Staff-family conflict in a multi-ethnic intensive care unit

Introduction: Conflicts between healthcare professionals and patients’
relatives are rather common in the intensive care unit (ICU). As a result
of societies’ increased ethnic diversity these conflicts more often involve
actors with a different ethno-cultural background. However few is
known about the specific nature of staff-family conflicts in a multiethnic
ICU environment. In this study, we give an overview of some
characteristics of conflicts between family members from ethnicminority
groups and staff members and compare them to characteristics
of staff-family conflict in general.

Methods: Ethnographic fieldwork was done in 1 ICU of a multiethnic
urban hospital in Belgium. During 6 months, data were collected
through negotiated interactive observation, in-depth-interviews with
staff, from patients’ medical records, and by making notes in a logbook.
Data were analyzed via grounded theory and compared to the literature
on staff-family conflict in general.

Results: It is known that, in general, physicians identify a situation
less often as conflict-loaded than relatives, suggesting the presence
of hidden conflicts during critical care [1-2]. However, in our studied
multi-ethnic ICU conflicts were found to be explicitly recognized by
both relatives as well as healthcare professionals, and to be very visible
and auditable on the ward. Moreover where in general relativestaff
conflict tend to be centered around crisis moments (end-of-life
decision making, patients’ death) [3], we found that in a multi-ethnic
ICU conflicts tend to be present during various care phases (curative
phase, end-of-life decision making, non-curative phase, patients’
death) and concern a broad spectrum of care aspects ( e.g. bedside
care activities, seeking a second opinion), easily assaulting the core
of actors’ identity. Consequently, end-of-life decisions, often a difficult
assignment in ICUs, might be even more problematical in a multiethnic
context than in general, as tensions in the pre-end of life decision
making phase might worsen conflicts in the end-of-life decision
making phase.

Conclusions: In ICUs, staff-family conflicts tend to be more severe
and overtly present in a multi-ethnic context than in general. Therefore
we urge for the development of specific and effective stafffamily
conflict prevention strategies in a multi-ethnic ICU.

References
1. Schuster RA et al. Crit Care Med 42:328-35, 2014.
2. Long AC et al. Crit Care Med 42:461-62, 2014.
3. Visser M et al. Crit Care doi: 10.1186/s13054-014-0604-z, 2014.