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

Abstract

Aggression and violence toward nurses is a growing problem in Canadian emergency departments. Existing literature often examines this issue through an individualistic lens, focusing primarily on individual behaviors of patients and staff, with limited attention to organizational and structural factors contributing to root causes. This paper presents a secondary analysis of a larger data set – including interviews with hospital staff, observational field notes, and open-ended patient survey responses – to explore the structural and contextual factors shaping aggression and violence in emergency departments. Using a structural lens informed by critical theoretical perspectives and guided by interpretive description, the research team conducted a thematic analysis to identify recurrent patterns across the data sources. The analysis reveals how policies, power relations, and institutional norms shape the conditions that give rise to violence, moving beyond individual-level explanations. Three themes were identified: (a) significant stress and frustration is the contextual backdrop, (b) dominant norms and a culture of efficiency in the emergency department create and maintain a stressful environment, and (c) widespread health and social inequities and a lack of community resources exacerbate stress and frustration. This analysis demonstrates that addressing aggression and violence requires multi-pronged strategies that engage with the structural contexts shaping these events.