{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:09:20Z","timestamp":1778774960786,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Healthcare workplace violence has evolved into a global crisis, significantly impacting high-risk specialties. While the \u201cSecond Victim Phenomenon\u201d (SVP) is well-established for trauma following medical errors, the specific psychological trauma resulting from intentional external aggression remains conceptually under-defined. This study aims to introduce and define the \u201cViolence Victim Phenomenon\u201d (VVP) by exploring the lived experiences of anesthesiology and intensive care specialists, providing a theoretical framework for this distinct clinical state. Methods: A qualitative study was conducted with ten anesthesiology and intensive care specialists using a semi-structured focus group discussion. The session was subjected to thematic analysis using MAXQDA software. The analysis focused on the nature of violence encountered, psychological and professional impacts, and the role of institutional support systems. Results: The thematic analysis identified six core dimensions of VVP: forms and trajectories of violence, vulnerability amplifiers, psychological and occupational sequelae, coping and containment strategies, expectations of institutional support, and pandemic-specific intensifiers. Participants described a trauma profile comparable to SVP in severity but distinct in its etiology, rooted in intentional harm and \u201cinstitutional abandonment.\u201d VVP is characterized by a profound sense of vulnerability, loss of professional dignity, and a perceived lack of legal and administrative protection. Conclusions: VVP represents a critical gap in current academic literature. Defining VVP allows for a more nuanced understanding of the trauma healthcare workers face due to intentional aggression. To mitigate VVP, healthcare institutions must move beyond basic security measures toward a \u201cjust culture\u201d that provides structured psychological, legal, and managerial support, recognizing clinicians as victims of systemic failure.<\/jats:p>","DOI":"10.3390\/jcm15041503","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:38:39Z","timestamp":1771231119000},"page":"1503","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Defining the Violence Victim Phenomenon: A Qualitative Study Among Anesthesiology and Intensive Care Specialists"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9941-3109","authenticated-orcid":false,"given":"Pinar","family":"Ayvat","sequence":"first","affiliation":[{"name":"Anesthesiology and Reanimation Department, Faculty of Medicine, Izmir Democracy University, 35140 \u0130zmir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7249-0104","authenticated-orcid":false,"given":"Ali Galip","family":"Ayvat","sequence":"additional","affiliation":[{"name":"Project Management Department, Izmir Project Agency, 35210 \u0130zmir, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, November 25). Preventing Violence Against Health Workers. Available online: https:\/\/www.who.int\/activities\/preventing-violence-against-health-workers."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1136\/oemed-2019-105849","article-title":"Prevalence of workplace violence against healthcare workers: A systematic review and meta-analysis","volume":"76","author":"Liu","year":"2019","journal-title":"Occup. Environ. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Vento, S., Cainelli, F., and Vallone, A. (2020). Violence Against Healthcare Workers: A Worldwide Phenomenon with Serious Consequences. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.570459"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.ijnurstu.2012.09.018","article-title":"Risk factors associated with patient and visitor violence in general hospitals: Results of a multiple regression analysis","volume":"50","author":"Hahn","year":"2012","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Spelten, E., van Vuuren, J., O\u2019Meara, P., Thomas, B., Grenier, M., Ferron, R., Helmer, J., and Agarwal, G. (2022). Workplace violence against emergency health care workers: What Strategies do Workers use?. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00621-9"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1136\/bmj.320.7237.726","article-title":"Medical error: The second victim","volume":"320","author":"Wu","year":"2000","journal-title":"Br. Med. J. BMJ"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e089923","DOI":"10.1136\/bmjopen-2024-089923","article-title":"Key elements for designing effective second victim support interventions: A focus group study in European clinical settings","volume":"15","author":"Mira","year":"2025","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ramzi, Z.S., Fatah, P.W., and Dalvandi, A. (2022). Prevalence of Workplace Violence Against Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.896156"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14429","DOI":"10.3390\/ijerph121114429","article-title":"Coping with workplace violence in healthcare settings: Social support and strategies","volume":"12","author":"Zhao","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sari, H., Yildiz, \u0130., Balo\u011flu, S.\u00c7., \u00d6zel, M., and Tekalp, R. (2023). The frequency of workplace violence against healthcare workers and affecting factors. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0289363"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/15299732.2023.2289195","article-title":"Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients Betrayal-Based Moral Injury and Mental Health Problems","volume":"25","author":"Park","year":"2024","journal-title":"J. Trauma Dissociation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1097\/ALN.0000000000005660","article-title":"\u201cThe Pain and Suffering Are Just Too Great for Me to Manage\u201d: A Qualitative Study of Emotional Distress among Anesthesiologists after Challenging Clinical Events","volume":"143","author":"Burns","year":"2025","journal-title":"Anesthesiology"},{"key":"ref_13","unstructured":"Krueger, R., and Casey, M.A. (2000). Focus Groups: A Practical Guide for Applied Research, SAGE Publications. [3rd ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100198","DOI":"10.1016\/j.glmedi.2025.100198","article-title":"Using thematic analysis in qualitative research","volume":"6","author":"Ahmed","year":"2025","journal-title":"J. Med. Surg. Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1080\/07399339209516006","article-title":"Content analysis: Method, applications and issues","volume":"13","year":"1992","journal-title":"Health Care Women Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1177\/002234336900600301","article-title":"Violence, peace, and peace research","volume":"6","author":"Galtung","year":"1969","journal-title":"J. Peace Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.cpr.2009.07.003","article-title":"Moral injury and moral repair in war veterans: A preliminary model and intervention strategy","volume":"29","author":"Litz","year":"2009","journal-title":"Clin. Psychol. Rev."},{"key":"ref_18","first-page":"34","article-title":"Violence against mental health professionals: When the treater becomes the victim","volume":"8","author":"Anderson","year":"2011","journal-title":"Innov. Clin. Neurosci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"41","DOI":"10.5334\/aogh.3203","article-title":"Violence against healthcare workers during the COVID-19 pandemic: A review of incidents from a lower-middle-income country","volume":"87","author":"Bhatti","year":"2021","journal-title":"Ann. Glob. Health"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lafta, R., Qusay, N., Mary, M., and Burnham, G. (2021). Violence against doctors in Iraq during the time of COVID-19. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254401"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"408","DOI":"10.33314\/jnhrc.v19i2.3694","article-title":"Ordinance on the Safety and Security of Health Workers and Health Institutions in Nepal: A Critical Analysis","volume":"19","author":"Belbase","year":"2021","journal-title":"J. Nepal Health Res. Counc."},{"key":"ref_22","unstructured":"World Health Organization, and International Labour Organization (2025, November 25). Caring for Those Who Care: Guide for the Development and Implementation of Occupational Health and Safety Programmes for Health Workers, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240040779."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Schablon, A., Wendeler, D., Kozak, A., Nienhaus, A., and Steinke, S. (2018). Prevalence and Consequences of Aggression and Violence towards Nursing and Care Staff in Germany-A Survey. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15061274"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hines, S.E., Chin, K.H., Glick, D.R., and Wickwire, E.M. (2021). Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18020488"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1503\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:53:54Z","timestamp":1771232034000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041503"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041503","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]}}}