Friday, 30 September 2016

The IC-HU soundscape

Hola a todos, my dear friends.

Noise maybe is something invisible in the ICU. And although we have spoken of it here or here, I have the feeling of that we have last of tiptoe, almost without making noise.

We are not aware of how alarms affects our patients, or how professionals are exposed in our day to day to this stressor.

In the Humanization plan of the ICU of Community of Madrid, the chapter of Humanized infrastructure addresses this issue and even speaks of the rules recommended by the WHO, with control of noise below 35 dB and accepting an operating noise up to 45 DB.

"The WHO recommends a level of noise of 30 decibels. According to the norm UNE 100713:2005 the maximum pressure sound for ICU is of 35 dB. We must maintain this level, especially during the hours of rest, because noise affects the patient, influencing in the emotional state and the quality of sleep can be very affected. An increase of 10dB to these levels of maximum noise environmental is admitted to allow the communication and the learning. I.e. a maximum noise level operating of 45 DB.

This level of noise requires a conscious effort to control the level of voice over professionals.

The noise generated in the unit can be internal (generated by the activity that takes place every day), or outside (which comes out of the unit).

We can combat noise using materials that isolate acoustically the unit, as special materials, ceilings, soils and enclosures that absorb the noise and isolated it, because we should compliance this according to the norm UNE in 12354, parts 1, 2 and 3. "Paragraph 3.1.3 of the DB HR

On the other hand, we can fight against the internal noise replacing acoustic alarms by luminous, or using automatic glass doors, phones in vibration, noise meters, moderating the tone of the talks and tone of mobiles, moderating the volume of television, radio and audio, avoiding shocks, sudden noises and slamming doors, not dragging furniture, using suitable footwear to avoid the noise so annoying that causes the friction of the gums with the pavement".

All of you who have any device of noise detection, would have observed that keep those 35 dB is impossible yet still in absolute silence .

Honestly, I believe WHO is very optimist and we follow a guidelines that hs little to do with reality, and so I think we should define what noise is.

We have asked several experts to explain it to us, and also their technologies to learn what really matters: the soundscape of each IC-HU.

Meanwhile, an image is worth more than thousand words: it´s necessary to know what do and how, to make the corresponding actions of improvement. This is the soundscape of a Spanish IC-HU a month ago: during the day, it works around the 58 dB, by night about 54 DB. Look at the marked peaks of noise, you can get your own conclusions: what happens to those hours in this ICU?.

Really, so much to think, . If we consciously noise, we can improve the quality of life for everyone: patients, families and professionals. And that is priceless.

Happy Friday,

Thursday, 29 September 2016

The family in the ICU of adults. By Ana Bejarano

I believe that the first step is to understand that despite we are human beings we are not always humanized, because humanize is a mode of being, living, interacting, growing us, moving us and traveling to the inside, to experience life in another way. 

All of us want to be older, but we could have best moments, and create highlights for our patients.

What are the family needs?

  • Receiving clear information in terms that they can understand 
  • Having proximity with the patient 
  • Feeling that there is hope 
  • Having time to accompany their loved one
  • Being relieved
  • Perceiving that the patient receives care of high quality 
  • Trusting in the clinical skill of the team of health. 
  • Knowing that the ICU team is concerned by the patient 
  • Reassuring, giving support and protecting their loved one
  • Having some grade of comfort during the process
Specific role of the team when a family comes into the ICU: providing the medical report as soon as possible, accompanying to the family to the unit, explaining how it works, offering availability to ask.

Visitation policies. To define the enlargement of the visits, we should: 
  • Agreeing on a protocol with the institution
  • Knowing the wish of the patient 
  • Agreeing with all the ICU team
  • Defining with the patient, if is possible, what family member is suitable for accompanying
  • Creating a space of privacy and comfort to the family (Chairs, closed doors or place screens if it´s possible) 
  • Defining with the team if the family member is going to collaborate in the care 
  • Nursing participation in the report to the family to know the type of family and what relationship have between them 
  • What patients we are going to expand visits depending on the current diseaset (for example in isolates, infectious diseases, etc)
What can family do during the visit?
  • Participating in the early mobilization 
  • accompanying patient from bed to a chair or sitting 
  • accompanying and assisting in feeding patient 
  • Supporting with elements of sensory stimulation 
  • Performing skin care (for example, place moisturizers in lower limbs) 
  • Participating of the hygiene of the patient (hairstyle brushed teeth, nails cut) 
  • Being educated by nursing before the ICU discharge of the patient 
It´s important explain to the family don´t worry by alarms or drips, make them feel that we need them to tasks that although we can make us, the affection and love of a relative are irreplaceable.

What is the contribution of flexibilization visitation policies?

For patients: 
  • Decreases anxiety, confusion and agitation 
  • Reduces cardiovascular complications
  • decreases ICU stay
  • Makes the patient feeling more safe 
  • Increases the satisfaction of the patient 
  • Increases quality and security 
For families:
  • Increases satisfaction 
  • Decreases anxiety 
  • Promotes a best communication 
  • Contributes to a better understanding of the patient 
  • Allows more opportunities for the teaching of the patient / family , and is involves them in the care.
Myths to topple: visits stresses to the patient, interfering in the provision of care, are tyring for the patient and the family and contribute to infections.

Visits for 
children: If children are adequately prepared, they should be allowed as visitors to the ICU, because they present a positive behavior and less emotional changes in relation to children who do not visit their loved one.

Ana María Bejarano
Nursing ICU Head.
Director of Critical Nursing of SATI at Sanatorio La Entrerriana
Argentinean Society of Intensive Care Medicine

Wednesday, 28 September 2016

Extremis: Facing the Final Decision. By Javier Martínez Sárria

It is brave to tackle a topic as death in a documentary, which has ceased to be a part of our everyday experience (but not in our destiny, what else we would like!).

Our culture has finished hiding so essential moment, that used to be another social event.

First relegating it to the intimacy of the family. Then, inadvertently, leaving it in the hands of the health system, which initially embraced the responsibility, perhaps in the belief that Almighty Medicine someday will avoid it.

But death is stubborn, and continues to end our stories, although the technology already allows the miracle of keeping with appearance of life a body that is not a person yet.

This leads to undignified, even pathetic situations. "Vegetable" without remedy maintained by the fear to the farewell, doctors taking vital decisions that don´t correspond them.

Fortunately the sense of dignity is returning to its site. In this documentary we can see a glimmer of the movement of return to have a death with dignity.

The struggle for the right to decide about our own lives has been championed especially by citizens/patients. In this case the heroine is a doctor, Jessica Nutik Zitter, whose compassion pushes her to take the trouble, time and - why not say it - evil swallow of discovering and respect the desire of the patient, when there is no more to do.

This is not always easy, because most of us run away from the thought of our own death and have not written this kind of will, which would alleviate this final decision to family and health care professionals.

If the purpose of the documentary was impacting us emotionally and awakening a debate so this practice is widespread, more or less it succeeds.

But if it wanted to get involved personally, put ourselves in the place of the dying man, make us thinking about how we want to spend those moments, it falls short. We don´t know if it longs just 24 minutes because the director wanted to avoid the saturation of the viewer, but it certain leaves us with hunger, especially to those of us who have been near the end.

If we decide to talk about death by a time, why not doing deeper?. My impression was it flies over above the theme without dipping in depth, in the details nothing accessories. Perhaps in a second part?

What did I miss?

The point of view of the patient. We always tend to see the scene from outside, nobody is dares to put more in the skin of the protagonist (normal, is very difficult!).

We don´t see the palliation, how the patient is prepared for his end in the way less painful possible, and here, there is much to explain about.

The process of the farewell with the being dears is touches very by over, and I think that is essential. Not only if it is carry out with "open doors", but give the option to do it at home (and how).

And entering in more depths, how we manage the farewell in life, i.e., if we have the culture of celebrate the life that is ending, when the interested is still with us. With the liturgy and importance that we are capable to give when already our loved has gone. It would be advisable that he/she could "shut down" well, celebrate the successes, forgive the grudges...

One of the critical moments is when a secondary character, whose testimony would have given a lot of stars in. The wife 38 years old, who is offered the disjunctive of "die naturally or not". Because she doesn't want to die, normal! Surely she never be raised her own death.

And you, does death catch you unprepared?

So, while we are here, while we still have time, we should celebrate life, until we will celebrate death.

Javier Martínez de Sarría
IC-HU Friki Zone

Tuesday, 27 September 2016

The IC-HU Proyect: all the colours

In the IC-HU Project (Humanizing Intensive Care) we are independent, passionate and have one thing very clear: our goal is to help making health care more kind for people and health environments the more livable as possible. In all the senses. For their users. For the professionals who care for the users. Nothing more and nothing less.

And this project does not have political color. We don´t sale to the highest bidder. None. It is an initiative that need values that honest people can provide. And wealth incorporated from different disciplines (medicine, nursing, psychology, physiotherapy, ergonomics, design, economics, bioethics, computing, architecture...). And doors that can be open by people and key institutions. And work, hard work. And for a timetable in which does not address all the issues at once, which are many, by no means.

It seems to us a good moment to reaffirm in this declaration since last September 18th and in a very spontaneous idea, we started the campaign #humaniza: #benditalocura (holy madness), in that crowd of people made pictures forming a "H" with the hands. 

The success has been overwhelming (watch the video here) and joined people of every type and color: patients, health professionals, anonymous people, health managers, actors... and politicians of different colors (one, little known outside their community,was even invited by us). Already is known: in our context politicians rise blisters, especially when they talk about health and education. Totally understandable. However, we will not be who criticise someone who joins the humanization of health movement. 

At the same time we want to leave clear that "not criticize" does not mean "leave of being independent". Or it does not mean that we are naive. Or it does not mean that many of us are not engaged in other battles related to transparency, healthcare advocacy or excellence in our professions. And we cannot avoid, although there are people and characters who come to the "H" of heart, others intend to use us as an added value.

We insist, our purpose is the humanization of health. We work to do so on many fronts and we are not going to disperse in ideological or political discussions: it would take us time and energy to focus on the task.

Our policy is called IC-HU. Starting from there, serene and reflective, we add, look for the diversity, establish alliances after weighing them very well. Therefore, to you, Yes, to you, that you heart beats and have (H) soul, we count on you because we are working on a integrator project.

Ah, and if it hadn´t been clear yet, we don´t fight in political colors because we are all the colours.

Concha Zaforteza
Nursing Director of Hospital Comarcal de Inca
On behalf and representation of the International Research Group the IC-HU Project for the humanization of intensive care units and the health care system