Using a Structural Lens to Understand and Address Aggression and Violence Experienced by Emergency Department Nurses:...

Area of Science:

• Healthcare Management
• Sociology of Health
• Nursing Studies

Background:

• Aggression and violence toward nurses are increasing in Canadian emergency departments.
• Existing research often focuses on individual behaviors, neglecting organizational and structural factors.
• A critical theoretical perspective is needed to understand the root causes.

Purpose of the Study:

• To explore structural and contextual factors contributing to aggression and violence in emergency departments.
• To move beyond individualistic explanations and identify systemic influences.
• To inform multi-pronged strategies for violence prevention.

Main Methods:

• Secondary analysis of a larger dataset, including staff interviews, observational field notes, and patient survey responses.
• Interpretive description methodology guided the research.
• Thematic analysis was used to identify recurrent patterns across data sources.

Main Results:

• Three key themes emerged: significant stress and frustration as a backdrop, dominant norms and a culture of efficiency creating a stressful environment, and health/social inequities exacerbating stress.
• Organizational policies, power relations, and institutional norms were found to shape conditions conducive to violence.
• Individual-level explanations were insufficient to capture the complexity of the issue.

Conclusions:

• Aggression and violence in emergency departments are shaped by structural contexts, including policies, power dynamics, and institutional norms.
• A culture of efficiency and widespread health inequities contribute significantly to workplace stress and frustration.
• Effective strategies to address workplace violence must engage with these broader structural factors.