From silenced shock to strategic resilience: a longitudinal qualitative study of nurse residents' trajectory in coping with patient verbal abuse.

BACKGROUND

In China, newly graduated nurses are required to complete a standardized 1-year clinical residency, a transition marked by high stress and limited authority. Patient verbal abuse is common and often normalized as "part of the job," yet it can destabilize emotions and shape early career trajectories. Longitudinal evidence on how nurse residents interpret and cope with patient verbal abuse across their first year remains limited. Grounded in Lazarus and Folkman's transactional theory, this study examines trajectories of appraisal and coping in response to patient verbal abuse during the first year of practice.

METHODS

We conducted a longitudinal qualitative study in a high-volume tertiary hospital in Southwest China. Eighteen nurse residents were recruited through maximum-variation purposive sampling and completed three waves of semi-structured interviews at approximately 1, 6, and 12 months of residency (T1-T3).

RESULTS

Four themes captured the evolving trajectory: (1) initial emotional shock and vulnerability; (2) negotiation of hierarchical and cultural constraints; (3) gradual acquisition of adaptive strategies; and (4) tension between professional maturation and gaps in institutional support. Over time, primary appraisals often shifted from threat-focused interpretations toward more differentiated threat-challenge evaluations. Coping moved from early avoidance and suppression to more proactive, skill-based responses, while reporting remained selective.

CONCLUSION

Verbal abuse operates as a dynamic stressor embedded in the transition to practice rather than a one-off incident. The findings support a phase-matched approach to residency support, progressing from early psychological validation to de-escalation skills training and system-level actions that rebuild trust in reporting pathways.