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Humanization: Improving patient and family experience in a public pediatric hospital
Jussara de Oliveira Zimmermann, Anna-Dulce S.C. Sampaio
Corresponding author
anna.dulce@hc.fm.usp.br

Corresponding author.
, Aide Mitie Kudo, Magda Carneiro-Sampaio
Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">In addition to offering advanced diagnostic procedures and treatments for patients with complex&#44; severe&#44; and rare diseases&#44; another equally relevant concern of our Children&#39;s Hospital &#40;ICr-HCFMUSP&#41; is the warm welcome&#44; as well as providing the least traumatic experience possible for both inpatients and outpatients and their families&#46; The commitment to reducing the suffering of sick children has always been intrinsic to pediatric practice worldwide&#46; In our Institution&#44; the establishment of formal practices linked to the Humanization of care and the discussion about them date back to the early 1990s&#44; under the coordination of social worker Ms&#46; Maria Jos&#233; Paro Forte and Prof&#46; Yassuhiko Okay&#46; Play therapy has always been part of the care routine and since the 1980&#180;s Occupational Therapists are primarily responsible for these activities and use playing as a strategy for their intervention&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">Humanization&#44; established as federal policy in Brazil in 2003&#44; aims at improving the experience of all those involved in health processes &#8210; patients&#44; families&#44; employees&#44; managers&#44; and volunteers &#8210; in institutions linked to the National Health System &#40;SUS - Sistema &#218;nico de Sa&#250;de&#41;&#44; and it represents a valuable framework for practices and institutional organization&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> In the following paragraphs&#44; some ICr-HCFMUSP initiatives and strategies are briefly described to make health care for infants&#44; children&#44; and adolescents more humanized&#44; focusing mostly on hospitalized patients&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">A pioneer program called &#8220;Child-friendly Diagnosis&#8221; &#40;in Portuguese &#8220;Diagn&#243;stico Amigo da Crian&#231;a&#8221;&#41; has been developed since 2012 with the involvement of physicians&#44; nurses&#44; and other professionals&#46; Its main objectives have been&#58; i&#41; Reducing the volume of blood withdrawal for laboratory analyses&#59; ii&#41; Reducing exposure to ionizing radiation &#40;X-Ray&#44; particularly for computed tomography&#41;&#44; prioritizing ultrasound whenever possible&#44; iii&#41; Reducing the child&#39;s emotional suffering during diagnostic procedures&#44; and for this&#44; ICr-HCFMUSP has promoted improvement of ambiance and reduction and even abolition of fasting for blood analyses&#44;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Therapeutic education for chronic diseases aimed at adolescents and families has been another innovative initiative proposed and developed by pediatricians together with other professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0004" class="elsevierStylePara elsevierViewall">Initiatives to improve the ambiance have been transforming the Hospital&#39;s atmosphere&#46; The presence of colorful and fun images on the walls and ceiling of some rooms has favored relaxation&#44; joy&#44; and well-being&#44; with a significant impact on patients and families&#44; as well as on the staff&#46; The first intervention began in 2014 and has been represented by the posting of several artwork reproductions by the painter Gustavo Rosa &#40;S&#227;o Paulo&#44; 1946&#8210;2013&#41; on the walls of various areas of the Hospital&#44; such as the main entrance&#44; outpatient clinics&#44; day hospital&#44; hemodialysis&#44; and emergency room &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46; Our outpatient clinic&#44; which has 26 posters in its corridors&#44; now looks like a small art gallery&#44; and patients enjoy taking different photos at each visit&#46; More recently&#44; improvements in ambiance were carried out in the Diagnostic Center&#44; with the adaptation of MRI &#40;magnetic resonance imaging&#41; equipment to simulate a yellow submarine at the bottom of a blue ocean full of fish and other animals&#44; while the walls of the blood withdrawal area were completely covered with figures of animals inside a forest &#40;<a class="elsevierStyleCrossRef" href="#fig0003">Figs&#46; 3</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0004">4</a>&#41;&#46; Children get curious and delighted when entering these spaces and&#44; therefore&#44; are less anxious about the procedures&#46; A virtual reality program is being developed with the aim of reducing the need to anesthetize older children undergoing MRIs&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><elsevierMultimedia ident="fig0003"></elsevierMultimedia><elsevierMultimedia ident="fig0004"></elsevierMultimedia><p id="para0005" class="elsevierStylePara elsevierViewall">Playing is an activity inherent to children&#39;s daily lives&#44; essential for neuropsychomotor development and for the establishment of social and affective relationships&#44; and guaranteed in the hospital environment&#46; In Brazil&#44; there is a public policy providing for the mandatory existence of toy libraries in pediatric health services&#44; which should represent a privileged space for allowing children to experience pleasant moments of relaxation&#44; learning&#44; social interaction&#44; and stimuli to recover their health&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> The use of interactive games and toys is also a resource to help patients in coping with the limitations resulting from their illnesses and hospitalization&#44; with the ultimate objective of improving their quality of life&#44; especially for children with chronic diseases&#46; Special toys and play activities have already been developed in ICr-HCFMUSP with the aim of elucidating diseases and procedures for patients&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">Promoting free or therapeutic artistic activities&#44; such as visual arts&#44; videos&#44; and music&#44; to hospitalized and ambulatory patients has been demonstrated as an effective way to humanize the treatment experience&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> People with chronic and severe illnesses spend a significant part of their lives in the hospital environment&#44; sometimes their entire lives&#46; Thus&#44; experiences related to education&#44; interpersonal relationships&#44; art&#44; spirituality&#44; and other aspects of life have to happen within the hospital environment&#44; or they will not happen at all&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">However&#44; artistic insertion in a hospital environment presents many challenges and limitations to be overcome&#44; especially in tertiary institutions&#44; where strict control of nosocomial infections is crucial&#46; Thus&#44; materials traditionally used in art therapy&#44; such as clay&#44; wood&#44; and stone&#44; are not allowed for hospitalized patients&#46; Even music therapy faces some barriers&#44; as many instruments are made of wood and should only be used by the therapist and always following the Infection Control Committee recommendations&#46; Wind instruments should be avoided&#46; On the other hand&#44; plastic&#44; or metal musical instruments&#44; as well as toys in general&#44; represent better options for patients&#44; as they can be adequately sanitized&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">Hospital schooling&#44; adopted as a public policy in Brazil&#44; offers educational content equivalent to that of public schools&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> It is largely available at ICr-HCFMUSP and represents an instrument for social inclusion that can mitigate the profound impact of long-lasting or repeated hospitalizations on the education of pediatric patients&#44; compromising their school performance and professional future&#46;</p><p id="para0009" class="elsevierStylePara elsevierViewall">To provide the aforementioned activities to its approximately 200 hospitalized patients and some recreational activities for approximately 250 outpatients per day&#44; the ICr-FMUSP has the collaboration of approximately 400 volunteers from different professional backgrounds&#46; They are organized into groups to offer recreational&#44; educational&#44; and artistic activities &#40;professional musicians and clowns&#41;&#44; pet visits&#44; spirituality&#44; and different types of crafts with accompanying parents&#44; among others&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Disseminating the concepts and practices of humanization of care is imperative among all health and administrative professionals for the success of the programs&#46; In addition to a warm welcome&#44; some topics should be addressed&#44; such as cultural&#44; religious&#44; ethnic&#44; gender&#44; and sexuality diversity&#44; non-violent communication&#44; and others&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">Based on the principle that &#8220;the patient is the most important person of the Institution&#8221;&#44; ICr-HCFMUSP has already achieved good welcoming practices and respect for the individuality of patients and their families&#44; as well as among staff members&#44; who need to feel comfortable in their care activities&#46; Moreover&#44; the authors are convinced that more than talks and courses&#44; the dissemination of everyday examples of solidarity&#44; empathy&#44; compassion&#44; and kindness allows the incorporation of good humanization practices aimed at improving the patient&#39;s experience in the hospital&#46;</p></span>"
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Article information
ISSN: 18075932
Original language: English
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