Background

Professional culture is a powerful influence in emergency departments, but incompletely understood. Disasters magnify cultural realities, and as such the COVID-19 pandemic offered a unique opportunity to better understand emergency medicine (EM) values, practices, and beliefs.

Methods

We conducted a collaborative ethnography at a tertiary care center during the acute phase of the response to the threat of COVID-19 (March–May 2020). Collaborative ethnography is a method that partners directly with communities during design, data gathering, and analysis to study culture. An ED-based research team gathered data including field notes from 300 h of participant observation and informal interviews, 42 semi-structured interviews, and 57 departmental documents. Data were deductively coded using a previously generated framework for understanding EM culture.

Results

Each of seven core values from the original framework were identified in the dataset and further contextualized understanding of EM culture. COVID-19 exacerbated pre-existing tensions and threats to the core values of EM. For example, the desire to provide patient-centered care was impeded by strict visitor restrictions; the ability to treat life-threatening illness was impaired by new resuscitation room layouts and infection control procedures; and subtle changes in protocols had downstream impact on flow and the ability to balance needs and resources at a system level. The cultural values related to teams were protective and strengthened during this time. The pandemic exposed problems with the status quo, underscored inherent tensions between ED values, and highlighted threats to self-identity.

Conclusion

COVID-19 has highlighted and compounded existing tensions and threats to the core values of EM, underscoring a critical mismatch between values and practice. Realignment of the realities of ED work with staff values is urgently needed.

中文翻译：

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COVID-19 加剧了急诊医学核心价值观之间的紧张关系，并暴露了对急诊医学核心价值观的威胁

背景

专业文化在急诊科具有强大的影响力，但未被完全理解。灾难放大了文化现实，因此 COVID-19 大流行为更好地了解急诊医学 (EM) 价值观、实践和信仰提供了独特的机会。

方法

在应对 COVID-19 威胁的急性期（2020 年 3 月至 2020 年 5 月），我们在一家三级护理中心进行了协作民族志研究。协作民族志是一种在设计、数据收集和分析过程中直接与社区合作以研究文化的方法。一个基于 ED 的研究团队收集的数据包括来自 300 小时的参与观察和非正式访谈、42 次半结构化访谈和 57 份部门文件的现场记录。使用先前生成的框架对数据进行演绎编码，以了解 EM 文化。

结果

原始框架中的七个核心价值中的每一个都在数据集中进行了识别，并进一步对 EM 文化进行了情境化理解。COVID-19 加剧了对新兴市场核心价值观的先前存在的紧张局势和威胁。例如，提供以患者为中心的护理的愿望受到严格的访客限制的阻碍；新的复苏室布局和感染控制程序削弱了治疗危及生命疾病的能力；协议的细微变化会对流量以及在系统级别平衡需求和资源的能力产生下游影响。在此期间，与团队相关的文化价值观受到保护和加强。大流行暴露了现状的问题，强调了 ED 价值观之间的内在紧张关系，并突出了对自我认同的威胁。

结论

COVID-19 突显并加剧了新兴市场核心价值观的现有紧张局势和威胁，突显了价值观与实践之间的严重不匹配。迫切需要重新调整 ED 工作的现实与员工价值观。