Understanding Treatment with Respect and Dignity in the Intensive Care Unit

Abstract

Despite wide recognition of the importance of treating patients with respect and dignity, little is known about what constitutes treatment in this regard. The intensive care unit (ICU) is a unique setting that can pose specific threats to treatment with respect and dignity owing to the critical state of patients, stress and anxiety amongst patients and their family members, and the highly technical nature of the environment. In attempt to understand various stakeholders' perspectives of treatment with respect and dignity, patients and family members were interviewed, a wide range of health care professionals participated in focus groups, and third party observers took field notes of interactions in the ICU. This paper compares and contrasts the data that were generated using these different methods. Triangulating the data in this way contributes to a more complete and nuanced understanding of treatment with respect and dignity in the ICU.

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.…”

“…ACCEPTED MANUSCRIPT 9 We were not surprised that the "ICU-RESPECT" index performed differently in different types of ICUs, although we did not know which direction such differences might take. We observed that surgical units scored significantly lower than the medical or disease-specific units.…”

“…information, attention to body/modesty/appearance, honoring patients' preferences and choices, and responsiveness to patients' needs and requests [9]. Based on our pilot study to assess the feasibility of administering a self-report questionnaire to ICU patients and families [10], it was evident that a briefer and simpler instrument than the HCAHPS or PDI, and one that captures particular behaviors reflective of respectful treatment in the ICU, would be extremely useful.…”

“…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.…”

Patient Dignity at The End-Of-Life: Is it Possible in Critical Care?

“…The ICU is a singular environment which poses a specific threat to respect and dignity due to the critical conditions of the patients and the stress and the anxiety of family members, together with the highlytechnical nature of the environment [16,17]. End of life care in the ICU implies the absence of pain, the ensuring of comfort, the participation of family members, the existence of a clear prognosis and the preservation of dignity [18].…”