Voices from the ICU: Perspectives on Humanization in Critical Care Settings
Gunchan Paul, Rubina K Mahajan, Parshotam L Gautam, Gursabeen Kaur, Sidakbir S Paul, Birinder Paul
Keywords :
Communication, Dehumanization, Experience of care, Families, Humanization, Infrastructure, Patient autonomy
Citation Information :
Paul G, Mahajan RK, Gautam PL, Kaur G, Paul SS, Paul B. Voices from the ICU: Perspectives on Humanization in Critical Care Settings. Indian J Crit Care Med 2024; 28 (10):923-929.
In the intensive care unit (ICU), relentless demands of immediate action, reliance on high-tech equipment, and weight of an overwhelming workload can obscure the patient's humanity. The impact of this dehumanization and humanization may be significant, hence the study aimed to understand experiences of ICU patients and their families and seek to understand the outcomes of such encounters during the course of ICU care. The study was based on inductive-grounded theory approach. After taking informed consent, the investigators invited the participants for the interview, in the vernacular language that was audio recorded and field notes were taken. Under the two main dimensions of humanization and dehumanization, the data yielded four main themes and eight sub-themes. The themes were communication, infrastructure, experience of care and patient autonomy. The dehumanizing behaviors contributed to patients feeling disregarded and undermined their sense of dignity and worth. To our understanding, this is the foremost barrier to a heathy patient–physician relationship. However, by prioritizing humanization in the ICU, healthcare professionals can create a more compassionate and supportive environment. Hence, it is essential to implement strategies that improve patient and family support in the ICU, such as providing regular updates on the patient's condition, offering emotional support through counseling services, and involving families in the care decision-making process. These measures can help alleviate the vulnerability experienced by patients and their families during such challenging times.
Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, et al. The practice of respect in the ICU. Am J Respir Crit Care Med 2018;197(11):1389–1395. DOI: 10.1164/rccm. 201708-1676CP.
Heras La Calle G, Ovies AA, Tello VG. A plan for improving the humanisation of intensive care units. Intensive Care Med 2017;43(4):547–549. DOI: 10.1007/s00134-017-4705-4.
Kerlin MP, McPeake J, Mikkelsen ME. Burnout and joy in the profession of critical care medicine. Crit Care 2020;24(1):98. DOI: 10.1186/s13054-020-2784-z.
Busch IM, Moretti F, Travaini G, Wu AW, Rimondini M. Humanization of care: Key elements identified by patients, caregivers, and healthcare providers. A systematic review. Patient 2019;12(5):461–474. DOI: 10.1007/s40271-019-00370-1.
Law AC, Roche S, Reichheld A, Folcarelli P, Cocchi MN, Howell MD, et al. Failures in the respectful care of critically ill patients. Jt Comm J Qual Patient Saf 2019;45(4):276–284. DOI: 10.1016/j.jcjq.2018. 05.008.
Sueiras P, Romano-Betech V, Vergil-Salgado A, de Hoyos A, Quintana-Vargas S, Ruddick W, et al. Today's medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care. PLoS One 2017;12(7):e0181514. DOI: 10.1371/journal.pone.0181514.
Meneses-La-Riva ME, Suyo-Vega JA, Fernández-Bedoya VH. Humanized care from the nurse-patient perspective in a hospital setting: A systematic review of experiences disclosed in Spanish and Portuguese scientific articles. Front Public Health 2021;9:737506. DOI: 10.3389/fpubh.2021.737506.
Charmaz K. ‘Discovering’ chronic illness: Using grounded theory. Soc Sci Med 1990;30(11):1161–1172. DOI: 10.1016/0277-9536(90) 90256-r.
Coyne IT. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J Adv Nrs 1997;26(3):623–630. DOI: 10.1046/j.1365-2648.1997.t01-25-00999.x.
Tessier S. From field notes to transcripts, to tape recordings; evolution or combination? Int J Qual Methods 2012;11(4):446–460. DOI: 10.1177/160940691201100410.
Simpson SH. Creating a data analysis plan: What to consider when choosing statistics for a study. Can J Hosp Pharm 2015;68(4):311–317. DOI: 10.4212/cjhp.v68i4.1471.
Basile MJ, Rubin E, Wilson ME, Polo J, Jacome SN, Brown SM, et al. Humanizing the ICU patient: A qualitative exploration of behaviors experienced by patients, caregivers, and ICU staff. Crit Care Explor 2021;3(6):e0463. DOI: 10.1097/CCE.0000000000000463.
Silva JND, Gomes ACMD, Guedes HCD, Lima EDP, Januario DC, dos Santos ML. Behavior of nursing professionals and the implementation of hospital humanization policy. Revista De Pesquisa-Cuidado E 2020;12:471–478. DOI: 10.9789/2175-5361.rpcfo.v12.8527.
Moslehpour M, Shalehah A, Rahman FF, Lin KH. The effect of physician communication on inpatient satisfaction. Healthcare (Basel) 2022;10(3):463. DOI: 10.3390/healthcare 10030463.
Wilson ME, Beesley S, Grow A, Rubin E, Hopkins RO, Hajizadeh N, et al. Humanizing the intensive care unit. Crit Care 2019;23(1):32. DOI: 10.1186/s13054-019-2327-7.
Belasen A, Belasen AT. Doctor–patient communication: A review and a rationale for using an assessment framework. J Health Organ Manag 2018;32(7):891–907. DOI: 10.1108/JHOM-10-2017-0262.
Adams SM, Case TI, Fitness J, Stevenson RJ. Dehumanizing but competent: The impact of gender, illness type, and emotional expressiveness on patient perceptions of doctors. J Appl Soc Psychol 2017;47(5):247–255. DOI: 10.1111/jasp.12433.
Hasandoost F, Mohammadi E, Khademi M, Seddighi M. Paradoxical perception of humanistic care in the intensive care unit: A qualitative study. Nurs Open 2023;10(3):1492–1502. DOI: 10.1002/nop2.1399.
Nin Vaeza N, Martin Delgado MC, Heras La Calle G. Humanizing intensive care: Toward a human-centered care ICU model. Crit Care Med 2020;48(3):385–390. DOI: 10.1097/CCM.0000000000004191.
Luxon L. Infrastructure – the key to healthcare improvement. Future Hosp J 2015;2(1):4–7. DOI: 10.7861/futurehosp.2-1-4.
Ženka J, Macháček J, Michna P, Kořízek P. Navigational needs and preferences of hospital patients and visitors: What prospects for smart technologies? Int J Environ Res Public Health 2021;18(3):974. DOI: 10.3390/ijerph18030974.
Connelly C, Jarvie L, Daniel M, Monachello E, Quasim T, Dunn L, et al. Understanding what matters to patients in critical care: An exploratory evaluation. Nurs Crit Care 2020;25(4):214–220. DOI: 10.1111/nicc.12461.
Daly BJ, Douglas SL, O'Toole E, Gordon NH, Hejal R, Peerless J, et al. Effectiveness trial of an intensive communication structure for families of long-stay ICU patients. Chest 2010;138(6):1340–1348. DOI: 10.1378/chest.10-0292.
Mahajan RK, Gupta S, Singh G, Mahajan R, Gautam PL. Continuous family access to the intensive care unit: A mixed method exploratory study. Indian J Crit Care Med 2021;25(5):540–550. DOI: 10.5005/jp-journals-10071-23805.
Lee YY, Lin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient–physician relationships and health outcomes. Social Sci Med 2010;71(10):1811–1818. DOI: 10.1016/j.socscimed.2010.08.008.
Wilkin K, Slevin E. The meaning of caring to nurses: An investigation into the nature of caring work in an intensive care unit. J Clin Nurs 2004;13(1):50–59. DOI: 10.1111/j.1365-2702.2004.00814.x.
Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020;24(Suppl 1):S43–S60. DOI: 10.5005/jp-journals-10071-G23185.
Omar Sultan Haque, Waytz A. Dehumanization in Medicine. Pers Psychol Sci 2012;7(2):176–186. DOI: 10.1177/174569161142 9706.