Humanising Critical Care; A Qualitative Prospective Study Exploring Patient, Surrogate And Health Care Professional Experiences

INTRODUCTION: Intensive Care units are high tech medical environments were critically ill patients receive life sustaining treatments. However in the pursuit of technological advancements and medical efficacy, healthcare professionals often overlook a crucial aspect of patient care, Humanity. Patients are frequently reduced to their diagnosis, treatment plans, and vital signs, rather than being treated as individuals with unique experiences, emotions and needs. Dehumanisation in the ICU can manifest in various ways, including: Objectification, isolation, depersonalisation, disempowerment, sensory deprivation etc, as a result of which patients may experience increased anxiety, stress, decreased satisfaction and trust in care along with prolonged recovery times and increased morbidity. Surrogates may experience, emotional distress, anxiety, depression, Post traumatic stress disorder and feelings of helplessness and exclusion. Studies have shown that, dehumanisation has got devastating effects on healthcare professionals in the form of compassion fatigue, burnout, decreased job satisfaction, decreased empathy and emotional exhaution. Humanising critical care is essential to address these issues, by prioritizing patient and surrogate centered care we can, improve patient outcomes, satisfaction and trust. Enhance surrogate experiences and involvement in care. Promote healthcare professional's well-being and resilience. OBJECTIVES: PRIMARY OBJECTIVES: 1. To assess the patients, surrogates and healthcare professionals satisfaction with care in the ICU before and after the implementation of Humanization practices. 2. To compare the differences in the satisfaction levels between patients, surrogates and health care professionals before and after humanization implementation. SECONDARY OBJECTIVE: To identify the key factors contributing to changes in satisfaction levels and explore the implications for ICU care. MATERIALS AND METHODS: We performed a qualitative prospective study on patients admitted to our ICU from the time period between August 2023 to August 2024. The study was done on patients who are > 18years of age who got admitted to our ICU for more than 24 hours. A wide array of changes, were included in the ICU, helping us to improve the patients, relatives and the health care professionals comfort. The changes implemented were incorporating humanised ICU architecture, modifying ICU counseling room, incorporating various ICU policies, incorporating liberal visitation policies for the surrogates, ‘know me’ chart for improving patient care and policies promoting patient comfort and sleep in the ICU. The pre and post implementation surveys were conducted among patients, surrogates and healthcare professions. Data was collected in the form of questionnaire assessing the satisfaction among patients, surrogates and healthcare professions. RESULTS: Patients, surrogates and healthcare professionals described the ICU environment as both dehumanising and humanising. Themes emerged around the importance of compassionate communication, empathy and respect for patient and surrogates autonomy. The survey results revealed that satisfaction levels significantly improved in the patient (pre implementation- 34.8%, post implementation 69%), surrogates (pre implementation-31.2%, post implemetation-64.3%) and health care professionals groups(pre implementation-37.7%, post implementation-82.5%). CONCLUSION: Dehumanisation is a pervasive and insidious phenomenon in the ICU, threatening the patient's and surrogates voice, dignity and autonomy in ICU care. The deleterious effect of dehumanisation on the healthcare professionals compassion and well being is also significant. Implementing humanising policies in the ICU can improve patient and surrogate satisfaction and reduce health care professionals compassion fatigue and burnout. Our findings inform strategies to promote humanising care in the ICU, prioritising the patients, surrogates and healthcare professionals wellbeing.