| dc.description.abstract | ABSTRACT
Background and Objective: It is of crucial importance to understanding what it is like to wait in an emergency department (ED) and to innovate major changes in EDs’ structure, processes, people, and culture with the intent of more closely matching services to patient needs and preferences. However, little appears to have been done to discover the cultural features of ED waiting and most of the previous studies were quantitative that investigated the time as the most important aspect of ED waiting and were unable to discover the experiences patients and their relatives have had while waiting, the interactions occurred among patients, their relatives, and the healthcare professionals (HCPs) and the overall culture of waiting in ED. Therefore, we aimed to explore, understand, and describe what it is like to wait in an Iranian ED focusing on its ongoing cultural features.
Materials and Methods: A focused ethnographic approach based on Spradley’s (1980) developmental research sequence was conducted to contribute to an in-depth understanding of the ongoing waiting culture among the patients, their relatives and the in the ED of a tertiary academic medical center in northwest Iran. Purposive sampling was used to identify the eligible participants: the patients, their relatives, and the HCPs. Data were collected using participant observations, ethnographic interviews, and document reviews and data collection continued until data saturation was achieved. The analysis were carried out at the same time as data were collected using an iterative-inductive process of the four fundamental tasks: domains analysis, taxonomy analysis, components analysis, and themes analysis using MAXQDA 12 software.
Results: The ethnographic data generation, treatment, analysis, and interpretation overally lead to 1142 initial codes, 119 primary concepts, 31 sub-themes, 12 main themes, and 6 cultural patterns of the ongoing waiting culture among the patients, their relatives and the HCPs. The cultural patterns were as follows: (1) patients and their relatives are spending their time in uncertainty due to lack of information; (2) further relatives feel obliged to insist on their presence; (3) the constructive/ destructive duality of further relatives’ presence is perceived; (4) lack of empathy casts a shadow on of reciprocity in healthcare; (5) disease-centeredness is institutionalized in healthcare actions; and (6) self-organized HCPs dynamically address the ED disorganizations.
Conclusion: Given the findings of this study regarding what the patients and their relatives want, need and experience during their ED waiting, not what HCPs believe they need or get, it can be used as a prelude to designing effective intervention strategies for promoting the quality of hoteling and healthcare services in a way that is more closely aligned with the needs, expectations, and preferences of patients and their relatives. An accountable patient/relative support liaison, a clearly-delineated process of ED care delivery, guidelines for providing culturally competent ED care, and public awareness programs are needed to address the concerns and conflicts which establish a mutual trust and rapport. | en_US |
