ORIGINAL RESEARCH

Interpersonal relations among nursing staff: fragilities and strengths

Mariana Pereira da Silva Araújo^I; Soraya Maria de Medeiros ^II; Líbna Laquis Capistrano Quental^III

^I Nurse. Master in Nursing. Specialist in Occupational Health Nursing. Vila Velha, Espírito Santo. E-mail: prof.marianaps@yahoo.com.br
^II Nurse. Adjunct Professor, Department of Nursing of the Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte. E-mail: sorayamaria_ufrn@hotmail.com
^III Nurse. Professor of the Post-Graduation Course in Public Health Management of the Estácio University of Rio Grande do Norte. E-mail: libnalaquis@hotmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2016.7657

ABSTRACT

Objective: to examine interpersonal relations among nursing staff in the work environment. Method: this qualitative, descriptive study was conducted at a state referral hospital for urgent care in the municipality of Natal, Rio Grande do Norte. Data was collected by semi-structured interviews of 16 selected subjects in April 2012. The study was approved by the research ethics committee (certificate number CAAE - 0289.0.051.000-11). Results: fragilities and strengths were found to pervade interpersonal relations among nursing staff, highlighting the role of communication in this context of singularities. However, the weaknesses predominated over the positive elements involved in the process of interaction in nursing. Conclusion: there is need to focus more on communicative action during the nursing work process in order to allow better interpersonal relations, and enable common goals to be constructed mutually among the nursing team.

INTRODUCTION

Nursing is recognized as a social practice characterized by activities developed by a team and having two different notions: the team as a group of agents, characterized by fragmentation and the team as work integration, characterized by articulation according to the proposal of integrality of health actions¹.

A set of individuals only works to perfection if its members are articulated among themselves, denominating them as a team. Within this context, interpersonal relationships are highlighted, understood in the work environment to improve the personal bond between the members of the team, establishing ethical relationships and respect².

In the performance of the caring function, language is an essential element, since it involves subjects of this relationship³.

The communicative action is an interaction where the participants use the language to claim the validity of their respective arguments. It is also emphasized the difference between behavior and action, being the behavior something that can be observed as a fact of nature, and the action considered an intentional behavior normalized by rules⁴.

The communicative action theory understands that interaction is the solution to the problem of coordination arising when different actors involved in the communicative process establish alternatives for a joint action plan. This theory also shows that the end-oriented activities of the participants in the interaction are integrated with one another through a medium: the language⁴.

In the meantime, language is hampered by the fact that nursing performs its activities in a piecemeal fashion, characterized by a heterogeneous, fragmented and diversified team. It is worth noting that the most elementary tasks are performed by the less qualified members and the tasks of supervision and command by those who hold the knowledge⁵.

Therefore, this study was motivated by the need of the nursing professionals to understand their work environment, their conflicts, their adversities, their working conditions, but also their factors facilitating the nursing process.

This study intends to approach the interpersonal relationships of the nursing team from the communicative action, contributing to the health work process. It aimed to analyze the interpersonal relationships of the nursing team in their work environment.

LITERATURE REVIEW

The team is composed of individuals of the work process, each professional having a technical autonomy, that is, a sphere of freedom of judgment and decision making of their activities, considering not only the technically established issues but also the socially legitimized according to the degrees of technical authority¹.

Interpersonal relationships are of great importance within the context of nursing work, since the group needs to act on differences developing a satisfactory teamwork³. The participants involved in the work should participate in an integrated way, pointing out the ways to constitute an integrated team, starting from the perspective of communicative action and to conceive the link between the participants of the group.

The communicative interactions are promoted by people involved for the same purposes, coordinating and executing their plans of action. In these actions, the act of speech of a subject will only be valid if the other involved in the communication accept the offer contained in it, accepting the position in an affirmative, even if it is implicit⁴.

Bringing communicative practice to the context of nursing, it is understood that professionals can build an adequate common work project daily through this activity, to enable a favorable communication between the nursing team. By allowing the communicative action, the team will seek the mutual understanding between the involved subjects and will enable care, from the improvement of the work environment and interpersonal relationships.

METHODOLOGY

This is a descriptive study with a qualitative approach, carried out in the ward of an emergency reference hospital in the city of Natal/RN.

The surgical clinic ward is characterized by admitting patients that perform general and orthopedic surgeries, counting on 48 nursing professionals, including nurses, technicians, and auxiliaries. The information was collected in April 2012, and the professionals who agreed to participate in the study were selected for signing the Informed Consent Form (TCLE) and were present at the hospital at the time of data collection, totaling 16 participants.

The choice of the surgical clinic ward was due to the high turnover of beds and the diversity of clients´ diagnoses, besides the routine presence of the police due to the hospitalization of the victims. Faced with this peculiar scenario, this environment is even more stressful.

The names of feelings that favor interpersonal relationships were chosen as pseudonyms for the subjects of the research to ensure the anonymity of the interviewees during the presentation and analysis of the results: affection, joy, gift, kiss, hug, attention, and others.

The research project was submitted to the Ethics and Research Committee (CEP) of the Federal University of Rio Grande do Norte (UFRN), respecting the norms of Resolution 466/2012, and approved by the Certificate of Ethical Appreciation (CAAE) 0289.0.051.000-11 and Protocol N° 262/11.

The data collection took place through semi-structured interviews, composed of open and closed questions. After the collection, the transcriptions of the recorded interviews were carried out, followed by the readings of the statements, and submitted to the theme. It was possible to identify the main weaknesses and strengths of the interpersonal relationship, relating them to the Habermas Theory of communicative action and the Characterization of the team and their interpersonal relationships of Peduzzi, originating one of the categories of analysis: Fragilities and Strengths of the interpersonal relationship.

RESULTS AND DISCUSSION

The hospital is a professional environment defined by several specialties and subjects, workers and patients. In this context, the nursing team is inserted as an indispensable component in the provision of care. However, the difficulties of relationship within the team can hinder the progress of the care process, and make the work environment unpleasant.

In this work atmosphere, subjects talk about their reality, often with expressions of suffering that may have gone unnoticed before, because they are professionals who deal with and care for sick people daily.

The interpersonal relationship of nursing can be a facilitating or disruptive factor of the work environment in such a way that it can have positive or negative consequences both in health workers and patients.

It was observed in the interviewees a preponderance related to the presence of fragilities that permeate the interpersonal relationship between the nursing team. Fragility means to become fragile; weaken; emotionally abate; sensitizing⁶.

According to the interviewees´ feelings, the highlighted fragilities comprise a complex of situations, which in this study are divided into objectives, those that are extrinsic to the team's relationship, such as daily wear and tear, work overload and lack of human and material resources. The subjective situations refer to the interpersonal relationship as a bad relationship with the patient and their relatives, lack of communication, relationship with the head of nursing, disunion, hierarchical relationship and difficulty in managing people.

The first subjective fragility evidenced as significant for this study was the relationship of nursing professionals with patients and their families, as in the following testimonies:

It is disturbing because there is a lack of education regarding the companion, posture. [...] They [the companions] defy people. (Companionship)

The patient and the companion do not want to know if the hospital has no material. They do not look for the right person to complain about, they complain about the technician or nursing, who has nothing to do. The caregivers hinder our service. (Empathy)

Despite referring to a failure in integration between the team (or one of its members) and the patient or partner, this highlighted fragility entails a failure in the interaction of the team itself. For the patient and the partner, the change of professionals due to routine, the rotation of individuals who pay attention to the patient and the lack of technical knowledge, in general, only allow a generic identification of the health and nursing teams. In turn, the interpersonal relationship (nursing worker-patient) promotes a therapeutic link between those involved, directly influencing the practice of care, once they pass through the behavior of the subjects, determining the established social interaction ^7,8.

The need to hospitalize an individual occurs when he or she needs special care, although sometimes this acceptance is waived by the professionals, who only aim at the disease and forget that there is a person who needs attention⁹.

The relationship between the nursing team and its manager was identified as another recurrent fragility. This factor was directly related to the hierarchy in this interaction. The report on the dissatisfaction with the hierarchical relationship established in the team was constant, as verbalized in the following transcriptions:

One thing that disturbs is: if you have a nurse who does not help you, just wanting to charge you. Knowing the professional that you are and getting charged, that is a mess. (Empathy)

Nursing technicians do not like to take orders. They think we just want to boss; they do not understand that our job is to manage. This makes the relationship very difficult. (Acknowledge)

Emphasizing the hierarchical relationship in these statements, it is observed that the nursing work process is characterized by a division of work based on qualification, legitimized by the school training, in which there is a hierarchy of tasks¹⁰.

It is perceived by the statements, that the professional of middle level does not adapt to the fact to receive orders and to be charged in their attributions. The high-level professionals recognize in the behavior of subordinates that the resistance and judges are something detrimental to the internal relationship of the team.

In this context, it is observed that social interactions are a little cooperative and stable, and a little conflicting or unstable. As the actors act exclusively to influence the opinion of the other, the strategic action is characterized. When the actors try to harmonize their actions internally, so that they negotiate their objectives through common convictions, the communicative act is understood⁴.

It is possible to make an association of this differentiation with the characteristic that will mark the relationship established in the nursing team: in the exercise of the hierarchical attributions in an authoritarian way, it is possible to identify only a strategic action. In turn, if the communication is directed to the better management of the team´s activity, and to the harmonization of its components, the communicative action can be identified.

By the hierarchy of their head, the nursing professionals also identified the difficulty of the nurse in the act of managing as a fragility for this analysis. The identification of this fragility is shown in the following testimony:

Regarding the nurse, he is very malleable [...] he should have a posture with a certain professional [...], and he is confused from the good professional to the rebel, I think it is a question of the nurse separating the professional rebel, the excellent professional, to handle. You have to separate because of people abuse. (Companionship)

This statement reinforces that when managing the people, the nurse must be attentive to the particularities and individualities of each member as an individual, and on the other hand, to possess an isonomic posture. They must be aware of the fact that they are dealing now with people who have different desires, yearnings, difficulties and life histories. Even so, they cannot make their administration a moment of personal satisfaction or burden-sharing, making other team members feel dissatisfied with undergoing different treatments improperly.

Management is fundamental to the role of nurses since it is at this moment that the limits and possibilities of each component in the group are defined, and it is then up to the one who manages the exercise of authority, when necessary, differentiated from authoritarianism² .

The lack of communication in the team is another fragility of interpersonal relationships, which can be identified in the following explanation:

There are many people who are disunited, for example, this patient is not mine, so I will not do anything. Moreover, there is no communication because it is not hard to help what they need; There is much disunity. (Dedication)

The communication deficit was found as a factor generating dissatisfaction and competition between the nursing team who understood that there is a need to re-signify the relationships in nursing, as the self-care and it is an indispensable condition for the care of the other client among professionals in the work environment¹¹.

In this sense, the absence of communication leads to situations of inadequate interpersonal relationships and creators of an environment that is inappropriate for the work of this team.

Therefore, in the absence of dialogue, it is not possible to reach consensus among individuals. When language is not established as a means of interaction between individuals, socialization is impaired, since it is not possible to form and maintain personal identities, that is, of individualities and the identification of the member with his or her group ⁴.

The strengths highlighted by the interviewees as contributory elements for the nursing team´s relationships were: companionship, effective communication, coexistence with differences and respect, ability to adapt, teamwork, team tranquility, patience with others, a good team and help your neighbor. Strengths are qualities or virtues of the strong people: strength, security, power and moral energy⁶. In this sense, the following section's report:

Moreover, what helps a lot in our sector is when we have a nurse that she helps us, that she throws us up, that she makes us trust that there is a person there to defend us when it is necessary. (Support)

I like to say what I think, and I have this freedom with the people I work for. I have no problem with that. (Dedication)

A good team, people that you feel good to work for, this is very important, it helps a lot, the colleagues and our superiors too. (Listening)

According to the previous statements, it is perceived that the presence of collaborative, attentive, quiet, safe professionals and a team that helps in the face of the other´s difficulties, are the professionals´ longings in the interpersonal relationship between the nursing team, configuring some strengths highlighted in this study.

Reinforcing this reasoning, a team made up of people has an affective interaction between its members inherently, and the existence of this bond between the participants may allow a link with their organization ¹².

From the testimonies, it is clear to see that the subjects aim for a team whose mutual help can hear criticism and understand them as constructive.

Given this, there is a need to focus more on the communicative action during the nursing work process, considering their social, cultural and subjective divergences, allowing a better interpersonal relationship, with the autonomy of its agents and mutual construction of common goals among the team.

Among the highlights pointed out by the interviewees, communication is a strength that corresponds to the main axis analyzed in this research. Also, the communication was emphasized in the analysis because it corresponds directly to the main element of Habermas' Theory of Communicative Action.

In this sense, the following transcript demonstrates the value of communication as a strength among the interviewees:

My ability to communicate and know how to ask, to know how to talk to them. Because everything must be the way to go. (Care)

The importance of a communication placement in an appropriate way, providing a climate of satisfaction and multi-professional valorization is identified. Nursing communication in a coherent way strengthens interpersonal relationships in the work environment, making the work process constructive and pleasurable^11,12.

Besides contributing to the multi-professional work process, communication plays an important role in the care offered to the patient, favoring health promotion, self-care and preventing suffering¹³. It is noteworthy that in the relationship between patient and nurse, the patient seeks solidarity and attention to their needs, evidencing that this relationship reflects in the actions of the professional team and the work environment^14,15.

The nursing team should be directed to communicative action, even though strategic action has been witnessed, which is not capable of overcoming the fragilities encountered and their conversion into strengths. Strategic action comprises individualistic practices or actions oriented by the interest for success, from a perspective of means and ends⁴.

Language is an instrument capable of reducing weaknesses and enhancing the strengths existing in the relationship between individuals. Understanding the importance and capacity of communicative action allows individualities, which form the heterogeneity of the team and the particularities of its participants, to cease to be elements detrimental to communication and become reinforcements of the consensus built by plural participation.

CONCLUSION

Weaknesses and strengths were identified in this process of interpersonal nursing relationships. The weaknesses were more marked for the interviewees, being more demonstrated in this research.

Communication was identified as a strength and its absence as a fragility, which represented a marked element in the health team, becoming detrimental in the interpersonal relationship. There is a disagreement among nursing professionals, who are actors in a scenario where strategic action predominates, with the presence of strong hierarchical and authoritarian relationships.

The strengthening of interpersonal relationships in the nursing team needs to expand until it reaches a level of democratic consolidation of the profession. Therefore, it is necessary to focus more the communicative action during the nursing work process on allowing a better interpersonal relationship, with the autonomy of its agents and mutual construction of common goals among the team. Thus, the components of this interactive process must be recognized as actors in a social world filled with divergent cultures, knowledge, and subjectivities, to enable an effective relationship.

REFERENCES

1.Peduzzi M. Equipe multiprofissional de saúde: conceito e tipologia. Rev Saude Publica. 2011; 35 (1):103-9.

2.Urbanetto JS, Capella BB. Processo de trabalho em enfermagem: gerenciamento das relações interpessoais. Rev Bras Enferm. 2004; 57(4):447-52.

3.Silva MP. Relações interpessoais no ambiente de trabalho da equipe de enfermagem: uma ação comunicativa. Dissertação (mestrado) – Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Departamento de Enfermagem, 2013.

4.Habermans J. Consciência moral e agir comunicativo. 2ª ed. Rio de Janeiro: Tempo Brasileiro; 2003.

5.Trezza MCAF, Santos RM, Leite JL. Enfermagem como prática social: um exercício de reflexão. Rev Bras Enferm. 2008, 61(6):904-8.

6.Ferreira ABH. Mini Aurélio Século XXI Escolar – O minidicionário da língua portuguesa, 2001.

7. Formozo GA, Oliveira DC, Costa TL, Gomes AMT. As relações interpessoais no cuidado em saúde: uma aproximação ao problema. Rev enferm UERJ. 2012; 20(1):124-7.

8.Novel G. La relación enfermera-paciente. In: Martí GN, Canut MTL, Vergara MDML. Enfermería psicosocial y salud mental. Barcelona (Es): Elsevier Masson; 2007. p. 217-26.

9.Bertone TB, Ribeiro AP, Guimarães J. Considerações sobre o relacionamento interpessoal enfermeiro-paciente. Revista Fafibe On Line. 2007; (3):1-5.

10.Lunardi Filho WD, Lunardi VL, Spricigo J. O trabalho da enfermagem e a produção da subjetividade de seus trabalhadores. Rev Latino-Am Enfermagem. 2011; 9(2):91-6.

11.Baggio MA. Relações humanas no ambiente de trabalho: o (des)cuidado de si do profissional de enfermagem. Rev Gaúcha Enferm. 2007; 28(3):409-15.

12.Zimerman D. Fundamentos teóricos In: Zimerman D; Osório LC. Como trabalhamos com grupos. Porto Alegre: Artes Médicas, 1997.

13.Vilela SC, Carvalho AMP, Pedrão L. Relação interpessoal como forma de cuidado em enfermagem nas estratégias de saúde da família. Rev enferm UERJ. 2014; 22(1):96-102.

14.Veiga KCG, Fernandes JD, Sadigursky D. Relacionamento enfermeira/paciente perspectiva terpêutica do cuidado. Rev enferm UERJ, 2010; 18(2):322-5.

15.David HMSL. O protagonismo da enfermagem no cuidado: a solidariedade necessária. Rev enferm UERJ. 2014; 22(3):301-2.