Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.
National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
Addict Sci Clin Pract. 2021 Oct 2;16(1):60. doi: 10.1186/s13722-021-00269-z.
Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED.
An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool.
150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes "flow," "risky environment," and "physical spaces and artefacts" are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients' and HCPs' encounters unfold in everyday practice. Subtheme "Professional differences" showcases how nurses and doctors address patients' alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes "gut-feeling vs. clinical parameters," "ethical reasoning," and "from compliance to zero-tolerance"; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are "occupiers" and "alcoholic or party animal?".
Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use-characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior-shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach.
急诊科（ED）是发现不良物质使用的重要场所。在外部资金支持下，一些 ED 环境中已经使用了针对不健康酒精使用的筛查、简短干预和转介治疗（SBIRT）。然而，广泛持续的实施并不常见，并且缺乏旨在了解文化作为实施决定因素的研究。本研究旨在探讨与急诊科收治的不健康酒精使用患者处理有关的文化实践。
在丹麦首都地区的一家急诊科进行了一项民族志研究。数据包括对医疗保健专业人员（HCP）的参与观察和对护士的半结构化访谈。数据收集于 2018 年 7 月至 2020 年 2 月进行。使用定性内容分析作为分析工具进行文化分析。
共进行了 150 小时的观察和 11 次访谈。分析得出了三个主题：（1）场景设置描述了亚主题“流动”、“危险环境”和“物理空间和人工制品”如何成为 ED 环境的一部分，以及它们对不健康酒精使用患者的影响，例如安置在特定房间；（2）相遇描述了患者和 HCP 日常实践中的相遇。亚主题“专业差异”展示了护士和医生如何以不同的方式对待患者的饮酒习惯，以及由于多种因素，他们不一定会根据提供的信息采取行动。这些因素在剩余的亚主题“直觉与临床参数”、“伦理推理”和“从合规到零容忍”中有所体现；（3）集体剧目展示了语言如何塑造对不健康酒精使用患者的看法，这可能导致污名化和刻板印象。亚主题是“占据者”和“酗酒者或派对动物？”。
急诊科的不健康酒精使用与复杂的文化网络交织在一起。具有严重且易于识别的不健康酒精使用特征的患者——电子病历中的酒精诊断、中毒或不良行为——塑造了对不健康酒精使用的一般方法和态度。因此，从预防的角度来看，这意味着不太明显的不健康酒精使用的患者往往被忽视或忽视，这需要一种系统的筛查方法。
