Humanizing care in the ICU: Implementation insights from the Footprints Project

The Footprints Project is a humanizing initiative that elicits and displays personal information from patients and families about a patient's life before illness. Key details recorded on a form are then written on a whiteboard in the patient's room to support person-centered care. The whiteboard keeps personal identity, preferences, and daily plans visible. The objective of this study was to explore how the Footprints Project evolved over time and to identify contextual determinants and practical strategies that may support its ongoing sustainability from the perspectives of patients, families, and clinicians.

This qualitative descriptive study was co-designed with patients and families in a 23-bed university-affiliated medical-surgical Intensive Care Unit (ICU). Implementation followed a preparatory audit, staff surveys, multi-directional communication, and volunteer integration. We enrolled survivors of critical illness, family members of ICU patients, and clinicians to participate in focus groups and individual interviews. Transcripts were analyzed using conventional qualitative content analysis and interpreted with attention to constructs within the Clinical Sustainability Framework as a sensitizing lens.

Participant interviews and focus groups with 7 patients, 19 family members and 40 clinicians identified four transitions reflecting the evolution and embedding of the Footprints Project: 1) transition from a nurse-led tool to an intentional interprofessional intervention; 2) transition from a patient-centered tool to a patient and family-partnered intervention; 3) transition from a stand-alone intervention to one embedded into daily workflows; and 4) transition in the format and content of the form and whiteboard.

In this qualitative study, patients, families, and clinicians identified practical strategies and contextual features that supported the evolution and ongoing use of the Footprints Project through interprofessional and family-partnered efforts, workflow alignment and refreshed tools.

Embedding Footprints into daily ICU workflows may strengthen person-centered care by making patient identity visible at the bedside. Interprofessional ownership and explicit family partnership can enhance consistency and sustainability. Updating and intentionally embedding tools may support staff engagement in high-acuity environments. These strategies may help ICUs to operationalize other humanizing practices in practice.