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

Abstract

Highlights

• Organizational culture can mitigate or exacerbate healthcare professionals’ experiences during patient safety incidents. Punitive and unsupportive environments favor the “second victim” condition.
• The “second victim” condition leads to emotional, physical, and social consequences for professionals, resulting in long-term effects on their health and personal and professional performance.
• Adequate support is crucial for managing the “second victim” experience and requires a holistic approach that considers the multiple factors that affect these professionals’ lives and work.
• Professionals in training or those indirectly involved in care may also be considered second victims, highlighting the need for comprehensive support programs for all individuals during critical events.

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.

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