Action plan for the communication process in a nursing team

Abstract

The objective of this study is to propose an action plan for the communication process in the nursing team. The theoretical references were: the model of a communication process proposed by Berlo and essential concepts of King´s Theory. It is a qualitative, convergent-care research. The data production technique was the semi-structured interview with 25 nurses of a public hospital. Data used the thematic content analysis technique. The elements of the communication team are: perception, self, space, time, stress, role, authority, power, status, audience, empathy and nonverbal communication. The plan proposes a dynamic, flexible, interactive and relational communication process, in order to contribute to the professional qualification and make new practices of care viable. It was concluded that its elements do not have a fixed and stable position, but throughout the process they are used according to the needs of each party.

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cta Scientiarum
http://www.uem.br/acta
ISSN printed: 1679-9291
ISSN on-line: 1807-8648
Doi: 10.4025/actascihealthsci.v38i1.29758
Acta Scientiarum. Health Sciences Maringá, v. 38, n. 1, p. 23-31, Jan.-June, 2016
Action plan for the communication process in a nursing team
Priscilla Valladares Broca* and Márcia de Assunção Ferreira
1Fundamental Nursing Department, Anna Nery School of Nursing, Universidade Federal do Rio de Janeiro, Rua Afonso Cavalcanti, 275, 20211-
110, Rio de Janeiro, Rio de Janeiro, Brazil.*Author for correspondence. E-mail: priscillabroca@gmail.com
ABSTRACT. The objective of this study is to propose an action plan for the communication process in
the nursing team. The theoretical references were: the model of a communication process proposed by
Berlo and essential concepts of King´s Theory. It is a qualitative, convergent-care research. The data
production technique was the semi-structured interview with 25 nurses of a public hospital. Data used the
thematic content analysis technique. The elements of the communication team are: perception, self, space,
time, stress, role, authority, power, status, audience, empathy and nonverbal communication. The plan
proposes a dynamic, flexible, interactive and relational communication process, in order to contribute to
the professional qualification and make new practices of care viable. It was concluded that its elements do
not have a fixed and stable position, but throughout the process they are used according to the needs of
each party.
Keywords: communication barriers. nursing team. nursing theory.
Plano de ação para o processo de comunicação da equipe de enfermagem
RESUMO. Objetiva-se propor um plano de ação para o processo de comunicação na equipe de
enfermagem. Os referenciais teóricos são: o modelo de um processo de comunicação proposto por Berlo e
os conceitos essenciais da teoria de King. Pesquisa qualitativa, convergente-assistencial. A técnica de
produção dos dados foi a entrevista semiestruturada, com 25 profissionais de enfermagem de um hospital
público. Aos dados foram aplicadas as técnicas de análise de conteúdo temática. Os elementos que integram
a comunicação da equipe são: percepção, self, espaço, tempo, estresse, papel, autoridade, poder, status,
audiência, empatia e comunicação não verbal. O plano propõe um processo de comunicação dinâmico,
flexível, interativo e relacional, de modo a contribuir para a qualificação profissional e viabilização de novas
práticas de cuidado. Concluiu-se que seus elementos não possuem um lugar fixo e estável, mas que ao
longo do processo são usados de acordo com a necessidade de cada interlocutor.
Palavras-chave: barreiras de comunicação. equipe de assistência ao paciente. teoria de enfermagem.
Introduction
Nursing professionals can be characterized by
the exceptional ability to listen actively, carefully
observe, and then carefully interpret and analyze the
information before proceeding with the assistance
(Rosenberg, 2015). Thus, sharing difficulties,
problem situations, frustrations and sufferings
caused by ineffective interactions (Silva, Terra,
Freitas, Ely, & Mostardeiro, 2013), can help
selecting the communication styles that best fit the
context of the involved process (Rosenberg, 2015).
Such factors can be introduced into the daily life
of these professionals through their valorization,
motivational incentives, and cooperation; possible
by effective communication and relationship among
all members of the nursing and health staff. Thus,
influencing a nursing care focused on the patient´s
needs, showing that the provision of care depends
on the relationships developed within a team
(Cowin & Eagar, 2013).
The consequences of the lack of dialogue,
incentive, motivation, valuation, being heard, may
cause lack of interaction and fellowship among
professionals (Freeney & Tierman, 2009). Also, it
can directly reflect on the care provided to the
patient, such as the failure on the process of
medication administration (Franco, Ribeiro,
D'innocenzo, & Barros, 2010), in which non
effective communication process can lead to an
error, threatening a patient safety.
For this process become effective and validated
among professionals, a plan of action is proposed for
the communication process in the nursing team.
This plan would become a guide indicating where to
go, how to follow, how to overcome obstacles and
difficulties and how to return if necessary in the
process of achieving the goal. In nursing, the plan
may indirectly influence (positively) the
communication of the nursing staff with the patient
to become effective and validated.

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Acta Scientiarum. Health Sciences Maringá, v. 38, n. 1, p. 23-31, Jan.-June, 2016
Berlo (2003), as one of the theoretical references,
presents the communication process model with
elements of how people communicate, what are the
factors composing it and the role of language in
human behavior. Also, he analyzes the individual’s
behavior, the relationship between the speaker and
the listener, attempting to identify and describe the
factors that influence positively and negatively the
communication process and its results and searches
for ways to increase understanding and effective
communication.
A communication process shows: source, coding,
message, channel, decoder and receiver, with some
factors influencing them (Berlo, 2003). In this sense,
identifying the components of the process can be an
attempt to interfere in order to make it more
comprehensive and assist in its effectiveness.
King (1981) proposes a conceptual structure of
interactive systems, such as: personal, interpersonal
and social systems. A personal system can be
understood as the position of the individual in the
environment; an interpersonal system is when
individuals interact with each other to form pairs,
trios or small and large groups; and social system is
when individuals see the need to form organizations
that compose communities or societies due to
special interests and needs.
In this sense, communication can be
characterized as a structure of symbols and signs
imposing order and meaning to human interactions.
With that, this structure contains verbal and
nonverbal behaviors, being the non verbal
recognized as the most accurate information when
compared to verbal statements.
Therefore, the aim of this article was to identify
the elements that influence the communication
process and propose an action plan for the
communication process co-built with the nursing
staff.
Material and methods
This is a qualitative, convergent-care research. It
requires the active participation of individuals,
aimed to make changes and or introduction of
innovations in health practices, so it involves
researcher and participants in a mutual supportive
relationship (Trentini & Paim, 2008).
In the healthcare field, there is a variety of
problems that need research so that they can expand
the possibilities of solutions for the benefit of the
assistance. On the other hand, it is possible to be
considered that the solutions are already placed on
the field itself, and, therefore, they deserve to be
investigated to validate their practice and
effectiveness and be spread out to the entire
scientific and healthcare environment, thus
improving patient care. The method of the
convergent analysis enables the establishment of a
close relationship of know-think with the know-
how because of the caregiving practice indicates
innovations and alternatives to mitigate or solve
problems and difficulties of the quotidian of health
professionals.
The implementation of convergent-care research
occurs through different phases: design, which is the
choice of the topic, the direction of the guiding
question, the establishment of the research
objectives and literature review; instrumentation,
that is the methodological procedures; reading in
detail, including how was the collection and
collation of data and; analysis and interpretation,
apprehension processes, synthesis, theory and
recontextualization (Trentini & Paim, 2008).
In order to establish an action plan for the
communication process in the nursing team it is
necessary to sensitize all individuals involved in the
process and secure their commitment. For that, it
was necessary to expose to everyone the purpose and
importance of such a plan to be integrated into the
communication process. That was made possible
through the convergent analysis, once the method
requires from the researcher great attachement to
nursing care, promoting greater interaction with the
subjects and the research scenario. As the research is
developed, there are exchanges of knowledge,
actions, experiences, thoughts and ideas about the
research topic, and thus, there may be a
dissemination in the context in which they are
inserted.
The research was carried out from 2011 to 2013,
with data collection between October and
December 2012. The data production technique was
the semi-structured interview based on a script with
open questions, characterized by a meeting with
individual conversations. All the verbal material was
transcribed in full, and analyzed applying the
content analysis technique. The categorization
process was carried with a pre-established system of
categories, based on the essential concepts of the
theoretical references (King, 1981; Berlo, 2003). In
this type of analysis, it was sought the occurrence of
themes on the content of the messages that are
classified in the boxes, organizing the categories
indicating that the most frequent themes, also
considering the co-occurrences of the subjects in
units of testimonies (Cavalcante, Calixto, &
Pinheiro, 2014). After that, the elements that

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influence the communication process were
identified in their positive and negative aspects, in
order to build a proposal of a communication plan
with the nursing staff.
To facilitate the construction and visualization of
the plan, a preliminary action plan was taken into the
scenario. It was not a complete plan, with problems
and established strategies, but a scheme/skeleton of
how relationships occur or would be desirable to
occur. To create such a flow, the researcher had the
data from previous research as a parameter.
Throughout the communication process
established between the researcher and the nursing
staff, the preliminary plan was completed according
to the findings from the interviews and at the end of
this relationships, participants expressed their
opinion if the collected impressions were correct or
not, and changes were made together. Thus, the
plan was formalized according to the data from each
interview, and from the individual plans, a collective
plan was created, built with the collaboration of all
participants based on the reflections about their
practices, converging the research with assistance.
This is a research conducted at the Medical
Clinic department of a federal university hospital in
the city of Rio de Janeiro, with 25 nursing
professionals. Inclusion criteria were: being a nurse,
technician or nursing assistant, of both genders,
integrating the nursing staff elected for the research,
18 years old or more. The exclusion criteria were:
being away from work for any reason during the
researching period.
Research approved by the Ethics Committee in
Research of the hospital with number CAAE
01305512.9.0000.5257. The participant´s rights were
respected according to the National Health Council
Resolution 466/12. All of them signed a consent
form. The identification of the research participants
was through alphanumeric codes, and the nurses
identified by the acronym N; and nursing
technicians by NT acronyms, followed by the
sequential number of the interview.
Results
To establish the plan, some essential concepts of
theoretical references were used as background and
parameters indicated as positive influencers or
negative elements of the process. Thus, the elements
that influence the communication process were
identified and how such influences usually occur.
Soon after, the action plan was presented with the
influential elements and examples of how
professionals act, or would act when facing them in
order to have fidelity in the interactions.
The influential elements of the communication
process of the professionals´ discourses are perception,
self, time, space, stress, non-verbal communication,
authority, hierarchy, power, and status.
In the nursing professionals statements,
perception is understood as an instrument: 1) To
observe the other as a whole, accepting him as he is,
and thus, paying due attention and knowing how to
deal with him; 2) The empathy when differences are
respected and the way of being of each one; 3) A
good communicative process; and 4) To understand
the problems and try to resolve them. Such findings
can be seen in the following statements:
For you to know how that person is, don´t you
think ?! Because nobody is identical! So, how you
will approach that person, how you are going to talk
to that person, so you don’t annoy that person. Not
to cause any trouble. So you have to watch how you
approach that person to be able to talk to her. (N1)
We have to understand each other, because not
everybody thinks the same way, do you agree? None
thinks the same. Each one has his/her own opinion,
his/her own way of being. You have to give one,
have to, as they say, have to pay attention to the
person, it is important yes, perception is everything,
with perception you have a lot. (NT18)
The nurses reported that they use the ‘self’ to
exercise companionship, patience, tolerance, respect,
understanding each other, and to do a self-
assessment and self-reflection of their attitudes and
behaviors. As noted:
People are not patient and not tolerant anymore!
Then one thing pulls the other, pretty soon there is
no more solution! Hard to undo it! However, the
little we can do, we do! We do it slowly! Even if we
cannot make the tree to grow! At least, the seed we
put it there! (NT2)
The only strategy I had was to call the two of them
to talk and explain the situation, asking them to do a
self-assessment, a self-reflection, I told them what I
had observed in my shifts, their professional
approach and showed them the complaints that
came to me, from patients, caregivers and from their
own colleagues. (N4)
Regarding the space, it was possible to observe
that its use is favorable and appropriate to establish
the communication processes and interactions, as
well as to respect each other’s space and the time.
Here it is a quiet and clean place. So, it does not
prevent nor hinder anything, no. (NT7)
It is to learn to understand each other's space!
Important! Let each one to respect the space of the
other, because I think it improves the relationship. It
will improve a lot. Also, because each one

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Acta Scientiarum. Health Sciences Maringá, v. 38, n. 1, p. 23-31, Jan.-June, 2016
experiences in a different way the problem they are
facing. (NT3)
They have enough time, but it is necessary to
manage it and plan the activities to provide
assistance with tranquility pay better attention to the
patient and have an effective communication process
with each other. Also, this planning needs to be
organized in the morning, and if there were more
professionals on the team, tasks could be shared, and
there would have even more time. Following there
are testimonials:
Actually, we have time, we say that we don’t, but we
do have time. [...] Let's think? … It’s a matter of
knowing how to manage it. Just manage it! (NT5)
As I told you, if we start early in the morning, we'll
have time to talk, talk about patients, sometimes
even work better with them. (NT7)
We have a work overload, you know? We have to
fulfill many tasks before we pass on our duty at
seven p.m., so sometimes we have no time to stop
[...] if at least, there was one day nurse, it would
help a lot. Because one would be on the
paperwork and the other into general care, you
know? (N4)
Nursing professionals use internal strategies,
such as attitudes and behaviors performed by the
nursing staff and; external strategies, such as actions
in practice before interacting with the nursing staff
to better cope with stress. As an internal strategy,
professionals reported that they must learn to deal
with differences and to respect and be tolerant with
their co-workers, since each individual has received
influences from various systems and each one has a
different view of the world, and his own limits to
meet a particular stressor.
The external strategy is not let the problems
outside the workplace interfere with care and not let
them accumulate with the problems faced at work.
In the following statements these findings can be
observed:
I think it is important to learn to deal with each
other’s differences. Then you know how to handle
every situation, know how to deal and talk. Then,
you learn to respect, to be professional! (N1)
Leave the stress out there! Leave them at home and
not bring them to work, for you not to cause damage
to your night shift colleague. If you live with stress
try out there to do something to remedy this stress,
but not here! (N4)
The use of nonverbal communication in the
communication process is through kinesic language
and paralanguage. For this, they make use of
observation and perception with greater intensity in
the care of facial expressions and the eyes and the
voice is used. The testimonies are:
I think at least paying attention, watching, giving
attention! Facial expression! So, this communication
is very important! To observe the facial expression is
important. (N4)
Everything has to do with the way of speaking. You
conquer the person by the way you approach her!
One thing is the same goal, in the same sentence,
the tone as you talk to the person is the tone you can
get a no or a yes! It depends on the way you talk!
(NT2)
When reporting about authority, hierarchy,
power and status, group meetings with effective
dialogue and respect were important steps to deal
better with these elements. As noted in the
following testimonials:
It is necessary to really have a communication, a
dialogue, a conversation, where the professional is
not intimidated to talk to his boss, and his boss is not
embarrassed to talk to his employee. I believe that
everything can be achieved with the meetings! (N5)
Certainly the group meetings! Because it is difficult
to expose, day by day, your problems, an
improvement in the environment and what's going
on inside your team. This person (who has a role of
authority, hierarchy, power and/or status) is always
above you and doesn’t give opportunity to listen to
you. So, it will be her and my way to give the yes or
no for the things. (N1)
Action plan for the communication process proposed by
the nursing team
The plan was composed of the main strategies
reported by nursing professionals regarding the
key concepts (King, 1981) and the noise (Berlo,
2003), highlighting: empathy; attention; kindness;
self-assessment; care planning; to be tolerant; do
not bring problems to work; offer the audience
needed to better observe and understand;
understand the body language and the look; group
meetings, with an effective dialogue in order to
provide understanding among all participants of
the process; and space to respect the time of each
one when wanted to be alone in certain contexts.
The action plan (Figure 1) is represented
diagrammatically by a cone, to confirm that the
process is formed by elements which are
combined to form a whole, emphasizing the
result: in this case, the effective interaction of the
nursing staff in favor of nursing care, and for the
practice of humanization in care, once it involves
the level of interactive relationships. Circular
arrows are to demonstrate that the cone has
continuous motion.

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Acta Scientiarum. Health Sciences Maringá, v. 38, n. 1, p. 23-31, Jan.-June, 2016
Figure 1. Action plan for the communication process of the
nursing team.
Discussion
According to King (1981), perception can be
considered as the representation of each individual
regarding reality, that is, the consciousness of an
individual’s about the objects and events that
surround him. The author says that despite the
individuals living in the same world and having
some common experience (or similar), they differ in
what they select to enter in the perceptual area.
With perception, there is an awareness of your
own self, objects, relationships, established
interactions, communicative acts and worldview
through the senses, allowed by the actions of
recognize, observe and select; and thereby gaining
significant knowledge because all individuals
perceive the objects and the environment around
them in an individual way, and these experiences
provide information on things. Although each
individual is unique, there is a similar instrument,
such as senses, where each person can perceive
differently (King, 1981) a living environment.
Each attitude, behavior, action, thinking, and
reasoning are based on the interpretation that
individuals make of the context around them, not
just on their reality. Every human being perceives
the world in a special and different way, where a
particular situation, object, and even a person is
interpreted in a certain way and is given a distinct
importance according to each moment.
A concern of professionals in trying to
understand and respect the other’s way of life was
identified, adapting to their time and space to have
interaction, understanding why the other changed
his attitude and behavior unexpectedly. Such
attitudes are in line with the thinking of Rosenberg
(2015), where the author states that before
communicating with patients, families and other
healthcare professionals, must select the
communication style that best suits the context, the
confidentiality of the content, the potential impact
on the person and how they are, sentimentally
speaking, in the moment.
Nursing professionals know how to approach,
analyze the way of speaking not contradicting the
other, understanding that no one is equal because
each person thinks and acts in a different way. They
understand that they must respect the space of
others and show disposition to adapt and get used to
other´s behavior.
Such behavior of the nursing staff can be
characterized by the fact of creating on the other,
expectations that influence the actions before
accomplishing them (Berlo, 2003). This is what
characterizes the empathy. Thus, one is able to
recognize a person not only physically but correctly
predicting what he/she will do, say and behave in
face of a certain reality.
Empathy is a human quality that to be practiced
the individual sets aside prejudice, cultural
restrictions and any difference between human
beings; because it is more important to take into
consideration the individual and the context he is
into and not be influenced by differences and
behaviors that undermine compassion and human
valorization (Dawood, 2010).
To be able to interact with the surrounding
reality, individuals make use of the values and beliefs
to help them balance their lives, and thus form and
shape their ideas, thoughts and knowledge. When
there are inconsistencies in the values and beliefs,
the ‘self’ tries to avoid them or, at least, clarify them,
since each new experience tends to influence a
change in itself (King, 1981), and each one of these
new insights is unique to the individuals.
‘Self’ is what makes the person what he/she is,
what he/she thinks it is, it is what is essential to be
what one is and the qualities are what differentiates
people from each other, giving subsidies for the
formation of the identity of the individual, so to
become aware of what is done, what values and goals
to achieve and how people recognize and identify
him/her.
‘Self’ can be a product of human interactions
because often the attitudes towards ‘self’ are
reflections of the attitudes towards others, and it is a
part of human experience (King, 1981). Such
thoughts are supported by Berlo (2003) when he
says that the individuals involved in the
communication process need to have a positive
attitude in order to have loyalty in the interaction. It
is also important the attitude towards each other,

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which when one has great affinity to whom you are
related to, greater will be the effectiveness. Thus, it
happens to the ‘self’, because when there is a good
interaction with the environment, with themselves
and with others, the greater the chance to share
experiences will be.
Many times people are mirrored in the attitudes
and behaviors of others to get the courage to face a
situation or reality because they do not have enough
willpower or simply do not know how to act, due to
insecurity or by never having gone through that
experience before. Then, when reflecting on the
experience of the others, being that positive or
negative, they learn a new value for the ‘self’ and
attitudes are changed towards that particular reality
or it will serve as an example to others.
Each individual experiences and perceives the
space in one way, thus, each one has a specific
concept when experiences it, and the way he/she
uses it is associated with the type of culture,
behavior, and the communication process. A
position that is occupied and the interactions that are
experienced can provide feelings of safety and better
use of the space (King, 1981).
The use of space for each individual is
influenced by perception and how sensory stimuli
identify and observe such environment. This can be
influenced exclusively, by their needs, past
experiences and their culture (King, 1981). The
cultural system can influence how it is used and
define the space because of beliefs, values and ways
of doing things dictate the type of behavior that one
must have towards each other (Berlo, 2003).
In this sense, the space seen by the nursing staff
is similar to the environmental concept which can
be characterized by the use of physical, social,
professional and interpersonal relationships space
established in the working process which are directly
involved in health care, therefore providing warm,
problem-solving and guided attention in the
precepts of humanization (Ribeiro, Gomes, &
Thofehrn, 2014). For the professionals the space
used for nursing care is seen as conducive and
adequate, that is, a facilitating tool of the working
process and the quality of health production.
Space is not only the physical environment but
can also be the personal space of each one. In some
moments of life, space is what individuals want. The
individual needs to be alone on his ‘world’ with no
one around, without requirements, speculation,
judgment, and accusations. It is a space to think,
reflect and even cry without audience; because his
needs in that situation, is of loneliness to face reality.
Fears, anxieties, joys, and pleasure influence the
need for space (King, 1981).
The time is not only the order and sequence of
events, but also the length of them experienced by
each individual, being described as a concept that is
cyclic or on the other hand, that is linear and
irreversible, measured by clocks and calendars or
that is a relational process in which all events are
organized in a succession (King, 1981).
The nature of time is complex and abstract;
nevertheless, there is a certain consistency and
individuals talk about it, trying to measure it with
clocks and calendars increasingly modern. Also, the
time controls the activities of daily life, whether at
work or leisure. That happens in a hospital where
the nursing team has a pre-set time to administer
medications and perform the various procedures
needed to provide nursing care with quality.
Therefore, professionals relate their time with
the activities carried out on a working day, such as a
bath, the administration of medicine; send the
patient to carry out an examination, the application
of the nursing process by the nurse. The
performance of activities at the right time is required
so that everything will proceed properly
synchronized because their main concern is to
provide a qualified and efficient assistance to meet
all or part of the needs of the individuals.
As the concept and the way time is confronted
are abstract, inherent in every person, the value and
the importance given to it will be based on the
experience of each individual. And, consequently,
the way to perform daily tasks too, because each
individual has a way of working and acting, that is,
one could be fast or slow. However, if the activities
are initiated in advance, planned and focused
without interruption, time may be enough as shown
in the testimony of NT5 and NT7. Thus, planning
favors the contact and, therefore, the practice of
humanization.
However, it is necessary to consider that even
planning and being available to provide care for
quality and efficiency, if there are no materials and
human resources, the professionals become
overworked and consequently tired, affecting the
care provided. As evidenced in research conducted
in twelve European countries, where professionals
were asked if they had time in their last shifts to
perform all nursing tasks, they said that due to
overload of activities some were set aside, such as
pain management, for only a small minority of
professionals in almost every country; and the act of
providing a communication comfort and health
education for patients and families, was in almost

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half or more than half of nurses in most countries
(Aiken, Sloane, Bruyneel, Heede, & Sermeus, 2013).
In another research conducted in nine European
countries it was evidenced that in each increase of
one patient per nurse, there is 7% increase in the
probability of a patient dying in a period of 30 days
of hospitalization. Each increase of 10% in number of
nurses in a hospital, there is a reduction of 7% of this
probability (Aiken et al., 2014). Thus, this evidence
subsidizes the speech of N4 showing the importance of
having an adequate quantity of nursing professionals to
avoid any harm to the patient.
Regarding the stressors, they are not limited to a
certain area or a certain time, that is, they are
everywhere; and to react to it, it is necessary that the
individual had the energy to face the threats and
noxious stimuli (King, 1981). If the stressor
stimulus is related to fear, the professional will have
greater difficulties to address the work-related
obstacles. According to Oommen, Wright and
Maijala (2010), fear influences the emergence and
maintenance of the stress when the nursing
professional realizes that his opinion was not valued,
there is a difficulty in thinking independently to be
able to act and the decisions of superiors cannot be
questioned.
Thus, stressors are not limited to a certain area or
a certain time, that is, they are everywhere. To react
to it, one needs energy to face the threats and
noxious stimuli (King, 1981). As the process of
communication and the interaction also require
energy (Berlo, 2003), the nursing professional may
have to choose between what demands less energy
or, what is more, important to engage and make use
of his energy.
Therefore, nursing care can be affected because
the stressors can influence the activities of the
professional, due to difficulties in labor relations and
nurse-patient interaction may not be effective due to
decrease of energy that was spent to better cope with
the stress. However, the opposite may happens:
professionals can spend their energy on nursing care
and the lack of it may lead to illnesses.
Consequently, the use of strategies becomes
important to address the life events as best as
possible, whether they are pleasant or unpleasant.
Moreover, when sharing such strategies,
confronting the stressors and the actual stress can be
mitigated because there is a multiplication of
energies as the interaction ties are developed,
cooperation and improvement of confidence
(Oommen et al., 2010).
It is necessary to consider that even with
knowledge sharing, the way individuals face the
stress and the increase and decrease of experienced
tension is particular, that is, each one reacts in a
different way, and this response is influenced by
space, time, age, gender, personality and motivation
(King, 1981). Changing the way of facing such
situations can come over time after the person
experiences and reacts to the same stress several
times; showing that the individual feels comfortable
in that situation.
Nonverbal communication can be characterized
by the manifestations of behavior, not understood
by words, but exposed by their facial and body
expressions: the postures when facing the other, the
way we touch, the body signals, natural or
superficial somatic singularities, by behavior,
organization of objects in space, and the distances
we maintain in interpersonal relationships with the
other individual (King, 1981).
As can be seen, the nurses have set their
understanding and importance of nonverbal
communication in body language. This type of
nonverbal communication is centered on body
signals and behavior, that is, the balance of the head,
body position, legs and crossed or uncrossed arms,
symmetry of the arms, the look, the hand gestures,
the appropriate contact, slight bending towards the
other (Little, White, Kelly, Everitt, & Mercer, 2015).
By their facial expressions, it is possible to show
a range of feelings, attitudes and information;
however, some aspects of the behavior expressed by
the individual and the physical appearance may be
intentionally generated, while others occur more
spontaneously or are even unable to be changed by
choice (Hirschmüller, Johannes, Nestler, & Back,
2013). Thus, it is an important indicator of the
effectiveness of the communication process, as if the
source identify expressions of indifference and
inattention, one can change the strategy used to
address the receiver and thus have a process to reach
a goal. Thus, it is important to confirm with the
caller what one is willing to show, such as: joy,
frustration, anger, worry, sadness, impatience,
among others; so there are no contradictions and
misinterpretations.
In this sense, it is important to use the attention
with greater intensity in the communication process
in order to capture all this whirlwind of emotions
and feelings involving individuals, but this depends
on the ability of the source to show their feelings,
because each person expresses his emotions and
feelings in a unique and different way, and is
influenced by the environment and their time of
life, which may suggest different interpretations and
understandings that individuals are actually living.
Thus, it is important not to judge in a situation
without first understanding the whole context that
surrounds it.

30 Broca and Ferreira
Acta Scientiarum. Health Sciences Maringá, v. 38, n. 1, p. 23-31, Jan.-June, 2016
Concerning authority, the individual who exercises
it has the task to make decisions that guide his own
actions and of others, when managing an event,
exercising or not the leading position, being directly
linked to the exercise of power (King, 1981; Berlo,
2003). The authority may be seen by some as in the
leading role, inherent to the person, and position in an
organization, and by others as residing in the person,
inherent to the person, by the knowledge and
experience, as well as the exercise of power being
dependent upon acceptance by someone else.
In the nursing team, these roles are exercised either
by a resident on the role (as a nurse section chief) or in
a person (such as a nurse on duty with a range of
experience at it) that comes to characterize the
hierarchy. The hierarchy characterizes authoritarian
classification of roles where one is perceived as with a
higher value, power, importance and influence than
others within the group (Berlo, 2003).
In this sense, the authority has the function of
guiding and directing the behavior of an
organization and needs to be reciprocal, in order to
influence one another; and these behaviors are
interdependent, being related to each other (King,
1981; Berlo, 2003). The existence of a strong
hierarchy in the work process can influence the
onset of problems in the communication process
and in the interaction between professionals, due to
a vertical relationship (Oommen et al., 2010). They
do not always feel free to question the actions of
those in authority (Aiken et al.,2013).
Besides that, the status also influences the
interactions within the nursing staff system, because
it is the position of an individual in a group since he
is perceived by others in the group in this important
role, which may be reversible (King, 1981; Berlo,
2003). Status comes with privileges, duties, and
obligations; linked to the role or position and is
related to who you are, what you do, what you know
and what you could achieve.
For the nursing staff, the best strategy for the
authority/hierarchy/power/status to be exercised and
achieved the best way possible, group meetings are
advisable. In such meetings a process of effective
communication, without fear of roles and positions,
exercised sharing good and bad situations, exchange
of experiences, not only pointing out the mistakes
but the solutions they bring, and minimizing
conflicts. However, for this to occur it is important
to have a respectful relationship and that one can try,
through empathy, to understand the other in his
human complexity.
The sense of group meeting can meet one of the
humanization policy devices, the humanization of
the working group, which aims to be a group
meeting of people interested in discussing the work
environment, the dynamics of teams and the
relationships established between them (workers,
managers and patients), and how they can improve
the process of work and the quality of health
production, becoming a space to provide good
relationships among people, in order to provide an
effective communication process that combats the low
quality of services (Hirschmüller et al., 2013). With
that, worker participation in decision-making is
increased, their level of satisfaction and patient´s
satisfaction, and, therefore, it becomes a space to
strengthen the ties among professionals, where they
can share information about the patients and better
assist them.
Such meetings would have the aim of providing
the feedback from professionals about personal
views on incidents; learn how to better handle
individuals considered complicated and difficult and
share thoughts and critical opinions about problems
in communication, interaction and hierarchic
relationships (Oommen et al., 2010). And with that,
lead them to reflect collectively on the working
process proposing and welcoming changes that
allow improvements and put them into practice.
When there is an increase in the implementation
of the communication process, when one is sensitive
and sympathizes with the other's behavior and when
there is motivation in an interactive relationship,
empathic accuracy increases (Berlo, 2003). For the
author, to such attitudes, the role of authority may
have the ‘yes you can’ reaction, where regardless the
position that the individual holds, some behaviors
only dependent on his will. As for example, there are
those cited by nursing professionals in the recording
units which illustrates this discussion, and thus, one
might have the inclination to exercise greater
cooperation among the participants of the group's
meeting’s and provide quality nursing care.
There was care convergence with some nursing
professionals in order tobecome aware of observing
each other to assess the way of being, to understand
how people behave, the view, the moment what the
other is experiencing; to provide space; to learn to be
patient and understanding; the importance of
nonverbal communication and how to observe it,
see it and identify it; to maintain a dialogue with
those who have the role of authority, hierarchy and
power in order to expose all their difficulties, what is
not working, problems that impair assistance while
bringing solutions to facilitate teamwork and thus
provide a better relationship between them and
indirectly or directly a more humanized practice.
The plan was conceived considering a dynamic,
flexible, interactive and relational process of

Communication in the nursing team 31
Acta Scientiarum. Health Sciences Maringá, v. 38, n. 1, p. 23-31, Jan.-June, 2016
communication, where its elements do not have a
fixed and stable place, but in the process are used
according to the needs of each one. It is important to
emphasize that the changes will not come within a
short time in a system that sometimes shows rigid
and hierarchic relationships, but they must consider
that communication skills can be improved
(Oommen et al., 2010) providing a communication
process that satisfies all of them.
Moreover, the plan aims to contribute to the
professional qualification trying new caregiving
practices, with the intention of to be a theoretical and
practical support indicating possible ways for the
nursing practice to really meet the patients’ needs.
Thus, it is necessary to consider that caregiving in its
whole requires the professional be included as an active
subject of this relationship, in order to help building a
comprehensive, fair, responsible health system,
accessible to everyone.
The limitations found in this study were the
performance of a specific scenario; therefore, the
expansion of research to other fields of activity of
the nursing staff can contribute to the testing of the
proposed plan.
Conclusion
The action plan for the communication process in
the nursing team represents flows of communication
and interaction between them and analyzes the
strategies and actions used to combat or reduce the
noise of these relationships thereby increasing the
process fidelity.
In this way, provide a nursing care aimed at
patient’s safety and humanization depends a lot of on a
teamwork, characterized by an authority and hierarchy
gradient that does not prevent the flow of information,
and on the use of effective strategies to improve the
relationship among them.
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Received on November 9, 2015.
Accepted on February 4, 2016.
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