ENSAYOS

Nursing care: an integrating vision in times of crisis

El cuidado de enfermería: una visión integradora en tiempos de crisis

Guevara, B.^*; Evies, A.^**; Rengifo, J.^*; Salas, B.^**; Manrique, D.^*** and Palacio, C.^***

^*PhD in Nursing. Professor. E-mail: bguevara5918@hotmail.com
^**Associate Professor
^***Assistant Professor. School of Nursing. Faculty of Health Sciences. University of Carabobo. Venezuela

ABSTRACT

Nowadays, there exist several organizations of humanitarian movements all over the world which try to fight against the dehumanization expressions; however there still exists the presence of situations which are the reasons of pain in the world. That is why we must construct a better and civilized world in which people worries about the quality of life instead of accumulating statistical numbers. Care is a common feature of all human beings. Therefore, human care is recognized as a universal concept, inherent in humanity. Heidegger, the philosopher for excellence of care, recognizes that this is "an ontological constitution that is always underlying to all what the human beings begin, project and make". Nursing as a profession of social nature tries that its staff, under an humanistic perspective, helps the person interested in care to reinforce his/her abilities and/or to minimize imbalances in her/his state of health. That is why it recognizes the human beings as a complex, mysterious and structured in several dimensions being that range from the organic to the spiritual, from the tangible to the intangible, including the social and historical aspect, which defines it as a being of permanent relationships with himself and the world. Under this point of view, nursing tries to recognize that the cared person is a unique entity which has attributes such as: awareness, intellect, dignity, emotions, feelings and knowledge. Therefore, the nursing care assumes a comprehensive and humanistic dimension of the human being whose subjectivity is structured by his experiences, meanings, feelings, emotions, intuitions, and reasoning.

Keywords: Nursing Care; Integrating Vision; Human Care.

RESUMEN

Existen diversas organizaciones y movimientos humanitarios a nivel mundial que tratan de luchar contra las expresiones de deshumanización, sin embargo, continúa la presencia de situaciones que son causas de dolor en el mundo, por lo que debemos constituir una sociedad para que el mundo sea civilizado, vivir por la calidad de vida y no por acumular cifras estadísticas. El cuidado es una característica común de todos los seres vivos. Por consiguiente, el cuidado humano se reconoce como un concepto universal, inherente a la humanidad. Heidegger, el filósofo por excelencia del cuidado, reconoce que éste es "una constitución ontológica, siempre subyacente a todo lo que el ser humano emprende, proyecta y hace". Enfermería como profesión de naturaleza social intenta que su personal, bajo una óptica humanista, ayude a la persona solicitante del cuidado a reforzar potencialidades y/o minimizar desequilibrios en su estado de salud, por ello reconoce al ser humano como un ser complejo, misterioso, estructurado por diversas dimensiones que van de lo orgánico a lo espiritual, de lo tangible a lo intangible; con inclusión del aspecto social e histórico, que lo define como un ser de interrelaciones permanentes consigo mismo y el mundo. Bajo esta perspectiva, en enfermería, se procura reconocer que la persona cuidada es una entidad única, poseedora de atributos: conciencia, intelecto, dignidad, emociones, sentimientos y saberes, por lo tanto, el cuidado en enfermería asume una dimensión humanista y comprensiva del ser, cuya subjetividad está estructurada por sus vivencias y significados, sentimientos, emociones, intuiciones, razonamientos.

Palabras clave: Cuidado de Enfermeria; Visión Integradora; Cuidado Humano.

Introduction

Civilizational crisis currently facing widespread, evidenced through a series of behavior in man which are summarized in a lack of care for both himself and for others, such as: exploitation and child trafficking, wars, spiritual malnutrition, intolerance, environmental damage, extreme poverty, the devaluation of personal values, Christians and institutional greed where the material to the spiritual than among other things that identify this century despite the scientific and technological advances.

Various organizations and global humanitarian movements that try to fight dehumanization expressions, however the continued presence of situations that are causes of pain in the world, so we must be a more humane society and live by the quality of life. You need people aware and committed to building a planetary civilization more human, more sensitive to others' pain and the need of others.

It requires a new philosophy that is holistic, ecological and spiritual that identifies us as citizens of the world with our works. Humanist professions Nursing social nature, whose professional practice should be based on providing a humanized care, which not only treat the organ or system that is ill, but it also addresses the different dimensions of the care recipient. It is essential to reflect on the holistic view of the person, visualizing permanently as a unit, whose conception is morally imperative in the human sciences, in an attempt to minimize fragmentation and / or objectification of the person and consider it as a subject, in this society of knowledge, scientific and technological breakthroughs. Some authors like Martha Rogers, define the human as "A unitary, irreducible being, which has its own integrity and a set of features that are different from the sum of its parts. In addition, the human being is an open system in a continuous process of interactions with ever-changing environment" Morin, recognizes that man is "physical, biological, psychological, cultural, social and historical. It is a complex unit to be restore, so that everyone from wherever you have knowledge and awareness at the same time complex identity and identity that is common to all other humans"⁽²⁾.

Nursing as a profession of social nature intends his staff, under a humanistic perspective, help the person seeking care at strengthening potential and / or minimize imbalances in your health, for it recognizes the human being as a complex being, mysterious, structured by various sizes ranging from organic to spiritual, from the tangible to the intangible, including the social and historical aspect, which defined as being of permanent relationships with himself and the world. Under this perspective, nursing, seeks to recognize that the person cared for is a single entity having attributes: awareness, intellect, dignity, emotions, feelings and knowledge, therefore, nursing care and assumes comprehensive humanistic being, whose subjectivity is structured by their experiences and meanings, feelings, emotions, intuitions, reasoning. The humanistic dimension of human beings, nursing puts us in harmony with existentialist thinkers, who question the positivist, reductionist Western philosophy itself. The existentialist approach recognizes that truth is present in the interior of every human being only source of living truth, so there we find the true essence that favors significant nursing care.

This humanized Nursing practice involves transcendence beyond the simple relationship between humans. It requires the significant presence of the caregiver and the person receiving it. This implies significant presence see, hear, touch and feel through a process of empathy that must be present in the relationship. The nurse caregiver, must approach the other's world to understand, and strengthen them in their own ability to care, for this, that professional must recognize its own existence⁽³⁾. The preceding ideas allow specify that the person is a unique being, with its own characteristics, possesses a unique individuality with a gregarious spirit since it began its development in the womb, so that necessarily establishes an ongoing relationship with its external and internal environment , which involves a process of adaptation to the various changes that permanently faces.

It is in this constant contact with the world, when a person has the opportunity to submit to the demands of the environment and to respond as a whole being to the stimuli of the same, in which you experience and live their own experiences, which are translated into behaviors to express, which favors their adaptation. Such ideas are based on the approach Calista Roy, who in his adaptation model, recognizes that " the individual is a biopsychosocial being in constant interaction with their environment. Interaction that requires continuous adaptations"⁽⁴⁾. To live is to reply, reply is to behave, behave is fit to continue transforming the world. It identified the environment, see the world, is crucial for man, for their stay, their survival and, with the other men, explore, shop and account for the known, teach and learn in order to live, to live, to transform⁽⁵⁾.

In this vein, it is considered that the person is a complex being, possessed of a mind with ability to think and discern the different situations in their daily experience. Such insight or reflection is a source of knowledge, you can make decisions guided by their system of values, which are learned and reinforced in the family, school, media and society. Among these values are respect, solidarity, self-esteem, justice, autonomy, among others.

Heidegger emphasizes that all human knowledge requires the question What is the self? Therefore, phenomenology as a method "opens the possibility to respond specifically to the question of the meaning of being." The author acknowledges that " answering that question involves directing the view, understand, access and constitutive forms of questioning"⁽⁶⁾. Develop the question of Being is viewed through a body, deep understanding through interpretation, is go into that intangible part of the person, their emic reality, in the conception of being there (Dasein ) or mode of being, which is human.

Dasein, is the way to be, characteristically human or Being-in-the-world. According to Heidegger, M. relevant aspects of the human being "is that there is a being, not a world and there is a world that is not defined in relation to a being for whom this world is his world "⁽⁶⁾ . Dasein responds and reacts according to the perception of self and the surrounding world. Consequently, the Heideggerian approach, based on phenomenology as a method favors the ability to access and develop the person who asks the question being. This is important to determine the ontological elements of human nature which guide and assist the nursing staff to care for themselves and others.

This means that human beings must never be treated as a means, or object, it is a thinking, free and independent, therefore a person whose dignity must be respected. The dignity of the person must always recognize, regardless of their physical traits, psychological or social and cultural group to which it belongs.

By making reference to human dignity , it is necessary to bring up the concept of the human condition expressed by Sartre , "is the general framework in which invariably human life unfolds , where the basic framework of human life is summed up in four activities are: a) Being thrown into the world, b ) Having to work , c) Living with others, d) Be deadly"⁽⁷⁾.

Jaspers, recognizes that the human condition is the very existence of the self, which was focused in stating that "the self is not what can and should be. This is me being as existence". Therefore, "existence is what relates to himself and therefore with transcendence"⁽⁸⁾ Human existence goes beyond subjectivity, because self is only done in communication with another, which makes possible realization⁽⁸⁾. Meanwhile, Buber, estimates that "the individual is a fact of existence in so far as it enters into relationships with other individuals living"⁽⁹⁾. Therefore, "the fundamental fact of human existence is man whith man".

In reflecting on the human condition or existence, it follows that the life of a person between the moment of conception until death. In this period, historical development as a human being stores a set of life experiences, which serve to develop their own human condition. This determines that the condition is inherent in the individual, conceived as a multidimensional being, dominated the plurality of thought, the singular characteristic and fundamental. The human condition is a universal constant and each person acquires through their relationships with others.

In this sense, one can conceptualize the human condition as a construction, a process of learning, interactive nature obtained in the norms, values, beliefs, knowledge, attitudes, behaviors. The same is subject to space-time synthesis, i.e. acquired in specific socio-cultural context and at a particular time. Therefore, this condition is worthy of respect.

Recognizing the value of the dignity, the life of the person takes a qualitative range similar to other congener, which is why that defends a broad philosophical ethics is the rational basis for human rights possible as this is what recognizes the dignity of living with a human face and from this recognition discern is that these beings are worthy and what obligations we must meet them. "Life is something sacred therefore all ethical decisions to be based on reverence for itself"⁽¹⁰⁾. From the religious point of view for some people, life is a gift from God and therefore only God corresponds remove. For others, life is an inalienable right, as necessary premise that makes all other rights possible⁽¹⁰⁾. It's true that life does not depend ours ourselves origin, but is a gift of which provides living beings therefore is an absolute good to be cherished and protected. The right to life is a requirement for the person because no one is allowed to have something that is not yours, in this case, his own life. We all have a duty to protect and preserve our life due to self-commitment, derived from the person or has done to herself, or she has given the value and dignity which has Life, " does not have the same value for those who sees it as a gift from God, unavailable to the man who believes that a mere property inherent in certain beings"⁽¹²⁾. The above on some concepts of life necessarily makes us think about taking care of yourself and take care of others, like the person existential phenomenon, considering that is inherent in life itself, hence the reason why all living with a human face through its evolution, has been the need for protective actions to take care of themselves and care for others. It is the foundation on which rests the continuity, multiplication and protection of human existence, therefore, all human action must be caregiver for himself and for others, extends to the nature and the cosmos. According to Ocean care Encyclopedic Dictionary means "to attend, save, preserve, watch one for his health prevented worry about something or against something"^{(13 )} . In this sense, Collière, specifies that "is to ensure the continuity of the life of the group, of the species.... Sustain life is ensuring the satisfaction of a set of essential needs for Life but they are diverse in their manifestation"⁽¹⁴⁾.

Watson, J. Recognizes care together with love, in that both structure the primordial and universal psychic energy. They are the cornerstone of our humanity; also the nourishment of these needs (care and love) gives meaning to the human condition The author appreciates that people have three spheres of being: "mind, body and soul and allow the expression of these forces leads to a better understanding of oneself and others"⁽¹⁵⁾. Therefore, Watson, J. prioritizes that: The human need care and love, and they often have to be seen as the ultimate, because humanity is to survive, which means that humans need to become more careful, more affectionate, more loving. The care and love are the most universal, the most sublime and the most mysterious of the cosmic forces⁽¹⁶⁾

Watsonian approach emphasizes that the ideal, and the value of care is a starting point, a stance, an attitude that has to become: desire, intention, commitment, and conscious judgment that manifests itself in concrete acts. "Human care is related to inter-human responses to health and disease conditions, and person-environment interactions"⁽¹⁵⁾. Effective human care can be demonstrated and practiced interpersonally, however, "the process of interpersonal relationship is defined within a transpersonal context , that transcends every human being, and moves in concentric circles of self to the other, the environment, nature and the universe"⁽¹⁷⁾ Previous approaches, concerning the humane care highlight implications with respect thereto. This structure together with the love energy that moves the universe and in its highest form could be the spirit, which we believe is the highest form of the person, although it is intangible, it reaffirms the idea of accepting that we mind, body and spirit, and as such respond uniformly. This makes us understand the need for autodescubrirnos, self-knowledge, love and appreciate every part of our body, which requires us to try to live in harmony with ourselves, with others and with nature. Care as a moral value represents the ideal of nursing to maintain respect for the dignity of the person seeking care. Emphasizes the axiological sense in making ethical decisions to perform actions caregivers. As interpersonal relationship, care promotes significant interaction between care person and cared person , which are incorporated : knowledge, feelings , responsibilities , opinions, attitudes , actions, thus showing care and concern for his alterego . The care and affection means affective and effective dedication of the nurse to provide support to the person needing care. As for care as a therapeutic intervention , we consider important to highlight this dimension because it is an opportunity to nurses to be in front of the person who for one or other reason requires actions caregivers . It is an opportunity to demonstrate their skills and approaching significant presence in that awakening , the confidence and recognize that the presence of this professional goes beyond the execution of procedures , significant care must therefore be determined by listening carefully in turn involves a learning process to learn to listen to ourselves to listen carefully to the other. Knowing when to play and how to how to do , playing a significant act , given that it is transmitted through security , affection, sincerity , warmth among many other feelings and I think the play many times speak louder than words , and this is important for the person receiving care .

The view is another caring attitude, that determines the significant presence of the nurse, who must learn to interpret each expression kinesthetic what the patient tries to express, what you feel at the time of the person contact. The person can demonstrate bodily expressions: loneliness, fear, pain, despair, misinformation, doubt, anxiety, among other feelings, and this is where the professional has the opportunity to exercise their role as caregiver, using empathy, understanding, respect, relevant guidance, emotional support and spiritual all together with the abilities, skills and safety in performing technical procedures. Therefore, the nurse should support the person cared for through attitudes and actions that show interest in their welfare and their acceptance as a person who thinks, feels, and suffers . Avoid consider it as being reified, it only responds to a biological imbalance manifested by signs and symptoms. In the context of human caring is essential to reflect on the care of the self as essential imperative to protect itself considered by Jersild as: A set of thoughts and feelings that are the conscience of the individual existence of the person, their conception of who is and what is. The self of a person is the sum total of all she can call her own and includes a system of ideas, attitudes, values, commitments. Subjective environment is the person⁽¹⁸⁾.

Overlapping definitions of those authors, reflect what is the self, therefore, it is recognized that this is who we are as people, is our bio-psycho and spiritual nature, is our own self, our singular and unique human form, not excepting our relationship with other human beings. In this regard, it is worth noting that the self requires protective measures and implicit self-caring.

Self-care is a vital act, represented in the infinite and complex range of activities that people perform to safeguard and maintain its existence. Self-care as a human construction, is the result of a socialization process where people learn: the customs, habits, attitudes, beliefs, values, typical of influential social groups, but also represents the self, the sensitivity, the commitment itself is taken. Self-care includes, among other things, to care: health, thoughts, attitudes, behaviors, emotions, values, the biopsychosocial needs, even the goods and everything that we generate welfare without damaging the welfare of others. In relation to care for himself, Collière, M. expressed under the name of care to mean "an individual act, that one gives to itself when acquired autonomy "⁽¹⁹⁾. Meanwhile, Mayeroff, M. recognizes that self-care requires the person to identify, understand and gratify their needs, become their protector and take responsibility to care primal existence. This responsibility is conceptualized by that philosopher, as a voluntary act, authentic, conscious, which is the autoresponder to meet their own needs, so it is valid to consider the attributes that characterize the care of others: "dedication, trust, patience, humility , sincerity "⁽²⁰⁾.

In this sense, Foucault, M. referring to care for himself, so I called technologies that: Allow individuals to carry out, on their own or with the help of others, a certain number of operations on his body and his soul, thoughts, behavior, or way of being to get well, a transformation of themselves, in order to reach a certain state of happiness, purity, wisdom or immortally⁽²¹⁾.

Martinez Ocana , E. recognizes that self-care is "a wisdom that we learn along our evolutionary process , because every step of the way has its specific needs and care"⁽²²⁾.

The approach to care for himself, presented by Collière, Mayeroff, Foucault and Martinez can recognize that this concept requires its permanent presence awareness on the person. It is as said before, a human construction, learning outcome schemes and influential sociocultural determinants, as each culture has its models, value judgments and even taboos regarding the human care and to care for himself.

Final thoughts

The human being is an integral being that unfolds in an environment with a social reality which characterizes it, it is influenced countless biological, psychological, social and spiritual do own individuality holder to think, discern, feel, make decisions and act. Consequently, the Nursing professional working in health-related organizations should bear in mind, that the person is a body comprehensive and primary health care; holder values and beliefs derived from the culture to be considered at time to provide the care, this will undoubtedly lead us towards a practice-based nursing humanized care . In order to understand the person as a whole, is required to reflect on the basic elements that structure the human condition, which include values, which are the cornerstones on which human life is oriented and are in turn the key to the behavior of people.

The person is in nature and in the universe to transcend through actions that distinguish him as a rational and emotional which is expressed, among other values, by love, solidarity, responsibility for continuous and reciprocal relationship with other people, animals, plants, in order to nature. The Universal Architect (God ) allows us to be present in this life at any given time, which means to use it to meet the significant mission of caring for all human beings or not. This, in one way or another, contribute to our growth as individuals and as holistic nurses, allowing develop spiritually, emotionally, and mentally, this in turn results in feeling good about themselves and others as that certainly refelctes in our professional practice.

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