Patient perceptions of microaggressions and discrimination toward patients during emergency department care.
Patient perceptions of microaggressions and discrimination toward patients during emergency department care.
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急诊科护理期间患者对患者的微侵犯和歧视的看法。
DOI：
10.1111/acem.14767
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Southerland,LaurenT
中科院分区：
文献类型：
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作者：
Punches,BrittanyE;Osuji,Evans;Bischof,JasonJ;Li-Sauerwine,Simiao;Young,Henry;Lyons,MichaelS;Southerland,LaurenT
背景急诊科(ED)护理中基于种族和民族的差异已经被证明。患者对紧急护理的看法可能会产生广泛的影响，包括不良的健康结果。我们的目的是测量和探索患者在急诊室护理期间的微攻击和歧视体验。方法采用混合方法对来自两个城市学术急诊室的成年患者进行研究，结合定量歧视测量和半结构访谈的方式了解急诊科护理期间的歧视体验。参与者完成了人口统计问卷和医疗设置歧视(DMS)量表，并被邀请进行后续访谈。利用传统的内容分析和逐行编码对主题描述进行分析。结果队列包括52名参与者，其中30人完成了访谈。近一半的参与者是黑人(n= 24，46.1%)，一半是男性(n= 26，50%)。在教育署访问期间，有22/48人(46%)报告了“没有”或“罕见”的歧视经历，19/48人(39%)报告了一些/中度歧视，7/48人(15%)报告了严重歧视。研究发现五个主题：(1)临床医生行为--沟通和同理心，(2)对医疗团队行动的情绪反应，(3)歧视的感知原因，(4)急诊室的环境压力，(5)患者对投诉犹豫不决。我们发现了一个新的概念，在讨论歧视的情况时，DMS评分中等/高的人经常反映以前的医疗保健经历，而不是他们现在的ED就诊。结论患者将微攻击归因于种族和性别以外的许多因素，包括年龄、社会经济地位和ED的环境压力。在最近访问教育署时透过调查回应支持中度至严重歧视的受访者中，大部分人在访问期间描述了历史上受歧视的经历。以前的歧视经历可能会对患者对当前医疗保健的看法产生持久的影响。系统和临床医生在患者融洽和满意度方面的投资对于防止对未来接触的负面期望和抵消已经存在的负面期望是重要的。
BackgroundDisparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care.MethodsThis mixed‐methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow‐up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line‐by‐line coding for thematic descriptions.ResultsThe cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n= 24, 46.1%) and half were male (n= 26, 50%). “No” or “rare” experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors—communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit.ConclusionsPatients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.