Education, ICU

#humaniza Will be a TEDx Valladolid

Hola a tod@s, mis queridos amig@s.
After a few days of rest and refuel, we come back harder than ever.

The second half of this 2015, a year that will change the history, comes very very entertaining and in line with the first half: full of activities that keep generating consciousness.

Yesterday leapt on social networks one of the early surprises coming from now.We have been invited to participate inTEDxValladolid!

And many of you could say: and What is TED?.

TED is a nonprofit organization with one annual event where some of the thinkers and entrepreneurs more important in the world are invited to share what they are most passionate about. “TED” means technology, entertainment and design, three large areas that together are shaping our future. Today TED already has been extended to any discipline of general interest and has grown to support those who, with their ideas, are trying to change the world through various initiatives.

Chema Cepeda, The impact of technologies of approach

This year, on September 26th at
Laboratorio de las Artes de Valladolid (LAVA) we will make several trips.

Every day we take steps, we cross paths, we design itineraries, draw routes, we explored routes, draw maps, we crossings. Some have beginning and end, others never end, ones we are going alone, other accompanied… Everything we do to learn, discover, or simply enjoy.

Some people take one step further and dare with unusual “Journeys”, which normally needed to break the status quo, challenge, overcome obstacles, and sometimes even looking crazy.

That’s DARING JOURNEYS, which will be the 4th edition of TEDxValladolid: ideas that dare to take that step more and start travel with trips, unusual in the world of knowledge, of life, innovation, and knowledge in science, art, technology, design, education, nature, language, economics, physics, power, space,… and much more.

DARING JOURNEYS, a day dedicated to the ideas, emotions, unforeseen, signals, shortcuts, challenges, surprises, and globetrotting trips and travel, sometimes without destination and goal clear, but always leave footprint and worth be lived and shared. And we will not go alone, because together we add more

The IC-HU Project awaits you in Valladolid. If you want to join us on our journey, do not hesitate to book your ticket as soon as posible.

Without emotion there is no project, so don’t miss it!

Dr. Gabriel Heras, MD, ICU Physician
*Re-posted with permission  and original can be found at:

The ten barriers to appropriate management of patients at the end of their life

In the article published in Intensive Care Medicine by Hillamn y Cardona-Morell, the main barriers that hinder an appropriate management of patients at the end of life are described.

It is becoming more common the dilemma of admitting and treat in ICU certain patients that intensive medicine no longer can offer them what they really need: accepting the death process and providing them the best care at the end of life. The medicalization of death involves sometimes futile and costly treatments without providing added value to patients or their families, and even sometimes by subtracting quality in this process.

Why is so difficult to accept the process of dying?

1. We believe in miracles: unrealistic expectations of society and of the professional about what medicine can offer, overestimating the benefits and not taking into account the possible damage of health care.

2. We deny aging and death as if they could be avoided or if not to mention, this would change the destiny.

3. As professionals we are educated and trained to treat and save lives without thinking deeply and honest about the context of the disease. We always have to do something, rather than consider that maybe we must not do anything more.

4. Medical specialization focused on the care of organs or systems leads to overestimate the real possibilities, without a holistic view of the patient, and sometimes exerts pressure to maintain the active treatment.

5. The uncertainty about the prognosis of certain pathologies and situations that justify to follow the treatment sometimes indefinitely. We need tools and predictive models to reduce uncertainty and making decisions based on evidence.

6. Economic incentives to professionals in some health systems with payments by activity, advocating to keep treatments rather than remove them.

7. Ambivalence of bioethical principles which can be interpreted in different ways depending on who prioritize them, justifying even contradictory actions.

8. Legal pressure in the process at the end of life that makes practitioners act for fear of possible claims or to violate the law.

9. Criteria and action dynamics based on the diagnosis rather than in the actual context of the patient and which leads to admission in ICU critically ill patients, but non-recoverable. Reflect and stop the process once started is hard

10. The lack of alternatives to offer palliative care helps the hospital admission and even in the own ICU, as a prelude to death, without taking into account the desire of many people to be the passed away at home.

Intensive Care Medicine plays an important role in promoting the open debate to define the best way to die and find appropriate solutions, without transferring them to actions that are not justified, that only mask and dilate the reality.

Accept the death and be prepared to do this is a pending matter.

Dr. Mari Cruz Martin Delgado
Head of Intensive Care Department
Hospital Universitario de Torrejón

*Re-posted with permission from Dr. Gabi Heras.

**Original can be found at:


Accompanying the Family

Hola a tod@s, my dear friends.

From Asociación Humanizar of Hospital San Juan de Alicante, we have been informed about the following workshop on 25 March:

One of the projects of this volunteer is the accompaniment and listening to/with the relatives of the patients admitted to the ICU: welcome them and accompanied by giving them some instructions and helping them to wear coveralls when a patient requires contact or respiratory isolation.

They wait with the families during the visit and are responsible for give comfort and even embrace people who need it.

For more information about this workshop, click here (only available in Spanish).

Excellent initiative that goes in harmony with the concept redesign your waiting room pointed by Isidro Manrique (@uciero) which is already been presented in our talks

What about you? How would you improve this space and handling it in a more useful area?

Share it with us, we want to hear you!

By Dr. Gabi Heras, ICU Physician
*Re-posted with permission
Original can be found at:
Healthcare, ICU

Day 2 #UCIamable (friendly ICU): Yoga in ICU of Hospital 12 de Octubre

Hola a tod@s, my dear friends.

Day 2 #UCIamable (friendly ICU) Campaining, and Maria Soledad Martínez Ávila shares with us a very interesting research project. Stay alert:

Yoga is an ancient practice that appears in the Indus Valley in the 17th Century BC.

There are different types of yoga, the most widespread and known in the West is Hatha Yoga. It is a system of physical postures called asanas, whose purpose is to prepare the body for meditation. This type of yoga emphasizes physical, mental serenity, and relaxation, through proper breathing, control of our body and the meditation.

Yoga and meditation favor a transformation or personal change that leads to a better quality of life.

This improvement is reflected:

* At the physiological level, it induces a response of the parasympathetic nervous system.

* At the cognitive level, it produces changes in the valuation of stressful situations (primary value) and the capacity to deal with it and the associated potential consequences (secondary assessment). An attitude of objectivity and fairness takes place before the events of life, favouring an attitude of detachment and distance to this events and their results, allowing relative problems and facilitate coping of them. In addition, the practice of yoga develops attention and consciousness about our acts, thoughts and emotions, which allows to detect the physical and mental state of tension to confront it with the available resources.

* At the behavioral level, it can contribute to access to internal resources for coping. People learn to control impulses, to relax, to ask for help, to seek information and to develop healthier habits and behaviors.

* On the emotional level, improves mood, increases optimism, acceptance and favour emotional regulation.

I am María Soledad Martínez Ávila, ICU nurse of the Hospital 12 de Octubre in Madrid. With all these benefits associated, I thought that it would be a good idea to bring yoga and meditation to the hospital, and that my mates could enjoy and feel this awakening of consciousness, which would turn around in our patients, families and work environment.

I’ve been practicing yoga for more than three years, and last year I began my training as a teacher of therapy yoga.

I am developing a research project in my hospital ICUs. We want to study what effects yoga and meditation have on stress in doctors, nurses and auxiliary nurses. Among other parameters, we intend to carry out two determinations of cortisol in blood, at the beginning of the study and at the end of this.

And although the truth is that the project has been well received, I need funding to make the analytical determinations. I am looking for ideas, sponsors or help to carry out the project, so do not hesitate to contact me ( Thank you for your collaboration!

“The richness of the human being is a human being, one who lives in peace with oneself and in harmony with the world. The principle of yoga is driving the mind.”

Swami Niranjanananda
*Re-posted with permission from IC-HU Project
Original can be found at:
Healthcare, ICU

The ICU of the Future

Yesterday I had dinner with Carles Calaf and Victor Úbeda, and we were talking about the future with a couple of beers. Philosophy of bar and brainstorming: probably the most creative combination.

How will be the ICU of the Future? As we have thought before, for me it is clear: centered in persons and to prevent disease.

The amazing technological developement is helping exponentially to improve the care of patients. Remember that not so long ago it was impossible to think that everyone would have a computer in the pocket, appliances, and design engineer is enabling health professionals to work in a more efficient way. And there our positions are logically coupled: technology help us and should be at the service of people. The ICU of the future is already here, and we are designing it.

But, what do people want? The best possible management with the most advanced technology at their service.

Secondly, in times of immediacy, where every year we change our phones simply by being the last, we are served.

What about first? From the IC-HU Project, we see an improvement that should be guided by researching. Many of our goals are qualitative, so we will have to think how to quantify them so that those results which we hope will also fix managers numbers.

It is no coincidence that in recent weeks we are looking for psychologists to integrate them to the research team, as it is not casual that they are connecting us spontaneously to join the paradigm shift. In fact, multidisciplinary work as in hackathon in medicine is landing.

In any case, you do not believe that we have invented the wheel. Reminding us last week, De Tots Els Colors shared a speech from 1931 by Dr. Edward Bach about how the hospital of the future would be for him, and he was not very wrong:

“It will be a sancturary of peace, hope, and joy. No hurry, no noise entirely devoid of all the terrifying apparatus and appliances of today: free from the smell of antiseptics and anaesthetics: devoid of everything that suggests illness and suffering.

… The patient will seek that refuge, not only to be relieved of his malady, but also to develop the desire to live a life more in harmony with the dictates of his Soul than had been previously done.

The physician of tomorrow will realise that he of himself has no power to heal, but that if he dedicates his life to the service of his brother-men; to study human nature so that he may, in part, comprehend itsmeaning; to desire wholeheartedly to relieve suffering, and to surrender all for the help of the sick; then, through him may be sent knowledge to guide them, and the power of healing to relieve their pain. And even then, his power and ability to help will be in proportion to his intensity of desire and his willingness to serve.
He will have no interest in pathology or morbid anatomy; for his study will be that of health.

He will have to be able, from the life and history of the patient, to understand the conflict which is causing disease or disharmony between the body and Soul, and thusenable him to give the necessary advice and treatment for the relief of the sufferer.

The treatment of tomorrow will be essentially to bring four qualities to the patient:

First, PEACE: secondly, HOPE: thirdly, JOY: and fourthly, FAITH.”

Ladies and gentlemen, Tomorrow is now.

What can you do Today? Because things we do now are building the ICU of the Future.

By Dr. Gabi Heras, ICU physician

*Re-posted with permission.

Original can be found at:


Duel with Sticks

This is a picture of Francisco de Goya, two villains fighting in a bleak landscape. The weapons were sticks and there were no rules and protocols. The duel ended with the death of one of the contenders and usually with the other wounded. The landscape in the background is empty, which accentuates the loneliness and the brutal nature of the situation. 

Is this scenario in which our patients die in intensive care units? Are there rules and proper protocols that enable standardized attention to end-of-life patients? In short: how do patients die in the ICU? and how is this process live by relatives and how is the immediate mourning?

There are numerous questions that have been raised regarding the end of life care. There is no doubt that death of a loved one is a painful experience and more if fits in a so tech environment, such as intensive care units.

This issue caused us a great interest and curiosity, so we began to research on it. We realized that there is a lack of guidelines or protocols that enable standardized attention to end-of-life patient in these units which is compounded by a shortage of scientific literature in our country about the topic. This shows the long road that we need to walk to get the level of attention that the terminal patient and their relatives receive in other environments where it has already adopted the model of care focused on the patient and the family.

Because all of this, we thought we needed to start at home (ICU ofHospital Royo Villanova, Zaragoza).

So we have designed a project that aims to meet the subjective experience of the family about the death of a loved one in our unit.The reality that we are interested in is the one that people study perceive as important and meaningful.

The overall objective of the study is to know how the family lived the end of life of their relative.

We developed a new questionnaire that was sent to the family home by postal mail, three months of the death of the patient.

This questionnaire consists of 18 questions, 17 of them closed and one open. It also includes the age and relationship with the deceased of the person who completed the questionnaire. 18 questions collect information concerning medical care and nursing, information received by family members throughout the process, aspects relating to decision-making and autonomy of the patient, care, spiritual character, adequacy of the physical space for the accompaniment and the satisfaction of family members with the care received.

The questionnaire is accompanied by a letter of condolence that explains the reason of the study, the form of filling it and the guarantee of confidentiality of the information obtained from their responses.

The field of study is the ICU of Hospital Royo Villanova of Zaragoza . The study population are the relatives of deceased in that unit during 2013-2014 and who meet the criteria for the inclusion of age (over 18), stay (more than 48 hours between the income and the death), visits (patients who receive visits during admission) and cause of admission (the patients admitted by autolytic attempt are discarded).

We are currently shipping the latest letters of 2014. After the phase of shipping and collection of letters, we will proceed to the statistical analysis of the answers.

With this research work, we expect to know how the picture we painted is in the ICU about end of life care. We don´t want our picture have entitled “Duel with sticks” and that the landscape would not be desolate and empty. In this picture we want “paint” both the family as the interdisciplinary team and the patient, and our brushes would be respect, dignity and humanity.

Yolanda García García.
ICU Nurse of Hospital Royo Villanova.
Member of the Committee on Bioethics

Miguel Angel Pelay.
Nurse at EAP Sta. Isabel. Zaragoza.

*Republished with permission of Dr. Gabi Heras. Original can be found at:

Healthcare, ICU

The Iatroref Study: Caring, the Healthcare providers to care patients

Research studies focusing on the critical patient safety are increasing. The flaws in the system and human factors are the main cause of adverse events. The complexity of the factors that contribute to health care risk required to deep through its analysis, in order to establish strategies for improvement in one of the key of quality dimensions .

The Iatroref study has been published online first this month in Intensive Care Medicine, the Journal of ESICM. In 31 French ICUs, the authors show that depression of professionals in intensive care units impacts negatively on the safety of the patient, increasing the risk of medical errors and adverse events.

The main objective of this study was to evaluate the potential association between factors such as depression, burnout, the culture of security and organizational characteristics of these units, and the occurrence of certain adverse events.

The authors show their results in how depression is a factor to take into account, not only because of its significant prevalence (18.8% of physicians and 15.6% in nurses), but by interacting significantly with a greater number of medical errors and adverse events (RR 2.07). Burnout is not related to increased medical risk and safety culture influenced limited in the occurrence of adverse events.

Other factors with a negative impact on patient safety were related to the Organization of the ICU, training professionals in patient safety, and workloads.
This interesting study explores factors which remain still unexplored and which require to be taken into account in the management of the health risk. New tools are required to detect early symptoms of dysfunction in the psychological well-being of the professionals and we need to support individual and organizational strategies.
The international project “Perceived Stressors in Intensive Care Units (PS-ICU)” led by Professor Gilles Capellier, from University Hospital of Besançon and Alexandra Laurant from University Franche-Comté is consistent with this research.
This International Network Team, in which members of the IC-HU Project participate, consists of researchers from France, Italy, Ireland, Australia, Canada, and Spain. Its main objective is to build and validate an internationally specific scale on stress perceived by ICU professionals and identify those factors with impact on mental health, job satisfaction and quality of care.
Dra. Mari Cruz Martín Delgado (@MCMartinDelgado )
* Re-posted with permission. Original can be found at: