A perceived duality of relatives’ presence in emergency departments: A focused ethnographic study

Introduction: In the Iranian Healthcare System, emergency departments (EDs) face many challenges such as limitations of the physical environment and overcrowding, meanwhile, unnecessary presence of relatives at their patients׳ bedside goes beyond EDs challenges and has made the situation worse. Therefore, the aim of this study was to explore, gain an understanding of, and describe the cultural beliefs and behaviors in an Iranian ED. Materials and Methods: A focused ethnographic approach based on Spradley’s (1980) developmental research sequence was conducted at the ED of Imam Reza University Hospital in Tabriz, Iran. Purposive sampling was used to identify eligible participants from patients, their relatives, and the healthcare professionals of this ED. Participant observation, ethnographic interviews, and examination of related documents and artifacts were used for data collection and continued until data saturation achieved. Results: The overarching cultural pattern of “perceived constructive/destructive duality of relatives׳ presence” emerged within which there were two main themes as follows: constructive presence (includes two sub-themes of compensation and support) and destructive presence (includes two sub-themes of dissuasion and workplace violence). Conclusion: Our findings provide valuable insight into the perceived duality of relatives׳ presence which strenuously affect not only the patients and their relatives but also the healthcare professionals, healthcare system, and healthcare quality. Conspicuously, most of the time, the relatives played the role of “12th man” in our healthcare system. However, their violent and aggressive behaviors against healthcare professionals were the most destructive aspect of their presence.