Objectives: To explore the perception of stakeholders (patients,
family members and health care workers) about humanistic care in the intensive
care unit.
Primary objective:
To understand how patients and family members experience humanizing or
dehumanizing treatment when admitted in the ICU.
Secondary Objective:
1) Factors leading to dehumanizing behavior
experienced during the ICU care
2) Outcomes of dehumanizing behavior experienced
during the ICU care
Methodology
1. Context and Location:
The study will be performed in the ICUs of a tertiary
care hospital in north India. The ICUs practice open visitation policy for the
visitors and allow active participation of the family in patient care.
2. Study design
The study will be carried out using mixed methodology
(qualitative and quantitative).
3. Data Collection:
3a. Qualitative investigation: This will be based on
inductive grounded theory approach.
Keeping
our focus on the patient’s, family member’s, doctor’s and nurse’s perception on
humanizing or dehumanizing during communication,
routine care and procedures, we
will be conducting in-depth interviews of all the stakeholders. Grounded theory
approach involves moving back and forth between data collection and analysis
until a theory that fits the data emerges. (8)
The participants will be selected by theoretical
sampling that is the individuals likely to provide the needed information will
be included and will also include people with different sex, age, varying
clinical and socio-demographic characteristics. The data obtained from the
first participants will determine which new participants need to be included
until the saturation of the data. Hence, the sample size will be governed by
the spectrum of data needed to develop a theory, so it cannot be determined
before the data collection starts. (9)
Family members will be defined as any of the relatives
and friends visiting the patient. Several family members will be included for
the same patient as experience may vary depending on the relationship with the
patient. For each family member, age, gender, educational status and relationship
with the patient will be recorded. The only inclusion criteria will be that
patients had stayed in an ICU more than one week , and these patients, their
families and HCW are aged 18 years or more.
The doctors and nurses with dedicated to the care of
critically ill patients in ICU will be interviewed. After taking an informed
consent, the main investigator will invite the participants for the interview, which
will be conducted in the vernacular language. It will be audio recorded and field
notes will be taken during the interview. (11) We plan to ask questions in all
forms: hypothetical, ideal, interpretative or leading.
3b.
Quantitative investigation: A structured proforma will be distributed to the
stakeholders by the main investigators. Items of the performa will be rated on
Likert Scale.
4. Analysis:
4a. Qualitative analysis: The methods will follow
recommendations for qualitative analysis by Ritchie et al. (12) The methods and
procedures of grounded theory will involve cycles of data collection and
analysis to identify interrelations among concepts, which eventually will be aggregated
into an integrative theory.
The data collected in the form of audio recordings
will undergo verbatim transcription and translation, and together with the
field notes, explanations will be developed, patterns detected, typologies
established and categories identified. (12)
4b. Quantitative analysis of structured data:
Responses to items will be coded as categorical variables and their association
with the main explanatory variable will be seen.
Statistics
5a. Qualitative Statistical Analysis: After
summarization the data, a thematic framework will be built. This will include
identifying initial themes or concepts, constructing a conceptual framework,
labeling the data followed by sorting and synthesising the data. This will be
followed by descriptive and associative analysis to develop an explanation.
(12)
5b.
Quantitative Statistical Analysis:
Responses
will initially be probed using univariate analysis by using the chi-square
test. Subsequently, multivariate analysis for those which have p value > 0.1
will be undertaken.
6.
Ethics
Before
submitting the study we will seek approval of the Institutional Ethical
Committee. Written informed consent in vernacular language will be taken from
the respondents. Privacy of participation and confidentiality of the data will
be maintained by coding the transcripts using numbers and not including any
participant identifiers on the transcripts. |