emergency care

– by DR. DANIELLI O. C. LINO, Clinical Cardiologist, Brazil, Public Health Graduate Program, University of Fortaleza, Brazil.

The word “humanization” de-rives from the Latin word humanus; a humanist is someone who has a worldview primarily focused on human values and life. The term “humanities” had been used since the nineteenth cen-tury, but it was related to mat-ters of “general culture”. Until the 1960s, humanities were embedded into the field of cul-ture and entertainment, apart from scientific knowledge, a fact that changed course in the United States with the creation of the National Foundation on the Arts and the Humanities, which defended humanities as necessary for the human de-velopment of society.

Humanization is a reflexive process, presupposing in addi-tion to treatment, dignified, soli-dary and friendly care on the part of health professionals; it is necessary to promote care aiming to prolonging life or pre-venting greater complications in the patient’s life. The human sciences and humanities have extended their role in health area, represented by a signifi-cant increase in the production of knowledge and practices.

Emergency care must be con-textualized in the health care model, mainly based on the profile of the disease that leads the user to seek this type of service. There is a struggle against time, aiming at the sta-bilization of the patient and life, which is seen as the goal of the performed work.

However, the aim of the health team work that provides urgency and emergency care reflects the true social misery in which the user lives. Accidents caused by firearms, traffic accidents, illicit drug in-toxications, urban and home violence, as well as the aggra-vation of chronic diseases comprise the daily lives of the teams that are confronted daily with this cruel reality.

The tension experi-enced by these professionals in this work environment, the demands of achieving positive outcomes and the exposure to violence are aspects that per-meate the professional’s activi-ty and their direct relationship with the user. On the other hand, patients fear the un-known – environment and pro-fessionals – and they feel frag-ile, and often react aggressive-ly when their expectations about care are not met. The situation of “imminent risk of death” directly affects the phys-ical and emotional balance of patients and their families, gen-erating constant conflicts and a tense environment in the team-patient relationship.

How is it possible, then, after disclosing the emergency physicians’ duties during their activities, to include humanization during patient care?

It is worth emphasizing, before evaluating the professional-patient relationship, the emergency/cardiologist physician as the leader in the multiprofessional team. The interprofessional relationship must occur in a full, healthy, and integrative manner, so that the obtained results can be satisfactory. A human attitude in this relationship undoubtedly leads to the mitigation of adverse working conditions, facilitates communication among professionals, accelerates the processes and, lastly, improves the service provided to the user.

Unfortunately, the topic of humanization is still poorly discussed among physicians. When evaluating the syllabi of the Medical Residency Program in Cardiology and Emergency Medicine, the quantitative superiority of the ‘technicist’ approach is well known. It is obvious that because of these professionals’ field of action, such subjects would show numerical prevalence, but basically there is a shortage of subjects referring to the social sciences, with emphasis on humanization.

In a practical manner, and considering the peculiarities of the emergency physician’s / cardiologist’s activities, how can humanization be included and what is its power to modify the cruel reality of Urgency and Emergency services?

Within the context of the emergency physician having a fundamental role in the decision-making and behaviors to be defined and performed by the care team, a human relationship with the multiprofessional team tends to have positive impacts on the dynamics of the patient care delivery. Tensions intrinsic to the work environment can be minimized, in an environment of relaxed dialogue, mutual cooperation and respect.

Finally, the emergency physicians / cardiologists must pay attention not only to the purely technicist aspects of their actions. Both the relationships with the multidisciplinary team, and with the patients and their families, especially in the presence of negative outcomes, are issues wherein the physician-humanization interface is crucial. The inclusion of humanization into the practices of advanced life support, performed in the emergency unit, becomes possible if humanistic competence is developed at the same level as the technical-scientific competence of the health professionals is stimulated, offering them encouragement for commitment with quality of care and by involving them in a new attitude when facing the demands of everyday life. As said by the American physician, Francis W. Peabody, “the treatment of a disease may be entirely impersonal; the care of a patient must be completely personal”.

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