Communication as a tesearch theme in Nephrology: basis for nursing care

Abstracts

OBJETIVOS: Identificar a tendência de pesquisas na área de Nefrologia com foco na comunicação e analisar a abordagem sobre comunicação nestas pesquisas. MÉTODOS: Levantamento de artigos nas bases de dados LILACS, SciELO, BDENF e MEDLINE, publicados entre 1997 e 2007, em português e espanhol, com foco na comunicação, ou no relacionamento com o cliente ou nos seus sentimentos, emoções e percepções. As informações sobre os artigos foram organizadas em quadros e divididas em três categorias: comunicação, relacionamento/interação e sentimentos/emoção/percepção. RESULTADOS: A maioria dos artigos relaciona-se aos sentimentos, emoções e percepções da clientela. O vínculo profissional/paciente aparece como facilitador da comunicação. Olhar o cliente de forma integral e individualizada promove um cuidado mais adequado. CONCLUSÃO: Através da investigação da comunicação, pode-se descrever melhor suas características fundamentais, suas perspectivas e possibilidades durante a interação e o cuidado prestado.

Pesquisa em enfermagem; Comunicação; Nefrologia; Cuidados de enfermagem

RIVISION ARTICLE

Communication as a tesearch theme in Nephrology: basis for nursing care

La Comunicación como temática de investigación en Nefrología: subsidio para el cuidado de enfermería

Giselle Barcellos Oliveira Koeppe^I; Sílvia Teresa Carvalho de Araújo^II

^IMaster on Nursing from the Escola de Enfermagem Anna Nery (EEAN) of the Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ), Brazil

^IIPhD on Nursing, Assistant Professor for the Medical Surgical Nursing Department of the Escola de Enfermagem Anna Nery (EEAN) from the Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ), Brazil

^{Corresponding Author}

ABSTRACT

OBJECTIVES: To identify trends on nephrology research that focus on communication and to analyze the use of communication as a theme in research.

METHODS: A literature search of publications in Portuguese and Spanish from 1997 through 2007 that focused on communication or interaction with clients regarding feelings, emotions, and perceptions, was performed in the LILACS, SciELO, BDENF, and MEDLINE databases. The publications were grouped into three categories: communication, relationship/interaction, and feelings/emotions/perceptions.

RESULTS: The majority of the publications were related to the feelings, emotions, and perceptions of the clients. Professional/Client interaction emerged as a facilitating mechanism of the communication. Holistic and individualized care were identified as the most adequate modality of care.

CONCLUSION: Identification and analysis of research on communication allowed the description of its main characteristics, its perspectives, and its potential to improve professional/client interactions during the delivery of care.

Keywords: Nursing research; Communication; Nephrology; Nursing care

RESUMEN

OBJETIVOS: Identificar la tendencia de investigaciones en el área de Nefrología enfocada en la comunicación y analizar el abordaje sobre comunicación en estas investigaciones.

MÉTODOS: Se llevó a cabo un levantamiento de artículos en las bases de datos LILACS, SciELO, BDENF e MEDLINE, publicados entre 1997 y 2007, en portugués y español, enfocada en la comunicación, o en la relación con el cliente o en sus sentimientos, emociones y percepciones. Las informaciones sobre los artículos fueron organizadas en cuadros y divididas en tres categorías: comunicación, relacionamiento/interacción y sentimientos/emoción/percepción.

RESULTADOS: La mayoría de los artículos se relaciona con los sentimientos, emociones y percepciones de la clientela. El vínculo profesional/paciente aparece como facilitador de la comunicación. Mirar al cliente de forma integral e individualizada promueve un cuidado más adecuado.

CONCLUSIÓN: A través de la investigación de la comunicación, se puede describir mejor sus características fundamentales, sus perspectivas y posibilidades durante la interacción y el cuidado prestado.

Descriptores: Investigación en enfermería; Comunicación; Nefrología; Atención de enfermería

INTRODUCTION

This study on theoretical conceptions on communication within the context of Nephrology' nursing care, is an integrating part of the Master's dissertation titled "Patient with incapable arterovenous fistula: non-verbal expressions highlights within the context of Nephrology' nursing care", presented in January 2009 at the Escola de Enfermagem Anna Nery, of the Universidade Federal do Rio de Janeiro, whose main focus is on nonverbal communication in the hemodialysis scenario.

The understanding of communication in such scenario poses relevant importance on professional care, once the connection between professional and patient is intensive, and allows for a full comprehension that goes beyond what is verbalized by the patient. This link is a service facilitator, as it broadens the capacity of observation, both on visible aspects and the ones that are not expressed. Conscious application of nonverbal patient expressions should be seen as interventions' strategic practice, in order to achieve the objectives of offering patients more comprehensive, singular and sympathetic nursing care⁽¹⁾.

Furthermore, acquired patients knowledge along therapy sessions allows registering how they behave in each of the numerous sessions. Considering behavior personal characteristics it is possible to identify a series of relevant emerging problems from physiological changes. The understanding and identification of such changes enables early interventions, which can avoid or prevent from future complications.

Considering the above mentioned evidences and the lack of communication-specific knowledge on Nephrology, interest is increased for further deepening studies on the issues of nonverbal communication in professional care practices, under the scientific rigor of investigations.

The study targets on communication aspects on Nephrology researches, and key objectives are:

- Identify Nephrology research trends focusing on communication;

- Analyse communication approach on these researches

METHODS

It applies a systematic revision, from various surveys' articles and researches' evidences gathered on non-verbal communication, from electronic data bases in the period October to December 2007.

Although the study main focus is on the homodialysis therapy patient, the search for articles included all patients with chronic renal failure and not only the ones under hemodialysis therapy. Thus, the study becomes more insightful while providing knowledge on communication from a broad Nephrology universe.

Criteria for selection of articles included: articles from the databases LILACS, SciELO, BDENF and MEDLINE, issued between 1997 and 2007; in Portuguese and Spanish languages, focused on communication itself, or on the relationship with the patient - communication has a context, and for that happens, interaction between people is needed. Additionally, articles based on patient's feelings, emotions and perceptions were included given non-verbal communication be certainly present on such conditions. Articles that are the same found across the three databases were excluded.

The search description criteria were: nephrology, chronic renal failure, hemodialysis, nursing communication, nursing care, perception, sense receptors, kinesics and proxemics. Search words were: hemodialysis, care, non-verbal communication; body; feelings; emotions; corporeal mimes; the touch and paralanguages. Several further matches with these words were made, resulting in a quite broad search

From the sample of 800 articles, all of their summaries were read in order to identify the relation between this study and proposed inclusion criteria. After that phase, potential articles with were selected for a thorough reading. At the end of that process, only 11 articles were selected for analysis.

Selected articles were summarized into charts, divided by the following categories: communication; relationship/interaction and feelings/emotions/perceptions. Each category is represented in those charts and had grouped information by title, author, sources, study type, objectives/object and main results found.

After that, data analyses were made based on the evaluation of those articles, considering chart's information provided. The analysis was supported by authors, actively involved with human issues in the nursing context, on health communication discussions, and Nephrology nursing care practice.

RESULTS

The majority of the selected articles (seven) focuses on patient's feelings, emotions and perceptions, not directly approaches communication. From 11 articles, three relates to relationship/interaction, and only one directly discusses communication within the hemodialysis scenario.

From the total, nine articles were published in specialized nursing magazines, and other two specialized on healthcare.

Only one study was not focused on the hemodialysis sector.

All selected articles were based and/or focused on patient perception related to the therapy.

Articles bring insights on a constant basis direct and indirect communication. The importance of effective communication within the scenario were approached, where patients very much want to hear and be heard, and also recognize the affection towards the team favors a more comforting therapy. The connection between nursing professional and patient in the scenario is widely considered a communication facilitator, while enabling a full patient knowledge, nonverbal formats can be observed and understood efficiently.

The mechanized aspect of this therapy is largely seen as harmful, once affects the comprehension of what is not said by the other. The equipment makes many nursing professionals see patients as an extension of it, robotizing the service quality.

Integral and singularly looking at the patient is mandatory, as it allows for a more customized service, better fulfilling the patient's real needs.

The nursing practice team is strongly pointed as the best prepared team to learn patient's nonverbal communication, as it spends most of his time monitoring patients during the therapy sessions. This aspect turns the role of the nursing practice team special and unique.

Other articles discuss patient's feelings, showing their fears, difficulties and vision on facing the process. Yet, it shows there are circumstances that influences very positively, such as the relationship with the involved nursing team, family support and faith.

The overview of main aspects found in the 11 selected articles, are summarized on the charts further presented.

Chart 1

Chart 2

Chart 3

DISCUSSION

Articles focusing on patient's feelings, emotions and perceptions dominate the most. That fact makes evident the overall fluidity of nonverbal communication amongst healthcare professionals, as by thinking, discussing and writing on such theme, further proves the individual was capable of perceiving and capturing sensations not verbally said by the patient. Understanding the nonverbal can rescue the capacity of healthcare professionals of more precisely perceiving patient's feelings, doubts and difficulties of verbalization⁽²⁾.

Articles approaching relationship and interaction indirectly discuss on communication, as previously said, for communication to happen, people interacting is required. "Effective communication is bidirectional. It happens when there are answers and validation of expressed messages"⁽²⁾.

Specifically regarding hemodialysis communication, it poses high importance within the scenario, emphasizing nonverbal communication as primary requisite for taking care of patients.

The significant number of articles published on nursing magazines demonstrates there are nurses who did not lose the essence of nursing practice, which is to take care beyond the practical, visible and tactile.

Although the biomedical model leads the hospital best practices, many nursing professionals yet take advantage of the long time with patients to try to capture evidences that go beyond physical vision. "Nursing has various requisites and attributes which distinguishes and characterizes itself by a profession of aid, in which the care concept is genuine, like the concept that embraces the attributes which make it a human and aid discipline"⁽³⁾.

The larger number of searches referencing hemodialysis therapy is related to the incidence and dominance across treatment alternatives for chronic renal failure. Hemodialysis is the preferred therapy globally. Thus, it is most likely additional researches focusing on this category of patients be made.

Further, that mode of therapy allows for a close contact between nursing staff and patient, originating important concerns on what subjective aspects represent for that patient.

Some studies focusing on patients, show health professionals' needs to better understand the individual being assisted by them. That concern suggests many professionals recognize the importance of an effective communication, while valuing thinking about the aspects that characterize their patients for better assisting them.

The connection professional/patient considered as key driver for understanding the patients' particularities, confirms the scenario of hemodialysis allows for a relationship that goes beyond the relation cure and illness. In the sector, relationships are intensive, proximity is frequent, friendship, and affection are shown all the time.

Regarding health professional's integral and singularly looking at the patient, it is highly important to recognize that the patient has feelings and should not be seen as a job object. Patients should not be treated as if they did not have their own expectations, fears or difficulties, being obliged to accept the way they are touched and treated. These same patients depending today on nursing care, were free and independent persons one day, with all expectations and commands of their own bodies⁽²⁾.

When we pay attention to what patients express nonverbally, we help them facing their current health condition. Selected articles particularly discuss this aspect, indicating that when we offer emotional support, we help them to relief their fears and tensions.

The mechanical aspect of this scenario, which many times reduces the practice of both an affectionate and effective communication, can be related to the overall existing technology available in the context, but also to professionals specialization itself in the biomedical model that fragments the assistance.

This evidence is clearly identified within the social services practices, where professionals are more concerned to fulfill tasks and schedules. The care essence has been forgotten given actual medical devices technology. As progress evolves, care itself becomes mechanized, fragmented and people seem to have forgotten such ability or talent, besides constituting an action, represents a value, a behavior, a philosophy, both an art and a science⁽³⁾.

Senses receptor as an element professional care approached in some of the articles are of fundamental practice relevance, given the most significant messages being expressed through the body language, and when we do not use them effectively, there is no effective communication. "Interaction is the result of the good utilization of our senses. Without them, we are restricted to the registries and a rationalized nursing assistance, merely instrumental, and maybe with a few or no affection involved, and thus empty"⁽¹⁾.

CONCLUSION

It is clear the communication theory knowledge and practice in the sector, yet incipient, poses a high importance to subside the human aspects on the quality of nursing care provided.

The articles analysed show that communication, especially the nonverbal, occurs broadly within the Nephrology scenario, and whenever effective, results on improved nursing care service.

Health communication learning process occur gradual and constantly and thus we must pay strict attention to communication standards with patients. When taking them into account, we experience a more integral interaction mode with those spending a good part of their lives connected to a medical device, living constantly with pain and with the disease.

The study on the human aspects confronts the mechanized model care, however without understanding subjectivity there will not be an effective communication to drive services excellence.

REFERENCES

1. Araújo STC. Os sentidos corporais dos estudantes no aprendizado da comunicação não verbal do cliente na recepção pré-operatória: uma semiologia da expressão através da sociopoética [tese]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 2000.

2. Silva MJP. Comunicação tem remédio: a comunicação nas relações interpessoais em saúde. São Paulo: Edições Loyola; 2002.

3. Waldow VR, Lopes MJM, Meyer DE. Maneiras de cuidar, maneiras de ensinar: a enfermagem entra a escola e a prática profissional. Porto Alegre: Artes Médicas;1995.

4. Lima EX, Santos I. Atualização de enfermagem em nefrologia. Rio de Janeiro: Editora Escola Anna Nery-UFRJ; 2004.

Publication Dates

• Publication in this collection
  09 Apr 2010
• Date of issue
  2009