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.
Am J Respir Crit Care Med. 2018 Jun 1;197(11):1389-1395. doi: 10.1164/rccm.201708-1676CP.
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.
虽然“尊重”和“尊严”是直观的概念，但很少有正式的工作来解决它们在 ICU 环境中的系统应用。在召集了一组相关的多学科专家后，我们对相关文献进行了回顾，并进行了协作讨论，重点是 ICU 中的尊重实践。我们报告了这一过程的结果，包括当前知识的总结、概念框架和一个理解和改善 ICU 中尊重和尊严实践的研究计划。我们将报告分为发现和建议。发现包括：1）尊严和尊重是相互关联的；2）ICU 患者和家属容易受到不尊重；3）在 ICU 中，违反尊重和尊严的行为似乎很常见，并且与去人性化有很大的重叠；4）不尊重可能与主要和次要伤害有关；5）系统障碍使 ICU 中尊重的理解和可靠实践变得复杂。建议包括：1）在 ICU 尊重实践领域开展和/或扩大研究；2）将“尊重失败”视为类似于患者安全事件，并利用现有的质量和安全机制进行改进；3）确定改善尊重实践的益处和潜在意外后果。尊重和尊严是 ICU 中的重要考虑因素，尽管仍需要进行大量的额外研究。
