title: Improving patient care through the prism of psychology: application of Maslow's hierarchy to sedation, delirium, and early mobility in the intensive care unit.
abstract: The intensive care unit (ICU) is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. This article addresses the medical community's resistance to adopting a culture of safety in critical care with regard to issues surrounding sedation, delirium, and early mobility. Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This article is not intended to provide a comprehensive review of the literature but rather a framework to rethink our currently outdated culture of critical care by employing Maslow's hierarchy of needs, along with a few novel analogies. Application of Maslow's hierarchy will help propel health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Veterans Administration Tennessee Valley Geriatric Research, Education and Clinical Center, Nashville, TN. Electronic address: james.c.jackson@vanderbilt.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Santoro
authors.affiliation: Tulane University, New Orleans, LA.
authors.forename: Taylor M
authors.initials: TM
authors.lastname: Ely
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Leanne
authors.initials: L
authors.lastname: Boehm
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Kiehl
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Lindsay S
authors.initials: LS
authors.lastname: Anderson
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Veterans Administration Tennessee Valley Geriatric Research, Education and Clinical Center, Nashville, TN.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: D000124:Achievement; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000523:psychology / Q000534:rehabilitation*; D003693:Delirium / Q000523:psychology / Q000534:rehabilitation*; D004434:Early Ambulation; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008960:Models, Psychological; D020380:Needs Assessment / Q000458:organization & administration*; D061214:Patient Safety; D012649:Self Concept; D012944:Social Support; D014481:United States
keywords: Cognitive impairment; Critical care; Patient safety; Psychology; Rehabilitation