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CUIDADO É FUNDAMENTAL UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO
R E V I S T A O N L I N E D E P E S Q U I S A
INTEGRATIVE REVIEW OF THE LITERATURE DOI: 10.9789/2175-5361.rpcfo.v12.9103
DOI: 10.9789/2175-5361.rpcfo.v12.9103 | Souza JSR, Costa ACB, Vilela SC | Interpersonal relations between nursing-patient in the perspective…
CUIDADO É FUNDAMENTAL UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO
R E V I S T A O N L I N E D E P E S Q U I S A
R. pesq.: cuid. fundam. online 2020 jan/dez 12: 648-653 648
INTERPERSONAL RELATIONS BETWEEN NURSING-PATIENT IN THE PERSPECTIVE OF CURRENT VIOLENCE
Relações interpessoais entre enfermeiro-paciente na perspectiva da violência atual
Relaciones interpersonales entre enfermero-paciente en la perspectiva de la violencia actual
Jhuliano Silva Ramos de Souza1, Andreia Cristina Barbosa Costa2, Sueli de Carvalho Vilela3
How to cite this article: Souza JSR, Costa ACB, Vilela SC. Interpersonal relations between nursing-patient in the perspective of current violence. Rev Fun Care Online. 2020 jan/dez; 12:648-653. DOI: http://dx.doi.org/0.9789/2175-5361.rpcfo. v12.9103.
ABSTRACT Objective: to re!ect on the importance of the interpersonal relationship between nurse-patient in the perspective of current violence. Methods: this is a descriptive-re!ective study. “e databases used were: Latin American and Caribbean Health Sciences Literature, National Library of Medicine, SCOPUS, Web Of Science and Cumulative Index to Nursing and Allied Health Literature, in the languages: English, Spanish and Portuguese, of the last ten years. Results: three categories emerged: 1) Violence su#ered by nursing professionals in the workplace; 2) Education as a tool to minimize workplace violence and 3) Nursing care for vulnerable people exposed to violence. Conclusion: interpersonal relationships can prevent acts of violence from being carried out in the workplace, and the institution itself and the management sectors can train the entire team, using continuing education as an e#ective tool for this issue. Keywords: Interpersonal relations; Nurse-patient relations; Communication; Violence.
RESUMO Objetivo: re!etir sobre a importância da relação interpessoal entre enfermeiro-paciente na perspectiva da violência atual. Métodos: trata-se de um estudo descritivo-re!exivo. As bases de dados utilizadas foram: Literatura Latino-Americana e do Caribe em Ciências da Saúde, National Library of Medicine, SCOPUS, Web Of Science e Cumulative Index to Nursing and Allied Health Literature, nos idiomas: inglês, espanhol e português, dos últimos dez anos. Resultados: emergiram três categorias: 1) A violência sofrida pelos pro$ssionais da enfermagem no ambiente de trabalho; 2) A educação como ferramenta para minimizar a violência no trabalho e a 3) Cuidado de enfermagem a pessoas vulneráveis e expostas a violência. Conclusão: as relações interpessoais podem evitar que atos de violência sejam
1 Enfermeiro, Mestrando em Enfermagem do Programa de Pós-Graduação em Enfermagem da Universidade Federal de Alfenas – UNIFAL-MG. Alfenas. Minas Gerais.
2 Doutora em Ciências. Professora da Escola de Enfermagem da Universidade Federal de Alfenas – UNIFA-MG. Alfenas. Minas Gerais. 3 Doutora em Ciências. Professora Adjunta da Escola de Enfermagem da Universidade Federal de Alfenas-UNIFAL-MG. Alfenas.
Minas Gerais. Brasil.
DOI: 10.9789/2175-5361.rpcfo.v12.9103 Interpersonal relations between nursing-patient in the perspective…
ISSN 2175-5361 Souza JSR, Costa ACB, Vilela SC
649R. pesq.: cuid. fundam. online 2020 jan/dez 12: 648-653
praticados no ambiente de trabalho, cabendo a própria instituição e os setores gerenciais capacitarem toda a equipe, utilizando a educação continuada como uma ferramenta e$caz para essa questão. Descritores: Relações interpessoais; Relações enfermeiro-paciente; Comunicação; Violência.
RESUMÉN Objetivo: re!exionar sobre la importancia de la relación interpersonal entre enfermero-paciente en la perspectiva de la violencia actual. Métodos: este es un estudio descriptivo-re!exivo. Las bases de datos utilizadas fueron: Literatura de Ciencias de la Salud de América Latina y el Caribe, Biblioteca Nacional de Medicina, SCOPUS, Web of Science e índice acumulativo de enfermería y literatura de salud aliada, en los idiomas: inglés, español y portugués, de los últimos diez años. Resultados: surgieron tres categorías: 1) Violencia sufrida por profesionales de enfermería en el lugar de trabajo; 2) La educación como herramienta para minimizar la violencia en el lugar de trabajo y 3) Atención de enfermería para personas vulnerables expuestas a la violencia. Conclusión: las relaciones interpersonales pueden evitar que se lleven a cabo actos de violencia en el lugar de trabajo, y la propia institución y los sectores de gestión pueden capacitar a todo el equipo, utilizando la educación continua como una herramienta e$caz para este problema. Descriptores: Relaciones interpersonales; Relaciones enfermero-paciente; La Comunicación; Violencia.
INTRODUCTION “e nursing profession is situated in teamwork, which
is con$gured in a collective aspect. For it to be practiced competently, it is necessary to have a good interpersonal relationship between the groups and an understanding of the elements that permeate the contact with the team. One of these elements is the communication process, which, when done e%ciently, can bene$t the patient and others involved, avoiding possible con!icts that may harm the care provided, such as the loss of important information for treatment and rehabilitation.1
In this sense, nursing care is characterized by the interaction or dialogical relationship that is built with the other, and is therefore considered as a primordial factor. “erefore, it is essential to develop the potential of professionals for an interpersonal relationship centered on both the biological character and social and emotional relationships through therapeutic listening and communication process.1
Regarding the work environment, nursing professionals experience very delicate situations, among which are the violence practiced by patients, family members and colleagues, and can thus be identi$ed as moral, physical, verbal, psychological, sexual and sexual violence. institutional However, it is added that nurses have various duties in their $eld of work, ranging from care to managerial functions, which makes them more exposed to various types of violence.2
It is worth noting that the very nature of the activity made him vulnerable to situations of violence at work, since they work in multidisciplinary teams with rigid organization and under constant pressure, thus experiencing daily con!icts arising from interpersonal relationships with patients, family
members, colleagues and other health professionals.3 Violence can negatively a#ect the lives of these professionals, causing discomfort, fear and fear in the workplace, which can cause dissatisfaction with it, as well as psychic changes through syndromes, pain crises and health alterations in general.2 “ey conclude that it is urgent to create institutional policies that protect professionals against all types of violence and o#er a safe environment to perform their activities in a digni$ed, respectful and ethical manner.
According to the World Health Organization4,5 violence is a global public health problem, being among the leading causes of death for men, women, children and the elderly who su#er sexual, physical and psychological abuse, among others. However, WHO states that these e#ects can be prevented through public policies and preventive actions, in which most violent attacks occur because of behavioral, social, economic, political and cultural factors that could be modi$ed.
Health professionals who are most a#ected by violence in the institutions in which they provide their services are those of nursing, and it is necessary to develop strategies for improvement in the workplace, with support from the governmental spheres, the class councils themselves, with to raise awareness about the importance of reporting, implementing prevention and education policies so that these professionals can improve the relationship between colleagues and patients.6
Violence at work is understood as any voluntary action between individuals or groups that can cause physical or psychological harm arising in the workplace, or involving institutional and organizational relationships or work-related activities. “ese can be caused in labor relations, work organization, working conditions, resistance, delinquency and symbolic violence.7 It is noteworthy that the main violence that the nursing professional su#ers in the hospital, especially in the sector of urgency and emergency, are verbal violence and bullying, in which negative factors are related to the lack of information to the patient and authoritarian professional attitude, which can generate con!icts regarding the delay of care and even of the professionals themselves. with their peers.6
“e rigid structure of the hospital environment, the predominance of vertical hierarchical relationships, the understatement of personnel, the precariousness of materials, an exhausting shi& work rate and the multiple cognitive and emotional demands, result in increased professional vulnerability to the phenomenon of violence.’
In this sense, protective and managerial measures should be implemented through proactive strategies to include the theme of violence in improving patient care, without undermining the team’s ethical-moral rights to contain or prevent it.8 In this case, it is urgent to create institutional policies that protect professionals against all types of violence, and to o#er a safe environment so that they can perform their activities in a digni$ed, respectful and ethical manner.2
Given the above, this study is justi$ed in the context of nursing work, since it is expected to awaken the importance
DOI: 10.9789/2175-5361.rpcfo.v12.9103 Interpersonal relations between nursing-patient in the perspective…
ISSN 2175-5361 Souza JSR, Costa ACB, Vilela SC
650R. pesq.: cuid. fundam. online 2020 jan/dez 12: 648-653
of interpersonal relationships, joining communication processes, therapeutic listening and nurse/patient interaction, allowing care to be appropriate and quali$ed in the development of e#ective and e#ective therapeutic plans in the scenario of violence and $nally, to be able to contribute scienti$cally, in the construction of a re!exive practice that allows thinking concepts and actions that involve interpersonal relationships in the scenario of violence in the nursing context. Considering that it is through the interpersonal relationship that the care process takes place, this study aims to re!ect on the importance of the nurse- patient interpersonal relationship in the perspective of current violence.
METHODS “is is a descriptive-re!ective article based on the
international and national literature on the theme of interpersonal relations between nurse-patient in the perspective of current violence. For this, articles were searched in the databases of the Virtual Health Library Brazil (VHL) and the Portal of Journals of the Coordination of Higher Education Personnel Improvement (CAPES): Latin American and Caribbean Health Sciences Literature (LILACS). ), National Library of Medicine (PUBMED), SCOPUS (Elsevier), Web Of Science (WoS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). “e Health Sciences Descriptors (DeCS) and the Medical Subject Headings of the U.S. National Library of Medicine (MeSH) were used, along with controlled and uncontrolled descriptors: Interpersonal Relations; Nurse-Patient Relations; Communication; Violence and “erapeutic Listening. Followed by the operator booling “AND” for their intersection; in the English, Spanish and Portuguese languages, with a time frame in the last ten years (2008-2018). Ten articles were selected for re!ective discussion and presented in categories.
RESULTS AND DISCUSSION From the study emerged three thematic categories
for re!ective discussion: 1) Violence su#ered by nursing professionals in the workplace; 2) Education as a tool to minimize workplace violence and 3) Nursing care for vulnerable people exposed to violence.
Violence suffered by nursing professionals in the workplace
In this theme, it is possible to argue the violence that nursing professionals su#er at work, especially in the hospital environment, and highlight the typologies, health consequences of these professionals and preventive strategies in order to promote a better relationship between nurse-patient and coworkers. In addition, it addresses the characteristics of the aggressors’ pro$le and the lack of preparation and information on the identi$cation of cases of violence among nursing professionals.
Violence at work triggers risks for the development of occupational injuries in health professionals, as well as occupational diseases, lack of communication between professionals, demotivation at work, con!icts, among others.9
Recently, the term horizontal violence has been used, which means the behavior of peers who have the same social position in a hierarchical institution, having a negative impact on job satisfaction and the relationship between hospital nurses. In this context, horizontal violence has been pointed as a source of dissatisfaction, demotivation, problems among co-workers and extreme overload, causing in these professionals the development of stress and recurrent illnesses at work.10
“e nurses who work in the hospital are exposed to violence at all times, and screening is the sector with the highest propensity for occurrences of this act, usually associated with the person, which involves stress, feelings of helplessness, male gender, age group between 20 and 30 and abuse of alcohol and other substances.11 O&en acts of violence are associated with insu%cient sta%ng, excessive patient waiting time, poor safety and overcrowding. In addition, professional inexperience is considered a negative factor in which lack of empathy, intolerance, and judgment can a#ect communication and attitude toward patients and their families.11
When it comes to communication in the workplace, when not properly performed can bring consequences that trigger acts of violence to professionals. In addition, it is up to the institutional bodies to question the possible causes that lead to changes in patients’ behavior and adopt preventive measures, as well as the creation of speci$c protocols to prevent acts such as this from harming the physical and psychological health of professionals.
“e emergency room is another environment very susceptible to acts of aggression with nurses, and the factors that induce this violence are related to the needs of unmet patients, such as delayed care and unsatisfactory responses, which cause con!icts when providing care. For these episodes to be avoided or minimized, it is necessary to use preventive strategies, as well as interpersonal relationships, health education as e#ective forms of care and preparedness to cope with situations of violence in health services.12
Understanding this phenomenon helps nurses to understand that violence is present in the hospital environment, and that there are tools that help improve care and interpersonal/interprofessional relationships, as well as the use of listening, paraphrasing and communication techniques (verbal and nonverbal) can be used to establish or reestablish communication and con$dence, preventing and minimizing situations of violence and modifying the nursing care scenario for the patient.13
On the other hand, relational factors, lack of communication, and sta# attitude towards patients and family members also increase the incidence of violent behavior. In this context, it is observed that interpersonal relationships and communication are present both in the sense of being intervention strategies and as preceptors in situations of violent behavior.
DOI: 10.9789/2175-5361.rpcfo.v12.9103 Interpersonal relations between nursing-patient in the perspective…
ISSN 2175-5361 Souza JSR, Costa ACB, Vilela SC
651R. pesq.: cuid. fundam. online 2020 jan/dez 12: 648-653
Education as a tool to minimize workplace violence
In this category we re!ect on the importance of education as a tool to promote, reduce and identify violence in the workplace of nursing professionals.
“e National Policy on Permanent Health Education (PNEPS), implemented in 2004 by the Ministry of Health, aims to stimulate and meet the demand regarding the professional quali$cation of health workers.14 According to this policy, quali$cation is one of the main ways to prepare them to face di%culties in health services. In this sense, PE is recognized as learning at work, in which learning and teaching are incorporated into the daily life of institutional organizations based on meaningful learning and the possibility of transforming professional practices.
As with PE, Health Education is an educational process of knowledge construction in health that aims at the thematic appropriation by the population, created by the Ministry of Education, is a set of practices in which contribute to the increase of the autonomy of people in their own health care, in the debate with professionals and managers, in order to achieve health care according to their needs.14, 15, 16
“us, the Health Education and PE process are strategies for democratizing the asymmetrical relations of power and decision, increasing access to information and involvement with work con$gured in collective spaces in the development of competences and skills.17
However, these tools came to improve, recycle and improve the relationship in the provision of care, in this case, in situations of violence at work, having possibilities to modify this reality. In addition, as regards professional skills and competences, they should also be directly linked to the patient’s general needs, which should be heard and respected, thus ensuring a good nurse / patient relationship.18
It is important to have a satisfactory approach with the use of instruments that facilitate the identi$cation and recognition of victims of violence. “erefore, it is not enough just to recognize them, it is necessary to train professionals so that they can o#er safe care in a welcoming environment, providing security so that victims have the opportunity to talk about it without any fear and fear.19
Although nursing science respects human rights and acts to minimize the individual’s biopsychosocial su#ering, failures in the care of this population are still evident, which indicates lack of knowledge and training regarding the referral, identi$cation and compulsory noti$cation of cases of violence. “e nursing sta# must adopt welcoming, safe and private behaviors so that this scenario can be modi$ed.20
In this context, it is important to awaken to the managers who work in the institutions, the relevance of the use of educational tools as a guide to these professionals, so that there is commitment from the administrative sector, in order to enable them in legislative issues, in the care approach and identifying clinical signs of violence and their social and judicial precepts. It also encourages nursing professionals to
seek such skills, as it enables greater security in performing actions, minimizing the consequences that violence causes to victims, such as negative and traumatic feelings.20
“erefore, Health Education and PE are important during health promotion activities in situations of violence, favoring possibilities for e#ective nursing practice, expanding concepts, competencies and skills of professionals, as well as of the assisted population.19
It is necessary for professionals to be aware that there are educational and managerial strategies that help them in making decisions and changes related to care and approach, so that they collectively and individually favor them in relation to eventual cases involving violence in the workplace perpetrated by the patients themselves, as well as their families and co-workers.
Nursing care for vulnerable people exposed to violence
Finally, this category addresses the role of nurses as a basic professional in helping people in situations of risk and vulnerability, including young students, women and people in situations of self-in!icted violence.21,22,23 “rough listening and welcoming, nurses who work in support groups work with prevention, promotion, protection and guidance strategies in relation to cases of violence in di#erent scenarios.
It is worth mentioning that nurses perform various care functions. One of them is to o#er therapeutic support focused on health promotion, prevention and rehabilitation focused on emotional problems, such as the use of support groups in schools, applying listening, respect, empathy and welcoming skills.21
“ese groups may be led by nurses, speci$cally mental health nurses, who will develop collective activities in which students will share their traumatic experiences, share experiences and concerns, promoting better coping with these situations. Focusing on primary prevention in school settings, with minimization of cases such as bullying, dating violence, trauma sequelae, and diagnosable mental disorders.21
Many people recognize the work of nurses as being performed exclusively in the hospital sector, linked to care and technical functions, while many are unaware of the quali$cation of this professional to answer questions related to the patient’s emotional aspect, since the service will not always have the presence of a professional psychologist. For this reason, it is of great relevance that the nurse is aware of when to use the appropriate therapeutic techniques and if they are having satisfactory results, including regarding the professional and personal satisfaction of the nurse in the face of various situations of vulnerability, in particular, the situations of violence.
When approaching a vulnerable person, professionals should be able to o#er comprehensive and quality care, providing an image of trust and welcome, attention and empathy, thus establishing a greater bond with the victims. However, many nursing professionals are resistant to acting
DOI: 10.9789/2175-5361.rpcfo.v12.9103 Interpersonal relations between nursing-patient in the perspective…
ISSN 2175-5361 Souza JSR, Costa ACB, Vilela SC
652R. pesq.: cuid. fundam. online 2020 jan/dez 12: 648-653
against victims of violence, $nding it very di%cult to approach and identify, arousing reactions of fear, unpreparedness and insecurity in caring for the victim.22
Professional incapacity causes feelings and negative reactions to the nurse, causing frustration to become a problem in patient care. “us, it is necessary to re!ect on vocational training as a strategy to solve problems involving victims of violence and their aggressors, thus improving the interpersonal relationship to victims of violence.
It is known that nurses are present in various situations of vulnerability, including suicide. Being a type of self- in!icted violence, it is up to the professional to develop strategies that help people involved in this su#ering. One very e#ective and widely used strategy is therapeutic listening. “erapeutic listening can avoid possible episodes of suicide attempt, because its technique allows the professional to o#er individualized assistance to those in psychological and emotional distress, using communication, understanding and understanding with the person who lives this process, thus providing assistance, protection and quali$ed guidance.23
“us, it is appropriate to point out that nursing care can unfold into group and individual activities, which are developed by light technologies as successful strategies. “ese are focused on the human relations of care, such as welcoming, relationship / interaction and communication, that is, they are technologies whose focus is between the worker and the user, in the production of their relationships.24
FINAL CONSIDERATIONS It is observed that interpersonal relationship and
communication are present both as intervention strategies and as preceptors in situations of violent behavior. “ese situations are evident in the nursing profession as pointed out, both in the fact of su#ering di#erent types of violence and in the narrow sense of caring for people in this condition. Given this, it is believed that nurses should be able to face and take care of victims and perpetrators, knowing how to preserve themselves physically and emotionally.
“erapeutic practices, especially therapeutic listening, have shown to be positively e#ective as a means of prevention and welcoming in situations of vulnerability and violence, as well as e#ectively favoring autonomy, empathy and understanding in the interpersonal relationships between nurse-patient about external causes and internal recurrent violence.
Health educational tools should be strategies present in nursing work, since it enables the professional and the user of health services to broaden the $elds of action and enable greater e#ectiveness in situations of violence in their professional practice.
We list as a limitation of the study the selection of material, considering that, as it is an evident theme in the profession, few studies are dedicated to this theme. Future studies on the e#ectiveness of interpersonal relationships between the interdisciplinary team itself, and the relationship with other $elds of activity, such as primary health care, maternal and child health and elderly health are suggested, since studies
addressing thematic in the hospital environment. Nor have studies been identi$ed that point to institutional, political and social practices that will assist such professionals in an e#ective relational approach.
“e study contributes to the knowledge about the dialectic of interpersonal relationships in situations of violence since it can be predisposing to situations of violence as a protective factor.
ACKNOWLEDGEMENT “is work was carried out with the support of the Higher
Education Personnel Improvement Coordination (CAPES) – Financing Code 001.
We are grateful to the Health Technologies, Innovations and Sustainability Research Group (GPTISS).
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Received in: 22/10/2019 Required revisions: Did not have
Approved in: 22/10/2019 Published in: 01/06/2020
Corresponding author Jhuliano Silva Ramos de Souza
Address: Rua da Liberdade, 72, Vila Betânia Alfenas/MG, Brazil
Zip code: 37137-090 E-mail address: jhulianoramoz@hotmail.com
Telephone number: +55 (35) 99129-9524
Disclosure: The authors claim to have no conflict of interest.
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