Enhancing nurses’ self-efficacy in peer support for second victims through simulation training: a randomised controlled trial

BACKGROUND: Patient safety incidents can cause emotional and psychological distress among healthcare professionals, known as second victims. Although peer support programmes are recommended, evidence on structured training for peer supporters remains limited. This study aimed to examine the effectiveness of an actor-based simulation training programme in enhancing nurses’ self-efficacy to provide peer support for second victims. METHODS: A randomised controlled trial with multiple-methods evaluation was conducted in two general hospitals in South Korea. Participants were stratified by hospital and professional role and randomised to intervention (lecture and actor-based simulation) or control (lecture only). Self-efficacy was assessed at four time points (baseline, post-lecture, post-simulation, and one-week follow-up) using a validated scale. Quantitative data were analysed using linear mixed-effects models and ANCOVA, and qualitative data were collected from focus group discussions with 16 intervention participants. RESULTS: Of the 104 nurses were randomised, 97 completed the study (47 intervention, 50 control). Self-efficacy increased after lecture-based education in both groups, but only the intervention group demonstrated further improvement after simulation, sustained at follow-up (group × time interaction, p = .025). ANCOVA confirmed higher post-simulation scores in the intervention group compared with controls (p = .003). Participants reported high satisfaction (Mean = 4.31) and emphasised greater awareness of the second victim phenomenon, enhanced empathic communication, and the need for continuous training. CONCLUSIONS: Actor-based simulation training significantly improved nurses’ self-efficacy in supporting second victims beyond lecture-based education. These findings suggest that actor-based simulation is an effective educational strategy for preparing peer supporters, and integration into formal hospital policies and ongoing staff development programmes is recommended. TRIAL REGISTRATION: Clinical Research Information Service (CRIS) KCT0009977. Retrospectively registered on July 11 2024.