Health Care Professionals’ Perceptions and Experiences of Respect and Dignity in the Intensive Care Unit

Abstract

Little is known about health care professionals' perceptions regarding what it means to treat patients and families with respect and dignity in the intensive care unit (ICU) setting. To address this gap, we conducted nine focus groups with different types of health care professionals (attending physicians, residents/fellows, nurses, social workers, pastoral care, etc.) working in either a medical or surgical ICU within the same academic health system. We identified three major thematic domains, namely, intrapersonal (attitudes and beliefs), interpersonal (behaviors), and system (contextual) factors that influence treatment with respect and dignity. Participants suggested strategies for improving treatment of patients and families in the ICU with respect and dignity, as well as the related need for enhancing respect among the multidisciplinary team of clinicians. Implementing these strategies will require innovative educational interventions and leadership. Future research should focus on the design and evaluation of such interventions on the quality of care.

ICU-RESPECT: An index to assess patient and family experiences of respect in the intensive care unit

“…In addition to its reliability, we are confident of the "ICU-RESPECT" index's face and content validity because our item development process was based on a robust, multi-method approach to defining the construct of respect in the ICU setting from the perspectives of patients, families, clinicians, and independent observers [9][10][11][12][13]. Furthermore, the concurrent validity of the scale is demonstrated by its ability to distinguish between groups, in this case, different intensive care units.…”

“…The research team developed an initial set of items for the draft instrument based on the literature, as well as qualitative analysis of the transcripts of interviews and focus groups, and direct observations, discussed in detail elsewhere [11][12][13]. Each of the specific types/sources of respect/disrespect identified by a participant or a direct observer was converted into a discrete candidate item for inclusion in a questionnaire.…”

“…However, study investigators agreed that it was important to retain this item for conceptual reasons. Our previous research [10][11][12][13] revealed that "introductions" is an important domain of respect. Removing any other items would have resulted in a decrease in internal consistency of the index, and all other items had an item-to-total correlation of at least 0.6.…”

“…To address the gap in our understanding of how patients and families experience respectful treatment in the ICU, and our ability to measure it, we previously conducted a multi-method study of respect and dignity in two ICUs at one large, academic medical institution [9][10][11][12][13]. Based on interviews with patients and their families, direct observations and clinician focus groups, 12 broad themes emerged that characterize what it means to be treated with respect.…”

Perception of Dignity of Patients in Palliative Care

“…9 Working conditions, as well as communication and interaction among the multidisciplinary team, also interfere with the involvement of professionals with patients. 30 Communication is a fundamental aspect that has a direct effect on patient care and may affect end-of-life care. 24,31 In addition, facts such as the workload of the nursing staff, gaps in difficult news reporting, as well as lack of material resources and inadequate physical structure also impact negatively on patient assistance in palliative care.…”