Friday, 19 August 2016

Looking at the invisible: The IC-HU Foundation in Colombia

Today, a nurse studente asked me in the morning shift:

- "What is the humanization of Intensive Care?".

I thought during a second and I have replied: "Look, how is it possible that we (as human beings), who in addition care another human beings (we are not descendants of Zeus or anything like that), we have now to stop, to think that we should humanize what we do every day!!!!" Why has happened this?.

I said to the student nurse: "Where did we get lost? Where did we leave our Northern?. Well, we lost North from the beginning: the Health Universities, for centuries have taught us about altered bodies, not human beings who have fallen ill of any Pathology: they taugh us to only see organs.

And social security laws have legislated on pathologies, also forgetting the human being carrying these bodies. And added to this picture so grey, the caregivers have believed the story that we are descendants of the gods: lies! We are same as all human beings.

As well: it´s time to unite all efforts into one single: we have to looking at the INVISIBLE: the human being has always been there: feeling, thinking, fearing with the five senses. In addition, we must look at the family and the person has a defined social role".

For this reason, I thought: the EPS (Social Health System in Colombia) nor the IPS (clinics or public and private hospitals), neither the Ministry nor the pharmaceuticals laboratories will bring to Colombia the IC-HU project of Spain. So we decided to make a foundation to humanize the ICU. The first branch of the Spanish Project.

But we want that FHU-CI will have all the legal and accounting power to endure in time (Dr. Carlos Colmenares U., distinguised attorney); with national representation: the
AMCI (Colombian Intensive Care Association, Dr. Agamenón Quintero), to give it the seriousness of academic and scientific; and four engines who will fight against storm and wind: Ms. Sandra Caicedo and Patricia Castaño (ladies of the Cucuta Society), Catalina Ospina (Psychology student) and a Social worker, Dora Rozo.

Through the proposals emanating from the humanization Plan created in Madrid with its eight strategies, profesional, our patients, families and institutions could see the invisible in Colombia.

This Foundation and its statutes will ensure the policies of education, research, academic exchange, teaching and service to all the pillars that were previously invisible: Today, we can see them.

Thanks Gabi. Thank you Spain.

Note: everything has been for free. People who have heard this story have told us: "I do it because I believed in it!: in human beings."

Dr. Arturo Arias
Head of ICU, Clínica Norte.
Cúcuta, Norte de Santander, Colombia

Thursday, 18 August 2016

The step from an ICU to an IC-HU

Last year I wanted to know your opinion, needs and suggestions regarding infrastructure and spaces in the ICU. After asking to the professionals Vicente Gomez Tello and Laura Diaz, to the ex-patient Jose Luis Diaz and to the family member Manuel López I was very surprised because people with different perspectives have the same opinions: privacy for the patient, natural light, warm spaces "to feel as at home", comfortable waiting rooms and elements for distraction to avoid the feeling that "the time doesn´t pass".

All of them demanded human and friendly spaces to improve the experience for patients, family and caregivers.

In the last posts we asked again the professionals: do you believe that there has been an evolution, do you note any change? are is humanizing the spaces in the units?.

The answer is YES, and the process of change has started.

As each person is a world, the ICU are also differents, because they have different priorities and needs. I was delighted to see how Laura and Vincente have told us all the actions that have been undertaken to humanize their IC-HU.

They are aware that investment is needed to improve or adapt existing infrastructure, but there are improvements that can be made and are in fact already being conducted as: installation of curtains for privacy, personalization of space of each patient with photos, drawings, books, music, etc... To worry and care for the acoustic comfort to reduce noise. Also they are testing electronic visual communication devices...

There are units that long time ago have made some of these actions daily and every day other IC-HU are increasingly adding in this sense. An example are #paseosquecuran (healing walks) that are "something new" for many IC-HU but they could normalize adapting infrastructure to make them more comfortable for everyone.

When I was in Barcelona, many of you told me what you were doing in your IC-HU or were considering to make. I'd love you to share it in the comments of this post.

I encourage you to humanize your units. If you feel lost and do not know by where begin, you can download the Humanization Plan of the Community of Madrid (we are working in the English traslation) and seek which of the objectives and activities can apply to improve your units. Without any doubt, the plan is a great starting point for units which want to walk the step from an ICU to an IC-HU.

Because as Vincente sais: "The goal of this section is creating human spaces that promote physical and mental well-being of patients, family members and professionals".

And to those who are "on fire" - 150% as Laura said- I encourage to continue because is addictive, already know: "Once you pop, you can´t STOP".


Mónica Ferrero

Interior designer at Lab In Action

Wednesday, 17 August 2016

One year later: Mónica Ferrero interviews Vicente Gómez

If yesterday we shared the experience of Laura Diaz on the evolution and the humanization in the spaces of her ICU, today we are going to know the experience of Vicente Gómez Tello.

Vicente is an specialist in Intensive Care Medicine at Hospital Universitario Moncloa, moderator of the module 2: Are technology, structure and humanization compatible? in the II National Conference on Humanizing Intensive Care and has been Secretary and member of the Working Group "Humanization of Intensive Care Unit" for the Humanization Plan of the Community of Madrid. 

-Vicente, a year has last from our interview. Have you noticed any change in your unit?

"The humanization Plan of the ICU of the Community of Madrid has been a milestone in the improvement of the human (not technical) aspect of health care. This document has centered on the proposition, definition and implementation of activities to that end.

The chapter on health infrastructure has been drafted by the close collaboration of professionals from different fields. This section establishes as objective to create human spaces to promote the wellness physical and psychologycal of patients, families and professionals. Through ten specific objectives and 40 activities, with, sometimes more than one indicator per activity, we want to get a change in structures to make them more efficient, comfortable and healthy for all agents involved in care.

We could say that, although ambitious in some of its aims, and the disadvantage of a not-always-low cost, infrastructure proposals try to reconcile the feasibility with the immediate impact. Measures on the control of noise, communication with the patient, and comfort in the family living room, can be examples of how change annoying habits and barriers. These activities were exposed visually in a presentation during the II Conference of Humanizing Intensive Care, held in Barcelona.

We are still at an early stage of dissemination and explanation of the document to all healthcare professionals of the ICU. But it is catching on the feeling that it is not science fiction to make simple modifications, without waiting to carry out expensive works, which make our environments (boxes, professional spaces and areas of family) more pleasant locations where care and work.

To collaborate in this document has made me think with my ICU mates on structural aspects. The changes are not dramatic, but we have made progress. Specifically in my ICU, we are more aware of the problem that generates the noise at night and there is a gradual awareness over its control.

Also we have worried about for further customization of the box so that the patient can recognize familiar stimuli (photos, pictures). Finally, we are testing devices of electronic visual communication with paralyzed or intubated patients that will allow us to find out what a patient with limitations of expression wants to say.

It is also relevant that during last year, humanization, also in the health infrastructures, has become a trending issue among patients, families, professionals and managers.

The humanization Plan, has enabled to create a friendly climate of opinion and debate between these groups. From this forum appears, and will emerge more and more, the need to implement changes in our way and enviroment of care. Not considering a priori the inevitability of a statu quo paved of concepts obsolete sanctified by a uncritical routine. "

A climate of opinion based on empathy and emotion springs with force, but based on instruments and verifiable methodology, which will make possible the "small mirable" of combining technical expertise with human warmth."

Thanks to Vicente Gomez Tello his collaboration. Thank you for again answering my question and do not miss the final post tomorrow.


Interior designer at Lab In Action

Tuesday, 16 August 2016

One year later: Mónica Ferrero interviews Laura Díaz

It is very important to take care of the spaces. To design them we must know very well the needs so we colect lots of information to project them.

Last year I did a serie of interviews to find out your opinion about spaces and infrastructure in the ICU: current status, needs, and suggestions.

To do this, I asked to professionals (
Vicente Gómez Tello and Laura Díaz), José Luis Díaz as an ICU expatient and Manuel López as a speaker for the families.

Many things have happened during this year. The IC-HU Project has had a great impact and continues to increase the number of national and international followers; the
II National Conference on Humanizing Intensive Care have been celebrated in Barcelona and the Humanization Plan of the Intensive Care Units of the Community of Madrid has been recently published.

One year later, I want to know if there has been an evolution, if spaces are been humanized interviewing the same professionals.
Laura Díaz is an Intensive Care Nurse of the Hospital Universitario Doce de Octubre, and has also participated in the elaboration of the Plan of the community.

- Laura, one year has passed since our enterview. Do you see any change in your ICU?

"I remember the day that Gabi Heras came to the hospital to tell us what The IC-HU project was... He talked about things that many of them we have spent years doing before the project, and he showed us that there were others that we could change or simply to organize, and therefore improve. Since then, many things have last, in a international and national level, and more specifically in my ICU: We started with the Open Door ICU for families... An idea that to the beginning caused discontent and was difficult to assimilate, but step by step experience and see how this helps to the patient, has made us understand how beneficial can get to be. Anyway, we did it before in some special cases or when the situation required it... Just now it has become a routine more of our daily work. 

To hear, as I heard yesterday to the wife of my patient, sayig; "This is the most cool ICU of Madrid, do you know that they let us be with you all day...?". It's very gratifying.

In addition, we created a group of humanization by nurses and doctors, in order to promote projects and protocols for its development in the unit, and in the II National Conference in Barcelona we have presented two posters with some of the improvements made to date.

Of course, we continue allowing photos, drawings, books, music, mobile... anything that can bring closer patient to family atmosphere, something that has been done in this unit for years.

The worse thing, and harder to change, is the infrastructure. Our hospital is old, one of the first large hospitals of Madrid, with many architectural barriers, without individual boxes, small spaces... In short, lack of intimacy. Slowly and with much effort (it seems that we are in times of ¨crisis" and the money allocated for changes is clearly insufficient) we have made also small improvements in this regard, as putting curtains between beds, which, at least partially, favors the respect to the privacy of the patient and consequently his family. For me this is a clue point and one of the things for what all the colleagues struggle day to day .

Because the project that has been created is very pretty and certainly very beneficial for the patient, but we need the collaboration of the management responsibles for assigning budgets for improvement to carry it out, because the involvement of health professionals in the project is 150%, without any doubt".

I want to thank Laura Díaz their collaboration. Thank you very much for answering my question again and remind you that you don't miss tomorrow Vicente Gómez response.


Mónica Ferrero
Interior designer at Lab In Action