Intensive and Critical Care Nursing (2015) 31, 343351

Available online at www.sciencedirect.com

ScienceDirect
journal homepage: www.elsevier.com/iccn

ORIGINAL ARTICLE

The intensive care unit psychosocial care

scale: Development and initial validation
Meena Hariharan a, Usha Chivukula b, Suvashisa Rana a,
a
b

Centre for Health Psychology, University of Hyderabad, Hyderabad, India

St Francis Womens College, Hyderabad, India

Accepted 19 June 2015

KEYWORDS
Intensive care unit;
Psychosocial care;
Human dignity and
rights;
Sustained patient,
Family orientation

Summary The main objective of the current study was to construct a new self-report scale
ICU-PC Scale to measure the psychosocial care (PC) of patients in Intensive Care Unit (ICU)
and examine different psychometric issues in the development and initial validation of this
scale. The ndings indicate that the ICU-PC Scale has established high internal consistency.
A three-factor structure protection of human dignity and rights, transparency for decision
making and care continuity and sustained patient, family orientation has been identied
with a substantial number of subjects (N = 250) in hospital settings. The three oblique factor solutions are found to be interrelated and interdependent with good indices of internal
consistency and content validity. This new instrument is the rst of its kind to measure the
psychosocial care to be provided to patients in the ICU. The present ndings indicate that the
ICU-PC scale, with additional factor analytic research, could become an established and clinical
tool.
2015 Elsevier Ltd. All rights reserved.

Implications for Clinical Practice

This new instrument ICU-PC Scale is the rst of its kind to measure the psychosocial care to be provided to
patients in the ICU.
Though the scale has been developed with cardiac patients only, the extent of measurement has potential to be
extended to any patients treated in ICU.

Corresponding author at: Centre for Health Psychology, University of Hyderabad, Central University Campus PO, Gachibowli, Hyderabad
500046, India.
E-mail address: suvemail@gmail.com (S. Rana).

http://dx.doi.org/10.1016/j.iccn.2015.06.003
0964-3397/ 2015 Elsevier Ltd. All rights reserved.

344

M. Hariharan et al.

This instrument is designed for use with both men and women in clinical settings.
Compared with other available instruments, this scale is brief, easy to understand, less time consuming and easy to
administer and score.
The scale has the potential to help the researchers and practitioners to quantify psychosocial care in clinical settings,
especially in ICU.

Introduction
Psychosocial care in the context of intensive care units
(ICU) in hospital settings refers to specic supportive interventions such as providing explanations, reassuring and
raising faith and hope, cheering-up, strengthening patients
self-esteem, giving emotional warmth, offering empathetic
listening, empathetic touch and spending extra time with
patients (Frazier et al., 2002). Such interventions can work
as a buffer against ICU trauma experienced by patients. ICU
trauma refers to intense negative psychological states that
impact well-being.
Psychosocial Care originates from the biopsychosocial
model of health care, which in short is referred as patient
centered care. The Institute of Medicine (IOM, 2001)
dened patient-centered care as care that respects and
responds to the individual patients preferences, needs and
values, and ensures that clinical decision-making incorporates patients values. In simple terms it refers to
viewing and responding to illness through the patients
perspective (McWhinney, 1989), that calls for high quality
communication (Hobbs, 2009) accompanied with appropriate intervention (Mead and Bower, 2000).
Psychosocial care, which is the crux of patient-centered
care, is advocated in the context of treating cancer where
the implied terminality of the disease gives rise to negative
psychological consequences. In such cases there is a pressing
need to effectively address the issue of emotional well-being
of patients and members of their families (Andrykowski and
Manne, 2006), management of pain (Gorin et al., 2012),
fatigue (Kangas et al., 2008), loss of body image and isolation and distress (Holland et al., 2013).
A negative emotional state is closely associated with
physical health status (Gallo and Matthews, 2003), heart
problems (Kubzansky and Kawachi, 2000), and experience
of pain intensity (Bair et al., 2008). This cannot be ignored
as an isolated factor because several studies demonstrated
its direct impact on health, illness, convalescence and prognosis (Rozanski et al., 1999).
A patient is admitted into ICU when s/he requires
constant observation from the medical team physician/doctor and nurse either because the medical
condition is serious or the patient is post major surgery.
Several studies identied psychological repercussions of ICU
stay, caused by a combination of physical pain, physical
environment, isolation from family, apprehensions about
the medical outcomes, dependency and loss of autonomy.
Known as ICU trauma, they include intense adverse emotions such as fear, anxiety, agony, loneliness, bewilderment,
depersonalisation, hopelessness and acute confusion (Lusk
and Lash, 2005), feelings of purposelessness and loss of
condence (Granberg-Axell et al., 2001; Johansson and
Fjellman-Wiklund, 2005; Johnson et al., 2006), dependency and vulnerability (Gjengedal, 1994; Samuelson, 2006;

Almerud et al., 2008), powerlessness, frailty and vulnerability (Henriksen and Vetlesen, 2000) and feelings of
insecurity (Samuelson, 2011). The ICU trauma manifests
in many ways such as delirium, characterised by a high
state of distress (Van Rompaey et al., 2008). Several studies have indicated that about 70% of patients admitted
in ICU suffer from delirium (Fong et al., 2009; Miller,
2008; Pun et al., 2005) whereas in the case of postoperative cardiac surgery patients the percentage is 14.7%
(Arenson et al., 2013).
Coronary artery bypass graft (CABG) surgery is associated with high levels of apprehension, anxiety, depression
and psychological distress (Ebirim and Tobin, 2011; Powell
and Johnston, 2007; Chaudhury et al., 2006), and cognitive
impairment (Duits et al., 1997). Association of depression
with poor recovery is also observed (Lopez et al., 2007;
Murphy et al., 2008). Recent studies validate that posttraumatic stress disorder (PTSD) is prevalent in 14.7% of
CABG patients (Dao et al., 2010). The symptoms of PTSD,
including traumatic memories related to CABG surgery,
are evident in up to 18% of 148 patients in a six-month
follow-up study. The study, on stressful experiences in CABG
patients, reveals that patients feel the ICU experience as
hard (Gois et al., 2012). CABG patients are at a risk of anxiety and depression. It is found that 8% of CABG patients had
major anxiety symptoms and 14% major depression symptoms (Murphy et al., 2008), and that depression continued
for three years in 52% of patients, adversely impacting their
well-being (Karlsson et al., 2008).
To minimise such inadvertent adverse impact of ICU
trauma, the Accreditation Boards of Hospitals such as
National Accreditation Boards of Hospitals (NABH), and Joint
Commission International (JCI) have provided specic guidelines that integrate psychosocial care into patient care in
ICUs. Indicating the mitigating effect of family support,
Bergbom and Askwall (2000) found the presence of family
as helpful in neutralising the psychological distress in ICU
patients. However, in view of life risk condition, the focus
of medical and para-medical staff gets concentrated on the
biomedical needs of the patients resulting in psychosocial
care taking a back seat (Hariharan and Chivukula, 2011).
Hence, in view of the negative impact of ICU stay and the
role of psychosocial care in minimising, if not mitigating the
adverse impact of ICU stay, there is a dire need to standardise a scale that measures psychosocial care in ICU so as to
quantify the psychosocial care in ICU practices. Such tools
will go a long way in measuring the parameter and ensuring a holistic approach in ICU practices so as to counter ICU
trauma.
Hence, the main objectives of the study were to (i) construct a self-report scale to measure the psychosocial care
of patients in ICU, (ii) assess its underlying structure and (iii)
examine different psychometric issues in the development
of this scale.

Intensive care unit psychosocial care scale

Phases in the development of the ICU-PC Scale

We developed items for the ICU-PC Scale in three phases
item construction, content evaluation and pre-test and
reliability analysis. After these three phases, a follow-up
study was conducted to evaluate the internal structure and
initial psychometric properties of the nal scale.
Phase 1: item construction. The preliminary pool of items
were developed from multiple sources. Initially items were
constructed based on pertinent reviews related to psychosocial care meant for different categories of patients,
especially patients admitted in the cardiac ICU. Certain
self-report measures (Hariharan and Chivukula, 2011) and
studies on ICU cardiac patients (Legg, 2011; Novaes et al.,
1999) were also referred to, in order to construct relevant
items. During the initial process of developing items, indepth interviews were conducted with ten cardiac patients
after their transfer from the ICU to a general ward. Experts
two cardiologists and two psychologists having at least
15 years of experience were consulted during the process of
generating items. Our observations also contributed to the
development of the items. During our observation in cardiac
ICU, we interacted with the nurses on duty and the caregivers of the patients to understand the various indicators
of psychosocial care. Thus initially 50 items were developed
and reviewed to avoid ambiguity, duplication, overlapping
and redundancy. An attempt was made to bring clarity and
simplicity to the items. During this review phase, four nurses
with 810 years of experience in cardiac ICU were consulted
and their feedback was taken for each item. A number of
items were also modied as per their suggestions. Following
the preliminary review, 35 items were retained in the initial
phase in the development of the ICU-PC Scale.
Phase 2: content evaluation. The extent to which the
scale represented all facets of psychosocial care for cardiac
patients in ICU was assessed by means of content validity
(Lawshe, 1975). Based on the assumption that higher levels
of content validity exist as larger numbers of experts agree
that a particular item is essential, Lawshe formulated the
content validity ratio (CVR) as follows.

CVR =

Ne

N
2

N
2

Here Ne refers to the number of experts indicating the item

as essential, and N refers to the total number experts.
This formula yields values ranging from +1 to 1. Thus, the
ICU-PC Scale was given to a panel of 10 experts in the eld
of Psychology and Medicine. The panel constituted of ve
doctors (intensivists/cardiothoracic surgeons) and ve psychologists. The panel of experts were asked to read each
of the items carefully and decide whether that item was
essential to measure the psychosocial care of the ICU
patients or not with two alternatives (0 = not at all essential, 1 = very much essential). Since the number of experts
was 10, the recommended CVR for each of the item was .62
and above (Lawshe, 1975). On this criterion, 11 items were
deleted and 24 items were retained as items in the preliminary form of the ICU-PC Scale for its trial run (pre-test) and
reliability analysis.

345
Phase 3: pre-test and reliability analysis. In the 24-item
preliminary form of the ICU-PC Scale, we assigned a vepoint scale for rating each item (1 = never to 5 = always).
In addition to this, we wrote instructions for completing
the scale. The written instructions for the participants also
indicated that they need to recall the experience carefully
and provide feedback based on their experience. The scale
was pilot tested with a sample of 50 cardiac patients to
observe the correlations among the 24 items and compute
reliability estimates based on the responses of this clinical sample. Of the sample, 74% were men and 26% were
women. The age of the sample ranged between 30 to 76
years (mean age = 60.12 years, SD = 9.32). The duration of
their stay in hospital varied between two and seven days
(mean duration = 3.74 days). After the data in respect of 24
items were analysed by means of reliability analysis with the
alpha model using IBM SPSS Statistics for Windows, Version
20.0 (IBM Corp. Released, 2011), six items were removed
due to their comparatively low item-total correlation. The
remaining 18 items revealed high internal consistency, with
an alpha coefcient of .75 and an average item-total correlation of r .34. When analysed, the content of the six
deleted items were found to be very general in nature.
After dropping the six items on the level of inter item correlations or face validity, there was also no redundancy in
meaning observed among the remaining 18 items. Thus, the
obtained alpha value exceeded the recommended value of
.70 (Nunnally, 1978), indicating adequate internal consistency of the 18-item ICU-PC scale.

Validation of the ICU-PC Scale: follow-up study

After the completion of the standard initial process for the
development of the scale (Norbeck, 1985; Cicchetti, 1994;
Haynes et al., 1995), we conducted a follow-up study with
a larger clinical sample and used exploratory factor analysis
(EFA) to identify the internal structure of the set of items of
the ICU-PC Scale and to group these items into factors.

Method
Participants
A multistage sampling method was used for the study. The
rst unit of sampling was the hospitals and the last unit of
sampling was the patients who underwent Coronary artery
bypass graft (CABG) and stayed in the ICU for a minimum
period of two days. A total of 250 patients constituted the
participants. In the rst stage, 15 hospitals out of a total
of 24 hospitals in two citiesHyderabad and Secunderabad
in Indiawere screened. Out of these, 10 hospitals were
selected by means of simple random sampling. These hospitals were approached for permission to conduct the study.
Based on the following inclusion and exclusion criteria, a
total of ve hospitals were retained in the sample. The inclusion criteria for hospitals were (1) hospitals that were
accredited by the National Accreditation Board for Hospitals (NABH), (2) hospitals with an Intensive Cardiac Care Unit
(ICCU), (3) hospitals where at least 12 CABG surgeries per
week were performed and (4) hospitals willing to sign the
Informed Consent Form.

346
In order to reach the sample size of 250 patients, a
quota sampling method was followed. A total of 50 CABG
patients from each of the ve hospitals were included in
the study. All the men and women patients within the age
group of 4075 years who underwent CABG, were moved
to the ward/room after a minimum stay of two days in the
ICU, in a condition to communicate verbally and signed the
Informed Consent Form, were included in this study. CABG
patients were excluded who were below the age of 40 years
and above 75 years, unable to communicate because of their
post-operative physical condition, with a history of chronic
or acute disease other than the cardiac problem, with a history of chronic psychological disorders or any other medical
complications, and those who were terminally ill. Among the
250 patients thus recruited for the study, 70% were men and
30% were women. The age of participants varied between
40 and 75 years (mean age = 55.2 years).

Procedure
This study was conducted after obtaining ethical approval
from the Ethics Committee of the University, where the
researchers worked. In addition to this, formal permission
was also taken from the authorities of the hospitals prior to
sample selection. The selected participants took part in this
study individually. They read the written instructions on the
scales. In certain cases, where the participants were unable
to read, the investigator read out the contents for the participants and recorded their responses. Then a brief clinical
history form was lled for the participants. Considering the
post-operative stage of the participants, administration of
the scale was staggered to two to three sittings as per the
convenience of the participants. In each session, the investigator claried the doubts raised by the participants. In
the last session with each participant, after completion of
the scale, a brief post-assessment interview was conducted
to understand their feelings. After completion of such interviews, when participant had no further questions, they were
debriefed verbally.

Results
Exploratory factor analysis
The 18 items of the ICU-PC Scale were subjected to
exploratory factor analysis (EFA) using the maximum likelihood (ML) extraction method, followed by the direct
oblimin (oblique) rotation method to allow for correlation
between the factors. The sample was rst assessed for its
suitability for factor analysis. Bartletts Test of Sphericity (Bartlett, 1954) was highly signicant (p < .001) and the
KaiserMeyerOlkin (KMO) measure of sampling adequacy
value was .84, which supported the factorability of the
matrix (Tabachnick and Fidell, 2013). Communalities are
presented in Table 1.
Items Nos. 5, 7, 9 and 17 having communality values lower
than .30 were deleted from the scale in order to increase the
total variance explained. Since these items were removed,
the EFA was run again to derive new solutions with the nal
14 items of the scale using the same extraction and rotation
methods. No prior number was assigned for the extraction

M. Hariharan et al.
Table 1
Scale.

Communalities for items of the 18-item ICU-PC

ICU-PC Scale items:

Original item number

Communalities
Initial

Extraction

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

.388
.442
.436
.404
.135
.408
.153
.404
.283
.496
.376
.373
.585
.606
.320
.446
.263
.344

.527
.471
.478
.429
.091
.377
.132
.477
.182
.592
.614
.412
.654
.808
.448
.500
.220
.434

Note. Extraction method: maximum likelihood.

of factors. Here Bartletts Test of Sphericity was also highly

signicant (p < .001) and the KMO measure of sampling adequacy value was .86, exceeding the recommended value
of .6 (Kaiser, 1970, 1974). This clearly indicated that the
sample was suitable for carrying out factor analysis for the
validation of the scale.
The item means, standard deviations and inter-item correlation matrix are presented in Table 2. On a ve-point
scale, where 1 = never to 5 = always, the means ranged from
2.85 (Item 8: the patient is assured that . . .) to 4.28 (Item 16:
A curtain is drawn around . . .). Examination of the correlation matrix indicated that the majority of the correlation
coefcients were .3 or above. No inter item correlation
exceeded r = .63, thus showing no problems with multicollinearity.
We used two criteria to determine factor extraction, such
as the scree plot and Kaisers eigenvalue >1. The scree plot
(Fig. 1) and Kaisers eigenvalue >1 criterion led to the extraction of three factors. From Table 3, it was observed that the
Factor 1, 2 and 3 accounted for 32.09%, 7.15% and 4.12%
respectively of the explainable variance. The factor solution converged in seven iterations within a simple structure.
The factors themselves were correlated, and the correlation
coefcients (r) between Factor 1 and 2, 1 and 3 and 2 and 3
were found to be .47, .36 and .43 respectively. This indicated
that all three factors were interrelated and interdependent.
Each item loaded .30 or higher on its expected factor. The
ICU-PC Scale items, pattern and structure coefcients (factor loadings), along with reliability estimates are presented
in Table 3.
After the identication of the three factors from the 14
items of the ICU-PC Scale based on the EFA, factors were
named as per their contents. Factor 1 was labelled Protection of human dignity and rights as all the six items loading
within this factor emphasised the practices in ICU that

Intensive care unit psychosocial care scale

Table 2

347

Correlation matrix, means and standard deviations for the 18-item ICU-PC Scale.

Item

10

11

12

13

14

15

16

18

1
2
3
4
6
8
10
11
12
13
14
15
16
18

1.00
.40
.36
.44
.25
.35
.08
.10
.10
.16
.22
.19
.31
.19

1.00
.55
.37
.35
.30
.33
.34
.34
.36
.34
.24
.28
.23

1.00
.36
.41
.36
.29
.26
.27
.29
.35
.17
.35
.18

1.00
.37
.39
.32
.34
.23
.35
.35
.26
.34
.14

1.00
.43
.36
.22
.23
.39
.35
.18
.20
.20

1.00
.21
.11
.25
.32
.22
.30
.22
.35

1.00
.43
.47
.49
.59
.07
.37
.18

1.00
.36
.47
.41
.27
.30
.13

1.00
.44
.35
.15
.19
.32

1.00
.63
.39
.45
.41

1.00
.18
.59
.31

1.00
.24
.30

1.00
.31

1.00

M
SD

3.84
0.83

3.41
0.84

3.48
0.82

3.09
0.91

3.48
0.88

2.85
0.97

4.07
0.77

3.09
0.88

3.43
0.78

3.20
0.95

4.04
0.79

2.95
0.85

4.28
0.77

3.35
0.83

protect the human dignity of the patient. Specically,

patients in a condition of high dependency and vulnerability
and addressing the rights of the patients and their families who are separated in the interest of the patient for
purely medical reasons. Further, the items in the factor refer
to catering to the emotional/spiritual needs of the family, which constitutes an important right. The items listed
under this factor ensure that such isolation of patients do
not deprive the family of necessary information about the
patient and adequate care is taken to maintain the information link between the family and the patient.
Factor 2 was labelled Transparency for decision making and care continuity as all the six items loaded within

Figure 1

this factor reected continued information to families for

democratic decision making related to treatment. Specifically the choice of doctor and continuation of patients
home care on discharge, as well as reassurance and anxiety reduction measures such as informing the patient about
the availability of family members outside the ICU in case
of need.
Factor 3 was labelled Sustained patient, family orientation as the two items loaded within this factor focused
on orienting the patient about time and orienting the family on the patients condition both on daily basis. This is
essential to prevent the cognitive health of the patient from
becoming susceptible to disorientation of time and date due

Scree plot from exploratory factor analysis of the ICU-PC Scale data.

348

M. Hariharan et al.

Table 3

Pattern and structure matrix for maximum likelihood with oblimin rotation of three factor solution of ICU-PC Scale.

ICU-PC Scale items:

original item number
and content

Pattern coefcients
1

Item
Item
Item
Item
Item
Item
Item
Item
Item
Item
Item
Item
Item
Item

.830
.724
.634
.520
.486
.405
.181
.134
.174
.152
.039
.234
.027
.149

.041
.045
.106
.043
.063
.176
.680
.676
.590
.504
.469
.399
.094
.035

.205
.086
.471
.069
.068
.146
.066
.122
.032
.057
.264
.038
.562
.462

.776
.776
.751
.565
.540
.541
.166
.412
.443
.412
.278
.438
.218
.330

.348
.427
.398
.319
.323
.432
.622
.688
.659
.601
.564
.527
.323
.305

.109
.363
.651
.272
.268
.366
.294
.217
.284
.328
.452
.294
.593
.530

10
14
13
11
12
16
1
3
2
4
8
6
15
18

Scale reliability estimate

Coefcient alpha
Number of items
Mean interitem correlations
Percentage of explained variance

Structure coefcients

Factor 1
.82
6
.44
32.09

Factor 2
.78
6
.38
7.15

Factor 3
.47
2
.30
4.12

Note. Extraction method: maximum likelihood; rotation method: Oblimin with Kaiser normalisation, rotation converged in seven iterations. The factor loadings for the ICU-PC Scale items belonging to each factor are printed in bold.

to the continuous stay in ICU. Furthermore orientating the

family about the patients condition on a daily basis to aid
reduction of anxiety for the family.
Subscale scores were calculated by adding the scores of
the items from each factor that the participant responded
to. The internal consistency of the entire set of 14 items
( = .86) was higher than that of the individual subscales
( = .82 for protection of human dignity and rights, .78
for patient-family care continuity, and .47 for respect to
patients privacy). However, the reliability of the two items
with respect to the patients privacy subscale was below
the acceptable norm for individual diagnosis (Nunnally and
Bernstein, 1994).
To identify the differences across the three subscale
scores, a one-way repeated measures ANOVA was carried
out. The results revealed a signicant difference across
the three-factor scores means, F(2,248) = 3540.05, p < .001.
Post hoc (Bonferroni) comparisons showed that average
scores for protection of human dignity and rights (M = 22.11,
SD = .23) and patient-family care continuity (M = 20.15,
SD = .23) were signicantly higher (p < .001) than that of
respect to patients privacy (M = 6.30, SD = .09). Thus the
participants viewed protection of human dignity and rights,
and patient-family care continuity as two important characteristics of psychosocial care in ICU.

Discussion
The main objective of the current study was to construct
a new self-report scale to measure the psychosocial care of
patients in ICU and to examine different psychometric issues
in the development of this scale. The ndings indicate that

the ICU-PC Scale has established high internal consistency.

A three-factor structure protection of human dignity and
rights, transparency for decision making and care continuity
and sustained patient, family orientation has been identied in hospital settings. The three oblique factor solutions
are found to be interrelated and interdependent with good
indices of internal consistency and content validity.
This new instrument is the rst of its kind to measure the
psychosocial care to be provided to the patients in the ICU.
Though the scale has been developed using cardiac patients,
the extent of measurement has potential to be extended to
any patients treated in ICU. This instrument is designed for
use with both men and women in clinical settings. Compared
with other available instruments, this scale is brief, easy
to understand, less time consuming and easy to administer
and score. The scale can facilitate researchers and practitioners to quantify the psychosocial care in clinical settings,
especially in ICU.
In this ongoing research work, though we have discussed
good preliminary psychometric information regarding the
ICU-PC Scale, it is essential for the potential users of this
measure to be aware of the limitations. Construct validity needs to be established by using conrmatory factor
analysis and other approaches. More numbers of inpatients are required to verify the stability of the factor
scores. There is also a need to establish the norm of the
scale for better interpretation and understanding patients
perspectives.
Despite these limitations, the ndings of our study indicate that the ICU-PC Scale has a well-dened structure
and good reliability estimates. As with any new self-report
measure, potential researchers could establish a range of
psychometric properties for the scale. For example one such

Intensive care unit psychosocial care scale

issue is for the examination of invariance of the structure
of the domains across men and women in vulnerable age
groups. Assessment of stability of scores on the scales also
needs to be done. Evaluation of the incremental validity of
scores of the scales could increase the objectivity of the
measure. Moreover, we request that researchers and practitioners build further support for the factor structure and

349
psychometric properties of the ICU-PC Scale by using the
measure in their research and clinical practice.

Conict of interest
The authors have no conict of interest to declare.

Appendix A.
ICU-PC Scale
(Information provided here in any form will be kept confidential and used purely for research purposes)
1. Patient ID: ________________________________________
2. Name: __________________________________________________________________________________
3. Gender: ___________________ 4. Age ________________ 5. Duration of stay in ICU: _________________
6. Nature of problem: ________________________________________________________________________

Instructions:
There is an attempt to observe and identify the practices in ICU. This rating scale relates to the specific
practices adopted in the ICU of the hospital you are admitted. The statements refer to you as patient and your
family as patients family. Kindly read them carefully and respond appropriately by giving information
regarding the ICU practices. Listed below are a few statements. You need to read each statement and select by
encircling a response from the five options mentioned in columns. For example,
The patient is monitored round the clock by the medical staff.

1 = Never
2 = Rarely
3 = Sometime
4 = Most Often
5 = Always
In case you feel that the medical staff rarely monitor the patient, you need to encircle 2 against the statement.
There is no right or wrong answer.
1. The family is informed in advance about the expenditure of the procedures.
2. Specific time is allotted to the family by one of the members of the health care team
to answer questions and concerns.
3. The diagnosis is informed to the family.
4. The doctors experience and expertise in handling particular kinds of cases is
notified.
*5. The family members are unsure as to where they can lodge a complaint or
represent their grievances.
6. The patient/family is clearly explained about the benefits of the treatment program.
7. The patients feelings agitation and anxiety are handled effectively by the ICU team.
8. The patient is assured that his/her family is just outside the ICU and available on
call.
*9. Patient family are informed about tests and procedures only after they are done.
10. A curtain is drawn around the patient during examination, procedures, and
treatment.
11. There is a provision in the hospital to take care of the spiritual needs of the
patient/family.
12. The family is kept informed about the progress or decline of the patients health
status.
13. There is an exit meeting before the patient is discharged, where the patient or
family is explained about post discharge care like diet, exercise, alarm signals etc.
14. A curtain is around the patient while taking care of his/her toilet and bowel needs.
15. The patient is kept informed about the change in the day, date, and time (day and
night).
16. A curtain is drawn around the patient while he/ she is sponged.
*17. The family is uncertain as to where the patient is taken for specific tests.
18. The doctor or the nurse briefs the family about the condition of the patient on a day
to day basis.
*Reverse scoring
Factor 1: Protection of human dignity and rights (Items 10, 11, 12, 13, 14, and 16)
Factor 2: Transparency for decision making and care continuity (Items 1, 2, 3, 4, 6, and 8)
Factor 3: Sustained patient, family orientation (Items 15 and 18)
Permission is required to use the ICU-PC Scale. For the permission, please write to the corresponding author.

1
1

2
2

3
3

4
4

5
5

1
1

2
2

3
3

4
4

5
5

350

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