For an open-door, more comfortable and humane intensive care unit. It is time for change

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"apellidos" => "Viña" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Calleja" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Por una UCI de puertas abiertas, más confortable y humana. Es tiempo de cambio" ] ] "textoCompleto" => "Restricting visits in the ICU is not kind, compassionate or necessary.Berwick D., Kotagal M.IntroductionScientific and technological advances have clearly improved medical practice, but such advances have not been accompanied by parallel progress in its humane aspects. Teamwork in hospitals eliminates the role of the single supervising physician and contributes to make medical care more impersonal. Patients are rendered naked physically and metaphorically, and although they are perfectly identified by means of a wristband, they are depersonalized by the system, which forgets about their emotional needs and transforms them into a medical study object. Hospitals are hostile places, and the patients and their families experience admission with anguish and concern. In the Intensive Care Unit (ICU) these emotions are intensified in the face of extreme life or death situations. Critical patients need especially humane and comfortable care, since they are very vulnerable and must face terrible illness with great discomfort associated both with the disease process and the structure/organization of the ICU.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> The ICU is a wonderful place where lives are saved, but it is also a hostile place, with too much light and permanent noise caused by respirators, monitor alarms and frequent (and often inadequate) conversations among healthcare professionals. All these cause discomfort, distorted by the administered medication, and lead to greater confusion. The patients moreover suffer pain and fear, with sleeping difficulties and disorientation, and are separated from their families by a restrictive visiting policy.As early as 1979, Molter<a class="elsevierStyleCrossRef" href="#bib0020">4</a> drew attention to the fact that professional effort was mainly focused on patient care, with scant attention to family care, and underscored the need to also extend care to the family unit–the latter being understood as patient family and friends. In line with this more integrating philosophy, nursing care in the ICU has changed, and is now also being extended to the family unit. Many studies underscore the importance of such change,<a class="elsevierStyleCrossRefs" href="#bib0025">5–11</a> since the family members experience a high prevalence of posttraumatic stress, anxiety and depression.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> The family needs are cognitive (the need to receive clear information on the diagnosis and prognosis), emotional (a consequence of sadness caused by the illness), social (the need to maintain ties with friends as a source of emotional support) and practical (environmental aspects that can improve wellbeing during the stay in the ICU).Consolation and emotional support of the patient/family should be seen as a fundamental part of our work. We need to provide relief from suffering while encouraging confidence in being able to cope with the disease and with hospital stay, and must improve aspects of our organization with a view to creating a more comfortable and humane ICU.The open-door Intensive Care unit. Expanding visiting hoursVisiting policy in Spain is very restricted, with a closed ICU culture despite the fact that many studies recommend an open-door approach with incorporation of the family to patient care.<a class="elsevierStyleCrossRefs" href="#bib0060">12–19</a> Families demand more time and flexibility in visiting. There is no reason for being restrictive in this regard, and it has been demonstrated that visits improve patient wellbeing, lessen family anxiety and increased perceived quality of care–thereby improving the image and humane dimension of the organization. A freer, expanded and more flexible visiting regimen allows families to adapt patient care to their working obligations and the care of other family members, such as children or the elderly. Closeness to the patient in critical situations or when death is imminent is even more necessary, and is of help in the mourning process. In cases of particularly vulnerable patients such as those with Down syndrome, mental disorders, very young patients or subjects with intense stress, permanent accompaniment by the family should be allowed.Pediatric visitsConsidering the risk of infections and potential psychological trauma, the visiting policy referred to children has been even more restrictive. However, in the pediatric and neonatology ICUs, where visiting is allowed, no increase in infections has been reported.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Some studies have found that patients see visits by their small children as a potent stimulus for recovery, and it has been demonstrated that children who have been able to visit their ill relative have been able to better understand the situation and the disease.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> If the patient/family so wishes, visiting by children should be allowed, adopting an individualized approach. This requires organizing the visit, providing information in simple language, offering all professional support for the child, and following a scheme or protocol established according to different age groups.Different international recommendations consider that family visits should have no restrictions, although logically visiting must be adjusted to the patient desires and clinical conditions.<a class="elsevierStyleCrossRefs" href="#bib0075">15,23</a> Our patients have the right to receive the affection and care of their relatives, and so an open-door policy should be a priority issue in the organization of the ICU.Family implication in patient careWe know that families wish to participate in patient care. If feasible from the perspective of the patient clinical condition, families could collaborate in some aspects of care, such as personal hygiene, the administration of meals, or the stimulation of physiotherapeutic exercises–in all cases under due nursing supervision. Offering the family the opportunity to contribute to recovery of the patient may have a positive effect for both the patient and the caregiver, reinforcing closeness and communication with the healthcare professionals. Some nursing societies have drafted recommendations on how to integrate family participation in patient care, based on the philosophy of centering care also on the family<a class="elsevierStyleCrossRef" href="#bib0050">10</a>.Information. The importance of communication in the Intensive Care UnitPeople increasingly demand more information and more active participation in relation to health decisions. Studies in different cultural and geographical settings indicate that one of the most important aspects referred to patient and family satisfaction is communication with the healthcare professionals.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a> Working in an ICU requires communication skills, since incorrect information can adversely affect the relationship with the medical team. In general, training in communication has been lacking, and conveying information is a difficult art that is learned through practice, mistakes and common sense. If we want to do things correctly, we must learn and use the specific methodology referred to communication in situations of crisis. We must be able to transmit very technical and complex information in simple and easily understandable terms; explain the diagnosis and prognosis; modulate the high emotional content of the message; and control the stress it produces. We also must remember that physicians are exposed to their own worries and concerns, and that the task of having to give bad news produces anxiety in the healthcare professional. Bad news must be explained clearly and with empathy, adapting ourselves to the rhythm of comprehension which the patient/family needs, and detecting situations of emotional block and denial of reality. The family suffers anxiety and depression, which complicate the understanding of information and the decision making process. The professional must understand, cope with and redirect inadequate emotional reactions with assertiveness, and at the same time must show understanding and empathy. The family typically has greater confidence with the nursing personnel, and lets them know their doubts and concerns. In this context it is necessary to divide the information given: the nursing professionals must talk to the family about general patient care and the use of apparatuses (respirators, monitors, alarm systems), and the physicians must address matters related to diagnosis, prognosis and treatment. It is important for the professionals working in the ICU to improve their training in communication skills with a view to achieving greater levels of satisfaction, a better physician–patient relationship, and less personal stress.Communication with the intubated patientSome studies have found that critical patients remember intubation and the incapacity to speak as one of the most bothersome and stressing experiences. Communication between the intubated patient and the healthcare personnel is generally insufficient and ineffective, and this proves frustrating for everyone. It is despairing to watch the efforts of intubated patients to express something, and to see how professionals try to explain different options without success–until they stop trying and simply say: “I don’t understand you, but don’t worry, everything is fine”.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Communication with intubated patients requires personal effort, time, interest, and a clear understanding of how important it is for the patient to be understood. Intensive Care Units should work to design and develop new non-verbal communication systems that can allow us to communicate with intubated patients, since the classical systems (involving written words or images) are limited and insufficient.Design of the Intensive Care Unit. Environmental wellbeingA recent study in France has found that only 72% of the ICUs have individual rooms, 66% have natural light, 26% have telephone access, 38% have radio access, 68% have a clock within view, and only 11% inform of the date.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> The lack of natural light and a visible clock causes a loss of time reference and alterations in circadian rhythm. Too much light during the night in turn prevents melatonin secretion, which is essential for inducing sleep. One of the most frequent patient complaints is the impossibility of sleeping because of too much light and noise.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Some studies have even found noise to exceed the maximum levels recommended by the World Health Organization.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> It has been described that poor sleep quality and delirium may be associated<a class="elsevierStyleCrossRef" href="#bib0145">29</a>–the latter in turn having important short- and long-term repercussions. In this respect, some studies have reported a decrease in the appearance of delirium when nighttime rest is facilitated by improving the environmental conditions (e.g., by turning off lights or making use of ear plugs and sleep masks).<a class="elsevierStyleCrossRef" href="#bib0150">30</a> If we want to improve patient sleep, one of the pending issues is lowering light intensity and noise levels. Strategies should be adopted, such as good alarm management, adequate illumination systems, and increased awareness among all healthcare professionals of the importance of caring for patient quality of sleep.In open-door ICUs, personal hygiene and clinical exploration are sometimes performed without taking patient embarrassment or the presence of other non-ICU professionals into account–this constituting a lack of respect for patient privacy. In general, patients in the ICU are naked–this being absolutely unnecessary provided they are clinically stable. Such a situation can go against patient dignity. In this regard, patient clothing should be considered, with the adoption of additional efforts to protect individual privacy. We also should ensure a more friendly environment and improve patient wellbeing (e.g., music, television), and facilitate communication and the right to maintain social ties, with access to mobile phones and electronics.One of the most common complaints among families is the fact that waiting rooms are uncomfortable and unpleasant. These rooms should be made more comfortable both in practical terms (with nearby toilets/bathrooms and cafeterias) and as regards their appearance–avoiding the typical dull institutional image and creating a more pleasant and relaxing environment. With a view to improving the comfort of patients in the ICU, some scientific societies have developed a series of recommendations<a class="elsevierStyleCrossRefs" href="#bib0075">15,23,31</a> that can help make the ICU a much more pleasant place.ConclusionsThe Intensive Care Unit is a wonderful place where lives are saved, but it is also a very harsh and unpleasant place where critically ill patients face terrible diseases under very adverse environmental conditions. We must change the design of the ICU and its organization; we must improve privacy, welfare and comfort of patients and families, paying attention to their personal and emotional demands. Opening the doors to the ICU, with more flexible visiting hours, and improving family care are among our most urging concerns, and should be delayed no further. We must equip ICUs with modern monitors and respirators (without becoming humanoid repair shops that incur in infinite expenses), but we must also invest in organization, design, environmental comfort and humanization. We need to redesign clinical practice so that intensive care becomes more agreeable and humane. We should not put off this change any longer, since it is an imperative social and professional necessity.Conflicts of interestThe authors declare that they have no conflicts of interest." 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We must change the design of the ICU and its organization; we must improve privacy, welfare and comfort of patients and families, following their personal and emotional demands. To free up the visiting hours and to improve family care are among our most urging matters, which we should delay no further. We must equip the ICUs with modern monitors and respirators but we must also invest in organization, design, environmental comfort and humanization. We need to redesign clinical practice so that ICU care becomes more agreeable and humane. We should put off this change no longer, since it is an imperative social and professional demand." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La Unidad de Cuidados Intensivos (UCI) es un lugar hermoso donde se regala vida, pero también es un lugar hostil donde los pacientes se enfrentan a una enfermedad terrible en condiciones ambientales muy adversas. Es necesario adaptar tanto el diseño como la organización de la UCI para mejorar la privacidad, el bienestar y la confortabilidad de pacientes y familias, cuidando especialmente sus demandas personales y emocionales. Abrir las puertas de la UCI liberalizando el horario de visitas y mejorar los cuidados dirigidos a la familia es una de las asignaturas pendientes que no debemos retrasar más. Debemos dotar a las UCI de modernos respiradores y equipos de monitorización, pero también debemos invertir en organización, diseño, bienestar ambiental y humanización. Necesitamos rediseñar la práctica clínica para que la atención en la UCI sea más confortable y humana. No se debe aplazar más el cambio ya que es una demanda social y profesional ineludible." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Escudero D, Viña L, Calleja C. Por una UCI de puertas abiertas, más confortable y humana. Es tiempo de cambio. 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For an open-door, more comfortable and humane intensive care unit. It is time for change

Por una UCI de puertas abiertas, más confortable y humana. Es tiempo de cambio

D. Escudero

Corresponding author

dolores.escudero@sespa.princast.es
lolaescudero@telefonica.net

Corresponding author.

, L. Viña, C. Calleja

Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

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and although they are perfectly identified by means of a wristband&#44; they are depersonalized by the system&#44; which forgets about their emotional needs and transforms them into a <span class="elsevierStyleItalic">medical study object</span>&#46; Hospitals are hostile places&#44; and the patients and their families experience admission with anguish and concern&#46; In the Intensive Care Unit &#40;ICU&#41; these emotions are intensified in the face of extreme life or death situations&#46; Critical patients need especially humane and comfortable care&#44; since they are very vulnerable and must face terrible illness with great discomfort associated both with the disease process and the structure&#47;organization of the ICU&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The ICU is a wonderful place where lives are saved&#44; but it is also a hostile place&#44; with too much light and permanent noise caused by respirators&#44; monitor alarms and frequent &#40;and often inadequate&#41; conversations among healthcare professionals&#46; All these cause discomfort&#44; distorted by the administered medication&#44; and lead to greater confusion&#46; The patients moreover suffer pain and fear&#44; with sleeping difficulties and disorientation&#44; and are separated from their families by a restrictive visiting policy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As early as 1979&#44; Molter<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> drew attention to the fact that professional effort was mainly focused on patient care&#44; with scant attention to family care&#44; and underscored the need to also extend care to the <span class="elsevierStyleItalic">family unit</span>&#8211;the latter being understood as patient family and friends&#46; In line with this more integrating philosophy&#44; nursing care in the ICU has changed&#44; and is now also being extended to the family unit&#46; Many studies underscore the importance of such change&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;11</span></a> since the family members experience a high prevalence of posttraumatic stress&#44; anxiety and depression&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The family needs are <span class="elsevierStyleItalic">cognitive</span> &#40;the need to receive clear information on the diagnosis and prognosis&#41;&#44; <span class="elsevierStyleItalic">emotional</span> &#40;a consequence of sadness caused by the illness&#41;&#44; <span class="elsevierStyleItalic">social</span> &#40;the need to maintain ties with friends as a source of emotional support&#41; and <span class="elsevierStyleItalic">practical</span> &#40;environmental aspects that can improve wellbeing during the stay in the ICU&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Consolation and emotional support of the patient&#47;family should be seen as a fundamental part of our work&#46; We need to provide relief from suffering while encouraging confidence in being able to cope with the disease and with hospital stay&#44; and must improve aspects of our organization with a view to creating a more comfortable and humane ICU&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The open-door Intensive Care unit&#46; Expanding visiting hours</span><p id="par0020" class="elsevierStylePara elsevierViewall">Visiting policy in Spain is very restricted&#44; with a <span class="elsevierStyleItalic">closed ICU</span> culture despite the fact that many studies recommend an open-door approach with incorporation of the family to patient care&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;19</span></a> Families demand more time and flexibility in visiting&#46; There is no reason for being restrictive in this regard&#44; and it has been demonstrated that visits improve patient wellbeing&#44; lessen family anxiety and increased perceived quality of care&#8211;thereby improving the image and humane dimension of the organization&#46; A freer&#44; expanded and more flexible visiting regimen allows families to adapt patient care to their working obligations and the care of other family members&#44; such as children or the elderly&#46; Closeness to the patient in critical situations or when death is imminent is even more necessary&#44; and is of help in the mourning process&#46; In cases of particularly vulnerable patients such as those with Down syndrome&#44; mental disorders&#44; very young patients or subjects with intense stress&#44; permanent accompaniment by the family should be allowed&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pediatric visits</span><p id="par0025" class="elsevierStylePara elsevierViewall">Considering the risk of infections and potential psychological trauma&#44; the visiting policy referred to children has been even more restrictive&#46; However&#44; in the pediatric and neonatology ICUs&#44; where visiting is allowed&#44; no increase in infections has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Some studies have found that patients see visits by their small children as a potent stimulus for recovery&#44; and it has been demonstrated that children who have been able to visit their ill relative have been able to better understand the situation and the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> If the patient&#47;family so wishes&#44; visiting by children should be allowed&#44; adopting an individualized approach&#46; This requires organizing the visit&#44; providing information in simple language&#44; offering all professional support for the child&#44; and following a scheme or protocol established according to different age groups&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Different international recommendations consider that family visits should have no restrictions&#44; although logically visiting must be adjusted to the patient desires and clinical conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;23</span></a> Our patients have the right to receive the affection and care of their relatives&#44; and so an open-door policy should be a priority issue in the organization of the ICU&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Family implication in patient care</span><p id="par0035" class="elsevierStylePara elsevierViewall">We know that families wish to participate in patient care&#46; If feasible from the perspective of the patient clinical condition&#44; families could collaborate in some aspects of care&#44; such as personal hygiene&#44; the administration of meals&#44; or the stimulation of physiotherapeutic exercises&#8211;in all cases under due nursing supervision&#46; Offering the family the opportunity to contribute to recovery of the patient may have a positive effect for both the patient and the caregiver&#44; reinforcing closeness and communication with the healthcare professionals&#46; Some nursing societies have drafted recommendations on how to integrate family participation in patient care&#44; based on the philosophy of centering care also on the family<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Information&#46; The importance of communication in the Intensive Care Unit</span><p id="par0040" class="elsevierStylePara elsevierViewall">People increasingly demand more information and more active participation in relation to health decisions&#46; Studies in different cultural and geographical settings indicate that one of the most important aspects referred to patient and family satisfaction is communication with the healthcare professionals&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a> Working in an ICU requires communication skills&#44; since incorrect information can adversely affect the relationship with the medical team&#46; In general&#44; training in communication has been lacking&#44; and conveying information is a difficult art that is learned through practice&#44; mistakes and common sense&#46; If we want to do things correctly&#44; we must learn and use the specific methodology referred to communication in situations of crisis&#46; We must be able to transmit very technical and complex information in simple and easily understandable terms&#59; explain the diagnosis and prognosis&#59; modulate the high emotional content of the message&#59; and control the stress it produces&#46; We also must remember that physicians are exposed to their own worries and concerns&#44; and that the task of having to give bad news produces anxiety in the healthcare professional&#46; Bad news must be explained clearly and with empathy&#44; adapting ourselves to the rhythm of comprehension which the patient&#47;family needs&#44; and detecting situations of emotional block and denial of reality&#46; The family suffers anxiety and depression&#44; which complicate the understanding of information and the decision making process&#46; The professional must understand&#44; cope with and redirect inadequate emotional reactions with assertiveness&#44; and at the same time must show understanding and empathy&#46; The family typically has greater confidence with the nursing personnel&#44; and lets them know their doubts and concerns&#46; In this context it is necessary to divide the information given&#58; the nursing professionals must talk to the family about general patient care and the use of apparatuses &#40;respirators&#44; monitors&#44; alarm systems&#41;&#44; and the physicians must address matters related to diagnosis&#44; prognosis and treatment&#46; It is important for the professionals working in the ICU to improve their training in communication skills with a view to achieving greater levels of satisfaction&#44; a better physician&#8211;patient relationship&#44; and less personal stress&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Communication with the intubated patient</span><p id="par0045" class="elsevierStylePara elsevierViewall">Some studies have found that critical patients remember intubation and the incapacity to speak as one of the most bothersome and stressing experiences&#46; Communication between the intubated patient and the healthcare personnel is generally insufficient and ineffective&#44; and this proves frustrating for everyone&#46; It is despairing to watch the efforts of intubated patients to express something&#44; and to see how professionals try to explain different options without success&#8211;until they stop trying and simply say&#58; &#8220;I don&#8217;t understand you&#44; but don&#8217;t worry&#44; everything is fine&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Communication with intubated patients requires personal effort&#44; time&#44; interest&#44; and a clear understanding of how important it is for the patient to be understood&#46; Intensive Care Units should work to design and develop new non-verbal communication systems that can allow us to communicate with intubated patients&#44; since the classical systems &#40;involving written words or images&#41; are limited and insufficient&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design of the Intensive Care Unit&#46; Environmental wellbeing</span><p id="par0050" class="elsevierStylePara elsevierViewall">A recent study in France has found that only 72&#37; of the ICUs have individual rooms&#44; 66&#37; have natural light&#44; 26&#37; have telephone access&#44; 38&#37; have radio access&#44; 68&#37; have a clock within view&#44; and only 11&#37; inform of the date&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The lack of natural light and a visible clock causes a loss of time reference and alterations in circadian rhythm&#46; Too much light during the night in turn prevents melatonin secretion&#44; which is essential for inducing sleep&#46; One of the most frequent patient complaints is the impossibility of sleeping because of too much light and noise&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Some studies have even found noise to exceed the maximum levels recommended by the World Health Organization&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> It has been described that poor sleep quality and delirium may be associated<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#8211;the latter in turn having important short- and long-term repercussions&#46; In this respect&#44; some studies have reported a decrease in the appearance of delirium when nighttime rest is facilitated by improving the environmental conditions &#40;e&#46;g&#46;&#44; by turning off lights or making use of ear plugs and sleep masks&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> If we want to improve patient sleep&#44; one of the pending issues is lowering light intensity and noise levels&#46; Strategies should be adopted&#44; such as good alarm management&#44; adequate illumination systems&#44; and increased awareness among all healthcare professionals of the importance of caring for patient quality of sleep&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In open-door ICUs&#44; personal hygiene and clinical exploration are sometimes performed without taking patient embarrassment or the presence of other non-ICU professionals into account&#8211;this constituting a lack of respect for patient privacy&#46; In general&#44; patients in the ICU are naked&#8211;this being absolutely unnecessary provided they are clinically stable&#46; Such a situation can go against patient dignity&#46; In this regard&#44; patient clothing should be considered&#44; with the adoption of additional efforts to protect individual privacy&#46; We also should ensure a more friendly environment and improve patient wellbeing &#40;e&#46;g&#46;&#44; music&#44; television&#41;&#44; and facilitate communication and the right to maintain social ties&#44; with access to mobile phones and electronics&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">One of the most common complaints among families is the fact that waiting rooms are uncomfortable and unpleasant&#46; These rooms should be made more comfortable both in practical terms &#40;with nearby toilets&#47;bathrooms and cafeterias&#41; and as regards their appearance&#8211;avoiding the typical dull institutional image and creating a more pleasant and relaxing environment&#46; With a view to improving the comfort of patients in the ICU&#44; some scientific societies have developed a series of recommendations<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;23&#44;31</span></a> that can help make the ICU a much more pleasant place&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">The Intensive Care Unit is a wonderful place where lives are saved&#44; but it is also a very harsh and unpleasant place where critically ill patients face terrible diseases under very adverse environmental conditions&#46; We must change the design of the ICU and its organization&#59; we must improve privacy&#44; welfare and comfort of patients and families&#44; paying attention to their personal and emotional demands&#46; Opening the doors to the ICU&#44; with more flexible visiting hours&#44; and improving family care are among our most urging concerns&#44; and should be delayed no further&#46; We must equip ICUs with modern monitors and respirators &#40;without becoming <span class="elsevierStyleItalic">humanoid repair shops</span> that incur in infinite expenses&#41;&#44; but we must also invest in organization&#44; design&#44; environmental comfort and humanization&#46; We need to redesign clinical practice so that intensive care becomes more agreeable and humane&#46; We should not put off this change any longer&#44; since it is an imperative social and professional necessity&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Intensive Care Unit is a wonderful place where lives are saved&#44; but it is also a very harsh and unpleasant place where critically ill patients face terrible diseases in very adverse environmental conditions&#46; We must change the design of the ICU and its organization&#59; we must improve privacy&#44; welfare and comfort of patients and families&#44; following their personal and emotional demands&#46; To free up the visiting hours and to improve family care are among our most urging matters&#44; which we should delay no further&#46; We must equip the ICUs with modern monitors and respirators but we must also invest in organization&#44; design&#44; environmental comfort and humanization&#46; We need to redesign clinical practice so that ICU care becomes more agreeable and humane&#46; We should put off this change no longer&#44; since it is an imperative social and professional demand&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La Unidad de Cuidados Intensivos &#40;UCI&#41; es un lugar hermoso donde se regala vida&#44; pero tambi&#233;n es un lugar hostil donde los pacientes se enfrentan a una enfermedad terrible en condiciones ambientales muy adversas&#46; Es necesario adaptar tanto el dise&#241;o como la organizaci&#243;n de la UCI para mejorar la privacidad&#44; el bienestar y la confortabilidad de pacientes y familias&#44; cuidando especialmente sus demandas personales y emocionales&#46; Abrir las puertas de la UCI liberalizando el horario de visitas y mejorar los cuidados dirigidos a la familia es una de las asignaturas pendientes que no debemos retrasar m&#225;s&#46; Debemos dotar a las UCI de modernos respiradores y equipos de monitorizaci&#243;n&#44; pero tambi&#233;n debemos invertir en organizaci&#243;n&#44; dise&#241;o&#44; bienestar ambiental y humanizaci&#243;n&#46; Necesitamos redise&#241;ar la pr&#225;ctica cl&#237;nica para que la atenci&#243;n en la UCI sea m&#225;s confortable y humana&#46; No se debe aplazar m&#225;s el cambio ya que es una demanda social y profesional ineludible&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Escudero D&#44; Vi&#241;a L&#44; Calleja C&#46; Por una UCI de puertas abiertas&#44; m&#225;s confortable y humana&#46; Es tiempo de cambio&#46; Med Intensiva&#46; 2014&#59;38&#58;371&#8211;375&#46;</p>"
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Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2014.01.001

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Year/Month	Html	Pdf	Total

2024 November	12	6	18
2024 October	68	86	154
2024 September	78	42	120
2024 August	90	41	131
2024 July	74	29	103
2024 June	87	41	128
2024 May	78	40	118
2024 April	93	37	130
2024 March	84	31	115
2024 February	77	44	121
2024 January	80	34	114
2023 December	63	42	105
2023 November	74	58	132
2023 October	75	37	112
2023 September	63	42	105
2023 August	53	19	72
2023 July	84	25	109
2023 June	51	32	83
2023 May	91	52	143
2023 April	53	34	87
2023 March	93	44	137
2023 February	89	42	131
2023 January	78	20	98
2022 December	67	51	118
2022 November	109	39	148
2022 October	124	51	175
2022 September	74	45	119
2022 August	73	45	118
2022 July	65	48	113
2022 June	59	33	92
2022 May	71	37	108
2022 April	71	59	130
2022 March	95	67	162
2022 February	80	40	120
2022 January	83	59	142
2021 December	71	51	122
2021 November	86	42	128
2021 October	101	76	177
2021 September	79	51	130
2021 August	105	60	165
2021 July	43	36	79
2021 June	55	26	81
2021 May	114	56	170
2021 April	303	135	438
2021 March	166	38	204
2021 February	145	15	160
2021 January	155	38	193
2020 December	107	34	141
2020 November	99	16	115
2020 October	68	26	94
2020 September	77	29	106
2020 August	65	10	75
2020 July	81	12	93
2020 June	55	20	75
2020 May	59	22	81
2020 April	106	32	138
2020 March	77	19	96
2020 February	166	47	213
2020 January	67	39	106
2019 December	56	25	81
2019 November	61	38	99
2019 October	81	26	107
2019 September	73	27	100
2019 August	58	31	89
2019 July	106	44	150
2019 June	85	49	134
2019 May	123	50	173
2019 April	90	31	121
2019 March	82	33	115
2019 February	72	45	117
2019 January	85	58	143
2018 December	102	49	151
2018 November	207	110	317
2018 October	156	28	184
2018 September	71	14	85
2018 August	54	12	66
2018 July	38	10	48
2018 June	47	13	60
2018 May	21	3	24
2018 April	43	16	59
2018 March	42	15	57
2018 February	37	12	49
2018 January	43	15	58
2017 December	38	13	51
2017 November	49	19	68
2017 October	50	6	56
2017 September	40	14	54
2017 August	27	12	39
2017 July	26	10	36
2017 June	44	13	57
2017 May	38	20	58
2017 April	56	10	66
2017 March	29	14	43
2017 February	25	15	40
2017 January	34	8	42
2016 December	62	11	73
2016 November	84	22	106
2016 October	116	17	133
2016 September	72	15	87
2016 August	72	17	89
2016 July	49	12	61
2016 February	1	0	1
2015 December	2	0	2
2015 September	1	14	15
2014 December	1	1	2

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