• Farimah Shirani Bidabadi, Ahmadreza Yazdannik, and Ali Zargham-Boroujeni.
• Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
• Nurs Ethics. 2019 May 1; 26 (3): 738-752.

BackgroundMaintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units.ObjectivesThe aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit.Research DesignThe study was conducted using a critical ethnographic method proposed by Carspecken.Participants And Research ContextParticipants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace.Ethical ConsiderationEthical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained.FindingsThe findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity".DiscussionThe prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches.ConclusionChanging an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

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