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Examples of the ABCDs of dignity-conserving care in the intensive care unit (ICU)

Examples of the ABCDs of dignity-conserving care in the intensive care unit (ICU)
Attitudes and assumptions can affect practice; make a conscious effort to reflect on how your own attitudes, assumptions, and life experiences affect the way you deliver care to each patient.
Create a culture within the ICU setting in which acknowledgement and discussion of attitudes and assumptions as they apply to the entire health care team becomes a standard part of delivering care.
Behaviors should always enhance patient dignity; a lack of curative options should never rationalize or justify a lack of ongoing patient contact.
Always invite the patient to have someone from his or her support network present, particularly if the planned discussion includes complex or difficult information.
Do not rush; try to be seated at a comfortable distance for conversation, at the patient's eye level, when possible; make eye contact when talking with patients and their families.
As much as possible, turn off digital devices and avoid jargon when talking with patients and their families.
Recognize and relieve suffering. Compassion is sensitivity to the suffering of others and the desire to relieve it.
Show compassion with an understanding look, or a gentle touch on the shoulder, arm or hand, or some form of communication (spoken or unspoken) that acknowledges the person beyond the illness.
Acknowledge the effect of the illness on the patient's broader life experience.
Acknowledge personhood and recognize the emotional impact that accompanies illness by making statements such as, "This must be frightening for you" or "It's natural to feel pretty overwhelmed at times like these."
Ask who else should be involved to help the patient and family through a difficult time (eg, psychosocial services, close friends, clergy).
Explore the issues and values that are most important to patients and their families as they face the end of life.
Adapted from:
  1. Cook D, Rocker G. Dying with Dignity in the Intensive Care Unit. N Engl J Med 2014; 370:2506.
  2. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ 2007; 335:184.
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