Gajic, Ognjen

Background Intensive care units are high-acuity environments characterized by time pressure, medical complexity, and organizational demands. These conditions may influence clinicians’ ability to provide patient-centered care and contribute to forms of care perceived as fragmented or dehumanizing. Objective To examine how ICU clinicians describe and make sense of the pressures shaping everyday critical care practice, and how these pressures give rise to interacting patterns of care, including those described as hurry, blur, burden, and cruelty. Methods We conducted a qualitative study using focus groups with ICU clinicians from a large academic health system. Discussions were informed by the concept of the pathologies of care as sensitizing concepts. Four focus groups were held with physicians, nurses, advanced practice nurses, and a social worker ( N = 14). Transcripts were analyzed using directed content analysis with both deductive and inductive coding. Results Clinicians described these patterns not as discrete phenomena but as interrelated, context-dependent processes shaped by shared operational pressures such as time constraints, workload, and information demands. These dynamics were often viewed as inherent to the structure and culture of ICU care and were described as co-occurring and compounding. Communication emerged as both a contributor to and a potential mechanism for mitigation, alongside system-level strategies such as reducing documentation burden and leveraging artificial intelligence to support care delivery. Conclusions Patterns reflected in hurry, blur, burden, and cruelty are best understood as emergent properties of complex care systems. Addressing these dynamics may require system-level approaches to improve communication, reduce workload pressures, and support more patient-centered, humanizing care.

Introduction Patient dehumanization when caring for critically ill patients in the intensive care unit (ICU) is commonplace. The Get to Know Me board (GTKMB) has been identified as a valuable tool for promoting humanized care and communication in the ICU; however, its implementation is highly variable. This study aimed to identify the barriers and facilitators influencing consistent implementation of the GTKMB in the ICU. Materials and methods We conducted multidisciplinary focus groups via teleconference with ICU clinicians at a large quaternary care academic medical center. A thematic content analysis was performed to identify key themes and concepts related to GTKMB implementation. Results Thirty-eight clinicians participated across six focus groups, including 10 nurses, 7 physicians, 6 advanced practice providers, 5 rehabilitation therapists (allied health clinicians), 1 respiratory therapist and 1 social worker. Major themes related to barriers and facilitators of GTKMB implementation included, (1) identifying appropriate patients and optimal timing for completing the GTKMB, (2) logistical challenges such as access to the board, visibility and unclear responsibility for completion, (3) the importance of clinician role modeling supporting the board completion, and (4) opportunities to improve the design and functionality of the board itself. Conclusion Although clinicians recognize the GTKMB as a meaningful tool to support humanized care in the ICU, inconsistent implementation limits its potential impact. This study highlights several key barriers and facilitators to its use. Future efforts should focus on targeted quality improvement initiatives to enhance consistent completion and integration of the GTKMB into ICU practice.