Table 3.

Main theme of emotional responses to trauma.

Sub-theme	Example quotes
Patients describe their conditions as ones in which they are simply trying to survive	Patient 4: “We just got to survive and make the best of it.” Patient 15: “Everybody’s doing something for a reason. Some people might not have food on their plates. That’s why, you know, survival is…the only way they can express their feelings.”
Residents describe their experience on the trauma service in terms of survival and war imagery	Resident 3: “It’s basically like survival mode…I have this mentality of, I’m going to battle.” Resident 14: “I thought I was in a war zone when I was on shift.”
Patients describe posttraumatic emotional responses and symptoms	Patient 4: “I was real mean up in here, antisocial…To me, it was hell up in here.” Patient 8: “I wake up out of my sleep at night and can’t go back, ‘cause I steady having nightmares, steady having flashbacks of what happened to me.”
Patients’ posttraumatic responses may lead to conflicts between patient and care team	Resident 11: “Some of our patients express like their stress and hurt over their situation by lashing out…and then a healthcare provider sometimes reacts in a way that’s kind of, I won’t say lashing back out but they’re like…That develops this friction and they get angry and upset about their care and not willing to accept as much of the care team’s direction.” Resident 7: “A lot of times these patients who are victims of violent and nonviolent trauma, they tend to be angrier, or more upset, or more sad, or more depressed… when patients are angry or upset they tend to sometimes take that out on the nursing staff, or even the physician and advanced practice providers. And that, I think, impacts our views of the patient and our ability to objectively care for patients as well.”
Residents describe posttraumatic emotional responses and symptoms	Resident 14: “You’re just fatigued, you’re tired of the killing, you’re tired of the acuity, the lack of sleep, the amount of effort and energy put forth, and just the emotional trauma.” Resident 2: “When I woke up for my shifts…the first thing, a lot of the times, what I would see were the shooting victims from the night before.”
Residents’ reaction to trauma may discourage them from connecting with patients	Resident 12: “A lot of people fall into a bad habit of, kind of like, dehumanizing everything on the service to try to cope with everything you’re seeing.”