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Home > Volume 34, Number 2 (2018) > Borges Damas

Influence of the performance of nursing professionals in

humanized delivery care

Lareisy Borges Damas 1

Arahí Sixto Pérez 2
Rolando Sánchez Machado 3

Provincial Health Directorate of Artemis. Cuba.
Faculty of Medical Sciences "October 10". Havana Cuba.
Teaching Polyclinic Dr. "Tomas Romay". University of Medical Sciences of
Artemis. Cuba.


Introduction: Childbirth is attended directly by health personnel, according to their

profile or specialization, and nurses have the responsibility for quality and the
achievement of excellence in the provision of services provided in a humanized,
assumed way. since the improvement of his professional performance.
Objective: To specify the influence of the performance of nursing professionals in the
humanized delivery care.
Methods: A systematic bibliographic review was carried out to develop a critical
reflexive analysis of the content of documents, they were considered doctoral thesis,
masters, original and review articles published between 1992 and 2015 in Spanish and
English. The search was carried out in the SciELO and Google academic databases from
January to March 2016, the keywords used were "obstetric nursing", "childbirth",
"humanization", "nursing professional performance" and "ethical and human values
". After the identification of the pre-selected studies, the titles, abstract and keywords
were read, checking the relevance of the study.
Conclusion: Humanized care for childbirth is an interaction between knowledge and
feelings for each woman, which allows establishing quality assistance with human
expression during nursing care, based on the influence of their mode of action, of their
doing, on achievement of humanization.

Keywords: Obstetric nursing; Birth; humanization; nursing professional

performance; ethical and human values.

Introduction: Birth labor is attended directly by the health personnel, according to

their profile or specialization, while the nursing staff has the responsibility for quality
and the achievement of the excellence in the provision of services offered in a
humanized way, assumed from the improvement of their professional performance.
Objective: To determine the influence of the performance of the nursing professionals
in the humanized attention to birth labor.
Methods:A systematic bibliographic review was carried out to develop a reflexive
critical analysis of the content of documents, Ph.D. and master's dissertations, and
original and review articles published between 1992 and 2015 in Spanish and
English. The search was made in the academic databases SciELO and Google, from
January to March 2016; the key words used in obstetric nursing [obstetric nursing],
childbirth [birth labor], humanization [humanization], nursing professional [nursing
professional performance], and ethical and human values [ethical and human
values]. After the identification of the pre-selected studies, the titles, summary and the
key words were read, verifying the relevance with the study.
Conclusion: The humanized attention to birth labor is an interaction between the
knowledge and feelings for each woman, which allows to establish a quality assistance
with human expression during the care offered by nursing initiated in the influence of
their way of acting, of doing, and resulting in the achievement of humanization.

Keywords: Obstetric nursing; birth labor; humanization; nursing professional

performance; ethical and human values.


Labor is a physiological and dynamic process characterized by the presence of regular

and painful uterine contractions that increase in frequency and intensity. It is
mentioned that the pain of childbirth is an experience that every woman must
experience to give birth to her children, it is something universal and common that
corroborates the uniqueness of the feminine role. 1

Its evolution is influenced not only by biological factors of each woman and baby, but
also by psychological, cultural and environmental factors. That is why the health
professionals and the rest of the staff that attend to it, must establish an empathic and
humanized relationship where the knowledge of science and the values of the human
being interact to establish quality assistance, applying love and patience, in the most
updated and comprehensive way. two

Nursing care during labor and delivery requires special considerations towards women,
given the changes inherent in this process, in which the intervention of the health
team and specifically of the nursing professional, play an important role in the
evolution and satisfactory results. two

The process of childbirth represents one of the most paradoxical experiences that
women live. On the one hand it creates life, it constitutes for some the best that could
have happened after pregnancy, but at the same time it can be the most painful event
that it experiences and implies a deep psychosocial experience, which tests its
femininity and personal skills and limits its abilities functional, mainly in the decrease
of the control that she can maintain in front of her own physiology. 3

The need to improve perinatal care encompasses not only scientific advances but also
the possibility of humanized care for the pregnant woman, considers her, her children
and her partner as the key characters in the care.

The delivery is attended directly by the health personnel, according to their profile or
specialization, to obtain favorable results within the Maternal and Child Care Program
(hereinafter PAMI) and in this area, the nursing staff is responsible for the quality and
the achievement of excellence in the provision of services that it provides in a
humanized manner assumed from the improvement of its professional performance.

The purpose of the research is to specify the influence of the performance of nursing
professionals in the humanized delivery care.


A systematic literature review was carried out to develop a critical reflexive analysis of
the content of documents, where doctoral thesis, masters, original and review articles
were considered.

The search strategy adopted was the use of keywords or descriptors, connected
through the Boolean operator AND.

The keywords used were "obstetric nursing", "childbirth", "humanization", "nursing

professional performance" and "ethical and human values", being identified through
DECs or MeSH. In this way, articles referred to descriptors in Spanish and English were
used for the search. The search was performed in the SciELO and Google academic
databases from January to March 2016.

The inclusion criteria for the selection of the articles were: Articles in Spanish and
English available in the selected data portals that presented adherence to the subject,
published between 1992 and 2015 that clearly presented the selected theoretical
methodology or reference. The exclusion criteria were the searches that were found
repeated in the databases.

After the identification of the pre-selected studies, the titles of the publications,
abstract and keywords were read, verifying the relevance with the study, and must
adhere to the subject addressed.

To describe the methodological approach to the results, the flow chart is shown,
see figure .

Starting from the concepts that human is to be compassionate, pious, tender,

understanding and that the act of humanizing is to soften, soften, pity, 4 humanization
carries with it the peculiarity that human beings are unique and unrepeatable and,
therefore, , individualities must be taken into account for care.

The humanization of health care is a focus of social interest, becoming a strategy that
allows to increase the well-being of users. In women's health, humanized care is
especially important in childbirth care. In it, women and children experience a situation
of vulnerability and the good care received constitutes a key element in the perception
of satisfaction and well-being referred to by women. 5

For several decades, currents have begun to appear in different countries that were
trying to solve the problem of women in labor and the pain of childbirth. 6

Rangel da Silva 2 in the 50s worked on fear and tension to pain and determined initial
currents of psychoprophylaxis. From that time they began to develop methods that
favored a natural development of childbirth focusing on the woman and / or the baby,
avoiding unnecessary medications and medical interventions. 6

In the decades of the 60s and 70s of the twentieth century, psychoprophylaxis, family-
centered motherhood, the constitution of a home atmosphere in the hospital,
immediate breastfeeding, began to approach the companion in childbirth and acquire
value satisfaction surveys for the parturient and her husbands. 6

In the European Congress of Perinatal Medicine held in 1985, the aspects of

humanization of childbirth were analyzed and marked in a very special way: "Every
woman has, independently of her culture, a great emotional commitment to her
pregnancy and childbirth and childbirth is a psycho-somatic event par excellence,
which involves the mother's body and mind. " 7

This recognition led to the need to clarify the concept of humanization of health care at
the International Conference on Childbirth Humanization, held in November 2000, in
Fortaleza, Brazil. 7

In 2003, Trevizan 8 stated that the nursing professional, as a member of the health
team, is responsible for managing care for people with substantial support in the
proposal with a humanistic vision.

Garzón , 9 in 1998, reported that humanization also includes the cultural, historical and
spiritual aspects of man, for which health professionals must establish appropriate
therapeutic relationships. The same author assures that the humanists of all
philosophical currents proclaim the dignity of man, his freedom and equal rights. He
affirms later in 2005, 10 that the person appreciates the value of himself and the ethics
of his behaviors and interrelations.

In 2004, Andreoni 11 expressed that the health professional should be open to

dialogue, to changes, to share and incorporate new knowledge from other
professionals or disciplines that speak the same language. 9 Among the authors
studied who focus their analysis on the humanized approach to childbirth
care: Garzón in 1999 9 and in 2005, 10 Declaration of Caeará in 2000 in
Brazil, 12 Trevizan in 2003, 8 Andreoni in 2004, 11
among others , show matching

• Humanized, based on the emotional, physical, psychological and social rights and
needs of women, their baby and their family.

• Based on Scientific Evidence and the recommendations of the World Health

Organization (WHO).

• Intercultural approach.

• Performed by qualified personnel and conducted by women with autonomy and


• Respect for human rights, reproductive, culture, rituals and ancestral knowledge.

• Vision of childbirth as a physiological fact.

• Personalized link between the couple and the health team.

• Respect for the choice of women over the people who will accompany her in
childbirth, to her privacy, dignity and confidentiality.

• Care for the mother's immediate bond with the newborn.

Among the civil and political rights in Cuba there is a National Health System, which
due to the state and social nature of medicine, including sexual and reproductive
health, has decisively managed to raise the health indicators of the entire population,
and in particular as a right of women and children, maternal and child health, benefits
that responds to the Universal Declaration of Human Rights. 10

Of the 25 contributions made by the Cuban Society of Gynecology and Obstetrics

(hereinafter SCOG) and presented by Professor Cabezas Cruz, President of the Cuban
Society of Gynecology and Obstetrics, in his report of the Universal Periodic Review in
2013, 13 Three of them are related to humanized care for women in the reproductive

· "During this period the Society has contributed from its different sections to the
promotion of Sexual and Reproductive Health and Sexual and Reproductive Rights.
Promoting a strict observance of ethical principles, with a high technical and cultural
scientific level. , without neglecting spiritual development, its humanistic, supportive
projection and the satisfaction of women and family members with the services
received. "

· "Childbirth is institutional and has an indicator of 99.9% of live births in health

institutions, which constitutes a human right of women to have a safe birth, performed
under optimal conditions by qualified medical personnel and graduates (as) in nursing
with specialization in Obstetrics. During this period these personnel have received the
support of SCGO for the training on technical scientific advances related to the
management of childbirth and care for the puerperium "

· "As part of the humanization of childbirth, as a right of the mother and the couple,
the accompaniment to women during labor is implemented and encouraged by the
relative or person she decides, for which they have created the basic courses that train
health personnel and family members for this process, and in which the SCGO has
participated for its improvement ".

It is appreciated that, despite the efforts, even the issue of humanization to women
during labor, childbirth and other events of their reproductive process, presents, from
the speech itself, absence of strengthening elements that allow reflection on the
human and professional relations that happen around these processes, recognizing
that professionals and women are exposed to the best and the worst in a particularly
momentous moment and that the protocolized practices, in general, do not respond to
the totality of the rights of women and family members and yes to the standardization
of norms whose main objective is to obtain a mother-child binomial in optimal
biological conditions, thus avoiding the holistic approach of the care provided by the
health team.

In relation to childbirth, its humanization implies that the woman has control of the
process, not the health team; It requires a respectful and careful attitude determined
by the improvement of the performance of nursing professionals who offer care
sensitive to the needs and expectations of women. 5

The systematization of the evolution of the concept of humanized care makes it

possible to operatively define the humanized care of the Nursing professional during
labor and delivery, such as: the performance of each nurse in providing care to women
during labor. and childbirth through an attitude where scientific knowledge is related to
the feelings, values and principles of nursing professionals and of each woman, quality
assistance is provided that is perceived by the woman through identification and
Satisfaction of your needs as a central axis in the delivery process.

The review and analysis of materials and results of research projects related to the
improvement of the professional performance of nursing work resources allowed the
search and identification of epistemological, theoretical and methodological references
that set stable livelihoods for analysis, assessment and finally propose solutions from
scientific positions to the category: professional performance.

The Vice Ministry of Teaching and Research of the Ministry of Public Health of Cuba
(hereinafter MINSAP), began the studies of the evaluation of competence and
professional performance, from the realization of four national workshops between
1992 and 1997, with the participation of advisers from the Pan American Health
Organization (hereinafter PAHO), from WHO and from foreign academic institutions
(Canadian and Guatemalan). 14.15

In 2006, León Román 16 stated that in accordance with its purpose of overcoming,
Nursing, it is up to the trend that tends to guarantee the quality of the health service
systems, which seeks to satisfy the needs of care that society has as a
whole. Likewise, competence and quality of performance have become essential
requirements in health services. 13

For Urbina Laza 17 , labor competencies are assumed as a starting point for the
evaluation and analysis of the performance of nursing professionals.

Añorga 18 in 2010 assumes professional performance as the ability of an individual to

carry out actions, duties and obligations of their position or professional functions
required by a job. This term designates what the professional actually does and not
just what he knows how to do.

For its part, in 2011, Martínez 19 addresses that the professional performance of
Nursing graduates in the hospitals of the second and third level of care becomes
complex; It is determined by the constant transformations and development of science
and technology, the diversity of diseases and their behaviors, always different in each
patient and the large number of procedures performed in these services.

Sixto Pérez, 20 in 2014, as part of his research in the pedagogical area, defines that
professional performance in its metacognitive component, is reflected in the reflection,
supports the regulation of the nursing professional and strengthens the disposition and
effort to set and achieve professional and personal goals that make an autonomous
person, self-regulated and identified with their profession, elements that from
Advanced Education are associated with the definition and operationalization of the
term: professional and human improvement.

The definition of Espinosa 21's professional nursing performance is assumed in 2015,

due to its coincidence with this work: "... the ability to demonstrate in practice the
functions and obligations of their own, assumed during the exercise of their profession,
and that contribute to the satisfaction of the needs of the individual, family and
community, in coordination with them and with the health team, where the technical,
professional and ethical influence received during their training and improvement in
the work alternatives adopted from the transformations occurred in the environment in
which he works ".

In their systematization, researchers have tended to associate the concept of

performance with: capacity, functions, exercise, competence, conduct and professional

The operational nature of the definition of professional performance in nursing that is

offered from the systematization of León in 2006, 16 Añorga in 2010, 17 Sixto Pérez in
2014, 20 and Espinosa in 2015, 21among others, they allow to define the professional
performance in nursing as the set of actions that the nursing staff manages to execute
in their work areas that are evidenced in the practical expression of the skills and
competences acquired in an integrative, regulated and coordinated way for the
attention to professional problems, manifested through their actions autonomously,
scientifically and appropriately, with the purpose of identifying, prioritizing and
satisfying the human needs dimensioned in metaparadigms: health, person,
environment and professional role.

The integral preparation of the nursing professional in different sciences, as well as his
preparation in health education techniques, make him an ideal collaborator in the
provision of services in such a delicate area as women are during the work of labor and
delivery This professional should not only prepare in the knowledge and techniques of
Nursing, but also in areas that are necessary to take care of the person in charge, from
their biological, psychological, social and spiritual integrity. 22

The assistance function for the care of labor and delivery will be a primary function of
doctors and nurses, regardless of whether there are other members who are
indistinctly incorporated into the provision of services according to need for care, these
are the members of the health team defined for the care of labor and delivery.
Resolution 54.12 of the World Health Assembly adopted in 2001, reflects the
recognition of the potential of Nursing and midwifery to improve the quality and
effectiveness of health care in member states. 17

The Nursing Care Model described in PAHO's strategic directions for the development
of nursing and midwifery in the period 2002-2008, describes how and the process to
provide health services to women and children, the key attributes of this Midwifery
process pose: 17

· Competencies based on critical thinking and clinical practice, responsible decision

making and ethical use of technology.

 Satisfaction of users and borrowers.

· Respect for human dignity and support for human rights.

 Respect for cultural and ethnic diversity.

 Support and promotion to the self-decision of the users.

· Focus on care services that are convenient for women and family-centered.

The Midwifery care model has a focus on health care that should involve all disciplines
related to reproductive health, it incorporates aspects such as values, ethics,
philosophy and human sensitivity necessary to work with Women throughout their lives
include one of the most vulnerable moments of motherhood. 17

Mur Villar 23 in 2009 expressed that job performance is an integral part of the
specialist's teacher training from the ability to apply nursing care in a different
approach to the areas of Mother and Child Science.

The systematization that is carried out in this section and the review of investigations
that are linked to the object of study of this research, both in the conceptualization of
professional performance and in the elements of humanization of childbirth, led us to
select the variable: performance Nursing professional in humanized care during labor
and delivery understood as: set of actions that nurses who work in obstetric services
that are evidenced in the practical expression of their communication skills, their
capacity for relationships interpersonal and individual assessment, their human
values,its ethical precepts and the development of holistic competences for the care
provided to women during labor and delivery in a comprehensive, humane, consensual
way and with special consideration to the state of vulnerability, identification,
prioritization and satisfaction of the humanized needs and desires of their protagonists
with strictly individual perceptions and sensations as holistic beings.

To assume the conception of professional performance of Nursing Graduates in the

humanization of childbirth, is to try to improve the quality of care, adapt interventions
to what is recommended by scientific knowledge while continuing to assume the
human component that accompanies them, increase safety of birth and allow women
greater control over the body, their birth process, their health and establish emotional-
emotional ties with their children.

Humanized care lies in decreasing routine practices during labor, therefore nurses
should encourage activities that build trust and reduce stress in women; This requires
developing and applying care that contributes to or improves perinatal care.

Humanized delivery care is the way in which each nurse provides care through
attitude, values and principles. It is an interaction between knowledge and feelings for
each woman, which allows to establish quality assistance with human expression
during the care offered by nursing starting from the influence of their mode of action,
of their doing, in the achievement of humanization.

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Received: 2016-05-24.

Approved: 2016-06-07.