Patient’s dignity in intensive care unit: A critical ethnography

• Published in: Nursing ethics Vol. 26; no. 3; pp. 738 - 752
• Main Authors: Bidabadi, Farimah Shirani, Yazdannik, Ahmadreza, Zargham-Boroujeni, Ali
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2019; SAGE PUBLICATIONS, INC
• Subjects: Anthropology, Cultural - methods; Attitudes; Cardiac surgery; Cultural factors; Culture; Ethics; Ethnography; Heart surgery; Human dignity; Humans; Intensive care; Intensive Care Units - organization & administration; Intensive Care Units - standards; Interviews as Topic - methods; Iran; Medical ethics; Nurses; Nursing care; Paternalism; Patients; Patients rights; Personhood; Physicians; Professional ethics; Professional-Patient Relations; Qualitative Research; Reductionism; Self Efficacy; Self esteem; Subcultures; Therapeutic alliances; Iran; topic areas; therapeutic relationship; intensive care; respect; dignity in care; ethics education; professional ethics; critical ethnography; organizational ethics; theory/philosophical perspectives; ethics of care/care ethics; clinical ethics; Areas of practice
• ISSN: 0969-7330; 1477-0989
• DOI: 10.1177/0969733017720826

Background: Maintaining patient’s dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. Objectives: The aim of this study was to uncover the cultural factors that impeded maintaining patients’ dignity in the cardiac surgery intensive care unit. Research Design: The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. Findings: The findings of the study fell into the following main themes: “Presence: the guarantee for giving enough attention to patients’ self-esteem”, “Instrumental and objectified attitudes”, “Adherence to the human equality principle: value-action gap”, “Paternalistic conduct”, “Improper language”, and “Non-interactive communication”. The final assertion was “Reductionism as a major barrier to the maintaining of patient’s dignity”. Discussion: The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Conclusion: Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.