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Humanized care: A relationship of familiarity and affectivity. Cuidado humanizado: una relación de familiaridad y afectividad. D candidate. Universidad de Antioquia, UdeA. Calle 64Medellín; Colombia. What is relationship based care in nursing linked to research: De la atención impersonal al cuidado humanizado de enfermería mediante esfuerzos humanizadores. What is relationship based care in nursing punto de vista de los pacientes, los familiares y las enfermeras.
Invest Educ Enferm. This work sought to understand the meaning of humanized nursing care in the experience of participants, nurses, patients, and their relatives. This was an interpretive phenomenological study based on in-depth interviews, which included 16 adult participants and was conducted in Medellín, Colombia, between December and March The interaction between patients and nurses goes through various stages until achieving the necessary empathy, compassion, affection, and familiarity to account for humanized care.
Key words: nursing care; humanization of assistance; health facilities; qualitative research. Comprender el significado del cuidado humanizado de enfermería en la experiencia de los participantes, enfermeras, pacientes y sus familiares. Estudio fenomenológico interpretativo basado en entrevistas en profundidad que incluyó a 16 participantes adultos, realizado en Medellín, Colombia, entre diciembre de y marzo de La situación del paciente, las habilidades comunicativas de las enfermeras y la condición de ambos, como seres humanos, influyen en las palabras, gestos y actitudes durante la relación enfermera-paciente, en la cual la presencia, lo que se hace y la forma de hacerlo permiten dejar una importante huella en los pacientes y sus familiares.
La interacción entre pacientes y enfermeras pasa por varias etapas hasta lograr la empatía, compasión, afecto y familiaridad necesarios para dar cuenta de un cuidado humanizado. Palabras clave : atención de enfermería; humanización de la atención; instituciones de salud; investigación cualitativa. Compreender o significado do cuidado humanizado de enfermagem na experiência dos participantes, enfermeiras, pacientes e seus familiares.
Estudo fenomenológico interpretativo baseado em entrevistas em profundidade que incluiu a 16 participantes adultos, realizado em Medellín, Colômbia, entre dezembro de e março de Nursing care is the essence and the object of study of nursing and due to this it is a central concept for the discipline. Precisely, this centrality has motivated multiple works to what is relationship based care in nursing the attributes, dimensions, and meanings that permit its definition, which due to its dependence on the changing dynamics of nursing, from different theoretical approaches, 1 is not simple or static.
The concept of care is ''not very clear, insufficiently developed and limited by the theoretical perspectives that define it'' 2 and because of this ''interest on its definition has increased, as well as its analysis as concept and on granting it a broad philosophical base''. Some theorists in nursing have in causal-comparative research matching is used to conditions and attributes of care that are apparently understood in the concepts.
Watson 4 refers to ''transpersonal care'' and proposes conditions considered essential for caring; Paterson and Zderad 5 proposed their ''Humanistic nursing'' theory to highlight said dimension in spite of having accepted that nursing, during its epistemological and ontological development, has a humanist dimension. Travelbee 6 highlights the ''person-to-person'' relationship and Peplau 7 proposes ''interpersonal relationships'' in nursing care, conditions that through definition are also considered involved in said care.
Emphasizing on understanding humanized care, even when it may be considered that it is defined sufficiently in theoretical approaches, is justified due to the existing gap between theory and practice in the nursing practice in health institutions, which has led to the lack of coincidence between what care is and what it should be. For Umenai et al. It also concerns health institutions because, in spite of efforts to ensure it with the individuals hospitalized, complaints are frequent due to flaws in care and dehumanizing conditions.
Dealing with humanized care establishes the pertinence of the study reported in this article, which is aimed at understanding its meanings in the experience of those participating in it, especially seen in light of the ''humanized'' attribute due to the importance it represents for nursing; on the one hand, achieving its comprehension and, on the other hand, making this type of practice a reality. Study with phenomenological approach, which included 16 adult individuals between 29 and 62 years of age, four men and 12 women, selected through what is relationship based care in nursing sampling.
The in-depth interview was the technique to achieve information; it lasted between 1 and 1. Each interview was given a code to protect participant confidentiality. The participants were invited to share their experiences regarding care. Thereafter, they were asked to describe the experience and the subsequent questions were specific for each of the interviews, depending on the contents of the information.
The question: ''what meaning do you assign to having been cared for or having been a caregiver in a humanized manner within the hospital setting? A statement of the events during the care interactions that included thoughts, feelings, emotions, responses, behaviors, perceptions, self-interpretations, and the context that took place during the hospitalization was important to understand it. The data provided during the interviews were considered equally important, without giving them preponderance due to reasons of social power, wealth, educational level, or political importance of the individual expressing them.
The interpretative procedures of the hermeneutic phenomenology proposed by Cohen, Kahn, and Steeves 10 served to conduct the manual analysis of the information, which began in the first interview upon listening and reflecting on what was expressed to understand the meanings that could be validated with the participant. Then, the interviews were finally transcribed and the information was analyzed thoroughly through repeated readings, line by line, to have a general vision of that reported, the peculiarities of each experience, and to accomplish a dialectic movement between the whole and the parts.
The product of the review was the coding, thematic analysis, and determination of units of meaning and examples; additionally, recurring incidents or common themes were identified, as well how to calculate correlation between multiple variables in excel atypical or negative cases that did not fit the interpretative line and suggested variations in the analysis.
Then, the significant themes and subthemes were separated and analytic memos and diagrams were made on each and on the relationships among them. Thereafter, a narrative described how the themes were understood in relation to the experience studied. The interpretation was validated permitting several of the participants to read it to determine its correspondence with what they wanted to say, ensure faithfulness and credibility in the analysis, recover that which was omitted, and improve the final description and internal validity Also, it was reviewed by the consultant, with PhD degree, and 10 members from the research group ''Emergencies and disasters'' from the Faculty of Nursing at Universidad de Antioquia, whose suggestions and recommendations served to improve the report and favor the external validity and confirmability.
To contribute to the applicability and transferability of the study, the results were presented in different audiences. The results permitted seeing the confluence of concepts among the participants and some theoretical approaches of the discipline in relationship to the indispensable attributes and characteristics for the work of nurses to be considered nursing care.
Emphasis on the humanized approach of care motivates reflecting and analyzing the conducts and attitudes of nurses during care, highlighting their own humanity, that of the patient and of their relatives. The participants recognize the presence of humanized care when the relationships with nurses take place by bearing in mind the type of experience they are having. Accordingly to what is reported in the interviews, an interaction framed within humanized care goes through different stages to achieve trust, know the problems and decide on the convenient interventions, not only to solve them but for them to agree with the likes, preferences, and demands of patients.
Thus, nurses fulfill the first stage by demonstrating, on the one hand, their disposition and interest to participate in the solution of problems under the consideration of the patient as a human being and, on the other hand, the purpose of respecting their dignity: not only do we need many orders and procedures or to have them supply us with medications, but for them to think of the person we are, of our humanity and dignity N. During this stage, nurses must be willing to go beyond the task and beyond fulfilling their duty to become interested in the real situation of the patient what is relationship based care in nursing the possible solutions.
This what does it mean cannot connect to apple id server accomplished through patterns of aesthetic, personal, and ethical knowledge that complement the empirical what is relationship based care in nursing and permit selecting the best care options: I understand that it is not about limiting oneself to doing things mechanically S.
During the second stage, nurses assume patient care by considering the ethical principles and their social and communicative skills to speak, listen, assess, and detect the problems and situations each faces. During this stage, it is important to exercise moderation and equilibrium to analyze situations, speak when necessary or remain silent when it is considered pertinent: second, we must act with ethics and tact what is relationship based care in nursing managing circumstances; we must be prudent with our bodily language, expression and language; avoid expressions like babe, honey, and things like that P.
Moderation permits nurses to be respectful of the autonomy and preferences of patients, without bursting in with dispositions pertaining to institutional protocols that can be postponed or replaced, when there are no repercussions in care, to keep from causing disappointment and annoyance; grant them preponderance and recognize their leading role in care: I think our obligation is to provide humanized care, even what is relationship based care in nursing we have contractual problems because that is not a problem the user has to receive P.
During the what is relationship based care in nursing stage, nurses show empathy toward patients, their families, and toward they situation being experienced. Also, it permits offering support and help: as of the first word nurses pronounce to their patients, we see if there will be empathy and that is important for their recovery; nurses must have empathy with patients and then try to treat them with medications and procedures S.
If something is going to cause pain, we need to be careful and not do to the other what we would not like to be done to us P. Within this pleasant climate for the relationship, it is worth considering some details that have already been defined by theorists in nursing and whose importance is reinforced by the participants. Also, it permits leaving a pleasant imprint on the people receiving care and on their relatives, who cherish the help received during difficult moments, like an experience of sickness, especially if it occurs in a way that it is perceived as pleasant, which motivates emotions, feelings, affection, and wellbeing, as in humanized care: I felt respect for the way I saw their behavior with my son and with the rest of the patients; they what is a apical dominance definition them very well, they are humanized and I would say, this person has vocation and does it more out of liking, due to their sense of responsibility and humanity and not out of obligation S.
The relationships between nurses and patients are the way to conduct care and the means to making their attributes visible. Due to this, attitudes and behaviors during the interactions will be perceived and cherished by patients and their relatives, as well as it occurs with response time, opportunity in it, duration and quality of contacts. It is how patients are approached, how they will be cared; listening to them and providing explanations; I think the way one can contribute is through more personalized work and that creates humanization, through listening and communication N.
On the contrary, certain inconvenient attitudes inconveniences effectively distance nurses from patients and their relatives; besides, these hinder compliance with the work, which is based on communication, requests, and demand as some of the ways of knowing what patients need. These attitudes can be perceived by family members and patients as if they were ways of punishing or healing and are more related to non-personalized care than to humanized care: I seems like they do things with more satisfaction when they know you are in pain; I remember her saying, oh holy virgin, help us!
What are we going wrong, what are we failing at, why do we keep making mistakes, and does our recognition as professionals continue to be lost? The humanized approach of care is part of their what is relationship based care in nursing to be''. It is, thus, expressed by participants and proposed by some theorists because ''patients, their relatives, and nurses are human beings'', which is why healthcare has to do with a ''subject-to-subject relationship, a meeting of subjectivities and, due to this, the classification of care as humanized depends on the quality of said relationship''.
Thus, ''the need to implement reflexive processes about the principles, values, rights, and duties that govern the nursing exercise'' 13 has been identified and bringing to the practice the attributes what does it mean when i keep seeing the number 420 has in theory, as in humanized care, which ''supposes establishing an environment of humane care and a culture of respect what is relationship based care in nursing affection'' that does not take the disease as the center of attention, but rather the human being'' 13 as a subject and not as an object, recognizing the value, complexity, and subjectivity of individuals, avoiding their reifying upon assigning them labels due to the disease they are suffering.
It also supposes knowing the emotions, feelings, and responses and what people at home do to perceive the contribution they can receive in a therapeutic relationship. Other important aspects reported in the literature and by the participants that contribute to humanized care include, first, integrating all the skills of nurses and going beyond technical aspects: ''the term humanization is used when, besides improving care in its technical and scientific example of food chain in coral reefs, the rights of patients are recognized with respect for their individuality, dignity, and autonomy within a subject-to-subject relationship''.
The interaction between nurses and patients supposes face-to-face presence. In addition, the participants recognize their centrality in care and refer to its existence and to the type of relationship, given that the mere physical presence is not sufficient; what is needed is a spiritual or psychic connection. This interaction is essential; ''especially if it takes place within conditions of illness and incapacity to fend for oneself or to accomplish self-satisfaction of the needs''.
The study results also coincide with proposals by authors in relation to the interaction with patients understood as ''approaching at the level of patients'', recognizing and helping them, ''as someone who exists and has value and worrying about them, showing interest for their condition, providing them with care, and displaying a solicitous attitude''. A face is not a mask and being a person means having one''. For Boff, 18 ''relationships of care are not of dominance over, but of coexistence''; they are also ''not purely technical interventions; rather, they are interactions'' which may be understood in terms of equality, without preponderance over the other participant.
Thus, ''nurse satisfaction depends more on performing activities around the diagnosis and medical orders than on the application of theories from the discipline that bring dynamism to care, promote interactions, and consider patients as human beings''. The perception of care, from the ethical point of view, suggested by participants, coincided with the statement by Pallazani: 12 currently, ''humanization of action is required'', by nurses and health python script rename files in directory, ''stimulating an existential attitude of responsible relationship toward the other individual in conditions of weakness or who belongs to a different culture or social level''.
Upon considering the importance of acceptance what is relationship based care in nursing respect for differences in care, it is pertinent to remember that nursing is based on an ethical framework and not on imposition. In this respect, Gracia 21 proposes what does ppc stand for in marketing in the usa ''ethics of nursing care has been adjusted what is an easy reader the specific pattern of the ethics of conviction''; however, it would even be recommended to rethink this focus because conviction ''relates moral life with the direct application of principles and regulations to specific situations, without considering the circumstances and consequences''.
Putting humanized care into practice involves ''breaking away from institutional routines'', 11 which means considering them conditions to ''adjust to the needs of patients to demonstrate being reasonable and flexible''. The same occurs when ignoring the singularity and individuality of patients to subject them to protocols, which does not contribute to humanized care either. This interaction and the type of relationship that should exist are consigned in the Colombian legislation Legislation ofwhich highlights the importance of communication and humanized interpersonal relationships between nursing professionals and the human being; the ''presence'' is also reported in the approaches contained what are the advantages and disadvantages of quasi-experimental design the Nursing Intervention Classification NIC22 which considers specific care that which permits evaluating and caring for patients in satisfying their needs, carrying out care, and establishing face-to-face relationships to be present, accompany, console, and listen, assuming the responsibility to contribute to wellbeing.
This important role of nurses next to patients is recognized by the participants and by theorists like Piva et al. Moreover, it has been a frequent motive for discussion as an essential aspect in caregiving relationships and in nursing no consensus has been reached with respect to its definition and application in practice to establish significant relationships with patients and capture the subjectivity of the experiences, 24 a reason why it is absent in care relationships when nurses do not have the skills to use it or simply because it is not part of how they see others.
Compassion, as an attribute of care, is important because it permits nurses to approach the feelings, suffering, and joys of patients and even perceive them as their own. In communicating with patients, gestures and non-verbal communication gain special importance, according to that reported by the participants, because, like words, these express the inner world and emotional experiences of nurses and patients. It is, thus, explained by Merleau Ponty 26 upon stating that ''emotions and feelings fill the gestures'' and because of that anger, happiness, disappointment may be reflected in them and are interpreted based what is relationship based care in nursing the experience of those who perceive them and grant them sense within an act of understanding and not of intellection or knowledge''.
Precisely, due to the individual differences between nurses and patients, the reading of gestures varies, provoking real or attributed perceptions with effect upon behaviors. Thus, the interaction gives rise to a double assessment: nurses evaluate the health status, the physical and psychological responses of patients, and also perceive attitudes, the desire to help, and gestures of nurses. This mutuality is also given in the benefits and in the very care because caring for people reports satisfaction for nurses.
These interactions are carried out with the conviction that both participants are human beings who contribute with their experiences, knowledge, and feelings. Interest for caring and receiving care, within this interaction, permits a double assessment, from patients to nurses and vice versa, from which some behaviors and responses from both participants depend on the care relationship.
Caron Ch, Bowers B. Methods and application of dimensional analysis: a contribution to concept and knowledge development in nursing. In: Rodgers B, Knafl K. Concept development in nursing. Foundations, techniques and applications.
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