Thursday, 23 June 2016

The flame is still alive: IV Albert Jovell Awards

Hola a todos, mis queridos amigos.

The first fruits of Foro Premios Albert Jovell are coming, where as you know the IC-HU Project was the protagonist thanks to "The Revolution of Emotion" and at the awards ceremony.

That´s why Tonight, at 7 pm at the Ateneo de Madrid will take place the ceremony of the IV Albert Jovell Awards by the Spanish Group of Patients with Cancer (GEPAC).

This year, GEPAC has bet for a speaker of ceremonies quite newbie in this type of event, and thus they felt it after hearing our talk last Thursday to more than 500 people at the Universidad Internacional de Cataluña.

But I can assure you that, as a family member of a person with cancer and as a professional at the service of others, I couldn't be more proud. And, as Dr. Wes Ely said, it´s time of swimming pools, so I accepted inmedialtely when they proposed it to me.

9 categories
which are intended to add value to all those professionals who make life a little easier for cancer patients and their families. The jury, made up of patients and survivors of cancer, who want to continue encouraging all the people who dedicate their time and work to the field of Oncology, with the quality and humanity that Albert Jovell promulgated throughout his life.

The flame is still alive, and you can´t miss it!

Happy Thursday,

Wednesday, 22 June 2016

It doesn´t look like an Hospital! By Mónica Ferrero

It doesn´t look like an Hospital!

That's what the first patient told when they visited the new Day Center of Oncology and Hematology Pediatric of the Hospital Materno Infantil Vall d’Hebron in Barcelona.

When we are going to receive a treatment, we are nervous and afraid. But our experience can improve if we find ourselves in an attractive, friendly, warm, and cozy space.

And that is what they have done in Vall d' Hebrón. They have created a concept based on different worlds and experiences that have been called "Park of attention". A space where patients and their families receive all care and attention: medical, personal and emotional.

"The objective is to make children feel comfortable during treatment should receive and for this reason, in addition to the latest technological advances, space design has been thought to that families are in a unique, pleasant environment and fostering a better state of mind, through the sum of small experiences."

To achieve this they have increased the area of 100 to 500 m2 and "the park of attentions" has been divided in three areas. It has started from a common base for all the "Park": white spaces and decorative elements made of wood. This base will be how link between areas.

Each zone has its personality characterized and identified by design, furniture, materials and colors combined with natural light and lighting enhance the warmth and friendliness of the space.

The waiting room recreates a forest, it has been raised with different environments designed for children and families: area seat, game and a more versatile and more technological space. The elements that identify the space are the wood in its natural color and the color green, a visual image with elements that represent the nature also made of wood and have been distributed to creating the environment of the forest has been created.

The universe, is the area of medical consultations. It is separated from the waiting area by a glass that does not close the space and allows the light to flow. Arises on the basis of a very simple design: space paneled in white with integrated doors that show a tidy and organized space to highlight and will enhance the decorative elements and signs made in wood. It is played with the theme and colors, in this case yellow is the principal.

And finally the boxes and treatment area are racing circuit. It arises as the pit-stop of repair of vehicles in a race which are represented in every shade.

In this case orange is the color that identifies the space, some of the boxes also have natural light, providing much luminosity. Seems very interesting how this idea has been raised since it creates an immediate environment for children.

We must design and bring to reality these functional, technological, efficient, warm and friendly spaces that allow us to improve the experience of the patient and family, impacting also on a better workspace for the health professionals with a purpose: humanizing healthcare.


Mónica Ferrero
Interiorist in Lab In Action

Tuesday, 21 June 2016

About Music and Music Therapy in ICU, by María Rojas

In all the world, much is been talking about "Music in the ICU", something very crazy not far away, no even imagine. And it is a wonderful thing.

Many efforts are made to bring the beauty of music to our ICU, because music accompanies us in conscious or unconscious way throughout our life, even before out birth. In a difficult time as been admitted in ICU fighting for life, music can be the best "medicine for the soul".

But that does not mean that we are making music therapy

Source: Pantosterapia

What is Music therapy?

In the United States, the definition most frequently used, raised in the American Association of Music therapy in 1980, and is this:

"Music therapy is the use of music to achieve therapeutic goals: recovery, conservation and improvement of mental and physical health"

Music therapy has been evolving and also by modifying its definition but in 2011 the
World Federation of Music Therapy (WFMT) went on to define it as :

"The use of music and/or its musical elements (sound, rhythm, melody and harmony) by a music therapist qualified, with a patient or group, in the process designed to facilitate and promote communication, relationship, learning, mobilization, expression, organization and other therapeutic targets relevant, in order to achieve changes and physical, emotional, mental, social, and cognitive needs".

And we are now trying to explain just how a person who is not even family, health of a patient, making a music therapy session in an ICU box, or how a nurse ends placing a DVD player among the connections of perfusion pumps, monitoring and the nozzles of the ventilator.
As well, these situations respond to the search for additional, non-pharmacological measures that help us manage the stressors, both environmental and psychological factors and which pose an "aggression" for our patients. We know that high doses for long periods of sedative and opioid analgesics are also associated with adverse effects. Sometimes the consequences are serious and these non-pharmacological measures would help us, not only to lower doses of drugs, but to make a less hostile environment of our units, establish new lines of communication with our patients and provide forms of expression and meeting with themselves, controlling anxiety, improves night rest... The possibilities are endless.

Today I tell you how we have started to work on our unit:

Music therapy in ICU is a complex work, that requires a rigorous study of each case.

With great humility and the desire to learn, we start creating a workgroup (a nurse, an intensivist and a music therapist). In an individualized music therapy session, the specialist (music therapist) works with the patient or his/her family, as we do a medical report and studies a "musical biographical history", that is unique to each of us. Through this, fix a few therapeutic objectives between the health care team and the music therapist. In another part of the session, we explore the physiological reactions of the patient using tools of music therapy where a new channel of communication is created.

In the majority of cases, families are an important part of this process, at the same time becoming subject to therapy, because not only opens a way new expression and channeling of emotions with the therapist and the health care team, they feel they share the care of their patient.

Another part of our project, consists in the use of music as a nursing care, to establish the diagnosis of a problem (NANDA).

For example, fear or anxiety. A plan of care is detailled, defining expected results (NOC) and nursing (NIC) interventions necessary for its achievement. Here is where the music therapy or music use as care becomes an nurse intervention, counting on the advice of the music therapist.

Many ICU recently have begun to take their first steps around this exciting topic, but also some stir.

On the one hand amazement and bewilderment among music therapists and other, enough misinformation by health care providers.

And the last thing we would like is that misunderstandings spoil the beginning of this wonderful story of love, love for life and something we have in common these two worlds that are destined to do great things together.

An exciting job: helping the human being.

Dra. Maria Rojas
Hospital Comarcal Infanta Margarita, Córdoba

Saturday, 18 June 2016

A swimming pool in the ICU? By Wes Ely

Published in The Wall Street Journal on June 17th, 2016

“A swimming pool in the ICU? You must be nuts.”

The nurse’s voice was almost lost amid the whooshing ventilator and infusion pumps.

Five days earlier, we had admitted Bennie, a Vietnam veteran, to the intensive care unit of our VA hospital in Nashville, Tenn. Frail and wrinkled, he had a look of utter confusion and a furrowed brow that would pluck the heartstrings of even the most calloused physician. Decades spent in Southern tobacco fields left him looking old enough to remember Hoover’s presidency. Double pneumonia and too much sedation made him delirious.

As his attending physician, I was thankful for his family. His daughter and son, Laura and Len implored: “Take good care of Dad. He’s all we have.” Seeing him on a ventilator is terrifying, they said, but we believe in miracles. While loving, such a mind-set could become problematic since their father’s situation had the makings of a fatal illness despite our best technology.

With antibiotics and fluids, Bennie improved dramatically and was taken off the ventilator several days later. That same night, though, a massive stroke paralyzed his entire left side, and he went back on life support. We quickly administered clot-busting medicine, and he rallied again, remarkably regaining movement of his left arm and leg. The following day, the intern reported, “His delirium has cleared, and he’s mouthing words around the endotracheal tube despite his wicked aspiration pneumonia.”

I sensed an unexpected window of opportunity. We revisited Bennie’s life goals in light of what had happened and spoke directly about the big picture. With his children looking on, I held Bennie’s hand and looked him in the eyes. Choosing my words based on what I knew about his background and the family’s expectation of miracles, I said, “Bennie, just like tobacco plants eventually wither and wilt, so do we. You have improved in some ways, but overall you are very weak. How can we serve you best?”

The next morning, Laura and Len were upbeat, which confused me since Bennie looked weaker than ever. They pointed to words on a whiteboard in the room, explaining they were Bennie’s goals, “Stable vital signs. Baptism.”

I spotted Kelly, our charge nurse, smiling like a cat who’d swallowed a canary. In her arms she clutched a box containing a large vinyl swimming pool. First I made sure this was actually Bennie’s request and not the family’s. My next thought was that we’d have a chaplain anoint him with holy water in his bed, but Laura disagreed. “Jesus wasn’t sprinkled, Doc, he was dunked.”

A senior physician protested that the patient was on a ventilator and said he’d never seen a bedside baptism like this in 50 years of practice. There was no shortage of opinions about whether this was appropriate, safe, or even possible.

A large area next to Bennie’s bed was cleared and an electric pump inflated the pool. When a multiperson bucket brigade proved too difficult, an engineer rigged dialysis tubing to circulate the pool with a stream of warm water. Bennie was then hoisted high into the air via a patient-transfer lift, and the ventilator was unplugged before he was lowered into the pool. Len gently took his father, the man who’d shown him how to farm, into his arms. Following the cherished Christian tradition, he slowly submerged Bennie’s head completely under the water saying, “Dad, I baptize you in the name of God the Father, Son and Holy Spirit.” On cue, the palliative-care social worker began belting out “Amazing Grace.” The rest of us stood frozen in time.

First out of the water was blue corrugated ventilator tubing. Then his face appeared around the breathing tube. Bennie’s huge smile seemed to say, “Better late than never.”

When he died a week later, Laura implored me to tell other people about her Dad, hoping his experience would show them that “we can all become strong through our weakness.” In fact, I have seen scores of patients and families use profound “outer wasting” as a catalyst for deep inner renewal. The two most important “frames” of our life are birth and death. We typically associate baptism with the former, yet Jesus spoke of his death as a baptism to indicate the formative next step that dying represents for our journey.

The ICU team’s bold yet careful response to Bennie’s unusual request taught me an enduring lesson regarding sympathy versus empathy. Sympathy is feeling sorry for someone; empathy is feeling “with” someone. In all the surrounding insanity of the hospital that day, diving deeply into Bennie’s life through his baptism on the breathing machine allowed all of us to be reborn, too. Being “with” him in that pool, and rising with him out of it, we walked into others’ lives better prepared to serve.

Dr. Wesley Ely
Professor of Medicine and Critical Care at the Nashville VA Medical Center and the Vanderbilt University Medical Center.