"Humanisation in the ICU must be daily, comprehensive, and constant, encompassing the entire environment of the patient and their family."

Dr. Jesús Andrés Álvarez Fernández, Chief Medical Officer of the ICU at Hospital Juaneda Miramar, bases humanisation on open doors, communication, patient well-being, family participation, staff care, prevention of post-ICU syndrome, human infrastructure, end-of-life care, and personalised medicine.

Since his arrival, after a long career in various key centres of intensive care medicine, Dr. Jesús Andrés Álvarez Fernández, Chief Medical Officer of the Intensive Care Unit (ICU) at Hospital Juaneda Miramar, has applied the philosophy of daily and comprehensive humanisation for both the patient and their family:

"Since I arrived at the ICU of Hospital Juaneda Miramar in July 2021, and with the support of the then-new supervisor, I conveyed to the medical and nursing team that humanisation must be practised here every day, at all times."

"And this humanisation," he adds, "must be carried out with the patient and their environment. It was in the second decade of this century that the 'HUCI' movement, with 'H' for humanisation, began to emerge in many hospitals simultaneously, especially in Madrid."

Humanisation as the foundation of care: "In the hospital's ICU Master Plan, I used the image of Bellver Castle, where each tower represented one of the strategic projects, but in the picture, the ground supporting everything was humanisation."

Indeed, "if someone spends a few hours with us in the ICU, they will see the daily care given to patients, which is so humane that the resulting feedback and satisfaction levels have been remarkable. Not a day goes by without receiving gratitude."

Humanisation in this ICU reaches a touching level: "We ask long-term patients to come back and say goodbye when they are discharged. When they return, the joy is so immense that we take a family photo (which we will soon display)."

To achieve this humanisation, "we pay close attention to the eight key points of the HUCI strategic lines. These strategies influence all our actions. Everyone working with us can see them daily on the notice board and knows they must uphold them."

The eight strategic lines are "open-door ICU, communication, patient well-being, family presence and participation, staff care, prevention, management and follow-up of post-ICU syndrome, infrastructure, and end-of-life care."

"The ICU must have open doors," Dr. Álvarez emphasises. "Many are closed, almost hermetically sealed. Ours is open not only to patients and their families but also to professionals from other specialties. There should be no barriers to information."

To achieve this, "we strive to meet all family requests for information, ensuring that communication channels are not broken, even with our professionals. For example, we must have a close link with the surgeon who treated the patient."

"No one comes to Hospital Juaneda Miramar asking for the ICU; they come to see a specialist for a health issue. During the process, they may need to go through the ICU. That is why we must be the 'partners' of that specialist."

For an open ICU, "we have increased visiting hours from one hour per day (during COVID) to three. We have adapted, for example, to the meal and dinner schedules of tourists staying in hotels, with excellent support from our interpreters."

Always considering that each case is different: "Some patients should not have restricted visiting hours. That is the 'extended ICU'. Their family is with them all day. The wife calls the ICU, gives her name (we know the names of patients and relatives), and is allowed in at any time."

Following the HUCI strategy on communication, "we convey to the patient and their relatives that the issue is the illness and that we are a team that includes them, working together—professionals, patients, and families—to overcome it.

"If a family has doubts about the information provided by our doctors, they are taken to the workspace, a computer is turned on, images and relevant data are shown, and diagrams are made to help them understand the problem."

For patient well-being, "we have changed the beds, chairs, applied a fresh coat of paint, and added new decorations, all to make the ICU more welcoming. Natural light floods the unit. Half the beds face the sea, the other half the mountains, and we switch patients to different views for long stays."

"We try to keep patients seated for as long as possible, providing early mobilisation. This is not only to discharge them sooner but to ensure their stay is as comfortable as possible."

The ICU values staff care: "I care deeply about how my colleagues feel, both individually and as a group. For example, once a month, we go to football matches in the Juaneda Hospitales box at the RCD Mallorca stadium. We must feel like part of a big team."

Other improvements have been introduced in patient care: "For some time now, physiotherapy services, which are vital during long ICU stays, are generally covered by the hospital at no extra cost."

In humanising infrastructure, "we have worked on specific aspects, such as repainting the unit, updating power outlets and lights, and switching to monitors and ventilators with night mode to aid rest."

Another example: "We have acquired a unified transport monitor and defibrillator. Previously, these devices were separate, creating challenges when moving patients and ensuring both elements were available."

The eighth HUCI point "was the first we implemented: end-of-life care, because the ICU is not just about saving lives. We must offer a dignified and accompanied death to patients for whom no further treatment is possible."

"These practices, which now seem widespread, were not common when the HUCI movement began. In recent years, no terminal patient at Hospital Juaneda Miramar's ICU has died without their loved ones by their side," says Dr. Álvarez.

He adds: "For terminal patients, we propose to their families the limitation of therapeutic effort, also known as limiting life-support treatments. This removes barriers to ICU access, such as cancer, age, or certain chronic illnesses."

"This way, in some cases, intubation—potentially a torment for the most fragile patients—can be avoided if it does not provide real benefit. We offer alternative treatments and discuss them with their relatives."

"We always review and discuss with the family whether, in the event of cardiac arrest, resuscitation should be attempted; if respiratory failure occurs, whether intubation is necessary; if there is heart failure, whether stimulant drugs should be used; and whether dialysis should be considered in case of kidney failure."

The ICU at Hospital Juaneda Miramar embodies one of the group's core values: "Medicine should not be 'off-the-rack', but tailored to each patient, especially in the ICU, where personalised care is essential."

"To care is to be attentive and responsive when the patient needs it. If they have to call twice, something is wrong. Ideally, they shouldn't need to call at all because the professional is already there, anticipating their needs," concludes Dr. Álvarez.

Share