Yarahmadi Sajad, Soleimani Mohsen, Gholami Mohammad, Fakhr-Movahedi Ali, Madani Seyed Mohsen Saeidi
Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.
Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
Nurs Crit Care. 2025 May;30(3):e13170. doi: 10.1111/nicc.13170. Epub 2024 Oct 9.
The intensive care unit has structural complexities, and critically ill patients are exposed to disparities. Thus, the intensive care unit can be a potential health disparity setting.
This study explored cultural knowledge associated with health disparities in the intensive care unit.
This critical ethnographic study was conducted using Carspecken's approach. It was carried out in intensive care units in Western Iran from 2022 to 2023. Data collection and analysis were conducted in three interconnected stages. The initial stage involved over 300 h of field observation. In the subsequent stage, a horizon analysis was performed. Conversations with 17 informants were recorded in the final stage to enrich the dataset further. Then, the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity.
This research revealed the following themes: (a) extension of the impact of political, social, and cultural powers, (b) being influenced by individual diversity, (c) balancing services based on the consideration of benefits and consequences, (d) departure from professional behaviour and (e) insufficient organizational discipline.
The findings of this study showed that individual diversity, political, social and cultural powers within a context of insufficient organizational discipline, and departure from professional behaviour influence the service delivery culture in the intensive care unit. Moreover, the benefits and consequences of service delivery impact its execution. These stereotypes have the potential to contribute to the emergence of health disparities. Cultural transformation is challenging because of deep-rooted stereotypes, but the reduction of disparities is possible through awareness, critical self-reflection and cultural competence.
The findings of this research can prompt staff self-reflection in situations prone to disparities. Health leaders can use these findings to shape health policies at both macro and micro levels.
重症监护病房结构复杂，危重症患者面临差异对待。因此，重症监护病房可能是一个潜在的健康差异环境。
本研究探讨了与重症监护病房健康差异相关的文化知识。
本批判性人种志研究采用卡尔斯佩肯的方法。于2022年至2023年在伊朗西部的重症监护病房开展。数据收集和分析分三个相互关联的阶段进行。初始阶段包括超过300小时的实地观察。在随后阶段进行了视野分析。最后阶段记录了与17名 informant 的对话，以进一步丰富数据集。然后，按照上一步的方式进行分析过程，以揭示健康差异的隐性文化。
本研究揭示了以下主题：(a) 政治、社会和文化力量影响的延伸；(b) 受个体差异影响；(c) 在考虑利益和后果的基础上平衡服务；(d) 背离职业行为；(e) 组织纪律不足。
本研究结果表明，在组织纪律不足的背景下，个体差异、政治、社会和文化力量以及背离职业行为会影响重症监护病房的服务提供文化。此外，服务提供的利益和后果会影响其执行。这些刻板印象有可能导致健康差异的出现。由于刻板印象根深蒂固，文化变革具有挑战性，但通过提高认识、批判性自我反思和文化能力可以减少差异。
本研究结果可促使工作人员在容易出现差异的情况下进行自我反思。卫生领导者可利用这些结果在宏观和微观层面制定卫生政策。
