Background: When relatives of patients in intensive care units (ICUs) perceive themselves to be respected, this may help prevent feelings of loneliness, guilt, and anger, thereby reducing the level of anxiety they experience. The aim of this study was to examine the relationship between the anxiety levels of relatives of patients in ICUs and their perceived respect from healthcare professionals, and to determine the predictive effect of perceived respect on anxiety.

Methods: This study, which was designed to be descriptive, correlational, and predictive, was conducted in the adult ICUs of an educational and research hospital in Türkiye. The study sample consisted of 300 relatives of patients receiving treatment in the ICUs. Data were collected using a Personal Information Form developed to determine participants’ characteristics, the ICU-Respect Index (ICU-Respect) to assess the level of respect perceived by relatives of patients from healthcare professionals, and the State–Trait Anxiety Inventory (STAI-S) to evaluate anxiety levels.

Results: The mean ICU-Respect score of the participants was 39.38 ± 1.32, while the mean STAI-S score was 43.39 ± 18.22. The correlation analysis revealed a statistically significant, moderate negative relationship between the scales (r = −0.449, p ≤ 0.001). According to the results of the regression analysis, the level of perceived respect was found to be a significant predictor of anxiety (β = −0.491, p ≤ 0.001), and the model explained 24% of the total variance (R² = 0.241).

Conclusions: It was determined that as the level of respect perceived by relatives of patients in ICUs increased, their state anxiety levels significantly decreased. This finding suggests that if healthcare professionals use respect-based communication approaches in combination with family-centered care principles, then this may be effective in reducing psychological distress among the relatives of patients. It is recommended that healthcare professionals develop an empathetic and respectful communication style that addresses the emotional needs of the relatives of patients.

1. Introduction

Intensive care units (ICUs) are specialized hospital settings where critically ill patients are continuously monitored and provided with advanced treatment and life-sustaining support. These units utilize high-level medical technologies and multidisciplinary healthcare teams to maintain vital functions and manage complex clinical conditions [1]. While ICUs are essential for the survival and recovery of patients with life-threatening illnesses, prolonged stays are associated with a variety of complications, including healthcare-associated infections, ICU-acquired muscle weakness, and delirium [2, 3]. These complications affect not only patients’ long-term physical and cognitive health but also impose emotional and psychological strain on their families. As a result, the ICU environment requires attention to be paid to both medical treatment and the growing psychosocial needs of patients and their relatives [4–6].

Having a family member treated in an ICU triggers a complex psychological process for relatives. This process is marked by high levels of stress, uncertainty, and emotional distress. During this period, relatives often struggle with anxiety, specific fears, and ambiguity due to a lack of clear information about the patient’s condition [7]. When the patient’s condition deteriorates, feelings of hopelessness may dominate, while signs of recovery bring a sense of hope. The constant emotional shifts between these extremes can be mentally exhausting. Moreover, the inability to actively participate in the care process may lead to feelings of helplessness and inadequacy, which in turn can cause many relatives to feel guilty [8]. Inadequate information, communication problems, or a distant attitude from healthcare professionals may trigger negative emotions such as anger and distrust, as well as feelings of disappointment. Prolonged ICU stays increase the risk of developing depression, anxiety, and even post-traumatic stress disorder in some family members of patients [9]. The psychological well-being of the relatives of patients should thus be assessed, as ICU stays and inadequate support may lead to severe emotional distress and mental health challenges.

Anxiety is a psychological state characterized by internal feelings of worry, fear, or concern, often related to excessive apprehension about potential negative outcomes or uncontrollable future situations [10]. Relatives of patients in ICUs often experience heightened levels of anxiety, driven by the critical and life-threatening conditions of their loved ones, the uncertainty surrounding medical procedures, the unpredictability of outcomes, and the emotionally charged ICU environment. This anxiety is further exacerbated by their limited access to information regarding the patient’s condition, the complexity and ongoing nature of medical treatments, and the inherently stressful ICU atmosphere [11]. In a prospective observational study by Lobato et al. [12]; it was reported that family members of ICU patients exhibited elevated levels of anxiety and depression, primarily due to the critical nature of their loved ones’ illnesses and the uncertainty surrounding the treatment process. Similarly, Gurbuz and Demir [7] found that nearly half of the family members of ICU patients experienced significant anxiety. Krishnamoorthy et al. [13] highlighted factors, such as inadequate information, limited involvement in decision-making, and poor communication with healthcare professionals, which significantly contribute to increased anxiety among relatives. Yanmaz et al. [14] reported that two-thirds of the family members of ICU patients exhibited symptoms of anxiety or depression, with the fear of losing a family member and the highly stressful ICU environment further intensifying these psychological conditions. In this context, the implementation of family-centered care (FCC) is crucial for effectively addressing the emotional and psychological challenges faced by relatives, as it prioritizes the active involvement of family members, as well as emotional support and respect. Liu et al. [15] demonstrated that FCC not only improves satisfaction levels among patients and families in the ICU but also significantly reduces anxiety and depressive symptoms. Similarly, Yangjin et al. [16] emphasized that FCC enhances the overall quality of patient care while promoting the psychological well-being of relatives. These positive effects of FCC are due to its promotion of practices such as respect, empathy, good communication, and compassion, which support an individual’s psychological well-being [17]. Imanipour and Taheri [18] showed that such good communication reduces anxiety and helps family members feel acknowledged and involved in the care process. Research by Gunnlaugsdóttir et al. [19] and Love Rhoads et al. [20] further supports the notion that respectful and empathetic communication not only alleviates emotional distress but also facilitates active family participation in the care process. Moreover, when respect is integrated into care, families are more likely to trust medical decisions and adjust to the challenges of the ICU setting. Conversely, a lack of respect, manifested through cold, distant, or indifferent attitudes from healthcare professionals, can heighten feelings of loneliness, insecurity, and uncertainty [21, 22]. Respectful engagement is not only a moral obligation but also a key principle of FCC that directly influences the psychological resilience of relatives of patients.

Respect is a multifaceted attitude that encompasses various emotional and behavioral components, including making others feel valued, recognized, and acknowledged. When individuals perceive themselves to be respected, they believe that their experiences, emotions, and autonomy are being taken seriously and that they themselves are being approached with empathy [23]. In this regard, respect is not merely a personal experienced attitude but also emerges as a fundamental principle in professional ethics and institutional practices, particularly within healthcare services. From an ethical perspective, a respectful approach involves acknowledging the autonomy, rights, and participation of the relatives of patients in all decision-making processes. Considering the opinions of these family members fosters a fair and transparent communication environment. This, in turn, enhances their trust in healthcare professionals, provides them with emotional relief, and promotes their active involvement in care decisions. Moreover, maintaining an attitude of respect, as an extension of patient rights, ensures that the family members of patients are also treated in a manner that upholds their human dignity [24, 25]. This ethical understanding does not remain solely within a theoretical framework but manifests concretely in clinical practice through the inclusion of relatives of patients in consultations, consideration of their concerns, and recognition of their roles in the recovery process. From a cultural perspective, the ability to be sensitive to different belief systems, values, and ways of life strengthens the relatives’ sense of feeling welcome and belonging in the hospital. Showing respect for different cultural values in healthcare services leads to a more meaningful and acceptable care experience for both the patient and their family. Such respect can lead family members to be more willing to participate in the care process and to do so with greater confidence, while also helping to prevent the conflicts that may arise from cultural misunderstandings [26]. Thus, a culturally sensitive understanding of respect not only promotes an inclusive approach but also plays a critical role in building the emotional trust that relatives of patients place in the healthcare system. In terms of communication, respectful behavior involves active listening, showing empathy, and taking the emotions of family members seriously. This type of communication helps family members feel understood and valued. This emotional validation not only enhances families’ engagement in the care process but also shapes how they cope with the uncertainty and emotional burden they face. At the same time, it reduces negative emotions such as stress, anxiety, and uncertainty, thereby alleviating their emotional burden. In this context, respect can be understood not only as a functional and psychological support mechanism that helps regulate the anxiety levels of relatives of patients, particularly in high-stress healthcare settings such as ICU. Respectful communication enhances mutual understanding and collaboration between healthcare professionals and families, making the care process more effective and cooperative [23]. Although the importance of respect in communication with patients and their relatives has been discussed in the literature, no study has been found that demonstrates the effect of perceived respect on the anxiety levels of the relatives of patients admitted to the ICU. Given the inherently uncertain and emotionally charged nature of ICU, investigating whether respect has a regulatory effect on anxiety levels in such settings constitutes a significant and necessary area of research. This study thus aimed to clarify the relationship by highlighting the direct effect of perceived respect on anxiety, contributing to a better understanding of this connection. It sought to answer the following research questions.

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Is there a relationship between perceived respect and anxiety levels among the relatives of patients in adult ICUs?
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How does perceived respect affect the anxiety levels of relatives of patients?

2. Methods

2.1. Design and Sample

This descriptive, correlational, and predictive study aimed to achieve three primary objectives: to describe the demographic characteristics of the relatives of patients using descriptive analysis; to examine the relationship between perceived respect and anxiety levels through correlation analysis; and to determine the predictive effect of perceived respect on anxiety levels by applying regression analysis. The study was conducted between April and November 2022 with the relatives of patients in the adult ICUs of an Education and Research Hospital in Türkiye. This study used the convenience sampling method. The sample was selected from among the relatives of adult ICU patients who met the appropriate criteria and volunteered to participate in the study. In the sample calculation of this study, previous studies were used as a reference point [27] and the sample size of the study was determined as 202 with a 95% confidence interval and 80% power. Thus, the goal was to reach at least 202 individuals by the completion of the study. In this respect, and to achieve a representative sample, a total of 300 relatives of patients, which was considered a sufficient number to reflect the general characteristics of the target population in the hospital where the research was conducted, were included in the study to prevent potential data loss and strengthen representativeness. The inclusion criteria were as follows: being 18 years of age or older; having a relative who had been hospitalized in the adult ICU for at least three consecutive days; being able to communicate verbally; and voluntarily agreeing to participate after being informed about the purpose and procedures of the study. The exclusion criteria were as follows: failing to provide consent; having any diagnosed psychological disorders; having other severe health issues; the existence of any communication barriers; being engaged in continuous caregiving; being unable to take part due to their emotional state; lack of psychological readiness; and not agreeing with the study’s objectives. In cases where more than one relative of the patient was included in the study, data were collected from them at different time intervals to ensure data independence, focusing on only one participant at each visit. Data were collected through face-to-face interviews with the relatives who agreed to participate.

2.2. Setting

In this study, the data collection process was carried out in the ICUs and great weight was placed on the ethical and methodological considerations. The interviews were held with the relatives of patients in the ICUs, and each interview took place in a quiet environment, such as the hospital waiting room, taking into account the emotional state of the participant. The data collection time ranged from 20 to 30 min for each interview; however, this duration was flexible depending on the emotional state and level of comfort of each participant. Emotional support was provided to the participants during the interviews, ensuring that they always felt at ease. Informed consent was obtained from the participants prior to their involvement in the study, and their participation complied fully with the principle of voluntariness. To facilitate the interviews, the participants were provided with detailed information about the purpose of the study, the processes involved, and the potential impacts. They were assured of their rights and their responses would remain confidential. This approach ensured compliance with ethical standards and guaranteed the reliability and accuracy of the data.

2.3. Instruments

Data were collected with a Personal Information Form, the ICU-Respect Index (ICU-Respect), and the State–Trait Anxiety Inventory (STAI-S).

2.3.1. Personal Information Form

This form included questions about the age, gender, and relationship status of the relatives of the patients.

2.3.2. ICU-Respect

This was developed by Geller et al. [28] to provide a brief index of patients’ and their families’ experiences of feeling or not feeling respected in ICUs. The validity and reliability of the scale in Turkish were confirmed by İbrahimoğlu et al. [27]. The ICU-Respect consists of 10 items and a single dimension and is a four-point Likert-type scale (1: “never/rarely”; 2: “sometimes”; 3: “often”; 4: “always”). The ICU-Respect scale encompasses 10 key dimensions of respectful and person-centered care in intensive care settings. These dimensions include: Introductions, reflecting whether healthcare team members introduce themselves to the patient or their loved ones upon first meeting; Courtesy, indicating respectful and polite interactions; Understanding, which assesses the extent to which the care team seeks to comprehend what is most important to the patient or family; Responsiveness, denoting attentiveness to the needs and requests of the patient or loved ones; Engagement, referring to the perceived level of active listening by the care team; Selfhood, which captures efforts to recognize the patient or their loved one as a distinct individual; Privacy, related to maintaining the patient’s physical modesty; Equal, highlighting whether patients or their families feel they are treated as equals by the care team; Comfort, addressing actions taken to alleviate pain and promote physical ease; and Treated as human being, which assesses whether patients or families feel they are cared for with the same dignity and compassion that the caregivers would expect for themselves in a similar situation. The lowest score that can be obtained from the scale is 10, and the highest score is 40. A high score for the total scale indicates that a high degree of respect has been perceived in the ICU. The Cronbach’s alpha of the scale was determined as 0.71 in the present study, and this result is considered acceptable [29].

2.3.3. STAI-S

This scale was developed by Spielberger et al. [30] to determine state and trait anxiety levels separately. It was translated into Turkish, and its reliability and validity studies were carried out by Öner and Le Compte [31]. The STAI-S, which is a four-point Likert-type scale consisting of 20 items, determines how a person feels at a certain moment and under certain conditions. The total score obtained from the scale ranges from 20 to 80. A high score indicates a high level of anxiety, while a low score indicates a low level of anxiety. The Cronbach’s alpha was determined as 0.99 in the present study, and this result is considered highly acceptable [29].

2.4. Data Analysis

For the statistical analysis, frequency, percentage, mean, and standard deviation values were calculated using the SPSS 21.00 program. The Kolmogorov–Smirnov test was applied to test the normality of the data. Since it was determined that the data did not show a normal distribution, the correlation between the scale scores was calculated with the Spearman correlation test. Correlation values were evaluated as follows: 0–0.2 = very weak; 0.2–0.4 = weak; 0.4–0.6 = medium; and 0.6–0.8 = strong. In the comparison of scores obtained from the scales, the ANOVA test was used, and the eta-squared (η²) formula was applied to determine the effect size. Clustering analysis was applied in the assessment of the wide-range variable (STAI-S). Additionally, regression analysis was performed. A level of p < 0.05 was considered statistical significance.

2.5. Ethical Considerations

Ethics committee approval for the study was obtained from Bilecik Şeyh Edebali University (Date: 2021-12-29, No: 8/1). The participants were informed both verbally and in writing about the purpose, scope, and procedures of the study. The Personal Information Form was prepared in clear and accessible language, ensuring it matched the participants’ levels of literacy. Participation was entirely voluntary; individuals had the right to refuse or withdraw from the study at any time without any consequences, and this was explicitly communicated during the consent process. Informed consent was obtained from all the participants prior to data collection. The research process was conducted in accordance with the Declaration of Helsinki (1975, revised in 2000).

3. Results

3.1. Participants’ Characteristics

The demographic characteristics of the participants are presented in Table 1. The average age of the relatives of the patients was 50.16 ± 11.96 (20–83) years, 67.7% were female, and 61% of them were the children of the patients (Table 1).

Table 1. Participants’ characteristics.

		N	%
Gender	Female	203	67.7
Gender	Male	97	32.3

Relationship to patient	Parent	12	4.0
	Child	183	61.0
	Partner	23	7.7
	Sibling	38	12.7
	Other	44	14.7

Age	50.16 ± 11.96 (20–83)

3.2. Mean Scale Scores

The means, standard deviations, and min-max values of the scores obtained by the participants from the ICU-Respect and STAI-S are shown in Table 2. The mean score of the participants for the ICU-Respect was 39.38 ± 1.32 (95% CI: 39.23; 39.53). The mean score for the STAI-S was 43.39 ± 18.22 (95% CI: 41.32; 45.46) (Table 2).

Table 2. Participants’ scale scores.

	Mean	Standard deviation	Min–max	%95 CI
	Mean	Standard deviation	Min–max	Lower	Upper
ICU-Respect	39.38	1.32	30–40	39.23	39.53
STAI-S	43.39	18.22	20–80	41.32	45.46

Abbreviations: CI = confidence intervals, ICU-Respect = ICU-Respect Index, STAI-S = State–Trait Anxiety Inventory.

Since the anxiety min-max values ranged between 20 and 80, the participants were divided into three distinct groups as a result of the K-means clustering analysis: low level of anxiety (21.33); moderate level of anxiety (44.21); and high level of anxiety (78.20) (Table 3). This result indicates that the participants’ anxiety scores were clearly grouped into distinct clusters.

Table 3. Anxiety K-means clustering analysis.

	Low		Moderate		High
	Score	%	Score	%	Score	%
STAI-S	21.33	26.33	44.21	58.33	78.20	15.33

Abbreviation: STAI-S = State–Trait Anxiety Inventory.

3.3. Correlation and Regression Analyses

Table 4 shows the correlation between the participants’ ICU-Respect and STAI-S scores, while Table 5 shows the effect of the perceived level of respect from ICU professionals on the participants’ anxiety levels.

Table 4. Correlation between ICU-Respect and anxiety levels (STAI-S).

	r	p
ICU-Respect	−0.449	≤ 0.001^∗
STAI-S	−0.449	≤ 0.001^∗

Abbreviations: ICU-Respect = ICU-Respect Index, STAI-S = State–Trait Anxiety Inventory.
^∗: p ≤ 0.001; Spearman’s correlation test.

Table 5. Regression analysis among scale scores.

Dependent variable	Independent variable	R²	Std. error	F	β	B	95% confidence interval for B		t	p
Dependent variable	Independent variable	R²	Std. error	F	β	B	Lower	Upper	t	p
STAI-S	ICU-respect	0.241	0.693	94.466	−0.491	−6.734	−8.098	−5.371	−9.719	≤ 0.001^∗

Abbreviations: ICU-Respect = ICU-Respect Index, STAI-S = State–Trait Anxiety Inventory.
^∗: p ≤ 0.001.

There was a statistically significant, moderately negative relationship between the scores for the ICU-Respect and the STAI-S (r = −0.449; p ≤ 0.001) (Table 4). According to this result, as the perceived level of respect increased, the participants’ anxiety levels decreased. However, it was determined that the effect of perceived respect as an independent variable on the participants’ anxiety levels was large (F = 21.260; p ≤ 0.001; η² = 0.338). According to the regression model, perceived respect explained 24.1% (p < 0.05) of anxiety (Table 5). No statistically significant association was found between participants’ gender, age, or relationship with the patient and their scores for the scale.

The findings obtained from the study suggest that higher levels of perceived respect in the ICUs were significantly associated with lower levels of anxiety and that respect accounted for a meaningful proportion of the variance in anxiety levels among the participants.

4. Discussion

Being in good health is universally recognized as one of the most fundamental human rights. Within this framework, healthcare services play a crucial role and are supported by legal regulations that aim to safeguard the rights and well-being of patients. These regulations primarily focus on preventing harm during medical care. However, contemporary perspectives on healthcare emphasize that patients and their families seek not only physical recovery and protection from harm, but also respectful and humane treatment throughout the care process. A growing body of research supports the notion that respectful interactions between healthcare professionals and patients significantly influence the patient and family’s experience. Specifically, when individuals feel respected, they report greater emotional comfort and a more manageable treatment process [23, 32–35]. These findings highlight that respect in healthcare is a core component of quality care.

In the present study, most of the relatives of the patients in the ICUs were women. This result is directly related to cultural and societal norms both in Türkiye and around the world [36, 37]. Studies have shown that the caregiving role takes precedence over the other roles women play within the family [38, 39]. Due to this caregiving burden, women often experience greater emotional loads and increased stress when their relatives are unwell. Research has shown that female caregivers tend to experience higher levels of stress, depression, and physical health issues [40–42]. This highlights the critical need for providing them with tailored psychological support and improving their access to appropriate healthcare services.

One of the key findings of this study is that the majority of the relatives of the patients were their children. This finding indicates that most ICU patients are elderly individuals and that the responsibility of caregiving is increasingly being transferred to their adult children. As a result of social and demographic changes, family roles are continuously being reshaped, which results in the intergenerational transfer of caregiving duties [38]. Traditionally, the family is defined as a fundamental social unit consisting of parents and children, and it is thought to be responsible for meeting the physical, emotional, and psychological needs of the individuals within it. Emotional bonds are strengthened with the birth and growth of children, and the roles that family members take on change according to age and their evolving needs. The caregiving role first assumed by parents often shifts to a care-receiving role as they age, with children stepping in to assume this responsibility. This process is closely linked not only to cultural norms but also to the emotional dynamics within the family. In well-functioning family systems, other members typically provide both emotional and practical support during crises such as illness or hospitalization. This reciprocal support reflects the core elements of how a family functions, including a sense of belonging, shared responsibilities, and emotional intimacy. Family relationships are shaped by the social roles, responsibilities, and emotional ties formed among individuals sharing the same physical space. The fact that roles within the family change over time shows that a family is not a static institution but a dynamic one that undergoes various developments [43]. In this context, the finding that most of the relatives of the ICU patients were their children is not only a demographic observation but also evidence of the typical generational shift in family responsibilities. This reversal of roles, where children take over the care of aging parents, represents a significant transitional process. Such a transition is a critical issue for healthcare systems and in the provision of psychosocial support mechanisms, as these role changes not only place emotional and physical burdens on individuals but also reflect the broader care crisis faced by societies with aging populations.

The average score that the relatives of the patients obtained from the ICU-Respect was found to be as high as 39.38 ± 1.32. This score is significantly higher than the average of 33.20 ± 6.60 reported in the study by İbrahimoğlu et al. [27]. This suggests that relatives of the patients perceived a high level of respect from healthcare professionals and that a positive communication environment existed within the ICUs. A perception that they are highly respected increases a sense of trust among relatives and may contribute to reducing the stress they feel during crises. On the other hand, the average score for the STAI-S was found to be 43.39 ± 18.22, indicating a moderate level of anxiety. Although approximately half of the participants experienced moderate anxiety, similar studies with comparable groups have reported higher scores (e.g., 52.43 ± 9.75) [44]. This difference may suggest that a high level of perceived respect from healthcare professionals partially mitigates anxiety levels. Nevertheless, having a loved one in intensive care, the patient’s critical health condition, the lack of communication, complex medical processes, and uncertainty all contribute to intense stress among the relatives of patients. This stress triggers the body’s alarm system. Physiological changes such as increased heart rate, rapid breathing, muscle tension, suppressed digestion, and the release of stress hormones like cortisol lead to symptoms of acute anxiety. If this condition continues for a long time, it may weaken the individual’s emotional resilience and result in sleep disturbances, difficulties in concentrating, and even psychosomatic symptoms. There is thus a greater need for psychological support during this process. In this context, the importance of effective communication between healthcare professionals and the relatives of patients is once again clear. The literature underlines that well-established interpersonal relationships positively affect relatives of patients’ access to information, levels of satisfaction, and psychological adjustment [45]. Scott et al. [35] also highlight that uncertainty during the intensive care process, the pressure of the technological environment, and life-threatening conditions may lead to persistent anxiety in families. Białek and Sadowski [8] found that being treated in an ICU causes significant stress reactions among the family members of patients. During periods when close relatives were staying in an ICU, approximately 90% of them reported experiencing very high levels of stress, while about 38% and 33% reported experiencing high levels of anxiety and depression, respectively. Abdul Halain et al. [46], in their scoping review, reported that several factors contributed to psychological distress among family members of patients in ICUs, including the stressful environment, sociodemographic characteristics and family relationships, restricted visiting hours, previous ICU experiences, and the severity of the patient’s condition. Understanding and addressing the needs of family members are fundamental steps in providing holistic care. Nursing interventions can include providing information about visiting policies, establishing effective communication, enhancing patient well-being, and offering flexible visiting options. These interventions not only increase the family’s satisfaction but also help reduce stress-related disorders, improve mental health, and offer better support to ICU patients. Büyükçoban et al. [47], comparing the perceptions of family members regarding the needs of the relatives of ICU patients in Türkiye, revealed that family members prioritized assurance and information, which were also identified as their most important needs. However, the study indicates that these needs are often not adequately met, highlighting a gap in addressing the informational and emotional needs of family members. Demirtaş et al. [48] emphasized that the family members of patients admitted to the hospital experience intense anxiety, primarily due to uncertainty and lack of communication, and highlighted the need for healthcare professionals to place greater emphasis on psychosocial support and informational strategies directed toward family. A study by Avcı and Ayaz-Alkaya [44] demonstrated that respectful, clear, and empathetic communication by healthcare professionals played a critical role in reducing the anxiety levels of patients’ family members and increasing their satisfaction. For this reason, adopting not only patient-centered but also family-centered approaches and expanding psychological support practices to include relatives of patients are of great importance. Furthermore, the psychological well-being of relatives of patients can directly influence patients’ treatment processes and recovery rates. Numerous studies have shown that the psychological health of family member, especially when they have low levels of anxiety, stress, and depression, can positively contribute to the recovery of patients [16, 46]. Family members play an important role in the treatment process, not only as caregivers but also as providers of emotional support. Relatives who are psychologically strong can support patients more effectively. For example, relatives of patients with high levels of stress may create emotional tension that negatively impacts the patient’s recovery process [49]. In contrast, a healthier and more emotionally supportive family environment can reduce patients’ anxiety, increase their treatment adherence, and thereby improve treatment outcomes [50, 51]. In ICUs, in particular, where the relatives of patients often hold primary caregiving responsibilities and actively participate in decision-making processes, the psychological condition of these individuals is even more significant. Just as patients need emotional support during the recovery process, it is also necessary to provide psychological support to their relatives. In this regard, integrating psychosocial support programs to strengthen the psychological well-being of family members into the healthcare process is essential. In addition, consultation and liaison with psychiatry units has also been recommended to detect and intervene at an early stage in any mental health problems, such as depression, anxiety, and post-traumatic stress disorder, experienced by the relatives of patients [45]. Such support may help reduce the anxiety levels of the relatives of patients and lead to better outcomes in patient care. The psychological health of relatives of patients is not only a factor affecting their own quality of life but also a critical element that influences patients’ treatment outcomes and recovery speed.

It was determined that as the level of respect perceived by the relatives of the patients increased, the level of anxiety decreased. According to the regression model, a one unit increase in the level of respect reduced the anxiety level by 0.491 units. From a psychological perspective, one of the mechanisms through which respect may reduce anxiety is related to the sense of control. According to Lazarus’ stress model, individuals who perceive themselves as having control over a situation are less likely to experience stress [52]. In the context of ICU settings, when family members feel respected and involved in the treatment process, they may experience a greater sense of control over the situation. This perception of control can reduce feelings of helplessness, thereby lowering anxiety levels. Furthermore, the sense of belonging and having trust in a healthcare setting can play a crucial role in reducing anxiety. When healthcare professionals demonstrate respect through empathetic communication and attentive care, family members are more likely to feel secure and supported, which can foster a sense of trust. According to attachment theory [53], trust is foundational in relationships, and when individuals feel supported, their anxiety decreases as their nervous system responds more calmly. In neuropsychological terms, sympathetic nervous system activation is often triggered by stress, leading to heightened anxiety. However, when family members feel secure in their relationship with healthcare professionals, this activation may decrease. It has been shown that supportive relationships can modulate the body’s stress response, leading to lower levels of anxiety and stress [54]. Thus, respectful and empathetic behaviors exhibited by ICU professionals can help to regulate family members’ stress responses, reducing their overall anxiety. In addition to these psychological mechanisms, it is important to consider cultural factors and the dynamics of the healthcare system. These factors can significantly influence how respect is perceived and experienced by individuals [55]. In addition, the dynamics of the healthcare system, including access to information and the level of communication between healthcare professionals and the relatives of patients, can significantly influence how respect is perceived and how anxiety is managed. In the clinical context, organizing visiting hours with sufficient time, providing adequate information, supporting participation in decision-making, and fostering respectful, empathetic, compassionate communication may play a vital role in reducing the anxiety of the relatives of patients by enhancing their sense of being respected. Healthcare professionals could thus benefit from training programs that focus on enhancing their communication and active listening skills, and their empathy. Furthermore, developing communication guides and integrating psychosocial support services in ICUs may assist in reducing the emotional burden on family members.

Research conducted in Türkiye shows that the experiences of relatives of patients in ICUs are multidimensional. Öztürk and Cerit [56] emphasize a strong relationship between meeting the needs of relatives of patient and their satisfaction levels, while Aktaş and Arabacı [57] highlight the importance of effective communication with patients and their families in the ICUs. Temür et al. [58] draw attention to communication barriers between patients and healthcare staff in ICUs. Gürkan [59] stresses that a holistic approach plays a critical role in addressing the psychological and emotional needs of relatives of patients. According to the study by Baykal et al. [60], approaching family members of intensive care patients with respect and understanding enhances trust and strengthens communication. A lack of respect, on the other hand, leads to feelings of stress, insecurity, and exclusion among the relatives of patients. These studies reveal that meeting both the physical and emotional support needs of intensive care relatives of patients, along with respectful and effective communication, are fundamental elements in this process in Türkiye.

4.1. Limitations

While the results of this study are promising, several limitations should be considered. First, the study was conducted in a single hospital, which means the findings may not be generalizable to other hospitals or cultural contexts. Additionally, the sample was limited to voluntary participants, which may have introduced selection bias. This could have affected the representativeness of the sample and the generalizability of the results. Moreover, the study did not adequately explore the physical, psychological, and sociological differences among the relatives of the patients, which may have influenced their perceptions of respect and anxiety. Although variables such as age, gender, and relationship to the patient were included in the dataset, they were not entered into the regression analysis due to the study’s primary focus on psychosocial variables and the lack of significant effects observed in preliminary analyses. However, this may have led to the omission of potential confounding effects and should therefore be acknowledged as a limitation. Since relatives’ experiences can vary based on the patient’s condition and other personal factors, future research should take these variables into account to gain a more comprehensive understanding of how they impact the relationship between perceived respect and anxiety. Another limitation is the data collection method, which relied on face-to-face interviews. This approach may have introduced social desirability bias, as the participants may have been motivated to provide socially acceptable answers rather than expressing their true feelings. Future studies should be mindful of this potential bias and consider using alternative methods, such as anonymous surveys, to minimize its impact. Finally, since this study was conducted with the relatives of patients hospitalized in adult ICUs at a single hospital, the findings cannot be generalized to other hospitals or healthcare settings. Future studies should aim to replicate this research in different contexts and with diverse populations to further understand the dynamics of respect and anxiety in critical care environments.

5. Conclusions

The findings of this study indicate that emotional and psychological outcomes in critical care settings are influenced not only by clinical interventions but also by interpersonal interactions and communication. Furthermore, the regression analysis showed that perceived respect was a significant predictor of anxiety levels, explaining 24% of the variance in this relationship. While the existing literature generally suggests that respect influences anxiety, no study has yet demonstrated that respect has such a strong and significant impact on anxiety levels. The present study provides a more comprehensive understanding of the effects of respect on psychological well-being, offering a new perspective, particularly in terms of improving the emotional states of relatives of patients in ICUs. This finding highlights the importance of healthcare professionals adopting a respectful approach toward the relatives of patients, not only for improving the patients’ health but also for the psychological well-being of their relatives. Based on the results of the study, it is recommended that healthcare professionals adopt a respectful and empathetic communication style that considers the emotional needs of the relatives of patients. Hospital managers and policymakers should prioritize the development of frameworks that support respect-based care practices. Specifically, time and resources should be allocated to the design and implementation of training programs aimed at strengthening a culture of respect, especially in ICUs. These efforts should focus on creating policies that recognize the emotional needs of relatives and ensure that healthcare professionals are equipped with the skills necessary to address these needs effectively. Healthcare professionals should be encouraged to adopt a patient- and family-centered approach that goes beyond clinical care. National and international health organizations should advocate for the inclusion of respect-based communication strategies in healthcare service guidelines. Policies should ensure that healthcare facilities are accountable for providing not only medical care but also holistic care that considers the emotional well-being of relatives of patients. Legislative measures could also be taken to help establish the framework needed to support FCC that emphasizes respect in ICUs and other critical care settings.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

Each author has made substantial contributions to both (1) the conception and design of the article or study, or acquisition of data, or analysis and interpretation of data, and (2) drafting the article or revising it critically for important intellectual content. Each author takes public responsibility for the entire work.

Funding

No funding was received for this manuscript.

Open Research

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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The Relationship Between the Anxiety Levels of Relatives of Patients in Intensive Care Units and Perceived Respect From Healthcare Professionals

Abstract

1. Introduction

2. Methods

2.1. Design and Sample

2.2. Setting

2.3. Instruments

2.3.1. Personal Information Form

2.3.2. ICU-Respect

2.3.3. STAI-S

2.4. Data Analysis

2.5. Ethical Considerations

3. Results

3.1. Participants’ Characteristics

3.2. Mean Scale Scores

3.3. Correlation and Regression Analyses

4. Discussion

4.1. Limitations

5. Conclusions

Conflicts of Interest

Author Contributions

Funding

Open Research

Data Availability Statement

References

References

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The Relationship Between the Anxiety Levels of Relatives of Patients in Intensive Care Units and Perceived Respect From Healthcare Professionals

Abstract

1. Introduction

2. Methods

2.1. Design and Sample

2.2. Setting

2.3. Instruments

2.3.1. Personal Information Form

2.3.2. ICU-Respect

2.3.3. STAI-S

2.4. Data Analysis

2.5. Ethical Considerations

3. Results

3.1. Participants’ Characteristics

3.2. Mean Scale Scores

3.3. Correlation and Regression Analyses

4. Discussion

4.1. Limitations

5. Conclusions

Conflicts of Interest

Author Contributions

Funding

Open Research

Data Availability Statement

References

References

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