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Evid Based Nurs 5:29 doi:10.1136/ebn.5.1.29
  • Qualitative

Emergency department care of women who were abused was driven by the prevailing practice pattern of efficient patient processing


 
 QUESTION: What is the relation between the social context of practice and the ways in which nurses respond to women who have been abused?

Design

Critical ethnography.

Setting

Emergency departments (EDs) of 2 urban hospitals in Canada.

Participants

30 healthcare providers (21 white, female nurses and 9 other providers including admitting clerks, social workers, physicians, and administrators) and 5 women who had been abused.

Methods

Data were collected through >200 hours of observation and interviews. A core sample of 12 nurses, who were observed extensively, were interviewed twice for about 2 hours. Other healthcare providers and the women who had been abused were interviewed once for 1–3 hours. Analysis of transcribed interviews and field notes used established critical ethnography approaches.

Main findings

In general, abuse was obscured by practices required to keep the ED running. Abuse went largely unrecognised. Most nurses did not think they saw much abuse and recognised it only when there was serious physical injury, which fit the pattern of emergency practice. Abuse was obscured through efficient patient processing. The unpredictability of the ED and the sense of scarce resources …

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