Emergency department violence involving patients who use unregulated substances: A systemic perspective

This paper examines emergency department staff perspectives of patient violence in the context of care provision for people who use unregulated substances. Study findings demonstrate that disconnects between what patients need and what staff can offer create conditions that contribute to staff-patient conflict and violence - disconnects situated within constrains produced by system structures. In navigating the potential for conflict, care choices of staff are shaped by factors including fear and hypervigilance, expectations of teamwork and autonomous practice, and a lack of violence prevention training. This is in contrast to the existing research concerning emergency care for people who use unregulated substances, which tends to portray substance use as a predisposing factor to patient violence, failing to acknowledge organizational structures and variations in staff practices as contributing to violence. Findings from this study have profound implications for current and future efforts of addressing patient violence in the emergency department, with the end goal of improving patient care for people who use unregulated substances.