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.
BMC Med Ethics. 2024 Oct 23;25(1):117. doi: 10.1186/s12910-024-01118-9.
The intensive care unit, with its structural complexity and the exposure of critically ill patients to various disparities, presents a significant setting for health disparities. This critical ethnographic study sought to uncover cultural knowledge and ethical practices for reducing health disparities in providing care services within the intensive care unit. The focus was on understanding how ethical considerations and cultural competence can address and mitigate these disparities effectively.
This critical ethnographic study was conducted in 2022-2023 at intensive care units in western Iran. Three interrelated phases were used to collect and analyze the data. More than 300 h of observation were done during the first phase. A horizon analysis was carried out in the next phase. To further enhance the dataset, 18 informants participated in semi-structured interviews and informal conversations. Following that, the analysis procedure was conducted to identify a culture of health disparities and factors that reduce it, as it had been in the prior stage. Trustworthiness data collection methods were implemented to ensure the validity and reliability of the study.
Two key themes emerged from the study: (A) Improved cultural competence, which encompassed empathy towards patients and their families, effective communication, prioritization of continuous learning, appropriate knowledge and awareness, sensitivity to cultural and religious beliefs, staff attitude and personality, and the delivery of customized care tailored to each patient's needs. (B) Supporting role and compensating for disparities involved recommendations for upholding ethical standards, compensatory actions, maintaining professional behavior despite external factors, addressing gaps and deficiencies, and actively defending and supporting patients.
The findings indicate that staff with high cultural competence can ethically mitigate health disparities through their supportive roles. Managers and health policymakers should create barriers to health disparity by improving staff cultural competence and knowledge about health disparities.
重症监护病房结构复杂，危重症患者面临各种差异，是健康差异的重要发生场所。本批判性民族志研究旨在揭示在重症监护病房提供护理服务时，减少健康差异的文化知识和伦理实践。重点是了解伦理考虑和文化能力如何有效解决和减轻这些差异。
本批判性民族志研究于 2022-2023 年在伊朗西部的重症监护病房进行。使用三个相互关联的阶段来收集和分析数据。在第一阶段进行了超过 300 小时的观察。在下一阶段进行了地平线分析。为了进一步增强数据集，18 名受访者参加了半结构化访谈和非正式对话。之后，进行了分析程序，以确定健康差异的文化以及减少健康差异的因素，就像在前一阶段一样。实施了信任度数据收集方法，以确保研究的有效性和可靠性。
本研究得出了两个主要主题：（A）提高文化能力，包括对患者及其家属的同理心、有效沟通、优先考虑持续学习、适当的知识和意识、对文化和宗教信仰的敏感性、员工态度和个性，以及提供根据每个患者需求定制的护理。（B）支持角色和弥补差异包括坚持伦理标准的建议、补偿性行动、尽管受到外部因素的影响仍保持专业行为、解决差距和缺陷，以及积极为患者辩护和支持。
研究结果表明，具有高文化能力的员工可以通过支持角色在道德上减轻健康差异。管理人员和卫生政策制定者应通过提高员工的文化能力和对健康差异的认识来为健康差异设置障碍。
