Skip to main content
SpringerLink
Log in

Humanizing Intensive Care: Questions, Balance, and Tragic Trade-Offs

  • Chapter
  • First Online:
Families in the Intensive Care Unit

Abstract

Intensive care units (ICUs) are medical-technological marvels but also loci of sometimes severe dehumanization. In this chapter we emphasize (1) the forms of and reasons for dehumanization, (2) negative consequences of dehumanization, (3) practical approaches to (re)humanization , (4) tragic trade-offs and research considerations, and (5) dehumanization of clinicians. The dehumanization in ICUs may be casual, physiological, or substantive. Rehumanization of patients, family members, and clinicians is an urgent priority. Attempts to improve humanization within ICUs will require careful planning and research given potential risks and benefits to specific strategies. We outline multiple levels of activities to rehumanize the ICU, employing the rating system of ski slopes to distinguish beginner, intermediate, and advanced techniques. We describe in detail a variety of such techniques with their potential application in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zimmerman JE, Kramer AA, Knaus WA. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care. 2013;17:R81.

    Article  Google Scholar 

  2. Brown SM. Through the valley of shadows: living wills, intensive care, and making medicine human. New York: Oxford University Press; 2016.

    Google Scholar 

  3. Alonso-Ovies A. Heras La Calle G. ICU: a branch of hell? Intensive Care Med. 2016;42(4):591–2.

    Article  Google Scholar 

  4. Brown SM, Beesley SJ, Hopkins RO. Humanizing intensive care: theory, evidence, and possibilities. In: Vincent JL, editor. Annual update in intensive care and emergency medicine 2016. Cham: Springer; 2016. p. 405–20.

    Chapter  Google Scholar 

  5. Haslam N, Loughnan S. Dehumanization and infrahumanization. Annu Rev Psychol. 2014;65:399–423.

    Article  Google Scholar 

  6. Haslam N. Humanizing medical practice: the role of empathy. Med J Aust. 2007;187:381–2.

    PubMed  Google Scholar 

  7. Haslam N. Dehumanization: an integrative review. Personal Soc Psychol Rev. 2006;10:252–64.

    Article  Google Scholar 

  8. Sokol-Hessner L, Folcarelli PH, Sands KE. Emotional harm from disrespect: the neglected preventable harm. BMJ Qual Saf. 2015;24:550–3.

    Article  Google Scholar 

  9. Brown SM, Azoulay E, Benoit D, et al. The practice of respect in the intensive care unit. Am J Respir Crit Care Med. 2018;197:1389.

    Article  Google Scholar 

  10. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. A critical care societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action. Am J Respir Crit Care Med. 2016;194:106–13.

    Article  Google Scholar 

  11. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care. 2007;13:482–8.

    Article  Google Scholar 

  12. van Mol MM, Kompanje EJ, Benoit DD, Bakker J, Nijkamp MD. The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: a systematic review. PLoS One. 2015;10:e0136955.

    Article  Google Scholar 

  13. Vaes J, Muratore M. Defensive dehumanization in the medical practice: a cross-sectional study from a health care worker’s perspective. Br J Soc Psychol. 2013;52:180–90.

    Article  Google Scholar 

  14. Schulman-Green D. Coping mechanisms of physicians who routinely work with dying patients. OMEGA-J Death Dying. 2003;47:253–64.

    Article  Google Scholar 

  15. Singh H, Petersen LA, Thomas EJ. Understanding diagnostic errors in medicine: a lesson from aviation. Qual Saf Health Care. 2006;15:159–64.

    Article  CAS  Google Scholar 

  16. Berwick DM, Kotagal M. Restricted visiting hours in ICUs: time to change. JAMA. 2004;292:736–7.

    Article  CAS  Google Scholar 

  17. Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM. Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med. 2007;35:497–501.

    Article  CAS  Google Scholar 

  18. Lonergan E, Luxenberg J, Areosa Sastre A. Benzodiazepines for delirium. Cochrane Database Syst Rev. 2009;(1):CD006379.

    Google Scholar 

  19. Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43:40–7.

    Article  Google Scholar 

  20. Pandharipande P, Banerjee A, McGrane S, Ely EW. Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care. Crit Care. 2010;14:157.

    Article  Google Scholar 

  21. Patel MB, Jackson JC, Morandi A, et al. Incidence and risk factors for intensive care unit-related post-traumatic stress disorder in veterans and civilians. Am J Respir Crit Care Med. 2016;193:1373–81.

    Article  Google Scholar 

  22. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30:421–34.

    Article  Google Scholar 

  23. Langer EJ, Rodin J. The effects of choice and enhanced personal responsibility for the aged: a field experiment in an institutional setting. J Pers Soc Psychol. 1976;34:191–8.

    Article  CAS  Google Scholar 

  24. Shapiro J. Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med. 2011;86:326–32.

    Article  Google Scholar 

  25. Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med. 2007;175:693–7.

    Article  Google Scholar 

  26. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504–10.

    Article  Google Scholar 

  27. Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22:1231–8.

    Article  Google Scholar 

  28. Redelmeier DA, Tversky A. Discrepancy between medical decisions for individual patients and for groups. N Engl J Med. 1990;322:1162–4.

    Article  CAS  Google Scholar 

  29. Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S. A systematic review of the impact of physician implicit racial bias on clinical decision making. Acad Emerg Med. 2017;24:895–904.

    Article  Google Scholar 

  30. Brown SM. We still lack patient centered visitation in intensive care units. BMJ. 2015;350:h792.

    Article  Google Scholar 

  31. Chapman DK, Collingridge DS, Mitchell LA, et al. Satisfaction with elimination of all visitation restrictions in a mixed-profile intensive care unit. Am J Crit Care. 2016;25:46–50.

    Article  Google Scholar 

  32. Ciufo D, Hader R, Holly C. A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centred care. Int J Evid Based Healthc. 2011;9:362–87.

    Article  Google Scholar 

  33. Fumagalli S, Boncinelli L, Lo Nostro A, et al. Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial. Circulation. 2006;113:946–52.

    Article  Google Scholar 

  34. See KC, Song XY, Aung HT. Effect of extended visiting hours on physician distractions in the ICU: a before-and-after study. Crit Care. 2017;21:243.

    Article  Google Scholar 

  35. Netzer G, Iwashyna TJ. Fair is fair: preventing the misuse of visiting hours to reduce inequities. Ann Am Thorac Soc. 2017;14:1744.

    Article  Google Scholar 

  36. Beesley SJ, Hopkins RO, Francis L, et al. Let them in: family presence during intensive care unit procedures. Ann Am Thorac Soc. 2016;13:1155–9.

    Article  Google Scholar 

  37. van de Graaff M, Beesley SJ, Butler JM, et al. Partners in healing: postsurgical outcomes after family involvement in nursing care. Chest. 2018;153(2):572–4.

    Article  Google Scholar 

  38. Kentish-Barnes N, Chevret S, Champigneulle B, et al. Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial. Intensive Care Med. 2017;43:473–84.

    Article  Google Scholar 

  39. Rose S, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002;(2):CD000560.

    Google Scholar 

  40. Bisson JI, Jenkins PL, Alexander J, Bannister C. Randomised controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiatry. 1997;171:78–81.

    Article  CAS  Google Scholar 

  41. Shalev AY. Posttraumatic stress disorder (PTSD) and stress related disorders. Psychiatr Clin North Am. 2009;32:687–704.

    Article  Google Scholar 

  42. Kentish-Barnes N, Cohen-Solal Z, Souppart V, et al. “It Was the Only Thing I Could Hold Onto, But...”: receiving a letter of condolence after loss of a loved one in the ICU: a qualitative study of bereaved relatives’ experience. Crit Care Med. 2017;45:1965–71.

    Article  Google Scholar 

  43. Curtis JR, Treece PD, Nielsen EL, et al. Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med. 2016;193:154–62.

    Article  Google Scholar 

  44. Khandelwal N, Benkeser D, Coe NB, Engelberg RA, Curtis JR. Economic feasibility of staffing the intensive care unit with a communication facilitator. Ann Am Thorac Soc. 2016;13:2190–6.

    Article  Google Scholar 

  45. Curtis JR, Back AL, Ford DW, et al. Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. JAMA. 2013;310:2271–81.

    Article  CAS  Google Scholar 

  46. Birnie K, Speca M, Carlson LE. Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress Health. 2010;26:359–71.

    Article  Google Scholar 

  47. Jack AI, Friedman JP, Boyatzis RE, Taylor SN. Why do you believe in god? Relationships between religious belief, analytic thinking. Mentalizing and moral concern. PLoS One. 2016;11:e0149989.

    Article  Google Scholar 

  48. Lammers J, Stapel DA. Power increases dehumanization. Group Process Intergroup Relat. 2011;14:113–26.

    Article  Google Scholar 

  49. Dickert NW, Kass NE. Understanding respect: learning from patients. J Med Ethics. 2009;35:419–23.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA

    Samuel M. Brown & Ramona O. Hopkins

  2. Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT, USA

    Samuel M. Brown & Ramona O. Hopkins

  3. Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Samuel M. Brown

  4. Intermountain Medical Center, Shock Trauma Intensive Care Unit, Murray, UT, USA

    Samuel M. Brown

  5. Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Michael E. Wilson

  6. Intensive Care Unit Patient-Family Advisory Council, Intermountain Medical Center, Murray, UT, USA

    Chris Benda

  7. Center for Health Innovations and Outcomes Research (CHIOR), Hofstra Northwell School of Medicine and Northwell Health, Manhasset, NY, USA

    Negin Hajizadeh

  8. Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA

    Ramona O. Hopkins

Authors
  1. Samuel M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael E. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chris Benda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Negin Hajizadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ramona O. Hopkins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel M. Brown .

Editor information

Editors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Giora Netzer

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Brown, S.M., Wilson, M.E., Benda, C., Hajizadeh, N., Hopkins, R.O. (2018). Humanizing Intensive Care: Questions, Balance, and Tragic Trade-Offs. In: Netzer, G. (eds) Families in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-319-94337-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-94337-4_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94336-7

  • Online ISBN: 978-3-319-94337-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation