Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1
Provincial Health Directorate of Artemis. Cuba.
2
Faculty of Medical Sciences "October 10". Havana Cuba.
3
Teaching Polyclinic Dr. "Tomas Romay". University of Medical Sciences of
Artemis. Cuba.
SUMMARY
INTRODUCTION
Its evolution is influenced not only by biological factors of each woman and baby, but
also by psychological, cultural and environmental factors. That is why the health
professionals and the rest of the staff that attend to it, must establish an empathic and
humanized relationship where the knowledge of science and the values of the human
being interact to establish quality assistance, applying love and patience, in the most
updated and comprehensive way. two
Nursing care during labor and delivery requires special considerations towards women,
given the changes inherent in this process, in which the intervention of the health
team and specifically of the nursing professional, play an important role in the
evolution and satisfactory results. two
The process of childbirth represents one of the most paradoxical experiences that
women live. On the one hand it creates life, it constitutes for some the best that could
have happened after pregnancy, but at the same time it can be the most painful event
that it experiences and implies a deep psychosocial experience, which tests its
femininity and personal skills and limits its abilities functional, mainly in the decrease
of the control that she can maintain in front of her own physiology. 3
The need to improve perinatal care encompasses not only scientific advances but also
the possibility of humanized care for the pregnant woman, considers her, her children
and her partner as the key characters in the care.
The delivery is attended directly by the health personnel, according to their profile or
specialization, to obtain favorable results within the Maternal and Child Care Program
(hereinafter PAMI) and in this area, the nursing staff is responsible for the quality and
the achievement of excellence in the provision of services that it provides in a
humanized manner assumed from the improvement of its professional performance.
The purpose of the research is to specify the influence of the performance of nursing
professionals in the humanized delivery care.
METHODS
A systematic literature review was carried out to develop a critical reflexive analysis of
the content of documents, where doctoral thesis, masters, original and review articles
were considered.
The search strategy adopted was the use of keywords or descriptors, connected
through the Boolean operator AND.
The inclusion criteria for the selection of the articles were: Articles in Spanish and
English available in the selected data portals that presented adherence to the subject,
published between 1992 and 2015 that clearly presented the selected theoretical
methodology or reference. The exclusion criteria were the searches that were found
repeated in the databases.
After the identification of the pre-selected studies, the titles of the publications,
abstract and keywords were read, verifying the relevance with the study, and must
adhere to the subject addressed.
To describe the methodological approach to the results, the flow chart is shown,
see figure .
DEVELOPING
The humanization of health care is a focus of social interest, becoming a strategy that
allows to increase the well-being of users. In women's health, humanized care is
especially important in childbirth care. In it, women and children experience a situation
of vulnerability and the good care received constitutes a key element in the perception
of satisfaction and well-being referred to by women. 5
For several decades, currents have begun to appear in different countries that were
trying to solve the problem of women in labor and the pain of childbirth. 6
Rangel da Silva 2 in the 50s worked on fear and tension to pain and determined initial
currents of psychoprophylaxis. From that time they began to develop methods that
favored a natural development of childbirth focusing on the woman and / or the baby,
avoiding unnecessary medications and medical interventions. 6
In the decades of the 60s and 70s of the twentieth century, psychoprophylaxis, family-
centered motherhood, the constitution of a home atmosphere in the hospital,
immediate breastfeeding, began to approach the companion in childbirth and acquire
value satisfaction surveys for the parturient and her husbands. 6
This recognition led to the need to clarify the concept of humanization of health care at
the International Conference on Childbirth Humanization, held in November 2000, in
Fortaleza, Brazil. 7
In 2003, Trevizan 8 stated that the nursing professional, as a member of the health
team, is responsible for managing care for people with substantial support in the
proposal with a humanistic vision.
Garzón , 9 in 1998, reported that humanization also includes the cultural, historical and
spiritual aspects of man, for which health professionals must establish appropriate
therapeutic relationships. The same author assures that the humanists of all
philosophical currents proclaim the dignity of man, his freedom and equal rights. He
affirms later in 2005, 10 that the person appreciates the value of himself and the ethics
of his behaviors and interrelations.
• Humanized, based on the emotional, physical, psychological and social rights and
needs of women, their baby and their family.
• Intercultural approach.
• Respect for human rights, reproductive, culture, rituals and ancestral knowledge.
• Respect for the choice of women over the people who will accompany her in
childbirth, to her privacy, dignity and confidentiality.
Among the civil and political rights in Cuba there is a National Health System, which
due to the state and social nature of medicine, including sexual and reproductive
health, has decisively managed to raise the health indicators of the entire population,
and in particular as a right of women and children, maternal and child health, benefits
that responds to the Universal Declaration of Human Rights. 10
· "During this period the Society has contributed from its different sections to the
promotion of Sexual and Reproductive Health and Sexual and Reproductive Rights.
Promoting a strict observance of ethical principles, with a high technical and cultural
scientific level. , without neglecting spiritual development, its humanistic, supportive
projection and the satisfaction of women and family members with the services
received. "
· "As part of the humanization of childbirth, as a right of the mother and the couple,
the accompaniment to women during labor is implemented and encouraged by the
relative or person she decides, for which they have created the basic courses that train
health personnel and family members for this process, and in which the SCGO has
participated for its improvement ".
It is appreciated that, despite the efforts, even the issue of humanization to women
during labor, childbirth and other events of their reproductive process, presents, from
the speech itself, absence of strengthening elements that allow reflection on the
human and professional relations that happen around these processes, recognizing
that professionals and women are exposed to the best and the worst in a particularly
momentous moment and that the protocolized practices, in general, do not respond to
the totality of the rights of women and family members and yes to the standardization
of norms whose main objective is to obtain a mother-child binomial in optimal
biological conditions, thus avoiding the holistic approach of the care provided by the
health team.
In relation to childbirth, its humanization implies that the woman has control of the
process, not the health team; It requires a respectful and careful attitude determined
by the improvement of the performance of nursing professionals who offer care
sensitive to the needs and expectations of women. 5
The review and analysis of materials and results of research projects related to the
improvement of the professional performance of nursing work resources allowed the
search and identification of epistemological, theoretical and methodological references
that set stable livelihoods for analysis, assessment and finally propose solutions from
scientific positions to the category: professional performance.
The Vice Ministry of Teaching and Research of the Ministry of Public Health of Cuba
(hereinafter MINSAP), began the studies of the evaluation of competence and
professional performance, from the realization of four national workshops between
1992 and 1997, with the participation of advisers from the Pan American Health
Organization (hereinafter PAHO), from WHO and from foreign academic institutions
(Canadian and Guatemalan). 14.15
In 2006, León Román 16 stated that in accordance with its purpose of overcoming,
Nursing, it is up to the trend that tends to guarantee the quality of the health service
systems, which seeks to satisfy the needs of care that society has as a
whole. Likewise, competence and quality of performance have become essential
requirements in health services. 13
For Urbina Laza 17 , labor competencies are assumed as a starting point for the
evaluation and analysis of the performance of nursing professionals.
For its part, in 2011, Martínez 19 addresses that the professional performance of
Nursing graduates in the hospitals of the second and third level of care becomes
complex; It is determined by the constant transformations and development of science
and technology, the diversity of diseases and their behaviors, always different in each
patient and the large number of procedures performed in these services.
Sixto Pérez, 20 in 2014, as part of his research in the pedagogical area, defines that
professional performance in its metacognitive component, is reflected in the reflection,
supports the regulation of the nursing professional and strengthens the disposition and
effort to set and achieve professional and personal goals that make an autonomous
person, self-regulated and identified with their profession, elements that from
Advanced Education are associated with the definition and operationalization of the
term: professional and human improvement.
The integral preparation of the nursing professional in different sciences, as well as his
preparation in health education techniques, make him an ideal collaborator in the
provision of services in such a delicate area as women are during the work of labor and
delivery This professional should not only prepare in the knowledge and techniques of
Nursing, but also in areas that are necessary to take care of the person in charge, from
their biological, psychological, social and spiritual integrity. 22
The assistance function for the care of labor and delivery will be a primary function of
doctors and nurses, regardless of whether there are other members who are
indistinctly incorporated into the provision of services according to need for care, these
are the members of the health team defined for the care of labor and delivery.
Resolution 54.12 of the World Health Assembly adopted in 2001, reflects the
recognition of the potential of Nursing and midwifery to improve the quality and
effectiveness of health care in member states. 17
The Nursing Care Model described in PAHO's strategic directions for the development
of nursing and midwifery in the period 2002-2008, describes how and the process to
provide health services to women and children, the key attributes of this Midwifery
process pose: 17
· Focus on care services that are convenient for women and family-centered.
The Midwifery care model has a focus on health care that should involve all disciplines
related to reproductive health, it incorporates aspects such as values, ethics,
philosophy and human sensitivity necessary to work with Women throughout their lives
include one of the most vulnerable moments of motherhood. 17
Mur Villar 23 in 2009 expressed that job performance is an integral part of the
specialist's teacher training from the ability to apply nursing care in a different
approach to the areas of Mother and Child Science.
The systematization that is carried out in this section and the review of investigations
that are linked to the object of study of this research, both in the conceptualization of
professional performance and in the elements of humanization of childbirth, led us to
select the variable: performance Nursing professional in humanized care during labor
and delivery understood as: set of actions that nurses who work in obstetric services
that are evidenced in the practical expression of their communication skills, their
capacity for relationships interpersonal and individual assessment, their human
values,its ethical precepts and the development of holistic competences for the care
provided to women during labor and delivery in a comprehensive, humane, consensual
way and with special consideration to the state of vulnerability, identification,
prioritization and satisfaction of the humanized needs and desires of their protagonists
with strictly individual perceptions and sensations as holistic beings.
Humanized care lies in decreasing routine practices during labor, therefore nurses
should encourage activities that build trust and reduce stress in women; This requires
developing and applying care that contributes to or improves perinatal care.
Humanized delivery care is the way in which each nurse provides care through
attitude, values and principles. It is an interaction between knowledge and feelings for
each woman, which allows to establish quality assistance with human expression
during the care offered by nursing starting from the influence of their mode of action,
of their doing, in the achievement of humanization.
BIBLIOGRAPHIC REFERENCES
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Regional Hospital, Quetzaltenango, Guatemala [thesis]. Quetzaltenango, Guatemala:
Rafael Landívar University, Faculty of Health Sciences; 2015
2. Rangel da Silva l, of Souza Serrano N, Moreira Christoffel M. The obstetric nurse and
the humanization policy of childbirth: in search of the change in the care model. Global
Nursing 2006 [cited 2012 May 22]; 9: 1-13. Available
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http://www.scielo.br/scielo.php?pid=S0104-11692003000500013& script = sci_arttext
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11. Andreoni S, Bruggemann OM, Camacho AV, Cianciarullo T, Land S, Tsunechiro MA,
et al. Nursing Guidelines and Guidelines for the Improvement of the Quality of Prenatal
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DC 2004 [cited 2016 Mar 20]. Available
at: http://www.paho.org/Spanish/AD/FCH/WM/PrenatalcareManualesp.pdf
12. Declaration of Ceará. Humanization of childbirth, Fortress. Brazil; 2002 [cited 2016
Mar 20]. Available at: http://www.relacahupan.com/caminos01.html
13. Cabezas Cruz E. Written Contributions and Human Rights. Universal Periodic
Review Report (UPR) of Cuba. Havana: Cuban Society of Gynecology and
Obstetrics; 2013
14. Accounts of the National Workshops for the Evaluation of Competition and
Professional Performance. Havana: CENAPET; 1992.
15. Reports of the National Workshops for the Evaluation of Competition and
Professional Performance. Havana: CENAPET; 1997
16. León Román CA. Nursing as a profession. In: Bello Fernández NL, León Román
CA. Nursing Fundamentals Part I. Havana: Editorial Medical Sciences; 2006. p. 21-27.
17. Urbina Lasa O. Methodology for the evaluation of labor competencies of nursing
professionals working in neonatology services [thesis]. Havana: National School of
Public Health; 2007
19. Martínez Isaac JA. Design by competences of the Diploma in Clinical - Surgical
Nursing [thesis]. Havana: University of Pedagogical Sciences "Enrique José
Varona"; 2011
20. Sixto Pérez A. Pedagogical strategy for the preparation of Nursing Graduates in
research skills [thesis]. Havana: University of Pedagogical Sciences "Enrique José
Varona", University of Medical Sciences of Havana. Faculty of Medical Sciences
"October 10"; 2014.
23. Mur Villar N, Iglesias León M, Cortés Cortés ME, Aguilar Cordero MJ. Determination
of the characteristics of the care teacher that trains the Maternal and Child Nursing
specialist. MediSur. 2010; 8 (5): 6-7.
Received: 2016-05-24.
Approved: 2016-06-07.