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Humanization of critical care—psychological effects on healthcare professionals and relatives: a systematic review

  • Imelda M. Galvin
  • Jordan Leitch
  • Rebecca Gill
  • Katherine Poser
  • Sandra McKeown
Review Article/Brief Review

Abstract

Purpose

To systematically review and evaluate the effects of humanized care of the critically ill on empathy among healthcare professionals, anxiety among relatives, and burnout and compassion fatigue in both groups.

Source

MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and ProQuest Dissertations were searched from inception to 29 June 2017 for studies that investigated the effects of interventions with potential to humanize care of the critically ill on the following outcomes: empathy among critical care professionals, anxiety among relatives, and burnout and compassion fatigue in either group. We defined a humanizing intervention as one with substantial potential to increase physical or emotional proximity to the patient. Two reviewers independently selected studies, extracted data, and assessed risk of bias and data quality.

Principal findings

Twelve studies addressing four discrete interventions (liberal visitation, diaries, family participation in basic care, and witnessed resuscitation) and one mixed intervention were included. Ten studies measured anxiety among 1,055 relatives. Two studies measured burnout in 288 critical care professionals. None addressed empathy or compassion fatigue. Eleven of the included studies had an overall high risk of bias. No pooled estimates of effect were calculated as a priori criteria for data synthesis were not met.

Conclusions

We found insufficient evidence to make any quantitative assessment of the effect of humanizing interventions on any of these psychologic outcomes. We observed a trend towards reduced anxiety among family members who participated in basic patient care, liberal visitation, and diary keeping. We found conflicting effects of liberal visitation on burnout among healthcare professionals.

Humanisation des soins critiques — effets psychologiques sur les professionnels de la santé et les membres de la famille : une revue systématique

Résumé

Objectif

Étudier et évaluer systématiquement les interventions de soins au potentiel « plus humain » chez les patients en état critique sur l’empathie chez les professionnels de la santé, l’anxiété des proches et l’épuisement et la compassion dans les deux groupes.

Source

La recherche a été menée dans les bases de données MEDLINE, PsycINFO, EMBASE, CINAHL, le Registre des essais cliniques Cochrane Central (CENTRAL), et ProQuest Dissertations depuis leur création jusqu’au 29 juin 2017 pour identifier les études portant sur les effets d’interventions susceptibles d’humaniser les soins de patients en état critique sur les critères d’évaluation suivants : empathie chez les professionnels de soins critiques, anxiété chez les membres de la famille, épuisement et usure de la compassion dans l’un ou l’autre groupe. Nous avons établi qu’une intervention d’humanisation était une intervention susceptible d’augmenter la proximité physique et émotionnelle avec le patient. Deux chercheurs ont sélectionné les études de façon indépendante, en ont extrait les données et évalué les risques de biais ainsi que la qualité des données.

Constatations principales

Douze études abordant quatre interventions particulières (ouverture libérale des visites, journaux personnels, participation de la famille aux soins de base et ressuscitation devant témoin) et une intervention mixte ont été incluses. Dix études ont mesuré l’anxiété chez 1 055 membres de la famille. Deux études ont mesuré l’épuisement chez 288 professionnels de soins critiques. Aucune étude n’a abordé l’empathie ou l’usure de la compassion. Onze des études retenues comportaient un risque global élevé de biais. Aucune estimation groupée de l’effet n’a été calculée, car les critères préétablis pour la synthèse des données n’ont pas été satisfaits.

Conclusions

Nous avons trouvé une insuffisance de données probantes pour quantifier une évaluation des interventions d’humanisation sur l’un ou l’autre des critères d’évaluation psychologiques. Nous avons observé une tendance à la baisse de l’anxiété chez les membres des familles ayant participé aux soins de base aux patients, ayant bénéficié d’horaires de visites libéraux et de la tenue de journaux personnels. Nous avons constaté des effets contradictoires de la libéralisation des visites sur l’épuisement chez les professionnels de la santé.

Notes

Acknowledgements

We sincerely acknowledge and thank Dr. John Drover and Dr. John Muscedere who both provided advice on study conduct and Dr. Dean Tripp who provided input on psychologic outcome measures and idea development.

Conflicts of interest

None of the authors have any conflicts of interest to declare.

Editorial responsibility

This submission was handled by Dr. Sangeeta Mehta, Associate Editor, Canadian Journal of Anesthesia.

Authors contributions

Imelda M. Galvin conceived the idea, prepared the protocol, selected studies, extracted and assessed the quality of the data, and drafted the manuscript. Jordan Leitch contributed to the development of the idea, selected the extracted studies, assessed the quality of the data, and provided input for manuscript refinement. Sandra McKeown assisted with refining the search strategy, conducted the searches, and wrote the search section of the manuscript. Rebecca Gill and Katherine Poser both screened and selected studies and assisted with manuscript preparation and refinement.

Supplementary material

12630_2018_1227_MOESM1_ESM.pdf (209 kb)
Supplementary material 1 (PDF 208 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Imelda M. Galvin
    • 1
    • 2
    • 5
  • Jordan Leitch
    • 1
    • 2
    • 5
  • Rebecca Gill
    • 3
    • 5
  • Katherine Poser
    • 4
    • 5
  • Sandra McKeown
    • 2
    • 5
  1. 1.Department of Anesthesiology & Perioperative Medicine and Department of Critical Care MedicineKingston Health Sciences CentreKingstonCanada
  2. 2.Queens UniversityKingstonCanada
  3. 3.Critical Care, Kingston Health Sciences CentreKingstonCanada
  4. 4.St Lawrence CollegeKingstonCanada
  5. 5.Surgical Perianesthesia ProgramKingston Health Sciences CentreKingstonCanada

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