The dimensions of the human being and nursing care in the pandemic context of COVID-19

ABSTRACT

Objective

to reflect on the dimensions of the human being and nursing care in the pandemic context of Covid-19.

Method

this is a reflection study, in which the corporeal dimensions (Homo somaticus), human life (Homo vivens), knowing (Homo sapiens), will (Homo volens), language (Homo loquens), social (Homo socialis), work (Homo faber), play and fun (Homo ludens) and nursing care in the pandemic context of Covid-19.

Results

the dimensions are being influenced by the pandemic context of the new coronavirus, requiring humanizing nursing interventions, such as transpersonal clinical and therapeutic management, support for the sick physical body, guarantee of a language that enables self-care and psychological support, attitude of open listening, encouraging game practices to spend time and methods of relaxation, meditation and guided imagination, among others. The act of reflecting on the dimensions creates new possibilities for signaling points of intercession for the understanding of the new reality experienced by man.

Conclusion and implications for practice

when reflecting on the dimensions of man in the light of anthropology with the theoretical basis of the Nursing Interventions Classification (NIC) Care Models, possibilities for holistic care are created in the context of the new coronavirus pandemic.

Keywords:
Anthropology; Coronavirus Infections; Existentialism; Nursing Care; Pandemics

RESUMO

Objetivo

refletir sobre as dimensões do ser humano e o cuidado de enfermagem no contexto pandêmico da Covid-19.

Método

trata-se de um estudo reflexivo, em que foram discutidas as dimensões corpórea (Homo somaticus), de vida humana (Homo vivens), conhecer (Homo sapiens), vontade (Homo volens), linguagem (Homo loquens), social (Homo socialis), do trabalho (Homo faber), jogo e divertimento (Homo ludens) e o cuidado de enfermagem no contexto pandêmico da Covid-19.

Resultados

as dimensões estão sendo influenciadas pelo contexto pandêmico do novo coronavírus, sendo necessárias intervenções de enfermagem humanizadoras como o manejo clínico e terapêutico transpessoal, suporte ao corpo físico em adoecimento, garantia de uma linguagem que possibilite o autocuidado e apoio psicológico, atitude de escuta aberta, incentivo às práticas de jogos para passar o tempo e métodos de relaxamento, meditação e imaginação guiada, entre outras. O ato de refletir sobre as dimensões cria novas possibilidades de sinalizar pontos de intercessão para a compreensão da nova realidade vivenciada pelo homem.

Conclusão e implicações para a prática

ao refletir sobre as dimensões do homem à luz da antropologia com o embasamento teórico dos Modelos de cuidados da Nursing Interventions Classification (NIC), geram-se possibilidades de estabelecer um cuidado holístico no contexto da pandemia pelo novo coronavírus.

Palavras-chave:
Antropologia; Infecções por Coronavírus; Existencialismo; Cuidados de Enfermagem; Pandemias

RESUMEN

Objetivo

reflexionar sobre las dimensiones del ser humano y la atención de enfermería en el contexto pandémico de Covid-19.

Método

este es un estudio reflexivo, en el que las dimensiones corporales (Homo somaticus), la vida humana (Homo vivens), el conocimiento (Homo sapiens), la voluntad (Homo volens), el lenguaje (Homo loquens), social (Homo socialis), trabajo (Homo faber), juego y diversión (Homo ludens) y cuidados de enfermería en el contexto pandémico de Covid-19.

Resultados

las dimensiones están siendo influenciadas por el contexto pandémico del nuevo coronavirus, que requiere intervenciones humanizadoras de enfermería, como el manejo clínico y terapéutico transpersonal, el apoyo al cuerpo físico enfermo, la garantía de un lenguaje que permita el autocuidado y el apoyo psicológico, la actitud de escucha abierta, fomentando prácticas de juego para pasar el tiempo y métodos de relajación, meditación e imaginación guiada, entre otros. El acto de reflexionar sobre las dimensiones crea nuevas posibilidades para señalar puntos de intercesión para comprender la nueva realidad experimentada por el hombre.

Conclusión e implicaciones para la práctica

reflexionar sobre las dimensiones del hombre a la luz de la antropología con la base teórica de los Modelos de Atención de la Clasificación de Intervenciones de Enfermería (NIC) genera posibilidades de atención integral en el contexto de la nueva pandemia de coronavirus.

Palabras clave:
Antropología; Infecciones por Coronavirus; Existencialismo; Atención de Enfermería; Pandemias

INTRODUCTION

Covid-19 is a disease that presents a clinical picture that varies from asymptomatic infections to severe respiratory conditions. According to the World Health Organization, 80% of the patients can be asymptomatic and 20% of the cases can require hospital care due to the presence of respiratory difficulty. Of these cases, approximately 5% will require support for the treatment of respiratory failure (ventilatory support).^1,2 Declared a pandemic disease, the infection has become a Public Health emergency, reaching the number of 35,179,573 cases and 1,037,340 deaths, such data had been made available up to October 5, 2020.³

This whole context of viral infection by SARS-COV-2 has demanded changes in the daily life activities of the human being, thus affecting the dimensions of his existence. In face of these changes, the significant repercussions in the health-disease process that affect health care are highlighted, especially those related to the practice of nursing because their skills and competencies are related to the development of care ranging from the promotion of health and prevention of diseases to the care of critical patients of high complexity.^4,5

The practice of nursing brings important contributions in the perspective of the health of the individual, in the sense of recognizing the human being as a complex being composed of several dimensions that go from the organic to the spiritual, from the tangible to the intangible, including the social and historical aspect, which defines him as a being of permanent interrelationship with himself and with the world.^6,7

From this perspective, the human is seen as possessing characteristics and attributes inherent to his world-life, highlighting the consciousness, the intellect, dignity, emotions, feelings and knowledge. Therefore, nursing care assumes a humanistic and comprehensive dimension, whose subjectivity is structured by its experiences, meanings, intuitions and reasoning.^6,7

Within this humanistic vision of care, Jean Watson's Theory of Transpersonal Care stands out, which proposes a transcendental care, capable of contemplating the individual in his whole body-mind-spirit. This philosophy of care transcends the periphery of a traditional care perspective and reaches the depths of the consciousness of the subjects who participate in the moment of care. Therefore, the nurse needs to approach the world of the other in order to understand it and strengthen him/her in his/her own capacity of caring. To do so, this professional must recognize the importance of his or her own existence, especially in this scenario of pandemic crisis, in which his or her abilities have become relevant to perform the human care.^6,7

In this perspective, the phenomenology of man allows the understanding of the various human dimensions, from life as knowledge to the functional reality of the body and how these can undergo adjustments in fron of the pandemic.⁸ In view of the complexity of the human being and the influences experienced in current times, the various consequences in people's lives are unquestionable, causing changes in their daily lives. Therefore, we tried to reflect on the human dimensions and their importance for nursing care in the Covid-19 pandemic.

METHOD

This is a study of reflection based on the dimensions of man, based on Mondin's anthropology, focused on nursing care, as well as on the critical reading of current scientific studies on Covid-19. This type of research approaches the qualitative approach, given the interpretation and analysis of the theoretical elements obtained through the bibliographic research consulted.⁹

Issues in the field of human dimensions were presented in the pandemic context of Covid-19, according to the ten dimensions: the dimension of the body (Homo somaticus), human life (Homo vivens), sensitive and intellectual knowledge (Homo sapiens), the will, freedom and love (Homo volens), the language (Homo loquens), the social dimension (Homo socialis), the culture (Homo culturalis), the work (Homo faber), the play and the amusement (Homo ludens) and the religious one (Homo religiosus).⁹

The study discusses the dimensions and influences of context that can lead to the prevention measures and the promotion of human health. In this perspective, the nursing presents prominence in the search for a care that enables a set of practices, technologies and procedures focused on health care and that transcends physiological care and reaches the affected dimensions, as highlighted in Jean Watson's Transpersonal Theory and Leininger's Theory of diversity and universality of cultural care, used in this research to establish reflections on humanized nursing care in people, families and communities.

RESULTS AND DISCUSSION

Nursing care and the dimensions of the body, life, knowledge and will

The expression 'homo somaticus' alludes to the body, under the prism of the properties related to its mechanism in perfect functioning both in the whole and in its singular parts, besides its bodily functions, since it is through the body that man is a social being, a being in the world. For this purpose, the main functions of corporeality, in general, are related to the functions of worldliness, individuation, self-understanding, possession, among others.⁸

The body presents in the context of Covid-19 as the one with possibilities of being affected by the disease, which puts at risk its physiological functions mainly due to the lung alterations caused by the disease.¹⁰ The body, in its physical reality, when affected by this disease, presents alterations in its properties.⁸

When realizing the body and the experience of life, man demonstrates another dimension that is the knowledge. This happens because he is endowed with sensitive and intellectual knowledge, making him aware of the world around him.⁸ However, knowledge of the pandemic reality through knowledge sometimes appears limited.¹¹

It is also possible to reflect on the dimension of will, characterized by the dynamism, movement, attitudes and activities of the human being. Man has spared no effort, motivated by his will, to fight Covid-19 individually or collectively, bringing together actions to promote his health and well-being.^11,12

Nursing care, in search of the integral health of the person, family and society, in this dimension, is related to the aspect of signs and symptoms marked by fever, tiredness, dry cough and difficulty to breathe. These hemodynamic alterations have levels of severity that, undoubtedly, can lead to deaths, reflecting in the life of the individual not only during the illness, but in all the process that it goes through, transposing the technical knowledge of the diagnosis and its measures of promotion, protection and recovery, until limitations of daily life, as measures of social isolation, interfering in the domain of the will and in the decision of the individual.^13,14

In this sense, isolation measures, hygiene, early identification of signs and symptoms suggestive of infection, follow-up and monitoring of drug treatment, among others, are considered fundamental strategies for combating the new coronavirus.¹³

However, people are not immune to the disease, and the involvement with the virus reveals a challenging experience during the hospitalization process marked by fear, anxiety, concern with the unknown, appreciation of the patient's opinion and transformation of professional practices and attitudes. This is the case of elderly people infected by COVID-19 in Spain who had the experience of facing from the physical symptoms of the disease to the emotional and social aspects, reinforcing the idea of the fragility of life. The team, especially the nurses, adopted transformative strategies such as touch or sound communication, since they were using protection barriers that made effective communication difficult, and sharing information with family members through phone calls to enable the highest possible standard of care.¹⁵

Nursing offers an integral care, guaranteeing full health with autonomy, individuality and integrity of each individual's life, thus reacting to Jean Watson's Transpersonal Theory composed of ten elements that consider the client as the sacred and proposes a philosophy and science centered on care, which constitutes one of the main axes of nursing practice (Chart 1).

Chart 1
Interventions for Humanized Nursing Care for dimensions, life, knowledge and will in times of Pandemic. Fortaleza, Brazil, 2020.

Humanized Nursing Care
Person, Family and Community
- Pay attention to the knowledge of the signs and symptoms involved, as well as the attitudes to be taken when identifying risks;
- Include preventive measures that reduce the spread of the virus in daily life;
- Use measures to overcome fears, anxieties and uncertainties when facing the preservation of quality of life and health;
- Effective family confrontation to add healthy and collaborative support measures;
- Personal, individual and non-transferable decision to be a participant of the will to contribute in the decrease of the viral load dissemination.
Health Professionals
- To know the pandemic, with emphasis on the identification of the prevalent signs and symptoms, as well as its therapeutic management;
- Pay attention to the increase in body temperature;
- Alert for signs and symptoms of Gripal Syndrome;
- Maintain an effective respiratory pattern of area pathways;
- Offer the client safety about the therapy developed;

• Source: Elaboration based on Nursing Interventions Classification (NIC).16

Nursing Care and the Language, Social and Cultural Dimensions

Man, as a social being who needs to communicate, uses language as his greatest instrument. Language presupposes three transcendental conditions: the subject who speaks, the object of which one speaks, and the interlocutor with whom one wants to communicate by speaking.⁸ Thus, the language revealed today reflects the concern of man, and the scientific community strives to understand the mechanisms that lead to illness, so that through clear language, the proper guiding directions of society are made possible in the perspective of understanding and adopting preventive measures, as well as ways of dealing with such a unique condition experienced in the current context.^12-17

The man is essentially sociable, and alone he would not be able to come into the world or achieve his highest aspirations. In order to obtain all these aspirations, one needs the company of others, whose relationships constitute the social dimension, which is greatly compromised due to the restrictions imposed by social distancing.^2,12,17

The commitment of the social dimension is expressed in reports of patients who have contracted the new coronavirus and needed hospitalization¹⁸ or stayed in quarantine places,¹⁹ revealing the initial fear before the new reality, in view of the breakdown of social relations, even considering the social isolation as necessary to protect others, feeling of being stigmatized, for those who had contact with the disease and the support received from friends and other family members.

The support of nurses has proven to be quite significant for the care of patients with Covid-19, regardless of their specialty, amidst the new challenges of acquiring new knowledge, complying with new protocols, and improving physical and psychological quality to enable care of patients.²⁰ Although there is intense work by nurses in the front line of care, both physically and emotionally, they demonstrate a spirit of dedication and feel responsible for collaborating with the lives of patients in the midst of the pandemic.²¹

Socially isolated people, with restricted mobility and little contact with other people have been more vulnerable to psychiatric complications that can range from insomnia, anxiety, depression to post-traumatic stress disorder (PTSD).²² In this context, nursing is active in humanized care that transcends physical assistance, as suggested by Jean Watson's theory that, at a more advanced level of care, nursing is able to access the emotional and subjective aspects, in order to achieve transpersonality through communication and empathy.⁸

These are the main instruments to establish and maintain the relationship of help and trust between professional and patient, since true care is guided by an empathetic relationship, in which one recognizes the other with whom one lives his/her unique experience of being patient.⁸

Another important dimension that is revealed in this scenario is the culture in which ways of living, behaviors and habits are integral parts of each individual and influence their health, as Leininger points out in his theory of diversity and universality of cultural care (TDUCC), which proposes care from a cross-cultural and holistic perspective.²³

The professional must have an empathic posture, which provides a balance both with the environment and with the patients. This behavior causes changes in an unfavorable context, meeting physical, mental and emotional needs.^8,23,24 In this sense, it is important to understand the socio-cultural relations in the health and disease process, extending care beyond the biological dimension.²²

Thus, the nurse as an educator has a fundamental role in sensitizing the population to adopt habits that reduce the spread of Covid-19, such as staying in social isolation, having hygiene habits, washing hands frequently, sanitizing objects and wearing masks, considering the environment and the limitations of each individual²⁵ (Chart 2).

Chart 2
Humanized Nursing Care Interventions based on language, social and cultural dimensions in times of Covid-19 pandemic. Fortaleza, Brazil, 2020.

Humanized Nursing Care
Person, Family and Community
- Use a calm and reassuring approach;
- Try to understand the perspective of the patient and family in relation to the feared situation;
- Listening to the patient and family with attention;
- Encourage the expression of feelings, perceptions and fears;
- Determine the adequacy of existing social networks;
Health Professionals
- Identify stressful events in the work environment;
- Initiate programs to promote health in the workplace;
- Identify and treat acute conditions at work;
- Initiate changes in the environment to eliminate or minimize risk;
- Use relaxation techniques;

• Source: Elaboration based on Nursing Interventions Classification (NIC).16

Nursing Care and the Dimensions of Work, Play and Religion

Work is an important activity for the study of man, as are knowledge, freedom and language, since the individual is essentially a creator of forms and a maker of works.⁸ Work is defined as any material and spiritual activity that seeks useful results. In addition, it adds important elements to its understanding as the use of the body to transmit energy, effort and perseverance.⁸

However, this dimension is significantly affected by the global economic recession in view of the effects on people's employment. Therefore, anxiety, worry, stress, problems with sleep and appetite, as well as the mixture of feelings or emotions are present in the people, due to the uncertainty of the situation, as well as the psychological impact mainly on health professionals who are in the front line, being the stress a constant in their daily lives.

The pandemic has revealed a new configuration in the work environment of nurses and has reinforced the precarious conditions of work, income, physical and mental health of these professionals with the need for studies to reinforce this reality in order to raise awareness and propose suggestions to Class Entities, society and the State in the perspective of a decent work.²⁶

Even in the face of the challenges presented, it is also valid to reflect on the dimension related to play, amusement and recreation, because, differently from those presented so far, this dimension can help to take the focus off the negative aspects of the reality experienced. Man invents games and has fun like no other animal can do. In this way, he is also defined as ludens. The game presents specific properties that are distraction and fun, so any activity done with the intention of amusing and distracting is part of the category of games.⁸

It is valid to reflect on this dimension in the context of Covid-19, since the game can also be a possibility to occupy time in this moment of social isolation.²⁷ The attention to the need for recreation is, however, an indispensable condition for nursing care and should be more present at the moment, because it is one of the strategies used in social isolation, besides the existence of the nursing diagnosis Deficit in recreational activities, which allows to perform a series of interventions, justifying the knowledge of this issue by nursing professionals.⁴

Finally, the religious dimension is expressed as a typical and exclusive manifestation in man. Anthropologists point out that man has developed religious activity since his first appearance on the scene of history, with an impression in all cultures. There are various philosophical, theological and historical criticisms around this dimension that help to understand its importance from different angles. However, it is valid to consider the definition of religion as the set of knowledge of actions and structures with which man expresses recognition, dependence and veneration in relation to the Sacred.⁸

Given the reflection around the religious dimension, it is likely that it contributes, among other aspects, to people's mental health.²⁸ Even so, the roles of religiosity and spirituality are more acute at this time because they provide strengthening for the daily experience of difficulties.^28,29 Religiosity is a resource for building hope in life, implying in man's relationship with a transcendent being.²⁸ These reflections are important to think about strengthening this dimension to help people face difficulties.

Jean Watson has in his theory of humanized care a factor called “Incorporation of faith - hope”, in which he speaks of the importance of faith and hope in care and healing, since it is present in our history, as well as in the whole narrative that explains our coexistence as a human species, in which there were influences of magic, prayers and charms (Chart 3).

Chart 3
Interventions for Humanized Nursing Care for Dimensions of Work, Play and Religion in Times of Pandemic. Fortaleza, Brazil, 2020.

Humanized Nursing Care
Work
Person, Family and Community
- The first thing is to keep an open listening attitude to what people manifest;
- Carefully evaluate the reactions of affected people and identify, with clear criteria, those that require the most urgent psychological attention to offer personalized support;
- You need to make her feel that she is accompanied, hold her hand, hug her, caress her, speak to her in an affectionate and serene tone, calling her by name;
- If the person expresses their feelings of pain or frustration with aggressive behavior, such as hitting objects, accompany them calmly, without trying to stop them immediately, unless the safety of yourself or others is at risk;
Health Professionals
- Spend some time with colleagues and vent to verbalize thoughts of lived situations;
- Avoid destructive criticism that affects everyone;
- Try to rest every two hours, taking a deep breath for a few minutes to help you relax;
- When leaving work, avoid excessive information about the pandemic (TV, radio, internet and WhatsApp).
Game
- Using relaxing, interesting and leisure activities to promote well-being;
- Using music to help achieve a specific change in behavior, feelings or physiology;
- Facilitating communication through drawings or other forms of art;
- Providing a calm environment;
- Encourage the person to describe their drawings or artistic creations;
Religion
- Identify the spiritual and religious needs of this person, using the knowledge to value and present spiritual and religious care daily;
- Provide an environment that favors the person with the possibility of a meditative / contemplative attitude of self-reflection;
- Be open to listening actively to expressions and concerns of loneliness and powerlessness in times of pandemic and, if necessary, help the individual to adequately express and release negative feelings;
- Use techniques to help the individual classify his or her beliefs and values, as well as areas and reasons for hope in life;
- Encourage the person to relate to family, friends, and other people;

• Source: Elaboration based on Nursing Interventions Classification (NIC).16

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The understanding of the body dimensions, human life, knowledge, will, language, social, cultural, work, play and religious gives support to take care of it, opportunizing the refection of the different dimensions of man, understanding those that need to be stimulated and worked under the nursing care for the necessary balance of the physical, social, emotional and spiritual body, which cannot be translated yet in numbers and concrete methods for understanding the reality in the midst of the existence of the human being during this reality.

The construction of care models based on Nursing Interventions Classification (NIC) and the theoretical basis creates possibilities for holistic care, helping people to reinforce their potential and/or minimize imbalances in their health status, especially in the midst of the Covid-19 pandemic, considering from the physiological and organic dimension until the social and spiritual dimension.

It is believed that this work becomes relevant, since it instrumentalizes the care of man in a holistic perspective, in situations of social isolation, body sickness, impediment to the work or occupational risk, as well as other aspects in the midst of the uncertainties of the pandemic context.

The limitation of the study is that it is not yet possible to evaluate in practice the theoretical considerations addressed. Moreover, it is not possible to know which of the dimensions are more affected; but that the study has the potential to direct nursing care in the context of Covid-19.

However, it is suggested that new approaches of this nature be implemented in order to enable for a broader and more intense discussion on the aspects that involve the dimensions of man in general and in the Covid-19 pandemic context.

• FINANCIAL SUPPORT

  Scholarship granted to Edna Johana Mondragón Sánchez. Programa de Excelência Acadêmica da Coordenação de Aperfeiçoamento de Pessoal do Nível Superior (Program of Academic Excellence of the Coordination of Improvement of Personnel of the Superior Level) (CAPES/PROEX - Process 88887.334871/2019-00).

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Edited by

ASSOCIATE EDITOR

Cristina Rosa Baixinho

Publication Dates

• Publication in this collection
  29 Jan 2021
• Date of issue
  2020

History

• Received
  05 Aug 2020
• Accepted
  24 Oct 2020