Humanization of Care: Key Elements Identified by Patients, Caregivers, and Healthcare Providers. A Systematic Review
Given the automatization of care and rationing of time and staff due to economic imperatives, often resulting in dehumanized care, the concept of ‘humanization of care’ has been increasingly discussed in the scientific literature. However, it is still an indistinct concept, lacking well-defined dimensions and to date no literature review has tried to capture it.
The objectives of this systematic review were to identify the key elements of humanization of care by investigating stakeholders’ (patients, patients’ caregivers, healthcare providers) perspectives and to assess barriers and strategies for its implementation.
We carried out a systematic search of five electronic databases up to December 2017 as well as examining additional sources (e.g., gray literature). Search terms included “humanization/humanisation of care” and “dehumanization/dehumanisation of care”. We conducted a thematic synthesis of the extracted study findings to identify descriptive themes and produce key elements.
Of 1327 records retrieved, 14 full-text articles were included in the review. Three main areas (relational, organizational, structural) and 30 key elements (e.g., relationship bonding, holistic approach, adequate working conditions) emerged. Several barriers to implementation of humanization of care exist in all areas.
Our systematic review and synthesis contributes to a deeper understanding of the concept of humanization of care. The proposed key elements are expected to serve as preliminary guidance for healthcare institutions aiming to overcome challenges in various forms and achieve humanized and efficient care. Future studies need to fully examine specific practices of humanized care and test quantitatively their effectiveness by examining psychosocial and health outcomes.
Compliance with Ethical Standards
Conflict of Interest
Isolde M. Busch, Francesca Moretti, Giulia Travaini, Albert W. Wu, and Michela Rimondini declare that they have no conflict of interest directly related to the content of this systematic review.
The authors received no specific funding for this work.
For this type of study, formal consent is not required.
For this type of study, ethics approval is not required.
Data Availability Statement
The full datasets of the systematic review can be made available upon reasonable request.
*Studies included in the systematic review
- 3.Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press (US), Washington, DC (2001).Google Scholar
- 5.Kienzle HF. Fragmentation of the doctor-patient relationship as a result of standardization and economization [in German]. Z Arztl Fortbild Qualitatssich. 2004;98(3):193–9 (discussion 206, 2013-5).Google Scholar
- 8.Hollnagel E, Wears RL, Braithwaite J. From safety-I to safety-II: a white paper. The Resilient Health Care Net: Published simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia; 2015.Google Scholar
- 9.Borbasi S, Galvin KT, Adams T, Todres L, Farrelly B. Demonstration of the usefulness of a theoretical framework for humanising care with reference to a residential aged care service in Australia. J Clin Nurs. 2012;22:881–9.Google Scholar
- 10.Balint E. The possibilities of patient-centred medicine. J R Coll Gen Pract. 1969;17:269–76.Google Scholar
- 11.Gerteis M, Edgman-Levitan S, Daley J. Through the patient’s eyes. Under-standing and promoting patient-centered care. San Francisco: Jossey-Bass; 1993.Google Scholar
- 13.Drolet BC, White CL. Selective paternalism. Virtual Mentor. 2012;14:582–8.Google Scholar
- *17.Cassiano AN, Araujo MG, Holanda CSM, Costa RKS. Perception of nurses on humanization in nursing care in immediate puerperium. J Res Fundam Care. 2015;7:2051–60.Google Scholar
- 22.Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews. Checklist for Qualitative Research. 2017. https://joannabriggs.org/critical_appraisal_tools. Accessed 17 Mar 2019.
- *24.Baratto F, Ferreira CLL, Ilha S, Santos Nunes S, Backes DS, Asta Pereiitora A. Humanization of care in primary care to people with neoplasia: perception of nursing professionals. J Nurs UFPE on line. 2016;10:615–22.Google Scholar
- *32.Grisales-Naranjo LV, Arias-Valencia MM. Humanized care; the case of patients subjected to chemotherapy. Invest Educ Enferm. 2013;31:364–76.Google Scholar
- *34.Oliveira LC, Silva RAR, Medeiros MN, Queiroz JC, Giumarães J. Humanized care: discovering the possibilities in the practice of nursing in mental health. J Res Fundam Care. 2015;7:1774–82.Google Scholar
- *37.Silva RM, Santos KB, Silva GA, Reis VN, Andrade AM. Humanization of care in bone marrow transplantation: the perception of the nursing team. J Nurs UFPE on line. 2015;9:8261–9.Google Scholar
- 42.Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10:38–43.Google Scholar
- 44.National Patient Safety Foundation’s Lucian Leape Institute. Safety is personal: partnering with patients and families for the safest care. Boston: National Patient Safety Foundation; 2014.Google Scholar
- 45.Haslam N. Humanising medical practice: the role of empathy. Med J Aust. 2007;187:381–2.Google Scholar
- 52.WHO Study Group on Integration of Health Care Delivery Health Organization (1994: Geneva, Switzerland) and World Health Organization (1996). Integration of health care delivery: report of a WHO study group. Geneva: World Health Organization. http://www.who.int/iris/handle/10665/38408. Accessed 17 Mar 2019.
- 57.The National Patient Safety Foundation’s Lucian Leape Institute. Shining a light. Safer health care through transparency. Boston: National Patient Safety Foundation; 2015.Google Scholar
- 61.National Patient Safety Foundation’s Lucian Leape Institute. Through the eyes of the workforce. Creating joy, meaning, and safer health care. National Patient Safety Foundation, Boston; 2013.Google Scholar
- 64.Todres L, Fulbrok P, Albarran J. On the receiving end: a hermeneutic-phenomenological analysis of a patient’s struggle to cope while going through intensive care. Nurs Crit Care. 2000;5:277–87.Google Scholar
- 65.Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2016 to 2030. 2018 update. Final report. 2018. https://www.heartland.org/publications-resources/publications/the-complexities-of-physician-supply-and-demand-projections-from-2016-to-2030. Accessed 17 Mar 2019.
- 72.Swanson JM. Questions in use. In: Morse JM, Swanson JM, Kuzel AJ, editors. The nature of qualitative evidence. Thousand Oaks: Sage Publications; 2001. p. 75–110.Google Scholar
- 74.Silva RMCRA, Oliveira DC, Pereira ER, Silva MA, Trasmontano PSl, Alcantara VCG. Humanization of health consonant to the social representations of professionals and users: a literary study. Online Braz J Nurs. 2014;13:677–85.Google Scholar