Implementation Barriers of Peer Support for Nurses as Second Victims: A Qualitative Study from the Supporters’ Perspective

Ya’nan Zhang,1,* Qianfei Li,2,* Xiaohong Zhang3 1Emergency Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China; 2College of Nursing, Shanxi Medical University, Taiyuan, People’s Republic of China; 3Nursing Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaohong Zhang, Nursing Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, No. 99, Longcheng Street, Xiaodian District, Taiyuan, 030032, People’s Republic of China, Tel +86-13453443366, Email [email protected]: This study aims to explore the obstacles faced by nurses in providing peer support to “second victims” from the perspective of support providers, in order to provide basis and strategic suggestions for medical institutions to construct systematic peer support strategies.Methods: A descriptive qualitative study design was adopted. The semi-structured interview method was used to formulate an interview outline based on the theory of “Knowledge-Attitude-Practice”, and was conducted in 2024 for 3 months, interviewing 14 nurses who had provided support to the second victim in a tertiary hospital in Shanxi Province, and using the thematic analysis method to analyze the data.Results: Three themes and eight sub-themes emerged: (1) Disconnection Between Conceptual Awareness and Personal Experience (Cognitive Blind Spots, role confusion); (2) The Triple Barrier to Peer Positive Support (Personal attribution bias, organizational culture constraints, systemic deficiencies); (3) Fragmented practices of support measures (Discrepancies Exist in the Timing of Support Interventions, Limitations in Support Content, Need for Standardized Protocols).Conclusion: To institutionalize peer support, we propose a tiered approach: (1) awareness training to address cognitive gaps; (2) cultural shifts to reduce fear of accountability; (3) structured programs for sustained implementation.Keywords: second victim, peer support, qualitative research, nursing adverse events, support barriers, organizational culture