Volume 20, Issue 1 (April 2022)                   Nursing and Midwifery Journal 2022, 20(1): 1-16 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Hassankhani H, Soheili A, Dehgannezhad J, Powers K. LACK OF EMPATHY IN INTERACTION BETWEEN PATIENT/FAMILY AND HEALTHCARE PROFESSIONALS IN AN IRANIAN EMERGENCY DEPARTMENT: A FOCUSED ETHNOGRAPHIC STUDY. Nursing and Midwifery Journal 2022; 20 (1) :1-16
URL: http://unmf.umsu.ac.ir/article-1-4532-en.html
LACK OF EMPATHY IN INTERACTION BETWEEN PATIENT/FAMILY AND HEALTHCARE PROFESSIONALS IN AN IRANIAN EMERGENCY DEPARTMENT: A FOCUSED ETHNOGRAPHIC STUDY
Hadi Hassankhani1 , Amin Soheili * 2, Javad Dehgannezhad3 , Kelly Powers4
1- Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
2- Assistant Professor, Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran (Corresponding Author) , soheili_a@khoyums.ac.ir
3- Assistant Professor Department of Medical Surgical Nursing, School of Nursing and Midwifery, Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
4- Assistant Professor, Department of Nursing, School of Nursing, University of North Carolina at Charlotte, North Carolina, USA
Abstract:   (2266 Views)
Background & Aims: The approach of reciprocity and mutuality in the patient/family and healthcare professional relationship is of great importance in achieving patient- and family-centered care in emergency departments (EDs). This study aimed to explore and describe the current status of reciprocity between patient/family and healthcare professionals in an Iranian ED with a particular focus on cultural features. Materials & Methods: A focused ethnographic approach was used in the ED of a tertiary academic medical center in the northwest of Iran from April 2018 to February 2019. A total of 54 participants including patients, family members, healthcare professionals, and other stakeholders were selected by applying the purposive sampling technique. Data were collected using three methods of participant observation, ethnographic interviews, and examination of related documents and artifacts until data saturation was achieved. Results: The overarching cultural pattern of “lack of reciprocity in providing and receiving emergency care” emerged within which there were two main themes: (a) responsibility avoidance (includes three sub-themes of evasion of liability a sense of superiority and slacking off at work) and (b) self-seeking (includes three sub-themes of me first, others later emotional expressiveness and destructive convergence). Conclusion: Lack of reciprocal interaction between patient/family and healthcare professionals is one of the main cultural barriers in providing and receiving optimal care in EDs. Findings indicate the need to change the extent, nature, and approach of interactions in the EDs by focusing on divergent behaviors and evasion of liability which leads to the establishment of mutual trust and rapport.
Keywords: Patients, Family Members, Healthcare Professionals, Interpersonal Relations, Emergency Department, Focused Ethnography, Culture
Full-Text [PDF 569 kb]   (892 Downloads)    
Type of Study: Research | Subject: پرستاری
References
1. Cypress BS. The emergency department: experiences of patients, families, and their nurses. Adv Emerg Nurs J 2014;36(2):164-76. [DOI:10.1097/TME.0000000000000017] [PMID]
2. Sayah A, Rogers L, Devarajan K, Kingsley-Rocker L, Lobon LF. Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care. Emerg Med Int 2014;2014:981472. [DOI:10.1155/2014/981472] [PMID] [PMCID]
3. Ajami S, Ketabi S, Yarmohammadian MH, Bagherian H. Wait time in emergency department (ED) processes. Med Arh 2012;66(1):53-7. [DOI:10.5455/medarh.2012.66.53-57] [PMID]
4. Mahmoudi H, Mohammadi E, Ebadi A. Experience of nurses from the emergency department management: A qualitative study. J Crit Care Nurs 2012;5(1):1-10. [Google Scholar]
5. Mahmoudi H, Mohmmadi E, Ebadi A. Barriers to nursing care in emergency wards. Iran J Nurs Midwifery Res 2013;18(2):145-51. [PMID] [PMCID]
6. Atkinson S, Haran D. Individual and district scale determinants of users' satisfaction with primary health care in developing countries. Soc Sci Med 2005;60(3):501-13. [DOI:10.1016/j.socscimed.2004.05.019] [PMID]
7. Fatovich DM, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005;22(5):351-4. [DOI:10.1136/emj.2004.018002] [PMID] [PMCID]
8. Abu-Laban RB. Emergency medicine certification in Canada: the years march on but the questions remain the same. Can J Emerg Med 2008;10(2):101-7. [DOI:10.1017/S1481803500009775] [PMID]
9. Johnson KD, Winkelman C. The effect of emergency department crowding on patient outcomes: a literature review. Adv Emerg Nurs J 2011;33(1):39-54. [DOI:10.1097/TME.0b013e318207e86a] [PMID]
10. Toma G, Triner W, McNutt LA. Patient satisfaction as a function of emergency department previsit expectations. Ann Emerg Med 2009;54(3):360-7. [DOI:10.1016/j.annemergmed.2009.01.024] [PMID]
11. Johnson BH, Abraham MR. Partnering with patients, residents, and families: A resource for leaders of hospitals, ambulatory care settings, and long-term care communities. Bethesda, MD: Institute for Patient-and Family-Centered Care; 2012.
12. Gray J. Beyond CAHPS: A Guide for Achieving Patient- and Family-Centered Care. Middleton, United States: HCPro a division of BLR; 2016. [URL]
13. Moghadam MZ, Sadeghi S, Ghyasvandian S, Kazemnejad A. Effects of comprehensive-care program on patients' satisfaction with trauma in emergency department. iran J Cardiovasc Nurs 2013;2(3):54-62. [Google Scholar]
14. Soleimani M, Grewal S, Rosychuk R, Newton A. Are wait times and length of stay in Alberta emergency departments for children's mental health meeting national benchmarks? Trends from 2002 to 2008. Paediatr Child Health 2013;18(6):e26-31. [Google Scholar]
15. Dahlen I, Westin L, Adolfsson A. Experience of being a low priority patient during waiting time at an emergency department. Psychol Res Behav Manag 2012;5:1-9. [DOI:10.2147/PRBM.S27790] [PMID] [PMCID]
16. Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, et al. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med 2013;61(6):605-11.e6. [DOI:10.1016/j.annemergmed.2012.10.026] [PMID] [PMCID]
17. Bond K, Ospina MB, Blitz S, Afilalo M, Campbell SG, Bullard M, et al. Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey. Healthc Q 2007;10(4):32-40. [DOI:10.12927/hcq.2007.19312] [PMID]
18. Mason S, Mountain G, Turner J, Arain M, Revue E, Weber EJ. Innovations to reduce demand and crowding in emergency care; a review study. Scand J Trauma Resusc Emerg Med 2014;22:55. [DOI:10.1186/s13049-014-0055-1] [PMID] [PMCID]
19. Soleimanpour H, Gholipouri C, Salarilak S, Raoufi P, Rajaei-Ghafouri R, Pouraghaei M. Assessment of patient satisfaction with emergency department services in Imam Khomeini hospital, Tabriz, Iran. Urmia Med J 2012;23(1):22-31. [Google Scholar]
20. Morse J. The Changing Face of Qualitative Inquiry. Int J Qual Methods 2020;19:1609406920909938. [DOI:10.1177/1609406920909938]
21. Renjith V, Yesodharan R, Noronha JA, Ladd E, George A. Qualitative Methods in Health Care Research. Int J Prev Med 2021;12:20. [PMID] [PMCID]
22. Tuckerman J, Kaufman J, Danchin M. How to use qualitative methods for health and health services research. J Paediatr Child Health 2020;56(5):818-20. [DOI:10.1111/jpc.14849] [PMID]
23. Polit D, Beck C. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2022. [Google Scholar]
24. Stahlke-Wall S. Focused Ethnography: A Methodological Adaptation for Social Research in Emerging Contexts. Forum Qual 2014;16(1):1-15. [Google Scholar]
25. Reeves S, Kuper A, Hodges BD. Qualitative research methodologies: ethnography. Bmj 2008;337:a1020. [DOI:10.1136/bmj.a1020] [PMID]
26. Strudwick RM. Ethnographic research in healthcare - patients and service users as participants. Disabil Rehabil 2021;43(22):3271-5. [DOI:10.1080/09638288.2020.1741695] [PMID]
27. Black GB, van Os S, Machen S, Fulop NJ. Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review. BMC Med Res Methodol 2021;21(1):274. [DOI:10.1186/s12874-021-01466-9] [PMID] [PMCID]
28. Cruz EV, Higginbottom G. The use of focused ethnography in nursing research. Nurse Res 2013;20(4):36-43. [DOI:10.7748/nr2013.03.20.4.36.e305] [PMID]
29. Richards L, Morse J. README FIRST for a User′s Guide to Qualitative Methods 3rd ed. United States: Sage publications; 2013. [DOI:10.4135/9781071909898]
30. Roper JM, Shapira J. Ethnography in nursing research. London, United Kingdom: Sage publications; 2000. [DOI:10.4135/9781483328294]
31. Cupit C, Mackintosh N, Armstrong N. Using ethnography to study improving healthcare: reflections on the 'ethnographic' label. BMJ Qual Saf 2018;27(4):258-60. [DOI:10.1136/bmjqs-2017-007599] [PMID]
32. Spradley JP. Participant observation. New York: Wadsworth Thomson Learning; 1980. [URL]
33. Lincoln Y, Guba E. Naturalistic lnquiry. Newbury Park, CA: Sage; 1985. [DOI:10.1016/0147-1767(85)90062-8]
34. Brennan TA. Charter on medical professionalism: putting the charter into practice. Ann Intern Med 2003;138(10):851. https://doi.org/10.7326/0003-4819-138-10-200305200-00018 https://doi.org/10.7326/0003-4819-138-10-200305200-00021 https://doi.org/10.7326/0003-4819-138-10-200305200-00020 [DOI:10.7326/0003-4819-138-10-200305200-00019] [PMID]
35. Jotkowitz AB, Glick S, Porath A. A physician charter on medical professionalism: a challenge for medical education. Eur J Intern Med 2004;15(1):5-9. [DOI:10.1016/j.ejim.2003.11.002] [PMID]
36. Masoomi R, Asghari f, Mirzazade A. What is medical professionalism and how should we teach it? Journal of Medical Education and Development 2018;13(3):176-93. [URL]
37. Sanjari M, Zahedi F, Aalaa M, Peimani M, Parsapoor A, Aramesh k, et al. Code of ethics for Iranian nurses. Med Ethics Hist Med 2011;5(1):17-28. [Google Scholar]
38. Seif-Farshad M, Bazmi S, Amiri F, Fattahi F, Kiani M. Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran. Medicine 2016;95(45):e5380. [DOI:10.1097/MD.0000000000005380] [PMID] [PMCID]
39. Garshasbi S, Bahador H, Fakhraei N, Farbod A, Mohammadi M, Ahmady S, et al. Assessment of Clinical Teachers' Professionalism in Iran: From Residents and Fellowships' Perspective. Acta Med Iran 2017;55(1):59-67. [Google Scholar]
40. Hassankhani H, Zamanzade V, Rahmani A, Haririan H, Porter JE. Family support liaison in the witnessed resuscitation: A phenomenology study. Int J Nurs Stud 2017;74:95-100. [DOI:10.1016/j.ijnurstu.2017.06.005] [PMID]
41. Parizad N, Hassankhani H, Rahmani A, Mohammadi E, Lopez V, Cleary M. Nurses' experiences of unprofessional behaviors in the emergency department: A qualitative study. Nurs Health Sci 2018;20(1):54-9. [DOI:10.1111/nhs.12386] [PMID]
42. Nakhaee S, Nasiri A. Inter-professional Relationships Issues among Iranian Nurses and Physicians: A Qualitative Study. Iran J Nurs Midwifery Res 2017;22(1):8-13. [DOI:10.4103/1735-9066.202076] [PMID] [PMCID]
43. Berger AS. Arrogance among physicians. Acad Med. 2002;77(2):145-7. [DOI:10.1097/00001888-200202000-00010] [PMID]
44. Dehghani A, Mosalanejad L, Dehghan-Nayeri N. Factors affecting professional ethics in nursing practice in Iran: a qualitative study. BMC Med Ethics 2015;16:61. [DOI:10.1186/s12910-015-0048-2] [PMID] [PMCID]
45. Jafaraghaee F, Mehrdad N, Parvizy S. Influencing factors on professional commitment in Iranian nurses: A qualitative study. Iran J Nurs Midwifery Res 2014;19(3):301-8. [PMID] [PMCID]
46. Feldman MD. Altruism and Medical Practice. J Gen Intern Med 2017;32(7):719-20. [DOI:10.1007/s11606-017-4067-1] [PMID] [PMCID]
47. Harris J. Altruism: Should it be Included as an Attribute of Medical Professionalism? Health Prof Educ 2018;4(1):3-8. [DOI:10.1016/j.hpe.2017.02.005]
48. ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium:a physician charter. Ann Intern Med 2002;136(3):243-6. [DOI:10.7326/0003-4819-136-3-200202050-00012] [PMID]
49. Maister D. The Psychology of Waiting Lines Boston. MA: Harvard Business School: D.C. Heath and Company, Lexington Books; 1985. [Google Scholar]
50. Jones MB, Jones DR. Preferred pathways of behavioral contagion. J Psychiatr Res 1995;29(3):193-209. [DOI:10.1016/0022-3956(95)00010-3] [PMID]
51. Tsvetkova M, Macy MW. The Social Contagion of Antisocial Behavior. Sociol Sci 2015;2:36-49. [DOI:10.15195/v2.a4]
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2025 CC BY-NC 4.0 | Nursing And Midwifery Journal

Designed & Developed by : Yektaweb