Violência institucional e humanização em saúde: apontamentos para o debate / Institutional violence and humanization in health: notes to debate

Resumo O presente trabalho parte das políticas de humanização e seu debate acadêmico para refletir sobre a violência institucional na saúde. Tendo por base pesquisa sobre as publicações científicas na Saúde Coletiva, constata-se que nesse debate a violência que se identifica nas relações entre profissionais e usuários, núcleo das indagações na temática da humanização, é concebida como um excessivo poder no uso da autoridade profissional, sendo esta pouco discutida. Apresentando as reflexões de Hannah Arendt como um novo aporte teórico acerca dos conceitos de 'autoridade', 'poder' e 'violência', objetiva-se distinguir e repensar esses fenômenos. Conjugando essas reflexões com a história da institucionalização da saúde no Brasil, em especial as mudanças no trabalho médico durante o século XX, concluímos que o problema da violência institucional na saúde não se fundamenta em um excesso de autoridade e poder dos profissionais, mas no seu contrário: quando a autoridade profissional se esvazia e as relações entre os homens não se dão através das relações de poder é que está aberto o espaço para o fenômeno da violência.

Abstract This paper starts from humanization policies and the academic debate around them to reflect about institutional violence inside health services. Based on research on scientific publications in Collective Health, it was observed that violence in relationships between health professionals and users - which is at the core of the humanization's debate - is conceptualized as an excessive power in exercise of professional authority. Using Hannah Arendt thinking as theoretical contributions regarding the concepts of 'authority', 'power' and 'violence', our objective is to define and rethink these phenomena. Melting these reflections with the history of institutionalization of health in Brazil, and especially the changes in medical work during the twentieth century, we conclude that the problem of institutional violence on health services is not based on excess of authority and power of professionals, but rather in its opposite. When there is a vacuum of professional authority, and relationships between people do not happen through power relations, there is space for the phenomenon of violence.

Nursing Ethical Significance of Humane Care- Based on the Treatment of Bladder Cancer Complicated with Coronary Artery Disease / 中国医学伦理学

Objective:To explore the effect of humane nursing for bladder cancer patients complicated with cor-onary artery disease and analyze the ethical significance. Methods:Seventy-eight patients of bladder cancer com-plicated with coronary artery disease were recruited and divided into control group ( n=39 ) and observation group (n=39). Subjects of the observation group accepted routine care and humane care, while those in the control group only accepted routine care. Before and after the intervention, level of hope, anxiety and depression, quality of life were assessed. Results:After the intervention, the subjects′hope level in the observation group was signifi-cantly higher (P<0. 05) than before, and significantly higher than the control group (P <0. 05). Both in the control group and observation group, SAS and SDS scores significantly decreased (P<0. 05) than before, and the observation group compared with the control group were significantly improved ( P<0 . 05 ) . It suggested that symp-toms, psychological and emotional state, physical function, and other items of daily life scores were improved sig-nificantly after the implementation of humane nursing ( P<0 . 05 ) . Conclusion: Humane care mode can signifi-cantly increase the hope level of bladder cancer patients complicated with coronary heart disease, and is conducive to improving bad emotion and quality of life, which embodies the new nursing spirit, consists with the requirements of nursing ethics, and has a certain value to nursing ethics.

A influência do lúdico no cuidado humanizado a pacientes oncológicos pediátricos no hospital do município de Aracaju-Se / Impact of playing activities on a humane care for pediatric cancer patients in the Aracaju-Se town hospital

Resumen:

Introducción: el estudio pretende conocer cómo las actividades de juego contribuyen a la atención humanizada a los niños con cáncer, hospitalizados en una institución de salud. Método: es un estudio exploratorio y descriptivo, cualitativo y cuantitativo, con una muestra de 40 acompañantes de niños hospitalizados. Resultados: los resultados mostraron que en los niños predominaron las edades entre 11 y 15 años, los acompañantes, hombres, adulto joven. La duración de la estancia hospitalaria entre 11 a 15 días. La causa más común de hospitalización es la del tratamiento para la leucemia. La influencia de los juegos es positiva, ya que minimiza el peso de la hospitalización, reduce el estrés tanto para el niño y el acompañante, socializa, reintegra al niño a su mundo infantil, ayuda a la recuperación de este.

Conclusión: se concluyó que la promoción del juego en un entorno sanitario contribuye al proceso de socialización y la comunicación entre pacientes, cuidadores y profesionales de la salud.

Abstract:

Introduction: The study was aimed to understand how playing activities contribute to a humane care for children with cancer admitted in a health institution.

Methods: A descriptive exploratory study, based on qualitative and quantitative methods, in a sample made of 40 people accompanying hospital-admitted children.

Results: A predominance of 11-15 years old children was observed; most accompanying individuals were young adult men. Length of hospital stay was 11 to 15 days. Most common cause for hospital admission was leukemia therapy. Impact of playing activities is positive, because they reduce the burden of hospitalization, reduce stress both for child and accompanying individual; enhance socialization, return patients to a children world, and help recovery. Conclusion: Promotion of playing activities in a hospital setting helps to enhance socialization and communication among patients, caregivers and health workers.

Introdução: o estudo objetiva conhecer como as atividades lúdicas contribuem para o cuidado humanizado às crianças com câncer internadas em instituição de saúde.

Método: trata-se de um estudo exploratório e descritivo, de natureza qualitativa e quantitativa, com 40 acompanhantes de crianças internadas. Resultados: os resultados mostraram que houve predominância para as idades entre 11 e 15 anos, sexo masculino, os acompanhantes tinham perfil adulto jovem, tempo de internação entre 11 a 15 dias, tendo o tratamento para leucemia a causa mais comum de internação. A influência do lúdico na ótica dos entrevistados é positiva, pois minimiza o peso da hospitalização, reduz o estresse tanto da criança como do acompanhante, socializa, reintegra a criança ao seu mundo infantil, ajuda na recuperação da criança.

Conclusão: concluiu-se que a promoção do brincar no espaço da hospitalização infantil contribui para o processo de socialização e comunicação entre pacientes, acompanhantes e profissionais de saúde.

A Qualitative Research of Medical Humane Care in Improving Doctor-patient Relationship / 中国医学伦理学

Using the method of semi -structure interviews to pre-interview 6 experts and officially interview10 experts , then the record of the interview was compiled into the paper .Using the grounded theory method to encode material of the interview , a summary was made for each case base on data collation and analysis .This paper ana-lyzed the humanities concern the connotation of the application in the construction of a harmonious doctor -patient relationship and the specific measures .On the basis of the application of humanistic care in the construction of a harmonious doctor -patient relationship , significance and limitation is discussed .

Percepção das mães sobre o cuidado do bebê de baixo peso antes e após implantação do Método Mãe-Canguru em hospital público da cidade de São Paulo, Brasil / Maternal perception of low birth weight babies before and following the implementation of the Kangaroo Mother Care in a public hospital, in the city of São Paulo, Brazil

OBJETIVOS: aumentar a compreensão sobre os diferentes modos que as famílias de baixa renda lidam com o nascimento de um bebê pré-termo, com vistas a aprimorar a implantação do Método Mãe-Canguru (MMC). MÉTODO: estudo qualitativo realizado em São Paulo, estado de São Paulo, em 2004, no qual foram entrevistadas 19 mães antes e 22 mães após implantação do MMC. O roteiro de entrevistas incluía questões abertas, das quais emergiram as informações sobre como as mães cuidaram de seus bebês de baixo peso, os arranjos domésticos e outras medidas a que recorreram. Para análise utilizou-se a abordagem da Grounded Theory. RESULTADOS: a necessidade de cuidar de outros filhos parece ser um dos principais limitadores para a opção ao MMC. Em comparação às mães entrevistadas antes da implantação do programa, as mães-cangurus eram mais jovens, mais escolarizadas, sem outros filhos, recebiam mais ajuda nas tarefas domésticas e relataram menos dificuldades na amamentação. CONCLUSÕES: a oferta do MMC em uma maternidade da periferia de São Paulo sugere efeitos positivos sobre a amamentação. A tendência à conformação de famílias nucleares dificulta a participação das mulheres no programa. Conhecer as limitações e possibilidades de cada família pode contribuir para o aperfeiçoamento do processo de implantação.

OBJECTIVES: increase the understanding of the different ways low income families deal with a preterm baby aiming at the improvement of the Kangaroo Mother Care (KMC). METHOD: qualitative study performed in the city of São Paulo, State of São Paulo, in 2004 with the interview of 19 mothers before and 22 mothers following the implementation of the KMC. The design of the interviews included open questions to obtain information on how mothers tended their low weight babies, household arrangements and other measures they resorted to. The Grounded Theory Method Approach was used for analysis. RESULTS: the need to care for other children seems to be one of the main KMC constraints. In comparison to mothers interviewed before the program's implementation, the mothers using the KMC were younger, had more schooling, no other children and reported less difficulty in breastfeeding their babies. CONCLUSIONS: the KMC offer in a maternity in the outskirts of São Paulo reflects positive effects on breastfeeding. The tendency of nuclear families hinders women's participation in the program. Awareness of the limitations and possibilities of each family may contribute to improve the program's implementation.

Influence of patient satisfaction on humane care hospitals and its analysis / 中华医学教育探索杂志

Objective To explore the humanistic nursing care for the impact on the overall quality of care.Methods 1000 patients were randomly divided into experimental and control group,traditional holistic nursing was implemented in the control group,while both traditional holistic nursing and humane care were implemented in the experimental group to compare the differences of patient satisfaction by questionnaire survey.Results The humane care group was significantly higher in patient satisfaction,and the differences are statistically significant(P