Preventive Support Strategies for the Second Victim Phenomenon in Nurses: A Mixed-Method Study

To identify nurses' preventive support needs related to the second victim phenomenon and develop consensus-based strategies.

Patient safety incidents can trigger the second victim phenomenon, causing psychological distress among healthcare professionals. While early approaches focused on post-incident support, recent research emphasizes preventive strategies. Pre-incident support remains limited, underscoring the need for nursing-specific preventive strategies.

A convergent mixed-methods design combined focus group interviews and a three-round Delphi survey. Eleven nurses explored preventive support needs through thematic analysis. Fourteen experts evaluated necessity, feasibility, and validity via Delphi. Reporting followed the Consolidated Criteria for Reporting Qualitative Research and Guidance on Conducting and Reporting Delphi Studies.

Nurses experienced emotional distress, stigma, and turnover intentions, exacerbated by limited formal support. Four key components were identified: incident prevention and response, understanding of the second victim phenomenon, post-incident support, and access to resources. Key strategies included case-based education, empathy training, and anonymous digital delivery. Experts validated these measures and advocated for systematic integration into institutional frameworks.

Findings align with and extend recent international models of second victim support. Blame-prone cultures, hierarchical structures, and shift-based work shaped distress and preferences for anonymous digital support, with managerial engagement as a cross-cutting enabler.

Preventive education, leadership engagement, and organizational preparedness should be embedded into routine systems to ensure accessible and sustainable support for second victims.

Preventive second victim interventions should be integrated into orientation programs, with leadership training to foster psychological safety and digital platforms to expand access for shift-based nurses.

Prevention strategies should be embedded in national guidelines and accreditation standards, requiring standardized protocols, dedicated funding, and coordinated policy commitment.