Humanized nursing care for cancer patients: integrative review Cuidado de enfermagem humanizado ao paciente oncológico: revisão integrativa

| OBJECTIVE: to verify how the nursing team promotes humanized care to cancer patients. METHOD: an integrative review, in which the steps described by Cooper were followed, using the databases SciELO, LILACS and BDENF, using the descriptors of humanization of care, oncology and nursing. The inclusion criteria were: articles available in full and free of charge, in Portuguese, published between 2008 and 2018. Data were collected between the months of January and February 2019 and analyzed with content analysis, enabling the discussion of their results. RESULTS: the factors that promote humanized care are: welcoming; valorization of the patient and attention to his global needs; establishing a good relationship, good communication, active listening and creating bonds with the patient and his family; respect for the patient's individuality, autonomy and particularities; spiritual needs and faith; qualification of professionals; periodic team meetings; protection of patient's rights; development of recreational activities; and improving infrastructure in the hospital environment. FINAL CONSIDERATIONS: the factors that promote humanized care are directly related to the attitudes and behavior of nursing professionals who assist patients guided by the National Health Humanization Policy. DESCRIPTORS: Humanization of care. Oncology. Nursing. RESUMO | OBJETIVO: verificar de que forma a equipe de enfermagem promove o cuidado humanizado ao paciente oncológico. MÉTODO: revisão integrativa,na qual foram seguidas as etapas descritas por Cooper, através das bases de dados SciELO, LILACS e BDENF, utilizando-se os descritores de busca humanização da assistência, oncologia e enfermagem. Os critérios de inclusão foram artigos disponíveis na íntegra e gratuitamente, em língua portuguesa, publicados entre 2008 e 2018. Os dados foram coletados entre os meses de janeiro e fevereiro de 2019 e analisados conforme técnica de análise de conteúdo, propiciando a discussão dos seus resultados. RESULTADOS: os fatores que promovem a assistência de enfermagem humanizada são: acolhimento; valorização do paciente e atenção às necessidades globais; estabelecimento de bom relacionamento, boa comunicação, escuta ativa e criação de vínculos com o paciente e sua família; respeito à individualidade, autonomia e particularidades do paciente; necessidades espirituais e fé; qualificação dos profissionais; reuniões de equipe periódicas; proteção aos direitos do paciente; desenvolvimento de atividades lúdicas; e melhoria da infraestrutura no ambiente hospitalar. CONSIDERAÇÕES FINAIS: os fatores que promovem a assistência de enfermagem humanizada estão relacionados diretamente com atitudes e comportamento dos profissionais de enfermagem que assistem os pacientes orientados pela Política Nacional de Humanização da Saúde. DESCRITORES: Humanização da assistência. Oncologia. Enfermagem. 1,2Faculdade Cesuca (Cachoeirinha). Rio Grande do Sul, Brazil. graziela.anacleto@bol.com.br, fatimacecchetto@cesuca.edu.br 3Corresponding author. Universidade Federal de Mato Grosso (Pontal do Araguaia). Mato Grosso, Brazil. fernandoriegel85@gmail.com How to cite this article: Anacleto G, Cecchetto FH, Riegel F. Humanized nursing care for cancer patients: integrative review. J Contemp Nurs. 2020;9(2):246-254. doi: 10.17267/2317-3378rec.v9i2.2737 Submitted 01/23/2020, Accepted 04/12/2020, Published 04/27/2020 J. Contemp. Nurs., Salvador, 2020 October;9(2):246-254 Doi: 10.17267/2317-3378rec.v9i2.2737 | ISSN: 2317-3378 Humanized nursing care for cancer patients: integrative review Cuidado de enfermagem humanizado ao paciente oncológico: revisão integrativa Literature Review


Introduction
Humanization, in its literal sense, means the act of making it human, or giving something and/or some situation a human condition; it is to make it benevolent, affable, compassionate, and charitable 1 .
According to Freitas and Ferreira 2 , the concept of humanization is associated with the right to health, and to the development of care in the health services that aims at quality of care, disregarding the fundamentals of charity and philanthropy, but understanding the autonomy of the individuals and their role in the context of citizenship.
The Brazilian National Humanization Policy (Política Nacional de Humanização, PNH) was launched by the Ministry of Health in 2003, with the purpose of applying the principles of the Unified Health System (Sistema Único de Saúde, SUS) in the routine of the health services, its principles being transversality; inseparability between attention and management; protagonism, co-responsibility and autonomy of the individuals and collectives, based on the guidelines of welcoming, participative management and coparticipation, ambience, expanded and shared clinic, valuing the worker, and defending the rights of patients 3 .
In this sense, Theobald et al. 4 highlight as pillars of humanized care establishing dialog, allowing the patient to have access to information about his illness, treatment and prognosis, and respect for autonomy.
According to Brito and Carvalho 5 , in different health services, especially in oncology and palliative care units, there is a need for humanized practice in the face of long periods of hospitalization of patients and the psychological fragility of the patient and his family, since patients with malignant neoplasms demand differentiated assistance, as it supports the pathology itself, and the stigma of the disease, living with an uncertain prognosis, fear of dying, anxiety and depression, and above all, his will to live.
The nursing team has great importance in care, and must consider aspects that can reduce the influences of suffering and enable the establishment of humanized care, implementing care that goes beyond the technical, such as the establishment of bond, friendship, empathy and trust, promoting to the patient the feeling of belonging to the process observing the entire human dimension 6 .
In this sense, the justification for carrying out this research is due to the growing number of patients affected by neoplasms in Brazil and in the world, becoming an important health problem in the scope of chronic non-communicable diseases; in view of this, there is the need to qualify and humanize the nursing care provided to cancer patients. Thus, it is expected that the results may contribute to understanding the specificities of cancer patient care and the ways to humanize the nursing care provided to them.
Nursing, for this aspect, needs to be prepared and trained to develop the humanized care that the cancer patient demands. In view of this, this study aims to verify how the nursing team promotes humanized care to the cancer patient.

Method
This is an integrative literature review carried out following the five stages described by Cooper, namely: problem formulation, data collection, data evaluation, data analysis and interpretation, and presentation of the results 7 .
In this sense, for this integrative review, the following guiding question was used: How does the nursing team promote humanized care to cancer patients? 3,466 articles were found, of which 1,010 were in the Lilacs database, 2,199 in the BDENF and 257 in the Scielo library. The previous selection that applied the established criteria generated a bank of 465 articles for use. Then, the subsequent choice through the observation of titles and abstracts excluded 358 articles unrelated to the theme of the study and another 65 due to duplication. After a full reading of the remaining 42 articles, 26 were excluded, as they did not answer the guiding question. Thus, 16 articles were included for analysis in this integrative review. The selected articles were analyzed critically and according to authenticity, methodology, importance and representation of the information, being possible to use tables constituted of detailed information of the articles, making verification possible at any time of the evidenced results and conclusions. In addition, it allowed the researcher challenges by discussing conditions of its impacts, recommendations, and suggestions for the nursing practice.
In this study, the compendium, confrontation, and discussion of the data were carried out through a synoptic table composed of Article number, Title, Journal (volume, number, and year of publication), authors, objectives, methodology, and factors that promote humanized nursing care to cancer patients.
For data analysis, the content analysis technique proposed by Bardin 8 was used. The results were presented in a descriptive way through discussion of the data, in a summary format, as well as the data obtained from the articles and journals used. Ethical care in relation to the scientific publications used in this study was observed with the appropriate citation to the authors of the included studies 9 .

Results and discussion
Of the articles selected for data analysis, 50% were published between 2014 and 2018. According to the methodology used, 94% of the articles were qualitative research studies. Table 1 represents the synthesis and characterization of the selected articles.
Numerous factors have been identified that promote humanized nursing care to cancer patients and, for a better understanding and discussion of the results found, Discussing the results of the elements found in Group 1, welcoming was presented as a factor directly linked to humanization by one of the studies (9A). Humanization is inserted in the welcoming process, based on the establishment of a comprehensive, altruistic, and reliable relation between the users and the health professionals 26 .
In this sense, it is noteworthy that patients with diseases with no possibility of cure should receive care that promotes comfort, relieves symptoms, and controls pain, enabling the reestablishment of their basic condition as human beings according to their potential 10 .
In this context, it is important to highlight the importance of valuing the patient in all his dimensions (bio-psycho-socio-spiritual), and the meeting of the global needs was presented in six studies (1A, 6A, 7A, 8A, 13A, 15A). Thus, it is essential to preserve the patient's dignity, considering them an integral human being, i.e., as the union of the body, the mind and the spirit, observing their weaknesses and potentialities with a view to improving the quality of the care provided 27 .
Establishing good relationships and building bonds between professionals, patients, and family members was pointed out in eight studies as being of great importance for the practice of humanized nursing care to cancer patients (3A, 4A, 5A, 8A, 9A, 11A, 12A, 15A); thus, humanization involves protagonism and valuation of the patient and his family in the care of cancer patients, as an important source of emotional support, identification of side effects, and for being with the patient in all care scenarios 28 .
However, one must consider the search for a new look to unveil and understand the phenomena; in this case, the transformations that cancer patients undergo, as well as the need for quality nursing care, this consists not only in the preparation and technicalscientific basis of the professionals, but also in the experience of the other person and in the approach of the professional practice, so that anyone who can understand the experiences of the patients can also be understood 11 . This premise leads to the valuation of the nursing team work as a strategy for the quality of care provided.
The practice of effective communication between the health team, the patients, and the family members, as well as qualified listening has been described in six studies (3A, 4A, 5A, 6A, 8A, 14A). Communication is defined as one of the pillars for the implementation of the National Humanization Policy (PNH) in the health services, favoring the health professional to understand the patient, in his needs and uniqueness 29 .
The second pillar of humanization refers to the patient's access to information about his diagnosis, treatment and prognosis, promoting his involvement in the choices about his own health 4 .
In this way, respect for the patient's individuality, autonomy, and uniqueness was presented in four studies (8A, 12A, 13A, 14A); and the need was evidenced in the studies for the nursing team to consider the patient's wishes, decisions, and acceptance, that is, their specificities and autonomy, contributing to humanized care 4,30-31 .
The support for the spiritual needs and Faith of the patient by the nursing professionals was described in four studies (5A, 7A, 12A, 16A), spirituality in its forms of expression is linked to the values of the human being, essential to life, and which allow enduring difficult situations and negative feelings 32 .
Another essential aspect in the care meeting in order to develop the relation of help and trust is empathy, understood as the nurse's ability to experience the private universe of the other and through the establishment of trust and bonding to enable the patient to believe and adhere to the treatment 14 .
Group 2 of the elements that favor the practice of humanized nursing care concerns the nursing team in its activities and conduct. In this group, the specific qualification of the professionals working in oncology and the holding of periodic team meetings to debate and discuss the theme was pointed out in five studies (2A, 3A, 5A, 11A, 12A). To improve the quality of care provided to cancer patients, training the professionals through permanent education, specialization, team meetings to discuss cases and exchange knowledge, and in-service training are essential for the structuring and practice of humanization 33 .
Regarding the protection of the patient's rights, two studies addressed this issue (2A, 14A), and reinforce that the health professionals working in oncology need to recognize and respect the rights and the ethical and legal aspects that involve patient care, informing and clarifying them about the care provided, assisting in decision making and coping with the difficulties found during the treatment 34 .
The development of recreational activities with patients undergoing cancer treatment was pointed out by two authors (3A, 10A); through games, the patient can express the negative feelings involved by the neoplasm, experiencing, reorganizing, and resignifying through the symbolism of playing out their conflicts 35 .
In the meantime, it is understood that nursing care is not restricted to the patient's therapeutic assistance, but must be extended to his family members, through actions that aim to encourage them to stay with the patient, supporting him during the treatment through healthy activities, obtaining necessary information on the use of the medications and on the care actions to be performed 16 .
Group 3 of the elements is related to the place of hospitalization where the care offer to the cancer patients occurs, which mostly comprises the hospital setting, the ambience conditions, as well as its infrastructure, being important for the practice of human care for patients affected by neoplasms (7A, 12A).
In addition to the infrastructure, the factors that contribute to human care in the care of cancer patients are also aspects related to the organizational culture, multidisciplinary team, and autonomy 21 .
In relation to the organizational culture, the following aspects stand out: the religious identity of the entity accredited, the position of the board with the employees, the concern with education for humanization, and the implementation of Accreditation programs in order to favor the implementation of the humanization of nursing care 21 .
In this sense, the infrastructure of a hospital serves as a support for management and for the promotion of humanization because, through comfort, individuality, and autonomy in the hospital setting, the cancer patient feels welcomed and satisfied with the care provided 1 .

Final considerations
This study allowed for the identification of the importance of promoting humanized care, in addition to highlighting the factors that promote humanized nursing care directly related to the attitudes and behavior of the professionals who care for the patients. In this way, the importance of the National Humanization Policy is maintained in directing and implementing the best practices of the humanization of care in the context of the healthdisease process of patients with neoplasms.
In view of the relevance of the theme, it is suggested that new qualitative and phenomenological studies be carried out that deal with the importance of humanized nursing care based on the reality experienced by the cancer patients, contributing to improving the quality of nursing and health care.