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Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, Rozenblum R, Sands K, Sokol-Hessner L, Talmor D, Turner K, Howell MD. The Practice of Respect in the ICU. Am J Respir Crit Care Med 2019; 197:1389-1395. [PMID: 29356557 DOI: 10.1164/rccm.201708-1676cp] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.
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Affiliation(s)
- Samuel M Brown
- 1 Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah.,2 Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Elie Azoulay
- 3 Medical School, Paris Diderot University, Sorbonne Paris-Cité, Paris, France
| | - Dominique Benoit
- 4 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.,5 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | | | - Gail Geller
- 8 Berman Institute of Bioethics and.,9 School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ronen Rozenblum
- 10 Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ken Sands
- 11 Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee
| | | | - Daniel Talmor
- 12 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kathleen Turner
- 13 Department of Nursing, University of California San Francisco Medical Center, San Francisco, California; and
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Brown SM, Talmor D, Howell MD. Building communities of respect in the intensive care unit. Intensive Care Med 2018; 44:1339-1341. [PMID: 29961105 DOI: 10.1007/s00134-018-5259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel M Brown
- Center for Humanizing Critical Care, Intermountain Medical Center and Department of Internal Medicine, University of Utah School of Medicine, Murray, UT, USA.
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Family Satisfaction in the ICU: Elusive Goal or Essential Component of Quality Care. Crit Care Med 2015; 43:1783-4. [PMID: 26181121 DOI: 10.1097/ccm.0000000000001097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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