Wednesday, 20 July 2016

All in one. By Mónica Ferrero

I have never thought it before. 

It was after attending to the #2JHUCI where I participated in Module 2: Technology, structure and humanization: are compatibles?.

And my respond is YES, for sure.

And it also begins to be already a reality. The new health spaces are projected by combining early technology, structure and humanization, as the new Hospital Royal Adelaide (RAH) of Australia.

Based on a project of construction with the most advanced in the world and focused on sustainability, they seek to improve the experience of the patient and the family during their stay in hospital providing professionals an optimal environment to develop their work.

The buildings that form the complex of the hospital are efficient and sustainable: they have been designed to optimize the light of the day through large windows and spaces glazed, by what besides the great benefit that supposed for all the people that are in the hospital to enjoy of it light natural and views, the consumption of energy is reduced as the demand of light artificial.

Design also has contemplated a good acoustic insulation: the glazing and the facade materials absorb the noise of helicopters arriving to the installations and trains that pass by, providing the necessary acoustic comfort.

Natural spaces are very important, and indoor and outdoor gardens have been built to disposal of patients, family and professionals because the contact with the nature relaxes us.

Privacy is basic for the patient and the 800 rooms are individual, each an of them with its own bathroom. You can enjoy in every room of fresh air and natural ventilation with windows for natural light and views of the river, parks and gardens of the Centre.

Beside the bed there is a device that allows patients to control entertainment systems. These devices can also be used by staff to access test results or make special requests for food for allergic patients or with special requests.

The family has an special area in the room, a space with bed and desk, so they can stay with the patient as comfortable as possible.

RAH has an advanced technology: electronic tags will allow staff to always know the location of the equipment. Thus its location will be known and they save time in the search. They will also be used to monitor patients at risk (such as mental patients, with alerts sent automatically to the security guards). 

Also they have automatic vehicles which distribute meals, lingerie, waste and medical equipment. 

In this video you can see the facilities and services offered by RAH:

We can see in RAH that technology, structure and humanization are compatible and necessary, but this combination should be thought since the beginning, when the spaces are projected, so that the result is functional and efficient. In this way on the basis of tangible will be much easier to be able to take care of the invisible.

Mónica Ferrero
Interior designer in Lab In Action

Tuesday, 19 July 2016

Family presence during ICU procedures. By Bárbara Salas

Annals of American Thoracic Society has just published in July a very interesting article on the presence of family members during Intensive Care Unit (ICU) procedures.

Its authors (physicians, nurses and members of the ICU Patient and Family Advisory Council at the Intermountain Medical Center in Utah, USA), present their experience of years trying to make the Intermountain Medical Center’s Shock Trauma (STICU) a more patient-centered and open space. A place where family members are not only welcomed, but are also part of the team looking after the patient.

The article discusses the benefits of allowing family members to be present during procedures (intubation, placement of central lines or paracentesis for example), including better communication with the healthcare team, improved patient and family satisfaction, decreased stress and anxiety, and reduced risk of suffering post-intensive care syndrome (PICS).

Physicians from other groups have raised concerns regarding the consequences of enabling families to be present during ICU procedures, particularly due to possible interference with trainee education, medicolegal implications, a decreased quality of care, and a raised stress in the provider due to feeling “observed”. 

However, these fears were not supported by evidence and did not reflect the experience of the STICU team.

Trainee education was not compromised, and neither family members nor physicians had problems with being in the same room during the procedure. The online supplement provides a script used by the senior author, Dr. Samuel Brown, to convey effectively to the patient, the family and the trainee physician what to expect during the procedure.

    * Litigation did not increase; on the contrary, the fact that family members were permitted to stay during the procedure improved communication and transparency, thus strengthening the trust of the family in the team.

    * The quality of care was not compromised, and clinicians did not report a higher level of stress due to being with the family member in the room.

    * Finally, sterility was not threatened, and although there is a higher “environmental microbial contamination” when family members are present, there has not been any infectious complications.

    After approximately 200-300 procedures with families in the room without negative experiences, the STICU team suggest that family procedural presence should be encouraged in other ICUs. Contrary to what many physicians fear, the presence of family members during the procedure promotes and facilities communication between the clinician and the relatives, and enables a better understanding of the patient’s situation by the family (among other benefits already discussed).

    The authors recommend four interventions in order to make the ICU a more humane and patient-centered place. These are:

    1) To educate clinicians about the fact that enabling family members to witness invasive procedures have benefits both on the relatives as well as on the patients.

    2) To invite family members to stay during the preparation of the procedure, should they wish to do so.

    3) To enable family members to remain in the room during the procedure, if both the clinician and the family member are comfortable with it.

    4) To “engage further”, that is: to include “debriefing of patient and families after procedures”.
    To conclude, it is still a fact that many adult ICUs have restricted visitations and almost always families have to leave the room during invasive procedures. However, this fascinating and innovative research proves that a change is needed in the way the ICU teams interact with family members in order to deliver a meaningful and patient-centered care.

    Barbara Salas
    Medical student, Newcastle University (UK)
    BA Theology, University of Oxford (UK)

Saturday, 16 July 2016

A call for action against burnout syndrome

Recently, four american scientific societies of Intensive Care Medicine, have launched a call for action about the burnout syndrome (BOS) of the ICU professionals.

The American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine have published a document whose aim is to generate awareness and give visibility to the burnout syndrome, also called a silent pandemic.
The authors highlight the impact of this syndrome, which affects 45 percent of the 10,000 intensivists and approximately one-third of the 500,000 U.S. nursing professionals and whose numbers are still higher in Pediatrics.

The BOS (in a more colloquial way "to be burned") is an occupational disease that is characterized by three classic symptoms: emotional exhaustion, depersonalization, and feelings of low self-esteem professional. This syndrome can have very negative consequences not only for professionals who suffer from it, but also for the patients and for the institutions themselves. The syndrome strikes a personal and professional level, and may lead to a post-traumatic stress syndrome and other severe psychological disorders, and even suicide. It also influences the quality of care, patient outcomes, and patient satisfaction, and is related to the replacement of professionals in organizations.

The contributing factors include individual personal characteristics, environmental and organizational factors. These, directly or through intermediate síndromes still less known as "moral distress", the perception of offering improper care or "compassion fatigue" can lead to a BOS.


But they also provide a vision from positive psychology looking for the motivation of health care provider ("engagement") and the need to create healthy and resilient organizations (HERO), defined as those organizations that carry out systematic, planned and proactive actions to improve the process and the results of both the employees and the organization. They are characterized by maintaining a positive adjustment, leaving strengthened in adverse situations and favorable results under pressure conditions of work. In Spain, a reference on the subject is the WoNT research team of the Jaume I University, led by Marisa Salanova. All this is quite applicable to the intensive care medicine.

The document makes a call to action, with the aim of reducing the BOS and its consequences, involving all interest groups:

- The ICU professionals their families. Professionals should be involved in their own care, recognizing early symptoms and using the resources and strategies of support at their fingertips. Family and friends can be a source of support, detecting risk situations and understanding the symptoms and consequences of the syndrome.

-The leaders of the ICU, department managers and supervisors, must know the incidence of the syndrome in their units and offer the best environmental conditions with innovative organisational models that can reduce the syndrome and encourage the health providers.

- The managers of the organizations must contemplate the rate of professional services as an indicator of quality related to a healthy work environment and foster conditions that reduce the most the burnout syndrome.

- The funding agencies should promote research in this area, until now little promoted and which should be developed to provide scientific evidence.

- The scientific societies should facilitate the diffusion and formation of these syndromes to their professionals.

- The universities responsible for the formation of the health professions should include in their learning paths, recognition, prevention and treatment of the BOS and train the coping skills.

- Patients and patient associations can help to give visibility to the syndrome, educating patients and families on how to interact with professionals effectively reducing the factors that favour the BOS.

- The official agencies and health policies must work in legislating and regulating aspects which can reduce the BOS in the critically ill workers, improving patient care and reducing the costs associated with the professional replacement.

All of the above is clearly consistent with the objectives established in the line six called "The care of the professional" in the
Humanization Plan of Intensive Care Units of the Community of Madrid (by the momento only available in Spanish), led by the IC-HU project.

Its strategic lines establish the need to measure the impact of the BOS in the ICU, promote detection and reduce the negative consequences on health professionals, patients and the institutions themselves.

It also includes in the specific actions develop a declaration of the Societies involved to recognize the importance of professional care.

The American scientific societies have already taken this first step.

Dra. Mari Cruz Martin Delgado
Head of Intensive Care Unit.
Hospital Universitario de Torrejón
SEMICYUC Vicepresident

Thursday, 14 July 2016

It could happen to anyone. By Aroa López

To be health care professional (in my case, a nurse) and at the same time a critically ill patient is hard.

To see the faces of teammates to attend you, monitors, techniques that are practicing you... everything is a summation and you know where you are going.

I am an emergency nurse in a a third level Hospital of Barcelona. Young and healthy. One night, my head started to hurt, it was a pain I felt never before... And some hours later I saw virtually dismissing me from my family and my colleagues, and asking the doctor (my partner) of emergency if he was going to call the intensivists. And later, I asked to the intensivist if he was going to intubate me.

Knowing that you leave your life in hands of your mates, that they are going to do everything to save you, fighting to your side. You can imagine what you feel like when you know that they are going to sedate you and you do not know what will happen!

I remember those professional eyes that attended me, the look of concern. My life was their work. I resisted to sleep: I went to my induced coma asking if my children had been infected and begging them to take care of my family.

It was hard. It could happen to anyone, but it happened to me. I caught an Influenza H1N1 flu with pneumonia and fulminant respiratory failure.

I have no memories of the first 8 days under mechanical ventilation and pronated. Some flash, some feeling. It was not right to be extubated, my lungs didn't work.

But if you thought it was hard to be admitted in ICU, it´s harder the weaning of mechanical ventilation. You open the eyes, try to orientate yourself. You get it minimally (you are still under the effects of the muscle relaxant and sedation). You can see all the cables and drugs that you take. You note the pipe and the probe. You have cough and the ventilator sounds (a sound that I will never forget). With the unpleasant sensation of coughing, you put your hands instinctively to the throat, which the nurse thinks that you're disoriented and you want to remove the tube.

To this situation previously explained, add the physical restraints. What feeling of defenselessness!

Trying to communicate is impossible. And you try, but it doesn't work. You want to ask and you can not. You want to know and is impossible, you depend of what they explain to you. You see they give you drugs, but what is it?. You say no with the head when you see your partner with the bag of enteral nutrition (I really hate it).

I was oriented by the shifts of the nurses. You know, how different I could see my room depending on whoever comes through the door!. I have only words of thanks to everyone who was concerned for my.

But there were people that lit up the room. When you know that it happened to me, but it could be anyone, you see it reflected in the faces of your teammates.

I could write a book about how you get worse in emergency, on how weaning is (it was the hardest and although it was progressive, for me it was an eternity), on what reflects your face as professional (my fellows) to the patient (I assure that the face is reflection of what you feel), on the professionalism of public hospitals (today I am alive thanks to the professionals), about prior amnesia what you suffer due to medication, about the time of extubation (very hard), about things your mates explain you, on recovery (blessed myopathy of the critically ill patient that practically makes you have to learn to walk or taking a simply shower alone seems a superhuman effort).

I have an infinite love for life to emergency team, especially to Santi. I looked his face changing each time he came into my box.

To all my nurses and auxiliary mates!. To Carmela, who help to me and my family. To Mauricio and Marcos that fought hours in those early moments. To Judit, my doctor. To Jesus by trusting my lungs that day (what a hard moment the extubation!). To the ICU nurses (Dory, Celia, Gemma, Alex, Elena D., Elena L., Julia, Montse and to my eternal Tati). And to all those who know me because I don´t, because of have been sleeping!.

To all those professionals I owe the life!. Thank you from my heart! You did very well your work!.

For my family was a true humanized ICU. They take care of them, inform and treat them with affection.

It could happen to anyone, but it happen to me.

Aroa López

Emergency nurse 
Hospital Vall d´Hebrón