Humanization policy in primary health care: a systematic review

Nora, Carlise Rigon Dalla; Junges, José Roque

doi:10.1590/S0034-8910.2013047004581

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Sumário

Reviews • Rev. Saúde Pública 47 (6) • Dec 2013 • https://doi.org/10.1590/S0034-8910.2013047004581 copy

Humanization policy in primary health care: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

: To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy.

METHODS

: 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.

RESULTS

: 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.

CONCLUSIONS

: 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.

Humanization of Assistance; Delivery of Health Care; Primary Health Care; Public Health; Unified Health System; Qualitative Research; Review

Year	Place	Title	Authors	Place	Objective	Type of study
2007	BDTD – Postgraduate Program in Health Care Sciences. Universidade Federal do Rio Grande do Norte	A representação social do cuidado no Programa de Saúde da família na cidade de Natal (The social representation of care in the Family Health Care Program in Natal)	Rodrigues MP	Family Health Care Program in Natal, RN	Understand the social representations of care of FHCP teams in Natal and how these representations guide the daily actions of these individuals during the work process.	Research
2009	BDTD - Postgraduate Program in Social Sciences. Universidade Federal do Rio Grande do Norte	A política de humanização e a Estratégia de Saúde da Família: Visões e vivências (A politics of humanization and the Family Health Care Strategy: Views and Experiences)	Vilar RLA	Family Health Care Strategy, Natal, RN	To reflect on the guiding theoretical and organizational frameworks of NHP and its echoes in municipal health policy in Natal; for analyzing milestones in local politics, discovering the views and experiences of humanizing agents in the day-to-day work processes and for the main challenges of the Humanization policy.	Research
2005	BDTD - Postgraduate Program in Health Care and Environmental Sciences - Universidade Católica de Goiás	Inovação e resistência na implantação do Processo de humanização na secretaria Municipal de saúde do município de Goiânia-GO, Sob as lentes da bioética (Innovation and resistance in implementing the humanization process in the municipal health department of Goiânia-GO, From a bio-ethical point of view)	Soares LFP	10 health care units in municipal health department of Goiânia	A bioethical focus on the public health care system professional involved in the process of humanizing health care as envisaged by the Ministry of Health, as well as their activity as a protagonist in this process.	Research
2009	BDTD - Postgraduate Program in Children and women’s health. Fundação Oswaldo Cruz	Humanização das condições de trabalho: Um dos pré-requisitos para a humanização da assistência ( Humanization of working conditions: One of the pre-requisites for humanizing health care)	Villar RMT.	Health care center and in a policlinic, both part of the municipal health department, Rio de Janeiro	To analyze the meaning health care professionals attribute to the interference of working conditions in humanizing health care provided to service users.	Research
2009	BDTD - Universidade do Estado do Rio de Janeiro . Institute of Social medicine.	Integralidade na prática assistencial da equipe de enfermagem: a relação da escuta na interação usuário e profissional no município de Paranavaí, PR (Comprehensiveness in the care practices of a nursing team: listening in user-professional interaction in Paranavaí, PR)	Urbano GB	Two primary health care units in Paranavaí, PR	To observe the activities of the nursing team in Primary Care, seeking to characterize interactions with the users and prioritizing listening as a requisite of integrality.	Research
2011	BDTD - Universidade de São Paulo – Nursing School, Ribeirão Preto	A Estratégia de Saúde da Família em sua micropolítica: um estudo de caso sobre a humanização nos processos de trabalho (Family Health Care Strategy in micro-policies: a case study of humanization in work processes)	Campos LVO	Family Health Care Strategy in Ribeirao Preto, SP	To map the ways of producing and capturing humanization activities which constitute micro-policies in the work processes of a FHCS team.	Research
2007	–	Acolhimento e os processos de trabalho em saúde: o caso de Betim, MG (Reception and work processes in health care: the case of Betim, MG)	Franco TB, Bueno WS, Merhy EE	Primary health care unit Rosa Capuche, in Betim, MG	To assess the impact of access mechanisms and explore the possibilities of new designs of day-to-day micro-policies in certain health care models.	Reports
2008	–	Caminhos do acolhimento: relato de experiência em uma Unidade de Saúde da Família no município do Rio de Janeiro (Paths the receiving users: reports of experience in a family health care unit in Rio de Janeiro)	Silva KA, Fernandes ND, Xavier MCS	Family health care unit in Rio de Janeiro	To discuss the experience of establishing reception of users in a family health care unit in Rio de Janeiro.	Reports

Year	Journal	Vol./N	Title	Authors	Place	Objective	Type of study
2003	O Mundo da Saúde	v.27, n.2	Humanização no Programa de Saúde da Família (Humanization of the Family Health Care Program)	Chaves EC, Martines WRV	Family health Care Program, Sao Paulo, SP	Understand how FHCP employees view humanization of the FHCP and what their mission would be when they speak of Humanization.	Research
2003	Cadernos de Saúde Pública	v.19, n.1	Acesso e acolhimento aos usuários em uma unidade de saúde de Porto Alegre, Rio Grande do Sul, Brasil (User access and reception in a health care unit in Porto Alegre, RS)	Ramos DD, Lima MADS	Health care unit in Porto Alegre, RS	Characterize, from the point of view of the users, access to health care and how services are provided, with regards the way they are received, in a health care unit in Porto Alegre, RS.	Research
2004	Cadernos de Saúde Pública	v.20, n.6	Acolhimento e vínculo em uma equipe do Programa de Saúde da Família (Reception and bonding in a Family health Care Program team)	Schimith MD, Lima MADS	A municipality in the Fourth Regional health care Department, RS	To analyze FHCP work with regards the reception of users and bonding during their work, aiming to characterize the mode of producing health care, as well as workers’ perception of service users.	Research
2004	Cogitare Enfermagem	v.9, n.1	Acolhimento no programa saúde da família: um caminho para a humanização da Atenção à Saúde (Reception in the family health care program: a path to humanizing Health Care)	Silveira MFA, Felix LG, Araújo DVd, Silva IC	FHCP, Campina Grande, PB	To identify the professionals’ views of the FHCP reception; to describe how they practice receiving users, showing favorable and unfavorable conditions in consolidating a culture of humanization within the FHCP.	Research
2004	Saúde e Sociedade	v.13, n.3	O cuidado, os modos de ser (do) humano e as práticas de saúde (Care, human behavior and health care practices)	Ayres JRCM	Primary Health Care Units	To examine philosophical and practical challenges in humanization in health care practices.	Report
2004	Revista Escola de Enfermagem da USP	v.38, n.2	Descrição e análise do acolhimento: uma contribuição para o Programa de Saúde da Família (Description and analysis of reception: contribution to the Family Health Care Program)	Fracolli LA, Zoboli ELCP	Family health Care Unit in Sao Paulo, SP	To identify the processes of “reception” in Family Health Care Units in Sao Paulo, SP.	Research
2006	Pediatria (São Paulo)	v.28, n.4	Humanização e autogestão em uma unidade básica de saúde (Humanization and self-management in a primary health care unit)	Silveira MGG, Baldacci ER	Primary Health Care Unit on the outskirts of the city of Sao Paulo, SP	To describe the self-management process developed within a primary health care unit and contribute to similar initiatives in other disadvantaged locations in the country.	Research
2006	Revista Espaço para a Saúde, Londrina	v.8, n.2	A implantação do acolhimento no processo de trabalho de equipes de saúde da família (Establishing receiving users in the work process of a family health care team)	Scholze AS et al	FHCP unit in Barra do Rio, Balneário Camboriú, SC	To describe the implementation of receiving users as a way of organizing work in health care in the FHCP.	Report
2007	Acta Paulista de Enfermagem	v.20, n.1	Acesso e acolhimento em unidades de saúde na visão dos usuários (Access and reception in health care units, from users point of view)	Lima MADS, et al	Two health care units in Porto Alegre, RS	To characterize, according to users’ opinions, how health care access is conformed and how health care is provided to them, with regards how they are received in health care units in Porto Alegre, RS.	Research
2007	Cadernos de Saúde Pública	v.23, n.2	Acolhimento e transformações no processo de trabalho de enfermagem em unidade básica de saúde de Campinas, São Paulo, Brasil (Reception and transformations in the work process in nursing in a primary care unit in Campinas, São Paulo, SP)	Takemoto MLS, Silva EM	Five health care centers in Campinas, SP	To report transformations in nursing work with the incorporation of reception into the process of establishing the Paideia health care project in Campinas, from 2001.	Research
2007	Revista APS	v.10, n.2	Acolhimento: uma experiência em pesquisa-ação na mudança do processo de trabalho em saúde	Andrade CS, Franco TB, Ferreira VSC	Family Health Care Strategy Jacinto Cabral de Itabuna, BA	To portray the development of research-action about reception and accessibility for service users in a Family Health Care Unit in Itabuna, BA.	Research
2008	Cadernos de Saúde Pública	v.24, supl. I	Acesso e acolhimento na atenção básica: uma análise da percepção dos usuários e profissionais da saúde (Access and reception in primary health care: an analysis of health care user and professional perception)	Souza ECF, et al	Family Health Care Primary Care Unit in three state capitals in the Northeast, two cities and a medium sized town	To evaluate the potential and the challenges to comprehensive care in Primary health Care, according to health care user and professional perception, with the work process developed in the primary health care units in the state capitals in the northeast as a reference.	Research
2008	Revista da Rede de Enfermagem do Nordeste	v.9, n.4	Assistência de saúde humanizada: Conquistas e desafios em Campina Grande, PB (Humanized health care: Victories and challenges in Campina Grande, PB)	França ISX, Marinho DDT, Baptista RS	Primary health care units, Campinas Grande, PB	To identify victories and challenges in the humanization process in primary health care units in Campina Grande, PB.	Research
2008	Arquivos Catarinenses de Medicina	v.37,n.4	Implantação do acolhimento em uma unidade local de saúde de Florianópolis (Establishing reception in a health care center in Florianópolis, SC)	Nascimento PTA, Tesser CD, Neto PP	Local health care units in Florianópolis, SC	To describe the establishment of reception as a form of organizing work in health in the family health care program.	Case study
2008	Revista Mineira de Enfermagem	v.12, n.2	O acolhimento sob a ótica de profissionais da equipe de saúde da família (Reception from the point of view of health care professionals in a family health care strategy team)	Freire LAM, et al	Family Health Care Program, Belo Horizonte, MG	To report the perception that FHCP professionals have of receiving users and to encourage reflection on reception practices in this unit.	Research
2008	Physis: Revista de Saúde Coletiva	v.19, n.4	Os processos de formação na política Nacional de Humanização: a experiência de um curso para gestores e trabalhadores da atenção básica em saúde (Formation processes in the National Humanization Policy: the experience of a course for managers and workers of primary health care)	Guedes CR, Pitombo LB, Barros MEB	Municipality in Rio de Janeiro	Report the experience of a National Humanization Policy training course focused on primary care managers and workers in municipality in the state of Rio de Janeiro, RJ.	Reports
2009	Interface: Comunicação, Saúde, Educação.	v.13, supl. I.	Gestão participativa e corresponsabilidade em saúde: limites e possibilidades no âmbito da Estratégia de Saúde da Família (Participatory management and responsibility in health: limits and possibilities within the Family Health Care Strategy)	Trad LAB, Esperidião MA	Six municipalities in Bahia, Sergipe and Ceará	To discuss the limits and possibilities of incorporating participatory management and incorporation of the principle of responsibility within the Family Health Care Strategy (FHCS).	Research
2009	Ciência e Saúde Coletiva	v.14, supl. I	Tecnologia das relações como dispositivo do atendimento humanizado na atenção básica à saúde na perspectiva do acesso, do acolhimento e do vínculo (Technology of relations as humanized care tools in primary health care from the perspective of access, reception and bonding)	Coelho MO, Jorge MSB	Fortaleza, CE	To discuss how users and workers perceive access, reception and bonding as light technologies in primary care in Fortaleza, CE.	Research
2009	Revista Gaúcha de Enfermagem	v.30 n.1	Humanização da assistência de enfermagem: percepção de enfermeiros nos serviços de saúde de um município (Humanization of nursing: perceptions of nurses in health care services in a municipality)	Beck CLC, et al	32 primary health care units in a municipality in the center of the state of RS	To identify the perception of nurses regarding the humanization of health care services in a municipality and point out users and nurses’ difficulties in performing humanized care.	Research
2009	Revista da Escola de Enfermagem USP.	v.43, n.2	Formação do vínculo na implantação do Programa de Saúde da Família numa Unidade Básica de Saúde (Bonding in implementing the Family Health Care Program in a Primary Care Unit)	Monteiro MM, Figueiredo VP, Machado MFAS	Primary health care units in Fortaleza, CE	To understand bonding strategies between health care users and professionals in the Family Health Care Program (FHCP) in a primary health care unit in Fortaleza, CE.	Research
2009	Revista Baiana	v.33, n.3	O acesso por meio do acolhimento na Atenção Básica (Access through reception in Primary Care)	Coelho MO, Jorge MSB, Araújo ME	PHCU of the Municipal Department of Health, Fortaleza, CE	To discuss how users perceive access to primary health care units through their reception.	Research
2009	Revista Gaúcha de Enfermagem	v.30, n.4	Representações sociais da relação auxiliar de enfermagem usuário no contexto do Programa Saúde da Família (Social representations of the auxiliary nurse-patient relationship in the context of the Family Health Care Program)	Eulálio MC, Santos ERF, Albuquerque TP	FHCP units in the city of Campina Grande, PB	To understand the auxiliary nurse-patient relationship through social representations of contact, constructed by these health care professionals in the context of the FHCP.	Research
2009	Revista Latino-Americana de Enfermagem	v.17,n.6	Preparando a relação de atendimento: ferramenta para o acolhimento em unidades de saúde (Preparing the service relationship: tool for receiving users in health facilities)	Matumoto S, et al	Health care unit in a municipality in the state of Sao Paulo	To identify and analyze aspects of preparing for the worker/user relationship established in a primary health care unit in a municipality in the state of São Paulo, from the perspective of receiving users.	Research
2009	Revista APS	v.12, n.4	A arte de acolher através da visita da alegria (The art of receiving users through happy visits)	Pekelman R, et al	Jardim Itu health care unit community health care service/ Conceição hospital Group, Porto Alegre, RS	To promote health through laughter, from the perspective pf humanizing care and promoting health, essential to the role of primary health care services.	Reports
2010	Physis Revista de Saúde Coletiva.	v.20, n. 4	Sentidos e Práticas da Humanização na Estratégia de Saúde da Família: a visão de usuários em seis municípios do Nordeste (Meaning and practice of humanization in the Family Health Care Strategy: views of users in six municipalities in the Northeast)	Trad LAB, Esperidião MA	Small and large municipalities in Bahia, Sergipe and Ceará	To investigate to what extent the principles of humanization are appropriated and translated in the context of Family Health Care Program units and teams.	Research
2010	Saúde e Sociedade	v.19, n.3	A visita domiciliar na ESF: conhecendo as percepções dos familiares (Home visits in the FHCS: discovering the families’ perceptions)	Cruz MM, Bourget MMM	East zone of the municipality of Sao Paulo, SP	To understand the meaning attributed by family members to home visit by Family Health Care Strategy (FHCS), aiming to recognize the difficulties and the potential of this practice.	Research
2010	Revista Latino-Americana de Enfermagem	v.18, n.4	A humanização do cuidado na ótica das equipes da Estratégia de Saúde da Família de um município do interior paulista, Brasil (Humanization of care from the point of view of Family Health Care Strategy teams in a municipality in the interior of São Paulo state)	Marin MJS, Storniolo LV, Moravcik MY	Municipality in the interior of Sao Paulo, SP	To analyze understanding of humanization of care, from the point of view of professionals in Family Health Care Strategy teams.	Research
2010	Ciência e Saúde Coletiva	v. 15, supl.3	Acolhimento na Atenção Básica: reflexões éticas sobre a Atenção à Saúde dos usuários (Reception in Primary Care: ethical reflections on health care)	Brehmer LCF, Verdi M	5 Primary health Care Units in a municipal health care network in a large municipality in Santa Catarina	To identify and analyze ethical implications of day-to-day reception practices in Primary Health Care Units and users’ reflections on SUS health care.	Research
2010	Revista Nursing	v,12, n.144	O acolhimento no cotidiano da saúde: um desafio para a enfermagem (Reception in day-to-day health care: a nursing challenge)	Santos EV, Soares NV	Primary Health Care Unit in a municipality in Rio Grande do Sul	To investigate, together with nurses practicing in Primary care of a municipality in Rio Grande do Sul, knowledge of the SUS National Humanization Policy, focusing on receiving users.	Research
2011	Ciência e Saúde Coletiva	v.16, n.3.	Condições e processo de trabalho no cotidiano do Programa Saúde da Família: coerência com princípios da humanização em saúde (Working conditions and processes in the day-to-day operations of the Family Health Care Program: coherence with principles of humanizing health care)	Trad LAB, Rocha AARM	3 states in the Northeast: Bahia, Sergipe and Ceará	To analyze humanization in work, in the context of the Family Health Care Program.	Research
2011	Interface: Comunicação, Saúde, Educação.	v.15, n.36	A contribuição do acolhimento e do vínculo na humanização da prática do cirurgião-dentista no Programa Saúde da Família (The contribution of reception and bonding in humanizing dental surgeon practice in the Family Health Care Program)	Pinheiro PM, Oliveira LC	FHCP Fortaleza, CE	To understand how light technologies are used in receiving and bonding with users in dental practice, in the Family Health Care Program, Fortaleza, Ceará, in the sense of constructing humanized care.	Research
2011	Interface: Comunicação, Saúde, Educação.	v.15, n.38	A visão de moral dos profissionais de uma unidade básica de saúde e a humanização (Moral vision of health care professionals in primary health care units and humanization)	Junges et al	Primary health care unit in Vila Campina, Sao Leopoldo, RS	To analyze the moral vision of health care professionals in a primary health care unit (PHCU) and highlight implications for humanizing health care.	Research

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[1] Correspondence
: José Roque Junges. Av. Unisinos, 950 Cristo Rei. 93022-000 São Leopoldo, RS, Brasil. E-mail: roquejunges@hotmail.com