Beyond security and surveillance : analyzing emergency department factors and responses to aggression and violence using an equity lens

This analysis aims to understand Emergency Department [ED] responses to varying forms of aggression and violence, and the implications these responses have for patients, nurses, and healthcare organizations. Through a secondary analysis of data collected from patients and staff in the EQUIP Emergency study, this thesis contributes to expanding understandings of (a) the contextual factors that contribute to the development of aggression and violence in EDs, (b) the organizational and structural responses to aggression and violence in EDs, including security surveillance strategies and (c) the potential impacts on patients experiencing various forms of health and social inequities. Results: Insights gained from analyzing patient survey responses, interviews with ED staff, and field notes collected by research assistants highlighted how aggression and violence tend to develop through various intersecting individual, organizational- and structural-level contributing factors. Patients may become stressed and frustrated in the ED if they feel their basic needs are not met, their health concerns are not addressed, or they experience stigma, discrimination, or racism. Meanwhile, staff expressed concerns in interviews that many institutional barriers exist that restrict them from meeting their patients’ needs, including staffing shortages and lack of resources. To add complexity to the situation, the ED serves as a part of the social safety net for some people whose needs cannot be met by community resources. Despite the complex, intersecting factors that contribute to the development of aggression and violence, current ED responses are one-dimensional and tend to place the responsibility on individual staff members to manage responses to perceived aggression or violence. Thus, this thesis argues that response strategies must be implemented simultaneously at the individual, organizational and structural levels to effectively respond to aggression and violence. Recommendations: Insights gained from this analysis were used to inform recommendations on how EDs might respond to aggression and violence in a more equity-oriented manner to improve patients’ and staff members’ experiences in EDs. Key recommendations include the prioritization of structural level response strategies and the importance of an explicit focus on reducing stigma and discrimination throughout all levels of response strategies.Applied Science, Faculty ofNursing, School ofGraduat