A Direct Observation Checklist to Measure Respect and Dignity in the ICU.
OBJECTIVE
Treating patients and family members with respect and dignity is a core objective of health care, yet it is unclear how best to measure this in the ICU setting. Accordingly, we sought to create a direct observation checklist to assess the "respect and dignity status" of an ICU.


METHODS
A draft checklist based on previous work was iteratively revised to enhance accuracy and feasibility.


METHODS
Seven ICUs within the Johns Hopkins Health System.


METHODS
A total of 351 patient-clinician encounters with 184 different patients.


METHODS
Four study team members pilot tested the checklist between January and August 2015.


RESULTS
Standard psychometric analyses were performed. The direct observation checklist exhibits strong content and face validity as well as high reliability and internal consistency. All items load on one factor that supports the unidimensionality of the total index. Furthermore, concurrent validity of the direct observation checklist is demonstrated by statistically significant differences in mean scores between ICUs, between types of clinicians, and between patients' clinical status and mood.


CONCLUSIONS
We rigorously developed, pilot tested, and analyzed a direct observation checklist designed to assess the extent to which patients and families in the ICU setting are treated with respect and dignity. Future research should validate this checklist in other settings and compare its results with other measures. Data gathered about individual items on the direct observation checklist could be used to target areas for training and education; doing so should help facilitate more respectful treatment of patients and their families.
1Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD. 2Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. 3Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 4Institute for Health and Aging, University of California, San Francisco, CA.
Joseph A
JA
Carrese
Gail
G
Geller
Emily D
ED
Branyon
Lindsay K
LK
Forbes
Rachel J
RJ
Topazian
Brian W
BW
Weir
Omar
O
Khatib
Jeremy
J
Sugarman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D003422:Critical Care / Q000592:standards; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D028723:Personhood; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D055815:Young Adult