Identifying loss of dignity and lack of respectful treatment as preventable harms in healthcare, researchers at Johns Hopkins have taken on the task of defining and ensuring respectful care in the intensive care unit (ICU). Their novel, multi-method approach is presented in a dedicated supplement to the journal Narrative Inquiry in Bioethics.
“In healthcare, the importance of respect and dignity is often invoked, but has not been clearly defined in regard to treatment in the ICU,” said Jeremy Sugarman, the Harvey M. Meyerhoff Professor of Bioethics and Medicine at the Johns Hopkins Berman Institute of Bioethics. “To prevent harms related to respect and dignity in the ICU there is a prerequisite need for clarity regarding what exactly constitutes optimal treatment in this regard, and then to develop methods to measure it.”
To lay that groundwork, bioethics scholars on the research team developed a conceptual model defining three sources of patient dignity: shared humanity, personal narrative, and autonomy. Each of these sources of dignity demands respect, said Leslie Meltzer Henry, a professor at the Berman Institute and first author of the article outlining the conceptual model.
“In the modern healthcare system, there is risk of technology-focused communication and decision-making taking precedence over dignityrespecting care,” Prof Henry commented
The conceptual model describes the types of respect that each source of dignity requires in the ICU, and offers a framework for identifying and rectifying threats to patients’ dignity in that setting. For example, the article states: “Respecting the dignity of patients as human beings begins with not objectifying them. When clinicians refer to patients by name, look them in the eye, introduce themselves, and describe the care they are providing, they treat patients as people rather than objects.”
The research team collected data through interviews with patients and families in the ICU, focus groups with healthcare professionals who work in the ICU, and direct observations. Four consensus areas were identified on what constitutes treatment with respect and dignity in the ICU: treatment as a human being, treatment as a unique individual, treatment as a patient who is entitled to receive professional care, and treatment with sensitivity to the patient’s critical condition and vulnerability in the ICU.
The study of respect and dignity in the ICU is the bioethics component of the larger ‘Emerge’ project at Johns Hopkins, led by the Armstrong Institute for Patient Safety and Quality and funded by the Gordon and Betty Moore Foundation. The project aims to decrease preventable harms in the ICU through systems engineering approaches. http://muse.jhu.edu/journals/ narrative_inquiry_in_bioethics/toc/nib.5.1A.html.
