The second victim phenomenon in Latin America: a scoping review

Brunelli, Maria Victoria; Fajreldines, Ana V; Catalán, Lucía; Kappes, María

doi:10.1590/1518-8345.7978.4828

person Maria Victoria Brunelli

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved · Data curation · Project supervision and management · Others (Drafting the manuscript and obtaining final approval)

schoolUniversidad Austral, Facultad de Ciencias Biomedicas, Derqui, Pcia de Buenos Aires, Argentina.

0000-0002-6960-1766

person Ana V Fajreldines

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved · Project supervision and management

schoolHospital Aleman, Departamento de Calidad y seguridad del paciente, Buenos Aires, Argentina.

0000-0002-8044-0617

person Lucía Catalán

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved · Others (Drafting the manuscript and obtaining final approval)

schoolUniversidad San Sebastian, Facultad de Ciencias para el cuidado de la Salud, Escuela de Enfermería, Santiago, Chile.schoolUniversidad Andrés Bello, Facultad de Enfermería, Santiago, Chile.

0000-0001-7060-473X

person María Kappes

Substantial contributions to the conception or design of the work · or the acquisition, analysis, or interpretation of data for the work · drafting the work or reviewing it critically for important intellectual content · final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved · Data curation · Project supervision and management · Others (Drafting the manuscript and obtaining final approval)

schoolUniversidad San Sebastian, Facultad de Ciencias para el Cuidado de la Salud, Escuela de Enfermeria, Puerto Montt, Chile.

0000-0001-8101-3898

personCorresponding author: Maria Victoria Brunelli E-mail:
vbrunell@austral.edu.ar https://orcid.org/0000-0002-6960-1766

Conflict of interest: the authors have declared that there is no conflict of interest.

Associate Editor:

Maria Lúcia Zanetti

Database	Search strategy
PubMed	(“second victim”(Title/Abstract] OR “second victims”[Title/Abstract]) AND (“Mexico”[Affiliation] OR “Panama”[Affiliation] OR “Puerto Rico”[Affiliation] OR “Dominican Republic”[Affiliation] OR Nicaragua”[Affiliation] OR “Honduras”[Affiliation] OR “Guatemala”[Affiliation] OR “El Salvador”[Affiliation] OR “Cuba”[Affiliation] OR “Costa Rica”[Affiliation] OR “Venezuela”[Affiliation] OR “Peru”[Affiliation] OR “Ecuador”[Affiliation] OR “Colombia”[Affiliation] OR “Brazil”[Affiliation] OR “Uruguay”[Affiliation] OR “Paraguay”[Affiliation] OR “Bolivia”[Affiliation] OR “Chile”[Affiliation] OR “Argentina”[Affiliation]) AND
PubMed	(“2000/01/01”[Date - Publication] : “2025/07/31”[Date - Publication])
BVS	(“segunda victima”) OR (“second victim”) Límites: País de afiliación: Brasil , Argentina; Colombia; Chile
CINAHL (EBSCO)	S1: TI (“second victim”) OR AB (“second victim”). Limiters - Hidden NetLibrary Holdings Expanders - Apply equivalent subjects Subject Geographic - Chile OR Argentina OR Brazil OR Costa Rica
ProQuest	“second victim” AND (location(“Argentina”) OR location(“Chile”) OR location(“Uruguay”) OR location(“Brazil”) OR location(“Colombia”) OR location(“Bolivia”) OR location(“Paraguay”) OR location(“Peru”) OR location(“Ecuador”) OR location(“Venezuela”) OR location(“Costa Rica”) OR location(“Cuba”) OR location(“El Salvador”) OR location(“Guatemala”) OR location(“Honduras”) OR location(“Nicaragua”) OR location(“Panama”) OR location(“Puerto Rico”) OR location(“Dominican Republic”) OR location(“Mexico”))
JSTOR	(“second victim” OR allintitle:(“segunda víctima” OR “segunda victima” OR “segundas víctimas” OR “segunda vítima” OR “segundas vítimas”)) AND (disciplines:(“Health Policy” OR “Health Sciences” OR “Latin American Studies” OR “Management & Organizational Behavior” OR “Psychology” OR “Public Health”))
Scopus	Title-abs-key(“second victim”) AND (affilcountry(“Mexico”) OR affilcountry(“Panama”) OR affilcountry(“Puerto Rico”) OR affilcountry(“Dominican Republic”) OR affilcountry(“Nicaragua”) OR affilcountry(“Honduras”) OR affilcountry(“Guatemala”) OR affilcountry(“El Salvador”) OR affilcountry(“Cuba”) OR affilcountry(“Costa Rica”) OR affilcountry(“Venezuela”) OR affilcountry(“Peru”) OR affilcountry(“Ecuador”) OR affilcountry(“Colombia”) OR affilcountry(“Brazil”) OR affilcountry(“Uruguay”) OR affilcountry(“Paraguay”) OR affilcountry(“Bolivia”) OR affilcountry(“Chile”) OR affilcountry(“Argentina”))
Scopus	AND pubyear > 1999
Google Scholar	(“second victim” OR “segunda víctima” OR “segunda victima” OR “segundas víctimas” OR “segunda vítima” OR “segundas vítimas”) AND (Argentina OR Chile OR Brazil OR Colombia OR Mexico OR Uruguay OR Paraguay OR Bolivia OR Peru OR Ecuador OR Venezuela OR “Costa Rica” OR Cuba OR “El Salvador” OR Guatemala OR Honduras OR Nicaragua OR Panama OR “Puerto Rico” OR “Dominican Republic”)
Google Scholar	Limites: 2000-2025

Variable	*N (%)** ^†
Country
Brazil	13 (52.0)
Argentina	5 (20.0)
Chile	3 (12.0)
Colombia	2 (8.0)
Ecuador	2 (8.0)
Publication type
Original article	17 (68.2)
Thesis	4 (16.0)
Comment	2 (8.0)
Editorial	1 (4.0)
Other: National Guide	1 (4.0)
Study design
Quantitative	11 (44.0)
Qualitative	9 (36.0)
Mixed	1 (4.0)
Not a research study	4 (16.0)
Year
2018	1 (4.0)
2019	2 (8.0)
2020	1 (4.0)
2021	2 (8.0)
2022	6 (24.0)
2023	7(28.0)
2024	5 (20.0)
2025	1 (4.0)
Professionals in study
Nurses	10 (40.0)
Health Professionals	9 (36.0)
Other	3 (12.0)
Not applicable	3 (12.0)

Country	Year	First author	Publication type	Study focus	Type of study	Objective	Population	n*	Main results
Argentina	2018	Brunelli MV ( ⁵⁵ )	Original article	Quantitative	Psychometric study of cross-cultural adaptation	To carry out the cross-cultural adaptation of the SVEST ^† and to evaluate the psychometric characteristics in the Argentine population.	Nurses	452	82% declared the mistake after it was made. SVEST ^† is used, with the psychological dimension being the most affected in the participants. Validation is presented by showing the Spanish version of the SVEST ^† .
	2019	Brunelli MV ( ⁵⁶ )	Comment	Comment	Not applicable		Not applicable	-	Health care professionals are negatively impacted after an AE ^‡ . There are not enough support mechanisms.
	2021	Rocabado CN ( ⁵⁷ )	Original article	Qualitative	Exploratory	To explore the perspectives of surgical instrumentators identified as second victims	Surgical technician	3	Anguish and guilt are described after an AE ^‡ . Lack of communication and adherence to protocols are described as causes of AEs ^‡ .
	2023	Brunelli MV ( ⁴⁶ )	Original article	Quantitative	Analytical cross-sectional	Characterize the phenomenon of second victims and know the perceived support measures	Health professionals	1190	56% made a mistake and psychological symptoms (SVEST ^† ) predominate. They perceive more support from family and friends.
	2024	Brunelli MV ( ⁵¹ )	Original article	Qualitative	Fenomenological	To explore the experience of second victims in professionals in Argentina.	Health professionals	7	The second victim experience occurs in a dynamic environment where organization and environment are important to deal with AE ^‡ .
Brazil	2019	Bohomol E ( ³³ )	Comment	Not applicable	Not applicable		Not applicable	-	There is a lack of knowledge of the term second victim and professionals fear punitive measures after an AE ^‡ .
	2020	Tartaglia A ( ³⁴ )	Editorial	Not applicable	Not applicable		Not applicable	-	It defines the second victim phenomenon in any health professional and emphasizes the need for support.
	2021	Souza VS ( ³⁵ )	Original article	Qualitative	Exploratory	To understand the experience of judicialization after an error from the perspective of the nursing professional.	Nurses	2	Lack of institutional support aggravates the symptoms of second victims such as a sense of injustice and frustration.
	2022	De Sordi LP ( ³⁶ )	Original article	Quantitative	Psychometric study of cross-cultural adaptation	To adapt and cross-culturally analyze the evidence of content validity of the SVEST ^† for the Portuguese language spoken in Brazil.	Health professionals	30	SVEST ^† is a valid and reliable tool in the Brazilian context.
	2022	Quadros DV ( ³⁷ )	Original article	Qualitative	Exploratory	To describe the support received by the second victim in the falls of hospitalized adult patients from the perspective of the nursing team.	Nurses	21	Feelings of guilt and distress predominate after AE ^‡ . Little support from the institution and support from family and friends stands out.
	2022	Quadros DV ( ³⁸ )	Original article	Mixto	Mixed	It analyzes the falls of hospitalized adults and their impact on nurses as second victims.	Nurses	21	Professionals involved in fall events experienced feelings of guilt, fear, anguish, and helplessness.
Brazil	2022	Ribeiro RN ( ³⁹ )	Thesis	Qualitative	Exploratory	To analyze the strategies adopted by nursing managers for the support of the second victims in the context of the coronavirus pandemic.	Nurses	8	The institution and nursing supervisors should provide support to professionals after an AE ^‡ .
	2022	Tavares APM ( ⁴⁰ )	Original article	Qualitative	Exploratory	Map the factors that are involved in incidents with harm and that contribute to the phenomenon of second casualty among nursing students.	Students	23	Multiple factors influence the prevalence of AE ^‡ . Students of health careers must be educated in patient safety.
	2023	Lima APA ( ⁴¹ )	Thesis	Quantitative	Psychometric study of cross-cultural adaptation	Translate and adapt the SVEST-R ^§ into Brazilian Portuguese.	Health professionals	146	The adaptation of the instrument was successful for the Brazilian context.
	2023	Silveira SE ( ⁴² )	Original article	Qualitative	Exploratory	Understand the impacts on nursing professionals as the second victim of patient safety incidents	Nurses	20	Nurses after an AE ^‡ experience guilt, anxiety, and decreased professional confidence, which can compromise their well-being and the quality of care they provide.
	2024	Alevi JO ( ⁴³ )	Original article	Quantitative	Analytical cross-sectional	To describe the prevalence of newly graduated nurses as second victims of adverse events and to know the conditions of support received in health institutions.	Nurses	138	After an AE ^‡ , 94.6% experienced emotional distress, including feelings of frustration, guilt, sadness, stress, inadequacy, shame, and insecurity in the performance of their job duties.
	2024	Rodrigues FM ( ⁴⁴ )	Original article	Quantitative	Descriptive	To understand nursing professionals’ experience and perceptions of second victims.	Nurses	46	Men showed greater psychological distress and interest in support measures. The support of colleagues was the most desired.
	2024	Abrantes M ( ⁴⁵ )	Original article	Qualitative	Exploratory	To understand the perception of nursing students about the phenomenon of second victim.	Nurses students	29	They did not know the term or its implications. They stressed that the issue is not discussed and there are no known strategies for coping with it.
Chile	2022	Mallea Salazar F ( ⁴⁷ )	Original article	Quantitative	Analytical cross-sectional	To determine the relationship between the consequences of an AE ^‡ on second victim and the quality of the support measures perceived in public and private health institutions in the Metropolitan Region of Chile during the second half of 2018.	Health professionals	301	After an AE ^‡ , 73% identified themselves as a second victim. A significant inverse relationship was found between the quality of perceived support and the psychological and occupational consequences derived from AE ^‡ .
Chile	2023	Kappes M ( ⁵³ )	Original article	Quantitative	Analytical cross-sectional	To determine the prevalence of the second victims in ICU ^\|\| nurses and its relationship with the support granted by its institutions.	Nurses	326	90.1% of ICU ^\|\| nurses reported having suffered an AE ^‡ . Shame was the most prevalent psychological symptom, reported by 69% of participants. The longer the seniority, the more support is perceived.
Chile	2024	Kappes M ( ⁵⁴ )	Original article	Qualitative	Grounded Theory	Describe the coping strategy of the second victims working in ICUs ^\|\| in a public hospital in Chile.	Nurses	11	The perception of support after an AE ^‡ is the most important thing to determine the overcoming of the phenomenon of second victim.
Colombia	2023	Florez F ( ⁵⁰ )	Original article	Quantitative	Analytical cross-sectional	To estimate the prevalence of adverse events and describe their manifestations in healthcare personnel, in order to evidence the phenomenon of second victim in a highly complex hospital.	Health professionals	412	Of those involved in AE ^‡ who are reported as second victim experienced difficulty concentrating, feelings of guilt, tiredness, anxiety, and doubts about their clinical decisions.
Colombia	2024	Rodriguez Gallo E ( ⁵² )	National Guide	Not applicable		Establish a set of recommendations and strategies, built on the basis of available experience, knowledge and evidence, in order to improve the identification of second victim and provide the support required to overcome the situation and to promote organizational learning.	Health professionals	Not applicable	This guide recognizes the phenomenon of the second victim as important and prevalent. It proposes coping strategies and highlights the culture of quality and safety within health institutions.
Ecuador	2023	Flores Garcia SL ( ⁴⁸ )	Thesis	Quantitative	Analytical cross-sectional	To determine the knowledge of the second victim and its impact on the health personnel of the Surgical Area of the Pablo Arturo Suarez Hospital.	Health professionals	88	There is a lack of knowledge of the term second victim. Health professionals who participated in adverse events experienced feelings of fear, questioning of their ability to provide care, anxiety, and insecurity.
Ecuador	2023	Fuentes E ( ⁴⁹ )	Thesis	Quantitative	Analytical cross-sectional	To reduce the incidence of adverse events through awareness, monitoring and promotion of the well-being of health professionals as a second victim who work in the Emergency Area of the Francisco de Orellana General Hospital January-August 2023.	Health professionals	66	There is a high occurrence of AEs ^‡ but a lack of notification. There is a lack of knowledge of the term second victim.

Author (year)	Country	Psychological	Physical	Professional self-efficacy	Colleagues support	Supervisor support	Institutional support	Support friends/family	Absenteeism	Turnover intentions
x ^† (SD) ^‡
Brunelli (2018)	Argentina	4.0 (1.0)	2.2 (1.1)	2.2 (1.3)	3.1 (1.1)	3.4 (1.2)	2.3 (1.4)	3.0 (1.4)	1.2 (0.6)	1.5 (0.9)
Brunelli (2023)	Argentina	3.4 (1.0)	2.1 (1.0)	2.2 (1.2)	2.3 (1.1)	2.4 (1.0)	2.9 (1.2)	3.1 (1.4)	1.8 (0.9)	1.7 (1.0)
Lima (2023)	Brazil	3.5 (0.0)	2.8 (0.0)	2.6 (0.1)	1.7 (0.0)	2.4 (0.0)			2.3 (0.1)	2.3 (0.1)
Mallea-Salazar (2022)	Chile	4.0 (0.7)	3.1 (0.9)	2.0 (1.1)	3.9 (0.0)	3.4 (1.0)	2.9 (1.0)	3.9(1.1)	2.5 (1.1)	2.0 (1.0)
Kappes (2023)	Chile	3.7 (1.0)	3.8 (1.0)	3.3 (0.9)	3.6 (0.8)	3.3 (0.8)	2.3 (0.8)	3.3 (0.9)	2.6 (1.0)	2.8 (1.0)

[1] *N = Absolute frequency; ^†% = Relative frequency