There is a traditional art called kitsugi or kintsukuroi in Japan, which repairs broken ceramic objects with a strong adhesive and gold, silver or platinum powder. The philosophy behind this technique is the belief that when the piece has suffered some damage, that is something that is part of its history. To repair it in this way means not only to give it a new life, but to beautify and make it even stronger from the deterioration suffered. It is not a matter of concealing defects and cracks, but of accepting and using them to make them the strongest part of ceramics.

As Ernesto Sábato says, “To the human being, the space of a crack is enough to flourish.” In the same way that in ceramics through kitsugi, the process of transformation that can occur in a person after the experience of very adverse or even traumatic situations can be amazing. That is what we call resilience and post-traumatic growth, and in the ICU day to day is something that we can see as spectators in patients and families. Serve to remember the experiences already exhibited in this blog and in the #3JHUCI of Raquel Nieto, Meritxell Naranjo, José Luis Díaz, Miguel Paz Cabanas, Esther Peinado, Carmen Prieto and Aroa López, among many others.

What about the ICU professionals? It is probably easy for us to detect and admire the resilient attitudes of patients and families, but that is something that we can also apply on a personal level and the experience as a team of work. The good news is that resilience, although it is to some extent determined by individual and personality variables, is something that is learned and trained, and that is also enhanced (or limited) by external aspects as certain characteristics of work conditions and organization.

In a recent study, Vera, Rodriguez-Sánchez and Salanova have analyzed the resilience of work teams to confront, recover and adjust positively to the difficulties, finding that dimensions such as collective effectiveness (their beliefs about to the effectiveness as a team for the accomplishment of the work), the existence of a leader with the capacity to manage the working group and to confront the obstacles (transformational leadership), the teamwork, and the support of the organization with organizational positive practices that provide resources necessary to achieve the goals. All of them are key factors for the construction of resilient teams, beyond the resilience capacity of each one of its members.

We also know professional wear, secondary traumatic stress or compassion fatigue are psychosocial risks of work in ICU, that are contagious in the teamworks and have to do with the work of high emotional burden. Its prevention and control depends on a priority form of organizational variables, but also of the self-care of the professional and on factors that depend on the group. For example, a recent study by Peter Barr in nurses from four neonatal intensive care units, points out the importance of perceived social support in the team as a protective factor (directly) in the face of compassion fatigue or secondary traumatic stress. In turn, this support is also a moderating element between labor stress and compassion satisfaction. That is, the social support perceived by peers and supervisors acts as much as a protective element of possible harmful consequences of work, as a booster of labor welfare.

Are we able to implement the #humantools we defend as our own profession when it comes to our colleagues, bosses, supervisors …? Perhaps on many occasions we have assumed as part of our professional role the humanized attention to the user of our care, but not always with respect to the one who performs that same work with us. The correct and clear definition of functions, the organization of work and technical skills, are not sufficient without adequate group cohesion, good regulation of emotions (own and others) and important doses of fluid and empathic communication. The strength of an ICU team and its resilience is put to a technical and emotional test every day to adverse situations of high emotional burden and to the inevitable conflict that always exists in a working group.

The path of resilience is not easy, and we must not make the mistake of trying to see the other, prematurely, the goal of personal growth, whether they be family patients or partners. It is a long and own path that can only begin with the acceptance of the situation and the loss. Optimism (realistic) and hope that will cover the pain cracks should be “simmered”, and in ICU teams, that includes caring for the companion close to us.

With it, we will get teams with “scars” but even strongers.

By Macarena Gálvez