A former nurse has said she was injured hundreds of times while working at Muckamore Abbey Hospital.
Christine Keenan said that at one point she was told she was the most injured worker within the Belfast Health Trust.
Her testimony was the first of staff evidence sessions at the public inquiry into abuse at the facility.
She said a patient once threw a fire extinguisher at her that could have left her "seriously brain damaged or possibly dead".
Ms Keenan said it was "very shocking" and that she ran to the toilet to cry for a few hours afterwards.
"There was a big patch on the floor [where the fire extinguisher landed]," said Ms Keenan.
"It broke through the covering in the floor. Had it hit me I probably wouldn't be here."
'In the firing line'
Muckamore Abbey Hospital in County Antrim provides inpatient services for adults with learning difficulties.
Ms Keenan worked at the unit between 1973 and 2016, initially as an enrolled nurse and later as a behavioural nurse therapist.
She worked mostly with children but also with adult patients on occasion.
The retired nurse said that at times patients' behaviours could be "challenging" but "there were very few where it was a deliberate attempt to harm you".
"It was difficult because I was constantly on the frontline and everyone I worked with had challenging behaviour," she told the inquiry.
"One patient said: 'I wish your husband died'... I have been grabbed, hit in the face and told by a patient that he was going to rape me."
However Ms Keenan said she could not change the behaviours without building relationships with patients.
"You put yourself in the firing line and sometimes you just accept it."
Ms Keenan alleged that one patient "wrote sexualised letters to staff and threatened to rape them".
She said he "stubbed cigarettes on nurses heads" and she spoke about another incident in which a patient smashed a nurse's face with his knee.
She said that if that had happened in another nursing setting it would have been on the news but it was not because it happened on a learning disability unit.
"The fact public don't hear about these assaults annoys me." she said.
Ms Keenan also described how staff tolerated lower-level injuries.
"When you're working with learning disability, the children - you had a relationship with them. You didn't want to make them be seen in a bad way.
"You didn't want them targeted all the time or negative things said about them."
Ms Keenan also said staff "didn't get any support" after they were injured.
After telling the inquiry panel about one patient who was hitting his head and biting his tongue, Ms Keenan said she did not know whether the public appreciates "the difficulties dealing with learning difficulties at times".
She said it had been "difficult to hear about incidents of abuse… I wouldn't have stayed if I saw abuse of patients".
Ms Keenan spoke about staff buying a teddy bear for a patient, bringing in ribbons for their hair, and a "family atmosphere".
She said her patients would frequently go for walks, attend a weekly film club, have supper dances and attend mass or church services.
However she said activities were removed as part of the "modernisation" at Muckamore Abbey Hospital in her later years working there.
"The removal of these meant the patient experience was diminished," she said.
Ms Keenan spoke of her "successes" in helping with behavioural techniques.
She described some former patients as "the most lovable child", "a beautiful child and a real character" and "a lovely, funny man"
She said she had been proud of her work and that "as a Christian I felt it was where I was meant to be".
Now she said she found it "difficult to say I worked there".
The inquiry chairman Tom Kark KC said it was "important we do everything we can to encourage staff to come forward".
He added: "We need to hear about good practice at the hospital as well as poor practice."
The staff evidence phase of the inquiry is due to be completed in February 2024.