Humanization of Critical Care – Psychological Effects on Healthcare Professionals & Relatives: A Systematic Review
CCCF ePoster library. Leitch J. Nov 9, 2018; 233386
Dr. Jordan Leitch
Dr. Jordan Leitch
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Abstract
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Introduction

Dehumanization is the process of depriving someone of positive human qualities. It is usually seen as an overt, active, extreme, conflict driven phenomenon,1 and not typically thought of as being associated with health care.  There is however a more subtle form of dehumanization called infrahumanization that can occur outside conflict situations. Infrahumanization can occur whenever groups identify others as being outside their cohort and has been shown to occur in medical settings.2,3 Capozza found that physicians and nurses caring for oncology patients perceived their own professional group as possessing more uniquely human traits than the patient group.2 A study of a variety of nursing showed that denial of uniquely human traits (reasoning, rationality, morality and intellectual ability) to patients was associated with lower levels of stress among nurses with high levels of organizational and affective commitment, suggesting that infrahumanization is a subconscious coping strategy to reduce the emotional burden of caring for patients.3



Those suffering from critical illness are particularly vulnerable to this unintentional dehumanization.  In an effort to refocus care of the critically ill to a more person-centered lens, several initiatives have been advocated (Figure 1), including diaries, liberal visitation policies, involvement of relatives in basic patient care and opportunities for relatives to be present during resuscitation.4,5,6 There seems to be a conflict between what feels intuitively right (to humanize patients) and what health care professionals do to protect themselves against burnout and emotional burden (dehumanize patients).  Equally important is what effect these interventions may have on family members.



Objectives

To systematically review and evaluate the effects of humanized care of the critically ill, on empathy among health care professionals, anxiety among relatives and burnout and compassion fatigue in both groups.

 

Methods

MEDLINE, PsycINFO, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest Dissertations were searched from inception to 29th June 2017 for studies that investigated the effects of interventions with potential to humanize care of the critically ill, on the following outcomes: empathy among critical care professionals, anxiety among relatives and burnout and compassion fatigue in either group. We defined a humanizing intervention as: one with substantial potential to increase physical or emotional proximity to the patient. Two reviewers independently selected studies, extracted data, assessed risk of bias and data quality.

 

Results

Twelve studies addressing four discrete interventions (liberal visitation, diaries, family participation in basic care and witnessed resuscitation) and one mixed intervention were included. Ten studies measured anxiety among 1055 relatives. Two studies measured burnout in 288 critical care professionals. None addressed empathy or compassion fatigue. Eleven of the included studies had an overall high risk of bias. No pooled estimates of effect were calculated, as a priori criteria for data synthesis were not met.

 

Conclusions

We found insufficient evidence to make any quantitative assessment of the effect of humanizing interventions on any of these psychological outcomes. We observed a trend towards reduced anxiety among family members who participated in basic patient care, liberal visitation and diary keeping. We found conflicting effects of liberal visitation on burnout among health care professionals.


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