Compassion fatigue, moral injury and the second victim
- Concept
Caring for suffering, acting against one's values and being involved in an error can hurt clinicians. Naming these harms helps support them.
What it is
Three related ideas describe harm to clinicians beyond burnout. Compassion fatigue is the exhaustion that comes from repeated exposure to others' suffering and trauma. Moral distress and moral injury arise when a clinician cannot do what they believe is right, or takes part in something that violates their values. The second victim is a health worker who suffers lasting distress after an unexpected adverse event or error.
Key facts
- Support for second victims works best in steps: colleagues in the unit first, then trained peer supporters, then professional help.
- A just culture, which separates system failures from blame, helps clinicians disclose errors and learn from them.
- Some people dislike the term ‘second victim’ because it could seem to equate the clinician's suffering with the patient's harm.
- Unmanaged distress may lead to alcohol misuse, depression or leaving the profession.
Telling the concepts apart
| Concept | Source of harm | Typical feeling |
|---|---|---|
| Burnout | Chronic unmanaged work stress | Exhaustion and cynicism |
| Compassion fatigue | Repeated exposure to patients' suffering and trauma | Emotional numbness, intrusive images |
| Moral distress | Constraints that block the right action | Frustration, powerlessness |
| Moral injury | Taking part in or witnessing a violation of one's values | Guilt, shame, betrayal |
| Second victim | Involvement in an adverse event or error | Guilt, fear of repeating it, self-doubt |
Clinical notes
- After a serious adverse event, a brief, early check-in with the clinicians involved is a simple support measure.
- Clinicians have the same right to confidential mental health care as their patients.
Test yourself
Think of the answer, then tap the question to see it.
Who introduced the term ‘second victim’, and who is the first victim?
Albert Wu, in 2000; the first victim is the patient harmed by the adverse event.
How does moral distress differ from moral injury?
Moral distress is being blocked from the right action; moral injury is the lasting harm of taking part in or witnessing a violation of one's values.
What is compassion fatigue?
Exhaustion and secondary traumatic stress from repeated exposure to patients' suffering and trauma.
What are three common reactions of second victims?
Guilt, anxiety, reliving the event; also loss of confidence and poor sleep.
Elsewhere in DurgiPedia
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Second victim syndrome in intensive care unit healthcare workers: A systematic review and meta-analysis on types, prevalence, risk factors, and recovery time (PLoS One, via PubMed Central (US National Library of Medicine), 2023); The Perceptions of Healthcare Staff Regarding Moral Injury and the Impact on Staff Life and Work During COVID-19: A Scoping Review of International Evidence (Journal of Religion and Health, via PubMed Central (US National Library of Medicine), 2023).
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Representative model, for educational purposes only.