Reducing health disparities in providing care services in the intensive care unit: a critical ethnographic study

Yarahmadi, Sajad and Soleimani, Mohsen and Gholami, Mohammad and Fakhr-Movahedi, Ali and Saeidi Madani, Seyed Mohsen (2024) Reducing health disparities in providing care services in the intensive care unit: a critical ethnographic study. BMC medical ethics.

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Abstract

Objective: 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. Methods: 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. Findings: 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. Conclusion: 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. Keywords: Critical ethnography; Cultural competence; Health disparities; Intensive care unit.

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