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Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study.

ABSTRACT: OBJECTIVES:To investigate the state of the mental well-being of patients from ethnic minority groups and possible related risk factors for the development of mental health problems among these patients during critical medical situations in hospital. DESIGN:Qualitative ethnographic design. SETTING:Oneintensive care unit (ICU) of a multiethnic urban hospital in Belgium. PARTICIPANTS:84 ICU staff members, 10 patients from ethnic-minority groups and their visiting family members. RESULTS:Patients had several human basic needs for which they could not sufficiently turn to anybody, neither to their healthcare professionals, nor to their relatives nor to other patients. These needs included the need for social contact, the need to increase comfort and alleviate pain, the need to express desperation and participate in end-of-life decision making. Three interrelated risk factors for the development of mental health problems among the patients included were identified: First, healthcare professionals' mainly biomedical care approach (eg, focus on curing the patient, limited psychosocial support), second, the ICU context (eg, time pressure, uncertainty, regulatory frameworks) and third, patients' different ethnocultural background (eg, religious and phenotypical differences). CONCLUSIONS:The mental state of patients from ethnic minority groups during critical care is characterised by extreme emotional loneliness. It is important that staff should identify and meet patients' unique basic needs in good time with regard to their mental well-being, taking into account important threats related to their own mainly biomedical approach to care, the ICU's structural context as well as the patients' different ethnocultural background.

SUBMITTER: Van Keer RL

PROVIDER: S-EPMC5623442 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study.

Van Keer Rose Lima RL Deschepper Reginald R Huyghens Luc L Bilsen Johan J

BMJ open 20170927 9

<h4>Objectives</h4>To investigate the state of the mental well-being of patients from ethnic minority groups and possible related risk factors for the development of mental health problems among these patients during critical medical situations in hospital.<h4>Design</h4>Qualitative ethnographic design.<h4>Setting</h4>Oneintensive care unit (ICU) of a multiethnic urban hospital in Belgium.<h4>Participants</h4>84 ICU staff members, 10 patients from ethnic-minority groups and their visiting family ...[more]

PMID: 28963277

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Project description:BackgroundThe COVID-19 pandemic resulted in substantial disruptions to the daily lives of young people. Yet knowledge is lacking about changes in mental well-being among young adults, whether those from ethnic minorities were more adversely impacted by the pandemic than the ethnic majority, and the extent to which pandemic-related stressors contributed to any declines in mental well-being.MethodsWe draw on nationally representative German CILS4COVID data, collected early in the pandemic (N = 3517, Mage = 25). Respondents provided information on mental well-being (psychosomatic complaints, anxiety, depression, life satisfaction) and exposure to pandemic-related stressors (financial worries, health worries, discrimination, contact with COVID-19). Responses on mental well-being were matched to responses from two pre-pandemic waves. Individual fixed effects regressions examined ethnic group differences in changes in mental well-being prior to, and at the early stage of, the pandemic. Path analysis tested the role of pandemic-related stressors in declines in mental well-being.ResultsOverall, young adults' mental well-being had improved at the pandemic assessment compared to pre-pandemic assessments, and few ethnic group differences in changes were found. However, greater pandemic-related stressors were associated with worsened mental well-being at the pandemic assessment. Among Asian minorities, indirect effects were found on anxiety via health worries, and on depression via health worries and discrimination. For Turkish, Middle Eastern and African minorities, indirect effects on anxiety and depression were found via health worries.ConclusionsWe did not find widespread declines in mental well-being among young adults at the early stage of the pandemic, and changes in mental well-being prior to and at the early stage of the pandemic were mostly similar across ethnic German and minority groups. Nevertheless, pandemic-related stressors posed risks for young adults' mental well-being, particularly increased discrimination and health worries among Asian minorities, and health worries among Turkish, Middle Eastern and African minorities.

Project description:BackgroundThere is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care.MethodsWe conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach.ResultsA majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers.ConclusionParticipants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.

Project description:US racial and ethnic minorities have well-established elevated rates of comorbidities, which, compounded with healthcare access inequity, often lead to worse health outcomes. In the current COVID-19 pandemic, it is important to understand existing disparities in minority groups' critical care outcomes and mechanisms behind these-topics that have yet to be well-explored. Assess for disparities in racial and ethnic minority groups' COVID-19 critical care outcomes. Retrospective cohort study. A total of 2125 adult patients who tested positive for COVID-19 via RT-PCR between March and December 2020 and required ICU admission at the Cleveland Clinic Hospital Systems were included. Primary outcomes were mortality and hospital length of stay. Cohort-wide analysis and subgroup analyses by pandemic wave were performed. Multivariable logistic regression models were built to study the associations between mortality and covariates. While crude mortality was increased in White as compared to Black patients (37.5% vs. 30.5%, respectively; p = 0.002), no significant differences were appraised after adjustment or across pandemic waves. Although median hospital length of stay was comparable between these groups, ICU stay was significantly different (4.4 vs. 3.4, p = 0.003). Mortality and median hospital and ICU length of stay did not differ significantly between Hispanic and non-Hispanic patients. Neither race nor ethnicity was associated with mortality due to COVID-19, although APACHE score, CKD, malignant neoplasms, antibiotic use, vasopressor requirement, and age were. We found no significant differences in mortality or hospital length of stay between different races and ethnicities. In a pandemic-influenced critical care setting that operated outside conditions of ICU strain and implemented standardized protocol enabling equitable resource distribution, disparities in outcomes often seen among racial and ethnic minority groups were successfully mitigated.

Project description:ObjectivesExamine well-being, measured as burnout and professional fulfillment, across critical care healthcare professionals, ICUs, and hospitals within a health system; examine the impact of the coronavirus disease 2019 pandemic.DesignTo complement a longitudinal survey administered to medical critical care physicians at the end of an ICU rotation, which began in May 2018, we conducted a cross-sectional survey among critical care professionals across four hospitals in December 2018 to January 2019. We report the results of the cross-sectional survey and, to examine the impact of the coronavirus disease 2019 pandemic, the longitudinal survey results from July 2019 to May 2020.SettingAcademic medical center.SubjectsFour-hundred eighty-one critical care professionals, including 353 critical care nurses, 58 advanced practice providers, 57 physicians, and 13 pharmacists, participated in the cross-sectional survey; 15 medical critical care physicians participated in the longitudinal survey through the coronavirus disease 2019 pandemic.InterventionsNone.Measurements and main resultsBurnout was present in 50% of ICU clinicians, ranging from 42% for critical care physicians to 55% for advanced practice providers. Professional fulfillment was less common at 37%, with significant variability across provider (p = 0.04), with a low of 23% among critical care pharmacists and a high of 53% among physicians. Well-being varied significantly at the hospital and ICU level. Workload and job demand were identified as drivers of burnout and meaning in work, culture and values of work community, control and flexibility, and social support and community at work were each identified as drivers of well-being. Between July 2019 and March 2020, burnout and professional fulfillment were present in 35% (15/43) and 58% (25/43) of medical critical care physician responses, respectively. In comparison, during the coronavirus disease 2019 pandemic, burnout and professional fulfillment were present in 57% (12/21) and 38% (8/21), respectively.ConclusionsBurnout was common across roles, yet differed across ICUs and hospitals. Professional fulfillment varied by provider role. We identified potentially modifiable factors related to clinician well-being that can inform organizational strategies at the ICU and hospital level. Longitudinal studies, designed to assess the long-term impact of the coronavirus disease 2019 pandemic on the well-being of the critical care workforce, are urgently needed.

Project description:BACKGROUND:Dien Bien Province in northwest Vietnam is predominantly populated with ethnic minority groups, who experience worse maternal and child health outcomes than the general population. Various factors are associated with maternal health care utilisation in Vietnam, including ethnic minority status, which is recognised as a key determinant of inequity in health outcomes. The aim of this study is to explore how and why ethnic minority women utilise maternal health services, and the factors that influence women and families' decisions to access or not access facility-based care. METHODS:We used a qualitative approach, interviewing primary health care professionals (n?=?22) and key informants (n?=?2), and conducting focus groups with Thai and Hmong women (n?=?42). A thematic analysis was performed. RESULTS:There were three main themes. 1. Prioritising treatment over prevention: women talked about accessing health services for health problems, such as unusual signs or symptoms during pregnancy, and often saw limited utility in accessing services when they felt well, or for a normal physiological event such as childbirth. Health professionals also saw their role as being mainly treatment-oriented, rather than prevention-focused. 2. Modernisation of traditional practices: health professionals and ethnic minority women discussed recent improvements in infrastructure, services, and economic circumstances that had increased access to health services. However, these improvements were less pronounced in Hmong communities, suggesting inequity. 3. Perceptions of quality influenced service utilisation: both health professionals and ethnic minority women perceived primary care facilities to be of lower quality compared to hospital, and some women made decisions about accessing services based on these perceptions, preferring to travel further and spend more to access higher quality services. Health professionals' perceptions of low service quality appeared to influence their referral practices, with even uncomplicated cases referred to higher level services as a matter of course. CONCLUSIONS:Primary health care facilities were technically available and accessible to ethnic minority women, however these services were likely to be underutilised if they were perceived to be of low quality. Some women had the means to access higher quality facilities, but others were limited to lower quality facilities, potentially reinforcing inequities in health outcomes.

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Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study.

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Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study.

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