The second victim of adverse events in health care: A systematic review of qualitative research

This is the authors' abstract. We don't add key points for this paper.

Background Adverse medical events not only harm patients, but also create second victims among healthcare professionals, causing significant psychological trauma and professional challenges. A critical issue confronting healthcare systems worldwide is that over two-thirds of healthcare professionals encounter such trauma during their careers. Objectives The purpose of this study is to examine the impact of the second victim phenomenon on individuals and organizations, as well as their reciprocal interactions. Design A qualitative systematic review. Data source Medline, Web of Science, Cochrane, Science Direct, CINAHL, and PsycINFO were searched from January 2015 until April 2025. Review methods Two individuals independently performed the literature screening, as well as the extraction and evaluation of information. Quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument for Qualitative Research, and data were integrated and summarized using the inductive analysis method. Results Three analytical themes emerged from 19 studies: (1) The double-helix emotional response mode, which highlights the dynamic game between emotional contraction and emotional expansion. (2) The dilemma of organizational support, focusing on the gap between the symbolic and substantive aspects of resource provision. (3) The systematic feedback of the second victim phenomenon, which explores the transition from personal post-traumatic growth to systemic evolution. Conclusions This study advances theoretical understanding of the second victim phenomenon by analyzing the double-helix emotional response mode, the dilemma of organizational support and the systematic feedback mechanism. It also offers innovative insights and practical approaches for enhancing and continuously optimizing healthcare quality. What is already known • Second victims typically experience multiphase psychological trauma following medical errors, which manifests in diverse adverse outcomes. • Despite institutional support provisions, second victims frequently experience unmet support needs during psychological crises. • Organizational responses to adverse events significantly influence second victims' recovery trajectories and professional reintegration. What this paper adds • The duality of second victims' emotional responses is not a simple antagonistic relationship but a dynamically interactive double helix structure, characterized by the bidirectional interaction between negative emotional load and positive growth motivation. • The core dilemma of organizational support is rooted in the structural misalignment between its symbolic provision and the substantive needs of second victims. • This study reveals the systematic feedback mechanism of the second victim phenomenon and posits that the multidimensional growth of second victims after trauma can drive organizational-level changes.