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Am J Respir Crit Care Med. 2018 Jun 1;197(11):1389-1395. doi: 10.1164/rccm.201708-1676CP.

The Practice of Respect in the ICU.

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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.
3 Medical School, Paris Diderot University, Sorbonne Paris-Cité, Paris, France.
4 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
5 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
6 Patient-Family Advisory Council.
7 Silverman Institute for Health Care Quality and Safety, and.
8 Berman Institute of Bioethics and.
9 School of Medicine, Johns Hopkins University, Baltimore, Maryland.
10 Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
11 Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee.
12 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
13 Department of Nursing, University of California San Francisco Medical Center, San Francisco, California; and.
14 Google Research, Google, Inc., Mountain View, California.


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.


dignity; patient engagement; patient experience; patient-centered care; respect


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