Good practices for humanization in pediatric intensive care units: a national Delphi consensus study

Abstract

Objectives: To adapt and validate a good practice manual on humanisation, originally designed for adult critical care patients, to the paediatric intensive care unit (PICU) context. Methods: A methodological study to adapt and validate a clinical practice manual was conducted using a threeround Delphi consensus technique between February and October 2023 with 53 experts (56.6 % nurses, 28.3 % physicians, 15.1 % other professionals) from 15 Spanish hospitals. In the first round, participants evaluated 160 practices from the Manual of Good Practices in Humanization for Adult Intensive Care Units (HU-CI Project) and adapted them to the paediatric context. In the second round, they validated these modifications and 30 additional proposals. In the third round, the consensus practices were classified into three levels. Consensus was defined as ≥75 % agreement. Results: Of 57 initial participants, 53 completed the three Delphi rounds, resulting in a 93 % retention rate. Among participants, 79.2 % were women, 56.6 % were nurses, and 94.4 % had experience in PICUs. From the original 160 initial practices, 47.4% (n = 76) reached consensus without modification, 16.9 % (n = 27) were modified, and 35.6 % (n = 57) were discarded. Additionally, 30 new practices were proposed and accepted, resulting in 132 final practices. These were categorised as basic (65 %, n = 86), advanced (22 %, n = 29), and excellent (13 %, n = 17). Conclusions: This study adapted and validated the first humanisation manual specifically for PICUs, providing a structured, measurable framework that may promote child- and family-centred care and support continuous quality improvement. Implications for clinical practice: The consensus-validated practices provide PICU teams with a structured, measurable framework that may help promote child- and family-centred care. Nursing staff play a key role in daily implementation of family involvement, communication, and comfort measures, whilst the three-level classification allows progressive evaluation of PICU humanisation according to unit resources.