Humanizing Critical Care and Promoting Person-Centered Nursing Practice

Critical care environments represent some of the most technologically intensive settings in modern health care.1 Yet while advances in monitoring and life-sustaining therapies have dramatically improved survival, the intensive care unit (ICU) can inadvertently strip patients of their personhood and dignity.2 Dehumanization, the failure to recognize or treat patients as full human beings, has been identified as a significant concern in critical care, affecting patient experience, family satisfaction, and clinician well-being.3–5In response to these concerns, a growing body of work has examined strategies to humanize the ICU, an approach that encompasses preserving patient dignity, fostering empathic nurse-patient relationships, promoting meaningful communication, and engaging families as active partners in care.2,6,7 Interventions such as patient photographs, biographical boards, dignity-focused questions, caring touch, and environmental modifications have been explored as means to counteract the depersonalizing effects of the ICU environment.8,9 Simultaneously, organizational factors including workload, burnout, and institutional culture influence the extent to which humanistic care is realized.10The purpose of this evidence synthesis was to examine what strategies and factors influence humanization and dehumanization in the critical care setting, and to evaluate their effects on patient, family, and clinician outcomes. The guiding PICO (patient/problem, intervention, comparison, outcome) question was, among adult patients and families in the ICU, what interventions, relational practices, and clinician-level factors promote humanization or mitigate dehumanization, and what are the resulting outcomes?A systematic search of PubMed was conducted in March 2026 using key terms including critical care, critical care nursing, humanism, compassion, empathy, dehumanization, personhood, dignity, person-centered care, and holistic nursing (Table 1). Inclusion criteria were original, peer-reviewed research published in English addressing humanization, dehumanization, or related constructs (eg, personhood, dignity, empathy, compassion) in the adult critical care setting; nonresearch articles such as editorials, commentaries, and case reports were excluded. Two reviewers independently screened titles and abstracts, resolving discrepancies by consensus, before reviewing full-text articles and extracting data using a standardized form. Study quality was appraised using the American Association of Critical-Care Nurses levels-of-evidence framework (Table 2), and findings were organized thematically using a narrative synthesis approach.11,12The PubMed search yielded 1069 records. After we had screened the titles and abstracts, we conducted a full-text review for eligible articles. After applying inclusion and exclusion criteria, 41 studies were retained for final synthesis. Studies were excluded for focusing on pediatric or neonatal ICU populations; representing nonresearch publication types such as editorials, commentaries, letters, and case reports; representing nonsystematic narrative, scoping, or integrative reviews; or addressing care settings outside the ICU or lacking a focus on patient-centered care. The study selection process is summarized in Figure 1.13Included studies were published between 2010 and 2026 and encompassed a range of methodological approaches (Table 3). Three studies were rated level B evidence: a quasi-experimental 2-group pre-post controlled study of family engagement during ICU interdisciplinary rounds, a single-group pretest-posttest quasi-experimental study of a tactile comfort intervention in ICU patients with COVID-19, and a quasi-experimental study with control group of a narrative nursing–based humanistic care program. Thirty-eight studies were rated level C, comprising primarily qualitative designs (including ethnography, phenomenology, hermeneutic inquiry, grounded theory, and qualitative description), cross-sectional descriptive and correlational studies, mixed-methods feasibility evaluations, pre-post quality improvement projects, and observational descriptive studies. Sample sizes varied widely, from 7 ICU nurses in a single qualitative study to 526 nurses in a large cross-sectional survey. Studies were conducted across diverse international settings spanning North America, Europe, the Middle East, Africa, Asia, and Australia, including the United States, France, the United Kingdom, Norway, Sweden, Italy, Spain, Greece, Denmark, Germany, Poland, Turkey, Egypt, Iran, Tanzania, China, South Korea, Japan, and Australia. Populations of interest included ICU patients, family members, nurses, physicians, and other clinicians.Narrative synthesis organized findings into 4 thematic domains: (1) structured tools and environmental interventions to preserve personhood; (2) relational and nursing practices that foster humanization; (3) patient and family perspectives on humanization and dehumanization; and (4) clinician and organizational factors influencing humanistic care (Figure 2).Several studies examined structured interventions to preserve patient identity and personhood in the ICU, spanning bedside tools, environmental changes, and system-level strategies.At the bedside, interventions aimed to foreground the patient as a person. The Get to Know Me board and bedside patient photographs made personal information visible to clinicians, fostering empathy and helping clinicians recognize patients as individuals beyond their diagnoses.9,15Adjunctive interventions addressed emotional and sensory experience. A music therapy intervention provided emotional comfort, distraction from the clinical environment, and a sense of well-being.39 The physical environment also played a key role: single-room ICU design improved patient and visitor experience, while studies of noise and sleep highlighted the harms of suboptimal environments and the benefits of noise-reduction strategies.16,43,46,47Comfort-focused interventions reinforced embodied care, with a quasi-experimental study showing improved comfort from a warm-water “love glove” during pandemic isolation, alongside evidence supporting patient diaries for recovery and family connection.26,36Finally, studies examining dignity itself identified clinician behaviors that either support or undermine it, with workload, hierarchical culture, and communication challenges as consistent barriers across settings.14,18,21,51In contrast to structured tools, several studies examined how nurses enact humanizing care through relational practices in everyday ICU work.Caring touch emerged as a foundational mode of communication. A hermeneutic study of ICU nurses in Norway identified touch as a core relational practice,40 a finding reinforced by a Swedish qualitative study showing that touch conveys presence, reassurance, and humanity in technologically intensive settings.48 Beyond touch, narrative approaches were also effective: a quasi-experimental study in China found that a narrative nursing–based humanistic care program improved outcomes among conscious ICU patients.30Relational care extended to family-inclusive practices. In a Japanese qualitative study of ICU nurses, Sasano and Odajima42 described outdoor excursions with patients and families as enhancing outcomes, strengthening collaboration, and deepening human connections, while helping nurses recognize patients as whole individuals rather than clinical cases. A complementary quasi-experimental 2-group study in US ICUs further showed that family engagement during interdisciplinary rounds significantly improved patient satisfaction with nursing care compared with usual care, supporting family inclusion as a humanizing structural intervention.20More broadly, qualitative work highlights humanizing care as a way of being rather than a discrete intervention. Studies from Australia24 and Greece50 describe compassion as enacted through presence, personal knowing, and emotional engagement, and as an immersive, embodied relationship between nurse and patient.Early mobilization further illustrates this relational dimension. Qualitative studies from China showed that mobilization promoted agency, dignity, and a sense of identity beyond illness, reframing it as a humanizing, not purely physiological, intervention.22,53Finally, communication itself is central to relational care. A Danish mixed-methods study demonstrated that structured communication support for nonvocal patients receiving mechanical ventilation was feasible and improved nurse-patient interactions,23 underscoring that both communication and touch are key mechanisms through which humanization is enacted in ICU practice.Patient and family perspectives provide critical insight into how humanization is experienced in the ICU. A convergent parallel mixed-methods study of 100 patients interviewed after ICU discharge showed that the ICU was consistently characterized as a hostile and stressful environment.41 Positive experiences were associated with a sense of safety facilitated by nurses, whereas negative experiences clustered around privacy violations, lack of empathy, inadequate support, and loss of control.Ethnographic studies further demonstrate that personhood is actively constructed in practice. An ethnographic study of ICU personnel showed that staff enacted personhood for unconscious patients by speaking to them and using their names, even without expectation of response, while personhood remained fluid and vulnerable to being “undone” in patients perceived as noncompliant or cognitively impaired.28 A complementary UK ethnography identified both humanizing and impersonal nursing discourses, reflecting tension between task-oriented care and recognition of the patient as a person.32 A complementary comparative ethnography across ICUs in 3 Western European countries similarly showed that dignity is enacted through everyday relational practice rather than as a fixed property, with cross-cultural differences shaping how dignity is performed and protected at the bedside.27Additional studies reinforce that dignity is grounded in relational care. Patients reported that dignity was preserved when they felt seen, named, and respected, and dignity eroded when the patient was treated as a body.33 Patients consistently identified communication, comfort, dignity, and family presence as priorities, with convergence across patient, family, and clinician perspectives on the centrality of human connection.19 Qualitative work with ICU nurses further extends this view to end-of-life care, framing dignity-preserving practices, relief of suffering, respect for patient identity, family presence, and a peaceful environment as central to dying with dignity in the ICU.35More recent work highlights that personhood is shaped through everyday interactions. A qualitative study of survivors of continuous positive airway pressure delivered via a helmet in Italy showed that nurse presence, communication, and reassurance preserved personhood, whereas isolation and depersonalization concerns eroded it during pandemic conditions.31 Together, these findings show that personhood is enacted through routine relational practice and is especially vulnerable under conditions of system strain.Clinician characteristics and organizational context strongly influence the delivery of humanistic care in the ICU. Two cross-sectional surveys quantified the individual factors associated with person-centered and dignified care. A study of ICU nurses in South Korea identified compassion satisfaction as the strongest predictor, followed by emotional intelligence and ICU experience52; a larger study in China similarly identified emotional intelligence and empathy as key predictors, along with professional values and training.29Qualitative studies provide insight into how these capacities operate in practice. A focused ethnographic study showed that empathy functions as a dynamic, reciprocal process shaped by nurse-patient relationships and unit culture, while a qualitative study identified training, role modeling, and personal experience as key sources of compassionate care.34,49 Nurses described compassion as both an ethical responsibility and a relational practice extending beyond task completion.Organizational context further shapes these capacities. Studies demonstrate that supportive work environments, education, and institutional culture enable humanistic care, whereas workload, burnout, and pandemic-related disruptions constrain it.17,38,44 Complementary qualitative work indicates that empathy is recognized by ICU nurses as central to humanized care and is shaped by individual, relational, and organizational factors.45 Targeted communication strategies, including specific verbal and nonverbal techniques for expressing empathy in family-clinician conversations,37 and explicit attention to the enablers of and barriers to compassionate care delivery25 further support a structured, organizationally supported approach to humanistic ICU practice.Together, these findings indicate that humanizing care depends on both individual clinician capacities and the organizational conditions that support, or limit, their expression.The best available evidence (levels B and C, Table 3) affirms that humanizing critical care is not ancillary to clinical excellence but central to it.Several structured interventions show promise and are available for immediate adoption at low cost. Patient photographs and biographical boards such as the Get to Know Me board have demonstrated benefit in preserving patient identity, fostering empathy, and helping clinicians relate to patients as individuals.9,15Attention to the physical care environment is equally warranted. A pre-post intervention study showed that a noise reduction bundle improved nurses’ knowledge and noise-reduction practice.43 A descriptive cross-sectional study likewise showed that environmental stressors negatively affected sleep and patient experience.16 These findings reinforce that small, routine aspects of the care environment can carry real weight for patients. Future work should examine environmental modifications such as room design, noise reduction, light cycle management, and family space as components of a broader humanization strategy.At the relational level, caring touch, narrative nursing approaches, and family-inclusive initiatives such as outdoor excursions and family engagement during interdisciplinary rounds each demonstrate value in fostering human connection in the ICU.20,30,40,42 Patient and family accounts reinforce what the data suggest: positive ICU experiences were defined above all by a sense of safety and being seen, whereas negative experiences centered on dignity violations, lack of empathy, and perceived loss of control.41 Ethnographic evidence further reveals that personhood is actively and continuously negotiated through clinical interactions and can be undone by the impersonal demands of task-based care.28,32 This evidence highlights that humanizing care is less about isolated acts and more about the overall environment nurses create.At the individual and organizational level, compassion satisfaction, emotional intelligence, and professional values are consistently the strongest drivers of person-centered and dignified care.29,52 Empathy functions not as a fixed trait but as a dynamic, reciprocal process shaped by unit culture and relational context.34,49 This body of evidence points to a clear need for institutional investment in programs that cultivate emotional intelligence, support compassion satisfaction, and actively mitigate burnout. The capacity of nurses to provide humanistic care is inseparable from the conditions in which they work.Beyond clinician-initiated recognition of personhood, future research should examine interventions that enable patients to actively enact their own identities during critical illness through meaningful activity, occupation, or role engagement as a distinct and underexplored mechanism of humanistic care. The International Classification of Functioning, Disability and Health offers a useful framework to distinguish participation (ie, engagement in meaningful life roles) from body function and activity alone.54 In practice, this might include music therapy tailored to a patient’s musical identity, occupation-specific activities guided by an occupational therapist, or early mobilization goals oriented around return to parenting, work, or other valued roles. Humanizing the ICU may ultimately require not only ensuring that clinicians see the patient as a person, but designing care that enables the patient to act as one.Although the search was conducted in PubMed using a broad, multiterm strategy, restriction to a single database may have introduced selection bias and limited the retrieval of relevant literature. Notably, the existing literature is characterized by significant conceptual heterogeneity with which humanization is operationalized across studies. Terms such as dignity, personhood, compassion, empathy, and person-centered care are often used interchangeably, yet each carries distinct theoretical and clinical implications. This inconsistency complicates cross-study comparison and underscores the need for consensus definitions and standardized measurement approaches to advance the field. Additionally, the studies identified in this review were predominantly qualitative, observational, or conducted at single sites, which limits how broadly their findings can be applied. Few have examined whether humanizing interventions produce meaningful downstream effects on clinical outcomes, length of stay, or family psychological well-being over time. Future research should employ prospective, controlled designs and assess implementation fidelity and sustainability across diverse ICU populations and settings.This evidence synthesis demonstrates that humanizing the ICU is not ancillary to clinical excellence but central to it. Low-cost bedside tools, intentional relational practices, and institutional investment in nurse emotional well-being each contribute to preserving patient personhood and dignity. Sustaining humanized care ultimately requires a commitment, at both the individual and organizational level, to recognizing every patient as a whole person.