The “Second Victim” Phenomenon in Nursing: A Qualitative Systematic Review of Lived Experiences, Moral Injury, and Institutional Support Needs

Background: Medical errors and adverse patient events have profound psychological impacts on healthcare professionals. While patient safety remains the primary focus, nurses involved in these incidents frequently experience severe emotional distress, characterizing them as "second victims." Recent literature increasingly links this phenomenon to moral injury and systemic cultural failures. Objective: To systematically review and synthesize qualitative evidence regarding the lived experiences of nurses as second victims, exploring the intersection of error-related distress with moral injury, and to identify their specific support needs and coping mechanisms. Methods: A systematic literature search was conducted to identify qualitative studies, meta-syntheses, integrative reviews, and mixed-method studies published between ۲۰۱۵ and ۲۰۲۶. The synthesized data encompassed registered nurses' experiences with medical errors, emotional distress, disclosure dilemmas, and institutional support mechanisms. Results: Analysis of the literature revealed three primary themes: ۱) The Profound Emotional Burden and Moral Injury, characterized by guilt, shame, PTSD-like symptoms, and ethical conflict; ۲) The Complex Trajectory of Recovery and Disclosure, illustrating the progression from acute distress and competency loss to the dilemma of patient disclosure; and ۳) The Critical Demand for Non-Punitive Safety Cultures and Peer Support, highlighting that while professional counseling exists, nurses overwhelmingly prefer structured, trusted peer-support systems. Conclusion: Nurses experience significant, trauma-like psychological distress following adverse events, often exacerbated by punitive organizational cultures. Healthcare institutions must transition toward a "just culture" by implementing accessible, peer-driven support programs and integrating moral injury awareness into nursing education and institutional policy.

کلیدواژه ها:

Second Victim Phenomenon ، Nursing ، Medical Errors ، Moral Injury ، Qualitative Synthesis ، Patient Safety Culture ، Peer Support