Lic. Gustavo Cusi Cari
El término humanización es un concepto difícil porque presenta características subjetivas y complejas y, a pesar de su tono cualitativo positivo, puede asumir diferentes significados debido a las diferencias culturales y los valores individuales. Lo que es atención humanizada para una persona puede no serlo para otra. En el ámbito de la salud, este discurso se organiza en torno a la defensa de los derechos humanos y la ética.
En Brasil, hubo un cambio en el acceso a la atención de salud para la población luego de la aprobación de la Constitución Federal en 1988, que establece en el Capítulo II que la salud es un derecho social, y prevé la reglamentación del Sistema Único de Salud (SUS) por medio de la Ley 8080 de septiembre de 1990, que establece en el Título I que “La salud es un derecho humano fundamental, debiendo el Estado proporcionar las condiciones necesarias para su pleno disfrute”(3). No existe un código unificado ni un estatuto de derechos para los pacientes, pero existen varias leyes y decretos que promueven y protegen a los usuarios, incluso por grupos de enfermedades, etnias y grupos de edad.
En 1995, el estado de São Paulo publicó un Manual de los Derechos del Paciente elaborado por la Secretaría de Salud del Estado y por el Foro de Patologías. Las directrices contenidas en este Manual inspiraron la Ley Estatal nº 10.241, de marzo de 1999, que regula los derechos de los usuarios de los servicios y acciones de salud en el Estado de São Paulo. A pesar de la importancia de la humanización, las investigaciones realizadas han demostrado que, en relación a la satisfacción de los usuarios con los servicios públicos de salud, los avances tecnológicos en la atención a la salud no han sido acompañados por una atención humanizada.
For the population served, the dehumanization of health care was due to problems such as: long lines; insensitivity of health care workers when dealing with people’s suffering; disrespectful treatment; the isolation imposed on patients from their families and social networks during procedures and hospitalizations; and authoritarian management and degradation of the environment and labor relations. These issues expressed not only ethical and individual flaws, but also the way of organizing health services in Brazil. Because of this, the Health Ministry sought ways, together with society, to identify complaints from users in order to redeem and humanize health care(6). Thus, in 2003, the National Policy of Humanization of Care and Management of the Unified Health System (PNH/Humaniza SUS) was launched. It was a program for change in models of care and management, and was deployed
as a public health policy, understanding humanization as “the valuing of the different subjects involved in the health production process: users, workers, and managers”(7) in order to better assist users and provide better conditions for workers.
Considering the diversity in definitions of the term humanization, its importance for professional practice, and the recognition of the existence of factors that interfere with its implementation, the present study aimed to investigate the meaning of humanization for nurses and physicians in a hospital; get to know how nurses and physicians perceive humanization of care in professional practice, and identify factors that hinder or facilitate humanization of care.
METHOD
It was an exploratory, elucidating, and subjective investigation led in a general, private medical clinic that has a Catholic strict direction. The foundation has 284 beds and gives care to singular patients and those with medical coverage. The examination included 19 experts from different medical clinic care units, who had in any event a half year of work involvement with the establishment. The information was gathered during the second 50% of 2011.
A two-section instrument was created to gather the information. One section secured portrayal of the members; the other used the accompanying controlling inquiries: "For you, what does the term emergency clinic refinement mean?" And "What are the variables that block or encourage the acculturation of care in this establishment?" A pretest was completed on the instrument and the progressions essential for better comprehension of the members were made. The information acquired in the pretest was not utilized in the examination.
RESULTS
Nineteen professionals participated in the study: 9 nurses and 10 physicians. Of these, 12 were female and 7 male. The time of professional experience in the institution ranged from 2 to 17 years and the daytime work shift prevailed among the subjects interviewed. As for the work location, 4 participants worked in the adult emergency room, 1 in the child emergency room, five in the adult intensive care unit, 1 on the maternity ward, 2 in clinical surgery, 2 in the oncology unit, 1 in clinical medicine, 1 in the neonatal intensive care unit, and 2 in the pediatric intensive care unit.
After analysis, the following categories emerged: “Meaning of the term hospital humanization,” “Facilitating factors for the humanization of care,” and “Overwork as a factor that hinders humanization of care.”
Meaning of the term hospital humanization
In this category, the participants related respect, caring, and empathy to the meaning of hospital humanization. To define humanization, the participants used the word respect, expressing it as respect for the customs, desires, beliefs, and values of patients. They said that when admitted, patients must reconcile their habits with care routines; this requires that care teams work to make adaptations that can be translated into respect for people. It became evident that hospital routines are important for teams to do their work without problems, but in order to offer dignified and respectful hospital care to patients, hospital professionals must seek to adapt these routines to the needs of patients and caregivers. The subjects believe that by respecting patients, they make them feel they are being treated in a dignified manner in an environment that is not their own. Thus, besides technical care, differentiated service that considers the particularities of each person should be provided.
To express the meaning of humanization, the participants also mentioned the importance of caring, explaining that this includes receiving patients with warmth and getting to know the context in which they are inserted, and not just looking after physical aspects and their disease. They affirmed that it is necessary to dedicate time and attention to patients’ anxieties and fears, and that this approach by professionals, with gestures of tenderness, protection, and concern for patients, is when humanization of the care takes place. It was shown that humanization is also related to improving the conditions of the environment, which should be warm and comforting to minimize the suffering from being ill and hospitalized, considering that patients are away from their homes and often deprived of interaction with their families.
Los profesionales destacaron acciones que flexibilizan algunas normas del ambiente hospitalario, como permitir visitas fuera del horario establecido y la presencia de un acompañante en las unidades de cuidados intensivos. La presencia de familiares es citada como un factor importante en el cuidado de los pacientes durante la hospitalización.
En cuanto a la empatía, los encuestados afirman que ponerse en el lugar del paciente les permite atenderlo mejor. Para algunos profesionales, la humanización es empatía hacia la persona. Significa tratar al paciente como si fuera un miembro de la propia familia, o un ser querido, y tratarlo como nos gustaría que nos tratasen a nosotros.
CONCLUSIONES
La Enfermería basada en las bases disciplinares del cuidado, tiene como esencia la entrega de una atención humanizada, oportuna y de calidad, siendo esta una de las principales características de los profesionales de Enfermería. Esto, sumado al énfasis actual de muchas Escuelas de Enfermería, en las que se ha enfatizado el cuidado integral de las personas, no teniendo en cuenta el aspecto emocional y cultural de los pueblos originarios de la provincia de Jujuy, hace que los pacientes perciban un trato no humanizado por parte de los profesionales de enfermería.
En el ámbito hospitalario se observan pacientes vulnerables, quienes han sufrido una interrupción en su vida cotidiana y han sido sacados de su entorno cultural para enfrentar un proceso de salud enfermedad, es aquí donde radica la principal importancia del profesional de Enfermería y la entrega de cuidados humanos y trato compasivo, que permitan a las personas sentirse acompañadas en el proceso tanto paciente como familiar.
Respecto a la utilidad del instrumento PCHE, ofrece una gran oportunidad para conocer la percepción de los pacientes, de las acciones que realiza el profesional de Enfermería, evaluando los diferentes ámbitos del rol, en la ciudad de Humahuaca, Jujuy esta evaluación desde la perspectiva del paciente es escasa, sin embargo el instrumento aún requiere de ciertas adaptaciones lingüísticas, como plantearse como una afirmación positiva.
54º Congreso Mundial de Enfermería y Atención de la Salud, 13 y 14 de mayo de 2020 .
Cita abstracta :
Lic. Gustavo Cusi Cari, Percepción del Cuidado Humanizado en el Área Hospitalaria, años 2014 – 2015, Congreso Mundial de Enfermería 2020, 54° Congreso Mundial de Enfermería y Atención de la Salud, 13-14 de mayo de 2020
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