title: Patterns of behaviour in families of critically ill patients in the emergency room: a focused ethnography.
abstract: OBJECTIVE
  The aim of this study was to understand the patterns of behaviour from relatives of critically ill patients admitted to the emergency room.
  
  
  BACKGROUND
  Admission of a critically ill family member to an accident and emergency department is often a sudden and unexpected experience for the family. This stressful event often creates feelings of instability and intense suffering in relatives. Understanding the experiences of these families is essential for the provision of comprehensive health care in the emergency room.
  
  
  METHODS
  A focused ethnography design was applied to the study.
  
  
  METHODS
  Peripheral participant observation and informal conversations were conducted in an emergency room in southern Brazil during January 2015. Analysis of data was based on Leininger.
  
  
  RESULTS
  Suffering was recurrent among family members of critically ill patients admitted to the emergency room. The environment, which was conditioned by the patient's life-threatening situation and professionals' attitudes, resulted in relatives experiencing a range of feelings from suffering to calm. A distant approach and poor communication of professionals made relatives confused and silent. Factors that seemed to foster feelings of calm in families were the establishment of a continuous and close communication with professionals and the possibility to remain with the patient outside the established visiting hours.
  
  
  CONCLUSIONS
  The findings of this study challenge emergency department providers and managers to promote comprehensive care in the emergency room by inviting family members to be with the patient and by engaging in family-centred care.
authors.affiliation: Department of Nursing, State University of Maringá, Maringá, Paraná, Brazil.|Faculty of Philosophy Sciences and Languages of Mandaguari, Mandaguari Paraná, Brazil.|Faculty Intermunicipal Northwest of Paraná, Loanda, Paraná, Brazil.
authors.forename: Mayckel da Silva
authors.identifier: http://orcid.org/0000-0003-2290-8418
authors.initials: MD
authors.lastname: Barreto
authors.affiliation: Department of Nursing, State University of Maringá, Maringá, Paraná, Brazil.
authors.forename: Sonia Silva
authors.initials: SS
authors.lastname: Marcon
authors.affiliation: School of Nursing, University of Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Garcia-Vivar
mesh_terms: D000884:Anthropology, Cultural; D001938:Brazil; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005190:Family / Q000523:psychology*; D006801:Humans; D010343:Patient Admission; D011368:Professional-Family Relations
keywords: critical illness; emergency room; family; family needs; focused ethnography; nursing; qualitative research