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

## TL;DR

This paper introduces a new scale to assess the well-being and sense of safety of intubated ICU patients, co-developed with patients and professionals.

## Contribution

A novel patient-co-constructed scale for real-time assessment of ICU patient well-being and safety.

## Key findings

- A 4-item scale (Comfort, Safety, Information, Trust) was developed and validated for bedside use.
- The scale demonstrated improved reliability and coherence after psychometric analysis.
- Focus groups emphasized the importance of communication and human support in ICU settings.

## Abstract

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.

The online version contains supplementary material available at 10.1186/s13054-026-05923-z.

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.

The online version contains supplementary material available at 10.1186/s13054-026-05923-z.