EXPERIENCE REPORT: IMPLEMENTATION OF THE VICTORY BELL AS A HUMANIZED PRACTICE IN THE SUS

Abstract

Introduction: Oncological treatment, marked by its prolonged and complex nature, requires an approach that goes beyond the clinical aspect, integrating psychosocial care and human dignity. In Brazil, the National Humanization Policy (PNH), launched in 2003, serves as a fundamental pillar of the Unified Health System (SUS) to promote more welcoming and comprehensive care. The PNH seeks to transform relationships and work processes by encouraging reception, expanded clinical practice, valuing health workers, and fostering citizen participation. Rather than a merely top-down policy, it proposes itself as a method to include diversity in management and care processes, recognizing each person as a rights-bearing citizen (BRASIL, 2004). In alignment with this guideline, the “victory bell” ritual emerges as an initiative that materializes the principles of humanization. This practice, reported in international studies and experience reports, describes the tradition of “ring the bell” as a symbolic way of marking the completion of a treatment cycle and celebrating the patient’s victory. Such a ritual has been identified and analyzed in nursing and oncology literature as a practice with emotional impact both for patients and for families and care teams (BRIDAROLLI; SPIERS; PITUSKIN, 2020; WILLIAMS et al., 2019). In Brazil, this rite has been adopted in reference centers and oncology services as a symbolic strategy of welcoming. The experience report we present constitutes a remarkable example of this practice. The installation of the bell in the oncology unit of the Regional Hospital of the West (HRO), in Chapecó (SC), was an initiative of Nursing students from the Federal University of Fronteira Sul (UFFS). The action was conceived as part of the Supervised Internship, with financial support from the Projeto Luzes UFFS, and the coordination of the Nursing program. This collaboration between academia, the health service, and public funding demonstrates how humanization can be collectively built, transforming a care space and reinforcing the relevance of the rite as a potential public policy for health management. Objective: To analyze the bell ritual as a practice of humanization of oncological care, based on the experience report of its installation by nursing students. The aim of this work is to identify the therapeutic and psychosocial impacts of the ritual on patients and teams, and to propose its adoption as a public health policy within the Unified Health System (SUS), aligned with the principles of comprehensiveness and welcoming. Methodology: This work is configured as an experience report that describes the implementation of a humanization action in an oncology service. The initiative, consisting of the installation of a commemorative bell for patients completing chemotherapy, was conceived and carried out by undergraduate Nursing students at the Federal University of Fronteira Sul (UFFS) – Chapecó Campus. The project was developed within the course Supervised Internship I and implemented in the Oncology Inpatient Unit of the Regional Hospital of the West (HRO), in Chapecó (SC), with installation scheduled for early July 2025. The experience was operationalized through a systematic six-step process aimed at ensuring the effectiveness and institutional alignment of the initiative: (1) drafting the proposal; (2) institutional approval; (3) acquisition and preparation of materials (bronze bell weighing approximately 1–1.5 kg and explanatory signage); (4) physical installation by the HRO maintenance team; (5) symbolic launch with the participation of staff and patients; and (6) communication, awareness, and follow-up through observation and collection of spontaneous feedback from the team. As this is an experience report that does not involve intervention or data collection from human subjects, the project did not require submission to a Research Ethics Committee, in accordance with the applicable regulations for this type of work. Results and discussion: The installation of the bell, conceived by Nursing students at UFFS, proved to be a humanization intervention of strong symbolic and therapeutic impact. The act of ringing the bell transformed the end of an exhausting treatment cycle into a moment of celebration and relief, functioning as a rite of passage positively perceived by patients and caregivers in qualitative studies on the tradition (BRIDAROLLI; SPIERS; PITUSKIN, 2020). However, the literature indicates that emotional reactions to the ritual can be heterogeneous: while many patients report emotional benefits and a strengthened sense of coherence, other studies suggest that the emotional intensity of the event may, in some cases, reactivate negative memories of treatment, requiring sensitive implementation centered on patient preferences (WILLIAMS et al., 2019). The impact on the multidisciplinary team was also significant: the integration of technical care with the human dimension strengthens bonds and contributes to greater recognition of the value of the work. Considering the high risk of burnout among oncology professionals, humanizing practices that promote welcoming and positive work relationships can help reduce burnout and improve the work environment (PAIVA et al., 2021). Furthermore, the initiative proved to be feasible at low cost and with high institutional acceptability, making it a replicable model for other SUS services when articulated between academia and healthcare services. Contributions of this work toward the Sustainable Development Goals: This work contributes to SDG 3 (Health and Well-Being), particularly with regard to promoting the psychosocial well-being of cancer patients and their families. By offering a low-cost symbolic intervention aimed at improving quality of life and self-esteem, the initiative aligns with targets related to mental health. Moreover, it strengthens SDG 17 (Partnerships) by exemplifying the cooperation between UFFS, HRO, and Projeto Luzes UFFS as a mechanism for implementing comprehensive care practices. Final considerations: The report demonstrated that the bell ritual is an effective tool for humanizing oncological care, with relevant therapeutic and psychosocial impacts for patients, families, and care teams. However, given the variability of emotional responses observed in the literature, it is recommended that future studies use quantitative and longitudinal designs to measure long-term effects, and that institutional protocols be developed to guide sensitive implementation adapted to each context. It is further recommended that SUS institutions adopting the practice develop guidelines for use, staff training, and mechanisms for monitoring and evaluation. The experience reported highlights the potential of symbolic and humanizing practices, of low cost and high psychosocial impact, to become integrated into public health policies aimed at oncology within the Unified Health System (SUS). The bell ritual, by articulating academic knowledge, social participation, and multidisciplinary care, proves to be an innovative, replicable, and sustainable strategy capable of strengthening the principles of comprehensiveness and welcoming set out in the National Humanization Policy (PNH). Its implementation not only contributes to valuing the subjective dimension of care but also reinforces the importance of the integration of teaching, service, and community as a structuring axis for the sustainability of SUS. In this sense, it is recommended that experiences such as this inspire broader institutional guidelines and public policies oriented toward the promotion of human dignity and the strengthening of bonds in the therapeutic process.