The Footprints Project: Individualizing Care and Influencing Clinicians in the ICU
CCCF ePoster library. Swinton M. Oct 2, 2017; 198191
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Marilyn Swinton
Marilyn Swinton
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Abstract
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The Footprints Project: Individualizing Care and Influencing Clinicians in the ICU

Swinton, Marilyn1; Hoad, Neala2; Takaoka, Alyson3; French, Tammy2; Toledo, Feli4; Tam, Ben2; Clarke, France3; Waugh, Lily2; Soth, Mark2; Duan, Erick2; Cook, Deborah1,5

1 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

2 Intensive Care Unit, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada

3 Critical Care Research Department, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada

4 Spiritual Care Department, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada

5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada 


Background and Objectives
In the technologic ICU setting, clinicians may inadvertently forget the “lives lived” of their patients before hospitalization, and have difficulty humanizing their patients. Initiated by 2 bedside nurses to improve the sense of humanity in a critical care encounter, the Footprints Project was developed to share a patient’s personal information during critical illness. The project includes a Footprints Form completed by family members to capture personal information about patients, some of which is transcribed onto a Footprints Whiteboard by the bedside in each patient's room. This mixed-methods multi-phase project aims to facilitate more holistic patient-centered critical care. The objective of this qualitative phase was to understand the impact of the Footprints Project on the experience of clinicians working in the ICU.

Methods
With 35 ICU clinicians, we conducted 10 semi-structured interviews (10 clinicians) and 5 focus groups (25 clinicians) 18 months after the Footprints Project was implemented.  Focus groups and interviews were digitally recorded, transcribed verbatim and anonymized. Transcripts were analyzed by 4 team members using conventional content analysis. Codes were developed through periodic consensus meetings and organized into categories and themes once coding was completed.

Results
Our sample included 13 bedsides nurses, 1 charge nurse, 4 physiotherapists, 2 respiratory therapists, 2 chaplains, 1 unit clerk and 12 physicians (5 fellows, 4 residents and 3 intensivists). Clinicians described using information found on the Footprints Form and Whiteboard as a 'conversation-starter' for talking with patients and families, and as an aid for difficult discussions about prognosis. Main themes identified in this qualitative analysis included: Enhancing Initial Communication, Informing Clinical Interventions, Promoting Interprofessional Collaboration, Facilitating Meaningful Relationships with Patients and Families, and Fostering Culture Change within the ICU.

Clinicians reported using the Footprints Form and Whiteboard for diverse purposes, with several beneficial consequences.  Sentiments about the untapped potential for the Footprints Project encouraged its more intentional use as a communication tool for both families and clinicians.

Conclusions
The Footprints Project is a non-digital initiative in the fast-paced ICU which influences clinicians in a myriad of ways, helping them to connect with patients and families, and colleagues, while having a positive influence on the culture of the ICU. 
 

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