Culture of paternalism in the emergency department: a critical ethnographic study
Abstract Background Paternalism refers to the act of overriding an individual’s preferences or decisions under the justification of acting in their best interest or protecting them from harm. When paternalistic care is delivered, it can result in adverse physical, psychological, and social consequen...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12913-025-13282-8 |
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| author | Nayyereh Davoudi Nahid Dehghan Nayeri Mohammad Saeed Zokaei Nematallah Fazeli Phil Francis Carspecken |
| author_facet | Nayyereh Davoudi Nahid Dehghan Nayeri Mohammad Saeed Zokaei Nematallah Fazeli Phil Francis Carspecken |
| author_sort | Nayyereh Davoudi |
| collection | DOAJ |
| description | Abstract Background Paternalism refers to the act of overriding an individual’s preferences or decisions under the justification of acting in their best interest or protecting them from harm. When paternalistic care is delivered, it can result in adverse physical, psychological, and social consequences for patients. This study aimed to describe, interpret, and critically examine the culture of paternalism within the context of the emergency department. Methods This critical ethnographic study was conducted in the emergency department of a public hospital in Khorasan Razavi Province, Iran. The research followed Carspecken’s method of critical ethnography, encompassing three preliminary and five main stages. Data were collected through participant observation, in-depth interviews, and document analysis to uncover the beliefs, values, actions, and power dynamics that reinforce paternalistic structures within the emergency care setting. Over 22 months of field work, empirical data were gathered and subsequently analyzed using reconstructive analysis. The identified systemic relationships were then interpreted in light of relevant sociological theories. Results Analysis of the data led to the identification of four categories: domination of the superior, facilitation of the domination of the superior, destruction of the inferior, and the echoes of paternalism. Conclusions The findings indicate the presence of an entrenched culture of paternalism in the emergency department—one that poses significant challenges to delivering humane and ethically grounded patient care. These results underscore the need to raise awareness among healthcare providers regarding the ethical dimensions of clinical interactions and to enhance their understanding of the social and legal issues related to patient care. Ultimately, such awareness can inform strategies to recognize and address structural barriers, promote respect for patient autonomy, and support adherence to patients’ rights. |
| format | Article |
| id | doaj-art-078fe44c8ad646a7843feafee378ea72 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-078fe44c8ad646a7843feafee378ea722025-08-20T04:01:53ZengBMCBMC Health Services Research1472-69632025-08-0125111210.1186/s12913-025-13282-8Culture of paternalism in the emergency department: a critical ethnographic studyNayyereh Davoudi0Nahid Dehghan Nayeri1Mohammad Saeed Zokaei2Nematallah Fazeli3Phil Francis Carspecken4Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical SciencesNursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical SciencesFaculty of Social Sciences, Department of Cultural Studies, Allameh Tabataba’i UniversityInstitute for Humanities and Cultural StudiesIndiana University BloomingtonAbstract Background Paternalism refers to the act of overriding an individual’s preferences or decisions under the justification of acting in their best interest or protecting them from harm. When paternalistic care is delivered, it can result in adverse physical, psychological, and social consequences for patients. This study aimed to describe, interpret, and critically examine the culture of paternalism within the context of the emergency department. Methods This critical ethnographic study was conducted in the emergency department of a public hospital in Khorasan Razavi Province, Iran. The research followed Carspecken’s method of critical ethnography, encompassing three preliminary and five main stages. Data were collected through participant observation, in-depth interviews, and document analysis to uncover the beliefs, values, actions, and power dynamics that reinforce paternalistic structures within the emergency care setting. Over 22 months of field work, empirical data were gathered and subsequently analyzed using reconstructive analysis. The identified systemic relationships were then interpreted in light of relevant sociological theories. Results Analysis of the data led to the identification of four categories: domination of the superior, facilitation of the domination of the superior, destruction of the inferior, and the echoes of paternalism. Conclusions The findings indicate the presence of an entrenched culture of paternalism in the emergency department—one that poses significant challenges to delivering humane and ethically grounded patient care. These results underscore the need to raise awareness among healthcare providers regarding the ethical dimensions of clinical interactions and to enhance their understanding of the social and legal issues related to patient care. Ultimately, such awareness can inform strategies to recognize and address structural barriers, promote respect for patient autonomy, and support adherence to patients’ rights.https://doi.org/10.1186/s12913-025-13282-8Emergency departmentEthnographyCritical ethnographyCarePaternalism |
| spellingShingle | Nayyereh Davoudi Nahid Dehghan Nayeri Mohammad Saeed Zokaei Nematallah Fazeli Phil Francis Carspecken Culture of paternalism in the emergency department: a critical ethnographic study BMC Health Services Research Emergency department Ethnography Critical ethnography Care Paternalism |
| title | Culture of paternalism in the emergency department: a critical ethnographic study |
| title_full | Culture of paternalism in the emergency department: a critical ethnographic study |
| title_fullStr | Culture of paternalism in the emergency department: a critical ethnographic study |
| title_full_unstemmed | Culture of paternalism in the emergency department: a critical ethnographic study |
| title_short | Culture of paternalism in the emergency department: a critical ethnographic study |
| title_sort | culture of paternalism in the emergency department a critical ethnographic study |
| topic | Emergency department Ethnography Critical ethnography Care Paternalism |
| url | https://doi.org/10.1186/s12913-025-13282-8 |
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