Well-being and sense of security of intubated patients in intensive care units: a patient co-constructed dedicated scale

Intensive care unit (ICU) patients endure significant stress due to their critical condition, communication difficulties, and the hostile environment. Despite efforts to humanize ICUs, there is a lack of real-time assessment tools for patient well-being and sense of safety. The aim of this project was to develop a scale assessing the feeling of well-being and safety in real time among intubated patients. A systematic review was performed to identify study outcomes evaluating well-being and sense of security. Results were used to organize focus groups and explore patients’ experiences during their ICU stay. The scale was then developed via Delphi methodology by a patient-professional group. The scale was validated through patient interviews for face validity and implementation in a multicentric French cohort. Lastly, the scale was translated in English. The systematic review included 137 articles. Focus groups (23 former patients and 5 relatives) highlighted communication challenges and the need for human support. Scale construction resulted in an initial 6-item pragmatic bedside tool. Face validation showed that the constructed scale was acceptable and led to refining the scale by changing item evaluation formats to a 4-stage Likert scale. Cohort validation, comprising 305 scale administrations (84 patients), indicated overall satisfaction and adequate completion rates. Psychometric analysis led to the removal of two items. A simplified 4-item scale (Comfort, Safety, Information, Trust) demonstrated improved reliability and coherence. The final scale provides a practical measure of patient well-being in ICUs and is usable in real time at the bedside. A simple, quick, and effective scale to assess, in real-time at the bedside, the well-being and sense of safety of intubated patients and all patients hospitalized in intensive care units, was co-constructed with former patients, relatives, and healthcare professionals.