Enhancing cultural competence and communication in ICU: addressing family conflicts

Abstract

Dear Editor,

I am writing this letter in reference to a recent study published in Critical Care entitled “understanding and addressing a difficult family in ICU” [1]. I would like to commend the authors for their interesting study of this important topic that explain conflicts between ICU staff and patient/family as a source of additional stress in an already tense. However, one issue requires further consideration.

While mentalization offers significant benefits, it also has inherent weaknesses including potential oversimplification and the need for more empirical support that must be acknowledged [2]. Cultural contexts and conditions profoundly influence various aspects of care, as well as the communication dynamics between the patient/family and the healthcare team [3]. Neglecting these cultural factors can hinder the establishment of a truly beneficial and positive therapeutic relationship [4].

To foster effective collaboration, it is essential to encourage both active and passive participation from the patient/family alongside the healthcare team. Active participation involves the healthcare team comprehensively informing the patient/family about all facets of the patient's care, both during hospitalization and after discharge. This process should be conducted with careful consideration of the evolving needs and concerns of both the patient and their family.

Conversely, passive participation refers to mere presence at the patient's bedside. While this is undoubtedly important, it often fails to yield positive outcomes, particularly for critically ill patients in intensive care units (ICUs) who face unique challenges similar to the case reported in the article [1]. In many instances, such passive involvement may lead to negative psychological effects and an increased risk of acquired infections.

To improve cultural competence in healthcare, it is vital to recognize how diverse beliefs, attitudes, values, and backgrounds impact patient care [4]. Healthcare providers must cultivate skills that enhance cross-cultural communication and actively engage in understanding their patients' cultural perspectives. This includes acknowledging language barriers that can complicate communication and affect the accuracy of symptom descriptions or diagnoses [5]. Employing interpreters and fostering an inclusive environment can significantly improve patient-provider interactions.

Moreover, healthcare organizations should prioritize training that enhances cultural awareness among staff members. By doing so, they can better accommodate diverse patient populations and ensure that care is respectful of cultural differences. Ultimately, promoting cultural competence leads to improved health outcomes and a more equitable healthcare system for all patients. I would appreciate if Victoria and colleagues could reflect on my comment.

No datasets were generated or analysed during the current study.

ICUs:

Intensive care units

1. Metaxa V, Nacul FE, Morris AC. Understanding and addressing a ‘difficult’family in ICU. Crit Care. 2025;29(1):22.

   Article PubMed PubMed Central Google Scholar

2. Lüdemann J, Rabung S, Andreas S. Systematic review on mentalization as key factor in psychotherapy. Int J Environ Res Public Health. 2021;18(17):9161.

   Article PubMed PubMed Central Google Scholar

3. Latif AS. The importance of understanding social and cultural norms in delivering quality health care-a personal experience commentary. Trop Med Infect Disease. 2020;5(1):22.

   Article Google Scholar

4. Ayonrinde O. Importance of cultural sensitivity in therapeutic transactions: considerations for healthcare providers. Dis Manag Health Out. 2003;11:233–48.

   Article Google Scholar

5. Brooks LA, Manias E, Bloomer MJ. Culturally sensitive communication in healthcare: a concept analysis. Collegian. 2019;26(3):383–91.

   Article Google Scholar

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Thanks to guidance and advice from the “Clinical Research Development Unit" of Baqiyatallah Hospital.

This research did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors.

Authors and Affiliations

1. Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Sheykh Bahayi Street, Vanak Square, P.O. Box 19575-174, Tehran, Iran

   Amir Vahedian-Azimi

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1. Amir Vahedian-AzimiView author publications

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Correspondence to Amir Vahedian-Azimi.

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Vahedian-Azimi, A. Enhancing cultural competence and communication in ICU: addressing family conflicts. Crit Care 29, 53 (2025). https://doi.org/10.1186/s13054-025-05298-7

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• Received: 18 January 2025

• Accepted: 22 January 2025

• Published: 30 January 2025

• DOI: https://doi.org/10.1186/s13054-025-05298-7

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