Humanized Care in the Community for Patients with Colorectal Cancer According to Jean Watson

Introduction: colorectal cancer is the most common neoplasm of the gastrointestinal tract. It is associated with the progressive aging of the population. Humanized care in the community for patients with colorectal cancer is of vital importance to achieve the best quality of life in those affected. 

Objective: analyze the ways to put Jean Watson's Theory of Human Care into practice. 

Development: Watson in her theory considers that care is a fundamental act of the human being, it is something more important than a simple medical cure. It requires interaction between the nursing staff and the patient. To ensure that a person recovers, it is necessary for nursing staff to transcend the body limit. Patients suffering from colorectal cancer in the community need the health personnel who care for them to get to know them. Nursing care is based on interaction that must surpass traditional conceptions of care. Respect for the idiosyncrasies, customs and social norms assumed by the patient is vital for them to feel satisfied with the care received. It is unacceptable that nursing care becomes something technical-scientific-mechanized. 

Conclusions: humanized nursing care for patients with colorectal cancer in the community must be a comprehensive and fair connection from the first interaction with the patient and their environment. Adequate humanized care will directly lead to greater satisfaction in the patient and their families.

Colorectal cancer (CRC) is the most common neoplasm of the gastrointestinal tract and is the third most common cancer in men and the second most common in women [1]. It is a disease that is associated with the progressive aging of the population. 

 Its appearance may be linked to risk factors such as obesity, sedentary lifestyle, bad eating habits, smoking, among others. The clinical presentation depends on the location, size, as well as the presence or absence of metastases.

The diagnosis of CRC is made by histological examination of a biopsy usually obtained during a colonoscopy or a surgical specimen. From the clinical point of view, the patient with CRC can present a wide variety of clinical manifestations ranging from asymptomatic individuals discovered through routine examinations or by the systematic detection of medium or high-risk subjects, patients with suspicious symptoms or signs and also patients presenting in emergency services with intestinal obstruction, perforation or acute gastrointestinal bleeding [1].

Treatments include endoscopic and surgical local excision, preoperative radiation therapy and systemic downstaging therapy, extensive surgery for locoregional and metastatic disease, local ablative therapies for metastases and palliative chemotherapy, targeted therapy, and immunotherapy. These can cause multiple adverse effects, among which physical, psychological and emotional ailments stand out, including pain, fatigue, anxiety, insomnia, neuropathy, cognitive impairment and gastrointestinal problems.

This situation can generate a variety of physical, social, spiritual and medical needs in affected patients, without ruling out the mental health needs they present due to high levels of anxiety and depression, which can lead to a poor quality of life related to physical and mental health. Treatment that is not well directed can produce worse adherence to treatment, deterioration of the patient's health, greater use of health services and greater mortality. 

Nursing staff involved in the care of these patients must find effective ways to improve health-related quality of life and mental health in the short and long term in patients suffering from CRC. These professionals will be limited to administering the treatment and monitoring possible adverse effects, their work goes beyond that.

These people with CRC need emotional support, education, and continuous monitoring to ensure optimal treatment and a timely response to adverse events. This multidimensional role is essential to maximize the benefits of treatment and improve patients' quality of life.

Nursing staff will be able to provide education and management of symptoms for adequate management of these, as well as comorbidities, nutritional deficiencies, frailty, and functional status of the patient. It will guide you on post-surgical care in the case of the management and care of the colostomy, surgical wound and recovery process. Palliative care can be used if necessary and always maintain great psychological and social support.

All these actions that nursing care must carry out are based on Jean Watson's Theory of Human Care. This theory is based mainly on humanized and transpersonal care, stating that the nursing profession at the time of care must offer humanized care to the patient, considering nursing as a science, [2]which is unquestionable.

Humanized care in the community for patients with colorectal cancer by nursing staff is of vital importance to achieve the best quality of life in those affected. It is the author's objective to analyze the ways to put Jean Watson's Theory of Human Care into practice.

Development

Watson in her theory considers that care is a fundamental act of the human being, it is something more important than a simple medical cure. This must be comprehensive, considering the mind, body and spirit of the person. It must be humanized care, take into account the person's needs and their capacity for growth, be personalized, and consider the unique characteristics of each person [3].

According to Jean Watson, nursing work focuses on three elements; the protection, improvement and preservation of human dignity. In his theory he states an integrated care that seeks balance between the mind, body and soul [3]. Supports the need for nursing staff to offer humane, creative and loving treatment, where the patient is the center, which is achieved with harmonious holistic care [4].

The interaction between the nursing staff and the patient is needed, which must be affectionate and allow the patient to feel accepted as they are. This theory includes three important elements given in transpersonal care, the moment in which the care is carried out and the environment.

When talking about transpersonal care, it means having a relationship with the patient that goes beyond the moment in which communication and empathy is established, reaching the point of creating spiritual connections with the patient and family [5]. Its main objective is to protect, improve and preserve the dignity, humanity and integrity of the person. 

The moment of care is the moment in which the nurse and the patient meet and relate in a way that creates an opportunity for humanized care. The therapeutic relationship becomes an encounter, not a simple coincidence of techniques that help physical restoration, but an encounter between people, which can transcend clinical reasons [5].

The environment depends fundamentally on the therapeutic environment that exists. A suitable environment allows the person to achieve a good level of healing aimed at their illness, but an unfavorable environment does not benefit the person in achieving healing. This environment must take into account beliefs, expectations, history, the patient's own perception and their historicity (past, present and future) [6].

This environment should be designed to foster comfort, safety, trust, and connection between the nurse and the patient. According to Watson, an appropriate care environment can facilitate the expression of a patient's needs and promote a deeper, more meaningful healing process [6].

To ensure that a person recovers, it is necessary for nursing staff to transcend the body limit. Treatment is established to resolve bodily problems that may be present, but it is necessary to take into account the spirituality of that sick person. 

Patients suffering from CRC in the community need the health personnel who provide their care to get to know them; it is necessary to have empathy between them. Factors that may prevent adequate care should not prevail, such as work overload, saturation of nursing interventions, among others that in the long run become justifications that lead to actions being carried out in a hurry and without quality.

It is necessary to integrate into the awareness of the professional caregiver the importance of what they can do for the patient and the consequences of their actions. It is very important to avoid insensitivity, feeling apathy toward what you do, or seeing care as a burden.

There are not a few examples that could be pointed out related to the difficulty in obtaining the information necessary for the application of Watson's theory, some embrace the scarce bibliographic evidence [4]. Other research suggests that nursing professionals sometimes fail to establish close interpersonal relationships or deal with existential issues with patients, due to the contradiction between wanting to get involved with the subject of care to provide comprehensive care but at the same time avoiding closeness. emotional due to their professionalism, which prevents the humanization of care as Watson conceived it [8].

Applying this theory in the community to care for patients affected with CRC is of great benefit to them. The help and trust that nursing staff transmit to patients facilitates the expression of positive feelings such as empathy and effective communication of the latter.

The cultivation of sensitivity in the Nursing professional, both towards himself and towards others, requires the willingness to establish a close and trusting bond with the person being cared for. Many times there is not enough time to establish a close relationship that allows them to be sensitive to their emotions and feelings [9, 10].

Sometimes barriers appear that prevent humanized care from being provided. One of them is the lack of professional identity, which is why it is necessary to strengthen the autonomy of the nurse, identify and overcome personal, professional and institutional obstacles to regain the necessary power that contributes to the strengthening of care. Professionals must put aside judgments and prejudices and accept spirituality as part of care [11, 12].

This conception of care in a humanized manner must begin with the undergraduate training of future nursing professionals, continuing with the training and evaluation of the application of these principles. It is necessary to strengthen professional identity and create new perspectives for ethical and humane nursing, without losing the scientific vision [13].

Nursing care is based on interaction that must surpass traditional conceptions of care. Many times, care becomes procedural, leaving aside the essence of nursing, which is to achieve moments of care that go beyond the concept of physical care, thus promoting human care, encouraging the person's self-care, showing trust and peace, which which allows creating a harmonious environment. 

This type of care allows the person with CRC to see their own situation as a human learning experience. To establish care, nursing staff can use various spaces and occasions, integrating nursing interventions in a way that makes care a human action guided by the highest human values [6].

Establishing this personal nurse-patient relationship allows for humanized care to work on the risk factors that these subjects with CRC may present in the community. Only with a relationship of mutual knowledge will the actions drawn up by the nursing staff be effective that allow them to achieve changes in factors that, although some are not modifiable (hereditary CRC syndromes; personal or family history of sporadic CRC or adenomatous polyps; disease intestinal inflammation; age, race and gender; among others) if it can be possible to improve the perspectives of those suffering from their disease.

There are factors that can be modified (obesity; Diabetes mellitus and insulin resistance; excessive consumption of red and processed meats; smoking and consumption of alcoholic beverages, sedentary lifestyle, among others) that can be acted upon more easily from comfort. of in-depth knowledge of the patient by the caring staff, in this case nursing. When this comfortable relationship is achieved, it is even possible to act proactively, avoiding complications associated with the disease. 

Respect for the idiosyncrasies, customs and social norms assumed by the patient is vital for them to feel satisfied with the care received by health personnel. Including the patient's spirituality as a key element in care leads to a better state of health. 

It is essential that nurses investigate and use their knowledge and love of care to turn the science of the profession into art. The current technicality, if not denied, of the profession cannot be allowed to lead to a distancing of the profession from the fundamental premises of humanized care.

It is unacceptable that nursing care becomes somewhat technical-scientific-mechanized, ignoring the human aspect that affects the relationship with patients. Patients identify more with care factors that involve comprehensive, protective and corrective assistance, even more than when some teaching strategy is implemented that is limited to learning actions related to their illness, the patient needs to be cared for with love.

Humanized care has been related to good treatment, empathy and holistic care, but it also includes self-knowledge, emotional control, knowing-knowing, knowing-doing and knowing how to be, as well as understanding the importance of the subject from the mind-body-spirit interrelation [14]. This type of attention must be incorporated into care as an inseparable element of it. 

The humanization of care facilitates the organization of processes, considering the patient as an integral being within a family, social, economic and work environment. This, therefore, implies an interdisciplinarity subject to constant evaluations that guarantee the provision of a competent and comprehensive service, which solves the problems of each patient.

Humanized nursing care for patients with CRC in the community must be a comprehensive and fair connection from the first interaction with the patient and their environment. Mutual well-being must be promoted through a dynamic, constant and fruitful process for those who provide care and those who receive it. 

Adequate humanized care will directly lead to greater satisfaction in the patient and their families. The nursing professional will have the challenge of achieving humanized care management, in the midst of technological development, which without denying it, cannot allow human action to be displaced, with the warmth and support that this professional offer to patients and families.

Conflicts of interest

The authors declare that they have no conflicts of interest.