HUMANITY

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THE ROLE OF HUMANITY FOR HUMAN LIFE
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THE ROLE OF HUMANITY FOR
HUMAN LIFE
Humanity - The Beginning Windows game - Indie DB.
Medical Research in Biblical Times

Examination of Passages from the Bible,
Exactly as Written
Liubov Ben-Nun
NOT FOR SALE
Author & Editor: Liubov Ben-Nun, Professor Emeritus
Ben Gurion University of the Negev

Faculty of Health Sciences, Dept. of Family Medicine
Beer-Sheva, Israel
REMARKS
The small number of pictures and drawings appearing in my books were
checked to the best of my ability regarding publication rights. If I have made a
mistake, I apologize to remove them. In any case on the first page of all my books,
the words: Not for Sale are printed in bold letters.
The Author gains no financial or other benefits.
I am grateful to my husband for his ideas, wisdom and courage

that made this research possible.
B. N. Publication House. Israel. 2021.

E-Mail: L-bennun@smile.net.il
Humanity is the human race, which includes everyone on Earth. It

is also a word for the qualities that make us human, such as the
ability to love and have compassion, be creative, and not be a robot
or alien. The word humanity is from the Latin humanitas for "human
nature, kindness.” Humanity includes all the humans, but it can also
refer to the kind feelings humans often have for each other.
The Biblical verses dealing with the human humanity are
presented, evaluating the virtue of the humanity, the characteristics
of humanistic medicine, the features of the humanistic health care,
the hospital care, nursing, various types related to the humanity, and
the strategies to promote the humanity such as education, teaching
and training.
The research indicates that the humanity has accompanied
humans during the long our existence. With years, the scientific
study validated the numerous dimensions associated with the
humanity that can help to promote this exceptional dimension in our
life.
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Ben-Nun L. Humanity
CONTENTS
INTRODUCTION 4
BIBLICAL VERSES 6
VIRTUE OF HUMANITY 7
HISTORICAL PERSPECTIVES 7
HUMANISTIC MEDICINE 12
PROFESSIONALISM AND HUMANISM 17
HUMANITY TYPES 20
HEALTH CARE 43
EMERGENCY SERVICES
HOSPITAL CARE
INTENSIVE CARE
NUTRITIONAL CARE
HUMANE DOCTOR 60
HUMANISTIC NURSING 65
STRATEGIES TO ADVANCE HUMANIZATION 76

NATIONAL HUMANIZATION POLICY
EDUCATION
TEACHING
TRAINING
SUMMARY 100
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INTRODUCTION
Humanity is the human race, which includes everyone on Earth.
It’s also a word for the qualities that make us human, such as the
or alien (1).
Mackay (2) mentioned that humanism includes, among its many
contexts, the ideal of the universal perfection of health. Procedures
for alleviation of disease existed through all epochs of human history,
but efficacy was mostly lacking. The prototypic humanism of the
Renaissance (ad 1300-1600) scarcely involved the medical -sciences
other than human anatomy. The Enlightenment of the seventeenth
century included discovery of the circulation of the blood, and
applications of microscopy. Discoveries relevant to medical practice
began in the nineteenth century, ushered in by vaccination and the
germ theory of disease. This 200-year period saw a transformation of
human health according to the surrogate marker of increased life--
expectancy. This has been variously attributed to 1] increased
prosperity following the industrial revolution, 2] efforts of humanistic
social and public health reformers and, more recently, 3] advances in
medical science. Yet the beneficiaries remain a minority of the
world's population. The nexus between poverty, illness, and low life-
expectancy between and within nations is the major challenge for the
future. Contemporary science is providing ever-expanding
knowledge on means to achieve the goal of perfection of human
health, but the need for humanism is as great as at any previous age.
Fortunately, however, the targets are more clearly visible than during
the periods of poverty, plagues, and pestilence of the past (2).
de Oliveira & Kruse (3) focused on the meanings and
transformations of healthcare humanization along the time through a
literature review. The analysis is pointed out by a reading hypothesis
of Revista Brasileira de Enfermagem (REBEn) and inspired by the
ideas of Michel Focault, especially his discourse concept. It was
identified as discourse appearing condition: the nursing professional
characteristics, the association of humanization meaning to scientific
knowledge and the re-affirmation of its traditional meaning related
to the new health policies. As delimiting instance of discourse, it is
presented: nursing, government, and technology. It is also presented
the sense attributed to humanization since 1970 decade until the
present time (3).
Chan & Nimmon (4) reported that divisive, disabling, and
dangerous power has featured heavily in health professions
literature, social media, and medical education. Negative accounts of
the wielding of power have discolored the lens through which the
public sees medicine and distorted the view of a profession long
associated with healing, humanism, and heart. What has been
buried in the midst of this discourse are positive accounts of power
where the yielding of power is encouraging, empathetic and
empowering. This article offers three personal vignettes illustrating
the ability of power to positively affect lives in the practice of
medicine, for patients and doctors alike. More of these stories are
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Ben-Nun L. Humanity
needed to uplift and rebalance the conversation on physician power

and how it can be used for good. It is necessary to provide a
narrative framework of what it looks like to be a healer and a
humanistic doctor to satisfy the general public through a
commitment to cultivate multidimensional future healthcare
providers (4).
Baertschi (5) mentioned that human beings desire to become
better. Education and development of tools have helped them to
reach this goal for many a time. But what is the ultimate goal? A
classical answer is: to be happy. Till now, the result has not been
very convincing, but transhumanism has recently taken responsibility
for this project, giving us hope to be happy and to live longer.
However, will we become more human or posthuman?
Transhumanists hesitate between but think after all that no limit
should be laid down in advance. Consequently, nothing is sacred in
human nature and changing it raises no moral concern. Saying this,
transhumanism puts itself inside an old tradition, claiming that the
value of a human being does not consist in his humanity but in the
fact that he is a person, that is a being endowed with reason - reason
being the source of all progresses. Consequently, there is a
continuity between humanism and transhumanism, and we have
good reasons to hope for a bright future. However, the life in our
contemporary societies, where everything goes faster and stronger,
does not seem to go in this direction. Will transhumanism be able to
correct our mistakes? To succeed, it should also aim at human moral
enhancement, a hope for some, but a nightmare for others (5).
Hanna (6) mentioned that Roy's philosophical assumption of
humanism, which is shaped by the veritivity assumption, is
considered in terms of her specific life values and in contrast to the
contemporary view of humanism. Like veritivity, Roy's philosophical
assumption of humanism unites a theocentric focus with
anthropological values. Roy's perspective enriches the mainly
secular, anthropocentric assumption. In this manuscript, the basis for
Roy's perspective of humanism will be discussed so that readers will
be able to use the Roy adaptation model in an authentic manner (6).
Thus, the word humanity is from the Latin humanitas for "human
What is the virtue of humanity? What are the characteristics of
humanistic medicine? What are the features of the humanistic
health care? Hospital care? Nursing? How can the humanity be
promoted? What are the characteristics of education, teaching and
training to advance the humanity?
In this research the Biblical verses dealing with the human
humanity are described. Therefore, the research deals with the role
of humanity in human life.
References
1. humanity - Dictionary Definition: Vocabulary.com.
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Ben-Nun L. Humanity
2. Mackay IR. Humanism and the suffering of the people. Intern Med
J. 2003;33(4):195-202.
3. de Oliveira CP, Kruse MHL. Humanization and its multiple
discourses - an analysis from REBEn's content. Rev Bras Enferm.
2006;59(1):78-83.
4. Chan M, Nimmon L. Spinning the lens on physician power:
narratives of humanism and healing. Perspect Med Educ. 2019;8(5):305-8.
5. Baertschi B. Faster, higher, stronger… To go where? Transhumanism
and yearning for happiness. J Int Bioethique Ethique Sci. 2018;29(3):170-
88.
6. Hanna DR. Roy's specific life values and the philosophical
assumption of humanism. Nurs Sci Q. 2013;26(1):53-8.
BIBLICAL VERSES
"Then God said, “Let us make man in our image, after our likeness.
And let them have dominion over the fish of the sea and over the
birds of the heavens and over the cattle and over all the earth and
over every creeping thing that creeps on the earth" (Genesis 1:26).
"So God created man in his own image, in the image of God he
created him; male and female he created them" (Genesis 1:27).
"Then the Lord God formed the man of dust from the ground and
breathed into his nostrils the breath of life, and the man became a
living soul " (Genesis 2:7).
"He created them male and female; and blessed them and called
their name Adam, in the day when they were created" (Genesis 5:2).
"And when the Lord smelled a sweet savor, the Lord said in his
heart, “I will not again curse the ground any more for man's sake, for
the imagination of man's heart is evil from his youth; neither will I
ever again smite any more very thing as I have done" (Genesis 8:21).
"You shall not see your brother's ass or his ox fallen down by the
way, and hide thyself from them: you shall surely help him to lift them
up again" (Deuteronomy 22:4).
"The rich and the poor meet together…." (Proverbs 22:2).
“If a stranger sojourns with thee in your land, ye shall not vex him.
But the stranger that dwelleth with you shall be unto you as one born
among you, and thou shall love him as thyself…" (Leviticus 19:33-34).
"In whose hand is the life of every living thing, And the breath of
all mankind?" (Job 12:10).
"The desire of a man is his kindness: and a poor man is better than
a liar" (Proverbs 19:22).
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Ben-Nun L. Humanity
"Give us help from trouble, for vain is the help of man" (Psalm
108:13).
VIRTUE OF HUMANITY
The word humanity is from the Latin humanitas for "human
refer to the kind feelings humans often have for each other. But
when you talk about humanity, you could just be talking about
people as a whole. When people do bad things, it tests his/her faith
in humanity. When people ask for money to help feed starving
children, they're appealing to his/her sense of humanity (1).
Humanity is a virtue linked with basic ethics of altruism derived
from the human condition. It also symbolizes human love and
compassion towards each other. Humanity differs from mere justice
in that there is a level of altruism towards individuals included in
humanity more so than the fairness found in justice (2). That is,
humanity, and the acts of love, altruism, and social intelligence are
typically individual strengths while fairness is generally expanded to
all. Humanity can be classed as one of six virtues that are consistent
across all cultures (3).
The concept goes back to the development of "humane" or
"humanist" philosophy during the Renaissance (with predecessors in
13th-century scholasticism stressing a concept of basic human dignity
inspired by Aristotelianism) and the concept of humanitarianism in
the early modern period, and resulted in modern notions such as
"human rights" (4).
References
1. humanity - Dictionary Definition: Vocabulary.com.
2. Peterson & Seligman 2004, p. 34. Available at
en.wikipedia.org/wiki/Humanity_(virtue).
4. Humanity. Available at en.wikipedia.org/wiki/Humanity_(virtue).
HISTORICAL PERSPECTIVES
CONFUSIONAL PHILOSOPHY
Confucius said that humanity, or “Ren”, is a “love of people”
stating “if you want to make a stand, help others make a stand” (1).
That is, the Confucian theory of humanity exemplifies the golden
rule. It is so central to Confucian thought that it appears 58 times in
the Analects (2). Similar to the Christian process of seeking God,
Confucius teaches seeking Ren to a point of seemingly divine mastery
until you are equal to, or better than, your teacher (3). The
Confucian concept of Ren encompasses both love and altruism (4).
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References
2. 4. Chan 1955, p. 296. Available at
3. 5. Chan 1955, p. 298. Available at
4. 6. Chan. 1955, p. 312. Available at
GREEK PHILOSOPHY
Plato and Aristotle both wrote extensively on the subject of
virtues, though neither ever wrote on humanity as a virtue, despite
highly valuing love and kindness, two of the strengths of humanity.
Plato and Aristotle considered "courage, justice, temperance" and
"generosity, wit, friendliness, truthfulness, magnificence, and
greatness of soul" to be the sole virtues, respectively (1).
Available
1. Peterson & Seligman 2004, p. 40. Available
THE THREE ABRAHAMIC RELIGIONS

Judaism, Islam, and Christianity described as the three Abrahamic
religions are symbolic of the three strains of humanity and of the
three candidates in the Masonic Legend who approach the Gates of
Initiation with their bags of gold to offer as their gifts to the Lord in
exchange for eternal peace. However, they were told that gold was
not an acceptable offering for the gift of eternal peace and that in
order to enter through the portals of Initiation they would have to
leave their gold behind. This occurrence took place in the very, very
ancient past of which humanity has little or no memory (1).
Reference
1. Etta D. Jackson. The three Abrahamic religions. Available at
unveiling33.wordpress.com/2011/03/24/the-three-abrahamic-religions/#
:~:text=The%20Three%20Abrahamic%20Religions…%20Judaism%2C%20
Islam%20and%20Christianity,to%20the%20Lord%20in%20exchange%20
for%20eternal%20peace.
MEDICAL HISTORY
Warner (1) mentioned that most American historians of medicine
today would be very hesitant about any claim that medical history
humanizes doctors, medical students, or the larger health care
enterprise. Yet, the idea that history can and ought to serve modern
medicine as a humanizing force has been a persistent refrain in
American medicine. This essay explores the emergence of this idea
from the end of the 19th century, precisely the moment when
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Ben-Nun L. Humanity
modern biomedicine became ascendant. At the same institutions

where the new version of scientific medicine was most energetically
embraced, some professional leaders warned that the allegiance to
science driving the profession's technical and cultural success was
endangering humanistic values fundamental to professionalism and
the art of medicine. They saw in history a means for rehumanizing
modern medicine and countering the risk of cultural crisis. While
some iteration of this vision of history was remarkably durable, the
meanings attached to 'humanism' were both multiple and changing,
and the role envisioned for history in a humanistic intervention was
transformed. Starting in the 1960s as part of a larger cultural critique
of the putative 'dehumanization' of the medical establishment, some
advocates promoted medical history as a tool to help fashion a new
kind of humanist physician and to confront social inequities in the
health care system. What has persisted across time is the way that
the idea of history as a humanizing force has almost always
functioned as a discourse of deficiency-a response to perceived
shortcomings of biomedicine, medical institutions, and medical
professionalism (1).
Cantor (2) noticed that Arthur Brock (1879-1947) is generally
remembered as the physician who treated poet Wilfred Owen for
shell shock and as the translator of Galen and other ancient
physicians. He was also a key figure in the early-twentieth-century
humanist revival within medicine. Brock's interest in humanism, is
argued, was inspired by a broader concern about modernity and by a
desire to return medicine and society to the more harmonious,
organic existence that he believed was characteristic of ancient
Greece and could still be found among "primitive" peoples, such as
the Scottish Gaels. This article explores Brock's anxieties about
modernity and its relations to his interests in ancient and "primitive"
peoples; to his medical thought and practice; to his interests in
history, sociology, language, and translation; and to his involvement
in the social and political life of Edinburgh and North Queensferry,
where he moved in 1925. Crucially, it shows how all these interests
and activities were influenced by Brock's mentor, Edinburgh
polymath Patrick Geddes. The article concludes with a discussion of
Brock's place in early-twentieth-century medical humanism (2).
Cordier (3) mentioned that Jean Fernel (1497-1558) embodied the
humanist spirit of the Renaissance. He studied philosophy (especially
Aristotle), astrology, arithmetic, mathematics, and Latin literature
before devoting his life to medicine. He conducted a comprehensive
synthesis of the medical system of Galen and invented the terms
"physiology" and "pathology". His taste for teaching, his extensive
clinical practice, his benevolent attitude to the sick, and his
consideration for individuals and for human nature all contribute to
Jean Fernel's image as a humanist. He was the most famous
physician of his time, although his work relying on philosophy and
galenic dogmatism eventually became obsolete. Forgotten for half a
millennium, this distant precursor of holistic medicine is worthy of
renewed interest (3).
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Kousoulis & al. (4) reported that Andrés Laguna, a Spanish

humanist physician of the 16th century, occupies an important
position in the history of medicine. An illustrious and brilliant mind,
pioneer of anatomy and urology, Laguna proved to be a true pacifist
and humanitarian with his knowledge standards and his political
eloquence. He deserves to be remembered today as the perfect
example of the Renaissance men, a true Homo Universalis (4).
Van Hee (5) described Jeremy de Drijvere or Thriverius (1504-
1564) as an important medical personality in the Habsburgian Low
Countries in the 16th century. In 1537 he got the medical doctor's
degree at the University of Leuven, where he was appointed few
years later as professor of medicine. He was mostly interested in
pathology and has translated and commented several works of
Hippocrates and Galen. Moreover, Thriverius has published many
original medical treatises in which he gives account of his personal
experience and of certain diagnostic innovations, amongst others
concerning the symptoms of scabies. Finally, Thriverius was a
renovator of medical teaching. Even if he has remained in favour of
the Galenic tradition, de Drijvere may be considered a humanist and
an excellent representative of the new ideas of medical Renaissance
(5).
Marinozzi & al. (6) aimed to shed light on some particular aspects
of the activity and the scientific thought of Baccio Baldini, Director of
the Laurentian Library and Court physician of the Medici family in
Florence. The analysis of his work as a humanist and the recovery of
some unpublished documents enable to define the figure of Baldini
as a paradigmatic example of the court physicians of modern age in
Italy, highlighting the complementarity between humanism and
experimentalism in the Renaissance medicine (6).
Podolsky & Greene (7) reported that In November of 1959,
William Bean published in the Archives of Internal Medicine a
scathing review of Félix Martí-Ibañez's Centaur: Essays on the History
of Medical Ideas. Martí-Ibañez and Bean were two of the leading
exponents of the importance of medical humanism during a
formative period from the 1950s through the 1970s. But the two
physicians differed fundamentally in their views of the ideal
relationships among the pharmaceutical industry, the medical
profession, and the medical humanities. Bean's review is situated
within its historical context, shedding light on the history, and
diverging uses of the medical humanities (7).
Craxì & al. (8) reported that Sir William Osler is celebrated today
not only for his contributions to the advancement of medical
education, but also for the humanism he brought to the practice of
medicine. He was a doctor whose bedside skills and manners were
emulated and can legitimately be called an infectious diseases
specialist. Nonetheless, he was also a humanist in the broader sense
of the term, a student of human affairs and human nature, who
emphasized compassion for the individual. To what extent, if any,
are today's challenges influenced by departures from the paradigms
created by Osler? In this paper the Authors sought to ascertain
whether such a tradition is still relevant to current practice and may
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Ben-Nun L. Humanity
foster a new perspective. Two features of Osler's legacy that may be

useful to clinicians were analyzed: the first is his vision of the patient-
physician relationship; the second is his approach to humanities.
William Osler saw medicine in its wider scope, with the right and duty
to be concerned with the human condition as a whole. Indeed, his
rounded concept of the medical profession as being engaged in
helping and caring for the whole human being could help physicians
build a more humanized medicine. Adopted in the age of evidence-
based medicine, the Oslerian approach can enhance the relationship
with patients and give physicians a role based on trust and
authoritativeness rather than on authority (8).
Wasserstein (9) reported that Michel de Montaigne, the great
French humanist, and inventor of the personal essay, suffered from
frequent and severe renal colic. He wrote about his illness in his
travel journal and in his last and greatest essay, "Of Experience." In
his illness narratives, Montaigne integrated disease and suffering into
his life and art. He humanized rather than conquered his disease. A
mature humanism replaced his youthful Stoic philosophy of
detachment and disengagement and provides a worthy model for our
own medical humanism (9).
Rabinowitz (10) aimed to position the birth of the Medical
Humanities movement in a greater historical context of twentieth
century American medical education and to paint a picture of the
current landscape of the Medical Humanities in medical training. It
first sheds light on the model of medical education put forth by
Abraham Flexner through the publishing of the 1910 Flexner Report,
which set the stage for defining physicians as experimentalists and
rooting the profession in research institutions. While this paved the
way for medical advancements, it came at the cost of producing a
patriarchal approach to medical practice. By the late 1960s, the
public persona of the profession was thus devoid of humanism. This
catalyzed the birth of the Medical Humanities movement that helped
lay the framework for what has perpetuated as the ongoing
incorporation of humanistic subjects into medical training. As we
enter a time in medicine in which rates of burnout are ever-
increasing and there are growing concerns about a concomitant
reduction in empathy among trainees, the need for instilling
humanism remains important. We must consequently continue to
consider how to ensure the place of the Medical Humanities in
medical education moving forward (10).
References
1. Warner JH. The humanising power of medical history: responses to
biomedicine in the 20th century United States. Med Humanit.
2011;37(2):91-6.
2. Cantor D. Between Galen, Geddes, and the Gael: Arthur Brock,
modernity, and medical humanism in early-twentieth-century Scotland. J
Hist Med Allied Sci. 2005;60(1):1-41.
3. Cordier J-F. Jean Fernel and the humanist spirit. Bull Acad Natl
Med. 2011;195(6):1399-407.
4. Kousoulis AA, Karamanou M, Androutsos G. Andrés Laguna: a great
medical humanist (1499-1559). Acta Med Port. 2011; 24(4): 671-4.
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Ben-Nun L. Humanity
5. Van Hee R. Jeremy Thriverius (1504-1554): humanist doctor, born

500 years ago. Rev Med Brux. 2005;26(5):475-8.
6. Marinozzi S, Giuffra V, Kieffer F. Baccio Baldini (1517-1589),
protomedicus on the medical court between humanism and
experimentalism. Acta Med Hist Adriat. 2015;13(2):345-64.
7. Podolsky SH, Greene JA. Are the medical humanities for sale?
Lessons from a historical debate. J Med Humanit. 2016;37(4):355-70.
8. Craxì L, Giardina S, Spagnolo AG. A return to humane medicine:
Osler's legacy. Infez Med 2017;25(3):292-7.
9. Wasserstein AG. Lessons in medical humanism: the case of
Montaigne. Ann Intern Med. 2007;146(11):809-13.
10. Rabinowitz DG. On the arts and humanities in medical education.
Philos Ethics Humanit Med. 2021 Jun 30;16(1):4.
HUMANISTIC MEDICINE
Little (1) mentioned that "Humanistic medicine" is a term
compounded, for therapeutic purposes, with the good intent of
reminding clinicians of their need to be compassionate and empathic.
Although the expression is arresting, and demands thought, it does
not go far enough. "Values-based medicine" is a stronger term,
reminding clinicians of the sustaining values that underpin the whole
health endeavor. These values include an acceptance of the value of
individual human life in quantity and quality, and of the importance
to both individuals and communities of human security and
flourishing. Values-based medicine can incorporate all the other
paradigms of medicine, including scientific and evidence-based
medicine, within it, because it can include anything that contributes
to human security and flourishing. If we are to seek a new paradigm
for a reconstructed view of health care, the term "values-based
medicine" might have more power and relevance than "humanistic
medicine" (1).
Rosselot (2) noticed that there is an urgent need, in our society,
to recover the real meaning of medicine as a complex of science and
humanistic values committed to person's health care. Following the
initiative of the American Board of Internal Medicine, the American
College of Physicians, and the American Society of Internal Medicine
(ACP-ASIM) and the European Federation of Internal Medicine, the
Medical Professionalism Project has launched a comprehensive
declaration to rephrase the social contract between medicine and
the society, emphasizing the principles and responsibilities that must
orient the thoughts and actions of the good physician. The
importance, soundness, and opportunity of this chart, stimulates an
ample dissemination of these concepts and to incorporate them as
moral assets, integrating the quality, as experts on a scientific
discipline, with the humanistic values provided in this era of
increasing bioethical demands (2).
According to Selzer & Charon (3), in this first article for the
feature Humanism and Medicine, Rita Charon introduces an excerpt
from Richard Selzer's introduction to his latest book, The Doctor
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Stories. In her introductory and concluding comments, Charon

contemplates the role of stories in medicine and how both truth and
healing can be found in both listening to and telling stories. In the
excerpt presented, surgeon and writer Selzer muses on his twin
crafts. As a writer, Selzer can fully appreciate that which he
witnesses in his life as a doctor. His rumination on his own dual
citizenship suggests that all doctors, perhaps, can deepen their
commitment to medicine, to their patients, and to themselves by
strengthening their capacity to behold their patients and to grasp
their predicaments. Selzer also traces his origins and, by implication,
projects his future. As practicing physicians and medical educators,
readers of Academic medicine might be inspired to do the same (3).
Forest & al. (4) mentioned that clinical ethics is generally related
to the clinical bedside activity. Clinical ethics constitutes one aspect
of bioethics. In particular, its aim consists in facilitating the solving of
conflicts of values in practical care. By encouraging effective
communication and discussion within the interdisciplinary team,
geriatricians will be able to make adequate diagnostic and
therapeutic interventions, in accordance with the fundamental desire
of the patient and her or his family (4).
Gordon (5) emphasized that the medical humanities are
concerned with "the science of the human", and bring the
perspectives of disciplines such as history, philosophy, literature, art,
and music to understanding health, illness, and medicine. The
medical humanities are designed to overcome the separation of
clinical care from the "human sciences" and to foster interdisciplinary
teaching and research to optimize patient care. Medical humanities
have become part of the mainstream in medical education in North
America and the United Kingdom and are now integrated into many
medical curricula in Australia. The Australasian Association for
Medical Humanities was inaugurated in November 2004; a
postgraduate program in the medical humanities began at the
University of Sydney in 2003 (5).
Humanity - Writers Space Africa. writersspace.net.
Ferry-Danini (6) emphasized that according to recent approaches

in the philosophy of medicine, biomedicine should be replaced or
complemented by a humanistic medical model. Two humanistic
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approaches, narrative medicine, and the phenomenology of

medicine, have grown particularly popular in recent decades. This
paper first suggests that these humanistic criticisms of biomedicine
are insufficient. A central problem is that both approaches seem to
offer a straw man definition of biomedicine. It then argues that the
subsequent definition of humanism found in these approaches is
problematically reduced to a compassionate or psychological
understanding. The Author's main claims are that humanism cannot
be sought in the patient-physician relationship alone and that a
broad definition of medicine should help to revisit humanism. With
this end in view, the Author defend what is called an outcomes-
oriented approach to humanistic medicine, where humanism is set
upon the capacity for a health system to produce good health
outcomes (6).
Bernardin (7) noticed that those in health care practice and
research must depend on humanism for guidance in making difficult
judgments and decisions that involve the individual patient's dignity
and value. But what kind of humanism will inform those choices?
Pragmatic humanism tends to view dignity in terms of human
functioning: One is human because he or she acts, produces, thinks,
achieves. The comatose, the insane, the hopelessly senile, fetuses
and the newborn may be accorded human dignity as well, but only
because society grants it to them. Thus, such dignity can be
manipulated or diminished in the name of overall human progress or
the common welfare. By contrast, personalist humanism holds that
human dignity is rooted in "being human" rather than in "doing
human things." An individual has full human value simply by being a
living person. This humanism suggests that health care providers
must use their capabilities even for nonproductive patients. This may
be difficult in the face of today's cost-benefit analyses. But if the
individual's basic value is not defended, human dignity will vary in
direct ratio to a person's social usefulness. And that would be
obscene (7).
According to Miles (8), the Medical University of Plovdiv (MUP)
has as its motto 'Committed to humanity". But what does humanity
in modern medicine mean? Is it possible to practise a form of
medicine that is without humanity? In the current article, it is argued
that modern medicine is increasingly being practised in a de-
personalized fashion, where the patient is understood not as a
unique human individual, a person, but rather as a subject or an
object and more in the manner of a complex biological machine.
Medicine has, it is contended, become distracted from its duty to
care, comfort and console as well as to ameliorate, attenuate and
cure and that the rapid development of medicine's scientific
knowledge is, paradoxically, principally causative. Signal occurrences
in the 'patient as a person' movement are reviewed, together with
the emergence of the evidence-based medicine (EBM) and patient-
centered care (PCC) movements. The characteristics of a model of
medicine evolving in response to medicine's current deficiencies--
person-centered healthcare (PCH) - are noted and described. In
seeking to apply science with humanism, via clinical judgement,
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Ben-Nun L. Humanity
within an ethical framework, it is contended that PCH will prove to be

far more responsive to the needs of the individual patient and his/her
personal circumstances than current models of practice, so that
neither a reductive anatomico-pathological, disease-centric model of
illness (EBM), nor an aggressive patient-directed, consumerist form
of care (PCC) is allowed continued dominance within modern
healthcare systems. The data show that it is argued that PCH will
enable affordable advances in biomedicine and technology to be
delivered to patients within a humanistic framework of clinical
practice that recognizes the patient as a person and which takes full
account of his/her stories, values, preferences, goals, aspirations,
fears, worries, hopes, cultural context and which responds to his/her
psychological, emotional, spiritual, and social necessities in addition
to his/her physical needs. MUP, in assimilating such arguments and
introducing person-centered medicine teaching into the University, is
engaged in a notable and laudable initiative which will function as a
salutary example to other medical schools within Europe and
elsewhere (8).
Marcum (9) mentioned that although biomedicine is responsible
for the "miracles" of modern medicine, paradoxically it has also led to
a quality-of-care crisis in which many patients feel disenfranchised
from the health-care industry. To address this crisis, several medical
commentators make an appeal for humanizing biomedicine, which
has led to shifts in the philosophical boundaries of medical
knowledge and practice. In this paper, the metaphysical,
epistemological, and ethical boundaries of biomedicine and its
humanized versions are investigated and compared to one another.
Biomedicine is founded on a metaphysical position of mechanistic
monism, an epistemology of objective knowing, and an ethic of
emotionally detached concern. In humanizing modern medicine,
these boundaries are often shifted to a metaphysical position of
dualism/holism, an epistemology of subject knowing, and an ethic of
empathic care. In a concluding section, the question is discussed
whether these shifts in the philosophical boundaries are adequate to
resolve the quality-of-care crisis (9).
Thibault (10) reported that humanism has been at the core of the
medical profession since its inception, and it has been a foundation
throughout modern history for political and community values. But
today, countries and leaders are increasingly adopting antihumanistic
policies and positions. In this Invited Commentary, the author probes
whether humanism in medicine can survive in the current culture.
The author defines humanism as any system or mode of thought or
action in which human interests, values, and dignity predominate.
He traces humanism as a philosophical and political movement from
the Renaissance through the Enlightenment to the development of
liberal democracies in the 20th century. He identifies the humanistic
roots of the medical profession and describes efforts to revitalize
humanism in medicine in recent decades. He then details
antihumanistic behaviors and policies in the current political
environment and makes the case that these behaviors and policies
threaten humanism in medicine. He calls on the medical profession
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Ben-Nun L. Humanity
to renew its commitment to humanism and to oppose antihumanistic

behaviors and policies. It will be hard, he concludes, to have
humanism in medicine if there is no humanism in the world around
us (10).
Figueroa (11) mentioned that we have entered a time of
enormous and rapid technological advance. We must pause and
reflect on the role of humanism in medicine on that part of our
professional calling that denotes the responsibility we have for
caring, and the relationship between our art and our science.
Humanism is defined as a mode of thought or action in which human
interests, values and dignity are taken to be of primary importance.
But Heidegger thinks that humanism esteems man too low. The
purpose of this article is to review the sense of the word "humanism"
in medicine. Theories of four general sorts are identified and
explained here. Man is unmeasurably more than a rational animal as
humanistic medicine postulates. We must pass beyond the
traditional interpretations of the nature of man, therefore beyond
humanism and humanistic medicines. The data indicate that it is
better to drop the word completely, with the danger of being taken
for anti-humanistic, rather than run the risk of having a subject is
interpretation. We must think about the nature of man in terms of
its exclusive relationship to his being and to Being (11).
Vaes & al. (12) mentioned that people humanize their ingroup to
address existential concerns about their mortality, but the reasons
why they do so remain ambiguous. One explanation is that people
humanize their ingroup to bolster their social identity in the face of
their mortality. Alternatively, people might be motivated to see their
ingroup as more uniquely human (UH) to distance themselves from
their corporeal "animal" nature. These explanations were tested in
Australia, where social identity is tied less to UH and more to human
nature (HN) which does not distinguish humans from animals.
Australians attributed more HN traits to the ingroup when mortality
was salient, while the attribution of UH traits remained unchanged.
This indicates that the mortality-buffering function of ingroup
humanization lies in reinforcing the humanness of our social identity,
rather than just distancing ourselves from our animal nature.
Implications for (de)humanization in intergroup relations are
discussed (12).
This chapter (1-12) shows that "Humanistic medicine" is a term

compounded, for therapeutic purposes, with the good intent of
reminding clinicians of their need to be compassionate and empathic.
All doctors, perhaps, can deepen their commitment to medicine,
to their patients, and to themselves by strengthening their capacity
to behold their patients and to grasp their predicaments.
The medical humanities are concerned with "the science of the
human", and bring the perspectives of disciplines such as history,
philosophy, literature, art, and music to understanding health, illness,
and medicine.
Biomedicine should be replaced or complemented by a
humanistic medical model.
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An individual has full human value simply by being a living person.

This humanism suggests that health care providers must use their
capabilities even for nonproductive patients.
References
1. Little JM. Humanistic medicine or values-based medicine. what's in
a name? Med J Aust. 2002;177(6):319-21.
2. Rosselot E. Restoring medicine as a scientific and humanist
profession. Rev Med Chil. 2003;131(4):454-6.
3. Selzer R, Charon R. Stories for a humanistic medicine. Acad Med.
1999;74(1):42-4.
4. Forest MI, Olmari-Ebbing M, Bizon M, et al. Medicine and
humanism: clinical ethics and the community dimension of geriatrics. Rev
Med Suisse Romande. 1998;118(12):1013-7.
5. Gordon J. Medical humanities: to cure sometimes, to relieve often,
to comfort always. Med J Aust. 2005;182(1):5-8.
6. Ferry-Danini J. A new path for humanistic medicine. Theor Med
Bioeth. 2018;39(1):57-77.
7. Bernardin J. Medical humanism: pragmatic or personalist? Health
Prog. 1985;66(3):46-9.
8. Miles A. Science, humanism, judgement, ethics: person-centered
medicine as an emergent model of modern clinical practice. Folia Med
(Plovdiv). 2013;55(1):5-24.
9. Marcum JA. Reflections on humanizing biomedicine. Perspect Biol
Med. 2008;51(3):392-405.
10. Thibault GE. Humanism in medicine: what does it mean and why is
it more important than ever? Acad Med. 2019;94(8):1074-7.
11. Figueroa G. At last a humanistic medicine?. Rev Med Chil.
1999;127(1):94-100.
12. Vaes J, Bain PG, Bastian B. Embracing humanity in the face of
death: why do existential concerns moderate ingroup humanization? J Soc
Psychol. 2014;154(6):537-45.
PROFESSIONALISM AND HUMANISM

Swick (1) emphasized that medical professionalism and humanism
have long been integral to the practice of medicine, and they will
continue to shape practice in the 21st century. In recent years, many
advances have been made in understanding the nature of medical
professionalism and in efforts to teach and assess professional values
and behaviors. As more and more teaching of both medical students
and residents occurs in settings outside of academic medical centers,
it is critically important that community physicians demonstrate
behaviors that resonate professionalism and humanism. As teachers,
they must be committed to being role models for what physicians
should be. Activities that are designed to promote and advance
professionalism, then, must take place not only in academic settings
but also in clinical practice sites that are beyond the academic health
center. The Author argues that professionalism and humanism share
common values and that each can enrich the other. Because the
cauldron of practice threatens to erode traditional values of
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professionalism, not only for individual physicians but also for the
medical profession, practicing physicians must incorporate into
practice settings activities that are explicitly designed to exemplify
those values, not only with students and patients, but also within
their communities. The Author cites a number of examples of ways
in which professionalism and humanism can be fostered by individual
physicians as well as professional organizations (1).
According to Cohen (2), the terms professionalism and humanism
are sometimes confused as being synonymous; even more confusing,
each is sometimes regarded as a component feature of the other.
The Author argues that, in the context of medicine, the two terms
describe distinctly different, albeit intimately linked attributes of the
good doctor. Professionalism denotes a way of behaving in
accordance with certain normative values, whereas humanism
denotes an intrinsic set of deep-seated convictions about one's
obligations toward others. Viewed in this way, humanism is seen as
the passion that animates professionalism. Nurturing the humanistic
predispositions of entering medical students is key to ensuring that
future physicians manifest the attributes of professionalism. Medical
educators are encouraged to recognize the role of humanism in
professional development and to incorporate into their curricula and
learning environments explicit means to reinforce whatever
inclinations their students have to be caring human beings. Chief
among those means are respected role models who unfailingly
provide humanistic care, ceremonies that celebrate the attributes of
humanism, awards that honor exemplars of the caring physician, and
serious engagement with the medical humanities to provide vivid
insights into what a humanistic professional is (2).
Hoga (3) reflected upon the humanization of health care, the
demand for which is growing. It involves several complex and
interdependent dimensions. The professional's subjective
perspective and the interpersonal relationship are discussed and
shown to be important factors in the humanization of health care.
The necessity of professional's self-awareness and the awareness of
their defenses are emphasized since they are considered to be
important for the creation of a real encounter between professionals
and patients. These topics are essential for the humanization and
promotion of health care (3).
Chin-Yee & al. (4) reported that medicine in the twenty-first
century faces an 'identity crisis,' as it grapples with the emergence of
various 'ways of knowing,' from evidence-based and translational
medicine to narrative-based and personalized medicine. While each
of these approaches has uniquely contributed to the advancement of
patient care, this pluralism is not without tension. Evidence-based
medicine is not necessarily individualized; personalized medicine may
be individualized but is not necessarily person-centered. As novel
technologies and big data continue to proliferate today, the focus of
medical practice is shifting away from the dialogic encounter
between doctor and patient, threatening the loss of humanism that
many view as integral to medicine's identity. As medical trainees, we
struggle to synthesize medicine's diverse and evolving 'ways of
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knowing' and to create a vision of doctoring that integrates new

forms of medical knowledge into the provision of person-centered
care. In search of answers, the Authors turned to twentieth-century
philosopher Hans-Georg Gadamer, whose unique outlook on "health"
and "healing," is believed, offers a way forward in navigating
medicine's 'messy pluralism.' Drawing inspiration from Gadamer's
emphasis on dialogue and 'practical wisdom' (phronesis), a dialogue
is initiated with the dean of the medical school to address the
question of how medical trainees and practicing clinicians alike can
work to create a more harmonious pluralism in medicine today. It is
proposed that implementing a pluralistic approach ultimately entails
'bridging' the current divide between scientific theory and the
practical art of healing and involves an iterative and dialogic process
of asking questions and seeking answers (4).
de Goulart & Chiari (5) intended to contribute with some
reflections about contemporary clinical approach concerning
humanized health assistance based on the review of literature
indexed and published in Brazil at BVS and Scielo between 1987 and
2007, including some authors referred in these studies and published
in the same period, when considered essential to consubstantiate the
discussions presented. Matters are also discussed regarding
humanized health care based on public policies and health related
professional practices, as well as the possibilities for extending
discussions related to the need of inclusion of these principles in
various stages of the health professional background, from
undergraduate studies. In addition, some propositions are presented
to contribute with the education of the healthcare professional, as
well as subsidies for the reflection related to curricular proposals and
opportunities offered by university professors, who may strongly
influence the professional education and, further, with the health
assistance and health services practices (5).
This chapter (1-5) demonstrates that medical professionalism and

humanism have long been integral to the practice of medicine.
Professionalism and humanism share common values and that
each can enrich the other.
Professionalism denotes a way of behaving in accordance with
certain normative values, whereas humanism denotes an intrinsic set
of deep-seated convictions about one's obligations toward others.
Viewed in this way, humanism is seen as the passion that animates
professionalism.
References
1. Swick HM. Viewpoint: professionalism and humanism beyond the
academic health center. Acad Med. 2007;82(11):1022-8.
2. Cohen JJ. Viewpoint: linking professionalism to humanism: what it
means, why it matters. Acad Med. 2007;82(11):1029-32.
3. Hoga LAK. Subjective dimension of the professional in the
humanization of health care: a thought. Rev Esc Enferm USP. 2004;
38(1):13-20.
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4. Chin-Yee B, Messinger A, Young LT. Three visions of doctoring: a

Gadamerian dialogue. Adv Health Sci Educ Theory Pract. 2019;24(2):403-
12.
5. de Goulart BNG, Chiari BM. Thinking about health related
professions humanized practice. Cien Saude Colet. 2010;15(1):255-68.
HUMANITY TYPES
This section deals with various types of humanity, including
preserving humanity, public humanization policies, human
dimensions of care in ambulatory settings, the beginning of human
life, humanization of birth: delivery care, humanized obstetrics, the
problem of spontaneous abortion, childbirth practices, medicalization
and prenatal care, a neonatal and pediatric intensive care unit,
HIV/AIDS children living in shelters under the perspective of nursing,
the family living with Down syndrome, the care interventions in
patients with lower extremity arteriosclerosis obliterans, the effect of
pustulosis, the care of surgery patients, dentistry practices,
homeopathy, the humanization and the formation of the professional
in physiotherapy, rehabilitation, homeless men, sexual relationships
with patients, communicating bad news, the approach between
caregivers and the elderly, palliative care the end of life, planetary
health respond to COVID pandemic, and bias in humanizing negative
characteristics.
PRESERVING HUMANITY
Mann (1) mentioned that preserving humanity in the present
technological age can be a challenge for all health care workers, but
perhaps particularly for staff working within an intensive care
environment. This article highlights some of the potential effects of
such technology on staff, patients, and relatives, particularly bringing
to light some of the disadvantages brought about by the use of such
technology. Areas considered include the role of nurses within a
technological environment, patients' and relatives' reactions to
technology, the potential effect on autonomy and responsibility for
both patients and nurses, economic issues, and finally ethical and
moral issues raised by the advent of further technology. Despite
many positive contributions to nursing care which arise from the use
of technology, there are disadvantages attributed to technology
which have only been mentioned superficially in previous literature
on this subject. The question arises as to whether nurses are able to
balance preserving the humanity of patients with the extensive use
of technology in an intensive care environment today (1).
Reference
1. Mann RE. Preserving humanity in an age of technology. Intensive
Crit Care Nurs. 1992;8(1):54-9.
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PUBLIC HUMANIZATION POLICIES

Moreira & al. (1) investigated the scientific literature on Public
Humanization Policies, available in online periodicals, from 2009 to
2012, in the health field. This is an integrative literature review
conducted in the Virtual Health Library databases: Latin-America and
Caribbean Health Sciences (Lilacs) and the Scientific Electronic Library
Online (SciELO) and Portal Capes. Data were collected in July 2013.
To this end, the following Health Sciences Descriptors (DeCS) were
used: "Humanization of Care," "Public Policies," "National
Humanization Policy". The sample consisted of 27 articles about the
investigated theme. From the publications selected for the research,
three categories emerged according to their respective approaches:
National Humanization Policy: history and processes involved in its
implementation; National Humanization Policy: health professionals'
contribution; Humanization and in the care process. The study
showed that the National Humanization Policy is an important
benchmark in the development of health practices. For this reason,
there is a pressing multiplication of related reflections on ways to
promote humanization in health services (1).
Reference
1. Moreira MADM, Lustosa AM, Dutra F, et al. Public humanization
policies: integrative literature review. Cien Saude Colet. 2015;20(10):
3231-42.
CARE IN AMBULATORY SETTINGS

Gracey & al. (1) stressed that humanistic medical care is an
important element of quality health care, and teaching humanism is
increasingly recognized as an integral component of medical
education. The goal of this article is to illustrate a series of tools that
are effective in fostering both the provision and teaching of
humanistic medical care in the ambulatory setting. Through a series
of discussions, workshops, literature review, and practice, the
authors have identified critical elements that promote the teaching
of humanistic care. These elements include establishing a humanistic
learning climate, creating clear individualized learning goals within a
framework of humanism, developing an educational diagnosis of the
learner, integrating psychosocial issues into the teaching
intervention, reflecting on the learning experience with the learner,
providing feedback throughout the teaching encounter, and planning
follow-up with the learner. Strategies for implementation of these
critical elements are presented with an emphasis on efficient
educational interactions as required by busy ambulatory settings.
Through the effective use of these teaching strategies, one can
promote the teaching of the human dimensions of care in the
outpatient setting (1).
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Reference
1. Gracey CF, Haidet P, Branch WT, et al. Precepting humanism:
strategies for fostering the human dimensions of care in ambulatory
settings. Acad Med. 2005;80(1):21-8.
THE BEGINNING OF LIFE

Schenker (1) emphasized that the Jewish religion is characterized
by a strict association between faith and practical precept. Jewish
law has two sections, the written and the oral tradition. The
foundation of the written law and the origin of authority is the Torah,
the first five books of the Scripture. It is an expression of God's
revelation, teaching and guiding humanity. The oral laws interpret,
expand, and elucidate the written Torah and behavior patterns
regulate new rules and customs. The main parts of the oral law are
as follows: the Mishnah, the Talmud, Post-Talmudic Codes and.
Responsa Literature. Life is a process that has a beginning and an
end. The consensus about the time when human life really begins is
still not reached among scientists, philosophers, ethicists, sociologists
and theologizes. The scientific data suggested that a single
developmental moment marking the beginning of human life does
not exist. Current biological perspectives on when human life begins
range through fertilization, gastrulation, to birth and even after. The
development of a newborn is a smoothly continuous process.
Procreation is acknowledged in the Bible to be the gift of God. The
(Halachic) Jewish interpretation of when human life begins is
extracted predominantly from procreation is acknowledged in the
Bible to be the gift of God. The Jewish interpretation of when human
life begins is extracted predominantly from The Halachic sources.
The Bible does not make any other direct references regarding the
beginning of human life. The data demonstrate that while the
Talmud gives the full status of humanness to a child at birth, the
rabbinical writings have partially extended the acquisition of
humanness to the 13th postnatal day of life for full-term infants. The
Babylonian Talmud Yevamot 69b states that: "the embryo is
considered to be mere water until the fortieth day." Afterwards, it is
considered subhuman until it is born. The issues of abortion, embryo
research, multifetal reduction and cloning will be discussed according
to Jewish Law perspectives. Life is a process that has a beginning and
an end. The consensus about the time when human life really begins
is still not reached among scientists, philosophers, ethicists,
sociologists and theologizes. The scientific data suggested that a
single developmental moment marking the beginning of human life
does not exist. Current biological perspectives on when human life
begins range through fertilization, gastrulation, to birth and even
after. The development of a newborn is a smoothly continuous
process (1).
Reference
1. Schenker JG. The beginning of human life: status of embryo.
Perspectives in Halakha (Jewish Religious Law). J Assist Reprod Genet.
2008;25(6):271-6.
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DELIVERY CARE
de Souza & al. (1) mentioned that this was a qualitative
exploratory study, which aimed to investigate how health
professionals working in delivery care perceive the humanization of
the birth process. Seventeen professionals who work in the area
were interviewed. The data were obtained through semi-structured
interviews and processed through thematic analysis. During the data
analysis three categories emerged: the meaning of humanization of
birth; the humanization practice in the studied services; and
difficulties of the humanization process. The results show that the
humanization of birth care is not yet a common practice in most of
the studied hospitals and that the staff is not prepared to provide a
humanized and qualified service for mothers and newborns. The
data show that it is essential to change the biomedical model from a
mainly technical approach to an approach that values the social and
cultural aspects of pregnancy and delivery (1).
Kruno (2) mentioned that in this paper is a descriptive exploratory
study developed with the objective of getting acquainted with life
experiences, preparation, feelings, and motivations of women who
have chosen home childbirth. The subjects of the research
comprised ten women who had at least one experience of home
childbirth in Porto Alegre, in the last five years. The data was
gathered through semi-structured interviews, which were analyzed
according to Minayo's proposal. It indicates that the women who
opted for home childbirth don't accept what the hospital system
offers to women in labor at present time, but they do recognize that,
for a few women, hospital delivery is the best choice, whether for
reasons that involve personal decisions or health ones (2).
Goer (3) described a survey of a convenience sample of 24
grassroots birth activist groups based in several countries that
revealed remarkable similarities despite differences in culture and
maternity care systems. With few exceptions, they began with a few
individuals, generally women, who were dissatisfied or angry with an
obstetric management system that failed to provide safe, effective,
humane maternity care, that suppressed alternative models of care
and nonconforming practitioners, or both. Responses indicated that
organizational structures tend to fall into a limited number of
categories, and strategies intended to accomplish reform overlap
considerably. All groups have experienced difficulties resulting from
the hegemony of conventional obstetric management and active
opposition of practitioners within that model. Most groups are
volunteer based, and all struggle under the handicap of limited
resources compared with the forces arrayed against them and the
scope of what they hope to accomplish (3).
Neves & al. (4) mentioned that breastfeeding is one of the key
practices which promote health, being associated with a reduction of
diseases and mortality in childhood. Thus, from the course
conclusive work, the present article was structured, which aimed to
recognize the perceptions of mothers in the face of the use of the
mother kangaroo method. With a qualitative, descriptive, and field
approach, it was held at the Philanthropic Hospital of Ponta Grossa,
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Paraná, Brazil, by the months of August to October 2006, in which six

mothers were included in the kangaroo mother method during the
admission of the baby. For the gathering, semi-structured interviews
were made, and data were analyzed by the content analysis. This
article analyzed two categories, maternal experience with the mother
kangaroo method, with the subcategories: mother kangaroo method
and maternal breastfeeding and experiences at the kangaroo
practice; and knowing the kangaroo method. As a conclusion,
nursing plays an essential role in the insertion of the family to the
method, from the provided cares (4).
References
1. de Souza TG, Gaíva MAM, dos Anjos Modes PSS. The humanization
of birth: how health professionals working in delivery care perceive it. Rev
Gaucha Enferm. 2011;32(3):479-86.
2. Kruno RB, de Lourenzi Bonilha AL. Home delivery as voiced by
women: a perspective at the light of humanization. Rev Gaucha Enferm.
2004;25(3):396-407.
3. Goer H. Humanizing birth: a global grassroots movement. Birth.
2004;31(4):308-14.
4. Neves PN, Ravelli APX, Lemos JRD. Humane care for low-weight
newborns (kangaroo mother method): mother's perceptions. Rev Gaucha
Enferm. 2010;31(1):48-54.
CHILDBIRTH PRACTICES
According to Pereira & al. (1), the humanization of care in
childbirth and the choice of performing cesarean or vaginal delivery
have long been discussed in Brazil and worldwide. The complexities
of the factors surrounding this issue range from the quality of
obstetric care through to the significance of childbirth for women. A
new proposal for humanization of delivery was introduced by the
Brazilian Ministry of Health, the objectives of which were to make
changes to the current system of delivery practices regarding, access,
care, quality, and resolution, in order to make it a more human and
less technical experience. The Sofia Feldman Hospital, in Belo
Horizonte - MG, is a benchmark in the adoption of best practices in
care during childbirth, according to the Brazilian National Health
Agency. However, for the humanization to become a national reality,
there are still many challenges to be overcome within the public
health system and the private partnerships. The most important
problems are related with the current education system that
continues to prepare health professionals to act in an interventional
way, focused on the physician figure. This study aims to provide an
overview about the different humanized care practices focused on
pregnancy and childbirth, conducted in southern and southeastern
Brazil (1).
Nagahama & Santiago (2) characterized hospital care for
childbirth in two hospitals affiliated with the Unified National Health
System in Maringá, Paraná, Brazil, and identify both obstacles and
facilitating factors for the implementation of humanized care, based
on women's perception of the care received. This was an exploratory
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and descriptive study with a cross-sectional design, analyzing hospital

patient charts and interviews with 569 women who gave birth at the
two hospitals from March 2005 to February 2006. Hospital care was
characterized on the basis of WHO quality-of-care guidelines for
labor and delivery. The data pointed to a healthcare model marked
by the hygienist legacy in physician-centered hospital protocols and
professional practices. Institutional factors, identified as difficulties in
institutional and infrastructure organization, hospital protocols, and
health professionals' individual practices and stances, denote barriers
that jointly hinder the implementation of a humanized model for
childbirth care (2).
Behruzi & al. (3) mentioned that humanizing birth means
considering women's values, beliefs, and feelings and respecting their
dignity and autonomy during the birthing process. Reducing over-
medicalized childbirths, empowering women and the use of
evidence-based maternity practice are strategies that promote
humanized birth. Nevertheless, the territory of birth and its socio-
cultural values and beliefs concerning child bearing can deeply affect
birthing practices. The present study aims to explore the Japanese
child birthing experience in different birth settings where the
humanization of childbirth has been identified among the priority
goals of the institutions concerned, and also to explore the obstacles
and facilitators encountered in the practice of humanized birth in
those centers. A qualitative field research design was used in this
study. Forty-four individuals and nine institutions were recruited.
Data was collected through observation, field notes, focus groups,
informal and semi-structured interviews. A qualitative content
analysis was performed. All the settings had implemented strategies
aimed at reducing caesarean sections and keeping childbirth as
natural as possible. The barriers and facilitators encountered in the
practice of humanized birth were categorized into four main groups:
rules and strategies, physical structure, contingency factors, and
individual factors. The most important barriers identified in
humanized birth care were the institutional rules and strategies that
restricted the presence of a birth companion. The main facilitators
were women's own cultural values and beliefs in a natural birth, and
institutional strategies designed to prevent unnecessary medical
interventions. The data demonstrate that the Japanese birthing
institutions which have identified as part of their mission to instate
humanized birth have, as a whole, been successful in improving care.
However, barriers remain to achieving the ultimate goal.
Importantly, the cultural values and beliefs of Japanese women
regarding natural birth is an important factor promoting the
humanization of childbirth in Japan (3).
References
1. Pereira RM, de Oliveira Fonseca G, Pereira ACCC, et al. New
childbirth practices and the challenges for the humanization of health care
in southern and southeastern Brazil. Cien Saude Colet. 2018;23(11):3517-
24.
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2. Nagahama EEI, Santiago SM. Childbirth practices and challenges for

humanization of care in two public hospitals in Southern Brazil. Cad Saude
Publica. 2008;24(8):1859-68.
3. Behruzi R, Hatem M, Fraser W, et al. Facilitators and barriers in the
humanization of childbirth practice in Japan. BMC Pregnancy Childbirth.
2010 May 27;10:25.
HUMANIZED OBSTETRICS
Kämpf & al. (1) reported that an initial analysis is made of the way
obstetricians that defend the humanization of childbirth in Brazil
understand and analyze the practice of episiotomy, a conventional
technique included in protocols in obstetrics that they had learned in
medical training and subsequently abandoned. An initial analytical
construct is presented through the prism of the social studies of
science and technology and raise questions about the neutrality of
science and technology and the impartiality of the specialist/scientist.
The relationships were further point out that seem to exist between
political activity, the production of scientific knowledge, and
technical activities in the professional work of the aforementioned
obstetricians (1).
Busanello & al. (2) aimed to analyze the practices developed in
assisting the adolescent, from the account of health workers, in an
Obstetric Center in a teaching hospital, based on the proposal of
humanization of parturition of the Health Ministry. According to the
workers, useful practices in assisting parturition, among them,
orientations about relaxation techniques at parturition, improving
the attachment between mother and child, are being carried out.
However, the right to a companion has not been considered. The
lithotomy position and standardization of trichotomy, episiotomy e
amniotomy were registered. Medical records, among them
partogram, anamnesis and physical and obstetric exam of the
parturient, proved to the unsatisfactory. The data show that, in the
scenario investigated, are developed practices considered
appropriate and inappropriate, showing the need to further
encourage the use of procedures grounded in scientific evidence and
inserted into the proposal to the humanization of birth (2).
References
1. Kämpf C, de Brito Dias R. Episiotomy from the perspective of
humanized obstetrics: reflections based on social studies of science and
technology. Hist Cienc Saude Manguinhos. 2018;25(4):1155-60.
2. Busanello J, da Costa Kerber NP, Mendoza-Sassi RA, et al.
Humanized attention to parturition of adolescents: analysis of practices
developed in an obstetric center. Rev Bras Enferm. 2011; 64(5):824-32.
SPONTANEOUS ABORTION
Blackshaw & Rodger (1) noticed that a substantial proportion of
human embryos spontaneously abort soon after conception, and
ethicists have argued this is problematic for the pro-life view that a
human embryo has the same moral status as an adult from
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conception. Firstly, if human embryos are our moral equals, this

entails spontaneous abortion is one of humanity's most important
problems, and it is claimed this is absurd, and a reductio of the moral
status claim. Secondly, it is claimed that pro-life advocates do not act
as if spontaneous abortion is important, implying they are failing to
fulfill their moral obligations. The Authors report that the primary
cause of spontaneous abortion is chromosomal defects, which are
currently unpreventable, and show that as the other major cause of
prenatal death is induced abortion, pro-life advocates can
legitimately continue efforts to oppose it. It was also defended the
relevance of the killing and letting die distinction, which provides
further justification for pro-life priorities (1).
Reference
1. Blackshaw BP, Rodger D. The problem of spontaneous abortion: is
the pro-life position morally monstrous? New Bioeth. 2019;25(2):103-20.
PRENATAL CARE
Warmling & al. (1) analyzed how discourses of medicalization and
humanization reconnect in primary healthcare and shape prenatal
care for pregnant women provided by family health teams. This was
a single and integrated case study with multiple analytical units and a
qualitative approach. A total of 17 focus groups were performed, in
which 47 health professionals were heard (14 physicians, 19 nurses,
and 14 dentists), members of 17 family health teams in 16
municipalities in the South of Brazil. The empirical material was
analyzed from the perspective of Foucauldian discourse analysis. The
family health teams, adopting general practice, reported difficulties
in conducting prenatal care, evoking, and bolstering the discourse of
obstetric medicalization that their practice should supposedly offset.
The discourse officially adopted by humanization, prioritized in the
generalist model of prenatal care, continues to function as a
complementary discourse to that of medicalization and
specialization, which prevails in the practices reported by the teams.
The emphasis on humanized care for pregnant women tests the
limits of professional territories and assumes the renegotiation of
competencies. Efforts at collaboration between the family health
teams and obstetricians have not proved very successful in this
specific case (1).
Barreto & al. (2) wanted to know how the approach of public
policy humanization prerequisites and health programs proposed by
the Ministry of Health occur in the practice of prenatal of care usual
risk. This field study used exploratory descriptive qualitative
approach. The survey was conducted from February to June 2014,
with participant observation and semi-structured interviews in four
family health units where five nurses and three doctors attended.
Operative Proposal was chosen for data analysis. The categories
revealed in this study that promoted the humanization of prenatal
care were: The approach and linking of pregnant woman and their
family-to-family health units and permanent education as a facilitator
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for humanization in prenatal care. The data demonstrate that it is

understood that to approach humanized attention, an enlarged look
in face of women's singularities is required (2).
References
1. Warmling CM, Fajardo AP, Meyer DE, Bedos C. Social practices in
the medicalization and humanization of prenatal care. Cad Saude Publica.
2018;34(4):e00009917.
2. Barreto CN, Wilhelm , da Silva SC, et al. "The Unified Health System
that works": actions of humanization of prenatal care. Rev Gaucha
Enferm. 2015;36 Spec No:168-76.
NEONATAL/PEDIATRIC CARE UNIT

da Silva & al. (1) reflected on technology and humanization in
care of newborns, having as theoretical premise the health-illness
process. Some parallels are established among the several
conceptions of health and illness, and their influences in the way we
behave and think about the care spaces as subjects of the neonatal
care. The Kangaroo Mother Care is presented as a relational
technology that proposes to shelter the family-baby unity in the
Neonatal Intensive Care Unit, valuing experiences and major needs of
affection and comprehension (1).
dos Reis & al. (2) mentioned that the humanization of healthcare
is one of the key priorities of healthcare policies in Brazil, and directly
reflects on the attitudes of user, employees, and managers of health
services. The aim of this study was to identify perception of the
nursing team in terms of humanization of assistance in a neonatal
and pediatric intensive care unit based on exploratory-descriptive
research and a qualitative approach. A total of 11 members of a
nursing team at the neonatal and pediatric intensive care unit of a
hospital in southern Brazil participated in this study. Data was
collected by means of semi structured interviews that were
subsequently processed according to reference standards of thematic
content analysis. This analysis resulted in three thematic categories:
to humanize is to perceive the other as all-providing and all-
supportive; bonding and communication as humanizing practices;
and lack of ambience as a dehumanizing practice. Results showed
that perception of the nursing team in relation to humanization is
determined by the actual science and awareness of nursing care
rather than specific acknowledgement of the National Humanization
Policy (2).
Spir & al. (3) learned the perception of accompanying mothers at
the neonatal unit as to humanizing actions. This is an exploratory
descriptive study, with a qualitative focus, developed at the neonatal
unit of the University of São Paulo Hospital with the accompanying
mothers of hospitalized babies, from their fifth day of life until
discharge. The study was performed from October 2007 to January
2008. A total 18 interviews were performed and analyzed according
to Bardin's framework, which permitted to develop the following
categories: assistance received, relationship with professionals and
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conditions of the institution. It was found that there was satisfaction

regarding the received assistance and team support, and there is a
need to make changes in the physical structure of the sector, to
provide assistance that is more humanized (3).
de Souza & Ferreira (4) analyzed, from the point of view of health
professionals, the proposal of humanized care and at detecting the
senses and limits, identified by those professionals to the provision of
such care. It was an exploratory and qualitative study where a group
of twelve professionals from a multiprofessional team in a neonatal
Intensive-Care Unit were interviewed. The survey showed that there
are significant obstacles to the provision of humanized care, such as
lack of material and human resources, which increase the workload,
relationship conflicts and absence of infrastructure both to
professionals and to the performance of humanization initiatives, as,
for instance, Breastfeeding Mother Accommodations. The study
showed that despite difficulties, professionals come up with
strategies to accomplish what is laid down in the National
Humanization Policy by the Ministry of Health (4).
References
1. da Silva LJ, da Silva LR, Christoffel MM. Technology and
humanization of the neonatal intensive care unit: reflections in the context
of the health-illness process. Rev Esc Enferm USP. 2009;43(3):684-9.
2. dos Reis LS, da Silva EF, Waterkemper R, et al. Humanization of
healthcare: perception of a nursing team in a neonatal and paediatric
intensive care unit. Rev Gaucha Enferm. 2013;34(2):118-24.
3. Spir EG, Soares AVN, Wei CY, et al. The companions' perception
about the humanization of assistance at a neonatal unit. Rev Esc Enferm
USP. 2011;45(5):1048-54.
4. de Souza KMO, Ferreira SD. Humanized attention in neonatal
intensive-care unit: senses and limitations identified by health
professionals. Cien Saude Colet. 2010;15(2):471-80.
HUMANISTIC NURSING OF CHILDREN

Medeiros & da Graça Corso da Motta (1) viewed the life of
HIV/AIDS children in shelters under the perspective of the Humanistic
Nursing Theory. This was a qualitative study with an existential-
phenomenological-humanistic approach based on the Nursology of
Paterson and Zderad. The scenario was a shelter for HIV/AIDS
children located in the state of Rio Grande do Sul, Brazil. Information
was collected using phenomenological interview carried out with
three children with AIDS. This article presents part of the
interpretation of the obtained information centered in two meaning
units. The results provided an understanding of the child's play as
way of feeling better in the environment of the shelter because the
child perceives himself/herself as part of that environment with
others. It also gives visibility to children with HIV/AIDS in shelters
and highlights the importance of including this theme in
undergraduate courses, training health professionals in humanistic
care, and managers to develop specific public policies for this
population (1).
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Holyoake (2) battled its way through the contemporary

philosophical assumptions regarding interactions with traumatized
young people. That is, interaction by nurses as they attempt to
provide 'a shoulder to cry on', 'someone to trust' or just simply 'a
hand to hold'. The young people that are nursed in the hospital
setting have experienced illness, surgery, and recovery to name just a
few, but when confronted with being separated from their families,
being frightened, and needing a friend the role of nursing takes on
many different facets. The child (Pandora) a traumatized child taken
from home to a strange new place, is warmly accepted by careers
who seem to share a set of beliefs and assumptions about
relationships and interaction. This article aims to explore the effects
humanist and existentialist philosophy has had in guiding current
nursing practice using extracts from his own practice and
observations (2).
França & al. (3) mentioned that the child with special health care
needs in a rehabilitation center for their vulnerable condition
requires a clinical practice centered on ethics and humanization. The
objective was to know the parents' and nurses' opinions on
humanized care in a pediatric rehabilitation unit and to identify
needs and strategies that promote the humanization of care in a
pediatric rehabilitation unit. Qualitative, descriptive, exploratory
study used interviews with nurses and questionnaires to parents of
hospitalized children. This study enhances the importance that
nurses should have in human relationships, with special attention to
each child and their parents, but also to the structural and
functioning conditions of the unit. The results agree with the
literature, highlighting the particular aspects of children with special
needs and their parents. The results contribute to more humanized
care and could be a basis for a Charter of Humanization (3).
Ullán & al. (4) presented and discuss a case-study of human
betterment through the arts applied to a children's hospital. The
experience related to the betterment of these environments took
place in the Children's Emergency Service of the University Hospital
in Salamanca. After describing the context of the case-study some
attention will be devoted to the phases of the process, emphasizing
those aspects linked to children's care culture and their families as
well as the symbolic dimension of the space and the participation of
different professionals in the experience. The case-study is assessed
from different standpoints, but special importance is given to
parents' opinions. 51 parents of children in the emergency unit were
interweaved during a month. Parents valued positively the service
and stated that artists' intervention had been beneficial for the
children's emotional state. The article concludes with a debate about
the meaning of the hospital environment and the quality associated
with its physical premises (4).
Bergan & al. (5) investigated the architectural and built
environment aspects involved in the humanizing process in a
pediatric hospital and its influence to the recovering of the
hospitalized child. Based on the Social Representation Theory, a
structural analysis was carried out, using free association of words
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and a semi-structured questionnaire for data collection. The study

was carried out in a public hospital in Rio de Janeiro, Brazil, and the
results presented refer to the representations produced by 75 people
accompanying hospitalized child. As central nucleus appears
"consultation", while "reform", "medicines", and "organization" and
"affection" appear as peripheral system. For this group humanization
seems to be strongly connected to the right to health and access to
care. Nevertheless, aspects keep the balance of the quality of care,
which are enrolled under humanization, are not neglected. The
results allow providing recommendations to improve the
contemporary hospitals architectural programs and the quality of
care (5).
According to Ceribelli & al. (6), the Live Library in Hospitals Project
is a strategy adopted by several health institutions for the purpose of
providing hospitalized children and adolescents the reading
mediation of infant-juvenile stories through professionals and
volunteers capable of this function. This study aimed to find out to
what extent the reading of stories strategy proposed by this project
in hospitals can be a communication resource to use with
hospitalized children. In order to do that, empirical data collection
was carried out through the use of semi structured interviews with
the reader and children above the age of seven years and
observation of reading sections. The qualitative data analysis was
doing it and it was verified that the reading mediation favors the
dialogs and relationships; contribute for the expansion of the
diagnostic and therapeutic and development processes of children,
relatives and health professionals (6).
Kissoon (7) emphasized that a humanistic approach to leadership
is especially important in the case of children in the technology-rich
intensive care unit (ICU) environment. Leaders should create a
humanistic milieu in which the needs of critically ill children, their
families and staff are never overlooked. Humanistic leaders are
tactful, accessible, approachable, and versatile, and have a sense of
humour. Humanness in the ICU environment has many faces and
poses a challenge to many in leadership positions. Humanistic
leaders treat others as they hope they will become. They are
constantly questioning themselves, seeking awareness of themselves
and others, but most importantly they are constantly learning and
evolving. Ultimately, humanistic leadership creates an ICU culture
that supports all, is conducive to enriching lives, and is sensitive to
the needs of patients and their families (7).
Tripodi & al. (8) mentioned that the term "humanization"
indicates the process by which people try to make something more
human and civilized, more in line with what is believed to be the
human nature. The humanization of care is an important and not yet
a well-defined issue which includes a wide range of aspects related to
the approach to the patient and care modalities. In pediatrics, the
humanization concept is even vaguer due to the dual involvement of
both the child and his/her family and by the existence of multiple
proposed models. The present study aims to analyze the main
existing humanization models regarding pediatric care, and the tools
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for assessing its grade. The main Humanization care programs have
been elaborated and developed both in America (Brazil, USA) and
Europe. The North American and European models specifically
concern pediatric care, while the model developed in Brazil is part of
a broader program aimed at all age groups. The first emphasis is on
the importance of the family in child care, the second emphasis is on
the child's right to be a leader, to be heard and to be able to express
its opinion on the program's own care. Several tools have been
created and used to evaluate humanization of care programs and
related aspects. None, however, had been mutually compared. The
data show that the major models of humanization care and the
related assessment tools here reviewed highlight the urgent need for
a more unifying approach, which may help in realizing health care
programs closer to the young patient's and his/her family needs (8).
Mandato & al. (9) emphasized that as the quality and quantity of
patient-centered care may be perceived differently by recipients and
independent observers, assessment of humanization of pediatric care
remains an elusive issue. Herein the aim was to analyze differences
between the degrees of verified existing vs. perceived humanization
issues of a pediatric ward. Furthermore, the study examined
whether there is concurrence between the degrees of humanization
perceived by users (parents/visitors) vs. staff members. The study
was conducted in the pediatric wards of seven medical centers of the
Campania region (Italy) categorized as general (n=4), children's (n=1),
and university (n=2) hospitals. The degree of existing humanization
was assessed by a multidisciplinary focus group for each hospital
through a pediatric care-oriented checklist specifically developed to
individuate the most critical areas (i.e., those with scores < 2.5). The
degree of perceived humanization was assessed through four
indicators: well-being, social aspects, safety and security, and health
promotion. The focus groups showed that critical areas common to
all centers were mainly concerned with welfare, mediation,
translation, and interpretation services. Specific critical issues were
care and organizational processes oriented to the respect and
specificity of the person and care of the relationship with the patient.
Perceived humanization questionnaires revealed a lack of
recreational facilities and mediation and translation services. As for
specific features investigated by both tools, it was found that
mediation and interpretation services were lacking in all facilities
while patient perceptions and observer ratings for space, comfort,
and orientation concurred only in the general hospital evaluations.
The data demonstrate that future humanization interventions to
ensure child- and family-friendly hospital care call for careful
preliminary assessments, tailored to each pediatric ward category,
which should consider possible differences between perceived and
verified characteristics (9).
According to Tripodi & al. (10), humanization of care (HOC)
interventions has rarely been evaluated and compared. The
outcomes of published interventions aimed to improve the HOC for
hospitalized children was systematically reviewed. PubMed and
Scopus were used as data sources. Studies published between
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January 1, 2000, and February 28, 2018, were considered eligible if

they reported analysis of results vs. either a control group or
baseline, or if they measured patient/family/staff satisfaction.
Neonatal age, emergency departments, and subspecialty settings
were excluded. Data were extracted using a standardized data
extraction form including study design, sample size, intervention,
outcome/objective, and evaluation of results or pre- post-
intervention satisfaction. Twenty-eight of the 12,012 retrieved
articles met the inclusion criteria. Most studies were of moderate to
low quality. Only six studies were of high quality. Areas of interest
dealt with environment (n=4), provider-patient relationship (n=6),
pet therapy (n=5), technology (n=5), family-centered rounds (n=2),
psychological support (n=3), and staff training (n=3). The overall
trend of the results indicated that interventions were mostly
effective and likely to have beneficial effects on several aspects of
pediatric hospitalization. The data show that pending further studies
of better research quality, the findings of this review may have policy
and practice implications for planning HOC interventions by pediatric
healthcare professionals. In pediatrics, HOC provides assistance
focused not only on the child as a patient, but on the whole family.
HOC programs have been developed, but information on the overall
outcome of local projects aiming to improve in a practical way the
hospital taking charge of pediatric patients is still lacking. Local HOC
interventions are mostly effective and have beneficial effects on
several aspects of hospitalization in general pediatrics wards. The
findings of this review may have practice implications for planning
HOC interventions by pediatric healthcare professionals (10).
References
1. Medeiros HMF, da Graça Corso da Motta M. HIV/AIDS children
living in shelters under the perspective of humanistic nursing. Rev Gaucha
Enferm. 2008;29(3):400-7.
2. Holyoake DD. A little lady called Pandora: an exploration of
philosophical traditions of humanism and existentialism in nursing ill
children. Child Care Health Dev. 1998;24(4):325-36.
3. França APM, Mendes ARB, Barrias MIF. OC34 - Paediatric
rehabilitation: humanizing nursing care to children and their families. Nurs
Child Young People. 2016 May 9;28(4):78.
4. Ullán AM, Fernández E, Belver MH. Humanization through the art of
environment of children's emergency in a hospital. Rev Enferm.
2011;34(9):50-9.
5. Bergan C, Bursztyn I, de Oliveira Santos MC, Tura LFR.
Humanization: social representations of a children's hospital. Rev Gaucha
Enferm. 2009;30(4):656-61.
6. Ceribelli C, Nascimento LC, Pacífico SMR, de Lima RAG. Reading
mediation as a communication resource for hospitalized children: support
for the humanization of nursing care. Rev Lat Am Enfermagem.
2009;17(1):81-7.
7. Kissoon N. Bench-to-bedside review: humanism in pediatric critical
care medicine - a leadership challenge. Crit Care. 2005;9(4): 371-5.
8. Tripodi M, Siano MA, Mandato C, et al. Humanization of pediatric
care in the world: focus and review of existing models and measurement
tools. Ital J Pediatr. 2017 Aug 30;43(1):76.
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9. Mandato C, Siano MA, De Anseris AGE, et al. Humanization of care

in pediatric wards: differences between perceptions of users and staff
according to department type. Ital J Pediatr. 2020 May 19;46(1):65.
10. Tripodi M, Siano MA, Mandato C, et al. Humanization
interventions in general pediatric wards: a systematic review. Eur J
Pediatr. 2019;178(5):607-22.
FAMILY WITH DOWN SYNDROME PATIENTS

Ramos & al. (1) socialized the process of coexistence of the family
of the bearers of syndrome of Down based in the Humanistic Theory
of Paterson and Zderad. The study was realized with research of
descriptive exploratory character, with a qualitative approach and
participant observation. It was accomplished in APAE/ Sobral-CE, with
the use of group dynamics and a guided interview for collection of
data. The results showed us that the parents don't have difference
between a normal son and a special one; the treatment is the same,
with a lot of love, affection, understanding and respect, however a
lot of times they find some difficulties in taking care, as the
communication and the feeding. It was observed that the family is
very important, necessary, so that the coexistence with the bearer
becomes more and more natural in spite of a society that, a lot of
times, still has prejudice (1).
Reference
1. Ramos AF, Caetano JA, Soares E, Rolim KMC. The family living with
Down syndrome patients in the perspective of Humanistic Theory. Rev
Bras Enferm. 2006;59(3):262-8.
LOWER EXTREMITY ARTERIOSCLEROSIS

OBLITERANS
He & al. (1) designed to investigate the application value of
humanistic care interventions in patients with lower extremity
arteriosclerosis obliterans (LEASO). Totally, 98 LEASO patients
undergoing interventional therapy in the hospital were enrolled into
this study, among whom 47 cases received conventional care
interventions (the regular group) while the other 51 received
humanistic care interventions based on conventional care
interventions (the research group). The two groups were compared
in negative emotions, complications, and quality of life of patients.
Scores of negative emotions were lower in the research group than in
the regular group after care (p<0.05). The pain intensity decreased in
both groups after care, with a sharper decrease in the research group
(p<0.05). The incidence of complications was lower in the research
group than in the regular group after care (p<0.05). The pain-free
walking distance (PFWD) increased remarkably in both groups after
care, with a longer PFWD in the research group than in the regular
group (p<0.05). Scores of the 36-Item Short-Form Health Survey (SF-
36) increased after care in both groups (p<0.05), with higher SF-36
scores in the research group than in the regular group (p<0.05). SF-
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36 reflects the quality of life of patients from four aspects including

vitality, emotional state, social function, and role-emotional. The
care compliance and satisfaction level with care of patients were
higher in the research group than in the regular group (p<0.05). The
care compliance rate and patient satisfaction level with care were
higher in the research group than in the regular group (p<0.05). The
data indicate that humanistic care interventions can reduce
postoperative pain intensity and improve the quality of life in
patients with LEASO (1).
Reference
1. He Y, Xie C, Xia Y, et al. Humanistic care interventions in patients
with lower extremity arteriosclerosis obliterans. Am J Transl Res.
2021;13(9):10527-35.
THE EFFECT OF PUSTULOSIS

Kharawala & al. (1) reported that generalized pustular psoriasis
(GPP) is characterized by widespread erythema and edema,
superficial sterile coalescing pustules, and lakes of pus. Although the
impact of GPP is thought to be substantial, emerging literature on its
clinical, humanistic, and economic burden has not previously been
described in a structured way. A structured search focused on the
identification of studies in GPP using specific search terms in PubMed
and EMBASE® from 2005 onwards, with additional back-referencing
and pragmatic searches. Outcomes of interest included clinical,
humanistic, and economic burden. Despite its significant clinical,
humanistic, and economic burden, GPP is poorly classified and
inadequately studied. A recent European (ERASPEN) consensus
classifies GPP into relapsing and persistent disease and classifies
patients on the presence or absence of psoriasis vulgaris.
Classification of GPP lesions involving >30% body surface area or use
of hospitalization as a surrogate may be a way to identify significant
flares. Given the frequency of flares, the impaired quality of life
during the post-flare period, and safety/tolerability issues, it is clear
that current treatment options are not sufficient. Long-term studies
utilizing the European consensus statement with subclassifiers are
required to supplement our current understanding of the burden of
GPP (1).
Kharawala & al. (2) described palmoplantar pustulosis (PPP) as a
chronic, relapsing, and refractory disease characterized by sterile
pustules appearing on the palms and/or soles, accompanied by
erythema, blistering, scales and/or keratinization. The overall burden
of PPP in terms of its clinical impact, effect on patients and families,
and economic consequences has not previously been investigated in
a structured manner. A structured search focused on identification
of studies in PPP using specific search terms in PubMed and
EMBASE® from 2005 onwards, with additional back-referencing and
pragmatic searches. Outcomes of interest included clinical burden,
humanistic burden, and economic burden. In cross-sectional studies,
approximately 75% of all PPP patients suffer from active disease, with
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risk of relapse remaining constant over time. Patients' health-related

quality of life is significantly impaired, as expected for a disease
affecting hands and feet. Tools have been described that assess the
clinical as well as patient-reported burden of PPP; their performance
in larger cohorts and/or clinical trials remains to be investigated. The
key data limitations identified include inconsistent definitions for
characterizing remission/relapse and limited humanistic and
economic burden data; future studies are required to address these
evidence gaps (2).
References
1. Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical,
humanistic, and economic burden of generalized pustular psoriasis: a
structured review. Expert Rev Clin Immunol. 2020;16(3):239-52.
2. Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical,
humanistic, and economic burden of palmoplantar pustulosis: a structured
review. Expert Rev Clin Immunol. 2020;16(3):253-66.
SURGERY PATIENTS
Medina & Backes (1) mentioned that the understanding and the
respect of the Human Being as an individual, the preoccupation with
his/her feelings, desires and rights, and the orientation for a qualified
care towards the humanization in the attendance of the customer
and family are the guidelines of this work, based on the Humanistic
Theory of Paterson & Zderad (1988). The study was done with fifteen
surgical patients interned in a Hospital in Santa Maria, Rio Grande do
Sul. The accompaniment in the preoperative tried to identify and to
reduce the factors responsible for anxiety, fear and discomfort
caused by the imminence of the surgical act. The key-elements used
in this humanization process regarding the client and his relatives,
were the ability to empathize and verbal and non-verbal
communication. The interaction experienced with the customers
enabled us to assemble technical knowledge (instrumental
rationality) and subjectivity (intuition and affection), developing a
differentiated nursing assistance, with a stronger support and
presence, orientation, and reflection and, safety and comfort to the
customer (the Human Being) attended (1).
Reference
1. Medina RF, Backes VM. Humanism in the care of surgery patients.
Rev Bras Enferm. 2002;55(5):522-7.
DENTISTRY PRACTICES
Nascimento & al. (1) evaluated public health dentistry practices of
two different family health models. Qualitative study conducted with
data obtained from focus groups consisting of 58 dentists working in
the Family Health Strategy for at least three years between August-
October, 2006. The Paideia Family Health Approach was used in the
city of Campinas and the Oral Health Initiative as part of the Family
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Health Strategy was implemented in the city of Curitiba,

Southeastern and Southern Brazil, respectively. Data was analyzed
using the hermeneutic-dialectic method. Analysis indicators were
employed to indicate backwardness, stagnation, or progress in oral
health practices effective from the implementation of the strategies
referred. The indicators used were: work process; interdisciplinary
approach; territorialization; capacity building of human resources;
health promotion practices; and responsiveness to users' demands.
There was progress in user access to services, humanization of health
care, patient welcoming and patient-provider relationship. The
results related to health promotion practices, territorialization,
interdisciplinary approach and resource capacity building indicated a
need for technical and operational enhancements in both cities. The
data demonstrate that both models have brought about important
advances in terms of increased access to services and humanization
of health care. Universal access to oral health at all levels of
complexity was not achieved in both cities studied. Local health
managers and oral health program coordinators must bring more
weight to bear in the arena that defines public policy priorities (1).
Moimaz & al. (2) assessed user evaluation about dental care in
the Unified Health System and analyze the associations between this
evaluation, sociodemographic characteristics, and aspects related to
humanization of the services. It involved a cross-sectional survey
with a quantitative approach, in which 461 users responded to
individual interviews. The outcome variable was obtained by means
of the question: "How do you consider the care given by the dentist
and by the team in this health unit?" Responses were grouped into
"positive evaluation" and "negative evaluation." The independent
variables integrated two groups: sociodemographic and related to
the humanization of care. The positive evaluation (90.4%) prevailed
over the negative. Using Poisson regression, it was found that the
negative evaluation was statistically associated with not having felt
confidence in the dentist and staff, and not being able to talk to these
professionals after the end of treatment. The results showed the
preponderantly positive user evaluation of the service and suggest
that the evaluation may be more related to the humanization in
services than to sociodemographic characteristics of the population
(2).
References
1. Nascimento AC, Moysés ST, Bisinelli JC, Moysés SJ. Oral health in
the family health strategy: a change of practices or semantics
diversionism. Rev Saude Publica. 2009;43(3):455-62.
2. Moimaz SAS, Lima AMC, Garbin CAS, et al. User evaluation on
dental care in the Unified Health System: an approach from the standpoint
of humanization. Cien Saude Cole. 2016;21(12):3879-87.
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CORONAVIRUS PANDEMIC
Lewis (1) emphasized that the coronavirus pandemic has
shattered our world with increased morbidity, mortality, and
personal/social sufferings. At the time of this writing, we are in a
biomedical race for protective equipment, viral testing, and vaccine
creation in an effort to respond to COVID threats. But what is the
role of health humanities in these viral times? This article works
though interdisciplinary connections between health humanities, the
planetary health movement, and environmental humanities to
conceptualize the emergence of "planetary health humanities." The
goal of this affinity linkage is to re-story health humanities toward
promotion of planetary health and community well-being. Wellbeing
is critical because the main driver of environmental destruction and
decreasing planetary health is coming from non-sustainable
definitions of wellbeing. We need the arts and humanities to help
reimagine the possibility of a sustainable community wellbeing. For
health humanities, a basic role and narrative identity starts to
emerge-we should become a planetary health (and well-being)
humanity (1).
Reference
1. Lewis B. Planetary health humanities-responding to COVID Times. J
Med Humanit. 2021;42(1):3-16.
HOMEOPATHY
Teixeira (1) mentioned that during the last decade, the traditional
medical model has endeavored to retrieve an improvement in the
patient-physician relationship by means of propositions for
humanization in the areas of education, medical care and policies. To
enhance holistic characteristics of non-conventional practices in
health, the incorporation of several aspects of humanities in
understanding the process of the individual's illness, stressing that
the physician's interest in aspects apparently not related to the
impaired organ (history of the patient's life, personality, interests,
etc.) should be added to the technical and less humanized
consultation. Since homeopathy embraces this wide semiological
approach as inherent practice, using the totality of characteristic
symptoms to evaluate organic unbalance and choose means of
treatment, homeopathic clinical practice can significantly contribute
to humanism in medicine (1).
Reference
1. Teixeira MZ. Homeopathy: a humanistic approach to medical
practice. Rev Assoc Med Bras (1992). 2007;53(6):547-9.
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PHYSIOTHERAPY
da Silva & de Fátima de Araújo Silveira (1) presented humanizing
attention and management in the health area at SUS is presented as
a way of qualification on health practices and a challenge to all the
people that work in the area. The research intended to verify the
conception of the physiotherapy graduating students about the
humanization in their formation. The study was conducted in a
qualitative, exploratory, descriptive, comparative, and analytic
approach, and its sample was composed by 24 individuals. The data
collected through semi-structured interviews were submitted to
content analysis, of the thematic kind, proposed by Bardin. The
Authors verified that the conception of the participants when it
comes to the conception about the humanization is: restricted,
superficial and with a lack of scientific knowledge; don't show a
consensus or basis related to the theoretical and even operational
aspects about the humanization in physiotherapy; and its coverage
and applicability aren't entirely demarcated, the view is only focused
on the relation worker/user. They refer to find difficulties in working
as a group and understand its insertion in the attention in health
area. The various bodies of SUS might perform a challenge maker
role in health practices, and for that, one of the necessities is on the
professional formation (1).
Reference
1. da Silva ID, de Fátima de Araújo Silveira M. The humanization and
the formation of the professional in physiotherapy. Cien Saude Colet.
2011;16 Suppl 1:1535-46.
REHABILITATION
Abrams & Gibson (1) argued that rehabilitation enacts a particular
understanding of "the human" throughout therapeutic assessment
and treatment. Following Michel Callon and Vololona Rabeharisoa's
"Gino's Lesson on Humanity," the Authors suggest that this is not
simply a top-down process but is cultivated in the application and
response to biomedical frameworks of human ability, competence,
and responsibility. The emergence of the human is at once a
materially contingent, moral, and interpersonal process. The Authors
begin the article by outlining the basics of the actor-network theory
that underpins "Gino's Lesson on Humanity." Next, we elucidate its
central thesis regarding how disabled personhood emerges through
actor-network interactions. Section "Learning Gino's lesson" draws
on two autobiographical examples, examining the emergence of
humanity through rehabilitation, particularly assessment measures
and the responses to them. The Authors conclude by thinking about
how rehabilitation and actor-network theory might take this lesson
on humanity seriously (1).
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Reference
1. Abrams T, Gibson BE. Putting Gino's lesson to work: Actor-network
theory, enacted humanity, and rehabilitation. Health (London).
2017;21(4):425-40.
HOMELESS MEN
Sumerlin & Privette (1) emphasized that the present humanistic
model for counseling homeless men assumed that counseling goals
evolve from each client's internal frame of reference and may include
a positive adaptation to his homeless experience. The model
encompasses Rogers' necessary components of psychotherapy,
Sullivan's interpersonal theory of psychiatry, Adler's use of wellness
and encouragement, and Privette's peak-performance contribution.
Factor analysis of history of homelessness, background data, ratings
of subjective health and of happiness, and scores on Jones and
Crandall's Short Index of Self-actualization yielded nine factors
relevant to counseling. Empirical support was reported for placing a
counseling services program in a multiservice facility for homeless
persons (1).
Reference
1. Sumerlin JR, Privette G. Humanistic constructs and counseling
homeless men. Psychol Rep. 1994;75(1 Pt 2):611-26.
SEXUAL RELATIONSHIPS WITH PATIENTS

Leggett (1) addressed the historical context, both ancient and
modern, of the injunction prohibiting sexual relationships with
patients. Reference is made to the increasing knowledge of factors
predisposing to such breaches of ethical conduct and to the common
dangers and consequences of sexual relationships with patients.
Such research findings demonstrate adequate cause for the
application of the injunction in all of the health care professions. The
modern social context of liberal humanism and feminism, along with
the recognized analogy with child sexual abuse, are considered as
influences in the current resurgence of interest in the injunction itself
(1).
Reference
1. Leggett A. Origins and development of the injunction prohibiting
sexual relationships with patients. Aust N Z J Psychiatry. 1995;29(4):586-
90.
COMMUNICATING BAD NEWS

According to Luna-Solis (1), communicating bad news is still a
communication challenge in the field of care and, despite the there
being methodologies that allow us to humanize information that has
a great impact on people's lives, it is usually neither taught nor used
in daily life, thus bringing about emotional outcomes, that can be, at
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times, more serious than the disease itself. The art of

communication is a component of medical praxis, so training in the
early years of medicine on methodologies related to the
communication of bad news incorporating cultural diversity, beliefs,
and customs will develop skills for the benefit of the patient.
Although at times it is better not to use verbal language, it is
important to remember that nonverbal communication can also
convey the respect that every human being requires before the
arrival of bad news (1).
Reference
1. Luna-Solis Y. How to say bad news without compromising the
patient's humanity. Rev Peru Med Exp Salud Publica. 2019;36(1):123-7.
BIAS IN HUMANIZING NEGATIVE CHARACTERISTICS

According to Kova & al. (1), four studies investigated whether
people tend to see ingroup flaws as part of human nature (HN) to a
greater degree than outgroup flaws. In Study 1, people preferentially
ascribed high HN flaws to their ingroup relative to two outgroups.
Study 2 demonstrated that flaws were rated higher on HN when
attributed to the ingroup than when attributed to an outgroup, and
no such difference occurred for positive traits. Study 3 replicated this
humanizing ingroup flaws (HIF) effect and showed that it was a]
independent of desirability and b] specific to the HN sense of
humanness. Study 4 replicated the results of Study 3 and
demonstrated that the HIF effect is amplified under ingroup identity
threat. Together, these findings show that people humanize ingroup
flaws and preferentially ascribe high HN flaws to the ingroup. These
ingroup humanizing biases may serve a group-protective function by
mitigating ingroup flaws as "only human" (1).
Reference
1. Kova P, Laham SM, Haslam N, et al. Our flaws are more human than
yours: ingroup bias in humanizing negative characteristics. Pers Soc
Psychol Bull. 2012;38(3):283-95.
THE ELDERLY
Mota & al. (1) described the use of oral life history as a strategy
for the approach between caregivers and the elderly. The aim is to
contribute to humanization of the relationship between health
professionals and patients. A qualitative descriptive study included a
sample of seven elderly individuals of both sexes and 65 years or
older. Open, semi-structured interviews were conducted, producing
narratives of the patients' life histories. The narratives were later
returned to the participants in the form of personalized booklets for
use as they saw fit. The approach contributed to the formation and
strengthening of bonds between the nursing staff and the elderly and
enhanced both the human and therapeutic aspects of this
relationship (1).
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Rose & Osterud (2) mentioned that a geriatric health

maintenance program, started in 1976 as a community medicine
elective, has developed into an innovative model in humanistic
health care. Junior and senior medical students act as live-in
facilitators of comprehensive health care for the elderly tenants in
publicly subsidized housing units. Students rotate emergency night
and weekend calls and hold weekly health clinics at the housing units.
Weekly seminars are given by faculty members during which case
presentations by students and topics related to the complex
problems of the elderly are discussed. Important aspects of this
elective are experiential learning in humanistic health care, exposure
to ambulatory well or stable elderly people, development of
communication/interpersonal skills, and acceptance of responsibility.
The program has been received enthusiastically by tenants,
community physicians, students, and an increasing number of faculty
members at the University of Oregon Health Sciences Center School
of Medicine (2).
References
1. Mota CS, Reginato V, Gallian DMC. Oral life history as a humanistic
strategy for the approach between caregivers and the elderly. Cad Saude
Publica. 2013;29(8):1681-4.
2. Rose BK, Osterud HT. Humanistic geriatric health care: an
innovation in medical education. J Med Educ. 1980;55(11):928-32.
PALLIATIVE CARE IN THE END OF LIFE

Alonso (1) analyzed the palliative care of terminal patients,
examining the tensions between the humanization of care and the
progressive medicalization at the end-of-life situation. The research
upon which the article is based adopts a qualitative methodological
approach derived from interviews with professionals and patients
and ethnographic observations in a palliative care unit in the City of
Buenos Aires, Argentina. The article describes the configuration of
personalized and comprehensive health care based on the core
values of more humanized end-of-life care promoted by palliative
care supporters. Similarly, the paper analyzes how these practices
are assisted by progress in the medicalization process in which the
dimension of care is considered less an unprofessional area of
medical practice than an area of care in which specific technical skills
and know-how are employed. The articles explore how instead of
being divergent, the logic of care and medicalization work in a
complementary fashion (1).
Reference
1. Alonso JP. Palliative care: between humanization and
medicalization at the end of life. Cien Saude Colet. 2013;18(9):2541-8.
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HEALTH CARE
Rider & al. (1) emphasized that changes in the organization of
medical practice have impeded humanistic practice and resulted in
widespread physician burnout and dissatisfaction. The objective was
to identify organizational factors that promote or inhibit humanistic
practice of medicine by faculty physicians. From January 1, 2015,
through December 31, 2016, faculty from eight US medical schools
were asked to write reflectively on two open-ended questions
regarding institutional-level motivators and impediments to
humanistic practice and teaching within their organizations. Sixty
eight of the 92 (74%) study participants who received the survey
provided written responses. All subjects who were sent the survey
had participated in a year-long small-group faculty development
program to enhance humanistic practice and teaching. As humanistic
leaders, subjects should have insights into motivating and inhibiting
factors. Participants' responses were analyzed using the constant
comparative method. Motivators included an organizational culture
that enhances humanism, which we judged to be the overarching
theme. Related themes included leadership supportive of humanistic
practice, responsibility to role model humanism, organized activities
that promote humanism, and practice structures that facilitate
humanism. Impediments included top-down organizational culture
that inhibits humanism, along with related themes of non-supportive
leadership, time and bureaucratic pressures, and non-facilitative
practice structures. The data show that while healthcare has evolved
rapidly, efforts to counteract the negative effects of changes in
organizational and practice environments have largely focused on
cultivating humanistic attributes in individuals. The findings suggest
that change at the organizational level is at least equally important.
Physicians in the study described the characteristics of an
organizational culture that supports and embraces humanism.
Suggestions were offered for organizational change that keep
humanistic and compassionate patient care as its central focus (1).
Five ways to lead with more humanity. incomethrone.com.
Kilpatrick (2) discussed the nature of humanism in healthcare

management and leadership. Humanism in healthcare management
should entail serving 1] patients and their families, 2] organizational
members, and 3] the community. The article describes how
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humanism is largely absent from healthcare organizations as a critical

and important value. In the twentieth century, a number of models
of healthcare leadership were developed that were humanistic in
focus. These models primarily stressed the value of attention by
leaders on the needs and values of people working in the
organization. However, humanistic, healthcare leadership involves
not only motivating and empowering employees, but a primary,
essential focus is for leaders to create environments that support and
uplift patients and their families. Humanistic care in healthcare
organizations can be facilitated by leaders establishing positive,
supportive, and empowering environments for clinicians and other
employees. Secondly, managers can establish programs to develop
and train employees to provide humanistic care (2).
Ferreira & Artmann (3) presented the pronouncements on
humanization of professionals and users of a health care and
research institution. Interviews were conducted with 16
professionals and 44 users. The analytical method employed was the
Discourse of the Collective Subject, the results of which were
discussed based on the theoretical framework presented, which
includes the Theory of communicative action of Habermas and
recognized authors in the public health area. The findings point to
the importance of the set of hard, light-hard, and light technologies
for humanized practice. The articulation role played by
communicative action was highlighted both for the creation of a
network of professionals and in the relationship between
professionals and patients. The practice of research was considered
by professionals and users as a factor that increases the quality of
care and contributes to humanization. Care at the institute was
considered good, both by practitioners and users, who emphasized
the importance of problem resolution for humanization. The
professionals highlighted the working conditions and the autonomy
of professionals and patients, with the appreciation of each person's
knowledge. The intersectoral work revealed itself to be an important
challenge for the Brazilian Health System (SUS) (3).
Gilmartin (4) mentioned that in the era of technological
proliferation the potential for the holistic intention and practice of
nursing to become overshadowed is immense. This article presents
an overview of the stakeholder theory of management as a useful
and important management model for the creation of health care
delivery environments where the human condition is celebrated,
exemplary service is cultivated, and human caring becomes an
enterprise wide value (4).
de Tarso Puccini & de Oliveira Cecílio (5) discussed the
possibilities and limits of proposals for the humanization of
healthcare. The theoretical references utilized are the concept of
"reification" as a causative explanation for the process of man's
estrangement from his world and the concept of "radical needs" as a
possible way of overcoming traditionalist humanism to achieve
transformative practice. From these notions, an understanding of
the difficulties and contributions of the movement towards
humanization is sought, highlighting the interdependence and limits
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of sectoral changes within healthcare in light of society's concepts

and general values. The article concludes by suggesting that
guidelines for humanization/satisfaction, in bringing together the
critique of society's general questions concerning the daily difficulties
of healthcare services, may keep the comprehensiveness of the right
to healthcare open beyond the limits of current social relations,
thereby favoring a stance that opposes the restrictive trend of
minimal public policies towards healthcare (5).
Franco & al. (6) presented a Modeling Language and its
technological infrastructure to customize the vocabulary of
Communication Boards (CB), which are important tools to provide
more humanization of health care. Using a technological
infrastructure based on Model-Driven Development (MDD) approach,
our Modelin Language (ML) creates an abstraction layer between
users (e.g., health professionals such as an audiologist or speech
therapist) and application code. Moreover, the use of a metamodel
enables a syntactic corrector for preventing creation of wrong
models. The ML and metamodel enable more autonomy for health
professionals in creating customized CB because it abstracts
complexities and permits them to deal only with the domain
concepts (e.g., vocabulary and patient needs). Additionally, the
infrastructure provides a configuration file that can be used to share
and reuse models. This way, the vocabulary modelling effort will
decrease our time since people share vocabulary models. The data
provided an infrastructure that aims to abstract the complexity of CB
vocabulary customization, giving more autonomy to health
professionals when they need customizing, sharing, and reusing
vocabularies for CB (6).
Humanity-Logo-1 – Thriving on Campus.

gbtq2sthrivingoncampus.ca 673 × 492 png.
Cheraghi & al. (7) mentioned that patient-centered care is both a

goal in itself and a tool for enhancing health outcomes. The
application of patient-centered care in health care services globally
however is diverse. This article reports on a study that sought to
introduce patient-centered care. The aim of this study is to explore
the process of providing patient-centered care in critical care units.
The study used a grounded theory method. Data were collected on 5
critical care units in Tehran University of Medical Sciences. Purposive
and theoretical sampling directed the collection of data using 29
semistructured interviews with 27 participants (nurses, patients, and
physician). Data obtained were analyzed according to the analysis
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stages of grounded theory and constant comparison to identify the

concepts, context, and process of the study. The core category of
this grounded theory is "humanizing care," which consisted of 4
interrelated phases, including patient acceptance, purposeful patient
assessment and identification, understanding patients, and patient
empowerment. A core category of humanizing care integrated the
theory. Humanizing care was an outcome and process. Patient-
centered care is a dynamic and multifaceted process provided
according to the nurses' understanding of the concept. Patient-
centered care does not involve repeating routine tasks; rather, it
requires an all-embracing understanding of the patients and showing
respect for their values, needs, and preferences (7).
Fontaine & al. (8) mentioned that the critical care environment
can be designed to become more humanistic. Consideration of the
environmental challenges of noise, lights, color, views, temperature,
and comfort is essential. This article identifies the issues and
concerns in the design of more humanistic healing in critical care
units. Strategies to improve the environment include improving the
physical and emotional tone of the unit through creative design,
family and pet visitation, sleep promotion, and aromatherapy among
others. In a life-threatening illness, attention paid to these concerns
may significantly improve quality of life for patients and family (8).
Busch & al. (9) emphasized that given the automatization of care
and rationing of time and staff due to economic imperatives, often
resulting in dehumanized care, the concept of 'humanization of care'
has been increasingly discussed in the scientific literature. However,
it is still an indistinct concept, lacking well-defined dimensions and to
date no literature review has tried to capture it. The objectives of
this systematic review were to identify the key elements of
humanization of care by investigating stakeholders' (patients,
patients' caregivers, healthcare providers) perspectives and to assess
barriers and strategies for its implementation. A systematic search of
five electronic databases was carried out up to December 2017 as
well as examining additional sources (e.g., gray literature). Search
terms included "humanization/humanization of care" and
"dehumanization/dehumanization of care". A thematic synthesis of
the extracted study findings was conducted to identify descriptive
themes and produce key elements. Of 1,327 records retrieved, 14
full-text articles were included in the review. Three main areas
(relational, organizational, structural) and 30 key elements (e.g.,
relationship bonding, holistic approach, adequate working
conditions) emerged. Several barriers to implementation of
humanization of care exist in all areas. The data demonstrate that
the Authors' systematic review and synthesis contributes to a deeper
understanding of the concept of humanization of care. The proposed
key elements are expected to serve as preliminary guidance for
healthcare institutions aiming to overcome challenges in various
forms and achieve humanized and efficient care. Future studies need
to fully examine specific practices of humanized care and test
quantitatively their effectiveness by examining psychosocial and
health outcomes (9).
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Costa & al. (9) are concerned a practice of assistance built and
implemented with the health team members of an Oncology and
Radiotherapy Service in a large general hospital in the east part of the
state of Rio Grande do Sul, attempting to make the assistance more
humane. It was a possibility of reflecting with the work team about
the assistance provided to the patients in light of the proposals of
SUS (New Public Health System) and with the perspective of the
humanistic approach and its methodological proposals (9).
References
1. Rider EA, Gilligan MC, Osterberg LG, et al. Healthcare at the
crossroads: the need to shape an organizational culture of humanistic
teaching and practice. J Gen Intern Med. 2018;33(7):1092-9.
2. Kilpatrick AO. The health care leader as humanist. J Health Hum
Serv Adm. 2009;31(4):451-65.
3. Ferreira LR, Artmann E. Pronouncements on humanization:
professionals and users in a complex health institution. Cien Saude Colet.
2018;23(5):1437-50.
4. Gilmartin MJ. Humanism in health care service: the role of
stakeholder management. Nurs Adm Q. 2001;25(3):24-36.
5. de Tarso Puccini P, de Oliveira Cecílio LC. Humanization of
healthcare services and the right to healthcare. Cad Saude Publica. 2004;
20(5):1342-53.
6. Franco NM, Medeiros GF, Silva EA, et al. A model-driven approach
to customize the vocabulary of communication boards: towards more
humanization of health care. Stud Health Technol Inform. 2015;216:800-4.
7. Cheraghi MA, Esmaeili M, Salsali M. Seeking humanizing care in
patient-centered care process: a grounded theory study. Holist Nurs Pract.
2017;31(6):359-68.
8 . Fontaine DK, Briggs LP, Pope-Smith B. Designing humanistic critical
care environments. Crit Care Nurs Q. 2001;24(3):21-34.
9. Busch IM, Moretti F, Travaini G, et al. Humanization of care: key
elements identified by patients, caregivers, and healthcare providers. A
systematic review. Patient. 2019;12(5):461-74.
9. Costa CA, Filho WDL, Soares NV. Humanized care for the oncologic
patient: reflections with the health team. Rev Bras Enferm. 2003;
56(3):310-4.
MENTAL CARE. Kogstad & al. (1) mentioned that several

studies in recent years have shown that recovery factors as
experienced by clients are not always compatible with professional
approaches. For example, clients often emphasize the importance of
relationships and the satisfaction of universal human needs. The aim
of the study has been to explore clients' descriptions of beneficial
factors and to discuss the implications of those factors for the
delivery of mental health services. Method has been qualitative
content analysis of 347 user narratives. The study confirms findings
in earlier recovery studies, but also demonstrates that the
investigation of clients' stories leads to a range of existential
dilemmas. Fundamental beliefs about what constitutes effective and
necessary treatment are challenged. Recovery is a fundamentally
personal process that involves finding a new sense of self and feeling
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of hope. it is not only an internal process; it also requires external

conditions that facilitate a positive culture of healing (1).
Fink (2) mentioned that contemporary health care systems have
been criticized as being insensitive to patients' affective needs.
Although the mental health care disciplines have assumed the
guardianship of medical humanism, psychiatrists and behavioral
scientists have unintentionally played a role in the development of
this insensitivity. Preclinical psychiatric curricula and the role models
presented by clinician-teachers often neglect the technologic aspects
of humanistic medicine. This has encouraged a schism between the
affective and cognitive components of medical practice. Alterations
of psychiatric teaching and practice that may foster humanistic
medical practice are suggested (2).
Szasz (3) emphasized that The Council for Secular Humanism
identifies Secular Humanism as a "way of thinking and living"
committed to rejecting authoritarian beliefs and embracing
"individual freedom and responsibility ... and cooperation." The
paradigmatic practices of psychiatry are civil commitment and
insanity defense, that is, depriving innocent persons of liberty and
excusing guilty persons of their crimes: the consequences of both are
confinement in institutions ostensibly devoted to the treatment of
mental diseases. Black's Law Dictionary states: "Every confinement
of the person is an 'imprisonment,' whether it be in a common
prison, or in private house, or in the stocks, or even by forcibly
detaining one in the public streets." Accordingly, the Author
maintained that Secular Humanism is incompatible with the
principles and practices of psychiatry (3).
Allen (4) proposed that psychotherapy is best grounded in science
informed humanism and, more specifically, that psychotherapists at
least implicitly promote ethical, moral - and indeed, virtuous-
behavior. In doing so, therapists are challenged continually to
engage in making evaluative moral judgments without being
judgmental. He contends that psychotherapists, and psychologists
especially, are overly reliant on science and might benefit from being
more explicit in their ethical endeavors by being better informed
about the illuminating philosophical literature on ethics. He highlights
the concept of mentalizing, that is, attentiveness to mental states in
self and others, such as needs, feelings, and thoughts. He proposes
that mentalizing in the context of attachment relationships is
common to all psychotherapies, and that this common process is best
understood conjointly from the perspectives of developmental
psychology and ethics. The Author defends the thesis that employing
psychotherapy to promote ethical, moral, and virtuous functioning
can be justified on scientific grounds insofar as this functioning is
conducive to health (4).
Fink (5) mentioned that contemporary health care systems have
been criticized as being insensitive to patients' affective needs.
Although the mental health care disciplines have assumed the
guardianship of medical humanism, psychiatrists and behavioral
scientists have unintentionally played a role in the development of
this insensitivity. Preclinical psychiatric curricula and the role models
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presented by clinician-teachers often neglect the technologic aspects

of humanistic medicine. This has encouraged a schism between the
affective and cognitive components of medical practice. Alterations
of psychiatric teaching and practice that may foster humanistic
medical practice are suggested (5).
Amieva (6) mentioned that the authors of the present selection of
Latin American Psychiatry texts were characterized by a common
deep humanistic attitude. These prolific writers were able to
establish or extend the scope of the discipline in which they chose to
act, questioning the establishment of rigid boundaries within the
framework of a rigorous epistemological reflection. Thus, the
systematizing spirit of Jose Ingenieros' in the context of positivist
evolutionism, resulted in the act of founding a discipline that
integrated the biological and the social. In the case of Guillermo Vidal
his conception of mental health went beyond the biomedical to
consider psychotherapies as an emotional commitment, continence,
and empathic understanding; with regard to César Cabral his
formation and extensive clinical practice resulted in a work defined
by the inquiring into the theoretical concepts underlying Psychiatry
and Clinical Psychology. This brief selection does not exhaust the
issues or the level of ideas and discussions of Psychiatry in Argentina
but constitutes a textual corpus representative of a disciplinary
conception understood as scientific and humanistic endeavor (6).
Thifault & Kirouac (7) examines the humanization movement at
the Saint-Jean-de-Dieu psychiatric hospital between the 1960s and
the 1990s. Conducting a historiography of psychiatric
deinstitutionalization in Quebec during the twentieth century shows
that the institution was a place of social control and, above all else, a
place where psychiatric patients were neglected and dehumanized.
While the historiography since the 1960s has focused on a largely
one-dimensional and critical reading of the way in which
deinstitutionalization took place in Quebec, the Authors have instead
chosen to focus on the changes that took place within the Quebec
hospital's walls. In addition to the medical records of the patients
who were interned in 1961, interviews were conducted to examine
the experiences and emotions of nurses who worked in the
psychiatric hospital between the 1960s and 1990s. The examination
of medical records revealed patients' reluctance and resistance to
reintegrate into society. The interviews with nurses revealed that
they often felt close to their patients. The words and memories of
nurses enrich and deepen the complexity of the history of psychiatric
nursing practices, extend the existing historiography, and open new
avenues for research in the field. The data indicate that the
deinstitutionalization movement promoted mental health policies
that transformed the old psychiatric hospital. This new analytical
approach contributed to renewing the history of psychiatric nursing
practices (7).
Beltrán-Salazar (8) sought to understand the meaning of
humanized care for those directly participating in it. This was
qualitative research with phenomenological interpretative approach
conducted in Medellín, Colombia, during 2013. It included 16
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participants among nurses, adult patients, and relatives. To gather

the information, in-depth interviews were used; data analysis was
performed manually according to the scheme proposed by Cohen,
Kahn, and Stevees. According to the participants, institutions do not
favor humanized care due to the inaccessibility of services whose
possible causes are, among others, excessive procedural red tape,
lack of resources, and long waits. Additionally, they state that nurses'
work overload keeps them away from the patients and prevents
caring for them. The data show that for the participants in the study,
the humanized care practice of humanized care is affected
negatively, on one side, by the service offered by healthcare
institutions; and, on the other, by the influence exerted upon nurses,
which conditions, in turn, how care is delivered (8).
Unity for Humanity Developer Challenge Begins.

gameindustry.com.
Kirkpatrick (9) mentioned that team ward rounding is a time-

honored practice. Trainees learn not only clinical aspects but also
ethical values of patient care. Despite current emphases on the
principles of professionalism and humanism in medicine, there
remains little discussion about applying these principles to ward
rounds. The Authors believe that rounds can become classrooms for
the intentional inculcation of professionalism and humanism as
counterweights to unintentionally promulgated brusqueness,
ambivalence, cynicism, and frustration. Examples were gathered of
"humanistic rounding" from various institutions that should stimulate
discussion and illustrate that no specialized training is required to
"humanize" rounds; rather, willingness and creativity are key
ingredients (9).
Soberón-Acevedo & al. (10) reviewed of the philosophical analysis
surrounding the concept of "humanism" and what it means to be a
human being, in relationship to daily life, education and medicine.
The authors establish a direct relationship between humanism and
bioethics as they relate to the new trends acquired through the
development of institutional medicine and the increasing application
of technological innovations in the health field. Both of these
conditions tend to depersonalize the practice of medicine and
transform an ill person into a clinical file. Reflections are made about
current topics, such as the knowledge and manipulation of human
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Ben-Nun L. Humanity
genome, assisted reproduction, abortion, survival of premature

infants, organ transplants, technological innovation, euthanasia and
disthanasia. Concepts and ideas are reviewed in relation to medical
institutions and the sick, the physician and the community, and the
physician and the government (10).
Kvesić & al. (11) emphasized that every successful health care
system should be based on some general humanistic ideals.
However, the nationally organized health care systems of most
European countries usually suffer from a deficiency in common
ethical values based on universal human principles. When
transitional societies, such as that of Bosnia-Herzegovina are
concerned, health care organizational models are even more
dysfunctional. The sources of a dysfunction in medical care system of
Bosnia-Herzegovina are manifold and mutually controversial,
including a lack of shared principles, an inappropriate involvement of
politicians in medical care and practice, administrative difficulties
arising from superficial communication systems, as well as economic
limits concerned with the financing of health care. The deficiency of
a moral culture of medicine, which is correlated to a general collapse
of morality is also responsible for many problems affecting various
aspects of life including medical care. Hence, medical ethics from a
virtue perspective is becoming an important ingredient of any
improvement deigned to provide better-quality medical care. The
aim of this paper is to underline the influence of humanism on the
organization of health care systems and the ethics of medical
interrelations in the society of Bosnia-Herzegovina. It is not intended
to diagnose or resolve the problems, but to analyze them. It is also a
critique of specific socio-political-economic influences on this health
care system, inquiring if well-educated individuals in the virtues,
which are involved in medical practice and education, would
counteract them. The data show that humanism creates a universal
ethical structure, which is based on human values such as fidelity,
trust, benevolence, intellectual honesty, courage, compassion, and
truthfulness. These values should represent the standard around
which medical care is organized. Since the health care system in
Bosnia-Herzegovina is not entirely founded upon humanistic ideals,
addressing the socio-political-economic conditions that constantly
undermine those values is a prerequisite for any much-needed
improvements of the medical care (11).
This chapter (1-11) shows that changes in the organization of

medical practice have impeded humanistic practice and resulted in
widespread physician burnout and dissatisfaction.
The characteristics of an organizational culture that supports and
embraces humanism.
Humanism in healthcare management should entail serving of
patients and their families, organizational members, and the
community.
The set of hard, light-hard, and light technologies are important
for humanized practice.
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Ben-Nun L. Humanity
The stakeholder theory of management is a useful and important

management model for the creation of health care delivery
environments where the human condition is celebrated, exemplary
service is cultivated, and human caring becomes an enterprise-wide
value.
The core category of a grounded theory is "humanizing care,"
which consisted of 4 interrelated phases, including patient
acceptance, purposeful patient assessment and identification,
understanding patients, and patient empowerment.
The critical care environment can be designed to become more
humanistic.
References
1. Kogstad RE, Ekeland T-J, Hummelvoll JK. In defence of a humanistic
approach to mental health care: recovery processes investigated with the
help of clients' narratives on turning points and processes of gradual
change. J Psychiatr Ment Health Nurs. 2011;18(6):479-86.
2. Fink EB. Psychiatry's role in the dehumanization of health care. J
Clin Psychiatry. 1982;43(4):137-8.
3. Szasz T. Secular humanism and "scientific psychiatry". Philos Ethics
Humanit Med. 2006 Apr 25;1(1):E5.
4. Allen JG. Psychotherapy is an ethical endeavor: Balancing science
and humanism in clinical practice. Bull Menninger Clin. 2013;77(2):103-
31.
5. Fink EB. Psychiatry's role in the dehumanization of health care. J
Clin Psychiatry. 1982;43(4):137-8.
6. Amieva AN. Psychiatry and humanism in Argentina. Int Rev
Psychiatry. 2016;28(2):133-53.
7. Thifault M-C, Kirouac L. Psychiatric nurses experiences of the
humanization movement during the first and second waves of
deinstitutionalization in Quebec (1960-1990). Rech Soins Infirm. 2019;
(139):99-108.
8. Beltrán-Salazar OA. Healthcare institutions do not favor care.
Meaning of humanized care for people directly participating in it. Invest
Educ Enferm. 2014;32(2):194-205.
9. Kirkpatrick JN, Nash K, Duffy TP. Well rounded. Arch Intern Med.
2005;165(6):613-6.
10. Soberón-Acevedo G, García-Viveros M, Narro-Robles J. New
challenges for humanism in medical practice. Salud Publica Mex. 1994;
36(5):541-51.
11. Kvesić A, Galić K, Vukojević M. Humanism influencing the
organization of the health care system and the ethics of medical relations
in the society of Bosnia-Herzegovina. Philos Ethics Humanit Med. 2019
Sep 14;14(1):12.
EMERGENCY SERVICES
Sousa & al. (1) analyzed the evidence of research carried out on
humanization in urgent and emergency care, considering their
contributions to nursing care. Integrative review of LILACS, CINAHL,
SciELO, Web of Science, SCOPUS, and BDENF databases, was
conducted using the keywords: humanization of care, urgencies,
emergencies, emergency medical services, and nursing. The search
resulted in a total of 133 publications, of which 17 were included in
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the scope of this review. The analysis enabled the elaboration of the
evidence units: 'Reception with Risk Classification: a device with good
results' and 'Barriers and difficulties to use the guidelines of the
National Humanization Policy'. The data indicate that the Reception
with Risk Classification was evidenced as the main device for the
effective implementation of the National Humanization Policy and
there are barriers to its effectiveness related to the organization of
health care networks, structural problems, and multi-professional
work (1).
Viotti & al. (2) examined whether humanity of care and
environmental comfort played a role in moderating the relationship
between waiting time and patient satisfaction in an emergency
department (ED). The study used a cross-sectional and non-
randomized design. A total of 260 ED patients in two hospitals in
Italy completed a self-report questionnaire. Moderated regression
showed that after adjusting for control variables, waiting time was
significantly and inversely associated with patient satisfaction.
Humanity of care and environmental comfort showed a positive and
significant association with patient satisfaction. Finally, the
interaction term between waiting time and humanity of care was
found to be significant, whereas the interaction effect between
waiting time and environmental comfort was not significant. The
conditional effect showed that when humanity of care was low,
waiting time was negatively and significantly related to patient
satisfaction. By contrast, when humanity of care was medium and
high, the relationship between waiting time and patient satisfaction
was not significant. These findings shed light on the key role of
humanity of care in moderating the relationship between waiting
time and patient satisfaction. The complex interrelations emerged
should be carefully considered when interventions to foster patient
satisfaction in an ED context are planned (2).
This chapter (1-2) demonstrates that humanization in urgent and

emergency services contribute to nursing care. Humanity of care and
environmental comfort show a positive and significant association
with patient satisfaction. The interaction term between waiting time
and humanity of care is significant, whereas the interaction effect
between waiting time and environmental comfort was not
significant.
References
1. Sousa KHJF, Damasceno CKCS, Almeida CAPL, et al. Humanization in
urgent and emergency services: contributions to nursing care. Rev Gaucha
Enferm. 2019 Jun 10;40:e20180263.
2. Viotti S, Cortese CG, Garlasco J, et al. The buffering effect of
humanity of care in the relationship between patient satisfaction and
waiting time: a cross-sectional study in an emergency department. Int J
Environ Res Public Health. 2020 Apr 24;17(8):2939.
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Ben-Nun L. Humanity
HOSPITAL CARE
Graber (1) noticed that caring and humanism in hospitals exist on
both the organizational and the individual levels. This paper
identifies key organizations and foundations that have succeeded in
promoting or fostering caring environments in hospitals. These
include the Picker Institute, the Baptist Healing Trust, Sage
Consulting, and the Caritas Consortium. Exemplary, caring clinicians
in hospitals are also described. These clinicians developed positive
relationships with patients and in interviews communicated a
number of approaches to express caring to patients. Health and
human services managers can take a number of steps to promote
caring among their clinicians. However, they must implement a
culture and a reward system that encourages humanism (1).
Lima & al. (2) aimed at evaluating the professionals' satisfaction
of a municipal pediatric hospital of Fortaleza with relationship to the
humanization of the attendance in the hospital, as National Program
of Humanization of the Hospital Assistance extolled by ministry of
Health. The descriptive study had as sample 38 professionals. The
data collection was carried out by a questionnaire, being the data
presented in tables. Interaction was detected between the
administration of the hospital and the professionals by internal
discussions to evaluate the service. They consider the work
environment is comfortable for their work practice, therefore some
improvement was indicated. The support for the professionals was
suggested as an improvement point. The professionals suggested
trainings, improvement of the atmosphere of the hospital and quality
of the attendance. It is expected that this study supplies subsidies for
the planning of actions favorable for the humanization of hospital
assistance (2).
Nogueira-Martins & al. (3) analyzed the profile of volunteers and
their work process in hospital humanization. The following
instruments were used: a sociodemographic questionnaire and a
semi-structured interview, applied to 26 volunteer coordinators and
26 volunteers, who belong to 25 hospitals in the metropolitan area of
São Paulo, Southeastern Brazil, between 2008 and 2009. Interviews
were analyzed according to thematic analysis principles. Five main
themes were identified: volunteer profile (age, sex, level of income);
volunteer work organization (volunteer agreement, training);
volunteer-hospital relationship (relationship with hospital
management and employees); motivation (solidarity, previous
experience with family members' or one's own diseases, personal
satisfaction, conflict resolution) and benefits (individual, dual,
collective); and humanization and volunteer activities (patient care,
logistic support, emotional support, development of patients'
abilities, leisure, organization of commemorative events). The data
demonstrate that in the activity developed by volunteers, there are
positive aspects (such as the contribution to hospital humanization)
and negative aspects (such as volunteers performing activities
assigned to employees). Attention should be paid to the regulation
of volunteer activities, especially patient care, and actions that value
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volunteer work in hospitals and volunteer integration into

humanization work groups (3).
Buffoli & al. (4) emphasized that in the healthcare environment,
nowadays, only a few among the available evaluation systems pay
enough attention to certain social sustainability aspects. Among
these, humanization plays a key role in an environment, like
hospitals, where the mental and physical well-being of patients and
healthcare operators is crucial. The research project, known as
'SustHealth', is focused on the deficiencies of the evaluation
methodology and aims at developing an assessment system related
to a questionnaire-based investigation capable of revealing the most
influential conditions and dynamics in people's hospital experience,
while also recommending areas in hospitals where efforts can be
made to sustain improvement strategies. The humanization of
healthcare structures began with a significant investigation to assess
all the major evaluation tools in both hospitals - to better understand
the physical and emotional interactions in the structure-user ratio -
and other areas. This helped understand the strengths and
criticalities of the systems that were examined. This first step also
allowed to shed light on the most important aspects to keep in mind
when developing an evaluation system. During the operational steps
an all-new LpCp - tool (Listening to people to Cure people) was
created, which includes a questionnaire-based investigation and
processing software, and its application for beta-testing in a 600-bed
hospital in Milan. The LpCp - tool proved to be effective and capable
of finding the deficiencies and potential in the examined hospital.
Considering different themes through alternative viewpoints (staff,
patients/visitors, technicians, etc.), the tool has allowed underlining
different perceptions of the same place and also provided sound
information to guide healthcare management in taking informed
decisions about specific problems or users. Former interesting
results show an inadequate appraisal about e.g., on-site facilities or
recreational activities and a lack of perception on existing services by
users (e.g., translation, P.R.). The data demonstrate that the LpCp -
tool was presented to other healthcare centres in Milan for wider-
scale testing. Therefore, the LpCp - tool will hopefully increase
healthcare companies' responsiveness towards improving comfort
and humanization levels in hospitals. Sometimes all that is needed
are small and inexpensive actions that often improve a hospital user's
experience, and often important services are not used due to a lack
of communication and information (4).
de Amorim Gomes & al. (5) evaluated the humanization of
hospital care ethnically, as perceived by the hospitalized patients.
Data were collected from 13 inpatients from January to July/2005 in
a public hospital in Fortaleza, Ceará, Brazil, according to the patient's
circuit. This analysis yielded the following categories: ethnic
evaluation of the hospital structure and dynamics, hospital and
professional image, human and technical competence. The subjects
used multiple aspects to soften their opinions, unveiling factors
named mediators of the ethnical evaluation. Such aspects were
categorized into conditions of the interview, socio-economic status,
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Ben-Nun L. Humanity
user's personality and religiousness, ironic speech, somber diagnosis,

and necessities met, and prior hospitalization experiences. The
elements revealed by the patients are significant in order to
encourage professionals and mediators to mobilize towards
humanizing changes, including the user as a social and critical ethnic
evaluator (5).
Lemos (6) noticed that since the late seventies, the Portuguese
pediatric health services have gradually been accepting and desiring
the presence of a family member during a child's hospital stay, due to
the affective and psychological benefits thereof. This attitude was
extended to include the emergency room, wards, and intensive care
units. In the majority of cases there is a perfect understanding
between the health care team and the family member. It would be
of the utmost importance for the humanization of the respective
Services that the health care professionals of the adult hospitals,
which are still very conservative with respect to this issue, should be
encouraged to follow the Pediatric experience (6).
This chapter (1-6) shows that caring and humanism in hospitals

exist on both the organizational and the individual levels.
The professionals' satisfaction of a municipal pediatric hospital of
Fortaleza with relationship to the humanization of the attendance in
the hospital.
There are positive aspects of the activity developed by volunteers,
(such as the contribution to hospital humanization) and negative
aspects (such as volunteers performing activities assigned to
employees).
Humanization plays a key role in an environment, like hospitals,
where the mental and physical well-being of patients and healthcare
operators is crucial.
LpCp-tool (Listening to people to Cure people) will increase
healthcare companies' responsiveness towards improving comfort
and humanization levels in hospitals.
References
1. Graber DR. Organizational and individual perspectives on caring in
hospitals. J Health Hum Serv Adm. 2009;31(4):517-37.
2. Lima FET, Jorge MSB, Moreira TMM. Hospital humanization:
professional satisfaction in a pediatric hospital. Rev Bras Enferm. 2006;
59(3):291-6.
3. Nogueira-Martins MCF, Bersusa AAS, Siqueira SR. Humanization and
volunteering: a qualitative study in public hospitals. Rev Saude Publica.
2010;44(5):942-9.
4. Buffoli M, Bellini E, Bellagarda A, et al. Listening to people to cure
people: the LpCp - tool, an instrument to evaluate hospital humanization.
Ann Ig. 2014;26(5):447-55.
5. de Amorim Gomes AM, Moura ERF, Nations MK, do Socorro Costa
Feitosa Alves M. Ethnic evaluation of hospital humanization by the users
of the Brazilian Unified Health System and their mediators. Rev Esc
Enferm USP. 2008;42(4):635-42.
6. Lemos L. The aspects of humanizing in hospitals for adults. We
learn from pediatric experience!. Acta Med Port. 1996;9(10-12): 383-5.
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INTENSIVE CARE
Luiz & al. (1) aimed to understanding perceptions of family
members and healthcare professionals about humanization at the
Intensive Care Unit (ICU) to direct it to an educational action.
Exploratory descriptive and qualitative study conducted in an ICU
level 3 of a public hospital in Porto Alegre, RS, Brazil, with fourteen
subjects, eight family members and six healthcare professionals.
Data collection carried out through semi-structured interviews and
focus group. Content Analysis was used. Emerged categories were
welcoming; communication; ethical and sensible professionalism;
unfavorable aspects; perception on humanization; and
religiosity/spirituality. Although the subjects have expressed their
perceptions about humanization in different ways, both groups
pointed out the same needs and priorities to improve humanization
in Intensive Care. From the results, a reflective manual of
humanizing assistance practices was created for professionals, a
board to facilitate communication of these professionals with
patients and a guideline book for family members (1).
Mongiovi & al. (2) mentioned that The National Policy of Care
Humanization and Health System Management are configured as a
complex public policy which encompasses the structural, technical,
and relational aspects of the health service. However, this policy has
failed at establishing the boundaries of its activities and the
conceptual aspects of the humanization term. This study aimed to
perform a reflection about the humanization of health through a
conceptual analysis of the term itself and in the interpretation of
speeches of nurses working in Intensive Care Units, collected in
qualitative research. It was concluded that nurses have an intuitive
insight of the definition of humanization, understanding the necessity
of conducting a holistic assistance beyond mere technique and also
covering the physiological, psychological, social, and spiritual aspects
of care. At the same time, they demonstrate the lack of preparation
in professional education for the implementation of this humanized
assistance (2).
Evangelista & al. (3) mentioned that the aim was to understand
the meaning of humanized care in intensive care units considering
the experience of the multidisciplinary team. This was a descriptive
and exploratory qualitative research. For this purpose, semi-
structured interviews were conducted with 24 professionals of the
heath-care team, and, after transcription, the qualitative data were
organized according to content analysis. From two main categories,
the Authors were able to understand that humanized care is
characterized in the actions of healthcare: effective communication,
team work, empathy, singularity, and integrality; and
mischaracterized in the management processes, specifically in the
fragmentation of the work process and health care, in the precarious
work conditions, and in differing conceptual aspects of the political
proposal of humanization. The data show that care activities in
intensive therapy are guided by the humanization of care and
corroborate the hospital management as a challenge to be overcome
to boost advances in the operationalization of this Brazilian policy (3).
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Rico & al. (4) analyzed those aspects of the relationship between
the health care team of an ICU that may be decisive in the
construction of humanized care. This was phenomenology:
descriptive and exploratory study. Analysis and observation unit
included Polyvalent 23-bed adult ICU. Nine extensive interviews
were collected. Healthcare professionals in interaction in the ICU
were studied. Analysis included assigning of data to emergent
categories. Contrasting with existing theories. Identification of
guideline values circumspect to the humanistic paradigm. The value
of professional role is accepted as emergency factor of certain
attitudes. All the professional groups detect lack of independence
situations, which are not always attributable to hierarchical reasons.
Systematic interdisciplinary communication is evaluated positively.
Humanization requires time, resources, and intergroup relationships
and explicit commitment by the institution. The data demonstrate
that relief of great suffering situations is the main reason for
interdisciplinary disagreement. Construction of a tolerant setting and
institutional recognition as factors favoring humanized care. Lack of
time and resources as obstacles to the humanization of care (4).
Harvey (5) mentioned that when the pregnant woman becomes
critically ill, it is essential that she and her fetus receive the care that
a specialized ICU provides. This unit is the setting for an expert
medical, nursing, and technical staff to use sophisticated, state-of-
the-art equipment for intensive monitoring and the immediate life-
saving interventions that may be necessary. However, care in an ICU
sometimes becomes focused on the machinery, rather than on the
patient. It is imperative that the humanizing aspects of critical care
be addressed in caring for a pregnant patient and her family.
Obstetric critical care can benefit from the data in the critical care
literature that addresses family and patient needs in an ICU.
Obstetric literature and past experiences in implementing family-
centered maternity care also can be used to identify the need for
humane care and to enhance the ICU experience (5).
Ashworth (6) mentioned that at surface level it is obvious that
high technology and humanity are involved in intensive care, since
many sophisticated biomedical techniques and machines are used,
and all varieties of humankind may pass through ICUs. But it is
important to consider the title topic, and it is proposed here to
consider first high technology, then human aspects of intensive care,
and the context which affects both (6).
This chapter (1-6) shows that although the subjects have

expressed their perceptions about humanization in different ways,
there is the same needs and priorities to improve humanization in
Intensive Care.
Nurses have an intuitive insight of the definition of humanization,
understanding the necessity of conducting a holistic assistance
beyond mere technique and also covering the physiological,
psychological, social, and spiritual aspects of care.
Care activities in intensive therapy are guided by the
humanization of care and corroborate the hospital management.
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Humanization requires time, resources, and intergroup

relationships and explicit commitment by the institution.
The humanizing aspects of critical care be addressed in caring for
a pregnant patient and her family.
High technology and humanity are involved in the. intensive care.
References
1. Luiz FF, Caregnato RCA, da Costa MR. Humanization in the intensive
care: perception of family and healthcare professionals. Rev Bras Enferm.
2017;70(5):1040-7.
2. Mongiovi VG, de Cássia Cordeiro Bastos Leite dos Anjos R, Soares
SBH, Lago-Falcão TM. Conceptual reflections on health humanization:
conception of nurses from intensive care units. Rev Bras Enferm.
2014;67(2):306-11.
3. Evangelista VC, da Silva Domingos T, Siqueira FPC, Mara Braga EM.
Multidisciplinary team of intensive therapy: humanization and
fragmentation of the work process. Rev Bras Enferm 2016; 69(6):1099-107.
4. Rico LR, Marsans MC, Márquez CM, et al. Interdisciplinary
relationships and humanization in intensive care units. Enferm Intensiva.
2006;17(4):141-53.
5. Harvey MG. Humanizing the intensive care unit experience.
NAACOGS Clin Issu Perinat Womens Health Nurs. 1992;3(3):369-76.
6. Ashworth P. High technology and humanity for intensive care.
Intensive Care Nurs. 1990;6(3):150-60.
NUTRITIONAL CARE
Pedroso & al. (1) analyzed the actions of alimentary and
nutritional care considering the perspectives of the nutritionists in a
hospital reference for the National Politics of Humanization (PNH).
From a qualitative approach, a focal group technique was used. The
nutritionists were divided in two groups by working time, following
homogeneity criteria. The interviews were developed for analysis of
the category: Being a nutritionist for a humanized assistance, seeking
to understand these professionals' following actions: nutritional
evaluation of the patient; planning, implementation, and evaluation
of the nutritional and alimentary care. The analysis of the content
was used as a technique for the systematization of the collected
information grouped in units of meaning. The study disclosed that
there is prioritization of the individualized assistance in function of
the number of beds and bureaucratic activities, lack of autonomy in
relation to the prescription of diets, difficulties of interaction with
other health professionals and between the nutritionists of the
clinical and meal production areas. The results will provide the
professional subsidies that substantiate actions for the construction
of a model of humanized alimentary and nutritional care on hospitals
(1).
Demário & al. (2) mentioned that the objective of the study was
to know the perception of patients about feeding in a reference
hospital for the National Humanization Politics. It is qualitative
research with twenty-six in depth and half-structuralized interviews
had been carried through. The interviews were applied to internee
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patients (adults and elders) with four or more days in health clinic.
The study revealed that the patients approved the good attendance
and the humanized health team care. The feeding is perceived as
part of the institution rules, relating it with the disease and the
health recovery. Also, the companion presence, the hospital
environment, medicines, and sensorial aspects are considered to
influence the feeding acceptance. The meal time was considered a
model to be followed. The patients had demonstrated difficulty in
revealing opinions about changes in the feeding or routines. The
meal time is an interaction moment among the patients,
companions, and health team. The study concluded that in order to
eat well in a hospital depends on what the patients is allowed to
because of their diseases, showing that, there is no hospital food
identification with their feeding history, preferences, or habits in life
(2).
This chapter (1-2) shows that hospital nutritional care: is

important perception of the nutritionist for humanized attendance.
Hospital food: is perceived as part of the institution rules of
humanized care, relating it with the disease and the health recovery
and of humanized care.
References
1. Pedroso CGT, de Sousa AA, de Salles RK. Hospital nutritional care:
perception of the nutritionist for humanized attendance. Cien Saude
Colet. 2011;16 Suppl 1:1155-62.
2 . Demário RL, de Sousa AA, de Salles RK. Hospital food: perceptions
of patients in a public hospital with a proposal of humanized care. Cien
Saude Colet. 2010;15 Suppl 1:1275-82.
HUMANE DOCTOR
Charlton (1) mentioned that the holistic doctor is sometimes
proposed as an ideal. However, holism involves an expansion of
medical categories to encompass most of 'normal' life as well as
sickness. The humane doctor is suggested as a better ideal. He or
she is wise, compassionate, and liberally educated; and knows that
there is more to life than medicine-both for doctors and their
patients. Humane practice is promoted by a broad and rigorous
education but inhibited by excessive busyness and pressurized
conditions of work. This has implications for medical training and
work practices (1).
Chou & al. (2) emphasized that humanism is fundamental to
excellent patient care and is therefore an essential concept for
physicians to teach to learners. However, the factors that help
attending physicians to maintain their own humanistic attitudes over
time are not well understood. The Authors attempted to identify
attitudes and habits that highly humanistic physicians perceive allow
them to sustain their humanistic approach to patient care. In 2011,
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the Authors polled internal medicine residents at the University of

Pennsylvania to identify attending physicians who exemplified
humanistic patient care. In this cross-sectional, qualitative study, the
Authors used a semistructured script to interview the identified
attending physicians to determine attitudes and habits that they
believed contribute to their sustenance of humanistic patient care.
Attitudes for sustaining humanism in this cohort of humanistic
physicians included humility, curiosity, and a desire to live up to a
standard of behavior. Many of the physicians deliberately worked at
maintaining their humanistic attitudes. Habits that humanistic
physicians engaged in to sustain their humanism included self-
reflection, connecting with patients, teaching and role modeling, and
achieving work-life balance. Physicians believed that treating their
patients humanistically serves to prevent burnout in themselves. The
data show that identification of factors that highly humanistic
attending physicians perceive help them to sustain a humanistic
outlook over time may inform the design of programs to develop and
sustain humanism in teaching faculty (2).
Arnold & al. (3) noticed that efforts to teach and evaluate
humanistic qualities in physicians in residency training are marred by
ambiguous goals. The humane physician can be characterized by
four distinct qualities: technical competence, humanistic attitude,
knowledge of humanistic concepts, and humanistic behavior.
Education in the humanities can foster humanistic attitudes, but it
cannot promise to lead to changes in behavior. Likewise, although
formal training in communication teaches the skills necessary for
humanistic behavior, without an understanding of humanistic
concepts these skills may not serve medical or moral ends.
Evaluation of the humane physician must also include modalities that
test attitude, knowledge, and behavior. Testing one characteristic
does not ensure competence in other areas; knowledge of the
requirements for informed consent, for example, does not guarantee
one's ability to discuss this concept effectively with patients. In this
article, ways are suggested to combine the humanities and
communication skills in the clinical setting and both the training, and
the evaluation of humane physicians are emphasized (3).
Vogt & al. (4) noticed that the practicing doctor, and most
obviously the primary care clinician who encounters the full
complexity of patients, faces several fundamental but intrinsically
related theoretical and practical challenges - strongly actualized by
so-called medically unexplained symptoms (MUS) and multi-
morbidity. Systems medicine, which is the emerging application of
systems biology to medicine and a merger of molecular biomedicine,
systems theory, and mathematical modelling, has recently been
proposed as a primary care-centered strategy for medicine that
promises to meet these challenges. Significantly, it has been
proposed to do so in a way that at first glance may seem compatible
with humanistic medicine. More specifically, it is promoted as an
integrative, holistic, personalized, and patient-centered approach. In
this article, the Authors ask whether and to what extent systems
medicine can provide a comprehensive conceptual account of and
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approach to the patient and the root causes of health problems that
can be reconciled with the concept of the patient as a person, which
is an essential theoretical element in humanistic medicine. This
question was answered through a comparative analysis of the
theories of primary care doctor Eric Cassell and systems biologist
Denis Noble. The Authors argue that, although systems biological
concepts, notably Noble's theory of biological relativity and
downward causation, are highly relevant for understanding human
beings and health problems, they are nevertheless insufficient in fully
bridging the gap to humanistic medicine. Systems biologists are
currently unable to conceptualize living wholes, and seem unable to
account for meaning, value and symbolic interaction, which are
central concepts in humanistic medicine, as constraints on human
health. Accordingly, systems medicine as currently envisioned
cannot be said to be integrative, holistic, personalized, or patient-
centered in a humanistic medical sense (4).
Sevilla-Godínez & Sevilla (5) presented a critical analysis of
current society making emphasis on the human needs to generate
domain among equals, as well as the sense of competition and
division that this creates. It addresses the process of dehumanization
that the same civilization has generated focusing on Laboral
paradigm of our days and the weak social justice that unequal wealth
distribution has generated. It has been seen that health
professionals involved in such context, have not escaped socio-
cultural pressure and postmodern neo-liberal position. The paper
discusses about the humanizing role health professionals have in
society, and the relevance of the philosophical exercise in their acts
above human frailty. Finally, it is suggested an alternative for
repositioning to himself and society (5).
Abbott (6) examined humanism as exhibited in physicians and to
develop and standardize an instrument measuring humanism in
physicians. This study had four specific objectives: 1] to determine
whether family practice residents are more humanistic than internal
medicine and surgery residents, 2] to determine whether there is a
difference in the level of humanism in residents in different years of
training, 3] to determine the relationship of demographic
characteristics to level of humanism, and 4] to determine the
relationship of family practice residency characteristics to level of
humanism. The Physician Humanism Scale was developed,
pretested, modified, and then administered to a sample (600) of
family practice, internal medicine, and surgery residents. The study
identified that family practice residents are significantly more
humanistic than internal medicine and surgery residents, although no
difference in level of humanism was identified according to year in
residency. Significant relationships were identified between
humanism and sex, race, age, marital status, and college major.
Residency characteristics significantly related to humanism were
numbers of residents, full-time faculty, nonphysician faculty, and
associated residencies; hospital size; and moonlighting policy (6).
Linn & al. (7) mentioned that in an extensive survey of
postgraduate physicians in two teaching hospitals (n=141) for their
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humanistic attitudes, values and behavior, all ratings of physicians'

humanistic performance, including physicians' own scores on self-
report measures, supervising faculty, nurses, and patient ratings,
were modestly but significantly correlated with each other. Sex,
ethnic or racial background, year of training, marital status, number
of children, Alpha-Omega-Alpha membership or number of articles
published were unrelated to physicians' humanistic behavior. Several
measures of humanism were positively correlated with having taken
more courses in the social sciences and humanities, having had more
early person-centered work experience, and reporting that before
medical school others had confided in them or sought their advice
more frequently (7).
Weaver & al. (8) determined what behaviors patients perceive as
reflecting a physician's humanistic qualities, to develop an instrument
for patients to use to assess the humanistic behaviors of their own
physicians, and to compare patient assessment of residents'
humanistic behaviors with patient satisfaction and the assessment of
attending physicians. This was a cross-sectional descriptive study,
using patient interviews and questionnaires, and evaluations of
residents by attending physicians. Setting: Inpatient medical service
in a tertiary care teaching hospital and in a primary care internal
medicine clinic. Participants included six medical interns and six
medical residents, 119 medical patients in the hospital, and 111
patients in the internal medicine clinic. The 25-item Physicians'
Humanistic Behaviors Questionnaire (PHBQ) was developed from
patients' statements about important humanistic behaviors. The
mean PHBQ scores were 4.46 +/- 0.22 (mean +/- SD, on a scale of 1 to
5) in the clinic and 4.18 +/- 18 in the hospital (p=0.003). The
Spearman's rank correlations between the PHBQ and the Medical
Interview Satisfaction Scale (MISS) were r = 0.8741 (p<0.001) in the
hospital and r = 0.8751 (p<0.001) in the internal medicine clinic. The
Spearman's rank correlation between the hospital PHBQ and the
attending physician evaluations (for the six residents for whom the
authors had complete data) was r = 0.5753 (p=0.232). The data
demonstrate that patients can evaluate the humanistic behaviors of
their physicians using the PHBQ. There is good correlation between
the PHBQ and patient satisfaction, which supports the validity of the
PHBQ. The relative lack of agreement between patients and
attending physicians suggests different observations, criteria, or
standards. The higher ratings from patients in the clinic compared
with those from patients in the hospital suggest that residents'
behaviors are different or that patients have different observations,
criteria, or standards in the two settings. Therefore, a complete
assessment of residents' humanistic behaviors may require sampling
in both settings (8).
Hatem & Ferrara (9) qualitatively examined themes covered in a
creative writing elective designed to enhance pre-clinical medical
students' writing, observation, and reflection skills relative to
experiences in their medical education. Qualitative analysis of
writings' themes was carried out via iterative consensus building
process and validated through member checks and literature review.
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Ben-Nun L. Humanity
Fourteen students completed the elective, seven for each year it was
given. Students submitted 86 written pieces. Qualitative analysis
demonstrated the presence of nine themes: students' role confusion,
developing a professional identity, medicine as a calling, physician
privilege and power, humanizing the teacher, the limits of medicine,
death and dying, anticipating future challenges, and identification
with the patient. Students evaluated this creative writing course
favorably, indicating value in writing and reflection. Themes covered
are of concern to second-year medical students as well as other
trainees and practicing physicians. Writing may aid in the
professional development of physicians (9).
This chapter (1-9) shows that the humane doctor is suggested as a

better ideal. He or she is wise, compassionate, and liberally
educated; and knows that there is more to life than medicine-both
for doctors and their patients.
Humanism is fundamental to excellent patient care and is
therefore an essential concept for physicians to teach to learners.
Attitudes for sustaining humanism include humility, curiosity, and
a desire to live up to a standard of behavior. Many of the physicians
deliberately worked at maintaining their humanistic attitudes. Habits
that humanistic physicians engaged in to sustain their humanism
included self-reflection, connecting with patients, teaching and role
modeling, and achieving work-life balance.
The humane physician is characterized by four distinct qualities:
technical competence, humanistic attitude, knowledge of humanistic
concepts, and humanistic behavior.
Patients can evaluate the humanistic behaviors of their physicians
using the Physicians' Humanistic Behaviors Questionnaire.
References
1. Charlton BG. Holistic medicine or the humane doctor? Br J Gen
Pract. 1993;43(376):475-7.
2. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly
humanistic physicians. Acad Med. 2014;89(9):1252-8.
3. Arnold RM, Povar GJ, Howell JD. The humanities, humanistic
behavior, and the humane physician: a cautionary note. Ann Intern.
1987;106(2):313-8. Erratum in Ann Intern Med. 1987;106(5):784.
4. Vogt H, Ulvestad E, Eriksen TE, Getz L. Getting personal: can systems
medicine integrate scientific and humanistic conceptions of the patient? J
Eval Clin Pract. 2014;20(6):942-52.
5. Sevilla-Godínez HT, Sevilla E. The physician's humanizing role.
Philosophical view of socio-anthropological work in medicine. Rev Med
Inst Mex Seguro Soc. 2010;48(1):87-90.
6. Abbott LC. A study of humanism in family physicians. J Fam Pract.
1983;16(6):1141-6.
7. Linn LS, Cope DW, Robbins A. Sociodemographic and premedical
school factors related to postgraduate physicians' humanistic
performance. West J Med. 1987;147(1):99-103.
8. Weaver MJ, Ow CL, Walker DJ, Degenhardt EF. A questionnaire for
patients' evaluations of their physicians' humanistic behaviors. J Gen
Intern Med. 1993;8(3):135-9.
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9. Hatem D, Ferrara E. Becoming a doctor: fostering humane

caregivers through creative writing. Patient Educ Couns. 2001;45(1):13-
22.
HUMANISTIC NURSING
Watson (1) offered a new view of old and timeless values: the
essential ethic of love, informed by contemporary European
philosophies, and caring theory, as well as ancient poetry and
wisdom traditions. It integrates some of the philosophical views of
Levinas and Logstrup with Watson's Transpersonal Caring Theory.
The metaphysics, metaphors, and meanings associated with "ethics
of face," the "infinity of the human soul," and "holding another's life
in our hands" are tied to a deeply ethical foundation for the timeless
practice of love and caring, as a means to sustain, not only our shared
humanity, but the profession of nursing itself (1).
Wu & Volker (2) presented a discussion of the relevance of
Humanistic Nursing Theory to hospice and palliative care nursing.
The World Health Organization has characterized the need for expert,
palliative, and end-of-life care as a top priority for global health care.
The specialty of hospice and palliative care nursing embraces a
humanistic caring and holistic approach to patient care. As this
resonates with Paterson and Zderad's Humanistic Nursing Theory, an
understanding of hospice nurses' experiences can be investigated by
application of relevant constructs in the theory. This article is based
on Paterson and Zderad's publications and other theoretical and
research articles and books focused on Humanistic Nursing Theory
(1976-2009), and data from a phenomenological study of the lived
experience of Taiwanese hospice nurses conducted in 2007.
Theoretical concepts relevant to hospice and palliative nursing
included moreness-choice, call-and-response, intersubjective
transaction, uniqueness-otherness, being and doing and community.
The philosophical perspectives of Humanistic Nursing Theory are
relevant to the practice of hospice and palliative care nursing. By
'being with and doing with', hospice and palliative nurses can work
with patients to achieve their final goals in the last phase of life. The
data demonstrate that use of core concepts from Humanistic Nursing
Theory can provide a unifying language for planning care and
describing interventions. Future research efforts in hospice and
palliative nursing should define and evaluate these concepts for
efficacy in practice settings (2).
Silva (3) represented the integration of a reflected nursing
experience, an organizing theoretical framework, and the
illumination from selected literature. The genesis of this work came
with an invitation to recall a treasured story of caring in nursing
practice. The story is situated within the nursing theoretical
framework of Paterson and Zderad's humanistic work. Relevant
selections from the literature provide thematic insights into the
meaning of caring as lived in nursing practice (3).
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Mulholland (4) addressed the emergence of a humanist discourse

within nursing and questions the extent to which it represents the
panacea implied within much of the humanist nursing literature.
Particular attention will be given to whether it represents an
ontological and epistemological framework capable of understanding
the social, economic, and political dynamics formative in the
structuring of nurse-client relations. It will be argued that the
humanist analyses extant within much nursing literature are vague,
idealistic, inconsistent, and inadequate in the sense that they offer
little by way of a meaningful analysis of power. A critique will also be
made of the methodological individualism implicit within much
humanist analyses. The paper will go on to identify the influence of
humanist approaches on transcultural theory, and the manner in
which the epistemological foundations of the latter have shared the
limitations of the humanistic nursing approach generally. As such,
the transcultural nursing literature is often vague, inconsistent in its
use of terminology, lacking in any rigorous analysis of power, and
suspect in its conceptualizations of culture. Its capacity for enabling
nurses to examine critically the socio-economic and political
dynamics of nurse-client relations and develop strategies for
addressing racisms, considered by many to be endemic within
nursing and health care system generally, is seriously undermined
(4).
Salazar (5) 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 2012
and March 2013. The patient's situation, the nurses' communication
skills, and the condition of both, as human beings, influence upon the
words, gestures, and attitudes during the nurse-patient relationship,
where the presence, that which is done, and how it is done permit
leaving an important impression on patients and their relatives. The
data show that the interaction between patients and nurses goes
through various stages until achieving the necessary empathy,
compassion, affection, and familiarity to account for humanized care
(5).
Collet & Rozendo (6) reflected on the theme of the 63rd. Annual
Nursing Week "Humanization and Work: reason and meaning in
Nursing". The relationship is discussed between humanization/work
in nursing, differentiating the aspects related to the humanization of
nursing work to those of the humanized work in nursing. The
challenges of the process of humanization of assistance and of work
relationships imply on the overcoming of the relevance given to the
technical scientific competence, routine patterns which are
crystallized, conventional models of management, corporativism of
the different professional categories in favor of interdependence and
the complementarity in health actions; construction of a utopia of
the humanization as collective process which can be reached and
implemented (6).
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Casate & Corrêa (7) analyzed the scientific production about

"humane health care/nursing", understanding what views on
humanization have been developing. A bibliographic survey was
carried out, covering the period from the end of the 1950's until
today, in the periodicals Revista Brasileira de Enfermagem, Revista
Paulista de Hospitais and Texto e Contexto, examining 42 articles,
which were then subject to analysis and integrative synthesis. The
issue has been developing from a charitable perspective to the
current preoccupation with the valuation of health as a civil right,
inserted in a political health project. Articles from all decades reveal
the need to invest in workers, valuing the subjective dimension.
Nevertheless, humanization receives little attention in education.
Care humanization supposes the meeting of subjects who share
knowledge, power, and experiences, implying political, administrative
and subjective transformations (7).
Braun & al. (8) mentioned that technology is increasing. "The
most stable characteristic of the present health care system, is
change, characterized by expansion and experimentation ". To date,
nursing has taken a reactive role, adapting out of necessity rather
than taking an active part in initiating or promoting specific change.
Consequently, the health care system has had and continues to have
a greater impact on nursing than nursing on the health care system.
Two hypothetical frameworks, humanistic and technological, are
presented with which to approach the problem of increasing
technology. The values and implications of each are examined within
the context of the nursing profession (8).
de Azevedo & al. (9) noticed that that aim was to understand the
perception of nursing workers working in the Intensive Care Unit
(ICU) regarding humanization in the work environment. The
reference of phenomenology, structure of the phenomenon was
used. Participated 25 nursing professionals working in an adult ICU
of a university hospital, through focused interviews, answering the
guiding question: What do you understand by humanization of the
working conditions of the nursing team working in the ICU? The
analysis revealed the themes: humanization in the ICU; working
condition in the ICU; management of people in the ICU and
management process in the ICU. Humanization is necessary through
the change of the work environment and the managerial process,
privileging the participatory management model as a way to
transform theory into practice and value the worker (9).
According to McCaffrey (10), humanism has appeared
intermittently in the nursing literature as a concept that can be used
in understanding nursing. The Author return to the concept in
response to noticing the term appearing in the context of health
humanities, where it is loosely associated both with humanities and
being humane. The usage and critiques of humanism were reviewed
in both nursing and medical literature and then re-evaluate what the
idea of humanism might hold for nursing, trying to avoid the traps of
an over-determination of the human subject, or dichotomizing
nursing as art or science, technology or caring. Writings on
humanism were drawn primarily from Emmanuel Levinas and Edward
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Said to emphasize strands in humanism of obligation towards others

and of critical discernment within history and culture directed
towards democratic practices. Passing the strong association were
discussed in the UK particularly between humanism and scientism as
a note of caution about the plurality of the term humanism. The data
demonstrate that humanism is a tradition that does offer productive
ways of thinking about nursing with the proviso that it ought to be
treated carefully as a problematic tradition and not as a new essence
for nursing (10).
Yeh & Lee (11) stressed that as nursing is an art that emphasizes
the nature of caring it should have humanistic attributes. Humanistic
education of a nursing professional should emphasize a person-
centered perspective in order to foster cultivation of the humanities
and infuse the spirit of humane care into medical practice.
Cultivation of humanism refers to the emotional level of personal-
affective experience that blends humanistic science and aesthetic
experience to enhance nurse observational abilities. The ability
generated by self-awareness and reflection can trigger deep empathy
and empathetic performance, which is ideal humanistic-nursing
behavior in nursing staff. Traditional nursing education focuses on
acquiring professional knowledge and largely ignores the cultivation
of a humanist spirit. To help nurses adjust to the rapidly changing
environment of nursing care and demonstrate a professional and
humane character, in addition to advocating for a humane medical
environment, the six Es of humanistic-nursing education (Example,
Explanation, Exhortation, Environment, Experience, Expectation)
should be promoted. The six Es are essential to building a framework
to cultivate humanistic education strategies and strengthen humanist
content in nursing education. In order to instill deeply the spirit of
humanistic care in nursing and make the nursing-care process more
humane, these ideals must be emphasized in nursing education to
raise the level of humanism (11).
Nelson (12) examined Western nursing practices by focusing on
their spiritual aspect. The transformation of the informal and poorly
trained nurse into the trained and uniform persona of the modern
nurse is the subject of many nursing histories and part of nursing
mythology. Using the work of Michel Foucault and Marcel Mauss,
the nursing that preceded the 19th century reformers is re-examined
and continuities between current and quite ancient practices of
nursing are explored. The development of practices or technologies
for care of the sick originated with the establishment of hospitals in
the 4th century as part of pious Christian practice. Current practices
of care and the discourse of holistic nursing are argued to have
grown from these traditional Christian technologies of care.
Humanist or holistic nursing represents the enshrinement of the
Christian ethos--freed of doctrine; the discourse of caring a redrafted
Christian discipline of love (12).
de Medeiros & al. (13) identified the elements that promote
comprehensiveness and humanization of nursing care management
in the ICU, with an ecosystemic approach. This was a documentary
qualitative study. The method of documentary analysis was used for
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data analysis. Four pre-established categories were identified -

Technical; Organizational; Technological; and Humanizing
Dimensions. Data resulted in forming two sub-categories that
integrate the humanizing dimension category, namely
'Comprehensiveness in healthcare actions' and 'Integrating processes
and promoters of humanization,' bringing forth implications and
challenges in forms of managing health work processes, enabling
organizational, structural, and managerial changes to the provided
healthcare. The data show that it was considered that all structural
elements in managing nursing care with a focus on the needs of users
should be in line with public policies and the principles of
comprehensiveness and humanization, thus possessing strong
potential for transforming health practices (13).
Khademi & al. (14) reported that humanistic nursing practice
which is dominated by technological advancement, outcome
measurement, reduced resources, and staff shortages is challenging
in the present work environment. The objective was to examine the
main concern in humanistic nursing area and how the way it is solved
and resolved by Iranian nurses in acute care setting. Data were
collected from interviews and observations in 2009-2011 and
analyzed using classic grounded theory. Memos were written during
the analysis, and they were sorted once theoretical saturation
occurred. Participants and research context: In total, 22 nurses, 18
patients, and 12 families from two teaching hospitals in Tehran were
selected by purposeful and theoretical sampling. Ethical
considerations: The research was approved by the Ethics Committee
of the university and hospitals. The main concern for the nurses is
the violation of their rights. They overcome this concern when there
is a synergy of situation-education/learning, that is, a positive
interaction between education and learning of values and sensitivity
of the situation or existence of care promotion elements. They turn
to professional values and seeking and meeting others' needs,
resulting in "success and accomplishment" of nurse/nursing manager
and patient/family. This theory shows that professional values,
elements of care promotion, and sensitivity of the situation have a
key role in activation of humanistic approach in nursing. Violation of
the nurses' professional rights often leads to a decrease in care, but
these factors make the nurses practice in an unsparing response
approach. It is necessary to focus on development of professional
values and provide essential elements of care promotion as
changeable factors for realization of humanistic nursing although
there is a context in which the nurses' rights are violated (14).
Mendes & al. (15) mentioned that nursing is a profession
committed to the promotion of human beings. It takes into
consideration their freedom, uniqueness, and dignity. Therefore,
communication plays an important role within the nursing process
and its results, and it is also a fundamental component of the
treatment. However, in the context of Brazilian hospitals,
communication between nurses and patients is limited to the
performance of these professionals' technical role. The purpose of
this study is to analyze the case of a hospitalized female adolescent,
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focusing on the communication that happens between her and the

nursing professionals who provide her assistance. This analysis was
based on Bales' categories. Through the technique of direct
observation, the behavior resultant from the interaction between
nurses and the adolescent was analyzed on a total of 30 hours during
five days. The observation showed 428 units of interaction which
were classified, by qualified professionals, in positive, negative, and
neutral socio-emotional areas. Considering the high incidence of
interactions in the neutral area (89.2%), Authors recommend a
humanistic correction in the communication during the nursing
process. This change in communication can qualify patient's care as
well as generate satisfaction at work through empathy and solidarity
(15).
Mendes & al. (16) noticed that nurse-patient communication has
been a pre-established, unvarying, technical professional and
impersonal form of manifestation, reflecting mainly the achievement
of nurse's instrumental role. This situation is opposed to our nursing
concept as well as to the professional values that we incorporated
during our professional life, all of which emphasize the importance of
the person and the patient and the meaning of the visualization of
care to a total human being. The present study aims at discussing
this question, propitiating an opportunity of reflection about the
necessity of humanizing this relationship in the Brazilian scenery.
Thus, the Authors focused on the importance of nurse-patient
relationship not only as an essential component of nursing assistance
but also as a treatment in itself. In addition, nurses were stimulated
to examine the way they are taking care of human beings: as objects
to be manipulated and treated or as persons that need care and
comprehension. The article is concluded with the thesis that nursing
is not a technical profession that manipulates knowledge and
technologies but a work of valuing human beings, their freedom and
dignity (16).
Betran Salazar (17) sought to understand the meaning of the
experience of humanized nursing care from the perspective of
patients, relatives, and nurses. This was an interpretative
phenomenological study that included 16 adult participants, and
which was based on in-depth interviews to gather the information
and on the procedures proposed by Cohen, Kahn, and Steeves to
analyze the information. Efforts by healthcare institutions and nurses
are key elements to advance from impersonal care toward
humanized care because these will permit revising and eliminating
the barriers present in the current exercise of caring. The results
highlight the importance of the effort for humanized behavior from
nurses, given that because they are human beings their behavior in
the relationship with patients is not always have that connotation.
The data show that humanized care is not only supported on the
human condition of nurses or on the institutional intentions, but on
attitudes and on a disposition focused on the patient's wellbeing.
Additionally, tensions in nursing care are solved through humanizing
efforts (17).
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Arruda & al. (18) mentioned that it is qualitative research, which

aimed to evaluate the user embracement and attachment in the
humanization of nursing care for people with Diabetes Mellitus in a
public specialized outpatient service. The theoretical support was
the National Policy of Humanization of the Health Ministry/Brazil.
Data were collected through semi-structured interviews with twenty
people with type 1 or type 2 diabetes, between 2010 March and
May. The analysis resulted in four categories that explore listening
and dialogue, relationships, problem solving and access. People with
diabetes recognize the user embracement and attachment as part of
humanized attention given, which is highlighted by the appreciation
of the patients' subjective dimension (18).
Arone & Cunha (19) emphasized that this essay approaches the
technology and humanization of Hospital organizations, focusing on
conceptual and strategic aspects of both areas in the realm of
nursing, where the strong presence of technological elements needs
to be jumpstarted by giving value to human nature, both in the use of
a product or in a caregiving process, placing further integrating
emphases, since both elements historically faced a dichotomy and at
present are inseverable and complementary, posing challenges to be
dealt with by the nurse on behalf of complete assistance (19).
Barnard & Sandelowski (20) questioned the validity of a boundary
presumed to exist between technology and humane care. It argues
the need for reconciliation of presumed tension(s) between
technology and person focused care and the need to reconsider our
ways of understanding the relations between technology and
nursing. Recent scholarship in the social sciences related to
reproductive and imaging technologies and emergency resuscitation
are examined and arguments are presented that question the
appropriateness of a humanist view that emphasizes technology on
the nonhuman and nonnatural side of a human/nonhuman,
nature/artifice divide. It is argued that what determines experiences
such as dehumanization is not technology per se but how individual
technologies are used and operate in specific user contexts, the
meanings that are attributed to them, how individuals or cultural
groups define what is human, and the organizational, human,
political and economic technological system (technique) that creates
rationale and efficient order within nursing, health care and society.
The data demonstrate that by asking whether the commonplace
appeal to resolve tensions between humane care and technology has
erroneously highlighted technology as the reason for impersonal care
and encourages re-examination of the relationship(s) between
technology, humane care and nursing practice (20).
Carvalho (21) arose from the need felt, during the position of
head nurse of an intensive care unit, to also provide care for nursing
staff. A head nurse who promotes both personal and professional
development of the team must be aware of the stressful experiences
of the nursing staff and attempt to reduce the effect that these
experiences may have on them. The sharing of emotions as well as
the nurses' need to express feelings, should be promoted and
stimulated by the head nurse. Emotions expressed by nurses caring
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for patients facing death, pain and suffering are a constant concern
for a head nurse who desires both the personal and professional
development for her staff, and the best possible recovery for the
patients in their care (21).
Del Mar Molero Jurado & al. (22) mentioned that healthcare
professionals may have certain psychological characteristics which
contribute to increasing the quality of their professional
performance. Study the effect that humanization of care and
communication have on the burnout syndrome in nursing personal.
The sample included a total of 330 Spanish nurses. Analytical
instruments used were the Health Professional's Humanization Scale
(HUMAS), Communication Styles Inventory Revised (CSI-R) and Brief
Burnout Questionnaire Revised (CBB-R). Two broad nursing profiles
could be differentiated by their level of humanization (those with
scores over the mean and those with scores below it in optimistic
disposition, openness to sociability, emotional understanding, self-
efficacy, and affection), where the largest group had the high scores.
A communication repertoire based on verbal aggressiveness
impacted indirectly on the effect of humanization on burnout, mainly
in the personal impact component. The relation of humanization
profiles was observed in nursing staff with the job dissatisfaction and
burnout components. Besides that, some communication styles,
verbal aggressiveness and questioningness, have an indirect effect on
the relationship between humanization profiles and job
dissatisfaction. The results on the relationship between
communication styles and burnout, and the mediator effect of
communication styles on the relationship between humanization of
care and burnout in nursing personnel are discussed (22).
Pott & al. (23) carried out descriptive, quantitative study at a
University Hospital in Curitiba-PR, Brazil. The objective was to analyze
the caring actions performed at a semi-intensive care unit, from the
perspective of the caring humanization, and also to evaluate the
presence of comfort and communication measures in performing
these actions. The data collection occurred under a systematic non-
participant observation. The caring actions were grouped, according
to its frequency, and presented in graphs. The comfort measures
were present at 45% of the caring actions performed, and
communication establishment was present at 40% of these actions.
Even today, the comfort and communication measures, as reflected
in the process of caring humanization, remain as an ideal speech.
However, they are too far from reality of the health care system's
users and workers (23).
Walsh (24) based this paper on a phenomenological study of the
nurse-patient encounter, the purpose of which was to uncover
meaning and generate understandings of being a psychiatric nurse.
The study was informed by the phenomenology of Martin Heidegger
(1962) and the philosophical hermeneutics of Hans-Georg Gadamer
(1975). Drawing upon this phenomenological study it is the Author's
intention to discuss three of the existential elements to emerge from
an interpretative analysis of these encounters; 'Being-with' as
understanding, 'Being-with' as possibility, and 'Being-with' as 'care-
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full' concern. The paper also discusses two modes of being-with

patients; the modes of the 'they' nurse and the 'self' nurse. An
underlying theme of shared humanity emerged from the study and
had the effect of unifying the other concepts uncovered (24).
Araújo & de Assunção de Ferreira (25) identified the ethical
aspects in the social representations of clients on the humanization
and to argue the implications of these for the nursing care. A
qualitative study was carried out whose data collection was by means
of semi-structured interview and participant observation with 24
patients hospitalized in a public institution. The social
representations about humanization of care gain contours of the
ethics and the moral, in the establishment of gradients of merit of
the good treatment, and resolute actions, clinical evaluation and
respect to the right of the client. The right to the good treatment is
not equal for all, what indicates the possible differentiations in social
representations about citizenship (25).
de Castro & al. (26) identified how nursing faculty perceive
humanization at work; to describe the factors that enhance
humanization and its implications on the health of nursing
professors. This was a descriptive and exploratory study carried out
at a Brazilian public university with 19 nursing professors who
answered a semi-structured interview. Thematic analysis was used
to process data, yielding three analytical categories. The faculty
indicated that humanization at work and the factors that enhance it
are associated with interpersonal relationships, including dialogue
and respect in work relationships, positively impacting their health.
The effective achievement humanization at work is a possibility that
generates health and wellbeing for nursing faculty (26).
Clark (27) mentioned that if we limit our gaze to epidemiologic or
medicalized discourse about health disparities, we risk losing sight of
the person living in a health disparity context. We may erase or
make invisible the person from a health disparity group; pathologize
difference at the population level and, by extension, stigmatize the
individual; eliminate the upstream context or causes of disparities;
and obscure the human story. For the continued viability of our ideas
about health disparities, it is crucial that we maintain cognitive
flexibility. The unconscious bedrock of trusted ideas about "culture"
and "disparities" can be enriched through a humanized view of the
person in the health disparities story. Transcultural nursing research
complements the biomedical gaze, placing the patient at the center
of a cultural context where health problems are embodied, place
based, and socially constituted. Humanizing our practice depends on
dialogues with those who experience health disparity conditions (27).
Castle & al. (28) provided a review of ways in which top managers
of nursing homes can provide or impact the humanistic component
of care provided in their facilities. The nursing home top
management team; the role of top managers in nursing homes; the
role of top managers as leaders in the nursing home; the literature
examining the impact of top managers in nursing homes are
described; and developments in the nursing home industry that are
influencing (or could potentially influence) the humanistic
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components of care are examined. The Authors conclude with

suggestions for top managers, nursing home owners, and policy
makers to create more caring humanistic environments. Suggestions
include resident-directed care initiatives and culture change (28).
Maxwell (29) mentioned that transforming the culture of the
workplace to improve patient satisfaction, nurse retention, and
patient care outcomes requires a wide range of nursing leadership
skills. Lessons learned from other organizations and from the
successful transformation of the public mental health system of care
are discussed. Innate tendencies of organizations to simplify in
efforts to manage complexities of the workplace contribute to the
challenge. Key to improving nurses' satisfaction is assisting them to
experience themselves as effective and their work as meaningful. A
model entitled BRIDGES is presented that emphasizes the importance
of collaboration, effective communication, and mission focus to the
success (29).
Arca (30) mentioned that the reflection upon the humanization of
the end-of-life process within healthcare systems and the implication
of healthcare professionals is the main objective of this article. The
evolution of the model of care and nurses' leadership role at the end-
of-life process is evaluated. This analysis starts from the first
European references regarding advance wills, made in 1997 at the
Oviedo Convention, until the introduction of the idea of advance
directives incorporated into Spanish law in 2002. It sets the concept
of advance planning in health-related decisions, which establishes a
process of voluntary dialogue where every person can clarify values,
preferences and wishes regarding the final moments of life, with the
support of the healthcare professional (30).
This chapter (1-30) shows that the interaction between patients

and nurses goes through various stages until achieving the necessary
empathy, compassion, affection, and familiarity to account for
humanized care.
The specialty of hospice and palliative care nursing embraces a
humanistic caring and holistic approach to patient care.
The future of nursing combines humanistic and technological
values.
Humanization is necessary through the change of the work
environment and the managerial process, privileging the
participatory management model as a way to transform theory into
practice and value the worker.
Nursing is an art that emphasizes the nature of caring it should
have humanistic attributes.
Humanistic nursing practice which is dominated by technological
advancement, outcome measurement, reduced resources, and staff
shortages is challenging in the present work environment.
Nursing is a profession committed to the promotion of human
beings. It takes into consideration their freedom, uniqueness, and
dignity.
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The effort for humanized behavior is important from nurses, given

that because they are human beings their behavior in the
relationship with patients is not always have that connotation.
People with diabetes recognize the user embracement and
attachment as part of humanized attention given, which is
highlighted by the appreciation of the patients' subjective dimension.
Communication and humanization of care affects the burnout on
nurses.
Nursing and the humanization of the end- of-life care are
important within healthcare systems.
References
1. Watson J. Love and caring. Ethics of face and hand - an invitation to
return to the heart and soul of nursing and our deep humanity. Nurs Adm
Q. 2003;27(3):197-202.
2. Wu HL, Volker DL. Humanistic Nursing Theory: application to
hospice and palliative care. J Adv Nurs. 2012;68(2):471-9.
3. Silva TN. Paterson and Zderad's humanistic theory: entering the
between through being when called upon. Nurs Sci Q. 2013;26(2):132-5.
4. Mulholland J. Nursing, humanism and transcultural theory: the
'bracketing-out' of reality. J Adv Nurs. 1995;22(3):442-9.
5. Betran Salazar OAB. Humanized care: a relationship of familiarity
and affectivity. Invest Educ Enferm. 2015;33(1):17-27.
6. Collet N, Rozendo CA. Humanization and nursing work. Rev Bras
Enferm. 2003;56(2):189-92.
7. Casate JC, Corrêa AK. Humanization in health care: knowledge
disseminated in Brazilian nursing literature. Rev Lat Am Enfermagem.
2005;13(1):105-11.
8. Braun JL, Baines SL, Olson NG, et al. The future of nursing:
combining humanistic and technological values. Health Values. 1984;
8(3):12-5.
9. de Azevedo Michelan VC, Spiri WC. Perception of nursing workers
humanization under intensive therapy. Rev Bras Enferm. 2018;71(2):372-8.
10. McCaffrey G. A humanism for nursing? Nurs Inq. 2019;26(2):
e12281.
11. Yeh M-Y, Lee S. The spirit of humanism should be cultivated in the
nursing profession. Hu Li Za Zhi. 2011;58(5):12-6.
12. Nelson S. Humanism in nursing: the emergence of the light. Nurs
Inq. 1995;2(1):36-43.
13. de Medeiros AC, de Siqueira HCH, Zamberlan C, et al.
Comprehensiveness and humanization of nursing care management in the
Intensive Care Unit. Rev Esc Enferm USP. 2016;50(5):816-22.
14. Khademi M, Mohammadi E, Vanaki Z. A grounded theory of
humanistic nursing in acute care work environments. Nurs Ethics. 2017;
24(8):908-21.
15. Mendes IA, Trevizan MA, Nogueira MS, Hayashida M. Humanistic
approach to nursing communication: the case of a hospitalized adolescent
female. Rev Bras Enferm. 2000;53(1):7-13.
16. Mendes IA, Trevizan MA, Nogueira MS, Sawada NO. Humanizing
nurse-patient communication: a challenge and a commitment. Med Law.
1999;18(4):639-44.
17. Betran Salazr OA. The meaning of humanized nursing care for
those participating in it: importance of efforts of nurses and healthcare
institutions. Invest Educ Enferm. 2016;34(1):18-28.
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18. Arruda C, da Silva DMGV. User embracement and attachment in

the humanization of nursing care for people with diabetes mellitus. Rev
Bras Enferm. 2012;65(5):758-66.
19. Arone EM, Cunha ICKO. Technology and humanization: managed
challenges by the nurse in behalf of complete assistance. Rev Bras Enferm.
2007;60(6):721-3.
20. Barnard A, Sandelowski M. Technology and humane nursing care:
(ir)reconcilable or invented difference? J Adv Nurs. 2001;34(3):367-75.
21. Carvalho C. The humanization of health care - the psychological
aspects of nurses in cardiac surgery. Rev Port Cardiol. 1999;18(7-8):763-6.
22. Del Mar Molero Jurado M, Herrera-Peco I, Del Carmen Pérez-
Fuentes M, et al. Communication and humanization of care: effects over
burnout on nurses. PLoS One. 2021;16(6):e0251936.
23. Pott FS, Stahlhoefer T, Felix JVC, Meier MJ. Comfort and
communication measures in nursing caring actions for critically ill patients.
Rev Bras Enferm. 2013;66(2):174-9.
24. Walsh K. Shared humanity and the psychiatric nurse-patient
encounter. Aust N Z J Ment Health Nurs. 1999;8(1):2-8.
25. Araújo FP, de Assunção de Ferreira M. Social representations
about humanization of care: ethical and moral implications. Rev Bras
Enferm. 2011;64(2):287-93.
26. de Castro MR, Zeitoune RCG, Tracera GMP, et al. Humanization in
the work of nursing faculty. Rev Bras Enferm. 2020;73(1): e20170855.
27. Clark L. A humanizing gaze for transcultural nursing research will
tell the story of health disparities. J Transcult Nurs. 2014;25(2):122-8.
28. Castle NG, Ferguson JC, Hughes K. Humanism in nursing homes:
the impact of top management. J Health Hum Serv Adm. 2009;31(4):483-
516.
29. Maxwell NA. Shaping humane healthcare systems. Nurs Adm Q.
2007;31(3):195-201.
30. Arca MG. Nursing and the humanization of the end- of-life care
within healthcare systems. Enferm Clin. 2014;24(5):296-301.
STRATEGIES TO ADVANCE HUMANIZATION
NATIONAL HUMANIZATION POLICY

Zanfolim & al. (1) identified the comprehension of Community
Healthcare Agents on the National Humanization Policy (NHP), as
well analyzed whether they recognize healthcare actions developed
in their daily lives, as those established by the NHP. Exploratory and
descriptive qualitative research was conducted between June and
September 2013, with 15 Community Healthcare Agents of the
Family Health Strategy Program in a city located in the West of Sao
Paulo state. The data collection was conducted through individual
interviews, using a semi-structured script, and submitted to content
analysis. Two categories emerged: "Superficial knowledge: an
obstacle to the construction of humanized care" and "Actions of
humanized health: trying to get closer". The data show that the basic
concepts of NHP are part of the knowledge of these professionals,
but the understanding they possess is superficial, which directly
affects the actions provided to the community (1).
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de Moraes Chernicharo & al. (2) identified and analyzed the

elements that constitute the representations of nurses and users
about the humanization of care and discussed strategies that can
contribute to the implementation of the National Humanization
Policy. Twelve professionals who were working effectively in nursing
care and fifteen users hospitalized adults participated in the research,
all of the medical clinic of a federal public hospital. Semi-structured
individual interviews were used to generate data, to which the
technique of thematic content analysis was applied. The conceptions
about humanization refer to social issues, which show the
relationship between professionals and users in nursing care; and,
also, to management issues, which show the difficulties in health care
facilities to obtain a humanized approach. The discussion with those
involved in the process presents itself as a strategy for the scope of
the precepts of the National Policy of Humanization (2).
da Silva & al. (3) analyzed the implications of the political devices
of the Brazilian National Humanization Policy, Singular Therapeutic
Project and Reference Team and Matrix Support, for nursing as a
professional discipline. The Brazilian Unified Health System, SUS-
Brazil, has as its principles regarding health care: universal access at
all levels of care; equality and non-discrimination; integrality;
community participation; and political and administrative
decentralization, regionalization, and hierarchization. The National
Humanization Policy is a public health policy that serves as the
methodological apparatus for the application of the SUS-Brazil
principles. Reference Teams refers to inter- and
transdisciplinary/professional teams. These team approaches are
associated with increased quality of care. Qualitative lexical content
policy analysis of the official documents was conducted for the
Brazilian National Humanization Policy. The Reference Team model
that is used to carry out Singular Therapeutic Projects leads to
discussion of disciplinary boundaries in the context of health care.
The Brazilian National Humanization Policy demands inclusion of
various kinds of knowledge and networking. Research is needed to
elucidate the nature of nursing care and its distinctive character in
relation to the work objectives of other professional disciplines (3).
Ribeiro & al. (4) identified and analyzed the production of
knowledge about the strategies that health care institutions have
implemented to humanize care of hospitalized children. This was a
systematic review conducted in the Virtual Health Library - Nursing
and SciELO, using the seven steps proposed by the Cochrane
Handbook. Fifteen studies were selected, and strategies that
involved relationship exchanges were used between the health
professional, the hospitalized child, and their families, which may be
mediated by leisure activities, music and by reading fairy tales. The
use of the architecture itself was also included as a way of providing
welfare to the child and his/her family, as well as facilitating the
development of the work process of health professionals. The data
show that investments in research and publications about the topic
are necessary, so that, the National Humanization Policy does not
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disappear and that the identified strategies in this study do not

configure as isolated and disjointed actions of health policy (4).
Santos-Filho (5) prompted discussions of the perspectives of the
Evaluation of Brazil's National Health Humanization Policy being
implemented by the Ministry of Health (PNH/HumanizaSUS). It
strives to systemize some Health Evaluation benchmarks,
distinguishing two key aspects of this evaluation: one examines
methodologies for the definition of Humanization actions monitoring
indicators; the other analyzes evaluatory surveys measuring the
impacts of these actions. Both aspects were scored, highlighting
specific characteristics that must be recognized in the approach and
use of evaluation methodologies under the aegis of this Policy. In
order to strengthen such specific characteristics and approach
perspectives, it explores the extent and complexity of the tools and
actions proposed in the field covered by this Policy, while also
offering a brief review of the concepts and components
encompassed by the Monitoring and Evaluation area (5).
Nora & Junges (6) analyzed humanization practices in primary
health care in the Brazilian Unified Health System according to the
principles of the National Humanization Policy. A systematic review
of the literature was carried out, followed by a meta-synthesis, using
the following databases: BDENF (nursing database), BDTD (Brazilian
digital library of theses and dissertations), CINAHL (Cumulative Index
to nursing and allied health literature), LILACS (Latin American and
Caribbean health care sciences literature), MedLine (International
health care sciences literature), PAHO (Pan-American Health Care
Organization Library) and SciELO (Scientific Electronic Library Online).
The following descriptors were used: Humanization; Humanizing
Health Care; Reception: Humanized care: Humanization in health
care; Bonding; Family Health Care Program; Primary Care; Public
Health and Sistema Único de Saúde (the Brazilian public health care
system). Research articles, case studies, reports of experiences,
dissertations, theses, and chapters of books written in Portuguese,
English or Spanish, published between 2003 and 2011, were included
in the analysis. Among the 4,127 publications found on the topic, 40
studies were evaluated and included in the analysis, producing three
main categories: the first referring to the infrastructure and
organization of the primary care service, made clear the
dissatisfaction with the physical structure and equipment of the
services and with the flow of attendance, which can facilitate or
make difficult the access. The second, referring to the health work
process, showed issues about the insufficient number of
professionals, fragmentation of the work processes, the professional
profile and responsibility. The third category, referring to the
relational technologies, indicated the reception, bonding, listening,
respect and dialog with the service users. The data indicate that
although many practices were cited as humanizing, they do not
produce changes in the health services because of the lack of more
profound analysis of the work processes and ongoing education in
the health care services (6).
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de Oliveira & al. (7) reflected on humanization in health care,

recovering the history of understanding about mankind, the human
and humanity, until humanization in humanity and health. The
national humanization program is discussed in hospital care and
reflect on this proposal and on the issue of humanization in Brazilian
health care nowadays. Communication is indispensable to establish
humanization, as well as technical and material conditions. Both
users and health professionals need to be heard, building a network
of dialogues to think and promote singular humanization actions. For
this process to take effect, there is a need to involve the whole that
makes up the health service. This group involves different
professionals, such as managers, public policy makers, professional
councils, and education institutions (7).
Pasche & al. (8) presented the context of the emergence and
implementation of the NPH, which was devised as a public policy to
address and overcome the challenges perceived by Brazilian society
regarding the quality and dignity of healthcare. The aims included
redesigning and joint initiatives for the humanization of care and
providing solutions for problems in the field of management and
organization of the health workforce. Highlighting it as a public
policy, the Authors analyzed the main focus and theoretical and
methodological approaches to cope with problems in management
and practice of healthcare, signaling the need to combine strategies
in both macro and micro policy areas. The analysis focused on
changes in the composition and strategies of action, which included
social mobilization, support to management systems, services and
health teams and the development of training processes for
institutional stakeholders. The article presented results obtained in
the first five years, as well as its limitations and prospects, especially
the challenge facing NPH to be seen as a public policy, which cannot
be achieved without the mobilization of social forces beyond the
State (8).
Serruya & al. (9) evaluated the implementation of the Brazilian
Ministry of Health's Program for Humanization of Prenatal and
Childbirth Care using data generated by the SISPRENATAL/DATASUS
database from the Unified National Health System. From its
beginning in June 2000 until December 2002, 3,983 municipalities
joined the Program, and 71% of participating municipalities (3,183)
reported their health care activities, constituting a database with
720,871 women. Nearly 20% of the women had six or more prenatal
visits, and approximately half of them had the postpartum follow-up
visit and required lab tests performed in 2002. In addition, 41% of
the women had been vaccinated against tetanus. The number of HIV
antibody tests was twice that of syphilis during the two-year period.
Only a small percentage of women (2% in 2001 and 5% in 2002)
received the entire set of prenatal and childbirth care services. The
low percentages attest to the need for permanent evaluation aimed
at improving quality of care and guaranteeing both high-quality
maternal and perinatal results and the inalienable right of women to
safe care and well-being during pregnancy and delivery (9).
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Barbosa & al. (10) mentioned that the NPH aims at innovations in
health production, management, and care with emphasis on
permanent education for workers in the Unified Public Health System
and training of university students in the health care field. This study
aimed to know, through an integrative review of the literature, the
scientific production about the NPH and education of health care
professionals, from 2002 to 2010. Ten articles were analyzed in
thematic strand through three axes: humanization and users caring,
humanization and the work process, humanization, and training. The
articles point to the need to overcome the biological conception,
valuing cultural aspects of users. The work process is marked by the
devaluation of workers and by users deprived of their rights. The
training of health professionals is grounded in health services where
the prevailing standards are practices that hinder innovative
attitudes (10).
This chapter (1-10) shows that various strategies can contribute

to the implementation of the National Humanization Policy.
The basic concepts of NHP are part of the knowledge of the
professionals, but the understanding they possess is superficial,
which directly affects the actions provided to the community.
References
1. Zanfolim LC, de Fáccio Azevedo AC, de Almeida Santos L, Buriola AA.
Comprehension of community healthcare agents on the National
Humanization Policy. Rev Gaucha Enferm. 2015;36(3):36-41.
2. de Moraes Chernicharo I, da Silva de Freitas FD, de Assunção
Ferreira M. Humanization in nursing care: contribution to the discussion
about the National Humanization Policy. Rev Bras Enferm.
2013;66(4):564-70.
3. da Silva RN, da S de Freitas FD, de Araújo FP, de A Ferreira M. A
policy analysis of teamwork as a proposal for healthcare humanization:
implications for nursing. Int Nurs Rev. 2016;63(4): 572-9.
4. Ribeiro JP, Gomes GC, Thofehrn MB. Health facility environment as
humanization strategy care in the pediatric unit: systematic review. Rev
Esc Enferm USP. 2014;48(3):530-9.
5. Santos-Filho SB. Perspectives of the evaluation of Brazil's National
Health Humanization Policy: conceptual and methodological aspects. Cien
Saude Colet. 2007;12(4):999-1010.
6. Nora CRD, Junges JR. Humanization policy in primary health care: a
systematic review. Rev Saude Publica. 2013;47(6):1186-200.
7. de Oliveira BRG, Collet N, Viera VS. Humanization in health care.
Rev Lat Am Enfermagem. 2006;14(2):277-84.
8. Pasche DF, Passos E, Hennington EA. Five years of the National
Policy of Humanization: the trajectory of a public policy. Cien Saude Colet.
2011;16(11):4541-8.
9. Serruya SJ, Cecatti JG, di Giacomo do Lago T. The Brazilian Ministry
of Health's Program for Humanization of Prenatal and Childbirth Care:
preliminary results. Cad Saude Publica. 2004; 20(5):1281-9.
10. Barbosa GC, Meneguim S, Lima SAM, Moreno V. National policy of
humanization and education of health care professionals: integrative
review, Rev Bras Enferm. 2013;66(1):123-7.
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EDUCATION
Beaudoin & al. (1) mentioned that the acquisition and nurturing
of humanistic skills and attitudes constitute an important aim of
medical education. In order to assess how conducive, the physician-
learning environment is to the acquisition of these skills, the Authors
determined the extent to which clinical teachers are perceived by
their trainees as humanistic with patients and students, and they
explored whether undergraduate and graduate students share the
same perceptions. A mail survey was conducted in 1994/95 of all
senior clerks and second-year residents at Laval University, University
of Montreal, and University of Sherbrooke medical schools. Of 774
trainees, 259 senior clerks and 238 second-year residents returned
the questionnaire, for an overall response rate of 64%. Students'
perceptions of their teachers were measured on a 6-point Likert scale
applied to statements about teachers' attitudes toward the patient (5
items) and toward the student (5 items). On average, only 46% of
the senior clerks agreed that their teachers displayed the humanistic
characteristics of interest. They were especially critical of their
teachers' apparent lack of sensitivity, with as many as 3 out of 4
declaring that their teachers seemed to be unconcerned about how
patients adapt psychologically to their illnesses (75% of clerks) and
that their teachers did not try to understand students' difficulties
(78%) or to support students who have difficulties (77%). Compared
with the clerks, the second-year residents were significantly less
critical, those with negative perceptions varying from 27% to 58%,
40% on average. Except for this difference, their pattern of
responses from one item to another was similar. This study suggests
the existence of a substantial gap between what medical trainees are
expected to learn and what they actually experience over the course
of their training. Because such a gap could represent a significant
barrier to the acquisition of important skills, more and urgent
research is needed to understand better the factors influencing
students' perceptions (1).
Casate & Corrêa (2) performed this literature review was for the
purpose of surveying and analyzing the scientific production in health
in Brazilian journals regarding the teaching of health care
humanization in undergraduate programs. The bibliographic survey
was performed on the LILACS database using the term humanization,
including texts published between 2000 and 2010 and examining 42
articles. The analysis of these articles revealed the following central
themes: Humanization: some thoughts on its concepts; University
and the National Curriculum Guidelines for Undergraduate Programs
in Healthcare: relations with the teaching of humanization; Curricular
changes, contents, and teaching-learning strategies regarding
humanized care; and Subjects of the teaching-learning process:
students and faculty learning the humanization of care. Some
theoretical and practical elements have been created about the
teaching of humanization in the context of health; however, it is
essential to make greater investments to effectively develop new
ways of providing care (2).
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Gerard (3) noticed that throughout the fields of medicine and

organization studies, there are growing indications of the value of the
humanities for enriching scholarship, education, and practice.
However, the field of healthcare management has yet to consider the
promise of the humanities for illuminating its particular domain. This
perspective paper explores how the humanities might begin to play a
role in healthcare management by focusing on three broad areas: 1]
understanding the lived experiences of management, 2] offsetting
the "tyranny of metrics", and 3] confronting rather than avoiding
anxiety. While preliminary in presentation, these areas are intended
to facilitate wider consideration of the humanities in healthcare
management and to encourage interdisciplinary dialogue. The paper
also identifies actionable approaches that might be derived from
such a dialogue, including substantiating critical healthcare
management scholarship, collaborating with humanities educators to
design novel curricula, proposing alternatives to unduly
circumscribed performance targets and competency assessments,
creating case studies of formative experiences of practicing
healthcare managers, and advancing guidelines for better managing
anxiety and its concomitant stress, burnout, and compassion fatigue
in healthcare organizations. The paper concludes by discussing the
potential risks of incorporating the humanities into healthcare
management, while also offering a prospective synthesis from an
interdisciplinary approach (3).
Dellasega & al. (4) reported that in the 1970s, the field of medical
humanities developed and included ethics, literature, history,
integrative medicine, and other topics, most often described from a
physician's perspective. During this same period of revolutionary
changes in health care, nursing curricula did not seek to emphasize
content in humanities, perhaps because stereotypical views of
nursing as the "caring profession" made such coursework seem
redundant. In 2001, as a result of the Institute of Medicine's call for
all health professionals to be educated in interdisciplinary teams,
there was a new focus on the importance of interdisciplinary
education. Collaborative experiences in the humanities can foster
professional relationships that lead to professional growth, promote
collaboration, and enhance patient-centered care. The purpose of
this article is to describe the relevance of humanities to the
interdisciplinary education and practice of health care providers. This
article extends the thinking about the value of interdisciplinary
education beyond the traditional dimensions of evidence-based
practice, quality improvement, and informatics to humanities. Ways
to provide nurses and physicians with interdisciplinary humanistic
experiences are illustrated through an overview of projects jointly
developed by the School of Nursing and the College of Medicine at
The Pennsylvania State University (4).
Coscrato & Bueno (5) mentioned that to know the conceptions of
undergraduates from the Teaching Diploma Program with Bachelor
degree in Nursing at a public state-owned higher education
institution in an interior city in the State of São Paulo about
spirituality and humanization, as well as to propose educative action
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in that sense. A qualitative study was undertaken, using the action

research method. The data were collected in the second semester of
2012 through participant observation, registered in a field diary, and
interviews with the help of questionnaires. For the interpretative
data analysis, categorization was used. The implicit predominance of
the technical-procedure care discourse was observed, to the
detriment of the educational care discourse, as complementary
constructs, according to the participant' statements. Nevertheless,
the educational action permitted constructivism and the
problematization of knowledge. The data indicate that although the
results may not reflect the reality at the investigated institution, it is
concluded that the academic education of nurse educators is a
moment of possibilities to include spirituality and humanization,
regarding the development of competences that grant individual
support to patients and families, in health promotion and coping with
disease situations (5).
Scanlon (6) addressed the topic of humanistic educative principles
and examines it in the context of Irish psychiatric nurse education.
Humanistic or existential philosophy influences the nursing
curriculum profoundly, and yet a dichotomy continues to exist in
relation to the epistemological basis informing nurse education. The
dichotomy is manifested broadly in relation to the notion of
individual choice and statutory responsibility as regulated
professional governing bodies. Humanism is based on the notion
that people are born 'blank slates' only to become who they are later.
McKenna would describe the humanistic theory of learning as
emphasizing feelings and experiences, leading to self-awareness,
personal growth, and individual optimization. A review of the
literature indicates there are very few empirical studies relating to
the area of the humanistic principles as applied to psychiatric nurse
education. Most of the literature that was initially located referred
to humanistic existentialism in the field of psychology, which
although provided interesting reading and relevant, to a point, did
not apply specifically to psychiatric nursing education. The emphasis
of this paper is psychiatric nursing education and these studies do
not apply to the area under investigation (6).
Shapiro & al. (7) mentioned that the humanities offer great
potential for enhancing professional and humanistic development in
medical education. Yet, although many students report benefit from
exposure to the humanities in their medical education, they also
offer consistent complaints and skepticism. The Authors offer a
pedagogical definition of the medical humanities, linking it to
medicine as a practice profession. They then explore three student
critiques of medical humanities curricula: 1] the content critique,
examining issues of perceived relevance and intellectual bait-and-
switch, 2] the teaching critique, which examines instructor
trustworthiness and perceived personal intrusiveness, and 3] the
structural/placement critique, or how and when medical humanities
appear in the curriculum. Next, ways are suggested to tailor medical
humanities to better acknowledge and reframe the needs of medical
students. These include ongoing cross-disciplinary reflective
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practices in which intellectual tools of the humanities are

incorporated into educational activities to help students examine
and, at times, contest the process, values, and goals of medical
practice. This systematic, pervasive reflection will organically lead to
meaningful contributions from the medical humanities in three
specific areas of great interest to medical educators: professionalism,
"narrativity," and educational competencies. Regarding pedagogy,
the implications of this approach are an integrated required
curriculum and innovative concepts such as "applied humanities
scholars." In turn, systematic integration of humanities perspectives
and ways of thinking into clinical training will usefully expand the
range of metaphors and narratives available to reflect on medical
practice and offer possibilities for deepening and strengthening
professional education (7).
Qian & al. (8) mentioned that medical humanity is the soul of
health education. Beginning medical students are taught various
aspects of basic medicine, such as biochemistry, anatomy, and
immunology. However, cultivation of the humanistic aspects of
medicine has received increasing attention in recent decades. A
comparison study based on a literature search and the experience
was performed with medical humanistic courses in Western and
Chinese medical colleges. It was found both similarities and
disparities in humanities courses offered in Western medical colleges
and Chinese medical colleges. The delivery of humanities courses,
such as medical sociology, medical ethics, medical psychology, and
medical history, is widespread and helps to prepare students for their
transformation from medical students to skillful medical
professionals. Both Western and Chinese medical colleges offer a
variety of medical humanistic courses for undergraduate students.
Although Chinese medical humanistic education has undergone
major changes, it still requires improvement and educators can learn
from Western practice. The data show that the analysis will
contribute to education reforms in the medical field (8).
McConnell (9) mentioned that health care technology occurs in
the cultural and organizational context of users and providers and
thus is inherently neither "good" or "bad." Situated at the midpoint
of the technologic-humanistic dualism, registered nurses facilitate
the coalescence of technology and humanism in nursing practice.
This coalescence does not just happen and does not come easily. It
requires both caring and expertise and is facilitated by education,
clinical practice, research, and administrative considerations. This
coalescence may indeed lead to some of the most exciting
breakthroughs of the 21st century in terms of what it means to be
human (9).
Scott & al. (10) emphasized that caring is fundamental to
competence in medicine. Expressions of humaneness in the
relationship between doctor and patient foster bonds of trust,
enabling doctors and patients to communicate in ways that enhance
diagnosis, treatment, and compliance. To be effective, a caring
attitude must be adopted by all persons involved in the delivery of
health care. Components of caring can be specified, learned, and
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incorporated into routine medical practice. Through their impact on

stress management and coping, as well as morale and job
satisfaction, the organizational and administrative practices
surrounding health care encounters decisively impinge on caring.
The organizational and financial arrangements for enhancing the
humane delivery of health care are examined (10).
Woolliscroft & al. (11) mentioned that the patient-physician
relationship is central to medical practice. Increasingly, educators
and certifying bodies seek to assess trainees' humanistic qualities.
The humanistic qualities of first-year internal medicine residents
were rated in 1987-88 and 1988-89 by patients hospitalized on the
general internal medicine and pulmonary services of the University of
Michigan Hospital. Attending physicians (for 1988-89 only), program
supervisors (program directors and chief residents), and nurses (for
1988-89 only) rated the same residents, and these ratings were
compared with those of the patients. A total of 625 patient
questionnaires for 70 residents were analyzed, with a mean of nine
patient evaluations per resident and a range from four to 24.
Analysis showed that more than 50 patients would need to rate each
resident to achieve desired levels of reproducibility. Large numbers
of attending physicians (20 to 50) would also be required to obtain a
reproducible assessment; the attending physicians' ratings correlated
only moderated well (r = .26) with the patients' ratings. Ratings from
smaller numbers of program supervisors (five to ten) and nurses (ten
to 20) would be needed for reproducible assessments. However,
only the nurses' ratings showed a moderately strong relationship (r =
.35) with the patients' ratings. The data show that patients,
attending physicians, program supervisors, and nurses view
differently the humanistic attributes of residents as they interact with
patients. Large numbers of patients and attending physicians would
be needed to obtain reproducible ratings. Nurses' and program
supervisors' ratings are much more reproducible, but nurses'
perceptions correlate more closely to those of patients (11).
Montgomery & al. (12) articulated a practical interpretive
framework for understanding humanism in medicine through the
lens of how it is taught and learned. Beginning with a search for key
tensions and relevant insights in the literature on humanism in health
professions education, a conceptual model designed to foster
reflection and action was synthesized to realize humanistic principles
in medical education and practice. The resulting model centers on
the interaction between the heart and the head. The heart
represents the emotive domains of empathy, compassion, and
connectedness. The head represents the cognitive domains of
knowledge, attitudes, and beliefs. The cognitive domains often are
associated with professionalism, and the emotive domains with
humanism, but it is the connection between the two that is vital to
humanistic education and practice. The connection between the
heart and the head is nurtured by critical reflection and conscious
awareness. Four provinces of experience nurture humanism: 1]
personal reflection, 2] action, 3] system support, and 4] collective
reflection. These domains represent potential levers for developing
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humanism. Critical reflection and conscious awareness between the

heart and head through personal reflection, individual and collective
behavior, and supportive systems has potential to foster humanistic
development toward healing and health (12).
Goldberg (13) challenged the widely held assumption that
humanism and professionalism are necessarily complementary
themes in medical education. He argues that humanism and
professionalism are two very different value systems with different
rationales, different goals, and different agendas. Whereas
humanism is a universal, egalitarian ideology, professionalism
represents the parochial, culturally determined practices of a
particular professional group that may or may not conform to lay
expectations. Distinguishing professionalism from humanism is
crucial to understanding the divergent attitudes of providers and lay
persons with regard to health care delivery and physician behavior.
Moreover, it highlights the tension that medical students experience
as they are tacitly asked to leave behind their lay, humanistic values
and embrace a new professional identity, a transition that the
common blurring of humanism and professionalism fails to recognize.
In this context, the Arnold P. Gold Foundation's widely acclaimed
White Coat Ceremony for entering medical students may actually be
inhibiting, rather than encouraging, the genuine growth of humanism
in medicine (13).
Maheux & al. (14) examined how medical trainees and recent
graduates of three Quebec medical schools value 16 dimensions of
medical competence classified in four broad categories: clinical,
technological, humanistic, and social and preventive. To assess
perceived educational needs, the trainees' perceptions of the
importance that medical faculties attribute to these same dimensions
in the education of physicians were also examined. The survey was
conducted in 1986-87 via a questionnaire mailed to 2,030 individuals,
including freshmen, juniors, interns, residents, and newly practicing
generalists; 80.3% responded. Compared with the views attributed
to the faculty, the medical trainees gave more importance to basic
diagnostic and therapeutic skills such as the medical history, the
physical examination, and the treatment of common diseases. They
also valued to a greater extent non-biological dimension of clinical
competence, such as communication with patients, patient
education, the social context of disease, and the multidisciplinary
nature of patient care, while they ascribed less importance to
medical technology and rare diseases. The study raises the question
of the relevance of medical education to medical practice by
suggesting that those who are preparing themselves to become
doctors may not be receiving the training they wish to receive (14).
Doukas & al. (15) reported that Abraham Flexner was
commissioned by the Carnegie Foundation for the Advancement of
Teaching to conduct the 1910 survey of all U.S. and Canadian medical
schools because medical education was perceived to lack rigor and
strong learning environments. Existing proprietary schools were
shown to have inadequate student scholarship and substandard
faculty and teaching venues. Flexner's efforts and those of the
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American Medical Association resulted in scores of inadequate

medical schools being closed and the curricula of the survivors being
radically changed. Flexner presumed that medical students would
already be schooled in the humanities in college. He viewed the
humanities as essential to physician development but did not
explicitly incorporate this position into his 1910 report, although he
emphasized this point in later writings. Medical ethics and
humanities education since 1970 has sought integration with the
sciences in medical school. Most programs, however, are not well
integrated with the scientific/clinical curriculum, comprehensive
across four years of training, or cohesive with nationally formulated
goals and objectives. The Authors propose a reformation of medical
humanities teaching in medical schools inspired by Flexner's writings
on premedical education in the context of contemporary educational
requirements. College and university education in the humanities is
committed to a broad education, consistent with long-standing
tenets of liberal arts education. As a consequence, premedical
students do not study clinically oriented science or humanities. The
medical school curriculum already provides teaching of clinically
relevant sciences. The proposed four-year curriculum should likewise
provide clinically relevant humanities teaching to train medical
students and residents comprehensively in humane, professional
patient care (15).
Schwartz & al. (16) mentioned that the inclusion of the
humanities in medical education may offer significant potential
benefits to individual future physicians and to the medical
community as a whole. Debate remains, however, about the
definition and precise role of the humanities in medical education,
whether at the premedical, medical school, or postgraduate level.
Recent trends have revealed an increasing presence of the
humanities in medical training. This article reviews the literature on
the impact of humanities education on the performance of medical
students and residents and the challenges posed by the evaluation of
the impact of humanities in medical education. Students who major
in the humanities as college students perform just as well, if not
better, than their peers with science backgrounds during medical
school and in residency on objective measures of achievement such
as National Board of Medical Examiners scores and academic grades.
Although many humanities electives and courses are offered in
premedical and medical school curricula, measuring, and quantifying
their impact has proven challenging because the courses are diverse
in content and goals. Many of the published studies involve self-
selected groups of students and seek to measure subjective
outcomes which are difficult to measure, such as increases in
empathy, professionalism, and self-care. Further research is needed
to define the optimal role for humanities education in medical
training; in particular, more quantitative studies are needed to
examine the impact that it may have on physician performance
beyond medical school and residency. Medical educators must
consider what potential benefits humanities education can
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contribute to medical education, how its impact can be measured,

and what ultimate outcomes we hope to achieve (16).
Kesselheim & al. (17) mentioned that humanism and
professionalism are virtues intrinsic to the practice of medicine, for
which we lack a standard, evidence-based approach for teaching and
evaluation. Pediatric hematology-oncology (PHO) fellowship training
brings new and significant stressors, making it an attractive setting
for innovation in humanism and professionalism training. A national
sample of PHO fellows was electronically surveyed to identify fellows'
educational needs in humanism and professionalism. Next, a case-
based, faculty-facilitated discussion curriculum was developed to
teach this content within pilot fellowship programs. It was assessed
whether fellowships would decide to offer the curriculum, feasibility
of administering the curriculum, and satisfaction of fellow and faculty
participants. Surveys were completed by 187 fellows (35%). A
minority (29%) reported that their training program offers a formal
curriculum in humanism and/or professionalism. A majority desires
more formal teaching on balancing clinical practice and research
(85%), coping with death/dying (85%), bereavement (78%), balancing
work and personal life (75%), navigating challenging relationships
with patients (74%), and depression/burn out (71%). These six topics
were condensed into four case-based modules, which proved feasible
to deliver at all pilot sites. Ten fellowship programs agreed to
administer the novel curriculum. The majority (90%) of responding
fellows and faculty reported the sessions touched on issues
important for training, stimulated reflective communication, and
were valuable. The data show that pediatric hematology-oncology
fellows identify numerous gaps in their training related to humanism
and professionalism. This curriculum offers an opportunity to
systematically address these educational needs and can serve as a
model for wider implementation (17).
Kleiman (18) described a teaching strategy that focuses students'
attention on the humanistic imperative in nursing practice. The
Humanistic Teaching Method provides a framework for adapting
nursing courses to accommodate person-to-person, human-centered
nursing care alongside scientific and technological competencies.
Through this approach, students integrate concepts such as
humanism, existentialism, and phenomenology into patient
interactions. In addition to producing a favorable effect on patients
and colleagues, this approach contributes to personal gratification in
making a difference in the lives of others. Pedagogical strategies
currently in use may need to be modified to accommodate the
humanistic conceptual framework (18).
Reid (19) noticed that a new masters-level course, 'Medicine and
the Arts" will be offered in 2014 at the University of Cape Town,
setting a precedent for interdisciplinary education in the field of
medical humanities in South Africa. The humanities and social
sciences have always been an implicit part of undergraduate and
postgraduate education in the health sciences, but increasingly they
are becoming an explicit and essential component of the curriculum,
as the importance of graduate attributes and outcomes in the
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workplace is acknowledged. Traditionally, the medical humanities

have included medical ethics, history, literature, and anthropology.
Less prominent in the literature has been the engagement with
medicine of the disciplines of sociology, politics, philosophy,
linguistics, education, and law, as well as the creative and expressive
arts. The development of the medical humanities in education and
research in South Africa is set to expand over the next few years, and
it looks as if it will be an exciting inter-disciplinary journey (19).
Kesselheim & al. (20) mentioned that educators in pediatric
hematology-oncology lack rigorously developed instruments to
assess fellows' skills in humanism and professionalism. A novel 15-
item self-assessment instrument was developed to address this gap
in fellowship training. Fellows (n=122) were asked to assess their
skills in five domains: balancing competing demands of fellowship,
caring for the dying patient, confronting depression and burnout,
responding to challenging relationships with patients, and practicing
humanistic medicine. An expert focus group predefined threshold
scores on the instrument that could be used as a cutoff to identify
fellows who need support. Reliability and feasibility were assessed,
and concurrent validity was measured using three established
instruments: Maslach Burnout Inventory (MBI), Flourishing Scale (FS),
and Jefferson Scale of Physician Empathy (JSPE). For 90 participating
fellows (74%), the self-assessment proved feasible to administer and
had high internal consistency reliability (Cronbach's α = 0.81). It was
moderately correlated with the FS and MBI (Pearson's r = 0.41 and
0.4, respectively) and weakly correlated with the JSPE (Pearson's r =
0.15). Twenty-eight fellows (31%) were identified as needing
support. The self-assessment had a sensitivity of 50% (95%
confidence interval [CI] 31-69) and a specificity of 77% (95% CI 65-87)
for identifying fellows who scored poorly on at least one of the three
established scales. The Authors developed a novel assessment
instrument for use in pediatric fellowship training. The new scale
proved feasible and demonstrated internal consistency reliability. Its
moderate correlation with other established instruments shows that
the novel assessment instrument provides unique, nonredundant
information as compared to existing scales (20).
Kirkpatrick (21) mentioned that team ward rounding is a time-
honored practice. Trainees learn not only clinical aspects but also
ethical values of patient care. Despite current emphases on the
principles of professionalism and humanism in medicine, there
remains little discussion about applying these principles to ward
rounds. The Authors believe that rounds can become classrooms for
the intentional inculcation of professionalism and humanism as
counterweights to unintentionally promulgated brusqueness,
ambivalence, cynicism, and frustration. Examples were gathered of
"humanistic rounding" from various institutions that should stimulate
discussion and illustrate that no specialized training is required to
"humanize" rounds; rather, willingness and creativity are key
ingredients (21).
Rosenthal & al. (22) reported that with the creation of the Gold
Humanism Honor Society (GHHS) in 2002, the Arnold P. Gold
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Foundation established a mechanism for recognizing medical

students who demonstrate exemplary humanism/professionalism/
communication skills. Currently, 80 medical schools have GHHS
chapters. Selection is based on peer nomination using a validated
tool. The objective of this survey was to assess the percentage of
residency program directors (PDs) who are aware of and are using
GHHS membership as a residency selection tool. Surgery (SURG) and
internal medicine (IM) PDs in 4 United States regions were surveyed
for familiarity with GHHS and perceived rank of GHHS membership
relative to Alpha Omega Alpha (AOA) membership, class rank,
medical student performance evaluation (MSPE), clerkship grade,
and United States Medical Licensing Examination (USMLE) score, in
evaluating an applicant's humanism/professionalism, service
orientation, and fit with their program. Program demographics and
familiarity with GHHS were also surveyed. The response rate was
56% (149 respondents). IM PDs rated GHHS membership higher than
did SURG PDs when evaluating professionalism/humanism and
service orientation. PDs familiar with GHHS ranked membership
higher when considering professionalism/humanism (4.1 vs 3.2;
p<0.05) and service orientation (4.1 vs 2.9; p<0.01). Familiarity with
GHHS correlated with being an IM PD, residency based at teaching
hospital, large residency program, knowledge of residents who were
GHHS members, and having a GHHS chapter at their school (p<0.01).
Familiarity with GHHS was related to rankings of GHHS
(professionalism/humanism F = 3.36; p<0.05; service orientation F =
3.86; p<0.05) more than the PDs' specialty was. In all, 157 GHHS
students (from all 4 United States regions) were also surveyed about
the 1197 interviews they had with residency PDs. They reported that
although a few PDs were aware of GHHS, PDs of core medical
specialties were more aware of GHHS than SURG PDs. The data
demonstrate that IM PDs were more aware of GHHS (70%) than
SURG PDs (30%). Awareness was related to the favorable ranking of
GHHS as a selection criterion for humanism/professionalism/service
orientation. PDs familiar with GHHS were from larger programs, were
likely to know residents who were members, and were likely to think
that GHHS membership predicted humanistic care. Membership in
GHHS may set candidates apart from their peers and allow PDs to
distinguish objectively the candidates who demonstrate
compassionate medical care. Increased knowledge about the GHHS
may therefore serve to be a useful adjunct for PDs when selecting
medical students for their residency programs (22).
Kumagai & Naidu (23) reported that in these days of
overwhelming clinical work, decreased resources, and increased
educational demands, time has become a priceless commodity.
Competency-based medical education attempts to address this
challenge by increasing educational efficiency and decreasing the
"steeping" of learners in clinical activities for set durations of time.
However, in this environment, how does one teach for
compassionate, humanistic practice? The answer arguably lies in
clinician-teachers' recognition and engagement in a different type of
time, that of kairos. Ancient Greek thought held that there were 2
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interrelated types of time: chronological, linear, quantitative, time-

chronos-and qualitative, opportune time-kairos. Unlike chronos,
kairos involves a sense of the "right time," the "critical moment," the
proportionate amount. Developing a sense of kairos involves
learning to apply general principles to unique situations lacking
certainty and acting proportionally to need and context.
Educationally, it implies intervening at the critical moment-the
moment in which a thoughtful question, comment, or personal
expression of perplexity, awe, or wonder can trigger reflection,
dialogue, and an opening up of perspectives on the human
dimensions of illness and medical care. A sensibility to kairos
involves an awareness of what makes a moment "teachable," an
understanding of chance, opportunity, and potential for
transformation. Above all, inviting kairos means grasping an
opportunity to immerse oneself and one's learners-even
momentarily-into an exploration of patients and their stories,
perspectives, challenges, and lives (23).
Purdy (24) mentioned that nurse education is dominated by the
humanist perspective and the educational theory that it generates.
Following a brief description of the perspective's phenomenological
foundations and definition of humanist ideology, humanist
educational theory is illustrated in an outline of the key contributions
of John Dewey, Carl Rogers, Malcolm Knowles, and Paulo Freire. The
article concludes by noting Freire's sociological challenge to the
individualism of the humanist perspective. This challenge recognizes
the ideological and social control role of education in securing the
reproduction of power relations and leads to questioning the
function of individualism and the interests that humanist ideology
may serve (24).
Purdy (25) questioned the viability of humanist educational
theory in nurse education and raises the issue of which interests are
served by humanist ideology. The limitations of the humanist
approach are traced. Self-directed learning is shown to be
problematic in nurse education, leading to tensions between
independent learning and required course content, and the
appropriateness of student-centered learning to the professional
education of nurses is queried. The need to produce safe
practitioners compromises the humanist model. Lifelong learning,
for example, becomes institutionalized, and its self-directed
character transformed into a mandatory process of lifelong
professional education. The humanist model has become the new
orthodoxy in nurse education and operates as a form of social
control. Through its individualism the approach supports a
competency model, which in turn restricts the potential diversity of
'product'. This individualistic bias denies the social reality of nursing
and fails to empower the nurse by emphasizing individual growth at
the expense of social learning. The article concludes that humanist
ideology serves the needs of a free-market philosophy. If nurse
education is to be challenging it must break with individualism and
seek to develop a different rationale, that of a collectivist ideology
(25).
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Mu (26) emphasized that the Humanistic Clinical Care and Nurse

Healing series of graduate studies courses at National Yang-Ming
University reflects the mission and goals of the master's and doctoral
programs to cultivate the core competence of students. The
humanistic nursing curriculum is designed to engender nurse
subjectivity by integrating multidisciplinary knowledge. Courses
focus on humanistic ideals and ontological, epistemological, and
methodological nurse fitness while cultivating nurses' humanistic
caring competence and humanistic knowledge development. The
Humanistic Clinical Care and Nursing Healing curriculum addresses
core subject areas including psychoanalysis and humanistic caring,
humanistic clinical knowledge exploration, western philosophy and
humanistic caring, imaging art and humanistic caring, and the
humanistic caring aspect of helping others as well as discusses
creative and evidence-based ideas in health promotion and
humanistic nursing. The curriculum begins with identifying and
understanding concepts, then advances toward applying concepts in
practice, reflection, and healing. This paper introduces curriculum
structure and content, evaluates student learning through focus
groups and assignment content analysis, and discusses the future
development potential of humanistic clinical care and nurse healing
(26).
This chapter (1-26) shows that various educational strategies can

be used to promote humanization.
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16. Schwartz AW, Abramson JS, Wojnowich I, et al. Evaluating the
impact of the humanities in medical education. Mt Sinai J Med. 2009;
76(4):372-80.
17. Kesselheim JC, Atlas M, Adams D, et al. Humanism and
professionalism education for pediatric hematology-oncology fellows: A
model for pediatric subspecialty training. Pediatr Blood Cancer. 2015;
62(2):335-40.
18. Kleiman S. Revitalizing the humanistic imperative in nursing
education. Nurs Educ Perspect. 2007;28(4):209-13.
19. Reid S. The 'medical humanities' in health sciences education in
South Africa. S Afr Med J. 2014;104(2):109-10.
20. Kesselheim JC, Agrawal AK, Bhatia N, et al. Measuring pediatric
hematology-oncology fellows' skills in humanism and professionalism: A
novel assessment instrument. Pediatr Blood Cancer. 2017 May;64(5).
21. Kirkpatrick JN, Nash K, Duffy TP. Well rounded. Arch Intern Med.
2005;165(6):613-6.
22. Rosenthal S, Howard B, Schlussel YR, et al. Does medical student
membership in the gold humanism honor society influence selection for
residency? J Surg Educ. 2009;66(6):308-13.
23. Kumagai AK, Naidu T. On time and tea bags: Chronos, Kairos, and
teaching for humanistic practice. Acad Med. 2020;95(4):512-7.
24. Purdy M. Humanist ideology and nurse education. I. Humanist
educational theory. Nurse Educ Today. 1997;17(3):192-5.
25. Purdy M. Humanist ideology and nurse education. 2. Limitations
of humanist educational theory in nurse education. Nurse Educ Today.
1997;17(3):196-202.
26. Mu P-F. Discourse on humanistic clinical care and nurse healing.
Hu Li Za Zhi. 2011;58(5):5-11.
TEACHING
Block & Billings (1) mentioned that after many years of neglect by
the medical establishment, the discipline of palliative medicine is
finally moving into academic health centers (AHCs). While hospice
programs have cared for dying patients in the community for years
with little input from mainstream medicine, palliative care is gaining
a foothold in AHCs, challenging these centers to integrate the hospice
approach with biomedicine. The discipline of palliative care promises
to be a rich source of learning and growth for physicians-in-training.
Teaching about palliative care affirms two essential but vulnerable
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Ben-Nun L. Humanity
dimensions of the practice of medicine - the importance of

relationship-centered care and the value of doctoring as a source of
meaning and growth for physicians. In addition to fostering
fundamental humanistic learning, palliative medicine is an excellent
vehicle for teaching basic but often neglected clinical competencies,
including pain and symptom control, communication, and working as
part of a health care team. Because palliative care settings offer
extraordinary learning opportunities, the authors recommend that
clinical experiences in palliative care be integrated into the core
curricula of all medical schools as well as appropriate residency
programs (1).
Stern & al. (2) mentioned that as the "passion that animates
authentic professionalism," humanism must be infused into medical
education and clinical care as a central feature of medicine's
professionalism movement. In this article, the Authors discuss a
current definition of humanism in medicine is discussed. It also
provides detailed descriptions of educational programs intended to
promote humanism at a number of medical schools in the United
States (and beyond) and identify the key factors that make these
programs effective. Common elements of programs that effectively
teach humanism include: 1] opportunities for students to gain
perspective in the lives of patients; 2] structured time for reflection
on those experiences; and 3] focused mentoring to ensure that these
events convert to positive, formative learning experiences. By
describing educational experiences that both promote and sustain
humanism in doctors, the Authors hope to stimulate the thinking of
other medical educators and to disseminate the impact of these
innovative educational programs to help the profession meet its
obligation to provide the public with humanistic physicians (2).
Branch & al. (3) mentioned that there is increased emphasis on
practicing humanism in medicine but explicit methods for faculty
development in humanism are rare. The Authors sought to
demonstrate improved faculty teaching and role modeling of
humanistic and professional values by participants in a multi-
institutional faculty development program as rated by their learners
in clinical settings compared to contemporaneous controls. Blinded
learners in clinical settings rated their clinical teachers, either
participants or controls, on the previously validated 10-item
Humanistic Teaching Practices Effectiveness (HTPE) questionnaire.
Groups of 7-9 participants at 8 academic medical centers completed
an 18-month faculty development program. Participating faculty
were chosen by program facilitators at each institution on the basis
of being promising teachers, willing to participate in the longitudinal
faculty development program. The 18-month curriculum combined
experiential learning of teaching skills with critical reflection using
appreciative inquiry narratives about their experiences as teachers
and other reflective discussions. The main outcome was the
aggregate score of the ten items on the questionnaire at all
institutions. The aggregate score favored participants over controls
(p=0.019) independently of gender, experience on faculty, specialty
area, and/or overall teaching skills. The data show that longitudinal,
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Ben-Nun L. Humanity
intensive faculty development that employs experiential learning and

critical reflection likely enhances humanistic teaching and role
modeling. Almost all participants completed the program. Results
are generalizable to other schools (3).
Cohen & Sherif (4) emphasized that the teaching of humanistic
values is recognized as an essential component of medical education
and continuing professional development of physicians. The
application of humanistic values in medical care can benefit medical
students, clinicians, and patients. This article presents 12 tips on
fostering humanistic values in medical education. The Authors
reviewed the literature and present 12 practical tips that are relevant
to contemporary practices. The tips can be used in teaching and
sustaining humanistic values in medical education. The data show
that humanistic values can be incorporated in formal preclinical
environments, the transition into clinical settings, medical curricula,
and clinical clerkships. Additionally, steps can be taken so that
medical educators and institutions promote and sustain humanistic
values (4).
This chapter (1-4) shows the importance of teaching in

humanization.
References
1. Block S, Billings JA. Nurturing humanism through teaching palliative
care. Acad Med. 1998;73(7):763-5.
2. Stern DT, Cohen JJ, Bruder A, et al. Teaching humanism. Perspect
Biol Med. 2008;51(4):495-507.
3. Branch Jr WT, Chou CL, Farber NJ, et al. Faculty development to
enhance humanistic teaching and role modeling: a collaborative study at
eight institutions. J Gen Intern Med. 2014;29(9):1250-5.
4. Cohen LG, Sherif YA. Twelve tips on teaching and learning
humanism in medical education. Med Teach. 2014;36(8):680-4.
TRAINING
Beckman & al. (1) mentioned that the American Board of Internal
Medicine (ABIM) has emphasized the development of humanistic
skills in trainees. Using video technology, transition outpatient visits
of first-year house officers in a primary care training program were
evaluated for the presence or absence of nine humanistic skills
before and after the initiation of an instructional program to
reinforce the skills. Thirteen videotaped PGY-1 encounters
constituted the preintervention group and 16 videotaped PGY-1
encounters constituted the postintervention group. The
preintervention group performed a mean of 1.38 skills while the
postintervention group performed a mean of 3.56 skills, a statistically
significant improvement (p<0.05). The Authors conclude that an
educational approach that focuses on specific elements of
interactions facilitates the incorporation of skills associated with
humane medical care (1).
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Ben-Nun L. Humanity
Andrade & al. (2) presented the results of a study of the type
before and after training in Shelter with Risk classification compared
to the humanization of social representations of health among 111
health professionals in an emergency hospital. Data collection was
performed using the technique of free evocation and analysis was
done using the EVOC software. The results showed changes in the
symbolic meaning attributed to terms inducers towards
incorporation of the right perspective in the representation of the
Unified Health System, the translation of Humanization in health as
Shelter, and the progression of understanding the Shelter, the
humanistic focus to the qualification of processes of care of the users
demand at emergencies. The results indicate that the differences
found in the core before and after training were due to an
apprenticeship, which based in peripheral elements, was able to
question the core elements and interchange between the central and
peripheral system, recognizing the functional complementarity
between these two systems and the relationships between
representations and practices. However, the method does not assert
the persistence of such changes in the social representations of the
objects studied in depth or measure the changes in daily practices
(2).
Misch (3) mentioned that physicians' professionalism and
humanism have become central foci of the efforts of medical
educators as the public, various accrediting and licensing agencies,
and the profession itself have expressed concerns about the
apparent erosion of physicians' competency in these aspects of the
art, rather than the science, of medicine. Of the many obstacles to
enhancing trainees' skills in these domains, one of the most
significant is the difficulty in assessing competency in physicians'
professionalism and humanism. The Author suggests that the
assessment of these aspects of the art of medicine has more in
common with the approaches used in criticism of the arts than with
the quantitative assessment tools appropriate to the scientific
method and the medical model. Quantitative and semi-quantitative
tools, so effective in elucidating the etiology, pathophysiology, and
treatment of disease, are often in-appropriate and invalid when
applied to evaluation of professional and humanistic competencies.
The Author proposes that humanism "connoisseurs" be employed to
qualitatively evaluate medical trainees' professionalism and
humanism. Such connoisseurs would possess expert knowledge,
training, and experience in the interpersonal aspects of the art of
medicine, allowing them to deconstruct concepts such as empathy,
compassion, integrity, and respect into their respective key elements
while evaluating physicians' behaviors as an integrated, cohesive
whole. Through the use of a rich descriptive vocabulary, humanism
connoisseurs would provide valid formative and summative feedback
regarding competency in medical professionalism and humanism. In
the process, they would serve to counteract the relative
marginalization of professionalism and humanism in the informal and
lived curricula of medical trainees (3).
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Ben-Nun L. Humanity
Casate & Corrêa (4) aimed at understanding undergraduate

Nursing students' experiences in daily hospital training situations,
reflecting on the formation process and highlighting the human
dimension. Understanding this may give subsidies for a reflection on
the humanization of health/nursing practice. Thirteen students who
were finishing the 6m and beginning the 7th semester in
November/December 2003 and February/March 2004 were
interviewed individually. The analysis of these interviews revealed
the following important themes: being faced with other peoples'
suffering is a "humanizing" experience; dichotomy technical
knowledge/human knowledge; value of the human dimension:
theoretical learning; the health team as a model of (un) learning;
training experiences arouse feelings in the students; student-teacher
relation: limits and facilities. There is a need to rethink the formation
process, investing in coordinated actions that favor transformations
in service and in schools involving teachers, students, and workers
(4).
According to Andreucci & al. (5), the Program for Humanization of
Prenatal and Childbirth Care (PHPN) was launched in Brazil in 2000,
with quantitative criteria for obstetric care and SISPRENATAL as the
database. The current study pooled the national data on prenatal
care using SISPRENATAL and other data sources. This was a
systematic review of prenatal care with an online search of articles in
MEDLINE, EMBASE, and SciELO. The study compiled publications
since 2001 that used PHPN process indicators. A meta-analysis was
performed, estimating the mean proportion of each process indicator
with its respective 95% CI. Process indicators increased over the
target period, but SISPRENATAL showed low coverage for PHPN as
compared to other data sources. The PHPN faces the challenge of
proper data recording through SISPRENATAL. Priorities should
include awareness-raising on the importance of data recording,
training for inclusion of data in the system, and more accessible and
less cumbersome data recording tools (5).
Markakis & al. (6) mentioned that though few question the
importance of incorporating professionalism and humanism in the
training of physicians, traditional residency programs have given little
direct attention to the processes by which professional and
humanistic values, attitudes, and behaviors are cultivated. The
Authors discuss the underlying philosophy of their primary care
internal medicine residency program, in which the development of
professionalism and humanism is an explicit educational goal. They
also describe the specific components of the program designed to
create a learner-centered environment that supports the acquisition
of professional values; these components include a communication-
skills training program, challenging-case conferences, home visits
with patients, a resident support group, and a mentoring program.
The successful ten-year history of the program shows how a
residency program can enable its trainees to develop not only the
requisite excellent diagnostic and technical tools and skills but also
the humane and professional attributes of the fully competent
physician (6).
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Ben-Nun L. Humanity
Giuliani & al. (7) reported that training in humanism provides

skills important for improving the quality of care received by patients,
achieving shared decision in-making with patients, and navigating
systems-level challenges. However, because of the dominance of the
biomedical model, there is potentially a lack of attention to
humanistic competencies in global oncology curricula. In the present
study, the aim was to explore the incorporation of humanistic
competencies into global oncology curricula. This analysis considered
17 global oncology curricula. A curricular item was coded as either
humanistic (as defined by the iecares framework) or non-humanistic.
If identified as humanistic, the item was coded using an aspect of
humanism, such as Altruism, from the iecares framework. All items,
humanistic and not, were coded under the canmeds framework using
1 of the 7 canmeds competency domains: Medical Expert,
Communicator, Collaborator, Leader, Scholar, Professional, or Health
Advocate. Of 7,792 identified curricular items in 17 curricula, 780
(10%) aligned with the iecares humanism framework. The proportion
of humanistic items in individual curricula ranged from 2% to 26%,
and the proportion increased from 3% in the oldest curricula to 11%
in the most recent curricula. Of the humanistic items, 35% were
coded under Respect, 31% under Compassion, 24% under Empathy,
5% under Integrity, 2% under Excellence, 1% under Altruism, and 1%
under Service. Within the canmeds domains, the humanistic items
aligned mostly with Professional (35%), Medical Expert (31%), or
Communicator (25%). The data indicate that the proportion of
humanistic competencies has been increasing in global oncology
curricula over time, but the overall proportion remains low and
represents a largely Western perspective on what constitutes
humanism in health care. The representation of humanism focuses
primarily on the iecares attributes of Respect, Compassion, and
Empathy (7).
Kesselheim & al. (8) mentioned although humanism and
professionalism are central tenets to the practice of medicine, few
formal curricula exist for medical trainees. Following a national
needs assessment among pediatric hematology-oncology (PHO)
fellows, a novel curriculum entitled "Humanism and Professionalism
for Pediatric Hematology-Oncology" (HP-PHO) is created. In this
study, outcomes were measured of this curricular intervention.
Randomized 20 PHO fellowship programs were clustered to deliver
usual training in humanism and professionalism (UT) or the novel
curriculum (intervention) during the 2016-2017 academic year. The
primary outcome measure was the Pediatric Hematology-Oncology
Self-Assessment in Humanism (PHOSAH). Secondary measures
included the Maslach Burnout Inventory, Patient-Provider
Orientation Scale, Empowerment at Work Scale, and a 5-point
satisfaction scale. Participating fellows completed pre- and posttests
at the beginning and end of the academic year, respectively, and we
calculated change scores for each study instrument. Cluster
randomization yielded 59 intervention and 41 UT fellows. The nine
intervention sites administered 33 of 36 modules. Change scores on
the PHOSAH were not significantly different between the UT and
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Ben-Nun L. Humanity
intervention arms. However, fellows on the intervention arm gave

significantly higher ratings on several items within the satisfaction
scale related to physician burnout, physician depression, balancing
professional duties and personal life, and humanism overall. The
data show that exposure to the HP-PHO curriculum did not alter
fellows' self-assessed humanism and professionalism skills. However,
intervention fellows expressed significantly higher levels of
satisfaction in their humanism training, indicating the curriculum's
potential for positive impact on the fellows' perceived learning
environment (8).
Martínez-Gutiérrez & al. (9) noticed that in a rapidly changing
culture like ours, with emphasis on productivity, there is a strong
need to find the meaning of health care work using learning instances
that privilege reflection and face to face contact with others. The
Diploma in Health and Humanization (DSH), was developed as an
interdisciplinary space for training on issues related to humanization.
The aim was to analyze the experience of DSH aiming to identify the
elements that students considered key factors for the success of the
program. A focus group was conducted with DSH graduates,
identifying factors associated with satisfaction. Transcripts were
coded and analyzed by two independent reviewers. DSH graduates
valued a safe space, personal interaction, dialogue, and respect as
learning tools of the DSH. They also appreciate the opportunity to
have emotional interactions among students and between them and
the teacher as well as the opportunity to share personal stories and
their own search for meaning. The data demonstrate that DSH is a
learning experience in which their graduates value the ability to think
about their vocation and the affective interaction with peers and
teachers. The Authors hope to contribute to the development of
face-to-face courses in the area of humanization. Face to face
methodology is an excellent teaching technique for contents related
to the meaning of work, and more specifically, to a group of learners
that require affective communication and a personal connection of
their work with their own values and beliefs (9).
This chapter (1-9) demonstrates that training in humanism

provides skills important for improving the quality of care received by
patients, achieving shared decision n-making with patients, and
navigating systems-level challenges.
References
1. Beckman H, Frankel R, Kihm J, et al. Measurement and
improvement of humanistic skills in first-year trainees. J Gen Intern Med.
1990;5(1):42-5.
2. Andrade MAC, Artmann E, Trindade ZA. Humanization health at
emergency service in a public hospital: comparison on social
representation of professional before and after training. Cien Saude Colet.
2011;16 Suppl 1:1115-24.
3. Misch DA. Evaluating physicians' professionalism and humanism:
the case for humanism "connoisseurs". Acad Med. 2002;7(6):489-95.
100
Ben-Nun L. Humanity
4. Casate JC, Corrêa AK. Nursing students' experiences in hospital

training: subsidies for a reflection on humanization of health. Rev Esc
Enferm USP. 2006;40(3):321-8.
5. Andreucci CB, José Guilherme Cecatti JG. Evaluation of the program
for humanization of prenatal and childbirth care in Brazil: a systematic
review. Cad Saude Publica. 2011;27(6):1053-64.
6. Markakis KM, Beckman HB, Suchman AL, Frankel RM. The path to
professionalism: cultivating humanistic values and attitudes in residency
training. Acad Med. 2000;75(2):141-50.
7. Giuliani M, Martimianakis MA, Broadhurst M, et al. Humanism in
global oncology curricula: an emerging priority. Curr Oncol. 2020;
27(1):46-51.
8. Kesselheim J, Baker JN, Kersun L, et al., Collaborative Network of
Pediatric Hematology-Oncology Fellowship Program Directors. Humanism
and professionalism training for pediatric hematology-oncology fellows:
Results of a multicenter randomized trial. Pediatr Blood Cancer. 2020
Nov;67(11):e28308.
9. Martínez-Gutiérrez J, Magliozzi P, Torres P, et al. Health and
humanization Diploma: the value of reflection and face to face learning.
Rev Med Chil. 2015;143(3):337-44.
SUMMARY
Humanity is the human race, which includes everyone on Earth. It
is also a word for the qualities that make us human, such as the
or alien. The word humanity is from the Latin humanitas for "human
In this research, the Biblical verses dealing with the human
humanity are described. Therefore, the research evaluated the
virtue of humanity, the characteristics of humanistic medicine, the
features of the humanistic health care, the hospital care, the humane
doctor, nursing, and the strategies to promote humanity such as
National Humanization Policies, education, teaching and training.
"Humanistic medicine" is a term compounded, for therapeutic
purposes, with the good intent of reminding clinicians of their need
to be compassionate and empathic.
The medical humanities are concerned with "the science of the
human", and bring the perspectives of disciplines such as history,
philosophy, literature, art, and music to understanding health, illness,
and medicine.
Medical professionalism and humanism have long been integral to
the practice of medicine. Professionalism and humanism share
common values and that each can enrich the other.
Humanism in healthcare management should entail serving of
patients and their families, organizational members, and the
community.
This research indicates that humanity has accompanied humans
during the long our existence. With years, the scientific study
101
Ben-Nun L. Humanity
validated the numerous dimensions associated with humanity that

can help to promote this exceptional dimension in in our life.
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THE ROLE OF HUMANITY FOR HUMAN LIFE

Book · December 2021

Liubov Ben-Noun (Nun)

Unique Medical Research in Biblical Times View project

The user has requested enhancement of the downloaded file.

Humanity - The Beginning Windows game - Indie DB.

Medical Research in Biblical Times

NOT FOR SALE

Author & Editor: Liubov Ben-Nun, Professor Emeritus

Ben Gurion University of the Negev

The Author gains no financial or other benefits.

I am grateful to my husband for his ideas, wisdom and courage

B. N. Publication House. Israel. 2021.

Humanity is the human race, which includes everyone on Earth. It

PROFESSIONALISM AND HUMANISM 17

STRATEGIES TO ADVANCE HUMANIZATION 76

needed to uplift and rebalance the conversation on physician power

"The rich and the poor meet together…." (Proverbs 22:2).

THE THREE ABRAHAMIC RELIGIONS

modern biomedicine became ascendant. At the same institutions

Kousoulis & al. (4) reported that Andrés Laguna, a Spanish

foster a new perspective. Two features of Osler's legacy that may be

5. Van Hee R. Jeremy Thriverius (1504-1554): humanist doctor, born

Stories. In her introductory and concluding comments, Charon

Humanity - Writers Space Africa. writersspace.net.

Ferry-Danini (6) emphasized that according to recent approaches

approaches, narrative medicine, and the phenomenology of

within an ethical framework, it is contended that PCH will prove to be

to renew its commitment to humanism and to oppose antihumanistic

This chapter (1-12) shows that "Humanistic medicine" is a term

An individual has full human value simply by being a living person.

PROFESSIONALISM AND HUMANISM

knowing' and to create a vision of doctoring that integrates new

This chapter (1-5) demonstrates that medical professionalism and

4. Chin-Yee B, Messinger A, Young LT. Three visions of doctoring: a

PUBLIC HUMANIZATION POLICIES

CARE IN AMBULATORY SETTINGS

THE BEGINNING OF LIFE

Paraná, Brazil, by the months of August to October 2006, in which six

and descriptive study with a cross-sectional design, analyzing hospital

2. Nagahama EEI, Santiago SM. Childbirth practices and challenges for

conception. Firstly, if human embryos are our moral equals, this

for humanization in prenatal care. The data demonstrate that it is

NEONATAL/PEDIATRIC CARE UNIT

conditions of the institution. It was found that there was satisfaction

HUMANISTIC NURSING OF CHILDREN

Holyoake (2) battled its way through the contemporary

and a semi-structured questionnaire for data collection. The study

January 1, 2000, and February 28, 2018, were considered eligible if

9. Mandato C, Siano MA, De Anseris AGE, et al. Humanization of care

FAMILY WITH DOWN SYNDROME PATIENTS

LOWER EXTREMITY ARTERIOSCLEROSIS

36 reflects the quality of life of patients from four aspects including

THE EFFECT OF PUSTULOSIS

risk of relapse remaining constant over time. Patients' health-related

Health Strategy was implemented in the city of Curitiba,

SEXUAL RELATIONSHIPS WITH PATIENTS

COMMUNICATING BAD NEWS

times, more serious than the disease itself. The art of

BIAS IN HUMANIZING NEGATIVE CHARACTERISTICS

Rose & Osterud (2) mentioned that a geriatric health

PALLIATIVE CARE IN THE END OF LIFE

Five ways to lead with more humanity. incomethrone.com.