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      Proyecto "Humanizando los Cuidados Intensivos", nuevo paradigma de orientación de los Cuidados Intensivos Translated title: Project "Humanizing Intensive Care", new paradigm of guidance in Intensive Care Unit Translated title: El projecte "Humanitzant la vigilància intensiva", un nou paradigma d'orientació de la vigilància intensiva

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          Abstract

          Resumen En los últimos 50 años, la Unidad de Cuidados Intensivos (UCI) ha alcanzado las cifras más altas de supervivencia gracias al trabajo de equipos multidisciplinarios, al papel de la tecnología en el campo del tratamiento, la enfermedad como centro, el soporte vital y el diagnóstico clínico. Este esfuerzo sumado al uso de la tecnología, el medio que rodea al paciente, centrándose solo en el tratamiento de su enfermedad, había desplazado a las personas y a sus individualidades del centro de cuidado. Esto resultó en la despersonalización de todos los agentes involucrados (pacientes, familias, cuidadores e incluso profesionales). Las investigaciones, han demostrado graves secuelas físicas y psicológicas en nuestros supervivientes, con consecuencias éticas. La despersonalización es uno de los signos del síndrome de burnout, un problema grave no resuelto y creciente entre los profesionales, y fue admitido como una enfermedad por la OMS en el 2019. Los grandes principios bioéticos no han sido capaces de responder a las causas del sufrimiento físico-psíquico. Se necesitan nuevas orientaciones éticas que se orienten al individuo y su particularidad, bajo aspectos más emocionales y afectivos, refiriéndonos a la "ética del cuidado" como un núcleo gravitacional donde crece el profesionalismo y la práctica de la resiliencia en el campo de la salud. La importancia de integrar la ética de la atención orientada hacia el binomio paciente-familia, y de combatir el agotamiento mediante la atención a profesionales, es un verdadero desafío dentro de la UCI, dos caras diferentes pero vinculadas que pertenecen a la misma moneda.

          Translated abstract

          Abstract In the last 50 years, Intensive Medicine has reached the highest survival figures thanks to the work of highly qualified and trained multi-disciplinary teams, the role of advanced technology in the field of treatment, the disease as a center, life support and clinical diagnosis. The effort involves the use of technology and all the environment surrounding the Intensive Care Unit (ICU), focused on treating patient disease, but had displaced people and their individualities from the care facility. This resulted in the depersonalization of all the agents involved (patients, families, caregivers and even professionals). Research has shown the serious physical and psychological injuries in our survivors, with significant ethical consequences. Depersonalization is one of the signs of burnout syndrome, which is a serious unresolved and growing problem among health professionals that in early 2019 has been admitted as a disease by the WHO. The great bioethical principles have not been able to respond to the causes of physical and psychic suffering. New ethical orientations are needed that are resized to the individual and their particularity, under more emotional and affective aspects, by which we refer to the ''ethics of care'' as a gravitational nucleus where professionalism and the practice of resilience in the health field are growing. The importance of integrating the ethics of care oriented towards the patient-family binomial, and of combating burnout by performing care for professionals, is a real challenge within the ICU, two different but linked sides that belong to the same currency.

          Translated abstract

          Resum En els últims 50 anys, la Unitat de Vigilància intensiva (UVI) ha aconseguit les xifres més altes de supervivència gràcies al treball d'equips multidisciplinaris, al paper de la tecnologia en el camp del tractament, la malaltia com a centre, el suport vital i el diagnòstic clínic. Aquest esforç sumat a l'ús de la tecnologia, el mitjà que envolta al pacient, centrant-se només en el tractament de la seva malaltia, havia desplaçat les persones i la seva individualitat del centre de la cura. Això va resultar en la despersonalització de tots els agents involucrats (pacients, famílies, cuidadors i fins i tot professionals). Les últimes recerques han demostrat greus seqüeles físiques i psicològiques en els supervivents, amb conseqüències ètiques. La despersonalització és un dels signes de la síndrome de burnout, un problema greu no resolt i creixent entre els professionals, i va ser admès com una malaltia per l'OMS el 2019. Els grans principis bioètics no han estat capaços de respondre a les causes del sofriment físic-psíquic. Es necessiten noves orientacions ètiques dirigides a l'individu i a la seva particularitat, incloent-hi aspectes més emocionals i afectius, referint-nos a l' ètica del curar com un nucli gravitacional on creix el professionalisme i la pràctica de la resiliència en el camp de la salut. La importància d'integrar l'ètica de l'atenció orientada cap al binomi pacient-família, i de combatre l'esgotament mitjançant l'atenció a professionals, és un veritable desafiament dins de l'UVI, dues cares diferents però vinculades que pertanyen a la mateixa moneda.

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          The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families.

          E Ely (2017)
          Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU liberation is an extensive program designed to facilitate the implementation of the pain, agitation, and delirium guidelines using the evidence-based ABCDEF bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In doing so, patients are "liberated" from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU liberation philosophy and to explain how this patient- and family-centered, quality improvement program is novel, generalizable, and practice changing.
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            The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey.

            ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses. Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale. Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p<0.001), and a lower prevalence of burnout syndrome (p<0.001). The presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Burnout, Job Satisfaction, and Medical Malpractice among Physicians

              Objectives: Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. Methods: We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians. Physicians who were members of the Taiwan Society of Emergency Medicine, Taiwan Surgical Association, Taiwan Association of Obstetrics and Gynecology, The Taiwan Pediatric Association, and Taiwan Stroke Association, and physicians of two medical centers, three metropolitan hospitals, and two local community hospitals were recruited. Results: There is high incidence of burnout among Taiwan physicians. In our research, Visiting staff (VS) and residents were more likely to have higher level of burnout of the emotional exhaustion (EE) and depersonalization (DP), and personal accomplishment (PA). There was no difference in burnout types in gender. Married had higher-level burnout in EE. Physicians who were 20~30 years old had higher burnout levels in EE, those 31~40 years old had higher burnout levels in DP, and PA. Physicians who worked in medical centers had a higher rate in EE, DP, and who worked in metropolitan had higher burnout in PA. With specialty-in-training, physicians had higher-level burnout in EE and DP, but lower burnout in PA. Physicians who worked 13-17hr continuously had higher-level burnout in EE. Those with ≥41 times/week of being on call had higher-level burnout in EE and DP. Physicians who had medical malpractice experience had higher-level burnout in EE, DP, and PA. Physicians who were not satisfied with physician-patient relationships had higher-level burnout than those who were satisfied. Conclusion: Physicians in Taiwan face both burnout and a high risk in medical malpractice. There is high incidence of burnout among Taiwan physicians. This can cause shortages in medical care human resources and affect patient safety. We believe that high burnout in physicians was due to long working hours and several other factors, like mental depression, the evaluation assessment system, hospital culture, patient-physician relationships, and the environment. This is a very important issue on public health that Taiwanese authorities need to deal with.
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                Author and article information

                Journal
                bioetica
                Revista de Bioética y Derecho
                Rev. Bioética y Derecho
                Observatori de Bioètica i Dret - Cátedra UNESCO de Bioética (Barcelona, Barcelona, Spain )
                1886-5887
                2020
                : 48
                : 111-126
                Affiliations
                [1] orgnameHospital de Barcelona orgdiv1Servicio de Medicina Intensiva Spain
                [2] orgnameHospital Barcelona orgdiv1Servicio de Medicina Intensiva Spain
                Article
                S1886-58872020000100008 S1886-5887(20)00004800008
                b3770109-f6f3-45d3-97b2-b6d0dada8451

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 26 August 2019
                : 25 September 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 42, Pages: 16
                Product

                SciELO Spain

                Categories
                Dossier Bioética y Medicina Intensiva

                síndrome burnout,síndrome overlap,professionalization,desgaste profesional,care ethics,Intensive Care,UCI humanization,HU-CI project,professional exhaust,burnout syndrome,desgast professional,overlap syndrome,Vigilància intensiva,humanització UVI,professionalització,projecte HU-CI,ètica del curar,profesionalización,ética del cuidado,proyecto HU-CI,humanización UCI,Cuidados intensivos

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