Resisting the ‘gaze’ ?: Nurses' perceptions of the role of accident and emergency departments in responding to alcohol-related attendances

Accident and emergency (A&E) departments are increasingly being viewed as possible sites for monitoring and intervention in a broad range of alcohol-related problems.¹ A study of alcohol-related attendances was conducted in two London hospitals. One of the aims was to explore the feasibility of routine monitoring in A&E departments and possible methods of screening. The process of carrying out the research and the results of the study raised a number of questions about the practicalities of monitoring in the A&E setting, which will be explored in this paper. Furthermore, nursing staff did not seem to embrace the new public health approach to alcohol² that underpins the calls for A&E departments to adopt a prevention role. On the whole, staff did not regard alcohol as their ‘business’; the focus was on the treatment of the presenting condition and for the most part alcohol was viewed as irrelevant or a ‘sideline’. Some nurses were uncomfortable with the concept of routine surveillance and what they saw as the problematization of ‘normal’ behaviour. Intervention, in the form of a referral, was reserved for those patients who were thought to be dependent on alcohol. This study highlights the problematic interface between research, policy and practice. Research evidence appears to have influenced the direction of policy but not its implementation.