ISSN: 1981-8963
Andrade KCS, Freitas FFQ, Marques DKA et al.
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Therapeutic communication: basic care...
ORIGINAL ARTICLE
THERAPEUTIC COMMUNICATION: BASIC CARE INSTRUMENT IN HOSPITALIZED
CHILDREN
COMUNICAÇÃO TERAPÊUTICA: INSTRUMENTO BÁSICO DO CUIDADO EM CRIANÇAS
HOSPITALIZADAS
COMUNICACIÓN TERAPÉUTICA: INSTRUMENTO BÁSICO DEL CUIDADO EN NIÑOS HOSPITALIZADOS
Kátia Cenira da Silva Andrade1, Fabiana Ferraz Queiroga Freitas2, Daniela Karina Antão Marques3, Adriana
Lira Rufino de Lucena4, Kátia Neyla de Freitas Macêdo Costa,5 Marta Miriam Lopes Costa6
ABSTRACT
Objective: to identify therapeutic communication strategy most commonly used in nursing care for
hospitalized children. Method: a descriptive, observational study with a quantitative approach, performed
between March and April 2013, with 13 nurses, 25 nursing technicians and all children assisted in pediatrics
and pediatric observation unit of a public hospital in Paraíba. To record data a checklist was used, then,
grouped in tables and analyzed from the literature. The research project was approved by the Research Ethics
Committee, CAAE: 12950813.0.0000.5179. Results: it shows the low use of therapeutic communication
techniques by the nursing team during the service, suggesting greater attention of these professionals about
the subject. Conclusion: it is considered necessary to work and develop strategies to obtain and prioritize the
process of therapeutic communication as relevant and critical care nursing activity during children´s
hospitalization. Descriptors: Nursing; Communication; Hospitalized Children.
RESUMO
Objetivo: identificar a estratégia de comunicação terapêutica mais utilizada na assistência de enfermagem à
criança hospitalizada. Método: estudo descritivo, observacional, com abordagem quantitativa, realizado
entre os meses de março e abril de 2013, com 13 enfermeiros, 25 técnicos de enfermagem e todas as crianças
atendidas na clínica pediátrica e no setor de observação pediátrica de um hospital público na Paraíba. Para o
registro dos dados, utilizou-se checklist, em seguida, estes foram agrupados em tabelas e analisados a partir
da literatura. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAAE:
12950813.0.0000.5179. Resultados: evidencia a pouca utilização das técnicas de comunicação terapêutica
pela equipe de enfermagem durante a assistência, sugerindo uma maior atenção desses profissionais sobre a
temática. Conclusão: considera-se necessário trabalhar e desenvolver estratégias para efetivar e priorizar o
processo de comunicação terapêutica como atividade de enfermagem relevante e essencial ao cuidado
durante a hospitalização infantil. Descritores: Enfermagem; Comunicação; Criança Hospitalizada.
RESUMEN
Objetivo: identificar la estrategia de comunicación terapéutica más utilizada en la asistencia de enfermería
al niño hospitalizado. Método: estudio descriptivo, observacional con enfoque cuantitativo, realizado entre
los meses de marzo y abril de 2013, con 13 enfermeros, 25 técnicos de enfermería y todos los niños atendidos
en la clínica pediátrica y en el sector de observación pediátrica de un hospital público en Paraíba. Para el
registro de los datos se utilizó un checklist, en seguida, fueron agrupados en tablas y analizados a partir de la
literatura. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAAE:
12950813.0.0000.5179. Resultados: muestra la poca utilización de las técnicas de comunicación terapéutica
por el equipo de enfermería durante la asistencia, sugiriendo una mayor atención de esos profesionales sobre
el tema. Conclusión: se considera necesario trabajar y desarrollar estrategias para efectuar y priorizar el
proceso de comunicación terapéutica como actividad de enfermería relevante y esencial al cuidado durante la
hospitalización infantil. Descriptores: Enfermería; Comunicación; Niño Hospitalizado.
1
Nurse, Assistant Health Secondary Care. João Pessoa (PB), Brazil. E-mail: [email protected]; 2Nurse, Master Professor in Nursing,
Federal University of Campina Grande/UFCG. Campina Grande (PB), Brazil. E-mail: [email protected]; 3Nurse, Ph.D. Professor in
Nursing, Nursing School Nova Esperança/FACENE. João Pessoa-PB Brazil. E-mail: [email protected]; 4Nurse, Specialist Professor
in Family Health, Nursing School Nova Esperança/FACENE. Master degree student in Education Science, Integrated Center for Technology
and Research/Cintep. João Pessoa (PB), Brazil. E-mail: [email protected]; 5Nurse, Ph.D, Professor in Nursing, Department
of Medical Nursing, Health Science Center, Graduate Program in Nursing, Federal University of Paraíba/PPGENF/UFPB. João Pessoa (PB),
Brazil. E-mail: [email protected]; 6Nurse, Ph.D. Professor in Sociology, Department of Medical Nursing, Health Science Center,
Graduate Program in Nursing, Federal University of Paraíba/PPGENF/UFPB. João Pessoa (PB), Brazil. E-mail: [email protected]
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
9784
ISSN: 1981-8963
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Andrade KCS, Freitas FFQ, Marques DKA et al.
INTRODUCTION
Communication
involves
seeking
understanding, knowledge, and contact. It is a
link, transmitting feelings and ideas.1 The
communication is used daily by nursing
professionals, being fundamental in the
relationship of help from nurses, nursing
technicians, hospitalized children and their
families, working as an indicator of care
provided to this patients.2
The communication becomes satisfactory
when there is understanding between sender
and receiver, with a positive feedback
between the communicators. Communication
is seen as an essential tool for nursing care
quality, contributing to promote the
emotional care, especially to hospitalized
patients.
Hospitalization is a process in which the
human being is in a different environment
than their own, away from their families and
loved ones, surrounded by devices that little
know what they are for, causing feelings of
anxiety and stress for the client and family.3
As for hospitalization of children, it is
known that this process tends to be
aggravated
because
the
illness
and
hospitalization are stressful experiences
involving profound adaptation of the child to
several changes in their daily routine, with
painful and unpleasant experiences, causing
crises in their life, because it is a strange and
often aggressive place, reflecting on their
intellectual and psychosocial development.4
Nurses can and should alleviate this
situation by providing information; recreation;
presence of family members; affection from
the health team and interpersonal interaction.
Assuming to be the man, a single, unique and
holistic, this interaction of nurse, nursing
technician
and
child
establishes
a
communication process that facilitates the
clarification of doubts as to the prognosis,
treatment, rules and routines of the service,
procedures to be performed, thereby reducing
the stress and anxiety that interfere with the
clinical picture of children.
For this to happen, it is essential that
nurses
and
nursing
technicians
have
knowledge of therapeutic communication and
its relevance as a basic instrument of care,
which when incorporated into nursing care
provides faster recovery. Because, it is the
capacity of the professional to help others, to
discover and solve their problems using their
skill and capability to resolve conflicts,
recognizing their own personal limitations,
adjusting to what cannot be changed and
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
Therapeutic communication: basic care...
facing their own challenges, looking for live in
a healthier way, seeking to make sense to live
independently.
However, therapeutic communication of
nurses and nursing technicians with these
children is still complex, since it is observed
unpreparedness of nursing professionals
regarding the ability to use appropriate
communication techniques. There is the need
to pay attention to solving this aspect even
during their studies and/or vocational
training, as this represents the starting point
so that there is an effective interaction
between the two. Thus, it is noteworthy that
from the therapeutic communication, a
mutual relationship is built of trust essential
to building a therapeutic approach.
In this context, being communication an
important aspect of nursing care and by being
the nurse and the nursing technician
professionals with greater proximity of the
child and family, this study then contributes
to the reflection of nursing professionals, in
order to provide quality care to hospitalized
children and their families from the
therapeutic communication.
To guide the study, the following goal were
defined:
to
identify
the
therapeutic
communication strategy most commonly used
in nursing care for hospitalized children.
METHOD
Descriptive, observational study with a
quantitative approach, developed in a public
hospital of Paraíba, in the areas of Clinical
Pediatric and Pediatric Observation in
Emergency. The choice of these places is
justified by the high turnover of children in
the sector. The Pediatric Clinic is structured
with 03 wards, containing 12 beds, distributed
in a wing. In the Pediatric Observation there
are 05 beds in that area of the emergency.
There were 13 nurses, 20 nursing
technicians and 15 children between one and
twelve years old participating in the study.
The objectives of the research were presented
to the nurses, who agreed to participate in
the study, and then signed the Informed
Consent Form – TCLE, and the children and
their parents, who agreed and signed the
Consent Form and the TCLE respectively. To
be part of the research and ensure the
uniformity of the sample group, the following
criteria
have
been
established
for
professionals: being a nurse or nursing
technician, agreed to participate and be
employed by that institution; for the child:
being hospitalized in pediatrics or pediatric
9785
ISSN: 1981-8963
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Andrade KCS, Freitas FFQ, Marques DKA et al.
observation and have permission of the
caregiver.
Data were collected from March to April
2013. In the data collection, Non-Participatory
Observation Technic was used, consisted of an
instrument adapted by Lima5, checklist type,
composed of three groups, expression,
clarification and validation. Regarding to
Expression, there were techniques that
allowed the description of the experience and
verbalization of thoughts and feelings at the
beginning of the therapeutic relationship of
nurses and nursing technicians with children.
In Clarification, there were techniques that
have helped the professional to clarify who
was sentenced by the patient, and finally, in
the Validation group, there were techniques
that have identified if the child´s
understanding was correct and that the
professional could understood the child.
The
observation
occurred
during
interactions between the nursing staff and the
children, as the nursing consultation,
execution of technical procedures and
guidelines regarding the care provided.
To avoid changes in the behavior of
professionals, the researchers have integrated
the search field seven days prior to collection,
in order to be part of the reality observed.
The collected data were grouped and
presented in tables, and then analyzed and
discussed according to the literature about
the theme. The guidance inherent in the
research protocol contained in Resolution
466/12 CNS6 were respected, about research
involving human being and it was approved by
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
Therapeutic communication: basic care...
the
Research
Ethics
Committee
FACENE/FAMENE under the Protocol 25/2013.
RESULTS
There were 13 nurses and 20 nursing
technicians participating, observing an age
variation among nursing technicians of 27 to
65 years old and among nurses of 27 to 60
years old; the period of professional practice
ranged from 0.5 to 33 years in nursing
technicians and 1.5 to 27 years among nurses.
With regard to weekly working hours, there
was 30 to 150 weekly hours in nursing
technicians and 30 to 100 weekly hours for
nurses, prevailing, however the average of 40
to 80 weekly hours. Regarding the training
time, most of the technicians and nursing had
11 years formation.
As for the children, the age ranged from
one to 12 years old incomplete in both
genders, and there were ten males (66.6%)
and five females (33.3%). There were 139
interactions observed between nursing staff
and children during hospitalization, with 117
(84.17%) in expression group; other 15
(10.79%) for clarification and 07 (5.04%) for
validation. Among nurses and children, there
were 115 interactions found, with 92 (80%) in
the group expression; 10 (8.70%) for
clarification group and 13 (11.30%) for
validation group.
9786
ISSN: 1981-8963
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Andrade KCS, Freitas FFQ, Marques DKA et al.
Therapeutic communication: basic care...
Table 1. Distribution of variables used in the Expression Group of Therapeutic
Communication by Nursing Technicians (n=20) and Nurses (n=13). – João Pessoa-PB,
2013.
Expression
Nursing Technician
Nurse
nº
%
%
nº
Remains silent
03
15
02
15,38
Listening reflectively
05
25
05
38,46
Shows interest
14
70
11
84,62
Shows acceptance
07
35
05
38,46
Uses incomplete sentences
03
15
03
23,08
Repeats comments made by the
patient
11
55
06
46,15
Repeats the last words said by 06
30
04
30,77
the patient
Asks questions to the patient
17
85
11
84,62
Focuses on the main idea
01
05
03
23,08
Shows doubts
07
35
07
53,85
Talks in a non-therapeutically 10
50
09
69,23
way
Stimulates
expression
of 02
10
01
7,69
underlying feelings
Uses humor
02
10
02
15,38
Encourages questions by the 04
20
04
30,77
patient
Returns the expression made by 10
50
03
23,08
the patient
Gives information according to 12
60
09
69,23
the patient´s understanding
Allows the patient choose other 02
10
05
38,46
matters
Regarding the therapeutic communication
techniques included in expression group,
there was fluctuation of 1 (5%) to 17 (85%)
among the nursing technicians in the variables
interactions and 1 (7.69%) and 11 (84.62 %)
among nurses.
Among all the variables, the most used
were Showing interest with 14 (70%) of nursing
technicians and 11 (84.62%) among nurses;
Repeats comments made by patients with
(55%) of nursing technicians and six (46.15%)
of nurses; Asks questions to the patient in 17
(85%) of nursing technicians and 11 (84.62%)
of nurses; Talks in a non-therapeutically way
with 10 (50%) of nursing technicians and nine
(69.23%) of nurses; Gives information
according to the patient's understanding with
12 (60%) of nursing technicians and nine
(69.23%) of nurses. The other techniques were
used to a lesser extent.
Table 2. Distribution of variables used in the Clarification Group of Communication
therapeutic by Nursing Technician (n=20) and Nurses (n=13). – João Pessoa-PB, 2013.
Clarification
Nursing Technician
Nurse
nº
%
nº
%
Stimulates comparisons
03
15
00
00
Encourages the use of terms in 01
05
01
7,69
common by the patient
Describes the events in a logical 11
55
0,9
69,23
sequence
Table 3. Distribution of variables used in the Validation Group of Communication
therapeutic by Nursing Technician (n=20) and Nurses (n=13). – João Pessoa-PB, 2013.
Validation
Nursing Technician
Nurse
nº
%
nº
%
Repeat messages to the patient
04
20
04
30,77
Asks the patient to repeat what 01
05
04
30,77
was said
Summarizes what was said in the
report
02
In the relationship between Nursing
Technicians/Nurses and the child and his
family, the variable remaining silent was
similar to nursing technicians and nurses.
Silence can represent some feelings for the
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
10
05
38,46
patient, how to find that the professional is
indifferent to the case, provoking anxiety.
However, when the silence is therapeutically
used, it exposes the patient to the need that
the professional participates actively in the
9787
ISSN: 1981-8963
Andrade KCS, Freitas FFQ, Marques DKA et al.
recovery process7, and being responsible for
the communication process. Tolerance to
silence differs from person to person, but
generally is ephemeral, because it is too long
may cause anxiety in all participants of the
interaction.5
IN the care provided to hospitalized
children, the presence of silence is necessary
for professionals to identify what is wrong
with the child, and depending on the age of
the child, the child may not know to say or
express his/her feelings in an effectively
understandable way.
To remain silent is part of listening, not
just hearing, but use gestures to express
acceptance and foster demonstration of
feelings. When the professional prioritizes
communication, it is necessary a change of
focus and attitude, moving from do to listen,
observe, understand, and from then on,
planning actions.8
Listening reflectively was identified in 25%
of nursing technicians and 38.46% of nurses
during the procedures. Good listeners are
few, being a very difficult task, they need to
be predisposed to listen to each other and
learn to suspend preconceived ideas not to
block what the patient wishes to verbalize.
Although essential and indispensable in human
daily life, communication is not as simple as it
requires various skills, among them, the
ability to listen, which is valuable tool in the
development and strengthening of a helping
relationship, leaving the other leading content
of their communication.
There was a greater use of this listening by
nurses, this factor may be assigned to their
own professional training, where the
communication issue is discussed since
graduation.
The variable showing interest during the
interactions, was recorded in 70% of nursing
technicians and 84.62% among nurses. It is
possible to see a greater interaction of
professionals in that item having the largest
participation of the child, through questions
and
finding
answers
that
convince.
Throughout the procedure, it is necessary for
the child to express his/her questions so they
understand what is happening to their body at
that moment. Thus, it is necessary for nurses
and nursing technicians observe signs that can
identify what and how the child is feeling at
that moment. If the child verbalize or express
their doubts or uncertainty, the professional
must clarify them, seeking to understand the
messages provided. When the professionals
interact
therapeutically
during
their
procedures, they establish a trust and
dependency relationship between the two of
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Therapeutic communication: basic care...
them,
showing
that
the
gateway
communication
for
consolidation
and
implementation of a good relationship.
As the variable showing acceptance, it was
observed in 35% of nursing technicians and
38.46% of nurses. Showing acceptance is one
of the basic human needs, because to feel
safe to speak, they need to feel accepted. To
this
acceptance
be
genuine,
nursing
professionals need to have a holistic view of
the patient as a person, so the child will
experience through empathy with each other,
the feeling of being accepted.8
At the same time, this feeling will be
complemented by the trust to be developed
from the demonstration or verbalization by
the nursing professional, making the patient
feel comfortable to express their feelings,
establishing a therapeutic relationship.
Also in the expression group, the variable
uses of incomplete sentences was present in
the interactions of 15% of nursing technicians
and 23.08% of nurses. This category expresses
the articulation between education strategies
and objectives of it. Its use, aimed at
identifying what the patient already knows,
guiding professionals and patients because it
will give the team information about their
understanding of current events, to thereafter
guide their work in assisting using
methodology,
specific
techniques
and
teaching
in
order
to
make
better
understanding of the offered information.9
In the variable repeats comments made by
the patient, 56% of nursing technicians and
46.15% of the nurses used it during
interactions, suggesting an effective behavior
to good communication between professionals
and hospitalized children.
By repeating the comments made by the
child, the professional shows interest and
attention to what they expound, valuing their
speech, prompting them to keep talking about
a subject that had stopped and explain it
better. So this repetition serves as echo so
they can reflect more deeply on the subject
discoursed of what they heard.
The variable repeats the last words spoken
by the patient, it was observed in 30% of the
interactions of nursing technicians and 30.77%
of nurses. These professionals express concern
about the child voice, and give them the
attention that they transmit which implies a
positive assessment of the patient about what
was explained. With that, it is prompted to
explain the matter that was communicating,
helping the description of the experience and
expression of thoughts and feelings.10
9788
ISSN: 1981-8963
Andrade KCS, Freitas FFQ, Marques DKA et al.
Since the variable asks questions to the
patient was observed in 85% of nursing
technicians and 84.62% of nurses. Some
authors highlight the use of this technique,
because depending on how it is used by
professionals, they can modify or not the
expected results and impact on well-being.5
The realization of the question should
always take place in a clear, short and simple
way, using common terms among the
participants, avoiding inducing answers,
worrying not to ask too many questions, since
many of them lead to emotional fatigue
making a less confident patient. It is essential
to avoid sentences starting with “how” and
“why”, since the patient may feel intimidated
or pressured.
This technique provides the child feel that
the nurse or nursing technician are attentive
and interested in their situation at the time of
interaction. The reliable diagnostic decisions
depend on good communication, where
questions are necessary, answers and
understanding by those involved.
As the variable focusing on the main idea,
only 5% of nursing technicians used it, while
23.08% of nurses used it in the interaction.
The demonstrated little knowledge of nursing
technicians about this communication theme,
while nurses express greater role on this issue,
even though they still used unconsciously. In
these situations, the patient focuses on
message
content
listening
to
what
professional means, concentrating on the
meaning of words and the context of
information.
In the interactions, 35% of nursing
technicians and 53.85% of the nurses showed
doubts, which enables dialogue through which
the patient expresses his feelings and
experiences, strengthening the bond between
them and the nursing staff.12 By verbalizing
their doubts, professional nursing places the
child in the care process, because “answering
doubts” will show their purest and real
feeling, thus facilitating the diagnosis of
nursing.
The variable talks in a non-therapeutically
way showed that 50% of nursing technicians
and 69.23% of nurses have used it during the
interaction with the children. The “no” is the
honesty and integrity of professional, when
not properly used it can cause the patient to
be manipulated.5 Thus, there is a need to be
used in times of interaction where the child
appears to be more accessible. It represents
the boundary between the power and no
power, and its understanding is critical to
successful treatment, welfare and child´s
sense of freedom.
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Therapeutic communication: basic care...
Among nursing technicians, 10% used the
variable stimulates the expression of
underlying feelings, but among nurses the
percentage was 7.69%. To use well this
technique, nursing professionals need a lot of
concentration, because at any time,
interference of their beliefs, behavior and
ideals can interfere. In the event of personal
interference by these professionals, there will
be interpretations of feelings of the patient,
which will not be beneficial to the his clinical
outcome.5
Thus, it is worth noting that the discovery
of these feelings is possible for professionals
who
use
non-verbal
communication
techniques, which enables greater observation
of the child, facilitating the understanding of
what it is not manifested.
The
variable,
uses
humor
during
interactions is used by 10% of nursing
technicians and 15.38% of nurses. When using
it in a particular way and intentionally, humor
can meet diverse needs, whether related to
social interaction or own style of each
individual. The mood in the work environment
must function beyond fun, also acting as a
mediation device in the process of
interpersonal interaction built on the work
environment, favoring the union of the group
and promoting the stress confrontation.13
Out of the observed professionals, 20% of
nursing technicians and 30.7% of the nurses
used the variable stimulates the questions of
the patient. When stimulated by questions,
professionals express their anguish, leaving
implied their questions about treatment and
effects that can suffer their body, mind and
feelings.14 When using this item, professionals
provide a closer relationship with the child
making them participate and face treatment
satisfactorily, taking along commitment with
their caregivers.
In the interaction using the variable returns
the expression made by the patient, appeared
in 50% of nursing technicians and 23.08% of
nurses. It is common to use this resource to
facilitate contact and expression of patients
about their experience. When returning the
expression made by the patient during the
service, the professional shall provide the
communication
of
opinions,
emotional
expression and reactions as resources to seek
interaction. This result is justified because it
is the nursing technician, within the whole
healthcare team involved in patient care, who
performs most of the tasks and therefore,
having longer time with them, developing
unique trust and complicity ties.
The variable passes information in
accordance with the patient's understanding
9789
ISSN: 1981-8963
Andrade KCS, Freitas FFQ, Marques DKA et al.
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Therapeutic communication: basic care...
was a highlight with 60% of the interactions
between nursing technicians and 69.23%
among nurses. Using this type of nursing
technique, there will be a clear, concise and
precise language not using technical or
professional jargon. It can be used to answer
questions, explain procedures, report the
operation and routine of the hospital, which
should be communicated with appropriate
tone and slowly, speaking according to the
vocabulary of the patient and should make use
of a simple and direct communication,
explaining only what is necessary.
understand
him.5
Therefore,
nursing
professionals
must
express
themselves
properly, sharing an understandable language
and in common with the patient.
However, this technique can lose its value
if it is used in an authoritarian manner as an
order. By using this type of technique, the
patient´s anxiety will tend to decrease
considerably, as it is often in a threatening
and unfamiliar environment.4
For the item describes events in logical
sequence, it is a communicative and effective
technique, particularly in patients undergoing
generating stress conditions, such as
hospitalized
children.
This
technique
appeared among the most used by nurses with
52.9% of interactions. Therefore, to report the
events in chronological sequence, there is the
possibility
of
establishing
relationships
between cause and effect or to correct the
information given before15, describing the
events in a logical sequence helping in patient
education, which has to be relevant in care.
As the variable allows the patient choose
other subjects, 10% of nursing technicians and
38.46% of nurses have used it, enabling
patients to participate effectively as well as
touching on issues that these professionals
have not brought into focus during service.
When this variable appears, it demonstrates
how this is essential and effective for
communication.7
By allowing the child to participate in the
assistance, accepting their suggestions,
respecting their opinion, respecting their
requests, to the extent possible, the nurses
will have an “ally”, “collaborator”, “helper”
and not just another patient. The medication
will have better acceptance, there will be less
crying and resistance to necessary procedures
during hospitalization, as they will feel part of
the team.
The technique to encourage comparisons is
used by nursing professionals to help patients
express their ideas. If used well, this
technique provides the patient reflect on
similar past experiences, seeking to find
solutions to their current problem, thereby
reducing anxiety.15 Using this technique offers
the chance to the patient to note that some
events experienced by him throughout his life,
have similarities with each other. It is
necessary for the nursing staff to be cautious
in using this technique, because it can
interfere with the results of communication.
For this reason, it is worrying to not use this
variable by nurses.
As the variable stimulates the use of terms
in common by the patient, this technique can
be used to not being able to identify or
understand the meaning of the message
conveyed by the patient, making it necessary
to clarify, showing the patient that both
nurses as nursing technicians try to
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
These unusual terms are appearing
gradually in the relationship between nursing
staff and patients, since each one has their
own vocabulary, religion, educational level,
culture, presenting an individual way of
communicating. In the event of an unfamiliar
term of nursing professionals, they should ask
the patient to explain what they mean by
those terms or phrases.
The group clarification becomes necessary
when the patient cannot express clearly or
understand the precise moment they are going
through, their thoughts and feelings, and
when they cannot describe the events in
sequence. By clarifying what was expressed by
the patients, nursing professionals offer new
opportunities for correction of information.2
Communication determines a relationship,
so the information must not only be
transmitted, but it must have different
behaviors and character in relationships that
are often set deliberately and consciously. It
is essential to clarify the messages by
everyone involved throughout the process of
communication.
The validation group is shown in Table 3.
Repeating the patient´s message is used to
facilitate understanding and learning. By using
this technique, nursing professionals seek to
return the message while the wait for
confirmation by the patient.5
By asking the patient to repeat what was
said, this technique should be performed
frequently, as many messages expressed by
them may have different meanings for
everyone involved in the therapeutic process.
Thus, their use can confirm the understanding
of the message transmitted between the
communicated people. Thus, it is important to
note that among the professionals who most
used this technique there are nurses,
featuring a plus point for nursing care in the
9790
ISSN: 1981-8963
Andrade KCS, Freitas FFQ, Marques DKA et al.
pursuit of effective care. When the nurses
summarize what was said in the relationship,
they reinforce the message clearly and
concisely, trying to leave no doubt as to the
content of the communication.
CONCLUSION
Communication is an important element of
human interaction, and therefore impact on
working groups and organizations. This
research aimed to identify therapeutic
communication strategy most commonly used
in nursing care for hospitalized children,
highlighting the role that communication plays
in the interactions between nursing staff and
children in the hospital researched.
It was noticed that the therapeutic
communication between nursing technicians,
nurses and hospitalized children could be
improved due to the low percentages
validated for each variable, although all of
them have been identified in the study. It was
evident that nurses use most frequently
techniques related to this type of
communication, where the expression group is
the most used, followed by clarification and
validation techniques. The same occurred
with nursing technicians. This fact may have
related to the working hours of these
professionals, which can make them with
little time and inclination to seek new skills,
fostering the realization of a work without the
effective use of communication resources as a
therapeutic process.
The study of this issue contributes to the
knowledge of the communication scenario
with children, suggesting the need for
incentives for the training of nursing
professionals in this field. This research may
provide support to direct future research and
disseminate existing knowledge in the area,
encouraging new studies, as well as perfecting
the context of the communication idea with
hospitalized children.
REFERENCES
1. Martins DS, Zilberknop LS. Português
Instrumental. São Paulo - SP: Atlas; 2007.
2. Negreiros PL, Fernandes MO, MacedoCosta
KNF,
Silva
GRF.
Therapeutic
communication between nurses and patients
from a hospital unit. Rev eletrônica enferm.
[Internet] 2010, Jan/Mar [cited 2014 Oct
13];12(1):[about 12 p.]. Available from:
http://www.revistas.ufg.br/index.php/fen/ar
ticle/view/9529/6598
3. Nieweglowski
VH,
Moré
CLOO.
Comunicação equipe família em unidade de
terapia intensiva pediátrica: impacto no
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Therapeutic communication: basic care...
processo de hospitalização. Estud psicol
(Campinas). [Internet] 2008, Jan/Mar [cited
2014 Oct 09];25(1):[about 12 p.]. Available
from:
http://www.scielo.br/pdf/estpsi/v25n1/a11v
25n1.pdf
4. Castro ARV, Rezende MA. Validação de
conteúdo para construção de sítio virtual
sobre uso do brinquedo na enfermagem
pediátrica. Cogitare enferm. [Internet] 2013,
Apr/June [cited 2014 Nov 11];18(2):[about 6
p.].
Available
from:
http://ojs.c3sl.ufpr.br/ojs2/index.php/cogita
re/article/view/32575/20688
5. Lima JTS, Oliveira DST, Costa TF, Freitas
FFQ, Alves SRP, Costa KNFM. Therapeutic and
Nontherapeutic
Communication
Between
Nurses and Hospitalized Elderly Citizens. Rev
enferm UFPE on line. [Internet] 2012 July
[cited 2014 Oct 30];6(7):[about 9 p.].
Available
from:
http://www.revista.ufpe.br/revistaenfermage
m/index.php/revista/article/view/2727/pdf_
1289
6. Ministério da Saúde (Brasil). Conselho
Nacional de Saúde, Comissão Nacional de
Ética em Pesquisa. Resolução Nº 466 de 12 de
dezembro de 2012: aprova as diretrizes e
normas
regulamentadoras
de
pesquisa
envolvendo seres humanos. Brasília: Ministério
da Saúde, 2012. 1-12p.
7. Stefanelli
MC,
Carvalho
EC.
A
comunicação nos diferentes contextos da
enfermagem. Barueri - SP: Manole; 2005.
8. Mourão CML, Albuquerque AMS, Silva APS,
Oliveira MS, Fernandes AFC. Comunicação em
enfermagem: uma revisão bibliográfica. Rev
RENE. [Internet] 2009 July/Sept [cited 2014
Oct 06];10(3):[about 6 p.]. Available from:
http://www.revistarene.ufc.br/revista/index.
php/revista/article/viewFile/552/pdf
9. Teixeira FM, Sobral ACMB. Como novos
conhecimentos podem ser construídos a partir
dos conhecimentos prévios: um estudo de
caso. Ciênc educ (Bauru). [Internet] 2010
[cited 2014 Nov 20];6(3):[about 10 p.].
Available
from:
file:///C:/Users/Microsoft/Downloads/C&E2010-1231.pdf
10. Damasceno MMC, Zanetti ML, Carvalho
ECC, Teixeira CRS, Araújo MFM, Alencar
AMPG. A comunicação terapêutica entre
profissionais e pacientes na atenção em
diabetes mellitus. Rev latinoam enferm.
[Internet] 2012 July/Aug [cited 2014 Nov
22];20(4):[about 8 p.]. Available from:
file:///C:/Users/Microsoft/Downloads/4860059227-1-PB.pdf
11. Lamprecht RR. Consciência dos sons da
língua: subsídios teóricos e práticos para
9791
ISSN: 1981-8963
Andrade KCS, Freitas FFQ, Marques DKA et al.
DOI: 10.5205/reuol.8008-72925-1-ED.0911201519
Therapeutic communication: basic care...
alfabetizadores, fonoaudiólogos e professores
da língua inglesa. Porto Alegre – RS: Edipucrs;
2009.
12. Shimizu HE, Lima MG. As dimensões do
cuidado
pré-natal
na
consulta
de
enfermagem. Rev bras enferm. [Internet]
2009
May/June
[cited
2014
Oct
02];62(3):[about 5 p.]. Available from:
http://www.scielo.br/pdf/reben/v62n3/09.p
df
13. Matraca MVC, Wimmer G, Araujo-Jorge
TC. Dialogia do riso: um novo conceito que
introduz alegria para a promoção da saúde
apoiando-se no diálogo, no riso, na alegria e
na arte da palhaçaria. Ciênc saúde coletiva.
[Internet] 2011 Oct [cited 2014 Nov
09];16(10):[about 11 p.]. Available from:
http://www.scielo.br/pdf/csc/v16n10/a18v16
n10.pdf
14. Silveira MT, Fernandes VFT, Schiller P,
Kater CE. Hiperplasia adrenal congênita:
estudo qualitativo sobre doença e tratamento,
dúvidas, angústias e relacionamentos (parte
I). Arq bras endocrinol metab [Internet] 2009
Dec [cited 2014 Oct 19];53(9):[about 12 p.].
Available
from:
http://www.scielo.br/pdf/abem/v53n9/v53n9
a08.pdf
15. Fermino TZ, Carvalho EC. Therapeutic
Communication
With
Bone
Marrow
Transplantation Patients: a profile of verbal
behavior and the effect of an educational
strategy. Cogitare enferm. [Internet] 2007
July/Sept [cited 2014 Oct 19];12(3):[about 8
p.].
Available
from:
http://132.248.9.34/hevila/Cogitareenfer
magem/2007/vol12/no3/2.pdf
Submission: 2014/12/23
Accepted: 2015/08/18
Publishing: 2015/11/01
Corresponding Address
Fabiana Ferraz Queiroga Freitas
Edf. Zenitte
Avenida Pomba, 630, Ap. 203
Bairro Manaíra
CEP 58038-241 ― João Pessoa (PB), Brazil
English/Portuguese
J Nurs UFPE on line., Recife, 9(11):9784-92, Nov., 2015
9792