approach using face-to-face semi-structured interviews to explore head nurses\u0026rsquo; authentic inner experiences when seeking support following patient safety incidents. The findings are intended to inform further support provision for head nurses.\u003c/p\u003e"},{"header":"Participants and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePurposeful Sampling\u003c/h2\u003e \u003cp\u003ePurposeful sampling was employed, using a maximum variation strategy to select head nurses from Shanxi Bethune Hospital in China as research participants. Inclusion criteria were defined as: (1) head nurses whose departments had experienced patient safety incidents; (2) head nurses willing and able to fully articulate their genuine experiences and feelings; (3) nurses who signed an informed consent form. Exclusion criteria included: (1) head nurses from non-clinical departments; (2) head nurses currently undergoing further training. The sample size followed the principle of information saturation, whereby interviews continued until no new themes emerged. Ultimately, 15 head nurses completed the interviews.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Methodology\u003c/h3\u003e\n\u003cp\u003eAs the experiences, attitudes, and support-seeking needs of head nurses as secondary victims are abstract and difficult to quantify, qualitative research was considered the most appropriate approach for exploring intrinsic experiences, attitudes, and beliefs. Accordingly, qualitative methods were employed to understand head nurses\u0026rsquo; authentic inner experiences of seeking support after patient safety incidents. Data were collected using semi-structured interviews. Drawing upon a review of recent literature on secondary victim experiences in patient safety incidents and head nurses\u0026rsquo; support-seeking behaviours, combined with cognitive behavioural theory, stress and coping theory, and social support theory [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], an interview outline was developed. This outline underwent pre-interview testing, and modifications were made based on preliminary findings to finalise the interview guide. The semi-structured outline was developed specifically for this study. The full outline is available as a supplementary file (see Supplementary File 1: Interview Outline).\u003c/p\u003e \u003cp\u003eThe study was conducted by two researchers: a ward manager who had personally experienced a patient safety incident and a senior nurse responsible for analysing and organising patient safety incident data at the hospital. Both researchers had prior involvement in patient safety incident management, had published related papers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and had participated in qualitative research workshops. Prior to conducting interviews, the first author, acting as the researcher, explained the study objectives and confidentiality commitments to participants. Following informed consent, demographic data collection and interviews were conducted. Identifiers were substituted for real names to ensure data anonymity.\u003c/p\u003e \u003cp\u003eInterviews were conducted face-to-face in quiet and comfortable private rooms. Mobile phones were used to record interviews, supplemented by notes and field observations. Interview duration ranged from 30 to 60 min, with an average of 45 min. The interview outline included the following questions: (1) Please recall a patient safety incident you personally experienced. Describe your handling process and inner feelings at the time. (2) Following the incident, whom or which channels did you approach for assistance? Why did you consider these the most appropriate options? (3) What concerns might you have had when seeking support? Could you illustrate these with specific examples? (4) Have you ever expressed stress during departmental meetings or similar settings, and how did such expression affect your working relationships? (5) If asked to design a support system for nursing managers, what features would genuinely address your pain points?\u003c/p\u003e\n\u003ch3\u003eData Analysis Methodology\u003c/h3\u003e\n\u003cp\u003eData analysis employed Colaizzi\u0026rsquo;s phenomenological approach [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and, considering the impact of language translation on coding accuracy, interviews were coded in Chinese. Within 24 h after each interview, one researcher transcribed the audio recordings into text, while another researcher conducted cross-checking. Two researchers then performed independent coding. Through careful and repeated reading of the transcripts, combined with field notes taken during the interviews, they gained an overall familiarity with the research content. Subsequently, the transcripts were read sentence by sentence, and recurring expressions relevant to head nurses\u0026rsquo; support-seeking experiences were extracted into Word documents to prepare for further coding. Recurring sentences were coded to construct meaning units. All meaning units were examined and synthesised into preliminary themes (sub-themes). Each preliminary theme was defined and described with reference to original statements. Similar preliminary themes were compared and integrated into final themes. These themes were then returned to the interviewees for verification of authenticity; if discrepancies arose, the process reverted to the initial step.\u003c/p\u003e \u003cp\u003eTo ensure coding consistency, cross-checking was conducted after independent coding. The coding results of the two researchers were compared, and discussions were held to resolve discrepancies and reach consensus. If consensus could not be achieved, a third researcher was invited to assist in resolving coding differences by providing neutral perspectives and recommendations. After completion of all coding procedures, the data were translated into English using specialised software and subsequently refined by an expert with English editing experience.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Characteristics of Study Participants\u003c/h2\u003e \u003cp\u003eA total of 15 head nurses (3 males and 12 females) participated in this study, and the general characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. General participant information disclosures have been anonymised and obtained with participants' written informed consent before the publication.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral information on the study participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation attainment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYears of Management Experience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSupervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSupervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociate Chief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSupervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSupervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSupervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eKey Themes\u003c/h2\u003e \u003cp\u003eAnalysis of the interview data yielded three themes and eleven sub-themes. The experiences and needs of head nurses as secondary victims seeking support after patient safety incidents were synthesised into the overarching theme \u0026ldquo;Explorations Under the Authority Role,\u0026rdquo; as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThematic coding of head nurses' support-seeking experiences following safety incidents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnits\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple Constraints Under the Authority Role\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eConflicted Perceptions of Responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMaking it feel as though everything is my fault\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eas if the entire department's affairs are your responsibility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ethe head nurse is often held accountable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eAuthority Role Inducing Exhaustive Emotional Labour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI must maintain emotional stability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI generally do not display my stress\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eonly adds to others' burdens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eShared Vulnerability Under Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ehope my stress can serve as motivation for nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ehelping nurses understand and empathise\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe Contradictory Evolution of Support-Seeking Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eThe Urgent Reality of Professional and Logistical Support Seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econtacted numerous places\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConsult the head nurse and physicians of the Nephrology ICU\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConsult with the respiratory nurse manager and physician\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFor review by the ICU Head Nurse\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eSeeking Emotional Support from Virtual Peer Communities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExchanging ideas in a WeChat group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCodenames, private complaints (Nursing Department)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eThe Status Quo of Silent Upward Support-Seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003erealized I may not have expressed myself very clearly\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConsidering direct requests for assistance as\u003c/p\u003e \u003cp\u003ebypassing proper channels\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emeeting them makes me feel rather intimidated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003efocused on assigning blame\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eEmergence of Digital Support-Seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003echat with Deepseek\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eposted anonymously on Zhihu website seeking advice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003escroll through videos\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultidimensional Support System Needs Amid Silence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMultidimensional Support System Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClear problem feedback mechanisms and processes are required\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRequires an open, inclusive safety culture (environment)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThird-party involvement may prove beneficial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAssist in reconstructing incident sequences\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRequirements for Efficient Cross-Departmental Collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno buck-passing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eComplete the (assistance application) right by the bedside\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eimmediately activate relevant personnel support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eAI-Empowered Decision Support Requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAI systems analysing and guiding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAll regulations are uniformly categorized within a single mini-program\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA repository of successful case solutions would be beneficial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003esystem could provide key information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheme 1: The Multiple Constraints Under the Authority Role\u003c/h3\u003e\n\u003cp\u003eAs team leaders, head nurses face substantial pressure. Multiple factors contribute to ambiguity regarding responsibility attribution during incidents. At the same time, role expectations requiring them to remain composed, professional, and authoritative prompt head nurses to regulate their emotions excessively to align with managerial norms, thereby intensifying emotional labour depletion. Under such pressure, head nurses tend to prioritise building emotional connections with nurses to strengthen the organizational safety climate.\u003c/p\u003e\n\u003ch3\u003eConflicted Perceptions of Responsibility in the Head Nurse Role\u003c/h3\u003e\n\u003cp\u003eWhen confronting safety incidents, head nurses are required to manage the situation and assume managerial responsibility. However, interviews indicated that even in incidents not directly related to nursing practice, patients and families often direct blame toward the head nurse. Coupled with misunderstanding from physicians and healthcare management bodies, this situation creates a practical dilemma in which the boundaries of head nurses\u0026rsquo; responsibility become blurred, resulting in conflicted perceptions of accountability.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN4: This also relates to our management practices, indicating inadequacies in oversight. Doctors lack understanding, which makes it feel as though everything is my fault.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN5: While doctors may also be at fault, this still falls within your core responsibilities. As the person in this role, you must fulfil these duties; you cannot simply refuse.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN9: Whether you are on duty or off, as if the entire department's affairs are your responsibility.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN11: When adverse events occur, patients' families naturally blame towards the head nurse. Even in severe liability incidents where nursing may bear little or no direct responsibility, the head nurse is often held accountable.\u003c/em\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAuthority Role Inducing Exhaustive Emotional Labour\u003c/h2\u003e \u003cp\u003eSeveral interviewees reported varying degrees of pronounced personal stress following patient safety incidents. Nevertheless, given their role as head nurses, they tended to refrain from displaying such stress in public contexts.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN3: I must maintain emotional stability. The responsibilities of a head nurse are extremely heavy, and I also need to protect the nurses.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN6: Everyone experiences pressure. Talking about it openly solves nothing and only adds to others\u0026rsquo; burdens.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN10: I generally do not show my stress, because if the head nurse constantly expresses it, the nurses will have even less motivation to remain positive.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eShared Vulnerability Under Pressure\u003c/h2\u003e \u003cp\u003eRegarding stress management among head nurses as secondary victims, some interviewees indicated that, under intense pressure, they deliberately choose to disclose their stress to nurses. They believed that this approach could help establish emotional connections with nursing staff and thereby improve the organisational safety culture.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN1: I hope my stress can also motivate nurses to standardise their operational practices. It is meant to encourage them and serve as a reminder that similar incidents should not recur.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN2: I share some of my stress by talking about my own experiences. This helps nurses understand and empathise.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN5: Appropriately revealing stress to build resonance with nurses serves one purpose: to show that we are all on the same front line.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN8: I think it can promote a sense of mutual empathy among us.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: The Contradictory Evolution of Support-Seeking Practices\u003c/h2\u003e \u003cp\u003eThe complex dilemmas encountered by head nurses when managing patient safety incidents often generate multiple unmet support needs. Interviews revealed that their support-seeking behaviours evolve in an internally contradictory manner: during the incident response phase, emphasis is placed on professional and resource-based support; during the stress adaptation phase, attention shifts toward emotional support; yet during the system improvement phase, behaviours show a notable transition from proactive expression to strategic silence. At the same time, the interviews indicated emerging trends toward artificial intelligence-based support-seeking methods, driven by ongoing digital advancements.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe Urgent Reality of Professional and Logistical Support Seeking\u003c/h2\u003e \u003cp\u003eTo achieve rapid problem resolution and stabilise patients and families, most interviewees reported actively seeking support from relevant specialists.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN2: We summoned the neurosurgery consultant for assessment, coordinated with logistics, and contacted medical services. We contacted numerous departments. Eventually, we reached the senior on-call officer and even the president on duty.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN3: After the incident, I consulted head nurses and doctors from Nephrology and the Critical Care ICU regarding possible consequences for the patient.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN9: I consulted both the head nurse and doctors from the respiratory department. After finalizing the video script, I first showed it to the respiratory head nurse. Following filming, I then asked both the respiratory head nurse and the ICU head nurses to assist with the review.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSeeking Emotional Support from Virtual Peer Communities\u003c/h2\u003e \u003cp\u003eWhen confronting and managing patient safety incidents, ward managers may find limited understanding and support within their departmental work environment. As a result, ward managers in similar roles and situations tend to seek communication with peers, with virtual peer communities serving as relatively safe emotional outlets.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN2: We all have our own small groups where we exchange ideas with each other.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN12: A few of us younger ones set up a WeChat group called \u0026ldquo;Gripe Squad\u0026rdquo; to offer advice when needed.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN13: We use coded language among ourselves to vent privately and release tension.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eThe Status Quo of Silent Upward Support-Seeking\u003c/h2\u003e \u003cp\u003eConstrained by traditional perceptions and after weighing costs against benefits, most head nurses as secondary victims indicated that they would not seek support from senior management or would discontinue such attempts.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN5: There may be reservations, such as whether I have expressed myself clearly enough, and I might also worry about disturbing the manager.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN8: The manager might interpret directly requesting assistance from the Nursing Department as bypassing the chain of command.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN12: I simply could not bring myself to seek support from management. Honestly, meeting them makes me feel intimidated, so I prefer to avoid them.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN4: Some managers place me under immense pressure because they tend to reprimand you.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN10: Management might conclude that the ward manager is failing in their duties, resulting in reprimands or formal criticism.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN13: Most managers focus primarily on assigning blame, and few provide genuine help or support. Seeking assistance feels futile.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN13: Leaving a negative impression could jeopardise my future promotion opportunities.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eEmergence of Digital Support-Seeking\u003c/h2\u003e \u003cp\u003eWith advances in the AI era, nursing supervisors are moving beyond traditional communication methods and experimenting with large-scale data platforms to seek support.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN3: Now we have Deepseek. I occasionally chat with it, and it is quite helpful.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN6: I once posted anonymously on the Zhihu website to seek advice, which allowed me to see others\u0026rsquo; suggestions.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN13: I scroll through videos and give likes to good advice or relatable content, but I rarely comment because I worry about others seeing it.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN14: Occasionally, I consult the literature, as it is quick and reliable.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Multidimensional Support System Requirements Beneath the Silence\u003c/h2\u003e \u003cp\u003eAmong the interviewed head nurses, experiences in managing patient safety incidents, ranging from feedback channels to organisational support systems, generated related suggestions and perspectives. These were summarised as multidimensional safeguards, seamless communication and collaboration across hospital departments, and expectations for AI-driven, evidence-based nursing decision support to provide more rational recommendations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eMultidimensional Support System Needs\u003c/h2\u003e \u003cp\u003eManaging patient safety incidents often requires multi-departmental coordination and multidimensional safeguards. These include hospital safety culture and issue feedback mechanisms or processes, logistics departments, third-party insurance providers, and information technology platforms.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN6: Clear problem feedback mechanisms and processes are required.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN7: An open and inclusive safety culture is needed.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN8: Third-party involvement may be beneficial in resolving these issues.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN10: Assistance is needed to reconstruct incident sequences, facilitate analysis, and identify improvement pathways while maintaining confidentiality.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN11: Purchasing insurance coverage is advisable, along with support from the hospital\u0026rsquo;s legal department.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRequirements for Efficient Cross-Departmental Collaboration\u003c/h2\u003e \u003cp\u003eCross-departmental coordination during incident management is often characterised by inefficiency and repetitive communication. The interviewed head nurses expressed a clear need for more efficient cross-departmental collaboration.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN2: Immediate feedback is essential, without buck-passing that leaves us repeatedly negotiating over the same issue.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN9: Could I complete the assistance application right at the bedside? It is a very simple procedure.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN13: Overly complex procedures should be avoided. When issues arise, a single phone call or system click should immediately activate relevant personnel support.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eAI-Empowered Decision Support Requirements\u003c/h2\u003e \u003cp\u003eTraditional management decisions rely heavily on the fragmented personal experience of ward managers, which may lead to biased or inaccurate judgements. With the increasing application of AI, ward managers expressed a desire to use intelligent platforms that integrate scientific management tools with evidence-based expertise to support patient safety incident management.\u003c/p\u003e \u003cp\u003e \u003cem\u003eN1: Given the current level of AI development, could AI systems analyse problems and guide resolution in the next step?\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN5: All regulations and newly issued directives could be categorised and integrated into a single application, enabling ward managers to access and implement them easily.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN8: A repository of successful case solutions would be particularly valuable, allowing direct application of prior experiences.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN9: Such a system could provide key information for continuous review and learning, enabling access to knowledge when support is needed.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN10: The electronic system should incorporate continuous online supervision functions.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eResearch indicates that ward head nurses encounter multiple difficulties and challenges during patient safety incidents. In response to their urgent yet often unspoken need for support, this study proposes potential systematic improvement strategies for consideration by healthcare management.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEstablishing A Multifaceted Support System for Head Nurses as Secondary Victims, Balancing Emotional Counselling with Managerial Support\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study found that head nurses who experience patient safety incidents as secondary victims are prone to excessive emotional regulation behaviours, particularly emotional labour burnout, which in turn increases emotional exhaustion. Previous research has documented role overload and role conflict among head nurses arising from their multiple responsibilities [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This is consistent with the present findings. Accordingly, senior management should prioritise addressing the emotional constraints faced by head nurses as secondary victims. Hospital administrators are encouraged to recognise their emotional exhaustion, foster a non-blaming organisational culture, streamline reporting procedures, and provide emotional support through structured peer support systems.\u003c/p\u003e \u003cp\u003eCurrent peer support systems for secondary victimisation among nurses primarily emphasise emotional reassurance and stress relief for frontline clinical nurses, while failing to offer equivalent emotional release and management stress-coping support at the head nurse managerial level [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. China\u0026rsquo;s hospital governance structure places nursing departments in a unified command position over head nurses across clinical departments. This hierarchical management system imposes substantial pressure on head nurses and may contribute to a \u0026ldquo;silent\u0026rdquo; response toward nursing department management [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This study further found that head nurses tend to alleviate emotional stress through virtual peer communication. The peer effect can transform individual risks into collective consensus through a process of \u0026ldquo;de-individualisation\u0026rdquo; [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This peer effect may be leveraged in nursing management by establishing a formal communication body for head nurses, mediated by a third-party agent. Through peer-to-peer interaction, a collective cognitive consensus among head nurses can be formed efficiently, after which the third party can engage in upward communication with the Nursing Department, thereby achieving upward communication management through a collective bargaining mechanism.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eDeveloping A Virtual Reality-Based Scenario Training and Emergency Response Enhancement Programme for Head Nurse Management\u003c/h2\u003e \u003cp\u003eIn China, head nurses are predominantly selected from among clinical nursing specialists, and most have not received systematic or standardised training in management, psychology, or organisational studies that matches the demands of their role [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This background often results in role confusion and misalignment when confronting patient safety incidents. For example, head nurses frequently concentrate on operational details rather than optimising management processes or analysing the root causes of adverse events. When cross-departmental collaboration is required, they may also fail to clearly distinguish their responsibilities from those of other functional departments, thereby devoting excessive attention to matters beyond their remit. Concurrently, The Development Plan for \u003cem\u003eChina\u0026rsquo;s\u003c/em\u003e Nursing Profession (2021\u003cem\u003e\u0026ndash;\u003c/em\u003e2025) emphasises strengthening management training for nursing administrators to enhance managerial philosophy and capability [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, targeted training for head nurses is essential to improve their management competencies in addressing safety incidents.\u003c/p\u003e \u003cp\u003eFor instance, Qi et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] developed a training curriculum for head nurses based on transformational leadership. Components such as emotional and stress management, effective communication, and role management may better equip head nurses to manage safety incidents. Given that the head nurse role integrates both clinical expertise and managerial responsibility, traditional training programmes have largely focused on theoretical knowledge. A review of relevant literature reveals a lack of immersive training in advanced managerial competencies, including decision-making, communication, and resource allocation in complex clinical scenarios [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In recent years, virtual reality technology has been widely applied in clinical skills training and has demonstrated clear advantages in enhancing procedural skills, emergency response capacity, and team collaboration [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. When managing safety incidents, head nurses require strengthened emergency response capabilities. It is therefore recommended that management establish a scenario simulation database and conduct emergency coordination training across diverse scenarios using virtual reality technology. This approach may enhance head nurses\u0026rsquo; rapid decision-making under pressure, cross-departmental collaboration skills, and psychological resilience.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCalling for Full-Process Intelligent Management of Patient Safety Incidents and the Establishment of a Third-Party Professional Handling Agency\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe head nurses interviewed in this study expressed the expectation that, with continued digital advancement, the entire process of reporting patient safety incidents and conducting decision analysis could be automated. This would involve streamlined reporting through intelligent submission systems to reduce manual data entry burdens, with incidents automatically identified and forwarded to relevant management departments. To address knowledge gaps within nursing specialities and nursing management, participants expressed interest in using evidence-based AI-driven intelligent decision support systems to assist decision-making. At present, intelligent information development in nursing mainly focuses on medication management, nursing assessment documentation, and health education. Intelligent systems related to patient safety incidents remain largely limited to reporting and preliminary statistics and lack a comprehensive decision support repository that provides theoretical analysis of incident-related factors and corresponding improvement recommendations [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. During interviews, head nurses indicated that such a system could facilitate rapid analysis and response.\u003c/p\u003e \u003cp\u003eFor non-specialist issues arising in patient safety incidents, participants also expressed a desire to draw on international experience by establishing third-party handling agencies. These agencies would possess multidisciplinary expertise, extensive legal knowledge, and systematic attribution management approaches. After an incident, the head nurse would evaluate its severity and complexity to determine whether third-party involvement is warranted. The agency would then assume responsibility for patient reassurance and communication, compensation coordination, logistical discussions, and management decision support, thereby facilitating effective resolution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aims to examine the lived experiences and perceptions of head nurses regarding support-seeking during patient safety incidents, with the objective of identifying key challenges and informing potential systemic improvement strategies for healthcare management.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe respondents in this study were limited to a single Grade III Class A public hospital in Shanxi, China, which may restrict sample representativeness and generalisability. Future studies could incorporate multi-centre and multi-level hospitals to capture a broader range of perspectives. In addition, the research scope may be expanded to include support providers such as nursing departments and hospital logistics departments, thereby offering further reference points for understanding head nurses\u0026rsquo; support-seeking from diverse viewpoints.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Ethics Review Committee of Bethune Hospital, Shanxi, China (YXLL-2023\u0026ndash;244) and was conducted in accordance with the Declaration of Helsinki. All methods were implemented in compliance with recommended guidelines and regulations. The purpose and significance of the research were explained to participants, and interviews were conducted only after written informed consent was obtained from all participants.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding support was provided by any institution.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors conceptualized the study and developed the interview guides.Cuiling Zhang designed interview outline and conducted the data collection.Tianshu Jiang, Jun Liang and Yali Liang conducted the data analysis and interpretation, aswell as drafted and revised the manuscript. Xiaohong Zhang provided critical revisions for important intellectual content. All authors reviewed and approved the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eTo access the data in this study, please contact the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Patient safety. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/patient-safety\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/patient-safety\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 6 Sep 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu AW. Medical error: The second victim. The doctor who makes the mistake needs help too. 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Chin J Nurs. 2020;55:397\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Head Nurse, Patient Safety Incident, Support-Seeking, Nursing Management, Qualitative Research","lastPublishedDoi":"10.21203/rs.3.rs-8851480/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8851480/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHead nurses are often confronted with multifaceted challenges when managing patient safety incidents. However, the ways in which they navigate the process of seeking support remain insufficiently explored. This study explores Chinese head nurses\u0026rsquo; support-seeking experiences during incident management, aiming to clarify their dilemmas and inform supportive strategies.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA descriptive phenomenological design, following Colaizzi\u0026rsquo;s method, was employed. Purposive sampling was used to recruit 15 head nurses from Shanxi Bethune Hospital, all with direct experience in managing patient safety incidents. Data were collected through in-depth, semi-structured face-to-face interviews until thematic saturation was achieved. The analysis rigorously adhered to Colaizzi\u0026rsquo;s seven-step framework to ensure a faithful exploration of participants\u0026rsquo; lived experiences.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eBased on the interview content, three themes and eleven sub-themes were identified: Theme 1: Multiple Constraints Under the Authority Role (Sub-themes: Conflicting perceptions of responsibility in the head nurse role; Overburdening emotional labour induced by the authority role; Shared vulnerability under pressure); Theme 2: The Contradictory Evolution of Support-Seeking Practices (Sub-themes: Urgent seeking of professional and logistical support; Seeking emotional support through virtual peer communities; Silent seeking of upward support; Emerging digital support seeking); Theme 3: Multidimensional Support System Needs Amid Silence (Sub-themes: Multidimensional safeguarding needs; Efficient cross-departmental collaboration needs; AI-empowered decision support needs). These findings were ultimately summarised as \u0026ldquo;Explorations Under the Authority Role.\u0026rdquo;\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study found that head nurses\u0026rsquo; support-seeking behaviour following safety incidents evolves through contradictory stages, wherein an urgent need for support coexists with a state of silent upward support-seeking. In response to these findings, we appealed to healthcare institutions to establish communication management platforms incorporating peer-based emotional support mechanisms, develop multidimensional management training programmes utilising virtual reality scenario simulations, and advance the intelligentisation of safety incident management systems alongside third-party professional intervention. These measures may foster a systematic support framework to safeguard nursing managers when addressing safety incidents.\u003c/p\u003e","manuscriptTitle":"A Qualitative Study on Support-Seeking Among Chinese Head Nurses: Explorations Under the Authority Role","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 18:08:18","doi":"10.21203/rs.3.rs-8851480/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-17T09:16:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-16T10:41:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-17T04:08:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-14T10:02:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-02-14T09:58:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0048c0d3-94fe-4b8b-a248-d66fd7db333d","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T18:08:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 18:08:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8851480","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8851480","identity":"rs-8851480","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}