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Fostering humanism: a mixed methods evaluation of the Footprints Project in critical care
  1. Neala Hoad1,
  2. Marilyn Swinton2,
  3. Alyson Takaoka2,
  4. Benjamin Tam1,3,4,
  5. Melissa Shears5,
  6. Lily Waugh1,
  7. Feli Toledo6,
  8. France J Clarke2,
  9. Erick Huaileigh Duan1,3,4,
  10. Mark Soth1,3,
  11. Deborah J Cook1,2,3
  1. 1 Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
  2. 2 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4 Department of Critical Care, Niagara Health System, St. Catharines, Ontario, Canada
  5. 5 Department of Medicine, Queen's University, Kingston, Ontario, Canada
  6. 6 Department of Spiritual Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada
  1. Correspondence to Neala Hoad; nealahoad{at}


Objectives The objectives of this mixed-methods study were to assess the uptake, sustainability and influence of the Footprints Project.

Setting Twenty-two-bed university-affiliated ICU in Hamilton, Canada.

Participants ICU patients admitted and their families, as well as clinicians.

Interventions We developed a personalised patient Footprints Form and Whiteboard to facilitate holistic, patient-centred care, to inform clinical encounters, and to create deeper connections among patients, families and clinicians.

Outcome measures We conducted 3 audits to examine uptake and sustainability. We conducted semi-structured interviews with 10 clinicians, and held 5 focus groups with 25 clinicians; and we interviewed 5 patients and 13 family representatives of 5 patients who survived and 5 who died in the ICU. Transcripts were analysed using qualitative content analysis.

Results The Footprints Project facilitated holistic, patient-centred care by setting the stage for patient and family experience, motivating the patient and humanising the patient for clinicians. Through informing clinical encounters, Footprints helped clinicians initiate more personal conversations, foster deeper connections and guide treatment. Professional practice influences included more focused attention on the patient, enhanced interdisciplinary communication and changes in community culture. Initially used in 15.8% of patients (audit A), uptake increased to 51.4% in audit B, and was sustained at 57.8% in audit C.

Conclusions By sharing valuable personal information about patients before and beyond their illness on individualised whiteboards at each bedside, the Footprints Project fosters humanism in critical care practice.

  • Adult intensive & critical care
  • Humanism
  • mixed methods

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  • Contributors Concept and design: NH, MS, AT, BT, MS, LW, FT, DJC. Acquisition, analysis or interpretation of data: NH, MS, AT, BT, MS, LW, FT, FJC, ED, MS, DJC. Drafting of the manuscript: NH, MS, AT, BT, MS, ED, DJC. Critical revision of the manuscript for important intellectual content: NH, MS, AT, BT, MS, LW, FT, FJC, EHD, MS, DJC. Statistical analysis: AT, BT, MS. Obtained funding: NH, DJC. Administrative, technical or material support: NH, MS, AT, BT, MS, LW, FT, FJC, MS, DJC. Responsibility for the integrity of the data: NH, DJC.

  • Funding This study was funded by a peer-review grant from the St. Joseph's Hospital Nursing Advisory Council (NH) and the Canadian Institutes for Health Research (DJC). Footprints was supported by a Hamilton Community Grant from the Walmart Foundation, as well as generous donations from families and colleagues in the ICU and broader community through fund-raising efforts led by Dr Michelle Kho, Ms France Clarke and Ms Mary Copland. DJC holds a Canada Research Chair in Critical Care Knowledge Translation from the Canadian Institutes of Health Research.

  • Competing interests NH received a grant from the Nursing Advisory Council of St Joseph's Healthcare Canada and a Walmart Community Grant. DJC received a Canada Research Chair from the Canadian Institutes of Health Research which helped to support this work. Otherwise, none of the authors have any competing interests to declare.

  • Patient consent for publication Not required.

  • Ethics approval The Hamilton Integrated Research Ethics Board approved this study (Project #3214).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.