Comunicação verbal com pacientes inconscientes

Abstract

Objective: Communication with critically ill patients in intensive care settings generates specific challenges for nursing staff, and demands well-developed skills. Methods: A study was conducted in two phases using qualitative methods to characterise and standardise verbal communication used with patients. The first phase consisted of a systematic search and content analysis of the literature concerning communication and verbal stimulation of unconscious patients. Results: The results of the content analysis were then used in phase two and informed the development of a standardised stimulus message. There appear to be four main problem areas: basic difficulty in communicating with a patient who cannot respond; pressures of the working environment; limited knowledge about unconscious patients' needs; limited detailed knowledge of why or how to communicate with unconscious patients. Conclusion: The stimulus developed, has been shown to facilitate the communication with the unconscious patients. ResumoObjetivo: A comunicação com pacientes críticos nas unidades de cuidados intensivos gera desafios para a equipe de enfermagem e demanda habilidades específicas. Métodos: Trata-se de um estudo desenvolvido em duas etapas, por meio de métodos qualitativos, para caracterização e padronização da comunicaçao verbal utilizada com pacientes inconscientes. A primeira etapa consistiu de revisão sistemática e de análise de conteúdo da literatura disponível sobre comunicação e estimulação verbal em pacientes inconscientes. Resultados: Os resultados da análise de conteúdo foram utilizados na segunda etapa do estudo e forneceram a base para a construção de uma mensagem padronizada de estímulo. Quatro áreas problemáticas foram identificadas: dificuldades básicas na comunicação com pacientes que não são capazes de responder, pressões do ambiente de trabalho, conhecimento limitado sobre as necessidades de pacientes insconscientes, e conhecimento detalhado limitado do porquê e de como se comunicar com pacientes insconscientes. Conclusão: A mensagem estímulo desenvolvida pode facilitar a comunicação com pacientes inconscientes.

Effect of implementing structured communication messages on the clinical outcomes of unconscious patients

“…National and international studies on nurse-patient interaction have been shown that nurses communicate minimally with unconscious patients. [1,6,15,19,20,31] In Egypt, Ibrahim [19] and Gergis [31] reported that CCNs spent very short time (less than 60 sec) in the verbal communication with unconscious patients and their communication included negative suggestions and social conversations with colleagues while ignoring the patient's presence. Similarly, a study was conducted on the experiences of critical care Jordanian nurses concerning communication with critically ill patients.…”

“…• An extensive literature review was conducted by the researchers to identify all available evidences concerning verbal communication with unconscious patients. The content of verbal messages was based on the results reported in the literature, [1,10,27] and the cooperation of a group of experts (critical care nursing, speech and language therapists). The results of the content analysis were used to construct the structured verbal messages that were utilized during conversation with unconscious patients.…”

“…Without communication nurses, can neither assess, plan, implement, or evaluate care effectively. [1][2][3][4] Intensive care units (ICUs) differ from other hospital settings because of the complexity of patient health problems, the treatment modalities used and the environment. The ICU environment is often noisy, technical and fear inducing to many patients.…”

“…Information received by the unconscious patients may assist in reducing stress, helping patients preserve selfidentity and self-esteem and reduce social isolation. [1,10] In addition, communication experts emphasized that the use of nonverbal communication in the form of caring touch with verbal communication has a considerable outcome for unconscious patients. It can enhance the messages patients receive, help to meet patients' psychological needs and prevents psychosis withdrawal and delirium, which may contribute to psychological stress, disorientation, anxiety and isolation.…”

“…[18] Despite its importance, there is evidence that communication in ICUs is not sufficiently implemented in practice. [1,6,15,[19][20][21] Researchers have also seen that nurses talk very little to the unconscious patient while doing any procedure. Even if they communicate it is to check only the patient's reflexes.…”