Rev Cuid. 2026; 17(2): 5000

https://doi.org/10.15649/cuidarte.5000

REVIEW ARTICLE

Second victim: a concept analysis based on Rodgers’ evolutionary model

Segunda vítima: análise de conceito fundamentada no modelo evolucionário de Rodgers

Segunda víctima: análisis del concepto basado en el modelo evolutivo de Rodgers

Master's student, Graduate Program in Clinical Nursing and Health Care, Universidade Estadual do Ceará, Fortaleza, Brazil. E-mail: matheus.tavares@ aluno.uece.br Corresponding Author Matheus Tavares França da Silva   
Registered Nurse, Universidade Estadual do Ceará, Fortaleza, Brazil. E-mail: carolcmendes12@gmail.com Caroliny Cristine dos Santos Mendes   
Master's student, Graduate Program in Clinical Care in Nursing and Health, Universidade Estadual do Ceará, Fortaleza, Brazil. E-mail: rebeca.furtado@aluno.uece.br Rebeca Furtado Fernandes    
PhD, Professor, Universidade Estadual do Ceará, Fortaleza, Brazil. E-mail: karanini@yahoo.com.br Sherida Karanini Paz de Oliveira    
PhD, Professor, Universidade Estadual do Ceará, Fortaleza, Brazil. E-mail: rhanna. lima@uece.br Rhanna Emanuela Fontenele Lima de Carvalho

Highlights

 

How to cite this article: Silva, Matheus Tavares França da; Mendes, Caroliny Cristine dos Santos; Fernandes, Rebeca Furtado; Oliveira, Sherida Karanini Paz de; Carvalho, Rhanna Emanuela Fontenele Lima de. Second victim: a concept analysis based on Rodgers’ evolutionary model. Revista Cuidarte. 2026;17(2):e5000.https://doi.org/10.15649/cuidarte.5000

Received: February 24th, 2025
Accepted: August 1rs, 2025
Published: June 26th, 2026

CreativeCommons 

E-ISSN: 2346-3414

Abstract

Introduction: Healthcare-related incidents affect both patients and professionals involved. The impact on these professionals, known as “second victims,” is one of the major hidden burdens of harm. Objective: To analyze the concept of the “second victim” from Rodgers’ evolutionary perspective. Materials and Methods: This study conducted a concept analysis based on Rodgers’ evolutionary perspective, using a scoping review to identify attributes, antecedents, consequences, surrogate terms, and related concepts associated with the “second victim” concept. Results: The attributes of the “second victim” concept involve persistent physical, emotional, and psychological consequences. Antecedents include a punitive culture and a lack of institutional and peer support. Consequences include sleep disorders, anger, fear, sadness, shame, intrusive memories, anxiety, depression, isolation, absenteeism, and leaving the profession. Related terms include patient safety and mental health, while surrogate terms include the “second victim phenomenon” and “second victim syndrome”. Discussion: Punitive environments exacerbate negative impacts, undermine patient safety, promote error concealment, and increase underreporting, thereby hindering organizational learning and the correction of failures. Conclusion: The “second victim” concept refers to healthcare workers, scholars, and administrative or support staff who are directly or indirectly involved in patient care and who, when involved in an unintentional healthcare-related incident, manifest physical, emotional, and psychological reactions with repercussions across biopsychosocial, ethical, and legal dimensions. Without adequate and timely support, these reactions can become chronic and, eventually, pathological.

Keywords: Patient Safety; Occupational Health; Concept Formation.

Resumo

Introdução: Incidentes na assistência à saúde afetam tanto os pacientes quanto os profissionais envolvidos. O impacto sobre esses profissionais, conhecidos como "segundas vítimas", é um dos principais fardos ocultos do dano. Objetivo: Analisar o conceito de “segunda vítima” sob a perspectiva evolucionária de Rodgers. Materiais e Métodos: A pesquisa realiza uma análise de conceito fundamentada na visão evolucionária de Rodgers, utilizando uma revisão de escopo para identificar atributos, antecedentes, consequentes, termos substitutos e conceitos relacionados ao conceito de “segunda vítima”. Resultados: Os atributos do conceito de “segunda vítima” envolvem repercussões físicas, emocionais e psicológicas duradouras. Os antecedentes incluem cultura punitiva e falta de apoio institucional e de pares. Os consequentes, destacam distúrbios do sono, raiva, medo, tristeza, vergonha, memórias intrusivas, ansiedade, depressão, isolamento, absenteísmo e abandono da profissão. Os termos relacionados abrangem segurança do paciente e saúde mental, enquanto termos substitutos incluem “fenômeno” e “síndrome” da segunda vítima. Discussão: Ambientes punitivos agravam os impactos negativos, desestimulam a segurança do paciente, promovem a ocultação de erros e aumentam as subnotificações, dificultando o aprendizado organizacional e a correção de falhas. Conclusão: O conceito de “segunda vítima” refere-se aos trabalhadores de saúde, acadêmicos e colaboradores administrativos ou de apoio, envolvidos direta ou indiretamente no cuidado ao paciente, que ao implicarem-se em um incidente relacionado à assistência à saúde de natureza não intencional, manifestam reações físicas, emocionais e psicológicas, com repercussões nas dimensões biopsicossociais, éticas e legais. As reações sem o suporte adequado e oportuno, podem se tornar crônicas e, eventualmente, patológicas.

Palavras-Chave: Segurança do Paciente; Saúde Ocupacional; Formação de Conceito.

Resumen

Introducción: Los incidentes en la atención sanitaria no solo afectan a los pacientes, sino también a los profesionales involucrados, conocidos como “segundas víctimas”. El impacto sobre estos profesionales se considera una de las principales cargas ocultas del daño. Objetivo: Analizar el concepto de “segunda víctima” desde la perspectiva evolutiva de Rodgers. Materiales y Métodos: La investigación consiste en un análisis de concepto basado en la visión evolutiva de Rodgers, utilizando una revisión de alcance para identificar atributos, antecedentes, consecuencias, términos sustitutos y conceptos relacionados con el concepto de “segunda víctima”. Resultados: El concepto de “segunda víctima” incluye repercusiones físicas, emocionales y psicológicas duraderas. Los antecedentes incluyen la cultura punitiva y la falta de apoyo institucional y de pares. Las consecuencias abarcan trastornos del sueño, ira, tristeza, ansiedad, depresión, aislamiento, absentismo y abandono profesional. Los términos relacionados son seguridad del paciente y salud mental, mientras que los sustitutos incluyen “fenómeno” y “síndrome” de la segunda víctima. Discusión: Los entornos punitivos agravan los impactos negativos, desmotivan la seguridad del paciente, promueven que se oculte errores y que no se reporten, dificultando el aprendizaje organizacional y la corrección de errores. Conclusión: El concepto de “segunda víctima” se refiere a los trabajadores de la salud, académicos y personal administrativo o de apoyo, involucrados directa o indirectamente en la atención al paciente, quienes, al verse involucrados en un incidente involuntario relacionado con la atención en salud, manifiestan experimentar reacciones físicas, emocionales y psicológicas, con repercusiones en las dimensiones biopsicosocial, ética y jurídica. Sin un apoyo adecuado y oportuno, estas reacciones pueden volverse crónicas y, con el tiempo, patológicas.

Palabras Clave: Seguridad del Paciente; Salud Ocupacional; Formación de Conceptos.

 

Introduction

Unsafe care, a widely recognized serious public health problem, affects millions of patients worldwide. This phenomenon compromises the reputation of health systems, trust in healthcare services, the wellbeing of professionals, and public perceptions of resource allocation in the sector. Such incidents can result in death, disability, and suffering for patients and their families, as well as generate economic costs1.

Incidents not only directly affect patients but also have consequences for the healthcare professionals involved. The collateral impact on these professionals is considered one of the major hidden burdens associated with adverse events. Affected professionals are described as “second victims,” experiencing detrimental effects on their physical and mental health, as well as an increased risk of new incidents in unsafe care settings2 .

In this sense, the analysis of the consequences of healthcare-related incidents has expanded to encompass not only the effects on patients and their support networks but also the repercussions for health professionals. The term “second victim” was introduced by Albert Wu in 2000, representing a conceptual milestone in broadening the discussions on the consequences of errors from the perspective of healthcare professionals3.

However, at the time of its formulation, a culture firmly centered on the physician prevailed, and patient safety research was still in its early stages, with little attention to systemic and interprofessional dynamics. Thus, the author largely restricted the concept to physicians, making only brief references to other professionals and recognizing, in a limited way, the impacts of errors on other groups of workers3.

The concept of the second victim, although introduced more than two decades ago, still lacks a consolidated definition. Its boundaries remain unclear, particularly regarding the identification of the individuals involved and the contextual and relational factors that shape the experience of this phenomenon. The theoretical contributions accumulated since then have been limited, often imprecise, and divergent with respect to who is truly affected, who needs support, what psychoemotional consequences are involved, as well as their prevalence and duration4,5

In the literature, only one evidence- and consensus- based definition of the “second victim” concept has been proposed. However, that research did not employ a concept analysis method nor draw on a theoretical framework for its development, resulting in the absence of identified contextual bases, surrogate terms, and related concepts5.

The definition has weaknesses in that it restricts the “second victim” experience to formally trained health professionals, overlooking practicum students and administrative or logistical support staff who, although indirectly involved in clinical care, may also be affected. In addition, the definition does not encompass the specific manifestations of the condition, including physical, emotional, psychological, or social symptoms.

The scenario highlights the need for research that proposes new descriptions or definitions and seeks to build a conceptual consensus. In this sense, recognizing that the current fragility of the concept hinders its reliable implementation, this study aims to structure and operationalize the second victim concept, making it more clearly defined and applicable in practice.

Thus, the study is distinguished by its methodologically rigorous concept analysis based on Rodgers’ evolutionary model. The evolutionary method of concept analysis considers contextual factors that influence the concept of a given term. It is a cyclical process guided by three elements: significance, use, and application. The meaning of a concept depends on its use and application6.

Accordingly, this research aims to analyze the concept of “second victim” from Rodgers’ evolutionary perspective. The following research questions guided the study: How is the concept of “second victim” used in the scientific literature? What are the contextual bases, surrogate terms, and related concepts associated with the “second victim” concept according to Rodgers’ evolutionary perspective?

In this sense, the results obtained are expected to promote reflection and foster debate on the subject, with the aim of developing a more consistent conceptualization of the “second victim.” Recognizing this concept may help those involved cope with the incident, thereby validating their thoughts and emotions.

The selection of this concept is justified by its complex construct and the need for a better understanding of how this condition manifests in individuals (its attributes), what underlies its emergence (antecedents), what repercussions (consequences) it entails for professionals in healthcare settings, and how the construct relates to other areas (related terms), particularly in the context of patient safety.

 

Materials and Methods

This study is a concept analysis based on Rodgers’ evolutionary approach6 applied to the “second victim” concept. This methodology was chosen because the concept has evolved over time and has been shaped by multiple factors.

The method was implemented following the six steps proposed by Rodgers: identification of the concept of interest; selection of the setting for data collection; data collection to identify attributes and context of the concept; evaluation of the concept’s characteristics; development of a conceptual model; and identification of hypotheses and implications6.

In the first step of the method, the selected concept was the “second victim.” The data collection setting was based on a scope review conducted following the Joanna Briggs Institute (JBI) guidelines7 and the PRISMA-ScR checklist8, given their suitability for mapping the literature, identifying gaps, and clarifying theoretical concepts.

The scoping review was registered in the Open Science Framework9 and is available in full. The study protocol can be accessed to provide a more detailed understanding of the methodological steps presented below.

The research question was formulated using the PCC framework (P: Population/C: Concept/C: Context), with healthcare workers as the population, the “second victim” as the concept, and patient safety as the context. The guiding question focused on the attributes, antecedents, and consequences of the “second victim” concept in the context of patient safety, as follows: “What are the attributes, antecedents, and consequences of the second victim concept among healthcare workers in the context of patient safety?”

The scoping review included publications addressing the attributes, antecedents, and consequences of the concept, with no language restrictions and a time frame starting in 2000, when the term was first documented. Primary empirical studies, quantitative and qualitative, were included, while incomplete, duplicate, preprint, or non-open-access articles were excluded. The identification of contextual bases (antecedents and consequences), surrogate terms, and related concepts was guided by the following questions, as presented in Table1.

Table 1. Items and guiding questions used in Rodgers’ evolutionary concept analysis method

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The search strategy used the terms “Health Personnel,” “Medical Errors,” and “Patient Safety,” selected from Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Equivalent terms in English, including synonyms in both singular and plural forms, were considered. The Boolean operator “and” was used to combine search terms as appropriate. The search strategy was adapted to each database's specific syntax and controlled vocabulary.

The searches were conducted in October 2024 across the following databases: Scientific Electronic Library Online (SciELO), Scopus, Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Web of Science, ScienceDirect, and the Virtual Health Library (VHL), which includes the Latin American and Caribbean Health Sciences Literature (LILACS), the Spanish Bibliographic Index of Health Sciences (IBECS), and Nursing Database (BDENF, in Portuguese). Grey literature was searched using Google Scholar and the Brazilian Digital Library of Theses and Dissertations (BDTD, in Portuguese).

The results retrieved from the databases were exported to the Rayyan® reference manager tool to remove duplicates and to enable independent selection and screening of studies by two reviewers, with any disagreements resolved through discussion until consensus was reached.

The first phase involved screening the titles and abstracts of the retrieved studies. Studies that met the inclusion criteria were assessed in the second phase through full-text review. The reviewers read the full texts and applied the eligibility criteria to select the studies.

The data extraction form included fields for title, authors, country, year, study design, and population. The extracted data, as well as the PRISMA flow diagram detailing the process leading to the final sample that informed the concept analysis, are available in Mendeley Data for open access and consultation10 and in the full report of the scoping review9.

The data extracted from the selected articles enabled the identification of the concept’s attributes, including its definition, antecedents, consequences, sociocultural and temporal variations, surrogate terms, and related concepts. The review of the studies facilitated an in-depth understanding of these aspects, enabling the extraction of data relevant to the analysis.

The third step, data analysis, was conducted after collecting and organizing all the information. The elements constituting the concept were examined based on the literature. The frequency of terms and their meanings was evaluated, highlighting similarities and discrepancies to identify the most commonly used terms for describing the concept. Subsequently, a practical example was developed to illustrate the concept. Finally, guidelines for future research were presented, emphasizing the concept's applicability and evolution among healthcare workers in the context of patient safety.

Results

The final sample of the review comprised 40 articles and one dissertation, published across 13 countries, with the highest number from the United States (16), followed by Brazil (6) and Spain (5). Other countries, such as Korea, Belgium, and Austria, contributed two publications each, while Germany, Saudi Arabia, Italy, Denmark, Canada, Ireland, China, and Colombia each contributed one article. Most studies were published in English (35), while five were in Portuguese and one was in Korean.

Regarding the methods employed, 17 studies used a cross-sectional design, with a predominance of qualitative approaches (8), which enabled in-depth analysis of the perceptions and challenges faced by second victims. Other studies employed mixed-methods (3), observational (1), descriptive (1), and exploratory (1) designs. In addition, editorial articles (5), commentaries (2), and informative papers (1) played a relevant role in the development and discussion of the concept within the scientific field. There was also an increase in publications over the past six years (2019-2024), with 25 studies published during this period, indicating a growing interest in the topic over time.

The study samples included different professional groups identified as potential second victims. The most frequently reported were nurses, nursing technicians, and nursing assistants (30), followed by physicians (18), practicum students and healthcare residents (12), pharmacists (3), physical therapists (2), social workers (1), laboratory technicians (1), physiopathology technicians (1), and cleaning staff (1). Several studies reported more than one professional group, underscoring the extent of the phenomenon across different healthcare actors. However, in some studies (4), authors referred to healthcare professionals in general without specifying professional groups.

The included studies sought to understand the experiences of second victims, emphasizing the impacts of adverse events in healthcare. The evolution of the concept has expanded the range of professionals beyond formally trained healthcare workers, underscoring the need to provide adequate support, strengthen patient safety, and adopt a more humanized approach. However, many studies continue to refer to these professionals in general terms, without specifying their professional group.

The remaining data were organized according to the categorization proposed by Rodgers, which includes three main dimensions: antecedents and consequences, which represent the factors associated with the concept and its ramifications; surrogate terms and related concepts, which contribute to its definition; and attributes, which describe its essential characteristics.

1. Analysis of attributes and context
The analysis of the studies enabled the identification and chronological organization of definitions attributed to the “second victim” concept. The compilation of definitions illustrates the concept’s maturation, reflecting changes in its conceptual development and highlighting variations in its interpretation, as well as their potential implications for practice. Figure 1.

See references for Figure 1: 3, 11, 23, 24- 39, 5, 40- 49

Figure 1 - Evolution of the “second victim” concept over time. Fortaleza (CE), Brazil, 2024


The definition of the “second victim” concept has progressively expanded over time as research has deepened understanding of healthcare professionals’ experiences. The process of scientific inquiry has contributed to refining the concept, reflecting the complexity of the situations encountered.

2. Analysis of data in relation to the characteristics of the concept
Antecedents and attributes of the “second victim” concept
The concept of “second victim” is preceded and influenced by several factors, such as situations, events, and phenomena. Studies indicate that a weakened patient safety culture, combined with the absence of support mechanisms, facilitates the emergence of this condition among healthcare professionals. The interaction between organizational culture and worker well-being is crucial for understanding how adverse experiences in healthcare affect the health of those involved. Table 2

.

 

Table 2. Distribution of antecedents and attributes of the second victim concept, Fortaleza, Brazil, 2024

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Table 2. Distribution of antecedents and attributes of the second victim concept, Fortaleza, Brazil, 2024

Antecedents Number of citations % (n)
              Lack of institutional support mechanism3, 11, 13, 15, 17- 20, 22, 26, 29, 31, 33, 37, 41, 43, 44 43.90 (18)
               Punitive culture3, 12, 18, 20- 22, 26, 31, 32, 34, 37, 38, 40, 47- 43, 48 35.50 (15)
               Reluctance to use support services12, 13, 15, 16, 20, 22, 31, 37, 38, 44, 47 26.80 (11)
               Lack of peer support3, 15, 20, 21- 22, 26, 29, 37, 43 21.90 (9)
               Lack of transparency in case management11, 15, 17, 20, 21, 26, 33, 37 19.50 (8)
               Failure to disclose 12, 13, 15, 20, 21, 26, 33 17.00 (7)
               Culture of perfection3, 11, 14, 22, 35, 37, 41 17.00 (7)
               Insufficient protocols12, 26, 40 7.30 (3)
               Inadequate crisis management12, 30 4.80 (2)
         Attributes
               Persistent/long-lasting11- 15, 18- 20, 26, 28- 31, 33- 36, 38, 41, 45, 47 51.90 (21)
               Emotional impact3, 11- 16, 18- 22, 26- 28 35.50 (15)
               Psychological impact3, 12, 15, 17- 21, 23, 26, 29, 31, 45, 46 34.10 (14)
               Physical impact11, 12, 14, 15, 17- 21, 26, 31, 35 29.20 (12)
               Ethical, legal, and juridical impact11, 14- 16, 19- 22, 29, 32, 43 26.80 (11)
               Moral impact12- 17, 20, 31, 35, 45 24.30 (10)
               Social impact3,11, 12, 14, 15, 18, 20, 23, 31, 47 24.30 (10)

     

 

The identified attributes indicate that the second victim condition affects the biopsychosocial aspects of the professionals involved, resulting in persistent consequences. In addition, they highlight the significance of the emotional, physical, and social consequences these professionals face, underscoring the need for adequate support.

Consequences of the “second victim” concept
The consequences related to the second victim concept highlight its impact on workers’ health and on personal and professional performance. The results indicate that these effects may compromise individuals’ physical and emotional integrity. The analysis of these repercussions highlights the importance of a holistic approach that accounts for the multiple factors influencing the lives and work of these professionals. Table 3.

 

Table 3. Distribution of consequences related to the second victim, Fortaleza, Brazil, 2024

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Table 3. Distribution of consequences related to the second victim, Fortaleza, Brazil, 2024

Consequences Number of Citations % (n)
         Physical Consequences
              Sleep disorders11 12, 14, 15, 17- 21, 23, 28, 29, 31- 33, 35, 36, 38, 42, 43, 45, 48, 49 63.40 (23)
              Fatigue11 16, 17, 19, 20, 21, 26, 32, 35, 42, 48 26.90 (23)
              Changes in vital signs11 18, 19, 42, 48, 49* 14.60 (6)
              Muscle tonus19 26, 32, 48, 49 12.10 (5)
              Loss of appetite20 32, 35, 49 9.70 (4)
              Headache19 45, 46, 48 9.70 (4)
              Nausea31 32, 42, 48 9.70 (4)
              Pain11 31, 32 7.30 (3)
              Vomiting20, 48 7.80 (2)
              Abdominal pain19 20 7.80 (2)
              Weight loss20 2.40 (1)
          Emotional Consequences
              Guilt3 11, 12, 14, 17, 20, 23, 26, 28- 30, 32, 33- 38, 42, 43, 45, 47, 48 65.80 (27)
              Anger3 11, 12, 14, 15, 18- 23, 26, 28, 32, 33 35 38, 43, 45, 46, 49 51.20 (21)
              Shame13 16, 20, 23, 26, 28, 29, 33, 37, 47, 48 43.90 (18)
              Fear 12 15, 16, 18, 23, 29, 31, 32, 35, 37, 41, 47 48 34.10 (14)
              Sadness11 16, 19, 20, 22, 26, 28, 36, 43, 48 49 26.80 (11)
              Reduced job satisfaction11 15, 18, 21, 23, 26, 32, 33, 49 26.80 (11)
              Remorse11 15, 16, 19, 26, 31, 37, 49, 19.50 (8)
              Concern 14 16, 18, 26, 31, 49 17.00 (17)
              Helplessness12 14, 15, 20, 26
              Disappointment 20 2.40 (1)
              Grief26 2.40 (1)
         Psychological Consequences
              Loss of self-confidence3 11, 20, 23, 26, 28, 30, 32, 34, 36, 38, 40, 42, 45, 48 68.20 (28)
              Anxiety3 16, 20, 11, 23, 26, 29, 30, 33, 34, 38, 43, 45, 48 49, 58.50 (24)
              Repetitive/intrusive memories3 11, 14, 17, 19, 20, 23, 26, 29, 31, 33- 36, 41- 43, 46, 47, 49 53.60 (22)
              Depression11 15, 19, 21, 26, 29, 30, 32, 37, 42, 45 36.50 (15)
              Decreased concentration11 12, 14, 15, 17, 19, 20, 26, 34, 38, 43, 45 31.70 (13)
              Post-Traumatic Stress Disorder11 16, 17, 19, 20, 21, 26, 32, 35, 42, 48 24.30 (10)
              Frustration11 19, 20, 23, 26, 34, 38, 49 19.50 (8)
              Suicide14 27, 29, 38, 45, 46 14.60 (6)
              Hypervigilance3 23, 32, 36, 47 12.10 (5)
              Burnout21 31, 37, 42 9.70 (4)
         Social Consequences
              Leaving the profession11 12, 19, 20, 23, 28, 33, 35, 41, 43, 45, 46 30.00 (16)
              Isolation3 11, 12, 14, 15, 18- 20, 29, 31, 32, 41, 45, 46, 48 29.20 (12)
              Absenteeism17 20, 23, 26, 28, 31, 33, 35 26.80 (11)
              Alcohol and drug use and abuse3 31, 37, 45 9.70 (4)
              Strain in relationships (children or partners)20 23, 43 7.30 (3)
         Moral Consequences
              Damage to reputation and professional prestige11 12, 14, 15, 17- 20, 26, 31, 37, 38, 41, 43, 45 47 49 41.40 (17)
              Humiliation18 2.40 (1)
          Legal Consequences
              Litigation11 14- 16, 19- 22, 29, 32, 43 26.80 (11)

     *Increased heart rate, respiratory rate, and blood pressure.

 

Related concepts and surrogate terms of the “second victim” concept
The concepts related to the “second victim” are intrinsically linked to patient safety and its impacts on workers’ health, with particular emphasis on the psychological dimension. However, the surrogate terms identified are more related to the manifestations arising from this experience, in terms of the chronicity and progression toward pathological responses, than to the individuals themselves. Tabela 4.

 

Table 4. Distribution of related concepts and surrogate terms for the “second victim” concept, Fortaleza, Brazil, 2024

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Table 4. Distribution of related concepts and surrogate terms for the “second victim” concept, Fortaleza, Brazil, 2024

Related concepts Number of citations % (n)
              Patient safety3, 11- 14, 17, 20- 24, 27, 29- 38, 40, 42, 43 63.40 (26)
              Worker’s health3, 11, 15, 23, 26- 28, 30, 31 17.00 (7)
              Mental health12, 17, 23, 28, 38, 44 17.00 (7)
         Surrogate terms
              Second victim phenomenon11, 14, 17, 20, 21, 24, 26, 32, 33, 35, 38, 44, 46 31.70 (13)
              Second victim syndrome13, 18, 22, 24, 30, 31, 46 17.00 (7)

 

The “second victim” concept
The identification of the fundamental elements of the concept enabled a clearer definition of the concept and its scope of application, which are directly related to the characteristics of healthcare professionals’ lived experiences.

In this regard, the conceptual definition of the second victim proposed in this study refers to healthcare workers, scholars, and administrative or support staff who are directly or indirectly involved in patient care and who, when involved in an unintentional healthcare-related incident, experience physical, emotional, and psychological reactions with repercussions across biological, social, ethical, and legal dimensions. Without adequate and timely support, these reactions may become chronic and, eventually, pathological.

Thus, the concept represents a multifaceted phenomenon intrinsically related to the historical background and culture of healthcare services. Its characteristics highlight relevant concerns, especially regarding the mental health and well-being of healthcare professionals in the context of patient safety. To facilitate understanding of the interrelationships within this construct, Figure 2 is a graphical representation of the concept’s nature and interconnections.

Figure 2. Conceptual structure of the second victim concept and its relationships among antecedents, attributes, consequences, and related concepts, Fortaleza, Ceará, 2024

3. Identification of a model case for the concept
In this analysis, a real case reported in the literature was used, with the appropriate adaptations to protect the identity of those involved. The selected practical example illustrates the “second victim” concept, highlighting its key attributes and consequences. This case aims to highlight the concept's characteristics, provide an accurate understanding, and facilitate its application.

“An experienced pediatric intensive care nurse, recognized for her dedication, made a medication error by administering an excessive dose of calcium chloride to an infant with severe heart problems.
The error occurred due to a momentary distraction during medication preparation. Although she promptly recognized the error, reported the incident, and intervened to stabilize the patient, she was overwhelmed by intense feelings of guilt and remorse for having caused harm to the infant, who died five days later. It is believed that the error exacerbated the child's heart condition, contributing to the fatal outcome.

The case received widespread media coverage, prompting the nursing board to initiate an investigation. During the proceedings, the institution placed the nurse on administrative leave without providing adequate emotional or professional support. In the absence of peer support, she began to question her professional competence, feeling deeply frustrated, ashamed, and helpless.

After the investigation was completed, the institution terminated her employment contract, and the nursing board imposed sanctions, including a fine and a four-year probationary period during which her medication administration would be supervised. The public repercussions and professional consequences further aggravated her emotional state, leading to insomnia, anxiety, and severe depression. She began to repeatedly relive the incident in her thoughts and dreams, progressively withdrawing from friends, family, and her religious community.

Despite several attempts to re-enter the workforce, the nurse encountered barriers, which intensified her isolation and despair. Faced with the prospect of no longer being able to practice her profession, persistent sadness and feelings of inadequacy culminated in her decision to take her own life seven months after the incident. The impact of her death was profound, with former patients and their family members attending a memorial service in her honor, where they expressed gratitude for her compassion and dedication throughout her career.”

4. Hypotheses identification and their implications
The analysis of the “second victim” concept based on Rodgers’ evolutionary approach offers a broader and more practical understanding of the construct. This proposal enables the integration of the concept into discussions on patient safety and workers’ health.

However, studies on second victims have examined the experiences and perceptions of formally trained healthcare professionals. Future research on the topic should adopt a broader scope. The conceptual framework proposed in this research underscores the need to include other healthcare workers who are indirectly involved in care, share responsibility for patient safety, and may also be affected as “second victims.”

It is also important to emphasize the need for future studies that differentiate between the “second victim phenomenon” and “second victim syndrome.” These terms are often used interchangeably with “second victim,” yet they lack a precise conceptual definition.

Discussion

Concept contributions
The “second victim” concept presented in this study revisits and expands the understanding of this condition by incorporating new dimensions into its definition. The proposal’s distinguishing feature is its comprehensive approach, which includes not only physicians but all healthcare workers, scholars, and administrative or support staff as potentially affected individuals. The definition also encompasses the physical, emotional, psychological, social, ethical, and legal consequences these individuals experience, highlighting the need for timely support to prevent chronic effects and associated diseases.

The inclusion of other healthcare workers, such as nurses, physical therapists, and pharmacists, as well as other non-traditional healthcare roles, such as laboratory technicians, cleaning staff45, radiotherapy professionals, and porters17, in addition to practicum students30,31,35,36,40,49 , represents a step forward in understanding the vulnerability of these groups. However, many of these professionals were generically classified as “others” in the studies, highlighting the need for greater recognition and formal inclusion of these groups in discussions on patient safety and exposure to events that may render them potential second victims.

The recognition that other professional categories, whether in training or indirectly involved in patient care, can also become second victims represents a significant contribution. This finding is a crucial step toward ensuring that educational institutions and hospitals develop more comprehensive support programs, so that no individual, regardless of their role or career status, is left without support in times of crisis.

The incorporation of repercussions and consequences into the definition, in turn, supports the conclusion that the resulting harm also affects healthcare workers. Such recognition is essential for planning practical approaches to support these professionals and promote actions that facilitate their recovery and prevent future adverse effects. A systematic review with meta-analysis revealed that the second victim syndrome affects 58% of professionals over the course of their careers, of whom 60% recover within one month, while 20% take more than a year to recover or do not recover50

Thus, including appropriate and timely support as an essential component of managing these experiences and recognizing its critical role in preventing progression toward chronic and pathological responses serves as a warning and holds health institutions accountable for developing support strategies for professionals to prevent these unfavorable outcomes.

Support mechanisms must be accessible, structured, and widely disseminated to ensure positive outcomes and encourage constructive approaches to addressing second victims’ experiences41. In this context, organizational culture directly influences the suffering of these professionals and may either mitigate or intensify it. Punitive environments exacerbate adverse effects, undermine a culture of patient safety, promote the concealment of errors, and increase underreporting, thereby hindering organizational learning and the correction of failures.40


Contextual basis
The concept’s antecedents highlight how a weakened patient safety culture contributes to the negative impacts on second victims. Punitive organizational cultures exacerbate emotional symptoms. These cultures, characterized by blame and fear-based management, compromise professional performance and hinder efforts to prevent new adverse events51. Therefore, promoting a patient safety culture based on transparency, without blaming or punishment, and continuous learning is essential for advancing organizational improvements48.

The attributes identified as essential to the concept reflect the prolonged and multidimensional nature of the experience, encompassing physical, emotional, psychological, social, moral, and legal repercussions, and highlighting the depth of its impact. The manifestations are particular and affect social, cultural, emotional, spiritual, and physical areas52.

Recurrent symptoms, such as hypervigilance, flashbacks, and feelings of shame, may persist for months or even years, especially in the absence of adequate institutional support5. When left untreated, these symptoms may progress to severe conditions, such as post-traumatic stress disorder, anxiety, depression, and suicidal ideation53. Although some individuals recover in the short term, others experience manifestations that may last a lifetime17, underscoring the need for effective interventions to prevent chronicity and worsening outcomes.

The discussion of duration, chronicity, and progression toward pathological responses in the second victim condition is intertwined with the surrogate terms identified in the analyzed studies. The expressions “second victim phenomenon”21,26, 33,35, 38,45, 46,49 and “second victim syndrome”13, 18, 30 are often used interchangeably with “second victim.” However, based on the literature reviewed, these terms are more related to lived experiences than to the individuals themselves. Nevertheless, these expressions reflect different aspects: “phenomenon” refers to the symptomatic manifestations following the incident, whereas “syndrome” is associated with cases in which the professional develops a pathological condition due to a lack of resources to cope with the experience.

The second victim condition is closely related to other important concepts, such as mental health, workers’ health, and patient safety, as extensively discussed in the study. These areas converge in addressing worker well-being, highlighting the importance of preventive and supportive measures in situations of work-related trauma. The relationship between occupational health and patient safety has gained attention, as adequate working conditions directly influence the quality of care and patient safety1.

Ensuring service quality requires continuous investment in education, training, and the maintenance of professionals’ health. However, high rates of illness among workers reveal a concerning reality, exacerbated by the absence of institutional policies aimed at balancing worker safety and patient safety. This scenario highlights the importance of implementing integrated actions that ensure this essential combination: safe workers and safe patients54.

Critical analysis of the concept
The analysis of the manuscripts included in this study indicates that, although the “second victim” concept has become established over time, its use remains controversial. Concerns have been raised abput the appropriateness of using the term “victim” to describe healthcare workers, as it may convey an idea of passivity, imply exemption from responsibility, and minimize the need for ethical and professional accountability.

Critics of the term “second victim” argue that it may conflict with patient safety culture, divert attention from the needs of affected patients and their families, and place excessive emphasis on professionals at the expense of a balanced approach24. According to them, the terminology may minimize or undermine patients’ experience by suggesting that “everyone is a victim,” thereby diluting the real pain experienced by patients and their families.

In addition, critics point out that this expression may convey the perception that professionals are more concerned with themselves than with their patients. For this reason, some researchers advocate reevaluating and, if necessary, replacing the term with more appropriate alternatives developed in consultation with patients and professionals39.

By contrast, proponents of the term “second victim” argue that it reflects the reality of professionals affected by errors arising from flawed systems, highlighting the need for institutional support and an approach focused on organizational well-being. The term is also seen as raising institutional awareness and promoting a patient safety culture that includes support for workers as an essential component of learning and prevention strategies25.

Supporters contend that introducing the term has been beneficial, as it has brought attention to the impact of errors on healthcare professionals without diminishing patients’ experiences. They emphasize that, although patient-centered care is essential, the well-being of professionals is equally crucial to the safety and quality of care. They further argue that the focus should be on preventing new incidents through collaboration among patients, family members, and professionals, moving beyond terminological debates and prioritizing practical support and prevention strategies.27

The creator of the term, Albert Wu, acknowledges that, despite criticism, the concept is well established and understood among healthcare professionals, and that changing it could lead to confusion. He argues that the term serves its purpose of drawing attention to the problems professionals face. However, he also admits that there are valid arguments both in favor and against its use. In this regard, he suggests that, at present, it is essential to allow advocates to adopt the terminology with which they feel most comfortable, provided that the goal remains the recognition of the problem and the implementation of appropriate solutions29.

The objective of this study was to conduct a concept analysis of the term “second victim” with the aim of establishing a more precise definition of the individuals involved and the repercussions of adverse events on healthcare workers. The study does not seek to reformulate the existing terminology; however, it acknowledges that the term “second victim” may not be the most appropriate for referring to these professionals. Accordingly, there is a need for further studies to propose alternative, equally representative terminologies that preserve the impact and relevance of the current term, while promoting greater precision and acceptance in academic and practical fields.

As a concept analysis, this study has limitations. Although it provides a historical and dynamic contextualization of the concept, it relies on the researchers’ interpretations, which may introduce bias and limit the generalizability of its propositions. Furthermore, the decision to include only open-access articles may have limited the sample analyzed, excluding relevant studies available in restricted-access databases. Nevertheless, the study contributes to the conceptual development and definition of the concept and may inform future research. In this sense, further research is recommended to integrate approaches that strengthen the practical application of the concept.

 

Conclusions

The concept analysis based on Rodgers’ evolutionary model provided a more accurate understanding of the “second victim” concept, with relevant implications for patient safety. Accordingly, the “second victim” concept refers to healthcare workers, scholars, and administrative or support staff who are directly or indirectly involved in patient care and who, following an unintentional healthcare-related incident, experience physical, emotional, and psychological reactions with repercussions across the biopsychosocial, ethical, and legal dimensions. Without appropriate and timely support, these reactions may become chronic and, eventually, pathological.

The identified antecedents indicate that weaknesses in patient safety culture and the absence of support mechanisms favor the emergence of the second victim condition among healthcare professionals. The influence of historical and cultural factors contributes to the perpetuation of suffering, reinforcing reluctance to seek help and maintaining an image of perfection in healthcare. In this context, the second victim experience warrants reflection on the physical, emotional, and psychological reactions that characterize it and underscore the need for appropriate support.

The consequences of this condition affect both professionals’ well-being and patient safety, as well as organizational dynamics, compromising the quality of care and workers’ performance. Accordingly, concepts related to the “second victim” are intrinsically linked to patient safety and workers’ health, highlighting the need for effective institutional approaches to prevention and support to minimize its negative effects and promote a safer and more supportive work environment.

Conflict of interest: The authors declare no conflicts of interest.

Funding: The research received no funding.

Author Contributions: Matheus Tavares França da Silva: Conceptualization; Data curation; Formal Analysis; Investigation; Methodology; Project administration; Software; Writing - original draft. Caroliny Cristine dos Santos Mendes: Data curation ; Formal Analysis; Methodology; Project administration; Software. Rebeca Furtado Fernandes: Data curation; Formal Analysis; Methodology; Project administration; Software. Sherida Karanini Paz de Oliveira: Supervision; Validation; Writing – revision & editing. Rhanna Emanuela Fontenele Lima de Carvalho: Supervision; Validation; Writing – revision & editing.

 

References

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References

  1. World Health Organization. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Geneva: WHO. [Internet] 2021 [cited 2024 Jul 5]. Available from: https://www.conass.org.br/wp-content/uploads/2024/07/9789240095458-eng.pdf

  2. World Health Organization. Global patient safety report 2024. Geneva: WHO. [Internet] 2024 [cited 2024 Jul 6]. Available from: https://iris.who.int/handle/10665/376928

  3. Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320(7237):726-7. https://doi.org/10.1136/bmj.320.7237.726

  4. Yorkshire Quality and Safety Research Group (Bradford Institute for Health Research and University of Leeds) and the Yorkshire and Humber Improvement Academy (YHIA). Spotlight on the ‘Second Victim’ term. Just Culture Network. [Internet] 2022 [cited 2024 Jul 8]. Available from: https://secondvictim.co.uk/wp-content/uploads/2022/07/JCN-branded-Full-Spotlight-SV-piece-v4.pdf

  5. Vanhaecht K, Seys D, Russotto S, Strametz R, Mira J, Sigurgeirsdóttir S, et al. An Evidence and Consensus-Based Definition of Second Victim: A Strategic Topic in Healthcare Quality, Patient Safety, Person-Centeredness and Human Resource Management. Int J Environ Res Public Health. 2022;19(24):16869. https://doi.org/10.3390/ijerph192416869

  6. Rodgers BL. Concept Analysis: An Evolutionary View. In: Rodgers BL, Knafl KA, eds. Concept Development in Nursing - Foundations, Techniques, and Applications. 2nd ed. Philadelphia: Saunders; 2000.

  7. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H.Scoping Reviews (2020). Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis JBI. 2024:417-462. https://doi.org/10.46658/JBIMES-24-09

  8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic. Rev Panam Salud Publica. 2022;46:e112. https://doi.org/10.26633/RPSP.2022.112

  9. Da Silva MTF, Fernandes RF, Mendes CCS, Oliveira SKP, Carvalho REFL. Atributos, Antecedentes e Consequentes do Conceito de Segunda Vítima em Trabalhadores da Saúde: Revisão de Escopo. OSF; 2025. https://doi.org/10.17605/OSF.IO/T8UCF

  10. Silva MTF da; Mendes CCS; Fernandes, RF; Oliveira, SKP; Anjos, SJSB; Carvalho, RFL. Segunda Vítima: Análise de Conceito Fundamentada no Modelo Evolucionário de Rodgers”,Mendeley Data, 2025. V1. https://doi.org/10.17632/7mrmv8p4vv.1

  11. Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Qual Saf Health Care. 2009;18(5):325-30. https://doi.org/10.1136/qshc.2009.032870

  12. Edrees HH, Paine LA, Feroli ER, Wu AW. Health care workers as second victims of medical errors. Pol Arch Med Wewn. 2011;121(4):101-8. https://dx.doi.org/10.20452/pamw.1033

  13. Clancy CM. Alleviating "second victim" syndrome: how we should handle patient harm. J Nurs Care Qual. 2012;27(1):1-5. https://dx.doi.org/10.1097/NCQ.0b013e3182366b53

  14. Hall LW, Scott SD. The second victim of adverse health care events. Nurs Clin North Am. 2012;47(3):383-93. https://dx.doi.org/10.1016/j.cnur.2012.05.008

  15. Schiechtl B, Hunger MS, Schwappach DL, Schmidt CE, Padosch SA. Second victim: Critical incident stress management in clinical medicine. Anaesthesist. 2013;62:734-41. https://dx.doi.org/10.1007/s00101-013-2215-5

  16. Harrison R, Lawton R, Perlo J, Gardner P, Armitage G, Shapiro J. Emotion and Coping in the Aftermath of Medical Error: A Cross-Country Exploration. Journal of Patient Safety, 2015,11(1):28- 35. https://dx.doi.org/10.1097/PTS.0b013e3182979b6f

  17. Mira JJ, Carrillo I, Lorenzo S, Ferrús L, Silvestre C, Pérez-Pérez P, et al. The aftermath of adverse events in Spanish primary care and hospital health professionals. BMC Health Serv Res. 2015,15:151. https://dx.doi.org/10.1186/s12913-015-0790-7

  18. Marmon LM, Heiss K. Improving surgeon wellness: The second victim syndrome and quality of care. Semin Pediatr Surg. 2015;24(6):315-318. https://dx.doi.org/10.1053/j.sempedsurg.2015.08.011

  19. Rinaldi C, Leigheb F, Vanhaecht K, Donnarumma C, Panella M. Becoming a "second victim" in health care: Pathway of recovery after adverse event. Rev Calid Asist. 2016;31(2):11-9. https://dx.doi.org/10.1016/j.cali.2016.05.001

  20. Van Gerven E, Vander Elst T, Vandenbroeck S, Dierickx S, Euwema M, Sermeus W, et al. Increased Risk of Burnout for Physicians and Nurses Involved in a Patient Safety Incident. Med Care. 2016;54(10):937-43. https://dx.doi.org/10.1097/MLR.0000000000000582

  21. Quillivan RR, Burlison JD, Browne EK, Scott SD, Hoffman JM. Patient Safety Culture and the Second Victim Phenomenon: Connecting Culture to Staff Distress in Nurses. Jt Comm J Qual Patient Saf. 2016;42(8):377-384. https://dx.doi.org/10.1016/s1553-7250(16)42053-2

  22. Han K, Bohnen JD, Peponis T, Martinez M, Nandan A, Yeh DD, et al. The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study. J Am Coll Surg. 2017;224(6):1048-1056. https://dx.doi.org/10.1016/j.jamcollsurg.2016.12.039

  23. Van Gerven E, Deweer D, Scott SD, Panella M, Euwema M, Sermeus W et al. Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study. Rev Calid Asist. 2016;31(2):34-46. https://dx.doi.org/10.1016/j.cali.2016.02.003

  24. Clarkson MD, Haskell H, Hemmelgarn C, Skolnik P J. Abandon the term “second victim”. BMJ. 2019;364:l1233. https://dx.doi.org/10.1136/bmj.l1233

  25. Petersen IG. The term “second victim” is appropriate for frontline Workers. BMJ. 2019;365:l2157 https://dx.doi.org/10.1136/bmj.l2157

  26. Kobe C, Blouin S, Moltzan C, Koul R. The Second Victim Phenomenon: Perspective of Canadian Radiation Therapists. J Med Imaging Radiat Sci. 2019;50(1):87-97. https://dx.doi.org/10.1016/j.jmir.2018.07.004

  27. Gómez-Durán EL, Tolchinsky G, Martin-Fumadó C, Arimany-Manso J. Neglecting the "second victim" will not help harmed patients or improve patient safety. BMJ. 2019;365:l2167. https://dx.doi.org/10.1136/bmj.l2167

  28. Gupta K, Lisker S, Rivadeneira NA, Mangurian C, Linos E, Sarkar U. Decisions and repercussions of second victim experiences for mothers in medicine (SAVE DR MoM). BMJ. Qual Saf. 2019;28(7):564- 573. https://dx.doi.org/10.1136/bmjqs-2018-008372

  29. Wu AW, Shapiro J, Harrison R, Scott SD, Connors C, Kenney L, et al. The Impact of Adverse Events on Clinicians: What's in a Name?. J Patient Saf. 2020;16(1):65-72. https://dx.doi.org/10.1097/PTS.0000000000000256

  30. Donahue KR, Gossai T, Succar L, Bhakta SB, Varkey AC. Second victim syndrome and the pharmacy learner. J Am Pharm Assoc. 2020;60(4):e14-e17. https://dx.doi.org/10.1016/j. japh.2020.01.020

  31. Huang H, Chen J, Xiao M, Cao S, Zhao Q. Experiences and responses of nursing students as second victims of patient safety incidents in a clinical setting: A mixed-methods study. J Nurs Manag. 2020;28(6):1317-1325. https://dx.doi.org/10.1111/jonm.13085

  32. Choi EY, Pyo J, Lee W, Jang SG, Park YK, Ock M, et al. Nurses' experiences of patient safety incidents in Korea: a cross-sectional study. BMJ Open. 2020;10(10):e037741. https://dx.doi.org/10.1136/bmjopen-2020-037741

  33. Burlison JD, Quillivan RR, Scott SD, Johnson S, Hoffman JM. The Effects of the Second Victim Phenomenon on Work-Related Outcomes: Connecting Self-Reported Caregiver Distress to Turnover Intentions and Absenteeism. J Patient Saf. 2021;17(3):195-199. https://dx.doi.org/10.1097/PTS.0000000000000301

  34. Almeida PP. Avaliação dos profissionais de enfermagem sobre a cultura de segurança e as manifestações de segunda vítima de evento adverso. 2021. 83 f. Dissertação [Mestrado Profissional em Saúde Ambiental e Saúde do Trabalhador] - Universidade Federal de Uberlândia, Uberlândia, 2021. http://doi.org/10.14393/ufu.di.2021.556

  35. Choi EY, Pyo J, Ock M, Lee H. Second victim phenomenon after patient safety incidents among Korean nursing students: A cross-sectional study. Nurse Educ Today. 2021;107:105115. https://dx.doi.org/10.1016/j.nedt.2021.105115

  36. Van Slambrouck L, Verschueren R, Seys D, Bruyneel L, Panella M, Vanhaecht K. Second victims among baccalaureate nursing students in the aftermath of a patient safety incident: An exploratory cross-sectional study. J Prof Nurs. 2021;37(4):765-770. https://dx.doi.org/10.1016/j.profnurs.2021.04.010

  37. Fatima S, Soria S, Esteban-Cruciani N. Medical errors during training: how do residents cope? abdescriptive study. BMC Med Educ. 2021;21(1):408. https://dx.doi.org/10.1186/s12909-021-02850-1

  38. Magaldi M, Perdomo JM, López-Baamonde M, Chanzá M, Sanchez D, Gomar C. Second victim phenomenon in a surgical area: online survey. Rev Esp Anestesiol Reanim. 2021;68(9):504-512. https://dx.doi.org/10.1016/j.redar.2020.11.009

  39. Tumelty ME. The Second Victim: A Contested Term? J Patient Saf. 2021;17(8):e1488-e1493. https://dx.doi.org/10.1097/PTS.0000000000000558

  40. Tavares APM, Barlem JGT, Silveira RS da, Dalmolin G de L, Feijó G dos S, Machado IA, et al. Support provided to nursing students in the face of patient safety incidents: a qualitative study. Rev Bras Enferm. 2022;75(2):e20220009. https://doi.org/10.1590/0034-7167-2022-0009pt

  41. Quadros DV de, Magalhães AMM de, Wachs P, Severo IM, Tavares JP, Dal Pai D. Modelagem de quedas de pacientes adultos e as repercussões à Enfermagem como segunda vítima. Rev Latino- Am Enfermagem. 2022;30:e3617. https://doi.org/10.1590/1518-8345.5830.3617

  42. Ganahl S, Knaus M, Wiesenhuetter I, Klemm V, Jabinger EM, Strametz R. Second Victims in Intensive Care-Emotional Stress and Traumatization of Intensive Care Nurses in Western Austria after Adverse Events during the Treatment of Patients. Int J Environ Res Public Health. 2022;19(6):3611. https://doi.org/10.3390/ijerph19063611

  43. Flórez F, López L, Bernal C. Prevalencia de eventos adversos y sus manifestaciones en profesionales de la salud como segundas víctimas. Biomed. 2022; 42(1):184-195. https://doi.org/10.7705/biomedica.6169

  44. Quadros DV de , Magalhães AMM de, Boufleuer E, Tavares JP, Kuchenbecker R de S, Dal Pai D. Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim. Aquichan. 2022;22(4):e2246. https://doi.org/10.5294/aqui.2022.22.4.6

  45. Krommer E, Ablöscher M, Klemm V, Gatterer C, Rösner H, Strametz R, et al. Second Victim Phenomenon in an Austrian Hospital before the Implementation of the Systematic Collegial Help Program KoHi: A Descriptive Study. Int J Environ Res Public Health. 2023;20(3):1913. https://doi.org/10.3390/ijerph20031913

  46. Mousa O, Sadeq Alghazal M, Abdullah AlBather A, Nasser Alhassan A, Hussain Alamer M, Taher Alghadeer Z et al. A Study on Patient Safety Incidents and the Second Victim Phenomenon Among Healthcare Providers in Al-Ahsa, Saudi Arabia. Cureus. 2023;15(11):e49324. https://doi.org/10.7759/cureus.49324

  47. Silveira SE da, Tomaschewski-Barlem JG, Tavares APM, Paloski G do R, Feijó G dos S, Cabral CN. Impactos de incidentes de segurança do paciente na enfermagem: um olhar para a segunda vítima. Rev enferm UERJ. 2023;31(1):e73147. https://doi.org/10.12957/reuerj.2023.73147

  48. Alevi JO, Draganov PB, Gonçalves GCS, Zimmermann GS, Giunta L, Mira JJ, et al. O enfermeiro recém-formado na condição de segunda vítima. Acta paul enferm. 2024;37:eAPE02721. https://doi.org/10.37689/acta-ape/2024AO0002721

  49. Albert-Galbis A, Pérez-Cañaveras RM, Vaismoradi M, Vizcaya-Moreno MF. The second victim phenomenon: A qualitative study among bachelor's degree nursing students within the clinical learning environment. Nurse Educ Pract. 2024;78:104038. https://doi.org/10.1016/j.nepr.2024.104038

  50. Naya K, Aikawa G, Ouchi A, Ikeda M, Fukushima A, Yamada S, et al. Second victim syndrome in intensive care unit healthcare workers: A systematic review and meta-analysis on types, prevalence, risk factors, and recovery time. PLoS One. 2023;18(10):e0292108. https://doi.org/10.1371/journal.pone.0292108

  51. Lemos G de C, Azevedo C, Bernardes MFVG, Ribeiro HCTC, Menezes AC, Mata LRF da. A Cultura de Segurança do Paciente no Âmbito da Enfermagem: Reflexão Teórica. Revista de Enfermagem do Centro-Oeste Mineiro. 2018;8:e2600. https://doi.org/10.19175/recom.v8i0.2600

  52. Ozeke O, Ozeke V, Coskun O, Budakoglu II. Second victims in health care: current perspectives. Adv Med Educ Pract. 2019;10:593-603. https://doi.org/10.2147/AMEP.S185912

  53. Busch IM, Moretti F, Purgato M, Barbui C, Wu AW, Rimondini M. Psychological and Psychosomatic Symptoms of Second Victims of Adverse Events: a Systematic Review and Meta-Analysis. J Patient Saf. 2020;16(2):e61-e74. https://doi.org/10.1097/PTS.0000000000000589

  54. Baldonedo-Mosteiro M, Almeida MC dos S, Baptista PCP, Sánchez-Zaballos M, Rodriguez- Diaz FJ, Mosteiro-Diaz MP. Burnout syndrome in Brazilian and Spanish nursing workers. Rev Latino-Am Enfermagem. 2019;27:e3192. https://doi.org/10.1590/1518-8345.2818.3192