Second Victim Phenomenon and Nursing Support: An Integrative Review

Health care providers involved in unanticipated medical errors or other negative patient outcomes are described as `second victims,’ particularly when events result in injury or death. Second victims may experience feelings of guilt, inadequacy, or shame, potentially resulting in anxiety, depression, and feelings of incompetence, leaving their profession and in extreme cases, suicide. As direct care providers, nurses remain at risk for medical errors, adverse events, and witnessing traumatic events. Creating organizational structures that support nurses involved in medical errors is essential to the development of a healthy work environment for these care providers. The primary aim for this integrative review was to describe specific hospital programs to support nurses as second victims. A secondary aim included describing the barriers and facilitators to the implementation of these programs including the use of program resources by nurses. Combinations of search terms related to second victim were used to search three electronic databases using the Whittemore and Knafl (2005) guidelines as a framework. For the purposes of this review, nurses were defined to include both registered nurses as well as advanced practice nurses such as nurse practitioners and certified registered nurse anesthetists. Using the described search methods, a total of 366 records were retrieved. A title review identified articles appropriate for abstract review after duplicates were removed. About 33 records underwent full-text review. Of these, six met final inclusion criteria. This review provided an overview of existing programs that support nurses who have become second victims, as well as characteristics of these programs that are both facilitators and barriers for success and sustainment. Of note, successful programs depended on elements of trained peer support, being readily accessible to nurses through a variety of communication avenues, and having methodology in place to evaluate outcomes. Barriers included securing stable funding for these programs and overcoming the stigma of revealing oneself as a second victim.