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

Abstract

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). Qualitative descriptive study. 29-bed university-affiliated ICU. 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. 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. Perspectives and experiences of patients, family members and clinicians. 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 <i>identity, inclusivity and impact</i>. 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. 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.