Carneiro-Sampaio, Magda

Kudo, Aide Mitie

Sampaio, Anna-Dulce S.C.

Zimmermann, Jussara de Oliveira

English

Cadernos Espinosanos (E-Journal)

Clinics 78 (2023) 100187journal homepage: https://www.journals.elsevier.com/clinicsEditorialsHumanization: Improving patient and familyexperience in a public pediatric hospitalIn addition to offering advanced diagnostic procedures and treat-ments for patients with complex, severe, and rare diseases, anotherequally relevant concern of our Children’s Hospital (ICr-HCFMUSP) isthe warm welcome, as well as providing the least traumatic experiencepossible for both inpatients and outpatients and their families. The com-mitment to reducing the suffering of sick children has always beenintrinsic to pediatric practice worldwide. In our Institution, the estab-lishment of formal practices linked to the Humanization of care and thediscussion about them date back to the early 1990s, under the coordina-tion of social worker Ms. Maria Jose Paro Forte and Prof. YassuhikoOkay. Play therapy has always been part of the care routine and sincethe 1980s Occupational Therapists are primarily responsible for theseactivities and use playing as a strategy for their intervention.Humanization, established as federal policy in Brazil in 2003, aims atimproving the experience of all those involved in health processes ‒patients, families, employees, managers, and volunteers ‒ in institutionslinked to the National Health System (SUS - Sistema Unico de Saude),and it represents a valuable framework for practices and institutionalorganization.1 In the following paragraphs, some ICr-HCFMUSP initia-tives and strategies are briefly described to make health care for infants,children, and adolescents more humanized, focusing mostly on hospital-ized patients.A pioneer program called “Child-friendly Diagnosis” (in Portuguese“Diagnostico Amigo da Criança”) has been developed since 2012 withthe involvement of physicians, nurses, and other professionals. Its mainobjectives have been: i) Reducing the volume of blood withdrawal forlaboratory analyses; ii) Reducing exposure to ionizing radiation (X-Ray,particularly for computed tomography), prioritizing ultrasound when-ever possible, iii) Reducing the child’s emotional suffering during diag-nostic procedures, and for this, ICr-HCFMUSP has promotedimprovement of ambiance and reduction and even abolition of fastingfor blood analyses,2,3 Therapeutic education for chronic diseases aimedat adolescents and families has been another innovative initiative pro-posed and developed by pediatricians together with otherprofessionals.4Initiatives to improve the ambiance have been transforming the Hos-pital’s atmosphere. The presence of colorful and fun images on the wallsand ceiling of some rooms has favored relaxation, joy, and well-being,with a significant impact on patients and families, as well as on the staff.The first intervention began in 2014 and has been represented by theposting of several artwork reproductions by the painter Gustavo Rosa(S~ao Paulo, 1946‒2013) on the walls of various areas of the Hospital,such as the main entrance, outpatient clinics, day hospital, hemodialysis,and emergency room (Figs. 1, 2). Our outpatient clinic, which has 26posters in its corridors, now looks like a small art gallery, and patientshttps://doi.org/10.1016/j.clinsp.2023.100187Received 1 February 2023; Accepted 2 March 20231807-5932/© 2023 Published by Elsevier España, S.L.U. on behalf of HCFMUSP. Thislicenses/by/4.0/)enjoy taking different photos at each visit. More recently, improvementsin ambiance were carried out in the Diagnostic Center, with the adapta-tion of MRI (magnetic resonance imaging) equipment to simulate a yel-low submarine at the bottom of a blue ocean full of fish and otheranimals, while the walls of the blood withdrawal area were completelycovered with figures of animals inside a forest (Figs. 3, 4). Children getcurious and delighted when entering these spaces and, therefore, areless anxious about the procedures. A virtual reality program is beingdeveloped with the aim of reducing the need to anesthetize older chil-dren undergoing MRIs.Playing is an activity inherent to children’s daily lives, essential forneuropsychomotor development and for the establishment of social andaffective relationships, and guaranteed in the hospital environment. InBrazil, there is a public policy providing for the mandatory existence oftoy libraries in pediatric health services, which should represent a privi-leged space for allowing children to experience pleasant moments ofrelaxation, learning, social interaction, and stimuli to recover theirhealth.5 The use of interactive games and toys is also a resource to helppatients in coping with the limitations resulting from their illnesses andhospitalization, with the ultimate objective of improving their quality oflife, especially for children with chronic diseases. Special toys and playactivities have already been developed in ICr-HCFMUSP with the aim ofelucidating diseases and procedures for patients.Promoting free or therapeutic artistic activities, such as visual arts,videos, and music, to hospitalized and ambulatory patients has beendemonstrated as an effective way to humanize the treatment experi-ence.6 People with chronic and severe illnesses spend a significant partof their lives in the hospital environment, sometimes their entire lives.Thus, experiences related to education, interpersonal relationships, art,spirituality, and other aspects of life have to happen within the hospitalenvironment, or they will not happen at all.However, artistic insertion in a hospital environment presents manychallenges and limitations to be overcome, especially in tertiary institu-tions, where strict control of nosocomial infections is crucial. Thus,materials traditionally used in art therapy, such as clay, wood, andstone, are not allowed for hospitalized patients. Even music therapyfaces some barriers, as many instruments are made of wood and shouldonly be used by the therapist and always following the Infection ControlCommittee recommendations. Wind instruments should be avoided. Onthe other hand, plastic, or metal musical instruments, as well as toys ingeneral, represent better options for patients, as they can be adequatelysanitized.Hospital schooling, adopted as a public policy in Brazil, offers educa-tional content equivalent to that of public schools.7 It is largely availableat ICr-HCFMUSP and represents an instrument for social inclusion thatcan mitigate the profound impact of long-lasting or repeated hospitaliza-tions on the education of pediatric patients, compromising their schoolperformance and professional future.To provide the aforementioned activities to its approximately 200hospitalized patients and some recreational activities for approximately250 outpatients per day, the ICr-FMUSP has the collaboration ofis an open access article under the CC BY license (http://creativecommons.org/Figure 1. Aspect of an outpatient waiting room.Figure 2. Aspect of the hemodialysis unit.Figure 3. Magnetic Resonance Imaging equipment.2J.d.O. Zimmermann et al. Clinics 78 (2023) 100187Figure 4. Aspect of the blood withdrawal area.J.d.O. Zimmermann et al. Clinics 78 (2023) 100187approximately 400 volunteers from different professional backgrounds.They are organized into groups to offer recreational, educational, andartistic activities (professional musicians and clowns), pet visits, spiritu-ality, and different types of crafts with accompanying parents, amongothers.Disseminating the concepts and practices of humanization of care isimperative among all health and administrative professionals for thesuccess of the programs. In addition to a warm welcome, some topicsshould be addressed, such as cultural, religious, ethnic, gender, and sex-uality diversity, non-violent communication, and others.Based on the principle that “the patient is the most important personof the Institution”, ICr-HCFMUSP has already achieved good welcomingpractices and respect for the individuality of patients and their families,as well as among staff members, who need to feel comfortable in theircare activities. Moreover, the authors are convinced that more than talksand courses, the dissemination of everyday examples of solidarity,empathy, compassion, and kindness allows the incorporation of goodhumanization practices aimed at improving the patient’s experience inthe hospital.Conflicts of interestThe authors declare no conflicts of interest.AcknowledgmentsThe authors, members of the ICr-HCFMUSP Humanization team, arevery grateful to all the staff of the Institution, to our volunteers anddonators who have contributed to our activities and initiatives, mostly3supported by external resources. We are also thankful to Prof. ClaudiaRegina Antunes Venier for the revision of the English language.Jussara de Oliveira Zimmermann, Anna-Dulce S.C. Sampaio *,Aide Mitie Kudo, Magda Carneiro-SampaioInstituto da Criança e do Adolescente (ICr), Hospital das Clínicas daFaculdade de Medicina da Universidade de S~ao Paulo (HCFMUSP), S~aoPaulo, SP, Brazil*Corresponding author.E-mail address: anna.dulce@hc.fm.usp.br (A.-D.S.C. Sampaio).References1. Brasil. Ministerio da Saude. Secretaria de Atenç~ao a Saude. Nucleo Tecnico da PolíticaNacional de Humanizaç~ao. Acolhimento nas praticas de produç~ao de saude /Ministerioda Saude, Secretaria de Atenç~ao a Saude, Nucleo Tecnico da Política Nacional deHumanizaç~ao. −2. ed. 5. reimp. − Brasília: Editora do Ministerio da Saude, 2010. 44 p.:il. color. − (Serie B. Textos Basicos de Saude).2. Valente M, Oliveira LAN, Carneiro-Sampaio MMS. Radiologia pediatrica: quando odiagnostico deve ser “amigo” da criança. Radiol Bras 2012;45(5). v.3. Carneiro-Sampaio M, Slhessarenko N. Let’s reduce the blood volume collected for labo-ratorial exams? Rev Paul Pediatr 2014;32(2):291–2.4. Oliveira LA, Carneiro-Sampaio MMS, Matuhara AM, Cominato L, Juliani RCTP, WaetgeARP. Therapeutic education program for children and adolescents with chronic diseases‒ letter to the editor. Clinics (S~ao Paulo) 2020;75:e2419.5. Brasil. Presidência da Republica. Subchefia para Assuntos Jurídicos. Lei n. 11.104, de21 de março de2005. Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/lei/l11104.htm.6. Yinger OS, Lownds K. Music therapy in pediatric medicine. In: Knight A, LaGasse B,Clair A, eds. Music Therapy. An Introduction to the Profession, Maryland, USA: Pub-lished by the American Music Therapy Association, Inc. Silver Spring; 2018:265–78.7. Ministerio da Educaç~ao. Classe hospitalar e atendimento pedagogico domiciliar:estrategias e orientaç~oes. Secretaria de Educaç~ao Especial. − Brasília: MEC Ministerioda Educaç~ao. SEESP; 2002.

Humanization: Improving patient and family experience in a public pediatric hospital

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Humanization: Improving patient and family experience in a public pediatric hospital

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