Open-Door ICU Model and Humanized Care: A Systematic Review

Background: Management of patients in closed-door intensive care units (ICUs) is often associated with limited family visits and a highly technological environment, which can lead to patient deconditioning through altered circadian rhythms and depersonalization, contributing to psychological distress in addition to physiological distress. In recent years, there has been a shift in trends in the management of ICU patients with an emphasis on more social and psychological support, with the option of an open-door ICU. Objective: This study aims to evaluate the role of humanized care through social and psychological support in improving patients' outcomes through the concept of open-door ICUs. Methods: This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Six databases were searched (LILACS, SciELO, PubMed, Scopus, ScienceDirect, and Dialnet) using a strategy based on MeSH and DeCS terms. Studies published between 2018 and 2025, in English, Spanish, and Portuguese, were included. Fifty studies were selected and analyzed using open, axial, and selective coding techniques. The review protocol was registered in PROSPERO (CRD420251080952). Results: Three main categories emerged: (1) Patient and Family Perceptions of ICU Care; (2) flexible visitation and technological mediation; and (3) humanization-centered care. These factors were linked to improved emotional well-being, reduced anxiety, enhanced communication, and stronger trust between families and healthcare professionals. Conclusions: Based on the results of our systematic review, we emphasize the importance of adopting humanized care practices in open-door ICUs. In particular, strategies like flexible visitation, emotional and spiritual support, respectful communication, and family involvement contribute to compassionate, patient-centered care. We recommend institutional policies that need to be designed that support humanization for patients and families.