"Holding Space in Chaos": Nurses' Experiences Delivering Trauma-Informed Care in Emergency Departments

Emergency departments (EDs) frequently serve individuals who have experienced acute or cumulative trauma. While trauma-informed care (TIC) offers a framework to support healing and psychological safety, little is known about how nurses implement these principles in high-acuity emergency settings. This study explored how emergency nurses understand, deliver, and emotionally navigate trauma-informed care in the context of a tertiary hospital in Saudi Arabia. A qualitative phenomenological design was employed. Seventeen registered nurses from the emergency department of King Faisal university Hospital participated in in-depth, semi-structured interviews. Data were analyzed thematically using Braun and Clarke's six-phase framework and managed with NVivo 14 software. Four interrelated themes were identified: (1) Holding Emotional Space in Clinical Chaos-nurses created micro-moments of psychological safety amid trauma and time pressure; (2) Systemic Misalignment with Trauma-Informed Values-organizational structures constrained relational care; (3) Protective Empathy and Adaptive Strategies-nurses developed emotional boundaries and grounding rituals to sustain compassion; and (4) The Accumulated Emotional Toll-ongoing exposure to trauma resulted in moral injury and emotional exhaustion, countered by reflection and peer support. Trauma-informed care in emergency settings is relational, emotionally taxing, and often constrained by systemic factors. Institutions must invest in trauma-informed systems, staff supports, and educational infrastructure to sustain ethical, emotionally attuned care in acute environments. Patients were not directly involved in this study, which focused on healthcare provider perspectives. Findings may inform institutional strategies to enhance patient-centered, trauma-informed practice.