Ways to Ensure Respectful Care of ICU Patients
How ICU nurses can maintain patient dignity in critical care environments
High-tech, fast-paced intensive care units save many patients’ lives, yet the high-stress environment makes it challenging for ICU nurses to look beyond physical needs and focus on the humanness of their patients. With greater awareness, however, nurses can ensure that patient dignity is maintained and that patients and their families have all concerns addressed.
“Respect and dignity are part of the ethical foundation of nursing,” said Cynda Hylton Rushton, PhD, RN, FAAN, a professor of clinical ethics in nursing at Johns Hopkins University, and co-chair of the Johns Hopkins Hospital ethics committee in Baltimore. “It’s reflected in the first provision of the code of ethics, and it’s essential for us to fulfill our ethical obligations. It’s not optional, not something to be dispensed with if stressed or tired or overstretched.”
Rushton and colleagues published a series of articles in 2015 in the journal Narrative Inquiry in Bioethics, focusing on the three sources of patient dignity: shared humanity, personal narrative and autonomy.
Top nursing leaders share a number of suggestions and reminders for helping ICU nurses be more aware of these issues in order to maintain patient dignity--even in the chaos of the critical care environment.
10 ways to ensure respectful care of ICU patients:
1. Treat every patient equally. “One of the fundamental tenets of nursing is respect for all people,” said Connie Barden, RN, MSN, CCRN-E, CCNS, chief clinical officer of the American Association of Critical-Care Nurses. “Respectful treatment honors the patients and their family and all of their unique characteristics. As professional health care team members, it is our job to focus on creating an environment that allows us to give the best possible care to any and all patients and leaves judgments aside.”
2. Remember basic courtesies. The behaviors you learned in nursing school, such as knocking before entering a patient room and addressing the patient by the preferred name, still apply in the ICU environment, even when things get stressful.
3. Be present with your patient. “Take the time to be with the patient,” advised Paulette Heitmeyer, MSN/ED, RN, chief nursing officer at Marina Del Rey Hospital in California. “Nurses become numb to the fact it’s a patient going through a very serious situation. We need to take a step back sometimes.”
ICUs are fast-paced, unpredictable and complex entities, Barden said, and that environment may inadvertently create opportunities for disrespect.
“It is so overwhelmed with technology that it’s easier to be distracted by the technology than to see the human in front of us,” Rushton said. “It takes awareness to stay connected to the human part of what we are doing.”
4. Get acquainted. Heitmeyer recommended getting to know patients and families and their beliefs, values and cultural preferences--and then honoring them. This might include being alert to food preferences, ensuring the patient receive spiritual care if desired and learning who will make decisions if the patient is not able. “It’s important to understand that piece about the patient,” she said.
Prioritize knowing patients as persons, not diseases or injuries, Rushton added.
5. Understand the patient perspective. “Keep the environment calm and quiet. Educate [patients] about the plan of care and make sure they are part of the decision,” said Heitmeyer.
Remember that patients are at their sickest and most vulnerable when in the ICU, and families are often at their most concerned and stressed, Barden explained.
“The environment doesn’t lend itself to being a compassionate place,” Heitmeyer explained. “These patients are being poked and prodded all day long. You are having blood drawn and tubes placed in your body.” Yet all of those procedures can be performed in a respectful manner.
6. Communicate with respect. Heitmeyer suggested speaking to the patient and family in non-medical terms and then validating that they understood what was said.
“Talk to the patient even if the patient is unconscious; tell the patient what you are doing and why,” said Heitmeyer. She added that when patients are conscious, nurses should ask open-ended questions and give the patient and family time to respond.
When ICU patients are sedated, they may not be able to make eye contact or talk. In these situations, ICU nurses need to be careful not to let their guard down; they can still maintain focus on the patient instead of the machines, Rushton said.
7. Replace labeling with positive solutions. The Johns Hopkins researchers evaluated patients’ and clinicians’ perceptions and experiences with respect and dignity in the ICU. The groups mentioned many similar factors, such as affording bodily privacy to the patient and accepting patients’ choices. However, clinicians brought up several behaviors that many nurses may not consider disrespect: for instance, calling a person who returns to the ICU often and does not follow prescribed medical care a “frequent flyer.”
“Labeling becomes a shorthand, but underneath it is a sign of disrespect that gets in the way of seeing [the patients] as human beings despite the fact they have behaviors we may not agree with,” Rushton said.
Instead, nurses can try to figure out what’s behind the label and what might work, such as making appointments for patients before they leave the unit. With adequate follow-up, the patient might not return to the hospital as often.
8. Keep personal conversations out of earshot. Nurses should be able to enjoy themselves at work, but the researchers noted that ICU patients may not appreciate hearing things like nurses catching up about vacations during shift change. Similarly, laughing and joking in the nurses’ station within hearing of acutely ill patients can be seen as disrespect, Heitmeyer said. Noise and voices should be kept to a minimum.
9. Support a healthy work environment. Barden added that she encourages nurses to challenge the belief that unhealthy work environments are inevitable and to role model professionalism.
“Organizations also need to have zero tolerance policies about disrespectful and abusive behaviors and these policies must be enforced,” Barden said.
10. Attend to your own well-being. Rushton suggested ICU nurses draw upon their reasons for entering nursing as a resource and advised nurses to pay attention to their own well-being; they shouldn’t let themselves become overly stressed, hungry or ignore other needs. If they do, it is “more likely they will act on autopilot.”
“Clinicians cannot give what they don’t have themselves,” Rushton said. “If we expect them to respect others, they need to be treated with respect, as well.”