Psychological Safety in Pediatrics: A Scoping Review

Abstract

Pediatrics in general and pediatric oncology in particular place the high demands on interprofessional teams. For teamwork, psychological safety is a basic prerequisite. Establishing it in pediatrics and their subspecialties requires extensive knowledge. While much is known about psychological safety in other industries, descriptions of psychological safety in pediatrics are lacking. Therefore, the aim of this scoping review was to (i) describe the current state of the literature, (ii) identify facilitating and hindering factors in individual areas, and (iii) highlight approaches in terms of best practice examples. In the period between March 25, 2024, and April 14, 2024, PubMed was searched in accordance with the PRISMA Guidelines Scoping Review Extension. The initial search retrieved 924 articles. Twenty-seven papers were included for final analysis. The main reasons for exclusion were a lack of thematic relevance, non-availability of a full text and languages other than English and German. Factors influencing psychological safety in interprofessional teams are discussed. In particular, the influences of communication, the working environment, and employees’ mental health are explained. In view of the of the increasing shortage of skilled workers, team turnover, and intention to leave, psychological safety in pediatrics should be addressed. Future studies should elucidate which interventions have a persistent positive influence on psychological safety in pediatrics.

Zusammenfassung

Die Pädiatrie im Allgemeinen und die pädiatrische Onkologie im Besonderen stellen höchste Anforderungen an interprofessionelle Teams. Die psychologische Sicherheit ist für die Teamarbeit eine Grundvoraussetzung. Sie in der Pädiatrie und ihren Subspezialitäten zu etablieren, erfordert umfangreiches Wissen. Während in anderen Branchen viel über psychologische Sicherheit bekannt ist, sind Beschreibungen zur psychologischen Sicherheit in der Pädiatrie limitiert. Ziel dieser Übersichtsarbeit war es daher, (i) den aktuellen Stand der Literatur zu beschreiben, (ii) förderliche und hinderliche Faktoren in einzelnen Bereichen zu identifizieren und (iii) Ansätze in Form von Best-Practice-Beispielen aufzuzeigen. Im Zeitraum vom 25. März 2024 bis zum 14. April 2024 wurde PubMed gemäß den PRISMA Guidelines Scoping Review Extension systematisch durchsucht. Bei der ersten Suche wurden 924 Artikel gefunden. 27 Arbeiten wurden anhand der Einschlusskriterien für die endgültige Analyse berücksichtigt. Die Hauptgründe für den Ausschluss waren mangelnde thematische Relevanz, Nichtverfügbarkeit eines Volltextes und andere Sprachen als Englisch und Deutsch. Es werden Faktoren erörtert, die die psychologische Sicherheit in interprofessionellen Teams beeinflussen: Insbesondere werden die Einflüsse der Kommunikation, des Arbeitsumfelds und der psychischen Gesundheit der Mitarbeiter erläutert. Angesichts des zunehmenden Fachkräftemangels, der Fluktuation in interprofessionellen Teams und der Patientensicherheit sollte die psychologische Sicherheit im interprofessionellen Team vermehrt Beachtung erhalten. Zukünftige Studien sollten beleuchten, welche Interventionen einen anhaltenden positiven Einfluss auf die psychologische Sicherheit in der Pädiatrie haben.

Schlüsselwörter

Psychologische Sicherheit - Pädiatrie - Pädiatrische Onkologie - Interprofessionelle Teamarbeit - Burnout - Fachkräftemangel

Keywords

Psychological safety - pediatrics - pediatric oncology - interprofessional teamwork - burnout - skills shortage - mental health

Publikationsverlauf

Eingereicht: 16. Juni 2025

Angenommen nach Revision: 29. Oktober 2025

Artikel online veröffentlicht:
28. November 2025

• References

• 1 Edmondson A. Psychological Safety and Learning Behavior in Work Teams. Adm Sci Q 1999; 44: 350-383
• 2 Remtulla R, Hagana A, Houbby N. et al. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Serv Res 2021; 21: 269
• 3 Leape LL, Shore MF, Dienstag JL. et al. Perspective: A culture of respect, Part 1: The nature and causes of disrespectful behavior by physicians. Academic Medicine 2012; 87: 845-852
• 4 Nembhard IM, Edmondson AC. Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J Organ Behav 2006; 27: 941-966
• 5 Baer M, Frese M. Innovation is not enough: Climates for initiative and psychological safety, process innovations, and firm performance. J Organ Behav 2003; 24: 45-68
• 6 Van Dyck C, Baer M, Frese M. et al. Organizational error management culture and its impact on performance: A two-study replication. Journal of Applied Psychology 2005; 90: 1228-1240
• 7 Toh SG, Ang E, Kamala Devi M. Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings. Int J Evid Based Healthc 2012; 10: 126-141
• 8 Mueller BU, Neuspiel DR, Stucky Fisher ER. et al. Principles of pediatric patient safety: Reducing harm due to medical care. Pediatrics 2019; 143: e20183649
• 9 Hunt DF, Bailey J, Lennox BR. et al. Enhancing psychological safety in mental health services. Int J Ment Health Syst 2021; 15: 33
• 10 Iyasere CA, Wing J, Martel JN. et al. Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med 2022; 182: 1190-1198
• 11 Munn LT, Lynn MR, Knafl GJ. et al. A study of error reporting by nurses: the significant impact of nursing team dynamics. Journal of Research in Nursing 2023; 28: 354-364
• 12 Vitale MG, Raman DL. Safety does not happen by accident: Preventing human error through high-reliability practices. Journal of Pediatric Orthopaedics 2022; 42: S35-S38
• 13 Bognár A, Barach P, Johnson JK. et al. Errors and the Burden of Errors: Attitudes, Perceptions, and the Culture of Safety in Pediatric Cardiac Surgical Teams. Annals of Thoracic Surgery 2008; 85: 1374-1381
• 14 Grailey KE, Murray E, Reader T. et al. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMC Health Serv Res 2021; 21: 773
• 15 Rahnfeld M, Wendsche J, Wegge J. Job demands and resources as drivers of exhaustion and leaving intentions: a prospective analysis with geriatric nurses. BMC Geriatr 2023; 23: 167
• 16 Cartland J, Green M, Kamm D. et al. Measuring psychological safety and local learning to enable high reliability organisational change. BMJ Open Qual 2022; 11: e001757
• 17 Suresh G, Horbar JD, Plsek P. et al. Voluntary Anonymous Reporting of Medical Errors for Neonatal Intensive Care. Pediatrics 113: 1609-1618 2004;
• 18 Burroughs TE, Waterman AD, Gallagher TH. et al. Patient concerns about medical errors in emergency departments. Academic Emergency Medicine 2005; 12: 57-64
• 19 Rosenberg AR, Barton K, Junkins C. et al. Creating a Resilient Research Program—Lessons Learned From a Palliative Care Research Laboratory. J Pain Symptom Manage 2020; 60: 857-865
• 20 Norman G, Sherbino J, Dore K. et al. The etiology of diagnostic errors: A controlled trial of system 1 versus system 2 reasoning. Academic Medicine 2014; 89: 277-284
• 21 Seibert M, Pfaff H, Scholten N. et al. Do trained nurses feel more psychologically safe?—Results from a multi-level modelling approach. Nurs Open 2021; 8: 3024-3035
• 22 Saddawi-Konefka D, Scott-Vernaglia SE. Establishing Psychological Safety to Obtain Feedback for Training Programs: A Novel Cross-Specialty Focus Group Exchange. J Grad Med Educ 2019; 11: 454-459
• 23 Morrison EW. Employee voice behavior: Integration and directions for future research. Academy of Management Annals 2011; 5: 373-412
• 24 Morris M, Mulhall C, Murphy PJ. et al. Interdisciplinary collaborative working on surgical ward rounds: reality or rhetoric? A systematic review. J Interprof Care 2023; 37: 674-688
• 25 Floren LC, Donesky DA, Whitaker E. et al. Are we on the same page? Shared mental models to support clinical teamwork among health professions learners: A scoping review. Academic Medicine 2018; 93: 498-509
• 26 Chen JY. Morale and role strain of undergraduate nursing students in a pediatric clinical setting. J Nurs Res 2010; 18 (02) 144-53
• 27 McClintock AH, Kim S, Chung EK. Bridging the Gap Between Educator and Learner: The Role of Psychological Safety in Medical Education. Pediatrics 2022; 149: e2021055028
• 28 Tricco AC, Lillie E, Zarin W. et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med 2018; 169: 467-473
• 29 Ouzzani M, Hammady H, Fedorowicz Z. et al. Rayyan-a web and mobile app for. systematic reviews. Syst Rev 2016; 5: 210
• 30 van der Veen R, van der Burgt S, Königs M. et al. Team functioning in Neurorehabilitation: a mixed methods study. J Interprof Care 2024; 38: 621-631
• 31 Uhlig PN, Doll J, Brandon K. et al. Interprofessional practice and education in clinical learning environments: Frontlines perspective. Academic Medicine 2018; 93: 1441-1444
• 32 Yamada NK, Catchpole K, Salas E. The role of human factors in neonatal patient safety. Semin Perinatol 2019; 43: 151174
• 33 Skegg E, McElroy C, Mudgway M. et al. Debriefing to improve interprofessional teamwork in the operating room: A systematic review. Journal of Nursing Scholarship 2023; 55: 1179-1188
• 34 Welch CE, Carbajal MM, Kumar S. et al. Development and Validation of a Theory-Informed Group Learning Environment Assessment Tool for Graduate Medical Education Programs. J Grad Med Educ 2020; 12: 447-454
• 35 Haviland C, Green J, Dzara K. et al. Psychological safety between pediatric residents and nurses and the impact of an interdisciplinary simulation curriculum. BMC Med Educ 2022; 22: 649
• 36 Tawfik DS, Profit J, Webber S. et al. Organizational Factors Affecting Physician Well-Being. Curr Treat Options Pediatr 2019; 5: 11-25
• 37 Buckley L, Berta W, Cleverley K. et al. What is known about paediatric nurse burnout: A scoping review. Hum Resour Health 2020; 18: 9
• 38 Chirico F, D’ettorre G, Lecce A. et al. Determinants of emotional distress in neonatal healthcare professionals: An exploratory analysis. Front Public Health 10: 968789 2022;
• 39 Tawfik DS, Profit J. Provider burnout: Implications for our perinatal patients. Semin Perinatol 2020; 44: 151243
• 40 Stocker M, Szavay P, Wernz B. et al. What are the participants’ perspective and the system-based impact of a standardized, inter-professional morbidity/mortality-conferences in a children’s hospital?. Transl Gastroenterol Hepatol 2021; 6: 48
• 41 Stocker M, Pilgrim SB, Burmester M. et al. Interprofessional team management in pediatric critical care: Some challenges and possible solutions. J Multidiscip Healthc 2016; 9: 47-58
• 42 Tawfik DS, Sexton JB, Adair KC. et al. Context in Quality of Care: Improving Teamwork and Resilience. Clin Perinatol 2017; 44: 541-552
• 43 Balistreri KA, Lim PS, Tager JB. et al. “It has added another layer of stress”: Covid-19’s impact in the PICU. Hosp Pediatr 2021; 11: E226-E234
• 44 Devaraj LR, Geisler B, Cooper C. et al. Impact of COVID-19 Policies on Hospitalists’ Psychological Safety. South Med J 2023; 116: 772-775
• 45 Tamminga SJ, Emal LM, Boschman JS. et al. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews 2023; 2023
• 46 Bock C, Heitland I, Zimmermann T. et al. Secondary Traumatic Stress, Mental State, and Work Ability in Nurses—Results of a Psychological Risk Assessment at a University Hospital. Front Psychiatry 2020; 11: 298
• 47 Luan R, Pu W, Dai L. et al. Comparison of Psychological Stress Levels and Associated Factors Among Healthcare Workers, Frontline Workers, and the General Public During the Novel Coronavirus Pandemic. Front Psychiatry 2020; 11: 583971
• 48 Bingemann TA, Laubach S. Physician well-being in allergy and immunology: Creating a culture of wellness. Annals of Allergy, Asthma and Immunology 2021; 126: 219-227
• 49 Salas E, Rosen MA. Building high reliability teams: progress and some reflections on teamwork training. BMJ Qual Saf 2013; 22: 369-373
• 50 Salas E, Shuffler ML, Thayer AL. et al. Understanding and Improving Teamwork in Organizations: A Scientifically Based Practical Guide. Hum Resour Manage 2015; 54: 599-622
• 51 Salas E, Almeida SA, Salisbury M. et al. What Are the Critical Success Factors for Team Training in Health Care?. The Joint Commission Journal on Quality and Patient Safety 2009; 35: 398-405
• 52 Mesmer-Magnus JR, DeChurch LA. Information Sharing and Team Performance: A Meta-Analysis. Journal of Applied Psychology 2009; 94: 535-546
• 53 McMahon CJ, Hickey EJ, Nolke L. et al. Organizational Culture as a Determinant of Outcome in Teams: Implications for the Pediatric Cardiac Specialist. Pediatr Cardiol 2023; 44: 530-539
• 54 Tiroke P, Sänger B, Mücke U. et al. SICKO. Development of a Multi-Disciplinary Training-Concept for Paediatric Oncology. Klin Padiatr 2017; 229: 316-321
• 55 Mayer CM, Cluff L, Lin W-T. et al. Evaluating Efforts to Optimize TeamSTEPPS Implementation in Surgical and Pediatric Intensive Care Units. The Joint Commission Journal on Quality and Patient Safety 2011; 37: 365-AP3
• 56 Fleig K, Tiroke P, Pittau F, Mücke U. Interprofessionelles Team-Training für Pflegeauszubildende und Medizinstudierende in der Pädiatrie: analoge und digitale Formate im Vergleich [Interprofessional Team Training for Nursing Trainees and Medical Students in Pediatrics: Comparing Analog and Digital Formats]. Klinische Padiatrie 2025; 237: 266-273
• 57 Al Sabei S, Qutishat M, Labrague L. et al. The Relationship Between Staffing, Nurses’ Emotional Exhaustion, and Adverse Patient Events in Critical Care Units in Sultanate of Oman. J Nurs Manag 2025; 2025: 1977327
• 58 Corral-Liria I, Losa-Iglesias M, Becerro-De-Bengoa-Vallejo R. et al. Second victim syndrome among nursing professionals as a result of COVID-19: qualitative research. BMC Nurs 2025; 24: 298
• 59 Wolf M, Smith K, Basu M. et al. The Prevalence of Second Victim Syndrome and Emotional Distress in Pediatric Intensive Care Providers. J Pediatr Intensive Care 2023; 12: 125-130
• 60 Wu AW. Medical error: the second victim. BMJ 2000; 320: 726-727
• 61 Günüşen NP, Wilson M, Aksoy B. Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital. Journal of Transcultural Nursing 2018; 29: 146-154
• 62 Davis AE, Copeland-Streeter DJ, Okoye RR. Effects of a Second Victim Peer Support Program in the Pediatric Intensive Care Unit. AJN, American Journal of Nursing 2025; 125: 54-60
• 63 Bock C, Zimmermann T, Kahl KG. The impact of post-traumatic stress on the mental state of university hospital physicians – a cross sectional study. BMC Psychiatry 2022; 22: 85
• 64 Coyne I, O’Mathúna DP, Gibson F. et al. Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database of Systematic Reviews 2016; 2016: CD008970
• 65 Mittal VS, Sigrest T, Ottolini MC. et al. Family-centered rounds on pediatric wards: A PRIS network survey of US and Canadian hospitalists. Pediatrics 2010; 126: 37-43
• 66 Masten M, Sommerfeldt S, Gordan S. et al. Evaluating Teamwork in the Neonatal Intensive Care Unit. Advances in Neonatal Care 2019; 19: 285-293
• 67 Lyndon A, Wisner K, Holschuh C. et al. Parents’ Perspectives on Navigating the Work of Speaking Up in the NICU. JOGNN – Journal of Obstetric, Gynecologic, and Neonatal Nursing 2017; 46: 716-726
• 68 Bsharat S, Drach-Zahavy A. Nurses’ response to parents’ ‘speaking-up’ efforts to ensure their hospitalized child’s safety: an attribution theory perspective. J Adv Nurs 2017; 73: 2118-2128
• 69 Berndt LP, Sellin J, Mücke U. et al. Exploring different stakeholders’ perspectives on ward rounds in paediatric oncology: a qualitative study. BMC Med Educ 2023; 23: 500