The impact of received support on distressing experiences among nurses as second victims: the mediating role of psychological capital - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Nurs . 2026 Mar 7;25:357. doi: 10.1186/s12912-026-04515-0 Search in PMC Search in PubMed View in NLM Catalog Add to search The impact of received support on distressing experiences among nurses as second victims: the mediating role of psychological capital Wei Zong Wei Zong 1 Emergency Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China Find articles by Wei Zong 1, # , Jing Qiu Jing Qiu 2 Nursing Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China Find articles by Jing Qiu 2, # , Lin Chen Lin Chen 3 Science and Education Training Department, Pengzhou City People’s Hospital, Chengdu City, China Find articles by Lin Chen 3 , Meng Zhang Meng Zhang 1 Emergency Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China Find articles by Meng Zhang 1 , Xiaobin Wang Xiaobin Wang 1 Emergency Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China Find articles by Xiaobin Wang 1 , Xiangguang Yin Xiangguang Yin 1 Emergency Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China Find articles by Xiangguang Yin 1 , Jing Wei Jing Wei 2 Nursing Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China Find articles by Jing Wei 2, ✉ Author information Article notes Copyright and License information 1 Emergency Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China 2 Nursing Department, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China 3 Science and Education Training Department, Pengzhou City People’s Hospital, Chengdu City, China ✉ Corresponding author. # Contributed equally. Received 2025 Dec 8; Accepted 2026 Feb 27; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13081468 PMID: 41795069 Abstract Background All healthcare professionals are potentially susceptible to becoming second victims of adverse events during the course of their careers. Nurses, as second victims, frequently encounter a series of distressing experiences, including anxiety, depression, tension, fear, sleep disorders, and occupational burnout. However, no studies have yet explored the relationships among distressing experiences, received support, and psychological capital in the context of nurses as second victims. Therefore, the present study aimed to examine the impact of received support on distressing experiences and verify the mediating role of psychological capital in this relationship. Methods A multicenter cross-sectional study was conducted among clinical nurses with a history of adverse events in the past year from six medical institutions in Xuzhou, China. A total of 422 valid questionnaires were collected. The data were collected using the Social-demographic Questionnaire, the Nurse Psychological Capital Scale, and the Second Victim Experience and Support Scale. Data were analyzed using SPSS (version 22.0). Results The findings of this study revealed a statistically significant correlation between the support received by nurses after adverse events and their distressing experiences ( r = 0.359, p < 0.01). Furthermore, significant correlations were identified between received support and psychological capital ( r = -0.326, p < 0.01), as well as between psychological capital and distressing experiences ( r = -0.434, p < 0.01). Additionally, the results confirmed that psychological capital exerted a partial mediating effect on the relationship between received support and distressing experiences, with the mediating effect size reaching 0.152, accounting for 32.27% of the total effect. Conclusions After an adverse event, adequate support systems and high psychological capital can effectively mitigate negative emotions and distress in nurses as second victims. Hospital administrators should proactively foster a fair patient safety culture, provide support to second victims based on individual characteristics and adverse event specifics, and engage psychologists for professional counseling. Additionally, fostering nurses’ psychological capital can alleviate distress and promote nursing profession development. Clinical trial number Not applicable. Keywords: Nurses, Second victims, Psychological capital, Experience and support, Cross-sectional study Introduction A second victim (SV) is defined as any healthcare worker directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury, who subsequently experiences negative impacts [ 1 ]. All medical personnel may be involved in adverse events during their careers and may experience physical, psychological, and professional impacts, becoming the second victim of such incidents [ 2 ]. As shown in previous studies, more than 60% of healthcare professionals have been involved in at least one adverse event during their careers [ 3 , 4 ]. This frequently results in such individuals becoming what is termed “the second victim” [ 5 ]. A survey result indicated that 47.2% of nursing staff were concerned that similar incidents would occur again in their work, and 28.2% of them stated that they continue to be affected by this incident [ 6 ]. Distress refers to the unpleasant experience arising when an individual’s integrity is threatened, including emotional, psychological, and spiritual dimensions [ 7 ]. Compared with other professions, nurses are more likely to be affected by adverse events due to factors such as the complexity and repetitiveness of their work, heavy workload, and the closest contact with patients [ 8 ]. As second victims, nurses often experience a range of distressing symptoms, including anxiety, depression, tension, fear, sleep disturbances, and occupational burnout [ 9 , 10 ]. In the absence of timely identification and intervention, these issues may give rise to adverse outcomes, including alcohol and drug abuse, impaired interpersonal communication skills, and diminished professional confidence, potentially leading to the attrition of skilled nursing professionals [ 11 – 13 ]. Therefore, identifying and addressing the distress experienced by nurses as second victims has become increasingly important, and this issue is gaining growing attention [ 14 , 15 ]. Received support refers to the various resources and assistance that nurses obtain from multiple sources in their contextual environment, a key construct for both individuals and groups [ 16 ]. Support strategies commonly employed for secondary victims include peer support [ 17 ], mindfulness-based stress reduction [ 18 ], and cognitive behavioral therapy [ 19 ]. A systematic review has shown that, regardless of its form, support can alleviate the physiological and psychological symptoms of secondary victims in the short term, reducing the incidence of psychological problems such as anxiety and depression [ 20 ]. However, while existing research has identified an association between support and distress experiences, the underlying mechanisms remain unclear [ 21 ]. Therefore, further clarification of these mechanisms is warranted to provide a theoretical foundation for nursing managers to develop targeted intervention strategies aimed at alleviating distress among second victims. Psychological capital is defined as an individual’s positive psychological developmental state, encompassing four core psychological capacities: self-efficacy, optimism, hope, and resilience [ 22 ]. It enables nurses to adopt a positive perspective toward encountered events, fully mobilize their internal potential to cope with stress, and alleviate negative emotions [ 23 ]. The enhancement of psychological capital has been demonstrated to assist medical personnel in mitigating psychological trauma, thereby reducing the likelihood of professional departure [ 24 ]. Nurses’ psychological capital has a negative predictive effect on distressing experiences; that is, the higher the level of psychological capital, the less obvious the distressing experiences of nurses after encountering adverse events [ 25 ]. Furthermore, studies have shown that psychological capital is associated with received support and both can influence mental health, although their mediating mechanism remains unclear [ 26 , 27 ]. Accordingly, it is crucial to further examine how received support and psychological capital jointly affect distress in nurses as second victims. The Stress and Coping Theory proposed by Lazarus emphasizes the impacts of individual cognitive appraisal (including primary appraisal and coping appraisal) and coping strategies (problem-focused and emotion-focused) on stress responses, where coping appraisal refers to individuals’ evaluation of their sufficient resources to manage stress while emotion-focused strategies denote psychological adjustments employed in confronting stress [ 28 ]. This theory provides a foundation for understanding how received support (independent variable) influences distress experiences (dependent variable) via psychological capital (mediating variable). Accordingly, psychological capital may act as a mediator between received support and distress. On this basis, the present study examines nurses’ distress as second victims and explores the underlying mediating mechanisms, and thus proposes the following four hypotheses: Hypothesis 1 Received support positively affects psychological capital. Hypothesis 2 Psychological capital has a negative impact on distressing experiences. Hypothesis 3 Received support has a negative impact on distressing experiences. Hypothesis 4 The effect of received support on distressing experiences is partly mediated by psychological capital. Materials and methods Study design This study was a multicenter cross-sectional study. From January to October 2025, a convenient sampling survey was conducted on nurses from six medical institutions in the Xuzhou area. After obtaining the informed consent of the nurses, the study was conducted in the form of a questionnaire. The study was designed, conducted, and its results reported in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Participants From January to October 2025, clinical nurses were recruited as study participants from six medical institutions in Xuzhou, China, using convenience sampling. The inclusion and exclusion criteria were as follows: (1) Inclusion criteria: ① Experiencing or witnessing patient safety incidents within the past year. ② Possessing a valid nurse’s practice qualification certificate and practicing during the survey period. ③ Giving informed consent and voluntarily participating in this study. (2) Exclusion criteria: ① Those on leave, in further study, or internship; ② Those diagnosed with mental or psychological disorders; ③ Those who had other traumatic events or major changes before the survey. According to Kendall’s sample size estimation method [ 29 ], cross-sectional studies generally require a sample size 5–10 times the number of variables. The present study included 30 variables: 15 demographic variables, 6 from psychological capital, and 9 from second victim distress and related experiences. To allow for missing or invalid data, the initial target sample size was increased by 20%, yielding an expected range of 180–360 participants. A total of 452 questionnaires were collected. After excluding 30 invalid responses, 422 valid questionnaires were retained, with an effective response rate of 93.36%. Ethical considerations This study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University before starting (ethic code: XYFY2025-KL132-01). This study conformed to the ethical guidelines specified in the Declaration of Helsinki, with all participants providing written informed consent before study participation. Measurements General information questionnaire The questionnaire’s design was conducted independently by the researchers, encompassing the following components: (1) General demographic information, including gender, age, marital status, educational level, and religious belief. (2) Occupational information: work seniority, position, title, night shift, and income satisfaction. (3) Caregiving-Related characteristics surveys: addressing family elder care and child care situations. (4) Adverse event-related characteristics included the type of the most recent adverse event experienced, the degree of responsibility attributed, and the duration elapsed since its occurrence. The psychological capital questionnaire for nurses This scale was compiled by Wang et al. from Chengdu University of Traditional Chinese Medicine in 2023 [ 30 ] and comprises six dimensions: hope, cooperative communication, emotional intelligence, responsibility, resilience, and confidence, with a total of 30 items. The Likert 6-point rating scale is used, where 1 represents “strongly disagree” and 6 represents “strongly agree”. The total score ranges from 30 to 180, with a higher score indicating a higher level of psychological capital among nurses. In this study, the tool was employed to assess the psychological capital level of nurses as second victims. In the present study, the Cronbach’s α coefficient of the scale was 0.955. The Kaiser-Meyer-Olkin (KMO) measure was 0.818, and Bartlett’s test of sphericity was significant ( p < 0.01). Second Victim Experience and Support Tool (SVEST) The introduction of this tool to China occurred in 2019 [ 31 ]. It consists of 9 dimensions and 29 items, using the Likert 5-point rating scale. Scores range from 1 to 5, with 1 being “strongly disagree” and 5 being “strongly agree”. It is important to note that a higher score is indicative of more severe symptoms, namely, greater distress and less support. The three dimensions of psychological distress, physical distress, and professional self-efficacy are utilized to delineate the distressing experiences of the second victim in the aftermath of the adverse event; the dimensions of colleague support, supervisor support, institutional support, and non-work-related support are employed to illustrate the current situation of support received by the second victim. In the present study, the Cronbach’s α coefficient of the scale was 0.858. The Kaiser-Meyer-Olkin (KMO) measure was 0.762, and Bartlett’s test of sphericity was significant ( p < 0.05). Data collection Before the study commenced, the project leader contacted the nursing management departments of the participating hospitals to explain the study purpose, target population, and questionnaire administration procedure. After obtaining approval, electronic questionnaires were distributed by hospital nursing managers via departmental work groups. Before participation, standardized instructions was provided to explain the concept of the second victim, study purpose, content, survey procedures, and precautions. Participants completed the questionnaire anonymously after providing informed consent. Four screening questions were included: whether participants had experienced or witnessed adverse medical events in the past year; whether they were on leave, undergoing further education, or serving as interns; whether they had been diagnosed with a mental health disorder; and whether they had encountered other traumatic events or major life changes in the past year. Respondents who answered “No” to the first question or “Yes” to any of the remaining three were automatically directed to the end of the questionnaire and excluded from analysis. Each account was restricted to one response, with a minimum completion time of two minutes. Two researchers independently reviewed all questionnaires using unified criteria. Data analysis Data analysis was conducted using SPSS 22.0 statistical software. The general demographic characteristics of the participants were described using frequency (n) and composition ratio (%). The levels of received support, distressing experiences, and psychological capital of the nurses were calculated using the mean and standard deviation. The correlation between the received support, distressing experiences, and psychological capital of the nurses as second victims was analyzed using Pearson correlation analysis. Subsequently, the present study examined the effects of sociodemographic characteristics on nurses’ distressing experiences using independent-sample t-tests and one-way analysis of variance (ANOVA). Mediation analysis was explored using the SPSS macro PROCESS Model 4 [ 32 ] to examine the mediating effect of psychological capital on the relationship between received support and distressing experiences, and 5000 bootstrap samples were extracted for testing. If the 95% confidence interval (CI) does not include zero, the mediating effect was correctly deemed statistically significant [ 33 ]. A difference was considered statistically significant if p < 0.05. Results General characteristics of participants and univariate analysis of distressing experiences Of the 422 second victims, 49 (11.61%) were male and 373 (88.39%) were female; 79.62% were aged 36 years or younger, and 85.78% held a bachelor’s degree. No participants were divorced or widowed. Univariate analyses indicated that distressing experiences differed significantly according to age, title, work seniority, income satisfaction, child-rearing, supporting the elderly, types of adverse events, responsibility for adverse events, and duration of adverse events, with detailed results presented in Table 1 . Table 1. Demographic characteristics and univariate analysis results Variables n (%) Distressing experiences Total score( ) t/F P Gender 0.937 0.349 male 49(11.61) 38.86± 6.70 female 373(88.39) 37.80± 7.50 Age(yr.) 8.106 <0.01 < 25 46(10.90) 40.33 ± 7.24 25–29 145(34.36) 35.54 ± 7.61 30–36 145(34.36) 38.08 ± 5.54 37–40 48(11.37) 39.77 ± 9.82 > 40 38(9.00) 41.21 ± 6.97 Degree 2.705 0.068 College 48(11.37) 39.85 ± 7.97 Bachelor 362(85.78) 37.59 ± 7.40 Master’s and above 12(2.84) 40.42 ± 2.91 Marital status 0.321 0.749 Married 270(63.98) 38.01 ± 7.62 Unmarried 152(36.02) 37.77 ± 7.05 Religious belief -0.184 0.854 None 390(92.42) 37.91 ± 7.39 Have 32(7.58) 38.16 ± 7.77 Position -1.619 0.119 No 399(94.55) 37.76 ± 7.30 Have 23(5.45) 40.78 ± 8.78 Title 6.699 <0.01 Junior 187(44.31) 36.49 ± 7.70 Middle 192(45.50) 38.90 ± 6.60 Senior 43(10.19) 39.79 ± 8.52 Work seniority(yr.) 4.119 <0.01 < 1 43(10.19) 39.79 ± 7.28 1-<4 49(11.61) 37.35 ± 7.45 4-<11 182(43.13) 36.38 ± 7.36 11-<21 119(28.20) 39.14 ± 6.91 21-<30 23(5.45) 39.96 ± 5.57 ≥ 30 6(1.42) 44.00 ± 14.24 Night shift 0.700 0.484 No 103(24.41) 38.37 ± 7.49 Have 319(75.59) 37.78 ± 7.39 Income satisfaction 5.413 <0.01 Satisfied 131(31.04) 37.35 ± 7.86 Moderate 253(59.95) 37.66 ± 6.79 Dissatisfied 38(9.00) 41.63 ± 8.84 Child-rearing 11.994 <0.01 0 201(47.63) 37.54 ± 6.38 1 127(30.09) 36.28 ± 7.32 ≥ 2 94(22.27) 40.98 ± 8.66 Supporting the old −3.140 <0.01 ≤ 2 231(54.74) 36.90 ± 7.60 > 2 191(45.26) 39.16 ± 6.99 Responsibility for adverse events 27.994 <0.01 No 154(36.49) 34.16 ± 7.43 Unclear 45(10.66) 37.93 ± 3.39 Secondary 152(36.02) 39.89 ± 6.12 Primary 71(16.82) 41.86 ± 8.15 Duration of adverse event 10.178 <0.01 < 1 mo. 69(16.35) 41.99 ± 6.57 1-<3 mo. 121(28.67) 38.14 ± 6.16 3-<6 mo. 68(16.11) 38.71 ± 6.74 6-<11 mo. 70(16.59) 36.56 ± 5.63 11–12 mo. 94(22.27) 35.12 ± 9.48 Types of adverse events 7.502 <0.01 Nursing errors 78(18.48) 40.87 ± 7.25 Patient accidents 115(27.25) 36.36 ± 6.32 Safety hazards 142(33.65) 38.46 ± 8.06 Others 87(20.62) 36.48 ± 6.97 Open in a new tab The current situation of the second victim regarding received support, distressing experiences, and psychological capital The total score of support received by the nurses as the secondary victims was 43.69 ± 5.64, indicating that the support received by the second victims may have been inadequate. The mean total score for nurses’ experiences of distress was calculated to be 37.92 ± 7.41, suggesting that their distressing experiences were of a moderate intensity. The mean psychological capital score was 127.52 ± 17.51, indicating that the psychological capital level of the nurses was moderately high. The scores for each dimension are displayed in Table 2 . Table 2. The scores of the second victim regarding received support, distressing experiences, and psychological capital Scale / Dimension No. of items Total( ) Item average score( ) Received support 13 43.69 ± 5.64 3.36 ± 0.43 Colleague support 4 12.75 ± 1.78 3.19 ± 0.45 Supervisor support 4 13.82 ± 2.15 3.45 ± 0.54 Institutional support 3 10.00 ± 1.52 3.33 ± 0.51 Non-work-related support 2 7.14 ± 1.63 3.57 ± 0.82 Distressing experiences 12 37.92 ± 7.41 3.16 ± 0.62 Psychological distress 4 13.83 ± 3.17 3.46 ± 0.79 Physical distress 4 11.76 ± 3.43 2.94 ± 0.86 Professional self-efficacy 4 12.33 ± 2.68 3.08 ± 0.67 Psychological capital 30 127.52 ± 17.51 4.25 ± 0.58 Hope 7 27.94 ± 4.62 3.99 ± 0.66 Cooperative communication 6 25.99 ± 4.19 4.33 ± 0.70 Emotional intelligence 5 21.72 ± 3.32 4.34 ± 0.66 Responsibility 4 17.58 ± 2.58 4.39 ± 0.65 Resilience 4 17.24 ± 3.15 4.31 ± 0.79 Confidence 4 17.05 ± 3.16 4.26 ± 0.79 Open in a new tab Correlations among the second victim’s received support, distressing experiences, and psychological capital The results of Pearson correlation analysis indicated a significant relationship between received support and distressing experiences ( r = 0.359, p < 0.01), received support and psychological capital ( r = -0.326, p < 0.01), psychological capital and distressing experiences ( r = -0.434, p < 0.01) among second victims. Tests were conducted on Hypotheses 1 through 3, and the findings demonstrated that the three variables investigated in this study are appropriate for incorporation into the mediation model to facilitate subsequent analysis. Table 3 provides detailed information on the correlation analysis results. Table 3. Correlations of the measures in this study Items Received support Distressing experiences Psychological capital Received support 1 0.359 ** -0.326 ** Distressing experiences - 1 -0.434 ** Psychological capital - - 1 Open in a new tab Notes: ** means p <0.01 The mediating effect of the second victim’s psychological capital between received support and distressing experiences Mediation analysis was performed using the PROCESS macro (version 2.13) in SPSS. In the analysis, C denotes the total effect (X→Y), while a*b represents the mediating effect (i.e., the indirect effect; X→M→Y). The significance of the mediating effect was assessed via the product term test, proposed by Baron and Kenny [ 34 ]. The principle of this test method is to assess the significance of the mediating effect by testing whether the 95% confidence interval (CI) for a*b includes zero. If the 95% CI excludes zero, the mediating effect is deemed statistically significant, indicating the presence of the mediating effect [ 33 , 35 ]. As shown in Fig. 1 ; Table 4 , the support received by the second victim had a significant overall effect on their distressing experience (β = 0.471, SE = 0.060, t = 7.78, p < 0.001). Following the incorporation of psychological capital, the direct effect retained significance (β = 0.319, SE = 0.059, t = 5.40, p < 0.001). Received support had a negative predictive effect on psychological capital (β = -1.011, t = -7.06, p < 0.001); psychological capital had a negative predictive effect on the distressing experiences (β = -0.150, t = -7.87, p < 0.001). Fig. 1. Open in a new tab The hypothesized mediation model relating the effect of Received support on Distressing experiences through Psychological capital. Abbreviations: a, The effect of Received support on Psychological capital; b, The effect of Psychological capital on Distressing experiences; c’, The direct effect of Received support on Distressing experiences; C, The total effect of Received support on Distressing experiences; a * b, The mediating effect of Psychological capital; *** , p < 0.001 Table 4. Mediating effect analysis Items β SE t p -value 95% CI Total effect 0.471 0.060 7.87 < 0.001 (0.353, 0.589) Direct effect 0.319 0.059 5.40 < 0.001 (0.203, 0.436) Indirect effect 0.152 0.034 - < 0.001 (0.095, 0.229) Open in a new tab The Bootstrap method was utilized to conduct 5,000 tests, with the objective of examining the mediating effect. The findings showed that the 95% CI for the direct effect of the received support on distressing experiences, as well as the 95% CI for the mediating effect, did not include 0. This suggested that the level of support received by the second victim not only directly predicts distressing experiences following adverse events, but also indirectly predicts such experiences through personal psychological capital. The mediating effect value is 0.152, with a standard error (SE) of 0.034, accounting for 32.27% (0.152/0.471 ≈ 32.27%) of the total effect. Discussion Analysis of the current status of the observed variables in the second victim The level of support received by nurses after experiencing adverse nursing events was relatively low, with a mean support score of 43.69 ± 5.64, which was higher than the result of Rongrong Huang et al. [ 31 ]. The reason for this difference in the results might be that the proportion of junior nurses in this study was relatively large. Research has shown that the support received by the second victim is influenced by work experience and the clinical ladder [ 12 ]. Junior nurses tend to receive lower levels of support [ 36 ]. Following criticism and accountability from managers, they are more likely to internalize such feedback as personal failure, experience self-doubt, and become reluctant to proactively seek support from the organization or management [ 37 , 38 ]. Furthermore, the associated shame is often intense, leaving them hesitant to disclose the incident to family or friends, which further limits their available sources of support [ 39 ]. However, even senior nurses, despite having extensive clinical experience, can still become the second victims [ 40 ]. Nevertheless, they could leverage their previous work experience to establish a strong support network, thereby obtaining higher levels of support [ 41 ]. In the present study, the score of the nurses’ second victim’s distressing experiences was (37.92 ± 7.41) points, indicating that they exhibited relatively severe pain symptoms in terms of physiology, psychology, and profession. This outcome bears a notable similarity to that of the research conducted by Kim et al. [ 42 ]. One potential explanation for this phenomenon could be attributed to the society’s elevated expectations for the nursing profession [ 43 ]. Following adverse events, they may develop concerns over potential adverse patient outcomes while simultaneously facing the dual challenge of expectations and doubts regarding their professional competence [ 44 ]. Research has indicated that individuals who have encountered adverse events may subsequently manifest psychological symptoms, including remorse, worry, guilt, anxiety, and depression [ 37 ]. Furthermore, it is important to note that, over time, some individuals may exhibit rumination behavior, and their distressing experiences may not diminish [ 45 ]. Consequently, it is imperative to dynamically monitor changes in their distress levels and, in collaboration with family members and organizations, provide emotional support and promptly adjust intervention strategies. In this study, although the psychological capital of the second victim was at a moderately high level, it was still lower than that of the group who had not experienced adverse events [ 46 , 47 ]. This suggests that the psychological capital level of the second victim requires more attention. The occurrence of adverse events may also expose nurses to harmful working environments, such as criticism and complaints from patients and their families [ 44 , 48 ], as well as emotional abuse from colleagues or management [ 14 ]. This will to some extent reduce the psychological capital level of the second victim [ 49 , 50 ]. However, the profound dedication to their profession is likely to mitigate the impact of adverse events on psychological capital [ 51 ]. Consequently, it is incumbent upon managers to prioritize the enhancement of nurses’ professional sense of belonging and mission as second victims, with a view to fostering their psychological capital [ 52 ]. Correlation of received support, psychological capital, and distressing experiences The results indicated that the support received by nurses after experiencing adverse events was negatively correlated with their distressing experiences. That is, lower levels of support were associated with more severe physical and psychological distress. It is important to note that managers have a responsibility to provide timely support strategies and psychological comfort to nurses who have experienced adverse events [ 31 ]. The provision of such support can alleviate psychological pain and promote psychological recovery [ 53 ]. Scott et al. [ 54 ] developed a three-level intervention model theoretical framework for the second victim support, namely, departmental superior support (Level I), colleague support (Level II), and senior expert support (Level III). Based on this, they created the “FOR YOU” second victim support network system. A substantial body of research has demonstrated that this support program has yielded notable outcomes in reducing the pain experienced by the second victims [ 55 , 56 ]. This theoretical framework has also served as a source of inspiration for Chinese researchers, who have developed support plans within the context of their own cultural framework [ 18 ]. The present study demonstrated that the higher the psychological capital level of the second victim, the fewer their distressing experiences. The occurrence of negative events has been evidenced to lead to a series of changes in the physiology and psychology of nurses, affecting their mental health [ 57 ]. Psychological capital could play a positive and proactive psychological role, thereby reducing the incidence of adverse psychological problems [ 58 ]. It suggests that nursing staff should take active measures to enhance their psychological capital, including confidence, optimism, emotional intelligence, communication assistance, and psychological resilience. This, in turn, should enhance their ability to withstand pressure, remain calm when facing sudden adverse events, actively seek solutions, report proactively, and minimize the risk and harm. The second victim’s psychological capital plays a mediating role between support received and distressing experiences The findings of the present study indicated that psychological capital played a mediating role of 32.27% between received support and distressing experiences. This suggested that receiving support directly affected the distressing experiences of the second victim, and at the same time, it could indirectly predict the distressing experiences of the second victim through psychological capital. Psychological capital is defined as an individual’s internal asset that has the capacity to stimulate the inner strength of the second victim, thereby enhancing their psychological resilience and engendering increased resilience, confidence, and responsibility when confronted with adverse events [ 30 , 59 ]. Promoting positive psychological capital in nurses has been associated with numerous benefits, including alleviation of negative emotions, active reflection and proactive coping, and positive self-evaluation, which may ultimately facilitate post-traumatic growth [ 60 ]. Therefore, the intervention for the second victim’s distressing experiences can be carried out from two aspects: providing support resources and enhancing psychological capital. This not only provides psychological “nutritional supplementation” but also improves the “immune system” defense function. Managers should pay attention to the mediating role of psychological capital between support and distressing experiences. In order to enhance the psychological capital of the second victims and improve the distressing experiences of this group of people, it is recommended that narrative therapy [ 61 ] and mindfulness meditation methods [ 18 , 62 ] be adopted. Moreover, the psychological recovery process for the second victim post-adverse event can be categorized into six stages: chaos and accident response, intrusive reflections, restoring personal integrity, enduring the inquiry, obtaining emotional first aid, and moving on [ 63 ]. This suggests that the formulation and implementation of psychological capital and support intervention strategies for the second victim should be in line with the psychological recovery process. Limitations This study is not without its limitations. First, constrained by the resources available to the researchers, all these participating institutions were located within a single geographical region. This characteristic might result in the restriction of the universality of the research results. Consequently, the recommendation is to undertake multi-region and large-sample repeated studies to thoroughly investigate the relationship between nurses’ second victim psychological capital, support acquisition, and painful experiences. This will assist in enhancing the generalizability of the research findings. Secondly, the participants recruited for this study were all those who experienced adverse events within one year. This might result in an overestimation of the obtained result scores, and it did not explore the dynamic changes in the relationship among the three factors as the time elapsed since the occurrence of the adverse events increased. It is recommended that subsequent studies adopt a longitudinal design to verify the relationship model among the variables. The advantage of this study lies in its being a multi-center research study. The participants came from multiple medical institutions, including both private and public hospitals, and the size of the institutions was not restricted. To a certain extent, this avoided biases caused by the working environment, thereby increasing the reliability of the research results. It is hypothesized that the results of this study will provide a reference and guidance for the construction of intervention strategies for nurses’ distressing experiences as second victims in the future. Conclusions The status of received support, distressing experiences, and psychological capital among nurses as second victims is concerning. This finding highlights the imperative to implement targeted intervention measures and strategies. The results of the present study demonstrated significant correlations among received support, distressing experiences, and psychological capital. Furthermore, the findings confirmed that psychological capital acts as a mediator between received support and distressing experiences. Therefore, healthcare institutions and administrators should continuously monitor the support received by nurses as second victims and their associated psychological problems. They should actively cultivate a just patient safety culture, such as advocating a learning-oriented and non-punitive error reporting culture. Meanwhile, priority should be given to expanding support resources for nurses, including psychological counseling, peer support, and legal assistance. In addition, mental health services and training should be provided in routine practice to enhance nurses’ psychological capital, enabling them to access timely support and effectively apply their psychological capital to alleviate distress after adverse events. Acknowledgements We would like to acknowledge all the nurses who participated in this study. Abbreviations SVEST Second Victim Experience and Support Tool CI Confidence interval SE Standard error Author contributions WZ and JQ: Data curation; formal analysis; investigation; project administration; writing - original draft(WZ and JQ are equal contribution). LC: Data curation; formal analysis. MZ: Investigation; project administration. XW: Data curation; project administration. XY: Data curation. JW: Data curation; formal analysis; investigation; project administration; writing - review and editing. Funding This work was supported by the Affiliated Hospital of Xuzhou Medical University [grant number 2024ZH20]. Data availability The datasets used or analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate Ethical approval for this study was granted by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Approval Code: XYFY2025-KL132-01). The research protocol adhered to the ethical principles stipulated in the Declaration of Helsinki, and written informed consent was voluntarily provided by each participant before study initiation. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Wei Zong and Jing Qiu contributed equally to this work. References 1. Vanhaecht K, Seys D, Russotto S, Strametz R, Mira J, Sigurgeirsdóttir S et al. 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