Evaluation of good humanisation practices and organisational determinants in paediatric intensive care units: a multicentre observational study

OBJECTIVES: To evaluate compliance with the Manual of Good Practices in Humanisation in Paediatric Intensive Care Units in Spain, identifying strengths and areas for improvement, and exploring the association between organisational determinants and the degree of implementation. METHODS: Descriptive, cross-sectional and multicentre observational study conducted between January and September 2025 in four paediatric intensive care units in Catalonia (Spain), covering 83.9% of regional bed capacity. The manual comprises 132 items across seven strategic lines and three levels (basic, advanced, excellent). Adherence was assessed via observation, documentary review, and interviews as implemented, in progress, or not implemented. Data were analysed using descriptive statistics, the Mann-Whitney U test, and Spearman's correlation (p < .05). RESULTS: Units implemented a median of 66.3% of practices (range: 54.5%-72.7%). Basic practices showed greater implementation (61.9%-75.0%) than advanced (45.2%-77.4%) or excellent (35.3%-58.8%). Care for staff (85.8%), infrastructure (84.8%), and end-of-life care (77.3%) showed the highest implementation; post-intensive care syndrome and discharge preparation, the lowest (4.2%). Overall implementation correlated with human resources (nurses, nursing assistants, doctors; ρ = 1.000, p < .001), with a trend toward structural capacity (ρ = 0.949, p = .051). CONCLUSIONS: This evaluation documents moderate, variable implementation across centres and strategic lines, with post-discharge monitoring as the key gap. Human resources were the main determinant, underscoring the importance of adequate staffing. IMPLICATIONS FOR PRACTICE: The manual is a diagnostic and monitoring tool that units can integrate into audit-and-feedback cycles to prioritise improvement and benchmark practice across centres.