A relational tool supporting identity, inclusivity...

A relational tool supporting identity, inclusivity and impact in the intensive care unit: a qualitative study of the Footprints Project

Abstract

Objective The objective of this study was to understand experiences of patients, families and clinicians with the Footprints Project - a tool used to counter the unintentional dehumanisation of critically ill patients in the intensive care unit (ICU). Design Qualitative descriptive study. Setting 29-bed university-affiliated ICU. Participants Of 66 participants, 7 were survivors of critical illness, 19 were family members of survivors or decedents and 40 were clinicians representing 10 different professions. Interventions The Footprints Project uses a written form to record personal details about each patient, then excerpts are transcribed onto a whiteboard in each patient’s room. Patients and family members were invited to participate in semistructured interviews or focus groups after ICU discharge (October 2024–August 2025). Clinicians were invited by email (January 2025–May 2025). Focus groups and interviews were audio-recorded, transcribed and anonymised. Outcome measures Perspectives and experiences of patients, family members and clinicians. Results Data collection was primarily in-person for patients and families (17 of 26, 65.3%), and virtual for clinicians (36 of 40, 90.0%). Qualitative content analysis of transcripts revealed three categories related to identity, inclusivity and impact . Footprints was experienced as a tool to highlight personhood by bringing patients into view, individualising conversations and encouraging use of preferred names. Features fostering inclusivity include increasing awareness of vulnerabilities, facilitating culturally-sensitive care and helping to avoid errant assumptions. Patients valued being acknowledged as a person. Families valued recognition of their loved one as an individual. Clinicians found shared humanity through Footprints. Participants identified barriers to consistent use, underscoring implementation challenges; they also shared ideas for more intentional, consistent utilisation. Conclusions The Footprints Project was viewed as a relational tool, reflecting a patient-facing approach to person-centred, family-partnered care that supports humanism in healthcare. Future work should include structured implementation strategies and assess how Footprints can be sustained and embedded into practice.