The second victim phenomenon : a case study for Malta

Abstract

The Second Victim Phenomenon (SVP) refers to the emotional and occupational challenges healthcare professionals face directly or indirectly after adverse events, with global prevalence ranging from 9% to over 90%. This study investigated SVP in Malta through a nationwide survey of 900 medical practitioners, nurses, and pharmacists. The Second Victims in Deutschland (SeViD) tool, the Big Five Inventory–10 (BFI-10), and open-ended questions were used to examine how demographic, workplace, cultural, and personality traits influenced risk, symptom load, and recovery. Prevalence reached 77.7% in medical practitioners, 69.8% in nurses, and 42.3% in pharmacists. Fewer than 40% recognised the term “second victim.” Event types varied by profession: medical practitioners reported patient deaths, harm, or aggression; nurses cited aggression and deaths; pharmacists noted aggression and dispensing errors. Emotional and cognitive symptoms predominated, particularly reliving the incident, self-doubt, and concentration difficulties, with prolonged symptoms reported by 18.9% of medical practitioners, 14.7% of nurses, and 11.0% of pharmacists. Risk factors differed: in medical practitioners, fewer years of experience predicted higher symptom load; in nurses, older age increased risk, while experience was protective; in pharmacists, female gender and non-Maltese nationality predicted higher symptom load, while area of practice influenced prevalence. Personality traits did not predict SVP status but shaped symptom severity, with neuroticism heightening symptoms in nurses and pharmacists and openness in medical practitioners. Support was largely informal: nurses relied on peers, medical practitioners reported minimal structured help, and pharmacists expressed stronger expectations for institutional backing. Findings aligned with European research but revealed distinctive patterns, including high prevalence and unresolved trauma in medical practitioners, age-related risk and stronger behavioural symptoms in nurses, and nationality-linked severity in pharmacists. This highlights the need for targeted interventions to build resilience, reduce stigma, and implement a phased strategy to prevent SVP and lessen its impact in Maltese healthcare.