FIGURE 1: Description of analyzed articles published in the period from 2004 to 2015.
REVIEW ARTICLE
Study of interpersonal human relations at work among nursing professionals: an integrative review
Roberta de Oliveira Jaime Ferreira Lima dos SantosI; Enéas Rangel TeixeiraII; Emília Gallindo CursinoIII
I
Nurse. Master's degree. Coordinator, Institute Martagão Gesteira of Child
Care and Pediatrics. Rio de Janeiro, Brazil. E-mail:
robertajaime@hotmail.com
II
Nurse. Full professor, Fluminense Federal University. Niterói, Rio de
Janeiro, Brazil. E-mail: eneaspsi@gmail.com
III
Nurse. Associate professor, Fluminense Federal University. Niterói, Rio de
Janeiro, Brazil. E-mail: ecursino@globo.com
DOI: http://dx.doi.org/10.12957/reuerj.2017.26393
ABSTRACT
Objective: to analyze the scientific production on human relations in nursing work, focusing on interpersonal relations. Method: integrative review in the LILACS, MEDLINE, BDENF and SCIELO repository databases from 2000 to 2015. When thematic content analysis was applied, the following categories emerged: social skills and nurse training/management. Results: a total of nine articles were selected that constituted the corpus of analysis. Social skills are those that meet different interpersonal expectations in the workplace. It was evidenced that the presence of embracement, bonding, cooperation, solidarity, commitment and effective communication are determinants of a favorable work environment; the absence of these attributes can pose difficulties for people management. Conclusion: people management focused on social interactions poses the need for nurses to encourage relational skills in teams and to break with the paradigm that emphasizes the bureaucratic area of management.
Keywords: Interpersonal relations; work environment; nursing; management.
INTRODUCTION
Man is a social and gregarious being by nature, establishing relationships to obtain information about himself, about others and about his environment; he exists only in function of his group interrelationships 1. Once part of a group, individuals perform their activities from the perspective of each one including their subjectivity, thus making each group unique2. However, every man is rational ( sapiens), mad (demens), producer, anxious/static constructer, and conscious/unconscious; this human recomposes himself thereby increasing human diversity as is shown by the potentialities of the generic man, complex in the sense in which he brings together contradictory traits3. This human individual, homo sapiens sapiens demens, finds himself in the workplace, a generic man, contradictory, crazy, who puts a little of himself and takes a little of the others in the interrelationships he establishes throughout his life, in this case, at work. Each individual lives and experiences himself as a subject in a singular way, being something universally shared. To understand this complex human being (homo complexus), a being that is woven together, it is necessary to unite it, to consider the parts that have been separated in order to understand the whole. This individual possesses the virtues of the spirit and it is thus an intrusion to dissolve it in species and in society, since only it has the consciousness and the fullness of subjectivity3.
Hence, the individual in the I-You encounter establishes a relationship, in which two distinct personalities begin to reveal their inner Selves in the condition of individual subjects coming to perceive and respect the other in their totality in a process of revelation/understanding. In interpersonal relationships, the quality of the relationship depends on a set of factors that delimit how these people relate, thereby dignifying the professionals and their dimensions4. In the professional perspective, human relationships are surrounded by coincidences and intentionalities designated by a collective effort that aims at personal comprehensiveness by looking at individual characteristics and relationships with the others2.
Thus, relationships in the nursing work environment play a prominent role in the process of caring for the client. By understanding nursing work as a team activity, it is important to value the other, listen to their needs and difficulties in the work environment, recognize and respect the subjectivities of all the members of this team.
Nursing is a profession that transpires through collective work with the interpersonal relationship being materialized by the diversity of the work and the professional relationships that are being established in the daily routine. The purpose of this study was to analyze the scientific production on human interactions in nursing work with a focus on interpersonal relationships.
METHODS
This is an integrative review whose method of research analysis makes the synthesis of facts possible, as this research summarizes studies important in a certain area of knowledge, in so doing allowing the identification of gaps in knowledge that need to be filled with future studies5,6. This integrating review consisted of six stages: elaboration of the research question; definition of the databases and the delineation of inclusion and exclusion criteria; data collection; reading articles in full taking into account the inclusion and exclusion criteria; interpretation of results; presentation of the results and synthesis of the knowledge.
The research question was defined in the first stage: What knowledge has been published on interpersonal relationships between nursing workers?
In the second stage, articles were researched in the period from January 2000 to December 2015 to select studies, as it is fundamental to explore all possible knowledge published in this period. The databases consulted were the Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF), Scientific Electronic Library Online (SciELO) and the National Library of Medicine and National Institutes of Health (PubMed/MEDLINE). The descriptors used were relações interpessoais / interpersonal relationships / relaciones interpersonales; enfermagem / nursing / enfermería; ambiente de trabalho / working environment / ambiente de trabajo. These were controlled and combined using the Boolean operators 'AND' and 'OR'. The inclusion criteria were studies that addressed interpersonal relationships between nursing workers derived from primary sources, and articles available in full in Portuguese, English or Spanish. The exclusion criteria were experience reports, monographs, dissertations, theses, and those that were not in the scope of this review.In the third stage, the titles and abstracts were read, in order to confirm whether the studies contemplated the guiding question of this research; 31 possible articles were identified.In the fourth stage, nine articles were selected after reading them in full to verify whether the studies met the inclusion and exclusion criteria7-15. A form was completed to collect the following information: authors, year of publication, title, source (where the study data was collected), study design and database.
All articles were read by two authors who independently filled in the form in order to minimize possible bias in the selection of studies. A third researcher also read the articles in order to resolve possible differences.
In the fifth stage, the results were interpreted and discussed using thematic content analysis16, the extracted information was compared and similar contents were grouped into two categories: social skills and nurse management/training. Finally, in the sixth stage, the results of the study were presented.
RESULTS AND DISCUSSION
The characterization of the studies showed that the majority (n = 6 - 67%) were performed in Brazil with the other three (33%) from Canada, the United States and Saudi Arabia. According to the defined period, the only publications that answered the study's guiding question have been published since 2004. Most (n = 4 - 44.4%) were published in 2009 and 2015 with two publications per year. The studies of qualitative nature were most common (n = 7 - 78%) followed by quantitative studies (n = 2 - 22%) (Figure 1).
FIGURE 1: Description of analyzed articles published in the period from
2004 to 2015.
The results of this study were delimited in two categories: social skills and nursing management/training.
Social skills
As a means of social integration, work occupies a central place in people's lives. Thus, in nursing work relationships, the presence of social skills allows moments of interaction between the different members of the team, essential for the development of roles, responsibilities, incentives and rewards17.
Social skills are those that meet different interpersonal expectations in the workplace with a view to maintaining the well-being of the team and respecting the rights of each other, considering their subjectivities, type of formation and cultural diversity1,8.
Two studies emphasized that trust, cooperation, communication, space for meetings, acceptance and bonding are important mediators to maintain good interpersonal relationships in the nursing work environment. However, these relationships are hampered by the lack of commitment of team members, difficulty in understanding the divergent manifestations, as well as the lack of space for meetings, which cause distancing between colleagues 11,14.
Approval can be a strategy to listen, attend and even favor the improvement of interpersonal relationships within the team, promoting the development of professional activities in accordance with the needs of the individuals. When acceptance does not occur, bonding between professionals is prevented, so that the responsibilities to find solutions are not defined, effectively blocking the social processes of work19.
One article emphasized the importance of nursing professionals recognizing the relevance of dealing with relationships as well as understanding work processes with the intention of maintaining healthy relationships, since these interfere significantly with the care provided to the client 15. Interpersonal relationships with co-workers based on cooperation are fundamental to the day-to-day tasks, facilitating the achievement of common goals established in the work environment 20. Another study that addressed the issue of professional ties emphasized that the dynamics of group relationships gives individuals a set of experiences that can increase the knowledge of themselves and others. It emphasized that the process of group integration corresponds to the formation of a social process, where tasks performed together require the cooperation of different members of the group, in which subjectivities meet with each contributing their skills to the collective work.
The subjectivity in interpersonal relationships in the workplace depends on how each subject looks after himself/herself as when individuals are well they tend to relate better with others. When professionals relate ethically, respectfully and cooperatively, they are taking care of each other9.
Two studies showed the importance of regular meetings in the workplace, because they not only favor the discovery of individual and collective creativity, but also minimize difficulties within the group. Meetings are facilitators for co-workers to get to know each other and help build relationships8,15.
It was stressed that social interactions, beyond work issues, positively contribute to interpersonal relationships, promoting collaboration at work, effective communication and mutual respect. This same study pointed to collaboration as a skill required by all nurses and an indicator of a healthy environment15.
Interpersonal relationships within the nursing team as such and the presence of social skills are significant in the evolution of established relationships; act as a facilitator in the work environment, functioning as an interface for collaborative work and promote the satisfaction of the nursing worker in performing group tasks, as well as in the treatment of the patient21.
Therefore, social skills refer to the existence of different classes of social behavior in the repertoire of the individual to deal adequately with the demands of interpersonal situations, since the potentialities are human existential forces can be stimulated to improve these competences.
In nursing work, interactions between team members is inevitable, since the work is fragmented. Depending on how the interactions between people occur, they have an impact on the quality of life at work, since social integration, trusting the group and colleagues helping to perform tasks can act as mitigating factors of the negative effects caused by the routine work22.
Social interactions may have diverse goals such as transmitting and obtaining information, and requesting changes in behavior, emotional state, attitudes or beliefs of the other, as well as being a mechanism to maintain chitchat within a group and even to supervise activities18.
In this sense, interaction is the condition of evolution of the individual with the results of interactions being individual. Thus, each subject lives the experience in his/her subjectivity in a unique manner, in the way it affects and is affected at each encounter with others as a condition that can only be conceived in an abstract way. Future encounters between the same individuals and dealings with others are important, in such a way that the results of the interactions are revealed in time, within the relationships between the same individuals23.
Nursing management / training
Teamwork focuses on collective activities that health professionals commonly perform in their daily routine services. Nursing work is characterized by the impossibility of being carried out by a single professional, that is, it must be performed by several individuals, who on the one hand demand management actions and on the other, perform the collective work. Thus, there are social and technical divisions of nursing work, differentiated by academic training and hierarchical functions 24.
Studies have pointed out that nurse managers/leaders have an essential role in maintaining healthy interpersonal relationships by seeking a way of managing that is not autocratic nor permissive, because both cause difficulties in interpersonal group relationships in the workplace. Research has shown that academic and professional training does not sufficiently prepare nurses for the management of interpersonal relationships since it is centered on the bureaucratic role of management 7,10,13,15.
Nurse managers must work out their potentialities in order to develop the social skills necessary in the undertaking of work processes. Therefore, it is necessary to seek feedback about their actions from the team, remembering that leadership practices are powerful indicators of nursing team work performance and that leadership based on power and punishment make team members dissatisfied and unmotivated, thereby hampering work relationships25,26.
The influence of the nurse manager/leader when negative can cause members of the team to question the power exerted by their superior. Therefore, the more nurses establish administrative/bureaucratic power relationships with their staff, the amount of power/knowledge of nursing they can share will be reduced 27,28. Thus, when nurses take on a role beyond the management of material and structural resources by paying attention to the human side of work, that is, to interpersonal relationships, they must be instrumental in developing the relational skills necessary for them to occupy the place of prominence and the still existing space of subjectivities7.
One article showed that the cultural training of nurses influences their ability to establish trust in interpersonal relationships with subjects of different nationalities, thus valuing cultural differences12.
The training of nurses in different areas prepares them for the leadership of the nursing team in its cultural, social and reflexive aspects, making it possible, in the daily routine of their work, to identify situations in interpersonal relationships that require interventions, taking into consideration the knowledge, beliefs and habits of the different subjects 29,30,31.
Therefore, as the nurse responsible for managing the members of the nursing team, it is up to this professional to seek relational tools that can help him/her to stimulate social skills existing in each individual and thus improve interpersonal relationships in the work environment. The nurse manager/leader should think about the human dimension, which is the consideration of the feelings present in the work relationships. This requires that those who manage not only have self-knowledge, but also have knowledge of human behavior, emotional awareness to manage differences of interests and projects and a real involvement with team members, respecting their values, beliefs, habits, customs, potentialities, needs and expectations that permeate and even determine relationships32.
CONCLUSIONS
When analyzing the knowledge produced related to human relationships in nursing work, in particular interpersonal relationships, there is an evident need for nurses to be attentive to person management within teams from a point of view centered on humanization by stimulating relational skills, such as solidarity, collaboration and bonding. Thus, it is important to break the paradigm that is still stimulated in universities that emphasize the bureaucratic area of management, thus forming nurses with difficulties to manage people.
Despite the limitations present in this study with the low number of publications, the evidence can be useful in discussions to broaden the knowledge about this subject, as well as to develop future research that addresses the relational processes in the work environment, valuing interpersonal work relationships within nursing teams and with other members of the multiprofessional team.
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