O termo humanização tem sido freqüente na prática assistencial, na formação dos profissionais da saúde e nas políticas públicas. Entretanto, não percebemos o apoio do conceito do termo humanização (quando ele existe) em uma teoria ou filosofia, o que dificulta a discussão da temática da humanização em nível científico. Partimos, neste trabalho, do seguinte conceito de humanização: encontro de subjetividades no e pelo ato de cuidar. Considerando que há uma necessidade urgente em tratar a humanização cientificamente, os objetivos desta pesquisa foram: eleger um referencial filosófico que possa sustentar a teoria e a prática do cuidado humanizado; refletir sobre o conceito de humanização proposto neste estudo à luz do referencial teórico escolhido; definir categorias filosóficas que subjazem as relações de cuidado de enfermagem; construir uma articulação entre o recorte filosófico escolhido e os saberes da enfermagem. O referencial escolhido foi a filosofia de Emmanuel Lévinas. Esta escolha baseou-se na finalidade da enfermagem, na complexidade que envolve o saber e o fazer desta profissão e, também, na necessidade de incluir um referencial apropriado sobre humanização na formação do profissional enfermeiro. O método utilizado para a leitura das obras foi a hermenêutica. Após a leitura destas obras elegemos as categorias que subjazem as relações de cuidado entre um eu enfermeiro e um outro, discorremos sobre elas e, por fim, articulamos estes conteúdos filosóficos com os saberes da enfermagem. Em seguida, consolidamos a fundamentação da humanização ancorando-a em uma realidade factual do profissional enfermeiro. As leituras nos mostraram que a relação que o eu estabelece com o mundo é fundamental para que se perceba como um ser separado que pode buscar aquilo que lhe falta. Entretanto, ao se deparar com outrem, este apresenta-se como rosto que traz o rastro do infinito, o qual impede a sua objetivação. Dessa forma, o outro apresenta-se em posição de altura relativamente ao eu enfermeiro, o que produz uma assimetria na relação eu-outro e desperta um desejo no eu. Este desejo não parte de uma necessidade do desejante, mas é despertado pelo desejado. A relação entre estes seres transcendentes se dá através da linguagem, a qual permite que o eu e o outro permaneçam separados e em relação. Nesta relação evidencia-se a separação do tempo do eu enfermeiro com o tempo do outro. E, como no mundo o eu está diante de vários outros, é necessário que ele responda a cada um deles com justiça. É nesta resposta que o eu torna-se uma subjetividade que é responsabilidade até a substituição. Esta responsabilidade infinita do eu, põe em questão a sua liberdade. Dessa forma, a relação humanizada com base na filosofia de Lévinas pressupõe uma assimétrica na qual a responsabilidade do eu é sempre voltada para o outro, a sua liberdade é livre apenas para ser para o outro. Portanto, o conceito de cuidado humanizado aqui proposto deve conter esta assimetria. Assim, substituímos o conceito inicialmente formulado por relação eu-outro no e pelo ato de cuidar. / The term humanization has been frequent in the assistance practice, in the graduation of the health professionals and public politics. However we don´t perceive the support of the humanization concept (when it exists) in a theory or philosophy what makes even more difficult the discussion of the humanization themes in a scientific level. In this research, we part from the humanization concept: a meeting of the subjectivities in and by the act of the care. Considering that is a urgent necessity in threatening humanization scientifically, the goals of this research were: elect one philosophic reference that can support the theory and practice of the humanizated care; a reflection about the humanization concept proposed in this study as a light of the referential theory choose; define philosophic categories that can support the relations of the nurse care; construct a articulation between a philosophic cutting out that has been choose and the nurse knows. The referential choose was an Emmanuel Lévinas philosophy. This choice was based in the nursing finality and the complexity that involves the knows and makes of this profession and the necessity to include a referential appropriated in humanization used in the graduation of the nurse professional. The method used in the reading of these works was the hermeneutics. After the reading of these researches we elected the categories to support the relations of the care between a I-nurse and a I- other we discuss about them and in the end we articulated about these philosophical contents with the knows of the nursing. After that we consolidated the fundament of the humanization anchoring in a factual reality of the nurse professional. The readings showed us that the relation that the I establish with the world is very important to show how a not complete human can search what it is losing. However when meets with another human this presents as a face that brings the trail of the infinity that impossibility the objective of all. This way the other shows in an I-nurse high position that produce a asymmetry in the relation I-other and awakens a desire in the I. This desire don´t go from a necessity of the desiring but is awakened by the desired person. The relation between this humans transcendence happens using the language that permits that the I and the other can stay related separated. In this relation it is evident the separation between the time of the I-nurse and the other. And because in the world the I is distant from the others it is necessary that it responds to each one with justice. It is in this response that the I turns into a subjectivity that is responsible until the substitution. This infinity responsibility of the I put in question it owns liberty. In this way the humanizated relation based in the Levinas´s philosophy presupposes one asymmetrical in which the responsibility of the I is always related to the other and its liberty is free only if is for the other. So the concept of the humanizated care proposed in this research should contain this asymmetrical way. So we substitute the initial formulated concept for relation I-other in and by the care act.

<p>Palliativ vård innebär ett förhållningssätt där patientens livskvalitet står i centrum. Vården kännetecknas av en holistisk människosyn där patientens fysiska, psykiska, sociala samt existentiella behov ska tillgodoses. Från sjuksköterskans perspektiv kan palliativ vård bedrivas inom såväl primärvård som slutenvård och omfattningen av det palliativa vårdandet varierar beroende på inom vilket område sjuksköterskan är verksam. Oavsett kontext har sjuksköterskan en relations­skapande funktion och relationen har stor betydelse för patientens välbefinnande. Professionell hållning inom palliativ vård innebär att sjuksköterskan medvetet tillämpar ett empatiskt förhållningssätt. Syftet var att beskriva sjuksköterskans upplevelse av att förhålla sig professionellt i relationen till patienten inom palliativ vård. Studien genomfördes i form av en vetenskaplig litteraturöversikt med systematisk insamling och granskning av data. Totalt inkluderades elva kvalitativa, vetenskapliga artiklar. Databearbetning resulterade i tre kategorier: ”Den unika relationen”, ”Sjuksköterskans utmaning” samt ”Professionell distansering”. Sjuksköterskor upplevde att relationen inom palliativ vård präglades av närhet och känslomässigt engagemang. Den nära relationen ansågs positiv samtidigt som den innebar en risk för emotionell överbelastning. Nödvändigt var att upprätta en professionell distans för att kunna särskilja yrkesliv och privatliv. Sjuksköterskor identifierade i det en utmaning att balansera mellan närhet och distans och att kunna vara personlig utan att bli privat.</p> / <p>Palliative care is an approach which has the main emphasis on the patient’s quality of life. It is characterized by a holistic view towards the patient’s physical, psychological, social and existential need. The nurse can work with palliative care in many different contexts, and to various degrees. Nonetheless, the nurse who conducts palliative care will always have a relation building function, and the relation between the nurse and the patient will have large impact of the patient’s perceived well-being. A nurse’s professional approach to palliative care is generally thought of as her taking on a compassionate role against her patients. The purpose of this paper was to describe the nurse’s experience of establishing and keeping a professional approach to her patients in palliative care. The study was conducted as a scientific literature review with a systematic gathering and scrutinizing of data. In total, eleven qualitative scientific articles were included in the review. Three main conclusions could be drawn. First, the nurses experienced that the relations within palliative care were characterized by closeness and emotional engagement. The close relationship between the nurse and her patients was regarded as being positive, although it constituted a risk of emotional overload. Second, it was found to be necessary for the nurse to maintain a professional distance to the patient to be able to separate work from private life. Third, many nurses identified a challenge of striking an appropriate balance between closeness and distance in order to be able to be personal without being private.</p>

Palliativ vård innebär ett förhållningssätt där patientens livskvalitet står i centrum. Vården kännetecknas av en holistisk människosyn där patientens fysiska, psykiska, sociala samt existentiella behov ska tillgodoses. Från sjuksköterskans perspektiv kan palliativ vård bedrivas inom såväl primärvård som slutenvård och omfattningen av det palliativa vårdandet varierar beroende på inom vilket område sjuksköterskan är verksam. Oavsett kontext har sjuksköterskan en relations­skapande funktion och relationen har stor betydelse för patientens välbefinnande. Professionell hållning inom palliativ vård innebär att sjuksköterskan medvetet tillämpar ett empatiskt förhållningssätt. Syftet var att beskriva sjuksköterskans upplevelse av att förhålla sig professionellt i relationen till patienten inom palliativ vård. Studien genomfördes i form av en vetenskaplig litteraturöversikt med systematisk insamling och granskning av data. Totalt inkluderades elva kvalitativa, vetenskapliga artiklar. Databearbetning resulterade i tre kategorier: ”Den unika relationen”, ”Sjuksköterskans utmaning” samt ”Professionell distansering”. Sjuksköterskor upplevde att relationen inom palliativ vård präglades av närhet och känslomässigt engagemang. Den nära relationen ansågs positiv samtidigt som den innebar en risk för emotionell överbelastning. Nödvändigt var att upprätta en professionell distans för att kunna särskilja yrkesliv och privatliv. Sjuksköterskor identifierade i det en utmaning att balansera mellan närhet och distans och att kunna vara personlig utan att bli privat. / Palliative care is an approach which has the main emphasis on the patient’s quality of life. It is characterized by a holistic view towards the patient’s physical, psychological, social and existential need. The nurse can work with palliative care in many different contexts, and to various degrees. Nonetheless, the nurse who conducts palliative care will always have a relation building function, and the relation between the nurse and the patient will have large impact of the patient’s perceived well-being. A nurse’s professional approach to palliative care is generally thought of as her taking on a compassionate role against her patients. The purpose of this paper was to describe the nurse’s experience of establishing and keeping a professional approach to her patients in palliative care. The study was conducted as a scientific literature review with a systematic gathering and scrutinizing of data. In total, eleven qualitative scientific articles were included in the review. Three main conclusions could be drawn. First, the nurses experienced that the relations within palliative care were characterized by closeness and emotional engagement. The close relationship between the nurse and her patients was regarded as being positive, although it constituted a risk of emotional overload. Second, it was found to be necessary for the nurse to maintain a professional distance to the patient to be able to separate work from private life. Third, many nurses identified a challenge of striking an appropriate balance between closeness and distance in order to be able to be personal without being private.

Inom vård av personer med demenssjukdom är vårdarens bekräftelse av personens värdighet och välbefinnande grundläggande. Bekräftelsens effekt avgörs av vad och hur vårdaren väljer att bekräfta. Då den inte är anpassad riskerar personens värdighet och välbefinnande att reduceras, skadas eller gå förlorad. Syfte: Syftet med studien var att beskriva vårdpersonals föreställningar om att bekräfta värdighet och välbefinnande hos personer med demenssjukdom. Vårdarens synsätt och antagande om personen med demenssjukdom, om att vårda samt innebörd av värdighet och välbefinnande antogs ha en betydande roll för vårdarens val att bekräfta. Metod: Tio informanter intervjuades kring sina uppfattningar av att bekräfta värdighet och välbefinnande hos personer med demenssjukdom. Analysen genomfördes utifrån fenomenografisk metod i fyra steg där informanternas uppfattningar presenterades i ett utfallsrum av beskrivningskategorier med underkategorier. Resultat: Resultatet visade att bekräftelse uppkommer i ett samspel av faktorer, vilka kan påverka bekräftelsen både positivt och negativt. Vårdarnas bekräftelse skedde med utgångspunkt i vårdarens föreställningar via sekundära värden, mot övergripande värden, i en kontext av omgivningsfaktorer och utifrån ett kommunikativt feedbacksystem. Vårdarna hade såväl underlättande som hindrande förställningar vilka kopplades till tid och organisatoriska förutsättningar, till vårdtagarens förmågor, kommunikation och uttryck. Reflektion och klinisk implikation: Studien ger kunskap om hur vårdpersonal tänker kring värdighet och välbefinnande.  Skillnader i vårdens utförande kan förstås utifrån ett livsvärldsperspektiv och kan användas som underlag för utbildning, handledning och reflektion. / In caring for people with dementia confirmation of dignity and wellbeing is essential. How and in what way the nurse chooses to confirm determines the effect on the confirmation itself. If not individually adjusted to the person with dementia there’s a risk of dignity and wellbeing being reduced, damaged or lost. Aim: The aim of the study was to describe nurses’ personal beliefs and constructs on confirming dignity and wellbeing in people suffering from dementia. The nurses views on the person with dementia, personal beliefs on caring and on the meaning of dignity and wellbeing was predicted to have a significant role on the way he or she confirms the person. Method: Ten informants were interviewed on their personal experiences on confirming dignity and wellbeing. The narrations were analysed using a phenomenographic methodology in four different steps. The informants’ experiences were presented in an outcome space consisting sets of categories and subcategories of description. Result: Confirmation takes place within an interplay of factors with the potentiality to effect in a positively or negatively way. The nurses’ confirmation took place on the basis of their personal beliefs and constructs through secondary values, towards overall values, within a context of external factors and from a communicative system of feedback. The nurses had both enabling and hindering personal beliefs and constructs which were linked to time and organisational factors and to cognitive and physical abilities, communication and expression of the patient. Reflections and clinical implications: The study brings knowledge on nurses’ personal beliefs and constructs on confirming dignity and wellbeing. The differences in nursing among the nurses can be further viewed and understood from a life-world perspective and contribute to nursing education, supervision and reflection.

Bakgrund: En psykos innebär att tappa fotfästet i verkligheten. Risken för att drabbas av försämrad livskvalitet med stort lidande är hög. Tidigt insatta interventioner hos personer med nydebuterad psykos kan hindra ett ogynnsamt sjukdomsförlopp men forskning av nyinsjuknade genererar sällan kunskap gällande omvårdnad. Patienters symptombild med starka vanföreställningar och oro komplicerar ofta försök att interagera och en gynnsam vårdrelation kan vara svår att utveckla i och med patienternas speciella tillstånd. Syfte: Att beskriva hur personalen kan skapa en vårdprocessfrämjande relation med personen som drabbats av nydebuterad psykos på en slutenvårdsavdelning. Metod: Systematisk litteraturöversikt inkluderat femton artiklar med kvalitativt perspektiv för att besvara syftet. Data har analyserats med hjälp av kvalitativ metasummering. Resultat: Resultatet antyder på fördelar med att skapa tillit på ett tidigt stadium med hjälp av vårdrelationen. I och med ökande tillit till omgivningen ökar också behovet av att ha personalen som stöd med kunskap och förståelse för att kunna lösa problem i ett ömsesidigt samarbete. Personalen bör vara tillgänglig, vänlig, kunnig, tydlig, empatisk, flexibel med positiv hållning för gynnsamt skapande av hälsoprocessfrämjande omvårdnad.  Diskussion: I den optimala vårdrelationen sker ett samarbete runt mål och hälsoprocessfrämjande interventioner där personalen stöttar patienternas val med kunskap, uppmuntran och positiv feedback. Att få patienten att acceptera sin situation, att det kanske aldrig blir som förr och att leda in patienten på nya realistiska banor som inger livsmod och hopp kan vara en av personalens största utmaningar. / Background: A psychosis brings a lost sense of reality and generates a high risk of impaired quality of life with great suffering. Research shows that early intervention can prevent a disadvantageous health course whilst seldom generates knowledge regarding nursing as such. The nurse patient relationship is essential but often complicated by lack of trust due to symptoms such as strong delusions and anxiety. Aim: To describe how staff can create a care process promoting relationship with persons affected by recent-onset psychosis at an inpatient ward. Methods: Systematic literature review based on fifteen articles with a qualitative perspective. A qualitative meta-summary was chosen as method for synthesizing and analyzing the findings. Results: The result shows that the caring relationships focus may be on gaining trust at an early stage. As the patient gains trust in the surrounding environment the need for support from staff increases. Problem solving, together with staff, becomes more appreciated as symptoms fade away. Staff who are accessible, friendly, knowledgeable, clear, empathetic, flexible with a positive attitude are beneficial in creating a healthy process of promoting nursing. Discussions: Optimal nurse patient relationship interacts around goals and health process promotion interventions where staff supports the patients’ choices with the use of knowledge, encouragement and positive feedback. Getting the patient to accept their situation, making them realize that life may never be the same, leading them onto new realistic paths inspiring courage and hope, can be one of the staff's greatest challenges.

Bakgrund Inom dialyssjukvården möts dialyssjuksköterskor och patienter regelbundet flera gånger varje vecka, kanske under flera år. Detta medför många möten där relationer uppstår. Syfte Att beskriva dialyssjuksköterskors upplevelser och erfarenheter av långvariga vårdrelationer med personer med kronisk njursjukdom som kräver hemodialysbehandling. Metod Tolv dialyssjuksköterskor i Mellansverige intervjuades. Kvalitativ innehållsanalys genomfördes. Resultat Tillfredsställelsen av långa vårdrelationer med dialyspatienter berikar dialyssjuksköterskan både professionellt och som person. Möten med patienter under lång tid ger många positiva känslor och det är roligt att få följa patienternas utveckling. Upplevelsen av Komplexiteten i långa vårdrelationer, att möta och nötas mot samma patienter över lång tid, ibland över flera år kunde upplevas utmanande att i professionen hantera dessa på ett bra sätt. Strategier att hantera gränser i professionen, att ha verktyg för att hantera gränssättningen mellan det professionella och patienten. Exempel är reflektion och handledning med kollegor för att detta kan underlätta att inte bli för privat i relationen med patienten och känna sig professionell. Kollegornas betydelse i arbetet är en viktig del med erfarenhetsutbyte och stöd för att hantera relationer och situationer som kan uppstå. Avslutande kommentar Det är berikande och positivt att arbeta med patienter i långa vårdrelationer. De komplexa situationer som uppstår kan påverka dialyssjuksköterskorna och det ses som värdefullt att ha tillgång till forum där frågor om vården av patienterna kan diskuteras och att riktlinjer sammansatta av arbetsgruppen är en trygghet att luta sig mot. / Background In the dialysis nurses and patients meet regularly every week, sometimes over several years. This makes it possible for relations to occur. Aim Describing dialysis nurses perceptions and experiences of long-term care relations with persons with chronic renal disease who requires hemodialysis. Method Twelve dialysis nurses at hospitals in the middle of Sweden were interviewed. Qualitative content analysis was performed. Results The satisfaction with long-term care relations with patients in hemodialysis enrich the dialysis nurse both professional and as a person. The encounter with patients during a long time gives many positive emotions and it is joyful to be able to follow the patient development. The experience of the Complexity in long term relations, to meet and be rubbed against the same patients over time, sometimes several years could be a challenge experience in the profession to deal with in a good way. Strategies to manage the boundaries of the profession are to have tools to handle the boundaries between the professional role and the patient. Examples of tools are reflection and coaching session with colleagues since this can make it easier to avoid to be too private in the relation and to feel professional. Colleagues' role in the work is an important part with exchange of experiences and support to deal with the relations and the situations that may occur, in these relations. Concluding comment It is enriching and positive to work with patients in long-term relations. The complex situations that occur can affect the dialysis nurses and it seems important to have access to forum where questions can be discussed and to have guidelines that is put together by the workgroup to rely on.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Thesis (M.S.)--University of Michigan, 1993.