Skip to main content

Humanising the ICU

  • Chapter
  • First Online:
Improving Critical Care Survivorship
  • 964 Accesses

Abstract

Critically ill patients and their family members are at risk for dehumanisation in the stressful environment of an intensive care unit (ICU). This chapter describes the behaviours a clinical team may adopt (intentionally or unintentionally) that can lead to dehumanisation and the associated negative outcomes. Research into this area is limited by difficulties surrounding clear interventions and outcomes, but the current evidence surrounding humanisation practices is presented. Recommendations are made regarding caring for ICU patients and their family members in ways that emphasise respect, dignity and humanisation.

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

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
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. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–10.

    Article  CAS  PubMed  Google Scholar 

  2. Iwashyna TJ. Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010;153:204–5.

    Article  PubMed  Google Scholar 

  3. Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005;171:340–7.

    Article  PubMed  Google Scholar 

  4. Cameron JI, Chu LM, Matte A, et al. One-year outcomes in caregivers of critically ill patients. N Engl J Med. 2016;374:1831–41.

    Article  CAS  PubMed  Google Scholar 

  5. Beesley SJ, Hopkins RO, Holt-Lunstad J, et al. Acute physiologic stress and subsequent anxiety among family members of ICU patients. Crit Care Med. 2018;46:229–35.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wilson ME, Beesley S, Grow A, et al. Humanizing the intensive care unit. Crit Care. 2019;23:32.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Aboumatar H, Forbes L, Branyon E, et al. Understanding treatment with respect and dignity in the intensive care unit. Narrat Inq Bioeth. 2015;5:55A–67A.

    Article  PubMed  Google Scholar 

  8. Gajic O. The hand. Am J Respir Crit Care Med. 2011;183:1587.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Masso Guijarro P, Aranaz Andres JM, Mira JJ, Perdiguero E, Aibar C. Adverse events in hospitals: the patient’s point of view. Qual Saf Health Care. 2010;19:144–7.

    Article  CAS  PubMed  Google Scholar 

  11. Chuang CH, Tseng PC, Lin CY, Lin KH, Chen YY. Burnout in the intensive care unit professionals: a systematic review. Medicine. 2016;95:e5629.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 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  PubMed  Google Scholar 

  13. Haque OS, Waytz A. Dehumanization in medicine: causes, solutions, and functions. Perspect Psychol Sci. 2012;7:176–86.

    Article  PubMed  Google Scholar 

  14. Sabo B. Reflecting on the concept of compassion fatigue. Online J Issues Nurs. 2011;16:1.

    PubMed  Google Scholar 

  15. 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  PubMed  Google Scholar 

  16. Hinderer KA, VonRueden KT, Friedmann E, et al. Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. J Trauma Nurs. 2014;21:160–9.

    Article  PubMed  Google Scholar 

  17. Quenot JP, Rigaud JP, Prin S, et al. Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices. Intensive Care Med. 2012;38:55–61.

    Article  CAS  PubMed  Google Scholar 

  18. Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45:103–28.

    Article  PubMed  Google Scholar 

  19. Kynoch K, Chang A, Coyer F, McArdle A. The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update. JBI Database System Rev Implement Rep. 2016;14:181–234.

    Article  PubMed  Google Scholar 

  20. Kovacs Burns K, Bellows M, Eigenseher C, Gallivan J. ‘Practical’ resources to support patient and family engagement in healthcare decisions: a scoping review. BMC Health Serv Res. 2014;14:175.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Barr PJ, O'Malley AJ, Tsulukidze M, Gionfriddo MR, Montori V, Elwyn G. The psychometric properties of observer OPTION(5), an observer measure of shared decision making. Patient Educ Couns. 2015;98:970–6.

    Article  PubMed  Google Scholar 

  22. Elwyn G, Barr PJ, Grande SW, Thompson R, Walsh T, Ozanne EM. Developing CollaboRATE: a fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Educ Couns. 2013;93:102–7.

    Article  PubMed  Google Scholar 

  23. Brown SM, Rozenblum R, Aboumatar H, et al. Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med. 2015;191:358–60.

    Article  PubMed  Google Scholar 

  24. Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect. 2016;19:1183–202.

    Article  PubMed  Google Scholar 

  25. Brown SM, Azoulay E, Benoit D, et al. The practice of respect in the ICU. Am J Respir Crit Care Med. 2018;197:1389–95.

    Article  PubMed  Google Scholar 

  26. Haines KJ, Kelly P, Fitzgerald P, Skinner EH, Iwashyna TJ. The untapped potential of patient and family engagement in the organization of critical care. Crit Care Med. 2017;45:899–906.

    Article  PubMed  Google Scholar 

  27. Pizzo P, Walker D, Bomba P. Dying in America: improving quality and honoring individual preferences near the end of life. Washington, DC: Insitute of Medicine; 2015.

    Google Scholar 

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

    Google Scholar 

  29. Johnstone MJ, Kanitsaki O. The neglect of racism as an ethical issue in health care. J Immigr Minor Health. 2010;12:489–95.

    Article  PubMed  Google Scholar 

  30. DeMartino ES, Dudzinski DM, Doyle CK, et al. Who decides when a patient can't? statutes on alternate decision makers. N Engl J Med. 2017;376:1478–82.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Butler J, Hirschberg, EL, Hopkins, RO, Wilson, EL, Orme, J, Beesley, SJ, Kutter, K, Brown, SM. Identification of intensive care unit preferences and attributes clusters and stimulated family decision making in critical illness. BMJ: Supportive & Pallitive Care. 2015.

    Google Scholar 

  32. Butler JM, Hirshberg EL, Hopkins RO, et al. Preliminary identification of coping profiles relevant to surrogate decision making in the ICU. PLoS One. 2016;11:e0166542.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Azoulay E, Pochard F, Chevret S, et al. Half the family members of intensive care unit patients do not want to share in the decision-making process: a study in 78 French intensive care units. Crit Care Med. 2004;32:1832–8.

    Article  PubMed  Google Scholar 

  34. Jabre P, Belpomme V, Azoulay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med. 2013;368:1008–18.

    Article  CAS  PubMed  Google Scholar 

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

    Google Scholar 

  36. 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  PubMed  Google Scholar 

  37. Rosa RG, Tonietto TF, da Silva DB, et al. Effectiveness and safety of an extended ICU visitation model for delirium prevention: a before and after study. Crit Care Med. 2017;45:1660–7.

    Article  PubMed  Google Scholar 

  38. Chapman D, Collingridge DS, Mitchell LA, et al. Family and nurse satisfaction with elimination of all visitation restrictions in a mixed-profile intensive care unit, a prospective observational study. Am J Crit Care. 2015.

    Google Scholar 

  39. Barratt F, Wallis DN. Relatives in the resuscitation room: their point of view. J Accid Emerg Med. 1998;15:109–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35:605–22.

    Article  PubMed  Google Scholar 

  41. Brown SM. We still lack patient centered visitation in intensive care units. 2015.

    Google Scholar 

  42. Carman KL, Dardess P, Maurer M, T W, D G, E P-S. A Roadmap for Patient and Family Engagement in Healthcare Practice and Research. Prepared by the American Institutes for Research under a grant from the Gordon and Betty Moore Foundation, Dominick Frosch, Project Officer and Fellow; Susan Baade, Program Officer 2014.

    Google Scholar 

  43. Karnatovskaia LV, Philbrick KL, Parker AM, Needham DM. Early psychological therapy in critical illness. Semin Respir Crit Care Med. 2016;37:136–42.

    Article  PubMed  Google Scholar 

  44. Munro CL, Cairns P, Ji M, Calero K, Anderson WM, Liang Z. Delirium prevention in critically ill adults through an automated reorientation intervention - a pilot randomized controlled trial. Heart Lung. 2017;46:234–8.

    Article  PubMed  Google Scholar 

  45. Pun BT, Balas MC, Barnes-Daly MA, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med 2018.

    Google Scholar 

  46. Davidson JE. Family-centered care: meeting the needs of patients’ families and helping families adapt to critical illness. Crit Care Nurse. 2009;29:28–34. quiz 5

    Article  PubMed  Google Scholar 

  47. Spruce L. Back to basics: patient and family engagement. AORN J. 2015;102:34–7. quiz 8-9

    PubMed  Google Scholar 

  48. Au SS, Roze des OAL, Parsons Leigh J, et al. A Multicenter observational study of family participation in ICU rounds. Crit Care Med. 2018;46:1255–62.

    Article  PubMed  Google Scholar 

  49. Cody SE, Sullivan-Bolyai S, Reid-Ponte P. Making a connection: family experiences with bedside rounds in the intensive care unit. Crit Care Nurse. 2018;38:18–26.

    Article  PubMed  Google Scholar 

  50. Curtis JR, Ciechanowski PS, Downey L, et al. Development and evaluation of an interprofessional communication intervention to improve family outcomes in the ICU. Contemp Clin Trials. 2012;33:1245–54.

    Article  PubMed  Google Scholar 

  51. White DB, Cua SM, Walk R, et al. Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. Am J Crit Care. 2012;21:396–409.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bosslet GT, Pope TM, Rubenfeld GD, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med. 2015;191:1318–30.

    Article  PubMed  Google Scholar 

  53. Azoulay E, Pochard F, Chevret S, et al. Opinions about surrogate designation: a population survey in France. Crit Care Med. 2003;31:1711–4.

    Article  PubMed  Google Scholar 

  54. Wyskiel RM, Weeks K, Marsteller JA. Inviting families to participate in care: a family involvement menu. Jt Comm J Qual Patient Saf. 2015;41:43–6.

    PubMed  Google Scholar 

  55. Van De Graaff M, Beesley SJ, Butler J, et al. Partners in healing: postsurgical outcomes after family involvement in nursing care. Chest. 2018;153:572–4.

    Article  Google Scholar 

  56. Segers E, Ockhuijsen H, Baarendse P, van Eerden I, van den Hoogen A. The impact of family centred care interventions in a neonatal or paediatric intensive care unit on parents’ satisfaction and length of stay: a systematic review. Intensive Crit Care Nurs. 2018.

    Google Scholar 

  57. Meyers TA, Eichhorn DJ, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation. Am J Nurs. 2000;100:32–42. quiz 3

    CAS  PubMed  Google Scholar 

  58. Boudreaux ED, Francis JL, Loyacano T. Family presence during invasive procedures and resuscitations in the emergency department: a critical review and suggestions for future research. Ann Emerg Med. 2002;40:193–205.

    Article  PubMed  Google Scholar 

  59. Benbassat J, Pilpel D, Tidhar M. Patients’ preferences for participation in clinical decision making: a review of published surveys. Behav Med. 1998;24:81–8.

    Article  CAS  PubMed  Google Scholar 

  60. Kebbe J, Raad S. Family presence during pulmonary procedures. Ann Am Thorac Soc. 2019;16:807–10.

    Article  PubMed  Google Scholar 

  61. Beesley SJ, Hopkins RO, Francis L, et al. Let them in: family presence during intensive care unit procedures. Ann Am Thorac Soc. 2016;13(7):1155–9.

    Article  PubMed  Google Scholar 

  62. Nurses AAoCC. AACN practice alert family presence during resuscitation and invasive procedures. 2010.

    Google Scholar 

  63. Jabre P, Tazarourte K, Azoulay E, et al. Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Med. 2014;40:981–7.

    Article  PubMed  Google Scholar 

  64. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998;352:614–7.

    Article  CAS  PubMed  Google Scholar 

  65. Hoffman J. Nightmares after the I.C.U. New York Times. 2013:D1.

    Google Scholar 

  66. Meert KL, Clark J, Eggly S. Family-centered care in the pediatric intensive care unit. Pediatr Clin N Am. 2013;60:761–72.

    Article  Google Scholar 

  67. Association AH. Web-based Integrated 2010 & 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. 2015.

    Google Scholar 

  68. Haycock C, Wahl C. Achieving patient and family engagement through the implementation and evolution of advisory councils across a large health care system. Nurs Adm Q. 2013;37:242–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The author gratefully acknowledges the ICU Patient and Family Advisory Council and the Center for Humanizing Critical Care, both at Intermountain Medical Center and led by Dr. Samuel Brown, for ongoing dedication to improving humanisation in our intensive care units.

Financial Support and Conflicts of Interest

No disclosures

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah J. Beesley .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Beesley, S.J. (2021). Humanising the ICU. In: Haines, K.J., McPeake, J., Sevin, C.M. (eds) Improving Critical Care Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-030-68680-2_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-68680-2_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-68679-6

  • Online ISBN: 978-3-030-68680-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics