Power, Influence, and Decision-Making: Emergency Department Healthcare Worker's Responses to Pediatric Patients with Suicidal Ideation

Abstract

Suicidal ideation is the second leading cause of death in U.S. for citizens ages 1 0- 25 (CDC, 2018). It often impacts marginalized communities the most and has been exacerbated by the current COVID-19 pandemic. Current literature evaluates patient demographics and social determinants of health to address inequities in treatment of suicidal ideation. However, utilizing Paulo Freire's ideas of praxis and dismantling systems that oppress people from the top down, interrupting inequitable practices would be best targeted at healthcare workers. Healthcare workers act as a type of "middleman" between larger hospital systems and patients themselves, meaning they can both be oppressed and take part in the oppression. This research focuses on two approaches to addressing any inequities discovered: the first is how healthcare workers who are treating patients with suicidal ideation are influenced by the systems that they work within and how this is further impacted by their own demographics. The second is to how they themselves influence the decision making when treating patients while considering their positionality. Our results indicate that workplace influences access to resources needed to treat suicidal ideation within the local area. There is also a difference in access to resources depending on job. Health care workers across gender, workplace, and job standpoints express differences in feeling supported enough to make clinical decisions regarding suicidal ideation scenarios. In addition, there is a difference in the comfort level of treating patients with suicidal ideation based on gender and job. Gender influences to what extent respondents feel tensions between their needs and the needs of the patient while workplace affects the extent to which respondents express difficulties in balancing their needs and those of the patient as well as their needs and those of the hospital. Lastly, there is a difference based on workplace, gender, job, and race when analyzing different groupings of suicidal ideation clinical scenarios. These findings are parallel with current discussion around limited resources in healthcare for mental health emergencies both before and during the COVID-19 pandemic. Lack of significant differences based on race across most of the study as well as in the availability of resources based on gender contradicts recent feminist kyriarchical ideology. However, respondents perception of patients as responsible for gathering n1ultiple sources of help for suicidal ideation reflects the influences of neoliberalism and biopower on medical workers. Differences in feelings of balancing needs based on gender can be analyzed through a kyriarchical and neoliberalist lens. Lastly, responses to scenarios can be regarded with neoliberalist, biopolitical, and kyriarchical outlooks.