Proyecto “Humanizando los Cuidados Intensivos”, nuevo paradigma de orientación de los Cuidados Intensivos
DOI:
https://doi.org/10.1344/rbd2020.48.29173Keywords:
Cuidados Intensivos, Humanización UCI, Proyecto HU-CI, ética del cuidado, profesionalización, desgaste profesional, síndrome Burnout, síndrome OverlapAbstract
En los últimos 50 años, la Medicina Intensiva ha alcanzado las más altas cifras de supervivencia gracias al trabajo de equipos multi disciplinares altamente cualificados y formados, del papel de una avanzada tecnología en el campo del tratamiento, la enfermedad como centro, el soporte vital y el diagnóstico clínico.
Este reconocimiento no ha llegado sin costes, en el 2008, una conocida persona pública explicó su experiencia vivida como paciente en una Unidad de Cuidados Intensivos (UCI), el cual describió la UCI como la sucursal del infierno.
El esfuerzo en la atención del paciente critico implica el uso de la tecnología y todo el medio que rodea la UCI, centradas en tratar la enfermedad del paciente, pero había desplazado a las personas y a sus individualidades del centro de cuidado. Esto dio como consecuencia la despersonalización de todos los agentes implicados (pacientes, familias, cuidadores e incluso los profesionales). Las investigaciones han demostrado las graves lesiones físicas y psíquicas en nuestros supervivientes, con importantes consecuencias éticas.
References
Garnacho Montero J, Lerma FÁ, Galleymore PR, et al. Combatting resistance in intensive care: The multimodal approach of the Spanish ICU “Zero Resistance” program. Crit Care. 2015. doi:10.1186/s13054-015-0800-5
2. Alonso-Ovies Á, Heras la Calle G. ICU: a branch of hell? Intensive Care Med. 2016. doi:10.1007/s00134-015-4023-7
3. Intensivos C. Grupo de Trabajo de Certificación de Proyecto HU-CI. Manual de Buenas Prácticas de Humanización En Unidades de Cuidados Intensivos. Madrid: Proyecto HU-CI; 2017 [Acceso 5 de Noviembre de 2017]. Disponible En: Http://Humanizandoloscuidadosintensivos.Com/Es. http://humanizandoloscuidadosintensivos.com/wp-content/uploads/2017/11/Manual-Buenas-Practicas-HUCI.pdf.
4. Berti D, Ferdinande P, Moons P. Beliefs and attitudes of intensive care nurses toward visits and open visiting policy. Intensive Care Med. 2007;33(6):1060-1065. doi:10.1007/s00134-007-0599-x
5. Baharoon S, Al Yafi W, Al Qurashi A, et al. Family satisfaction in critical care units: Does an open visiting hours policy have an impact? J Patient Saf. 2017;13(3):169-174. doi:10.1097/PTS.0000000000000140
6. Liu V, Read JL, Scruth E, Cheng E. Visitation policies and practices in US ICUs. Crit Care. 2013;17(2). doi:10.1186/cc12677
7. Wilson ME, Beesley S, Grow A, et al. Humanizing the intensive care unit. Crit Care. 2019. doi:10.1186/s13054-019-2327-7
8. Petrinec AB, Martin BR. Post-intensive care syndrome symptoms and health-related quality of life in family decision-makers of critically ill patients. Palliative and Supportive Care. 2017:1-6.
9. Dziadzko V, Dziadzko MA, Johnson MM, Gajic O, Karnatovskaia L V. Acute psychological trauma in the critically ill: Patient and family perspectives. Gen Hosp Psychiatry. 2017;47:68-74. doi:10.1016/j.genhosppsych.2017.04.009
10. Jezierska N, Borkowski B, Gaszynski W. Psychological reactions in family members of patients hospitalised in intensive care units. Anaesthesiol Intensive Ther. 2014;46(1):42-45. doi:10.5603/ait.2014.0009
11. Olesen TSW, Kruse M, Pawlowicz-Dworzanska M, Klostergaard K, Leutscher PDC. [Post intensive care syndrome]. Ugeskr Laeger. 2017;179(45):2-6. http://www.ncbi.nlm.nih.gov/pubmed/29108536.
12. María Casado (Coord.). No Title. “Sobre la Dignidad y los principios. Análisis de la Declaración Universal sobre Bioética y Derechos Humanos de la UNESCO”, Ed Civitas, 2009, 600 pp, ISBN 978-84-4703-261-7.
13. Cabré Pericas LL, Abizanda Campos R, Baigorri González F, et al. Código ético de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC). Med Intensiva. 2006. doi:10.1016/S0210-5691(06)74471-0
14. Torralba i Roselló F, MAPFRE Medicina F. Ética del cuidar : fundamentos, contextos y problemas. January 2002.
15. Lévinas, Emmanuel. Descubriendo la existencia con Husserl y Heidegger. Pensamiento Rev Investig e Inf Filosófica. 2016.
16. Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35(2):605-622. doi:10.1097/01.CCM.0000254067.14607.EB
17. Tovar S, Westemeyer W, Foltz L, et al. Open the doors! Visiting hours revisited. Crit Care Nurse. 2006;26(2):S24-S24. http://sire.ub.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106451757&login.asp&lang=es&site=ehost-live&scope=site.
18. Ayllón Garrido N, Montero Rus P, Acebes Fernández MI, Sánchez Zugazua J. Open door intensive care unit: View of the professionals. Enfermería Intensiva. 2014;25(2):72-77. doi:10.1016/j.enfi.2013.11.007
19. Spreen AE, Schuurmans MJ. Visiting policies in the adult intensive care units: A complete survey of Dutch ICUs. Intensive Crit Care Nurs. 2011;27(1):27-30. doi:10.1016/j.iccn.2010.10.002
20. Giannini A, Miccinesi G, Prandi E, Buzzoni C, Borreani C. Partial liberalization of visiting policies and ICU staff: A before-and-after study. Intensive Care Med. 2013;39(12):2180-2187. doi:10.1007/s00134-013-3087-5
21. Black P, Boore JRP, Parahoo K. The effect of nurse-facilitated family participation in the psychological care of the critically ill patient. J Adv Nurs. 2011;67(5):1091-1101. doi:10.1111/j.1365-2648.2010.05558.x
22. Quinn S, Redmond K, Begley C. The needs of relatives visiting adult critical care units as perceived by relatives and nurses. Part 2. Intensive Crit Care Nurs. 1996;12(4):239-245. doi:10.1016/S0964-3397(96)80148-0
23. Hupcey JE. Looking out for the patient and ourselves - The process of family integration into the ICU. J Clin Nurs. 1999;8(3):253-262. doi:10.1046/j.1365-2702.1999.00244.x
24. Ely EW. The ABCDEF bundle: Science and philosophy of how ICU liberation serves patients and families. Crit Care Med. 2017;45(2):321-330. doi:10.1097/CCM.0000000000002175
25. Rotondi AJ, Chelluri L, Sirio C, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002;30(4):746-752. doi:10.1097/00003246-200204000-00004
26. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018. doi:10.1097/CCM.0000000000003299
27. Downar J, Delaney JW, Hawryluck L, Kenny L. Guidelines for the withdrawal of life-sustaining measures. Intensive Care Med. 2016. doi:10.1007/s00134-016-4330-7
28. Ulrich RS. View through a window may influence recovery from surgery. Science (80- ). 1984. doi:10.1126/science.6143402
29. Thompson DR, Hamilton DK, Cadenhead CD, et al. Guidelines for intensive care unit design. Crit Care Med. 2012. doi:10.1097/CCM.0b013e3182413bb2
30. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008.
31. Chen KY, Yang CM, Lien CH, et al. Burnout, job satisfaction, and medical malpractice among physicians. Int J Med Sci. 2013. doi:10.7150/ijms.6743
32. Elshaer NSM, Moustafa MSA, Aiad MW, Ramadan MIE. Job Stress and Burnout Syndrome among Critical Care Healthcare Workers. Alexandria J Med. 2018. doi:10.1016/j.ajme.2017.06.004
33. Regan A, Howard RA, Oyebode JR. Emotional exhaustion and defense mechanisms in intensive therapy unit nurses. J Nerv Ment Dis. 2009. doi:10.1097/NMD.0b013e3181a20807
34. Seguí Diaz M, Linares Pou L, Blanco López W, Ramos Aleixades J, Torrent Quetglas M. Tiempos durante la visita médica en atención primaria. Aten Primaria. 2004. doi:10.1157/13061607
35. Jha, A; Iliff A. A CRISIS IN HEALTH CARE : A CALL TO ACTION ON physician burnout. Massachusetts Med Soc. 2019.
36. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. An Official Critical Care Societies Collaborative Statement—Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action. Chest. 2016. doi:10.1016/j.chest.2016.02.649
37. Lumb PD. Burnout in critical care healthcare professionals: Responding to the call for action. Crit Care Med. 2016. doi:10.1097/CCM.0000000000001944
38. World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. MAY 2019. https://www.who.int/mental_health/evidence/burn-ou.
39. El Khamali R, Mouaci A, Valera S, et al. Effects of a multimodal program including simulation on job strain among nurses working in intensive care units a randomized clinical trial. JAMA - J Am Med Assoc. 2018. doi:10.1001/jama.2018.14284
40. Onge SC. Creating a Healthy Work Environment With Collaborative Team Meetings Triad of Communication-Patient, Physician, Nurse—Improving the Physician Nurse-Physician Collaboration. CRITICALCARENURSE. 2006;26(2). http://ccn.aacnjournals.org.
41. Dzau VJ, Kirch DG, Nasca TJ. To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis. N Engl J Med. 2018. doi:10.1056/nejmp1715127
42. Mealer M, Jones J, Newman J, McFann KK, Rothbaum B, Moss M. The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. Int J Nurs Stud. 2012. doi:10.1016/j.ijnurstu.2011.09.015
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