Maria Júlia Paes da Silva

Paciente crítico e comunicação: visão de familiares sobre sua adequação pela equipe de enfermagem

A comunicacao e considerada importante variavel no cuidado do paciente critico e de sua familia, cuja dificuldade em se comunicar e expressa na literatura. O objetivo da pesquisa foi verificar o que e comunicacao adequada com a equipe de enfermagem na percepcao do familiar do paciente critico. Estudo exploratorio e de campo, realizado na UTI do Hospital Universitario da USP. A populacao constituiu-se de 13 familiares de pacientes internados. Os dados foram coletados em novembro de 2003 e analisados, segundo a proposta de Bardin. Foi considerada comunicacao adequada aquela em que a comunicacao e um meio de informacao - as informacoes sao claras e objetivas, ha esclarecimento de duvidas, ha orientacoes; e a comunicacao e uma forma de tornar o cuidado mais humanizado - havendo comunicacao verbal mesmo com o paciente sedado, tendo alguem como referencia para que os familiares possam recorrer.Communication is considered an important variable in the care of critical patients and their families, whose difficulty concerning communication is expressed in the literature. The purpose of this survey was to verify what is considered adequate communication with the nursing team in the perception of the critical patients family. This is an exploratory and field study carried out at the Intensive Care Unit of the University of São Paulos Hospital Universitário. The population surveyed was comprised of 13 relatives of critical patients. The data was collected in November of 2003 and analyzed according to Bardin proposal. Communication was considered adequate when it was a means for information - the information was clear and objective, doubts were clarified, orientation was provided and communication was a form of humanizing health care - and there was verbal communication even when the patient was sedated, with somebody as a reference whom the relatives could resort to.

Comunicação não-verbal: reflexões acerca da linguagem corporal

Buscamos com este estudo refletir sobre a importância da linguagem corporal, atraves da identificacao do que um grupo de enfermeiras pos-graduandas, sabiam sobre o assunto. Analisamos o conteudo dos relatos de onde emergiram cinco categorias: conceito, funcao, importância, significado e formas de manifestacao da linguagem corporal. A linguagem corporal foi valorizada pelo grupo como uma forma complexa de interacao interpessoal da qual temos pouca consciencia, ocorrendo por vezes a margem do nosso controle. Tem por funcao expressar sentimentos, emocoes e transmitir mensagens, cujos significados sao influenciados pelo contexto. O conhecimento da linguagem corporal amplia nossa percepcao profissional e e mais um instrumento para melhorar a qualidade da assistencia de enfermagem.The present study aimed to reflect on the importance of body language through the identification of what a graduate nursing group knew about this topic. We analyzed the contents of reports from which five categories emerged: concept, function, importance, meaning and forms of body language manifestation. The group valued body language as a complex way of interpersonal interaction that sometimes occurs out of our control and of which we have little conscience. It has the function of expressing feelings, emotions and transmitting messages whose meanings are influenced by context. Body language knowledge increases our professional perception and it is one more instrument to improve nursing assistance quality.

Terapias alternativas/complementares no ensino público e privado: análise do conhecimento dos acadêmicos de enfermagem

Este estudio ha realizado un analisis sobre el conocimiento de los alumnos de pregrado en enfermeria de una institucion publica y otra privada sobre terapias alternativas/complementarias, una vez que las dos instituciones ofrecen asignatura especifica en esta area, de forma optativa y obligatoria respectivamente. Los datos encontrados sugieren que el conocimiento del tema es de uso general ademas de lo academico. Las terapias alternativas/complementarias mas conocidas son: la terapia floral, la acupuntura, la homeopatia, la cromoterapia, la fitoterapia, la musicoterapia y masaje, pero, aunque los alumnos las recomiendan, no las utilizan tanto. El punto mas algido en el proceso de ensenanza/ aprendizaje de esta asignatura se refiere a los aspectos legales de la especializacion en este campo para el enfermero.

Comunicação competente: visão de enfermeiros especialistas em comunicação

Objective: To perceive the meaning of competent communication to nurses who are communication-expert nursing professors. Methods: This is a qualitative exploratory study using the following guiding question: “What is competent communication?” Data analysis was performed by means of Content Analysis. Results: Competent communication is an interpersonal process that must achieve the communicators’ objectives. It presupposes basic communication knowledge, and that the individuals involved are aware of verbal and non verbal signs during interaction. It also requires clarity and objectivity, promotes self-knowledge and enables a more authentic life. Conclusion: These meanings for communicative competence point out the need for technical and human preparation, as well as the importance of listening and having an accurate perception of others, and the possibility of using that learning as an investment in self-knowledge and as a support for respecting those around us.Objective: To perceive the meaning of competent communication to nurses who are communication-expert nursing professors. Methods: This is a qualitative exploratory study using the following guiding question: “What is competent communication?” Data analysis was performed by means of Content Analysis. Results: Competent communication is an interpersonal process that must achieve the communicators’ objectives. It presupposes basic communication knowledge, and that the individuals involved are aware of verbal and non verbal signs during interaction. It also requires clarity and objectivity, promotes self-knowledge and enables a more authentic life. Conclusions: These meanings for communicative competence point out the need for technical and human preparation, as well as the importance of listening and having an accurate perception of others, and the possibility of using that learning as an investment in self-knowledge and as a support for respecting

A comunicação não-verbal enquanto fator iatrogênico

The current study has the purpose of verifying if nurses are able to identify situations in which the nonverbal aspects of interpersonal communication between health professionals and patients constitute an iatrogenic factor. The data were collected through semistructured interviews with eight nurses and were analyzed according to the content analysis methodology. Three categories appeared from the professional discourses, and these categories make evident the perception of iatrogenesis, its consequences and characteristics and the interrelation between nonverbal language and nursing care.O estudo teve como objetivo verificar se os enfermeiros identificam situacoes nas quais os aspectos nao-verbais da comunicacao interpessoal entre profissionais de saude e pacientes constituem fator iatrogenico. Os dados foram coletados por meio de entrevista semi-estruturada com oito enfermeiros e analisados segundo a metodologia de analise de conteudo. Do discurso dos profissionais emergiram tres categorias, que evidenciam a percepcao da iatrogenia, suas consequencias e caracteristicas e a interrelacao entre a linguagem nao-verbal e o cuidado.

A comunicação com o paciente em cuidados paliativos: valorizando a alegria e o otimismo

Este estudo objetivou conhecer as expectativas de pacientes em cuidados paliativos em relacao a comunicacao com as pessoas da equipe de enfermagem. Os dados foram coletados no primeiro semestre de 2005, por meio de entrevistas semi-estruturadas, junto a 39 pacientes oncologicos sem prognostico de cura, submetidos a quimioterapia paliativa em uma instituicao hospitalar privada da cidade de Sao Paulo, Brasil. Apos transcricao das falas, os dados foram analisados segundo a metodologia de analise do conteudo. Dos discursos dos entrevistados emergiram quatro categorias. A comunicacao interpessoal comprovou ser importante atributo do cuidado paliativo, evidenciando a atencao dada aos sinais nao-verbais do profissional para o estabelecimento do vinculo de confianca, a necessidade da presenca compassiva, o desejo de nao focar a interacao e o relacionamento apenas na doenca e morte e a valorizacao da comunicacao verbal alegre, que privilegia o otimismo e o bom humor.

Música e dor crônica músculoesquelética: o potencial evocativo de imagens mentais

Noventa mulheres com diagnosticos de fibromialgia, lesao por esforcos repetitivos/doencas osteoarticulares, relacionadas ao trabalho (LER/DORT), e afeccoes relacionadas a coluna vertebral foram submetidas a audicao individual de tres pecas musicais. Os dados foram obtidos por meio de entrevista e a intensidade da dor foi avaliada pela escala numerica verbal (0-10) antes e ao termino da audicao musical. As imagens mentais foram quantificadas mediante a analise de desenhos realizados durante cada audicao. Os tres grupos apresentaram reducao estatisticamente significativa da intensidade da dor ao final da audicao musical (p<0,001). As imagens mentais nao diferiram quantitativamente, entre Ravel e Wagner. O Mix apresentou resultados quantitativamente inferiores. As estruturas musicais se relacionaram a producao de imagens e o efeito terapeutico observado, sugerindo que analises nesse sentido podem contribuir para a utilizacao da musica pela Enfermagem.Ninety women with diagnosed fibromyalgia, work-related repetitive strain injury/osteoarticular diseases (RSI) and diseases related to the spinal column were submitted to individual listening of three musical pieces. Data were obtained by means of interviews and pain intensity was evaluated by the verbal numeric scale (0-10) before and after listening to the music. The mental images were quantified by analyzing the drawings made during each listening session. The three groups presented a statistically significant reduction in pain intensity at the end of the listening session (p<0.001). The mental images did not differ in quantity, between Ravel and Wagner. The Mix presented quantitatively lower results. The musical structures related to the production of images and the observed therapeutic effect suggests that structural analyses may contribute to the use of music by nursing.

Comunicar-se com o paciente sedado: vivência de quem cuida

How can we interact with sedated patients who are seemingly unable to express themselves? On the basis of these questions, we chose to realize a qualitative phenomenological study aimed at comprehending communication with the sedated patient from the perspective of the nurses who take care of those patients. Ten individual interviews were realized with intensive nurses from a Hospital School in S o Paulo. After data analysis, four general thematic categories were revealed: communication with sedated patient x sedation degree; communication with sedated patient x attributed perception capacity; valuation of communication with sedated patient; forms of communication with the sedated patient. This research concluded that the communication with the sedated patient exists and occurs at different moments and in different ways through verbal and non-verbal communication.

Estratégias de comunicação utilizadas por profissionais de saúde na atenção à pacientes sob cuidados paliativos

The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care.O presente estudo objetivou verificar a relevância e a utilizacao de estrategias de comunicacao em cuidados paliativos. Estudo quantitativo multicentrico, realizado entre agosto/2008 e julho/2009, junto a 303 profissionais de saude que trabalhavam com pacientes sob cuidados paliativos, por meio da aplicacao de questionario. Os dados foram submetidos a tratamento estatistico descritivo. A maioria (57,7%) nao foi capaz de citar ao menos uma estrategia de comunicacao verbal e apenas 15,2% mencionaram cinco sinais ou estrategias nao verbais. As estrategias verbais mais citadas foram as de cunho interrogativo sobre a doenca/tratamento e, dentre as nao verbais, destacaram-se o toque afetivo, olhar, sorriso, proximidade fisica e escuta ativa. Embora os profissionais tenham atribuido alto grau de relevância para a comunicacao em cuidados paliativos, evidenciaram escasso conhecimento de estrategias de comunicacao. Faz-se necessaria a capacitacao dos profissionais no que tange a comunicacao em cuidados paliativos.

Autonomia em cuidados paliativos: conceitos e percepções de uma equipe de saúde

Objectives: To analyze the concept that a health teamwork, acting on the field of palliative care, has about the terminal patient’s autonomy and to identify the attitude of professionals facing the manifestation of that autonomy. Methods: Exploratory and descriptive study with a qualitative approach. 22 members of a palliative care team were interviewed. The data was analyzed using the content analysis methodology. Results: Three different categories were obtained from each professional group (Groups I and II): understanding the autonomy of terminal patients in a palliative care context, reactions of professionals on the daily assistance services, and, limitations of the relationship (autonomy vs. palliative care). Conclusion: Autonomy is an essential component in the palliative care philosophy; it must be able of creating ethical sustainability, applicable to therapeutic projects of terminal patients.ABSTRACT Objectives: To analyze the concept that a health teamwork, acting on the field of palliative care, has about the terminal patient’s autonom yand to identify the attitude of professionals facing the manifestation of that autonomy. Methods: Exploratory and descriptive study witha qualitative approach. 22 members of a palliative care team were interviewed. The data was analyzed using the content analysis methodology. Results: Three different categories were obtained from each professional group (Groups I and II): understanding the autonomy of terminalpatients in a palliative care context, reactions of professionals on the daily assistance services, and, limitations of the rel ationship (autonomyvs. palliative care). Conclusion: Autonomy is an essential component in the palliative care philosophy; it must be able of creating ethicalsustainability, applicable to therapeutic projects of terminal patients. Keywords: Palliative care; Multiprofessional team; Communication; Bio-ethics