Understanding the needs and expectations of family members when a critically ill relative is admitted to accident and emergency in Kuwait

This is a small ethnographic study that attempts to learn directly from a purposive convenience sample of eight Arab family members how they felt, what they wanted and expected in the way of emergency care, and why they responded to the situation in the ways they did when a relative was admitted critically ill to the Emergency Room (ER) of Accident and Emergency (A & E) in a community hospital in Kuwait. An ethnographic approach was utilised because of the culturally loaded character of healthcare in Kuwait. The study was predicated on the basis that by understanding culturally the meaning and concerns that emergency admission holds for relatives, expatriate healthcare staff would be better able to respond to their needs, provide culturally meaningful care, minimise risks of abusive and aggressive behaviour towards staff and enhance health outcomes for their clients. The findings generated from participant observation, interviews and survey were augmented by field notes. The emotions and behaviours of family members most frequently observed were shock, fear and panic, confusion, suffering for and with their critically ill relative, emotional distress and spiritual faith. Family members' over-riding needs and expectations were found to relate to access to immediate medical attention, to be with their critically ill relative, to be told the truth gently, tactfully, not immediately but in stages, availability of information from the doctor, and to have the waiting room close by. Coping, family ties and family centred-care, transcultural sensitivity and abuse and aggression towards nurses also surfaced as important issues. Supportive behaviours valued by family members included health care staff being present, being provided with timely, on-going information, being acknowledged by staff, being permitted to stay with their loved one and staff respecting their faith in Islam. Although the participants cannot be claimed as representative or the results of the study generalisable, this study furnishes insight about the pervasive impact of Islam in all aspects of family members' life including their strong belief that whatever the outcome, it was God's will (inshalla); insight that is culturally enriching, and potentially transferable to similar situations and groups.