HUMANI ZI NG CARE THROUGH THE VALUATI ON OF THE HUMAN BEI NG:
RESI GNI FI CATI ON OF VALUES AND PRI NCI PLES BY HEALTH PROFESSI ONALS
Dir ce St ein Back es1 Magda Sant os Koer ich2 Alacoqu e Lor en zin i Er dm an n3
Backes DS, Koerich MS, Erdm ann AL. Hum anizing care t hrough t he valuat ion of t he hum an being: resignificat ion of values and principles by healt h professionals. Rev Lat ino- am Enferm agem 2007 j aneiro- fevereiro; 15( 1) : 34- 41.
This qualit at ive st udy aim ed t o find t he values and pr inciples st eer ing healt h pr ofessionals’ pr act ice, in or der t o r each t he v alues guiding hum anizat ion. The st udy t ook place bet w een Oct ober and Nov em ber 2005, w hen 17 pr ofessionals fr om a m ult ipr ofessional t eam at a hospit al in t he Sout h of Br azil w er e int er v iew ed in t hr ee differ ent sam ples. The m et hodology used for com par at iv e dat a analy sis and int er pr et at ion w as based on Gr ou n ded Th eor y , r esu lt in g in t h e cr eat ion of a t h eor et ical m odel, gu ided by “ h u m an izin g car e t h r ou gh t h e valuat ion of t he hum an being” . Dat a dem onst r at ed t hat new com pet encies can be developed, w hich ar e capable of pr ov oking a r esignificat ion of v alues and pr inciples guiding hum anizat ion, w it h a v iew t o r eaching per sonal/ pr of ession al accom plish m en t s t h r ou gh w or k , ally in g t ech n ical an d h u m an sk ills in pr of ession al pr act ice an d ex p er ien cin g h u m an ized car e.
DESCRI PTORS: pat ient car e t eam ; pr ofessional- pat ient r elat ions; nur sing
HUMAN I ZAN DO EL CUI DADO A TRAVÉS DE LA VALORI ZACI ÓN DEL SER HUMAN O:
RESI GNI FI CACI ÓN DE LOS VALORES Y PRI NCI PI OS POR LOS PROFESI ONALES DE SALUD
Est u dio de apr ox im ación cu alit at iv a con obj et o de bu scar los sign ificados de los v alor es y pr in cipios qu e dir igen la pr áct ica de los pr of esion ales en salu d, con el f in de alcan zar los v alor es qu e con du cen a la h u m an i zaci ó n . El est u d i o f u e r eal i zad o en t r e o ct u b r e y n o v i em b r e d e 2 0 0 5 , co n l a p ar t i ci p aci ó n d e 1 7 pr ofesionales, ent r ev ist ados en t r es m uest r as, del equipo m ult ipr ofesional de un hospit al de la r egión sur de Br asil. Par a el análisis com par at iv o e int er pr et ación de los dat os, fue ut ilizada la m et odología pr econizada por la Teor ía Fundam ent ada en los Dat os, r esult ando en la const r ucción de un m odelo t eór ico, que t uvo com o hilo conduct or “ hum anizando el cuidado a t r avés de la valor ización del ser hum ano” . Los dat os dem ost r ar on que es posible desar r ollar n u ev as com pet en cias, capaces de pr ov ocar u n a r esign ificación de los v alor es y pr in cipios q u e co n d u cen a l a h u m an i zaci ó n , v i san d o el t r ab aj o co n r eal i zaci ó n p er so n al / p r o f esi o n al , ag r eg an d o l a com pet encia t écnica y hum ana en la pr act ica de los pr ofesionales y v iv enciando el cuidado hum anizado.
DESCRI PTORES: gr u po de at en ción al pacien t e; r elacion es pr ofesion al- pacien t e; en fer m er ía
HUMANI ZANDO O CUI DADO PELA VALORI ZAÇÃO DO SER HUMANO: RE- SI GNI FI CAÇÃO
DE VALORES E PRI NCÍ PI OS PELOS PROFI SSI ONAI S DA SAÚDE
Est udo de abor dagem qualit at iva com o obj et ivo de buscar os significados dos valor es e pr incípios que n or t eiam a p r át ica d os p r of ission ais d a saú d e, a f im d e alcan çar os v alor es q u e b alizam a h u m an ização. Par t icipar am do est udo, r ealizado ent r e out ubr o e novem br o de 2005, 17 pr ofissionais da equipe m ult ipr ofissional de um a inst it uição hospit alar da Região Sul, ent r evist ados em t r ês gr upos am ost r ais. Par a a análise com par at iva e int er pr et ação dos dados, foi ut ilizada a m et odologia pr econizada pela Teor ia Fundam ent ada nos Dados, que r esu lt ou n a con st r u ção d e u m m od elo t eór ico, q u e t ev e com o f io con d u t or “ h u m an izan d o o cu id ad o p ela valor ização do ser hum ano” . Os dados dem onst r ar am que é possível desenvolver novas com pet ências, capazes de pr ovocar um a r e- significação dos valor es e pr incípios que balizam a hum anização, visando o t r abalho com o r ealização pessoal/ pr ofissional, aliando com pet ência t écnica e hum ana na pr át ica dos pr ofissionais e vivenciando o cu idado h u m an izado.
DESCRI TORES: equ ipe de assist ên cia ao pacien t e; r elações pr ofission al- pacien t e; en fer m agem
1
Doct or al St udent in Nur sing, Nur sing Ser vice Manager at t he Sant a Casa de Miser icór dia de Pelot as, RS, e- m ail: backesdir ce@ig.com .br ; 2 Doct or al St udent in Nur sing, Assist ant Pr ofessor, Sant a Cat ar ina Federal Univer sit y, e- m ail: m agm au@m at r ix.com .br ; 3 RN, PhD in Nur sing Philosophy, Full Pr ofessor, Sant a
Cat ar ina Federal Univer sit y, CNPq r esear cher, e- m ail: alacoque@new sit e.com .br
TH E H UM AN BEI N G GI VI N G CARE - W H AT
HUMANI ZATI ON DOES HE PRACTI CE?
P
h i l o so p h i cal r ef l ect i o n s o n h u m an i zat i o n h av e becom e v er y im por t an t , m ain ly in v iew of t h epr inciple of scient ific and social r esponsibilit y and t he
appar ent im pot ence of et hics t o act on t echnological
h u m a n b e i n g s , w h o a r e c a p a b l e o f o r g a n i z i n g ,
disor ganizing and r adically changing t he foundat ions
of life, t hat is, t o cr eat e and/ or dest r oy t hem selv es.
Th e g r ow i n g d ev el op m en t of sci en ces an d
t heir applicabilit y t o hum an life lead hum an beings t o
an infinit y of inquir ies, per plex it ies and uncer t aint ies
t h a t f r e q u e n t l y p r o v o k e a p r o f o u n d v a l u e cr i si s,
ch allen g in g p r of ession als’ et h ical p ost u r e an d t h eir
abilit y t o conciliat e new dem ands and com pet encies.
D esp i t e t h e i n d i sp u t a b l e b en ef i t s o f t ech n o l o g i ca l
p r o g r e s s , m o r e s p e c i f i c a l l y a s s o c i a t e d w i t h t h e
p r ob lem - solv in g cap acit y of t h er ap eu t ic d iscov er ies
an d h ealt h p r of ession als’ q u alif icat ion , w e n eed t o
d i scu ss a n d r e d e f i n e / r e o r i e n t t h e l i m i t s t h a t w i l l
est ablish how far hum an beings can or should go( 1- 2). I n t h i s se n se , a co n sci o u s a n d co h e r e n t
philosophical reflect ion about t he hum an values guiding
t he hum anizat ion pr ocess and t he pr inciple of social
responsibilit y can help t o problem at ize t he act ual needs,
t hat is, t he advant ages and/ or disadvant ages progress
im poses on healt h pr ofessionals’ pr act ice. Ther efor e,
it should be rem inded t hat t he ent ire t echnical- scient ific
dev elopm ent r elat ed t o life not only conduct s hum an
beings t ow ar ds nov elt ies associat ed w it h t her apeut ic
hopes, but can also giv e r ise t o fear s and enor m ous
et hical dilem m as t hat challenge healt h pr ofessionals’
pr act ice. I n t his cont ex t , t her e is an ur gent need t o
d e v e l o p n e w c o m p e t e n c i e s t h a t a r e c a p a b l e o f
provoking a resignificat ion of t he values and principles
guiding hum anizat ion in t he healt h scenario.
Th e d e v e l o p m e n t o f t e c h n i c a l - s c i e n t i f i c
progress can follow different courses and use different
m e t h o d s . H o w e v e r, i t s h o u l d b e r e m i n d e d t h a t
k n ow ledge is a v alu e in it self an d t h at t h e decision
ab ou t w h at k n ow led g e societ y, scien t ist s or h ealt h
p r o f e ssi o n a l s sh o u l d co n ce n t r a t e t h e i r e f f o r t s o n
im plies t he consolidat ion of m oral, et hical and hum an
values and t he crit ical and reflexive analysis of realit y.
Hence, t he debat e bet w een values and int er est s about
ea ch o f t h e o p t i o n s d ep en d s o n r esea r ch er s’ a n d
pr ofessionals’ et hical and social r esponsibilit y( 3 ). On e im por t an t in it iat iv e in t h e h ealt h ar ea,
besides academ ic reflect ions, w as t he Brazilian Healt h
Mi n i st r y ’ s i m p l a n t a t i o n o f t h e Na t i o n a l Ca r e a n d
Ma n a g em en t Hu m a n i za t i o n Pr o g r a m i n t h e Si n g l e
Healt h Sy st em - Hu m an iza SUS. Th is pr oposal calls
upon all st ak eholder s, m anager s, w or k er s and user s
t o com m it t h em selv es t o t h e h u m an izat ion pr ocess,
as t he Minist r y it self ident ified a gr ow ing num ber of
user com plaint s about lack of w elcom ing, access and
w or k condit ions, am ong ot her s( 4).
Ho w ev er, a p o l i cy can n o t b e i m p l em en t ed
b ecau se p u b lic an d / or in st it u t ion al en t it ies w an t t o
o n l y. I t r e q u i r e s a l l s t a k e h o l d e r s t o c o m m i t
t hem selves, m ainly t hose in daily cont act w it h user s,
as w ell as ot her professionals w ho show , t hrough t heir
w o r k a n d a t t i t u d e s, t h e ch a r a ct e r i st i cs o f h e a l t h
ser v ices offer ed t o t he populat ion.
To r each a new under st anding of t he pr inciples
and values guiding hum anizat ion, healt h professionals
need t o ar t iculat e t heor et ical and t echnical scient ific
k now ledge w it h affect iv e, social, cult ur al and et hical
aspect s of t he r elat ions t hey est ablish t hr ough t heir
p r a ct i ce , so t h a t h u m a n i z a t i o n d o e s n o t r e m a i n
rest rict ed t o m erely t echnical at t ribut ions, but includes
t he capacit y t o under st and and r espect hum an beings
in t heir differ ent for m s of being and ex ist ing( 5). I n su m , an in f in it y of q u est ion in g s, d ou b t s
and uncer t aint ies or iginat ed fr om and/ or per sist under
t he t echnical- scient ific par adigm , guided by t he values
of t echnical efficiency and scient ific know ledge. I n t his
per spect iv e, pr ofessionals focus on disease and cur e,
i n st e a d o f h u m a n s a s w e a k e n e d a n d v u l n e r a b l e
b ein g s. Th is g iv es r ise t o q u est ion s lik e: Wh er e is
hist or y heading and/ or t o w hat point can it adv ance
w it h ou t in f r in g in g h u m an d ig n it y ? How can a m or e
d ig n if ied ex p er ien ce b e con st r u ct ed ? How can car e
r elat ion s be h u m an ized?
Th e h u m a n c o n d i t i o n a s a p r i n c i p l e o f
cit izenship and/ or principle of hum anizat ion is act ually
r eco v er ed t h r o u g h au t h en t i ci t y, d i g n i t y, so l i d ar i t y,
affect and r espect for hum an indiv idualit y( 6).
Th e u n c e r t a i n t i e s a n d d e s t a b i l i z a t i o n o f
v alu es ar e t h e v isible side of a h u m an it y im m er sed
i n a p r o f o u n d c r i s i s , s e e k i n g n e w d e b a t e s a n d
p o s s i b i l i t i e s t h a t a r e c a p a b l e o f r e c o n s t r u c t i n g /
r eor d er in g k n ow led g e b ased on h u m an an d et h ical
pr inciples( 1 , 7 - 8 ).
Fr om t h is v iew p oin t , cr isis is ch ar act er ized
by an explosion of com plexit y, cont radict ory direct ions
in evolut ion and high doses of uncer t aint y. At t he sam e
t im e as av ailable t echnological k now ledge m ult iplied
disor ganizat ion of k now ledge, cr eat ing pr act ices t hat
j eopar dize t he hum an r ace it self.
Hence, w e need a new par adigm , t hat is, a
new v iew on r ealit y, a radical change in our t hink ing
t h at is cap ab le of f acin g t h e com p lex it y of r ealit y,
co n f r o n t i n g t h e p a r a d ox e s o f o r d e r a n d d i so r d e r,
singular and gener al, t he par t and t he w hole( 7- 8). I n v iew of t his univ er se of new r at ionalit ies,
t h e par adigm of com plex it y in t en ds t o r edef in e t h e
f o r m o f cu r r e n t d e v e l o p m e n t , g u i d i n g k n o w l e d g e
t hr ough hum an and et hical v alues and conquer ing a
n e w sy st e m a t i c p e r ce p t i o n , b a se d o n a r e f l e x i v e
subj ect w ho is capable of ar t iculat ing differ ent k inds
of know ledge. Com plex t hinking helps hum an beings/
p r o f e s s i o n a l s t o a c k n o w l e d g e t h e c o m p l e x i t y o f
r ealit ies, t hat is, it r ev eals t he uncer t aint ies inher ent
i n k n o w l ed g e st r u ct u r es t h em sel v es a n d a l so t h e
“ black holes of uncer t aint y in cur r ent r ealit ies”( 8). Th e m ai n ch al l en g e o f h u m an i zat i o n i s t o
r ej oin / r econ n ect in q u ir ies, k n ow led g e an d , m ain ly,
et h ical, m or al an d social v alu es. To r ed r aw a n ew
h o r i z o n , d i st a n ce d f r o m t h e r e d u ct i o n i st d e b a t e
or ient ed t ow ar ds individual r ight s and m or e concer ned
ab ou t t h e r ecov er y of b r oad er con cep t s r elat ed t o
h u m a n d i g n i t y a n d t o t h e d e c o n s t r u c t i o n o f
p a r t i c u l a r i t i e s , w i t h a v i e w t o c o n s t r u c t i n g t h e
h u m an izin g k n ow ledge ecology( 9 ).
Tech n o l o g i cal so l u t i o n s d o n o t n ecessar i l y
involve t he academ y, but t hey do include t he m ent or s
of t h ese t ech n olog ies t h r ou g h t r ain in g or p r act ical
orient at ions( 6). What is im port ant in t his area is not t o k n o w t h e o r i g i n s o f p r o f e s s i o n a l s ’ t e c h n o l o g i c a l
t h in k in g , b u t t h e cap acit y t o st im u lat e t h e cr it ical
r e i n se r t i o n o f h u m a n b e i n g s i n r e a l i t y, b a se d o n
com plex t h in k in g.
Th u s , h u m a n i z a t i o n , i n t h e l i g h t o f t h e
com p lex it y p ar ad ig m , can b e ach iev ed t h r ou g h t h e
r ev olut ion of “ r elat ions am ong hum ans, r anging fr om
r e l a t i o n s w i t h t h e m s e l v e s a n d o t h e r s , r e l a t i o n s
bet w een nat ions and st at es and r elat ions bet w een m en
a n d t h e t e c h n o - b u r e a u c r a c y, b e t w e e n m e n a n d
societ y, m en and k now ledge, m en and nat ur e”( 7). Hu m an izat ion p r esu p p oses a v alu e sy st em ,
t h a t i s , a c o m p l e x s y s t e m o f o r g a n i z a t i o n a n d
c i v i l i z a t i o n t h a t r e s p e c t s i n d i v i d u a l s ’ a u t o n o m y,
d i v er si t y o f i d eas an d f r eed o m o f ex p r essi o n an d
r ecov er s su b j ect i v i t y. Hen ce, h eal t h p r o f essi o n al s’
challenge in view of t echnical- scient ific pr ogr ess is t o
con st r u ct t h e p r ocess of in clu d in g all p er son s an d
peoples and beneficiar ies of t his pr ogr ess( 1).
I n s u m , h u m a n i z a t i o n i s a p r o c e s s o f
t r an sf or m in g or gan izat ion al cu lt u r e, w h ich n eeds t o
ack n o w l ed g e an d v al u e cl i en t s’ an d p r o f essi o n al s’
su b j ect i v e, h i st o r i cal an d so ci o cu l t u r al asp ect s, i n
or der t o im pr ove w or k condit ions and car e qualit y by
pr om ot ing act ions t hat int egrat e hum an and scient ific
v al u es.
I n or der t o cont r ibut e t o t he developm ent of
new com pet encies t hat incor por at e bot h hum an and
t echnical- scient ific values, t hat is, t o include t he hum an
b e i n g i n s c i e n t i f i c p r o c e s s e s a n d a l l o w f o r t h e
e x p e r i e n c e o f a n d c o p i n g w i t h a f r a g m e n t e d
d iscip lin ar y log ic, t h is st u d y aim ed t o look f or t h e
v alu es an d pr in ciples dir ect in g h ealt h pr of ession als’
pr act ice, w it h a view t o r eaching t he values t hat guide
t h e h u m an izat ion pr ocess.
METHODOLOGY
We car r ied out a qualit at iv e st udy. This k ind
of st u d y is cap ab le of an sw er in g v er y sin g u lar an d
su b j ect iv e q u est ion s, t h at is, of “ w or k in g w it h t h e
u n i v e r s e o f m e a n i n g s , m o t i v a t i o n s , a s p i r a t i o n s ,
beliefs, v alues and at t it udes, w hich cor r esponds t o a
m o r e p r o f o u n d sp a ce i n r e l a t i o n s, p r o ce sse s a n d
p h e n o m e n a t h a t c a n n o t b e r e d u c e d t o t h e
oper at ion alizat ion of v ar iables”( 1 0 ).
I n t he at t em pt t o r espond t o a r esear ch, dat a
an aly sis an d com p ar at iv e sy st em at ic in t er p r et at ion
m et hod for t he const ruct ion of philosophical m eanings
in t he cont ext of hum anizat ion, t he choice of Grounded
Theor y ( GT) w as an im por t ant m et hodological st rat egy.
Thr ough induct ion and deduct ion, t he m et hod allow ed
for t he const r uct ion of a t heor et ical m odel t o ex plain
t he st udy phenom enon, w it h a view t o explaining t he
w ealt h and div er sit y pr esent in hum an ex per iences.
Based on Sy m bolic I nt er act ionism , Gr ounded
Th e o r y i s o r i e n t e d t o w a r d s k n o w l e d g e a b o u t
per cept ion and/ or m eaning, w it h a v iew t o capt ur ing
t h e in t er su bj ect iv e aspect s of h u m an bein gs’ social
ex p er ien ces an d , t h u s, ad d in g n ew p er sp ect iv es t o
r ef l ect i o n s a b o u t t h e p h en o m en o n . Hen ce, a l l GT
pr ocedur es ar e aim ed at ident ify ing, dev eloping and
r e l a t i n g c o n c e p t s , s t a r t i n g f r o m v a r i o u s sa m p l e
gr oups, t hat is, t o gener at e t heor ies on t he basis of
t he r esear ch dat a, w hich ar e analyzed and com par ed
sy st em at ically and concom it ant ly( 1 1 ).
The const ant com par ison of t he int er view ees’
t he cat egories highlight ed on t he basis of t hese sam e
dat a. I n com par at ive analy sis, how ev er, aspect s like
t he follow ing have t o be t aken int o account : know ledge
o f t h e e n v i r o n m e n t , d a t a c o d i n g , c a t e g o r y
f o r m u l a t i o n , r e d u ct i o n o f n u m b e r o f ca t e g o r i e s,
ident ificat ion of cent ral cat egory and m odificat ion and
int egr at ion of cat egor ies( 12).
The st udy w as car r ied out bet w een Oct ober
an d No v em b er 2 0 0 5 . Par t i ci p an t s w er e sev en t een
pr ofessionals fr om t he m ult ipr ofessional healt h t eam
at a hospit al in t he Sout h of Br azil, w ho const it ut ed
t hr ee sam ple gr oups. The st udy inst it ut ion and one of
t he aut hor s hav e been inser t ed in t he Hum anizat ion
Policy sin ce Ju n e 2 0 0 3 , w h ich f acilit at ed t h e st u d y
d ev elop m en t . Th e n u m b er of p ar t icip an t s ( 1 7 ) an d
sa m p l e g r o u p s ( 3 ) w a s d e t e r m i n e d t h r o u g h t h e
t h e o r e t i c a l s a m p l i n g p r o c e s s r e c o m m e n d e d b y
Gr ou n d ed Th eor y.
Pa r t i c i p a n t s w e r e i n f o r m e d a b o u t t h e
obj ect ives and pr oposed m et hodology, and t he r ight
t o a c c e s s t h e d a t a b a s e a n d a n o n y m i t y w e r e
guar ant eed. At t hat m om ent , t hey w er e asked t o sign
t h e Fr e e a n d I n f o r m e d Co n s e n t Te r m , a s
r ecom m ended by Resolut ion CNS/ MS196/ 96 on et hics
f or r esear ch in v olv in g h u m an bein gs. Besides t h ese
et hical pr ecaut ions, t he pr oj ect w as subm it t ed t o and
a p p r o v e d b y t h e Et h i cs Co m m i t t e e f o r Re se a r ch
inv olv ing Hum an Beings at t he sam e inst it ut ion.
I n or der t o guarant ee par t icipant s’ anonym it y,
t he let t er “ e” w as used and t he num ber cor r esponding
t o t he st at em ent , ident ified in t he t ext as ( e1) ; ( e2) ;
( e3) and so on.
The fir st sam ple gr oup consist ed of six nur ses
w ho w er e m em ber s of t he Nur sing Car e Syst em izat ion
Gr ou p at t h e st u d y in st it u t ion . Th ese n u r ses w er e
act u ally in v olv ed in h u m an izat ion an d n u r sin g car e
sy st em izat ion .
The second group included clinicians fr om t he
hospit al. Par t icipant s w er e r andom ly chosen, seek ing
t o r epr esen t dif f er en t m edical specialt ies. How ev er,
d u r in g t h e f ir st m eet in g , on ly t w o p h y sician s, on e
p e d i a t r i c i a n a n d o n e i n t e n s i v e c a r e p h y s i c i a n
par t icipat ed, r equ ir in g a secon d appoin t m en t , w h en
s i x p h y s i c i a n s t o o k p a r t : o n e p e d i a t r i c i a n , o n e
g y n ecolog ist , on e on colog ist , on e g en er al clin ician ,
one cardiologist and one ur ologist . The lat t er w as t he
hospit al’s t echnical dir ect or.
Th e t h i r d sa m p l e g r o u p co n si st e d o f f i v e
r an d om ly ch osen p r of ession als w h o w er e m em b er s
of t he Hum anizat ion Gr oup at t he st udy hospit al: one
a d m i n i s t r a t o r, o n e a d m i n i s t r a t i v e t e c h n i c i a n
( r e sp o n si b l e f o r t h e h o sp i t a l k i n d e r g a r t e n ) , o n e
a c c o u n t a n t , o n e n u t r i t i o n i s t a n d o n e n u r s i n g
t ech n ician .
Dat a w er e collect ed t hr ough gr oup int er view s,
w h ich w er e t ap e- r ecor d ed an d t ook ap p r ox im at ely
on e h ou r. Dat e an d t im e w er e pr ev iou sly sch edu led
for t he t hr ee gr oups. The int er view t echnique is used
t o obt ain in- dept h infor m at ion, t hat is, infor m at ion in
t he r espondent s’ ow n w or ds and a det ailed descr ipt ion
o f s i t u a t i o n s . A t t e n t i v e l i s t e n i n g i s p a r t o f t h i s
inst r um ent ’s act ions( 12).
Th e f ollow in g gu idin g qu est ion w as u sed t o
st ar t t h e in t er v iew s: Wh at ar e t h e m ean in gs of t h e
v alu es an d pr in ciples t h at gu ide y ou r pr act ice as a
h ealt h pr of ession al?
Af t er t h e t ap es h ad b een t r an scr ib ed , d at a
w e r e v a l i d a t e d b y t h e p a r t i c i p a n t s a n d t h e n
cat egor ized, int er pr et ed and com par ed w it h dat a fr om
t h e su b seq u en t in t er v iew an d so on , in a con st an t
back- an d- f or t h m ov em en t , as r ecom m en ded by t h e
pr oposed an aly sis m et h od. Fin ally, t h r ee cat egor ies
r esu lt ed: Wor k as per son al/ pr of ession al r ealizat ion ;
A l l y i n g t e c h n i c a l a n d h u m a n c o m p e t e n c e i n
p r of ession al p r act ice an d ; Ex p er ien cin g h u m an ized
ca r e.
A N A L Y S I S A N D CO M P A R A T I V E
S Y S T E M A T I C I N T E R P R E T A T I O N O F
CATEGORI ES
Wor k as per sonal and pr ofessional r ealizat ion
I n under st anding t he w or k er ’s logic as w ell,
t h e h u m an izat ion pr ocess poin t s t ow ar ds w or k as a
hum anizing and/ or dehum anizing inst r um ent . I n t his
per spect iv e, in st it u t ion s occu py an im por t an t place,
m a i n l y t o g e t t o k n o w w o r k e r s ’ p e r s o n a l a n d
p r of ession al sat isf act ion an d / or d issat isf act ion lev el
a n d cr ea t e co n cr et e sp a ces f o r t h e ex p r essi o n o f
subj ect ivit y and t he developm ent of hum an pot ent ial.
Th e Nat i o n al Heal t h Ser v i ce Hu m an i zat i o n
pr ogr am - PNHSS - aim s t o r educe difficult ies dur ing
u s e r t r e a t m e n t a n d a l s o a t t e m p t s t o f o c u s o n
p r of ession als, f or t h em t o p er f or m t h eir w or k w it h
sat isfact ion / r ealizat ion an d social r espon sibilit y( 4 ).
You need t o like w hat you do. But w e need t o t ake int o
acco u n t p r o f essi o n al s’ p r i v at e l i f e, p er so n al an d f i n an ci al
pr oblem s [ ...] When som et hing bot her s t hem , t his soon ends up
Ac c o r d i n g t o t h e w o r k e r s , t a l k i n g a b o u t
h u m a n i za t i o n b a se d o n t h e f e d e r a l g o v e r n m e n t ’ s
p r op osal r eq u ir es t h at m an ag er s an d p r of ession als
r eflect on t h e r elat ion al con t ex t in - an d ou t side t h e
organizat ion. Thus, sat isfact ion and realizat ion at w ork
cover a set of elem ent s t hat r efer t o t he hum an being
- pr ofessional - as t he subj ect of t he pr ocess( 13). As a com plex com pany, hospit als should give
pr ior it y t o a st r u ct u r ed or gan izat ion an d a dy n am ic
an d d em ocr at ic m an ag em en t t eam t h at is ab le t o
u n d e r st a n d t h e p r o f o u n d ch a n g e s i n t h e f i e l d o f
d e v e l o p m e n t . H o sp i t a l m a n a g e m e n t sh o u l d a l so
priorit ize a clim at e of good relat ionships and favorable
condit ions t o per for m act iv it ies.
I t is com plicat ed, because w e can’t alw ays do as w e’d
like t o. You need t o have t he condit ions t o deliver good pat ient
car e. I t hink doct or s ar e not t hat valued. They lost a lot of t heir
aut onom y. I t hink it should be an exchange because, if qualified
and sat isfied in all senses, doct or s w ill be able t o deliver good
car e t o t heir pat ient s ( e3) .
Th e c a r e p r o c e s s n e e d s t o o c c u r i n a n
i n t e r a c t i v e r e l a t i o n , i n a n a c t u a l e x c h a n g e o f
in f or m at ion , k n ow ledge an d in t er est s, based on t h e
et h i cal co m p r o m i se est ab l i sh ed b et w een b o t h . No
or ganizat ion can be consider ed hum anized if it does
not fully k now it s client s’ needs, w het her int er nal or
ext er nal, or if it know s t hose needs but ignor es t hem .
I t should be ack now ledged t hat client s’ ex pect at ions
al w ay s cr eat e i m p r o v em en t s, as a n eed s- o r i en t ed
en v ir on m en t is dy n am ic an d con st an t ly adapt in g t o
t heir aspir at ions. That is because t heir needs change
in t he sam e w ay as t heir ex pect at ions of how t hese
needs w ill be sat isfied( 5).
I n t h i s p r o cess, i t i s r el ev an t t o cr eat e a
dem ocr at ic and par t icipat iv e env ir onm ent in or der t o
ach iev e p er son al an d or g an izat ion al ob j ect iv es an d
g o a l s. Pa r t i ci p a t o r y m a n a g e m e n t , w i t h a v i e w t o
realizat ion and hum anizat ion, cont ains a st rong social
ch ar act er ist ic, d u e t o t h e d ev elop m en t of solid ar y
pract ices in relat ions bet ween professionals and client s.
Healt h p r act ices p oin t t ow ar d s a st r on g cor r elat ion
b e t w e e n h a p p y / r e a l i ze d e m p l o y e e s a n d sa t i sf i e d
client s. Thus, em ploy ees w ho ar e sat isfied w it h t heir
work reflect in work qualit y and in a posit ive feedback
by client s. I n t he last inst ance, hum anizat ion em erges
fr om pr ofessional pleasur e at w or k and, at t he sam e
t i m e, f r o m a f av o r ab l e o r g an i zat i o n al cl i m at e an d
adequat e work condit ions. I t should also be highlight ed
t hat , w hen people lik e w hat t hey do, hum anized and
hum anizing pract ice flow nat urally and spont aneously.
A Buddhist saying concludes: “ discover som et hing you
like t o do and you will never have work again”.
A l l y i n g t e c h n i c a l a n d h u m a n c o m p e t e n c e i n
p r of ession al p r act ice
The const ant and cont inuous developm ent of
pr ofessional com pet ences inv olv es not only t echnical
im pr ovem ent and acquisit ion of new t echnologies, but
m ainly t he capacit y t o m obilize, ar t iculat e and put in
act ion values, know ledge and abilit ies needed for t he
e f f i c i e n t a n d e f f e c t i v e p e r f o r m a n c e o f a c t i v i t i e s
r equir ed by t he nat ur e of t he j ob( 14).
Respect for t he pat ient is fundam ent al and t hat is t he
need for per m anent r ecycling ( e4) .
Co m p e t e n c e i s , a l s o , “ a c a p a c i t y t o a c t
effect ively in a cert ain t ype of sit uat ion, base don but
n ot lim it ed t o k n ow ledge”. Kn ow ledge is con sider ed
a s “ c o m p l e m e n t a r y c o g n i t i v e r e s o u r c e s ” , o r
“ r ep r esen t at ion s of r ealit y w e con st r u ct an d st or e
d ep en d in g on ou r ex p er ien ce an d t r ain in g ”. Hu m an
act ions, “ t he m or e com plex , abst r act , m ediat ized by
t echnologies and suppor t ed on sy st em at ic m odels of
r ealit y, t h e d eep er, m or e ad v an ced , or g an ized an d
r eliable t he k now ledge t hey r equir e”. But k now ledge
is not enough for com pet ences t o m anifest t hem selves
as act ions, t his know ledge needs t o be used t o “ r elat e”,
t hat is, t o “ j udge it s per t inence t o t he sit uat ion and
m obilize it j udiciously, it is t he “ art of execut ion”( 15). Values do not com e along w it h t he degr ee. College
br ings t he t echnique, but values ar e const r uct ed in life ( e5) .
We m a y say, t h e n , t h a t b e i n g co m p e t e n t
im plies know ing w hat t o do in each concret e sit uat ion
and pr esupposes a j udgm ent about t he sit uat ion and
an int ent ional act ion. I t r equir es a set of k now ledge
b u t is n ot lim it ed t o t h is set . Pr of ession als act in g
com pet ent ly base t heir pract ice on cognit ive, t echnical
and com m unicat ional com pet ences. That is, a set of
charact erist ics t hat involve t he acquisit ion of solid and
u p d at ed t ech n i cal k n o w l ed g e, t h e d ev el o p m en t o f
h u m a n i st v a l u e , a r e sp o n si b l e e t h i ca l p o st u r e , a
per m anent lear ning at t it ude, besides t he capacit y t o
act upon t he unexpect ed and w or k in m ult ipr ofessional
t eam s( 16).
Respect for life, com m it m ent and, m ainly, t eam w or k
ar e gr eat values for m e t oday. [ ...] in t he t eam , each one has his
ow n w ay, at t it ude, w ay of w or king. We need t o lear n how t o look
w it h t he ot her ’s eyes ( e8) .
I believe t her e’s a need t o link t he hum an w it h t he
pat ient s’ cur e pr ocess, but w e need t o under st and t hat it ’s not
ever yt hing ( e4 and e12) .
Te ch n i ca l co m p e t e n ce ca n b e a l l i e d w i t h
hum anizat ion t o t he ex t ent t hat t he dev elopm ent of
sciences and t heir applicabilit y in car e for hum an life
e n t a i l t h e s o c i a l r e s p o n s i b i l i t y f o r a b r o a d e r
u n d er st an d in g of w h at is q u alif ied an d h u m an ized
p r of ession al car e.
The pat ient has t o be t reat ed as if he w ere our relat ive.
I per ceive t hat t he int er ns oft en t r eat t he pat ient as an obj ect
[ ...] . We should est ablish a fam ily r elat ion bet w een physician
and pat ient . Dur ing visit s, I usually lose a lot of t im e w it h t he
r elat ives. I t hink t hat or ient at ion is fundam ent al for t hem t o feel
m ore secure. Som et im es, relat ives even ask: ‘doct or, what ’s your
n am e?’. Th e r elat iv e per ceiv es t h e pr ofession al’s sm ile an d
sensit ivit y. I t ’s not j ust t he dr ug and t he doct or t hat cur e t he
pat ient ( e6) .
I n t he hum anized hospit al env ir onm ent , t he
p h y si cal , t ech n o l o g i cal , h u m an an d ad m i n i st r at i v e
st r uct ur e values and r espect s hum an beings and is at
t heir ser v ice, guar ant eeing high- qualit y car e( 17- 18). Th e r ecov er y of h u m an v alu es, t h at is, of
hum anit y as t he essence of hum an beings, does not
der iv e fr om m echanic and r out ine w or k but , t hr ough
w o r k a s p e r s o n a l / p r o f e s s i o n a l r e a l i z a t i o n , f r o m
t e c h n i c a l a n d h u m a n c o m p e t e n c e a n d f r o m t h e
e x p e r i e n c e o f h u m a n i z e d c a r e a s a n i n n o v a t i v e
pr act ice t hat t r ansfor m s t he r elat ions and condit ions
of pr odu ct ion sy st em s.
I n m y opinion, r espect for t he pat ient is a fundam ent al
at t it ude and t hat is t he need for perm anent recycling [ ...] . Act ually,
r esponsibilit y and r espect ar e t he st r ongest values ( e10) .
I t hink t hat value is all about t he educat ion we get from
bir t h. Value does not com e w it h t he degr ee. College br ings t he
t echnique. Hum an values ar e const r uct ed in life. Values com e
fr om good char act er . People w ho only t hink about t echnique ar e
m er ely or ient ed t ow ar ds econom ic int er est s ( e8) .
Hen ce, t ech n ical an d h u m an com pet en ce in
professional pract ice is not lim it ed t o care as a pract ice
t hat is realized from professional t o pat ient only, in a
v er t icalized an d pat er n alist w ay. On t h e opposit e, it
consider s t hat ever ybody is a subj ect and r eceiver of
car e in it s m ost div er se for m s and ex pr essions. Just
lik e pat ient s, pr ofessionals ar e unique hum an beings
an d , as su ch , d em an d v alu at ion an d r ecog n it ion of
t h eir n eed s an d t h e at t en t ion n eed ed t o h av e t h e
co n d i t i o n s t o d e v e l o p h u m a n i z e d ca r e i n h e a l t h
p r a ct i ces. I n h u m a n i t a r i a n m a n a g em en t a n d ca r e
p r a c t i c e s , p r o f e s s i o n a l s a l l o w t h e m s e l v e s t o b e
hum an, t o feel t hem selv es in r elat ion t o an OTHER,
w ho is also hum an, t o m anifest t heir sensit ivit y, creat e
em pat hy, est ablish a subj ect / subj ect r elat ion and, t hus,
t ur n car e int o a hum anizing pr act ice( 13).
Ex per ien cin g h u m an ized car e
I n t he last inst ance, hum anized car e m eans
d i r e c t i n g t h e e x p e r i e n c e o f b e i n g i n a h o s p i t a l
envir onm ent t o t he hum an being as m uch as possible,
considering values, beliefs, feelings, em ot ions and not
j ust t he biological aspect . Hum anized car e st ar t s w hen
t he professional ent ers t he pat ient ’s phenom enal field
an d is capable of det ect in g, f eelin g an d in t er act in g
w it h him , t hat is, capable of est ablishing an em pat hic
r e l a t i o n , c e n t e r i n g c a r e o n t h e c l i e n t a n d t h e
env ir onm ent in or der t o per ceiv e t he ot her per son’s
ex per ience and how he liv es it( 18).
Besides t h e pat ien t , t h is car e also in clu des
t he pr ofessionals inv olv ed in t he pr ocess.
I t hink t hat t he hum an being’s value is alr eady a value
in it self [ ...] , t he value of pat ient s and pr ofessionals as w ell.
Hum anizat ion ar oused a new at t it ude in people, especially in
t heir w ay of get t ing closer t o t he ot her , of being sensit ive t o t he
ot her ( e6) .
H e n ce , h u m a n i ze d ca r e i s a n e x p e r i e n ce
process t hat perm eat es professionals’ being and doing
in differ ent ex pr essions, dim ensions and int er act ions.
I have lear ned a lot . Respect for life, com m it m ent and
t eam w or k ar e gr eat values for m e t oday. I lear ned t hat , in t he
t eam , each one has his ow n w ay, at t it ude and w ay of deliver ing
car e. We need t o lear n how t o look w it h t he ot her ’s eyes. When I
under st and t his pr ocess, it seem s t hat ever yt hing ar ound m e
get s bet t er . I consider t hat t he t eam has t o be a w hole, but t he
w hole in all ar eas ( e11, e15, e16) .
I n t h i s p e r s p e c t i v e , u n d e r s t a n d i n g a n d
ex per ien cin g h u m an ized car e does n ot on ly in clu de
t e c h n i c a l a t t r i b u t i o n s a n d / o r a v e r t i c a l i z e d
professional- pat ient relat ion, but t he abilit y t o perceive
a n d w e l c o m e h u m a n b e i n g s i n t h e i r d i f f e r e n t
dim ensions, int er act ions, and t o under st and how t hey
d ev elop t h eir id en t it y an d con st r u ct t h eir ow n lif e
h ist or y. Wh en d eliv er in g car e, p r of ession als sh ou ld
b e f u lly p r esen t , g iv e ev er y t h in g t h ey h av e, v alu e
t he ot her per son’s exper ience and know ledge. I f t hey
only face t heir act ivit ies as an obligat ion and not as a
s o c i a l c o m m i t m e n t , t h e y w i l l n e i t h e r f e e l
e n co u r a g e m e n t n o r p a ssi o n a b o u t w h a t t h e y a r e
doing( 5).
When we m odify our way of being, we end up m odifying
t o t r ansm it t he im por t ance of sm all expr essions of car e t o t he
ot her s. Hum anizat ion has m ade us t hink m or e. The t hing is t hat
t hese quest ions had never been addr essed. You act ed isolat edly,
m echanically, w it hout t hinking. Hum anizat ion alr eady exist ed at
t he hospit al, it ’s j ust t hat ev er y body did it his ow n w ay and
w or ked ver y separ at ely. Hum anizat ion cam e as a call for gr eat er
int egrat ion ( e12, e13, e14) .
St ar t ing fr om r eal and concr et e ex per iences,
r esear ch par t icipant s point ed t ow ar ds t he im por t ance
of t he hospit al hum anizat ion process as an innovat ive
pr oposal t hat t r ansfor m s w or k r elat ions and condit ions.
Their st at em ent s dem onst r at ed t he pow er of posit iv e
p e r s o n a l / p r o f e s s i o n a l a t t i t u d e s t o i n f l u e n c e t h e
dynam izat ion, m obilizat ion and pot ent ializat ion of care
pr act ices. The hum anized car e exper ience st r engt hens
p e r s o n a l a n d c o l l e c t i v e c o m m i t m e n t i n t h e
c o n c r e t i z a t i o n o f p r a c t i c e s t h a t a r e c a p a b l e o f
r ecov er in g t h e h u m an dim en sion in differ en t spaces
an d ex p r ession s.
Pr ofession als m ov e ar oun d in or ganizat ion al
spaces, con st r u ct in g oppor t u n it ies f or r elat ion s an d
ex per iencing car e t o t he ex t ent of t heir pot ent ial t o
d elim it an d u se t h is sp ace, t h at is, of d ep en d en ce
and int er dependence, of belonging and pr iv acy( 6). Thus, in t his per spect iv e, hum anized car e as
t h e essen ce o f l i f e r an g es f r o m t h e sm al l act s o f
t h in k in g, bein g an d doin g t o t h e con f igu r at ion of a
car e pr ocess t hat inv olv es bot h t he per son r eceiv ing
care and t he caregiving pr ofessional. At t his m om ent ,
t he m eanings at t r ibut ed t o car e do not m at t er. I t is
im port ant for hum anized car e t o pr ior it ize t he essence
of hum an beings as unique, indivisible and aut onom ous
b e i n g s w h o a r e f r e e t o c h o o s e , t h a t i s , t h e
under st anding of hum an beings as int egr al beings.
THEORETI CAL MODEL CONSTRUCTI ON
The const r uct ion of t he t heor et ical m odel t o
ex p lain t h e st u d y p h en om en on aim s t o est ab lish a
r e l a t i o n a m o n g t h e ca t e g o r i e s, b a se d o n ca u sa l
condit ions, int ervening condit ions, cont ext , act ion and
int er act ion st r at egies and consequences cont ained in
t hese cat egor ies, w it h a v iew t o t he ident ificat ion of
t he cent r al idea( 11).
I n t r y ing t o r epr esent a t heor et ical m odel t o
explain t he values and principles guiding hum anizat ion
in t h e h ealt h scen ar io, w e at t em p t t o id en t if y t h e
dynam ics and com plexit y of t he hum anizat ion pr ocess,
e x p r e s s e d i n t h e f o l l o w i n g c a t e g o r i e s : Wo r k a s
personal/ professional realizat ion; allying t echnical and
h u m a n co m p e t e n ce i n p r o f e ssi o n a l p r a ct i ce a n d
ex per ien cin g h u m an ized car e.
D u r i n g d a t a a n a l y s i s a n d c o m p a r a t i v e
syst em at ic int er pr et at ion, fr om t he st ar t of coding unt il
cat egor izat ion and connect ion am ong cat egor ies, w e
v er if ied t h e n eed f or in t egr alit y an d in t er act iv it y in
p r o f e s s i o n a l p r a c t i c e . Th e d i f f e r e n t p h a s e s
d em on st r at ed h u m an izat ion as a g r ad u al, d y n am ic
and syst em ized pr ocess, det er m ined by t he incessant
sear ch f or et h ical v alu es an d p r in cip les w it h social
r espon sibilit y f or h u m an bein gs’ dign it y. I n seek in g
p r o f e s s i o n a l i n t e g r a t i o n a n d t h e i n c r e a s i n g
st r engt hening of hum an and r elat ional com pet ences,
h ealt h p r of ession als con t r ib u t e t o t h e d ev elop m en t
of new com pet ences t hat incor por at e bot h hum an and
t echnical- scient ific values, t hat is, t he inclusion of t he
hum an being in scient ific processes and t he possibilit y
of liv in g an d cop in g w it h a f r ag m en t ed d iscip lin ar y
log ic.
Thus, pr ofessionals ar e: Hum anizing car e by
valuing t he hum an being, as an expr ession of hospit al
h u m an izat ion . Th is cen t r al t h em e is su r r ou n d ed b y
t h e cat egor ies t h at con st it u t e t h e t h eor et ical m odel
r epr esent ed in Figur e 1.
I n sum m ar y, healt h pr ofessionals at t he st udy
i n st i t u t i o n e x p e r i e n ce h u m a n i ze d ca r e b y a l l y i n g
t e c h n i c a l a n d h u m a n c o m p e t e n c e s a n d a c h i e v e
p er son al an d p r of ession al r ealizat ion in a d y n am ic
and cont inuous car e pr ocess, valuing t he hum an being.
Th e i r v a l u e s a n d p r i n c i p l e s e x p e r i e n c e d i n c a r e
relat ions allow t hem t o hum anize care by valuing t he
h u m an bein g.
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EQORGVGPEGKPRTQHGUUKQPCN RTCEVKEG 'ZRGTKGPEKPI JWOCPK\GFECTG
Figur e 1 - Theor et ical m odel const r uct ed on t he basis
FI NAL CONSI DERATI ONS
Most st udy par t icipant s associat ed t he values
gu idin g t h eir pr of ession al pr act ice in t h e f ir st place
w it h hum anizat ion. Values and pr inciples dir ect ed at
r esp ect , d ig n it y an d act u al v alu at ion of t h e h u m an
bein g. Th ey con sider t h at v alu es can r eceiv e a n ew
m eaning, t hat is, t hey can be t r eat ed and int er nalized
t o t he ext ent t hat people ar e w illing t o or decide t o go
t h r ou g h a p er son al/ p r of ession al t r an sf or m at ion an d
socializat ion pr ocess.
H e n c e , h u m a n i z e d v a l u e s r e p r e s e n t a n
in t er n al per son al pr ocess, st im u lat ed by a space of
r ef lect ion , con f r on t at ion an d collect iv e m obilizat ion ,
capable of under st anding t he par t s in t he w hole and
t h e w h o l e i n t h e p a r t s, t h a t i s, st i m u l a t e d b y a
par t icipat or y h u m an izat ion pr ocess.
Pa r t i c i p a n t s a l s o p o i n t e d t o w a r d s t h e
im por t an ce of t h e h ospit al h u m an izat ion pr ocess an
i n n o v at o r y p r o p o sal t h at t r an sf o r m s r el at i o n s an d
w or k con dit ion s. Th ey also dem on st r at ed t h e pow er
of posit iv e per sonal/ pr ofessional at t it udes t o influence
t h e dy n am izat ion an d m obilizat ion of pr act ices t h at
t r an sf or m r ealit y. I n t h is sen se, v alu es st r en g t h en
p e r s o n a l a n d c o l l e c t i v e c o m m i t m e n t i n t h e
c o n c r e t i z a t i o n o f p r a c t i c e s t h a t a r e c a p a b l e o f
r e c o v e r i n g t h e h u m a n d i m e n s i o n i n d i f f e r e n t
sit u at ion s.
I n sum , hum anizat ion r equir es a pr ocess of
r ef l ect i o n ab o u t t h e v al u es an d p r i n ci p l es g u i d i n g
p r o f e ssi o n a l p r a ct i ce , p r e su p p o si n g , b e si d e s t h e
d e l i v e r y o f a d i g n i f i e d , s o l i d a r y a n d w e l c o m i n g
t r eat m en t an d car e by h ealt h pr of ession als t o t h eir
m ain w or k ob j ect / su b j ect - t h e sick h u m an b ein g /
w e a k e n e d b e i n g - , a n e w e t h i c a l p o s t u r e t h a t
per m eat es all pr ofessional act iv it ies and inst it ut ional
w or k p r ocesses.
This st udy show ed t hat new com pet encies can
b e d e v e l o p e d , w h i ch a r e ca p a b l e o f p r o v o k i n g a
r esig n if icat ion of t h e v alu es an d p r in cip les g u id in g
h u m a n i z a t i o n , a i m i n g a t w o r k w i t h p e r s o n a l /
pr ofessional r ealizat ion, ally ing t echnical and hum an
com pet ence in pr ofessional pr act ice and ex per iencing
h u m an ized car e.
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