Intersecting vulnerabilities in emergency care: A scoping review

BACKGROUND: Vulnerability in emergency care is increasingly recognized as multifactorial, yet it is often conceptualized through fragmented or individual-level approaches. Intersectionality offers a framework to understand how multiple social and structural factors interact to shape health outcomes, but its application in emergency care research remains unclear. PURPOSE: This scoping review aimed to map how vulnerability is conceptualized in emergency departments, identify patterns of intersecting vulnerabilities, and examine their implications for care pathways, with a focus on nursing-relevant processes. METHODS: A scoping review was conducted following JBI methodology. Four databases (MEDLINE, CINAHL, Embase, ScienceDirect) were searched for studies published between 2020 and 2025. Eligible studies included adult populations in ED settings and addressed social, structural, or individual vulnerability. Data were extracted using a theoretically informed framework grounded in intersectionality and Intersectionality-Based Policy Analysis. DISCUSSION: A total of 137 studies were included. Vulnerability was predominantly conceptualized through single-axis or additive approaches, with limited use of explicit intersectional frameworks. Six patterns of vulnerability interaction were identified, ranging from formal intersectionality to single-dimension analyses. Emergency departments emerged as sites where structural and social vulnerabilities are both concentrated and amplified, contributing to disparities in access, clinical decision-making, and outcomes. Nursing perspectives were underrepresented across the literature. CONCLUSIONS: Current research inadequately captures the complexity of vulnerability in emergency care. Integrating intersectionality into nursing research and practice is essential to address inequities. Emergency nurses play a critical role in identifying and responding to intersecting vulnerabilities and in advancing structurally competent, equity-oriented care.