Emergency Departments as places of social inclusion in pandemics

Published June 2020 by Associate Professor April Wright

Wright, A.L., Meyer, A.M. Reay, T., Staggs, J. (2020) “Maintaining places of social inclusion: Ebola and the emergency department”. Administrative Science Quarterly. doi:10.1177/0001839220916401.

Markwell, A., Mitchell, R., Wright, A.L., Brown, A.F. (2020). “Clinical and ethical challenges for emergency departments during communicable disease outbreaks: Can lessons from Ebola Virus Disease be applied to the COVID-19 pandemic?”, Emergency Medicine Australasia, 1742-6723.13514. doi.org/10.1111/1742-6723.13514

Wright, A.L., Meyer, A.M., Reay, T. and Staggs, J. (2020) "Working in the emergency department during a virus outbreak: Lessons from the Ebola crisis”, Contexts: Sociology for the Public (publication of American Sociological Association)  https://contexts.org/blog/healthcare-and-critical-infrastructure/#wright

Significance

  • Emergency Departments serve an important frontline function in Australia’s public health system as “places of social inclusion” where people with acute medical needs can go to receive free access to care and treatment.
  • During pandemics, the ability of emergency departments to function as places of social inclusion becomes more difficult as ideals of social inclusion and universally accessible care come into tension with staff risk perceptions and the hospital’s finite resources.
  • Understanding what hospital managers can do to keep emergency departments open and functioning during pandemics is important for supporting people’s health and wellbeing and for the preserving the order and stability of Australian society.

What’s new

  • The research is based on a study of an emergency department before, during and after the Ebola global health emergency and draws out insights for how emergency departments are responding to COVID-19. The research exposes that:
    • Emergency doctors and nurses feel a strong sense of professional identity and commitment as custodians who uphold and protect the value of accessible health care.
    • During a pandemic, professional commitment to the custodian role can be compromised if perceptions of unknown risk create fear that cannot be controlled by moral emotions.
    • When emergency staff are given clear information and appropriate and evidence-based resources, perceptions shift from unknown risk to known risk. Custodians are better able to draw on moral emotions of wanting to do the “right thing” by patients to dampen fear.
  • The key insight?  The work of emergency departments during pandemics depends on frontline health professionals adopting an identity as custodians of a place of social inclusion and on their ability to live out that identity in patient care provision by balancing risk, moral emotions, and fear.

Bottom line

Government and hospital managers can keep emergency departments functioning as places of social inclusion during and after pandemics by ensuring healthcare workers are given the necessary information and resources to mitigate personal harm, sustain moral emotions, and manage fear.

 

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