Second Victim Trauma Recovery Pathway of Emergency Nurses After Patient Safety Incidents: A Grounded Theory Study

Drawing on Strauss and Corbin's grounded theory, this study systematically examined the internal mechanisms underlying trauma recovery among emergency nurses as secondary victims of patient safety incidents. A context-specific theoretical model was developed to provide empirical evidence to inform the design of targeted support strategies for nursing managers.

A combination of purposive and theoretical sampling was used to recruit 18 frontline emergency nurses who had experienced patient safety incidents in the emergency department of a tertiary Grade A hospital in Chengdu between January and June 2025. Data were collected through semistructured, in-depth interviews. NVivo 12.0 was applied to conduct open, axial, and selective coding. Additional interviews were undertaken to confirm theoretical saturation.

The analysis yielded 68 initial categories, 22 subcategories, and 7 core categories. These findings informed the construction of a circular, dynamic theoretical model of trauma recovery comprising four sequential stages: trauma stress trigger, cognitive appraisal and emotional response, acquisition of intervention and support, and recovery reconstruction and career reorientation. Managerial support and proactive coping strategies emerged as key factors influencing trauma recovery.

Trauma recovery among emergency nurses as secondary victims of patient safety incidents represents a dynamic, cyclical process shaped by the interaction of individual, organizational, and contextual factors. Nursing managers can apply the stage-specific features of this model to establish a stratified and integrated support system, thereby improving psychological recovery, sustainable career development, emergency nursing management, and patient safety outcomes.

Emergency nursing managers should implement phased support strategies: immediate nonblaming crisis intervention with temporary duty adjustment during acute stress; structured psychological counseling and peer support groups during emotional processing; accessible three-tier support framework combining managerial, professional, and organizational resources; and career development opportunities transforming trauma into professional growth. These measures operationalize "just culture" principles, fostering nurses' well-being, team resilience, and patient safety.