Fostering humanism: a mixed methods evaluation of the Footprints Project in critical care

Abstract

ObjectivesThe objectives of this mixed-methods study were to assess the uptake, sustainability and influence of the Footprints Project.SettingTwenty-two-bed university-affiliated ICU in Hamilton, Canada.ParticipantsICU patients admitted and their families, as well as clinicians.InterventionsWe developed a personalised patient Footprints Form and Whiteboard to facilitate holistic, patient-centred care, to inform clinical encounters, and to create deeper connections among patients, families and clinicians.Outcome measuresWe conducted 3 audits to examine uptake and sustainability. We conducted semi-structured interviews with 10 clinicians, and held 5 focus groups with 25 clinicians; and we interviewed 5 patients and 13 family representatives of 5 patients who survived and 5 who died in the ICU. Transcripts were analysed using qualitative content analysis.ResultsThe Footprints Project facilitated holistic, patient-centred care by setting the stage for patient and family experience, motivating the patient and humanising the patient for clinicians. Through informing clinical encounters, Footprints helped clinicians initiate more personal conversations, foster deeper connections and guide treatment. Professional practice influences included more focused attention on the patient, enhanced interdisciplinary communication and changes in community culture. Initially used in 15.8% of patients (audit A), uptake increased to 51.4% in audit B, and was sustained at 57.8% in audit C.ConclusionsBy sharing valuable personal information about patients before and beyond their illness on individualised whiteboards at each bedside, the Footprints Project fosters humanism in critical care practice.

Clinician Perspectives on Caring for Dying Patients During the Pandemic

“…Our methods were informed by recent narratives and innovations ( 39–43 ). The high clinician participation rate allowed documentation of professional observations and personal experiences in the context of goal-concordant care ( 44 ) and practice-based interventions promoting personhood ( 12 , 20 , 26 ), also operating elsewhere ( 15–17 , 45 ).…”

“…At this institution, typical end-of-life care includes interventions designed to humanize the experience for patients and families as built into the daily workflow and staff training ( 16 ). To learn more about each patient, the clinical team telephoned family members, collating personal information about patients to share with staff via a whiteboard and in the electronic medical record (EMR) ( 12 ), which served to reassure families that the staff was interested in their loved one as a person ( 20 ). Building on this information in recognition of each dying patient, staff elicited and implemented final wishes ( 15 ).…”

“…Wishes were then implemented by staff or family and documented in the EMR. Before the pandemic, conversations to learn about patients and elicit wishes occurred informally with families and bedside staff, recorded on the Footprints form and whiteboard ( 12 ). As visitor restrictions were introduced, staff adapted their approach as necessary to align care with practice norms.…”

“…We previously found that initiatives to ensure human connection and extend compassion while honoring the life and legacy of dying patients can be meaningful to all involved ( 12–14 ). For example, eliciting and implementing terminal wishes of patients and their families provided solace in a multicenter study, reinvigorating a sense of vocation for staff ( 15–17 ).…”

Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic

“…Close communication between families of acutely ill patients has been shown to improve psychological outcomes and lead to higher quality surrogate decision making surrounding the direction of care. 39,40 Electronic communication through phone calls or video conferencing was widely adopted by health care systems during the COVID-19 pandemic. 28 A study that evaluated the feasibility and acceptability of electronic communication for palliative care family meetings found that 80% of family members felt comfortable articulating questions and expressing thoughts throughout the meeting.…”