Second Victim Experiences Among ICU Nurses: Findings From a Mixed-Methods Study.

Abstract

Background: Adverse events are common in intensive care units (ICUs), and nurses involved may experience the second victim phenomenon (SVP), which includes a range of physical and psychological symptoms. This study aimed to understand the SVP among ICU nurses in Chilean public hospitals by describing its prevalence and characteristics and by exploring nurses’ personal experiences. Methods: A sequential explanatory mixed-methods design was used. The quantitative phase involved a cross-sectional, multicenter study with ICU nurses selected through cluster probabilistic sampling. The Second Victim Experience and Support Tool (SVEST) and a safety culture checklist were applied. Analyses were conducted using SPSS. The qualitative phase was designed to deepen understanding of the quantitative findings and included in-depth interviews and a focus group with nurses meeting predefined criteria for second victim distress; qualitative data were analyzed following an interpretive descriptive approach, supported by ATLAS.ti. Results: Among 326 ICU nurses, 81.9% reported involvement in at least one adverse event. Psychological distress emerged as the most affected domain, with guilt reported as the predominant emotion. Peer support was the most valued, while institutional support was considered limited. Quantitative findings also indicated high intention to absenteeism, reduced professional self-efficacy, and significant regional differences. Qualitative findings from 11 participants revealed intense emotional responses, including fear, guilt, and helplessness. A lack of institutional support and the presence of a punitive culture were frequently reported. Peer and family support were essential for coping and encouraged individual and collective learning. The absence of formal support mechanisms intensified the psychological burden. Conclusions: SVP is highly prevalent among ICU nurses in Chile and significantly impacts their emotional well-being. While peer support plays a crucial role in recovery, the lack of institutional support reinforces a punitive environment. These findings underscore the need to develop structured support strategies that foster a culture of safety and promote the well-being of healthcare worker.