Eventos adversos e a experiência da segunda vítima: construção, validação psicométrica de instrumento e análise das repercussões em profissionais de saúde

Abstract

Introduction: The experience of the second victim following adverse events remains insufficiently explored in a systematic and comprehensive manner across its emotional, psychological, professional, and institutional dimensions, which limits understanding of the phenomenon and the development of effective support strategies. Objective: To analyze the impact of adverse events in hospitals from the perspective of the second victim. Methods: This is a quantitative study conducted in two complementary phases: a methodological study aimed at the development, content validation, and psychometric evaluation of an instrument designed to measure second victim experience following adverse events, and a cross-sectional study intended to apply the validated instrument in the target population. The methodological phase included the participation of seven expert judges, 30 professionals from the target population, and 205 healthcare professionals for psychometric testing. The instrument’s psychometric properties were assessed using the Content Validity Index, Exploratory Factor Analysis, and model fit indices. In the cross-sectional phase, 428 healthcare professionals from medical, nursing, and physiotherapy backgrounds participated. Data collection took place between September 2025 and February 2026 through the application of a structured instrument using a five-point Likert scale. Statistical analysis was performed using descriptive and inferential statistics, including Pearson’s chi-square test, Cramer’s V, and multinomial logistic regression, with a significance level set at 5%. Results: The validated instrument showed a three-dimensional structure composed of 26 items, with adequate fit indices (RMSEA = 0.073; CFI = 0.980; TLI = 0.975) and high internal reliability (McDonald’s omega = 0.92). Among participants, there was a predominance of females (70.5%) and nursing technicians (45%). Approximately half of the respondentes (n=428) reported prior involvement in adverse events, with frequent manifestations of feelings such as fear, guilt, anxiety, frustration, and insecurity following these occurrences. Statistically significant associations were identified between professional category and variables related to emotional and behavioral repercussions (p < 0.001), including episodes of anxiety, changes in professional behavior, feelings of guilt or shame, and fear of career damage. Multinomial logistic regression analysis revealed significant associations between variables related to the second victim experience, highlighting items such as difficulties in emotional recovery (p = 0.013), perception of overcoming emotional effects (p = 0.035), and reflection on professional skills (p = 0.016). The final model showed statistically significant fit (p < 0.001), indicating good explanatory power. Although the existence of institutional patient safety protocols was reported, weaknesses were identified regarding accessibility and the availability of emotional support in the workplace. Conclusion: The instrument was developed and validated, and after its application it was found that adverse events produce significant emotional and professional repercussions among healthcare professionals, characterizing them as second victims in the clinical context. The lack of institutional support and the fragility of organizational coping strategies contribute to the worsening of emotional distress and may compromise the quality of care provided. The findings reinforce the need for the implementation of structured second victim support programs and the strengthening of patient safety culture, aiming to promote safer, more resilient, and institutionally learning-oriented healthcare environments.