Power and Violence in ER: Analysis of Conflictual Interactions between Patients and Caregivers in the Emergency Room of a Local Hospital in Northern France

Emergency departments in public hospitals in France are open 24/7. During the night, the emergency room (ER) becomes the main point of admission to the hospital. Each patient arriving in the ER must be examined. The ER staff typically deal with organisational constraints and a variety of patients, whose conditions range from “life or death emergencies” to “routine consultations”. In performing their duties, the ER staff are constantly confronted with individual patients’ subjective perceptions of their own health. Analysing professional practices and caregivers’ victimization, this proposal, based on ethnographic fieldwork (combining observations and interviews) conducted over a year in the ER of two local hospitals in northern France, will discuss the conflictual interactions caregivers face in their daily practice and the balance of power that takes place between patients and health professionals. Three situations experienced as potentially violent will be highlighted:

• Patients leaving against medical advice or refusing to take treatment despite medical advice, which can be experienced by healthcare professionals as a negation of their professional identity.
• Applying medical restraints during certain medical procedures to restrain patients and prevent them from injuring themselves is often considered by caregivers as a “dirty job”, raising the question of individual rights and freedom.
• The use of patient flow management systems by nurses involves monitoring patients, who are asked to comply with the role of the “good patient”.

These three examples highlight the balance of power in the ER which expression can be experienced as violent by caregivers and patients and that both parties experience forms of stress and discomfort in ER.