Short answer: An emergency department nurse who was assaulted by a patient returned to full pre-injury duties after an eight-week occupational therapy program. The OT worked alongside the nurse's psychologist on anxiety management, daily routines, graded exposure to workplace triggers and a graduated return to work that started with supernumerary shifts.
The short version
- Who: a hospital emergency department nurse, assaulted by a patient at work.
- Focus: work-related PTSD symptoms, anxiety and loss of confidence in the workplace.
- Approach: anxiety management, daily routines, SUDS monitoring, graded exposure and a graduated return to work, coordinated with the treating psychologist.
- Outcome: back to full pre-injury duties in eight weeks.
Identifying details have been left out to protect the client's privacy.
Background
A nurse working in a hospital emergency department was assaulted by a patient while on duty.
After the incident, the nurse experienced psychological distress that affected their confidence, their sense of safety and their ability to go back into the emergency department.
They were referred to occupational therapy (OT) for a structured rehabilitation program covering anxiety management, graded exposure and functional restoration. The goal was a return to their pre-injury nursing role.
The rehabilitation approach
The OT built an individualized program in collaboration with the nurse's treating psychologist. Treatment focused on rebuilding coping strategies, restoring daily function and steadily increasing tolerance for work-related triggers.
1. Anxiety management and coping strategies
The nurse built a practical toolkit of anxiety management strategies to support emotional regulation and help them handle distressing situations. Strategies were introduced, practised and refined throughout the program.
2. Daily routines and structure
A consistent daily routine was set up to support recovery, build activity tolerance and rebuild confidence in everyday functioning. Meaningful activities were reintroduced step by step, and daily responsibilities became more consistent.
3. SUDS calibration and anxiety monitoring
The OT introduced the Subjective Units of Distress Scale (SUDS) so the nurse could identify, rate and track their anxiety in different situations and around specific triggers.
Through structured calibration, the nurse came to understand their anxiety thresholds and got better at recognizing and managing distress as it built.
4. Graded exposure
A progressive exposure program targeted the situations and cues in the environment that were linked to the incident.
Each step was graded to the nurse's tolerance, using SUDS ratings to decide when to move on. The OT worked closely with the psychologist so exposure work stayed consistent with the wider psychological treatment plan.
5. Graduated return-to-work planning
As function and confidence improved, the OT developed a structured graduated return-to-work (GRTW) plan.
The first stage was supernumerary duties, so the nurse could be back in the workplace without immediately carrying a full patient load.
Duties and responsibilities increased as tolerance and confidence grew, allowing a measured transition back into the emergency department.
Outcome
After an eight-week program, the nurse progressed from a supernumerary return to work to their full pre-injury duties.
The coordinated approach gave the nurse practical anxiety management skills, better daily routines, more tolerance for work-related triggers and renewed confidence at work.
What the evidence says
The approach was informed by research supporting multidisciplinary, function-focused rehabilitation and return to work after psychological injury.
- A scoping review of occupational therapy return-to-work interventions for trauma- and stress-related mental health conditions found most interventions focused on the person, such as stress management and coping, and that many were delivered by multidisciplinary teams [1].
- A systematic review of interventions for work-related PTSD found that psychological treatments, including trauma-focused cognitive behavioural therapy and EMDR, helped people recover from PTSD symptoms and return to work [2].
- A systematic review and meta-analysis found strong evidence for multicomponent interventions and for contact with the workplace, and moderate evidence for graded return to work, in workers off sick with mental health conditions [3].
Together, the evidence supports an integrated approach that addresses both psychological recovery and a return to meaningful work.
Why this case matters
This case shows the role occupational therapy can play for health care workers after a traumatic incident at work. Combining functional restoration, structured anxiety management, graded exposure and a collaborative return-to-work plan helps bridge the gap between psychological recovery and actually getting back to the job.
At Creative Therapy Consultants, recovery means more than fewer symptoms. We focus on restoring meaningful function, rebuilding confidence and supporting a return to work and everyday life that lasts. See counselling and mental health, vocational rehabilitation and return-to-work services, or make a referral.
References
- Edgelow M, Harrison L, Miceli M, Cramm H. Occupational therapy return to work interventions for persons with trauma and stress-related mental health conditions: a scoping review. Work. 2020;65(4):821-836. doi:10.3233/WOR-203134
- Torchalla I, Strehlau V. The evidence base for interventions targeting individuals with work-related PTSD: a systematic review and recommendations. Behavior Modification. 2018;42(2):273-303. doi:10.1177/0145445517725048
- Mikkelsen MB, Rosholm M. Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders. Occupational and Environmental Medicine. 2018;75(9):675-686. Read the article
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