Relationship Between Second Victim Distress, Resilience, Deliberate Rumination and Compassion Fatigue Among ICU Nurses: A Moderated Mediation Model.

BACKGROUND

Patient safety is a critical global health issue. ICU nurses, burdened by heavy workloads and psychological stress, are particularly vulnerable to second victim syndrome following adverse events. This can diminish their sensitivity to patient harm and emotional engagement, potentially resulting in compassion fatigue. Deliberate rumination and resilience may serve as protective factors in this process.

AIM: This study investigates the relationships among second victim distress, deliberate rumination and compassion fatigue in ICU nurses and examines resilience as a moderating factor.

STUDY

DESIGN

A cross-sectional survey was conducted using convenience sampling. Data were collected using the General Information Questionnaire, Second Victim Experience and Support Tool, Event-Related Rumination Inventory, Resilience Scale and Professional Quality of Life Scale. Correlation analyses were performed using SPSS 26.0, and mediation and moderated mediation were examined using the PROCESS macro (Models 4 and 14) with 5,000 bootstrap resamples and 95% confidence intervals.

RESULTS

Between December 2024 and April 2025, a total of 370 ICU nurses were recruited from 25 secondary and tertiary hospitals across nine prefecture-level cities in Henan Province. The results showed that second victim distress had a direct effect of 0.257 (p < 0.01) and a total effect of 0.456 (p < 0.01) on compassion fatigue among ICU nurses. The indirect effect was 0.199 (p < 0.01; 95% confidence interval = 0.145-0.260). The significance of the direct and indirect effects was tested using bootstrapping (5000 resamples, 95% CI) in the PROCESS macro (Model 14). Moreover, resilience moderated the indirect pathway between second victim distress and compassion fatigue.

CONCLUSIONS

Second victim distress in ICU nurses directly contributes to compassion fatigue and indirectly influences it through deliberate rumination. Resilience moderates this mediating effect, with higher resilience strengthening the protective role of deliberate rumination against compassion fatigue.

RELEVANCE TO CLINICAL PRACTICE: Following adverse events, nurses often experience considerable psychological distress. Nursing managers should prioritise cultivating nurses' psychological resilience, strengthening their internal resources and promptly guiding second victims to engage in constructive cognitive processing. Only when sufficient personal and organisational resources are available can deliberate rumination effectively alleviate second victim distress, reduce compassion fatigue and improve both care quality and patient safety.