It was aimed at validating the applicability of the Model of Verbal Communication with blind people in nursing appointment in the stages of the nursing process. A methodology of quantitative study was used with 30 nurses and 30 blind people who participated in the study, divided in control and experimental groups. 30 nursing appointments took place; they were recorded and analyzed by three judges. The experimental group had excellent performance in following protocol (95.6%); taking notes informing the reason for silence (93.4%); and avoiding long silence (100%). In interventions, it presented excellence in all the items, in the evaluation stage, there were no bad/terrible actions. In none of the actions the control group presented better performance than the experimental one. The use of the Model is recommended in nursing appointment with blind patient.
One of the current challenges found by nursing is to offer effective and humanized assistance, conciliating va- riables such as cost and quality in adequate proportions, independently of the type of the clientele. In a previous study [
In order to face this challenge, new paths are established in studies regarding the models of communication, which are facilitators for the acquisition of abilities and competences in nursing [
The elaboration of the Model was developed into seven steps: 1) reception, initial contact between both; 2) data collection concerning the history; 3) diagnosis of nursing; 4) planning; 5) implementation of care; 6) evalu- ation of nursing; and 7) closing, in which there is the end of communication and consequently, interaction. These moments emphasized the communication according to the steps of the nursing process, so that the nurse could work in a systematized and individualized way, using their critical thought [
The communication with the blind patient is made using universal precepts, which contemplate the specificity of such clientele. While the health professional that can see absorbs 80% of the information of the environment through his look, the blind patient uses the verbal, tactile and olfactive communication; this requires, from the nurse, special abilities to lead effective and efficient communication with the blind patient. The Model of Verbal Communication covers these universal matters of the communication with the blind, and, afterwards, details each predominant action, following the steps of the nursing appointment. So, during the reception, it is possible to observe if the nurse uses communication with sympathy, telling him/her when he has arrived and assuming the function of transmitting communication, informing the activity of the moment, explaining the aim of the ap- pointment material and describes the instrument of register during the steps of diagnosis and planning following the protocol step and, informs the reason of the silence. While he takes notes and avoids prolonged silence.
While she is in the implementation step, the nurse must stimulate the patient to speak, wait for the blind pa- tient to conclude his statement, use common language and prioritize verbal communication, asking for informa- tion and suggestions, covering contents on the disease and matters of daily activities, on his personal life, be- coming aware of the difficulties of the blind patient, keeping attention to the speaker’s emotions. So, the Model, during the steps of evaluation and closing, uses the cooperation of the patient, strengthens the information re- ceived, says goodbye, shaking his hand and following him to the door.
When researching the verbal communication with the nursing team, with their attention focused on the atten- tion to the blind patients, it is possible to contribute for better quality assistance. From the above focus presented, it is possible to motivate and subside new investigation. It is necessary to include the relevance for the education of the nurses, under the perspective of social inclusion. So, the aim is at validating the Model of Verbal Com- munication with the blind patient during the nursing appointment.
A methodology of quantitative study was made at the Communication Laboratory and Health from Nursing De- partment of the Federal University of Ceará (UFC) a venue prepared for experiments of communication, with filming resources, at this venue, a model nurses’ office was made in order to discover diabetes. The topic dia- betes was chosen for being a problem of public health covered during the education of the nurse, and also be- cause it is a pathology which contributes for lesions in the visual system.
Newly graduated nurses participated in the study, invited through publicizing at the secretaries of the courses when the explanation of the objectives of the research. The criterion of selection of the newly graduated nurses was established once they master basic abilities to lead a nursing appointment, because this is a traditional activity in the process of education of the nurse; blind patients of both eyes and their caregivers were also subjects of the study. Three specialists collaborated analyzing the filming. It is a non-probabilistic sample where the first 15 nurses who agreed to the invitation formed the control group and guided the nursing appointments supported by previous knowledge and the available standard form.
Afterwards, the following 15 nurses who participated formed the experimental group and were prepared to use the Model of Verbal Communication with the blind patient. They received a photocopy of the Model [
The appointments were filmed and evaluated by three specialists, trained nurses according to the steps of the Model; of the theory of Verbal Communication and the use of the instrument of analysis of the Model of Verbal Communication with the blind patient [
Data processed in the Statistical Package for Social Sciences (SPSS) 14.0 and organized in univariate tables with relative frequency and percentages. For the association among the variables and the specialists the chi square test (χ2) was used with the maximum probability. The level of significance was established at 5% [
The variables are organized according to the steps of the Model of Verbal Communication, as follows: recep- tion, data collection, diagnosis and nursing planning, implementation of nursing, evaluation and closing.
Considering 30 filmings (15 control group and 15 experimental) and the evaluation of three specialists, each group of action evaluated received 45 concepts. 23 groups of actions were evaluated, with a total of 1035.
Within the experimented group, there was an excellent result in five of the six evaluated actions (
. Comparison of the nursing actions between the control and experimental groups of nurses related to reception and data collection of the patients. Fortaleza, CE, Brazil
Action | Terrible/Bad | Regular | Good | Excellent | Test* | P | ||||
---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |||
1. Communication with sympathy | ||||||||||
Control | 8 | 17.8 | 8 | 17.8 | 20 | 44.4 | 9 | 20.0 | 47.14 | 0.0001 |
Experimental | - | - | - | - | 4 | 8.9 | 41 | 91.1 | ||
2. Warning when arrival | ||||||||||
Control | 44 | 97.8 | - | - | - | - | 1 | 2.2 | 86.17 | 0.0001 |
Experimental | - | - | 6 | 13.3 | 17 | 37.8 | 22 | 48.9 | ||
3. Sender of part of the communication | ||||||||||
Control | 19 | 42.2 | 16 | 35.6 | 5 | 11.1 | 5 | 11.1 | 54.35 | 0.0001 |
Experimental | - | - | 1 | 2.2 | 14 | 31.1 | 30 | 66.7 | ||
4. Report moment of the activity | ||||||||||
Control | 41 | 91.1 | 3 | 6.7 | 1 | 2.2 | - | - | - | 0.0001 |
Experimental | - | - | - | - | 9 | 20 | 36 | 80.0 | ||
5. Explain the purpose of the material | ||||||||||
Control | 40 | 88.9 | 2 | 4.4 | 3 | 6.7 | - | - | - | 0.0001 |
Experimental | - | - | 3 | 6.7 | 4 | 8.9 | 38 | 84.4 | ||
6. Describe instrument | ||||||||||
Control | 43 | 95.6 | - | - | 2 | 4.4 | - | - | - | 0.0001 |
Experimental | - | - | 5 | 11.1 | 7 | 15.6 | 33 | 73.3 |
*1) χ2 test; 2) Test of Fisher-Freeman-Halton.
all the actions, the experimental group presented a better performance than the one under control. And that was highlighted in the communication with sympathy (91.1%), when explaining how and what for the purpose of the materials (84.4%) and the description of the instrument they were using (80%).
In
In
Also in all the nursing actions, in
The experimental group had excellent acting in five of the actions proposed concerning reception of the patient (
It is up to the nurse to express herself without ambiguities, he must show herself secure and consistent, pre- sent positive feelings to the other, allowing her to be independent and stimulate his autonomy. Besides that he must accept him totally and avoid feelings that represent a threat to the other, independently of the situation ex- perienced.
. Comparison of the actions of nursing between the control and experimental groups of nurses concerning the diag- nosis and nursing planning. Fortaleza, CE, Brazil
Action | Terrible/Bad | Regular | Good | Excellent | Test* | P | ||||
---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |||
1. Follows the protocol | ||||||||||
Control | 9 | 20 | 17 | 37.8 | 15 | 33.3 | 4 | 8.9 | 25.15 | 0.0001 |
Experimental | - | - | 2 | 4.4 | 30 | 66.7 | 13 | 28.9 | ||
2. Reports the reason of silence | ||||||||||
Control | 45 | 100 | - | - | - | - | - | - | - | 0.0001 |
Experimental | - | - | 3 | 6.73 | 17 | 37.8 | 25 | 55.6 | ||
3. Avoids silence | ||||||||||
Control | 41 | 91.1 | 1 | 2.2 | 1 | 2.2 | 2 | 4.4 | - | 0.0001 |
Experimental | - | - | - | - | 16 | 35.6 | 29 | 64.4 |
*1) χ2 test; 2) Test of Fisher-Freeman-Halton.
. Comparison of the actions of nursing between the control and experimental groups of nurses concerning the im- plementation of nursing. Fortaleza, CE, Brazil
Action | Terrible/Bad | Regular | Good | Excellent | Test* | P | ||||
---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |||
1. Stimulates the patient to speak | ||||||||||
Control | 25 | 55.6 | 11 | 24.4 | 8 | 17.8 | 1 | 2.2 | 47.57 | 0.0001 |
Experimental | 1 | 2.2 | 6 | 13.3 | 12 | 26.7 | 26 | 57.8 | ||
2. Waits for the blind patient to conclude his statement | ||||||||||
Control | 8 | 17.8 | 13 | 28.9 | 16 | 35.6 | 8 | 17.8 | 50.42 | 0.0001 |
Experimental | - | - | - | - | 4 | 8.9 | 41 | 91.1 | ||
3. Uses common language | ||||||||||
Control | 1 | 2.2 | 8 | 17.8 | 23 | 51.1 | 13 | 28.9 | - | 0.0001 |
Experimental | - | - | - | - | 13 | 28.9 | 32 | 71.1 | ||
4. Prioritizes verbal communication | ||||||||||
Control | 4 | 8.9 | 10 | 22.2 | 17 | 37.8 | 14 | 31.1 | 29.24 | 0.0001 |
Experimental | - | - | - | - | 7 | 15.6 | 38 | 84.4 | ||
5. Requires information/suggestion | ||||||||||
Control | 16 | 35.6 | 12 | 26.7 | 9 | 20.0 | 8 | 17.8 | 38.37 | 0.0001 |
Experimental | - | - | 1 | 2.2 | 16 | 35.6 | 28 | 62.2 | ||
6. Contents on diseases | ||||||||||
Control | 13 | 28.9 | 13 | 28.9 | - | - | - | - | 41.00 | 0.0001 |
Experimental | - | - | 1 | 2.2 | 19 | 42.2 | 16 | 35.6 | ||
7. Matters on daily life | ||||||||||
Control | 32 | 71.1 | 9 | 20 | 3 | 6.7 | 1 | 2.2 | 66.87 | 0.0001 |
Experimental | - | - | 3 | 6.7 | 18 | 40 | 24 | 53.3 | ||
8. Matters on personal life | ||||||||||
Control | 33 | 73.3 | 7 | 15.6 | 5 | 11.1 | - | - | 63.26 | 0.0001 |
Experimental | - | - | 4 | 8.9 | 17 | 37.8 | 24 | 53.3 | ||
9. Is aware of the difficulties of the blind patient | ||||||||||
Control | 24 | 53.3 | 10 | 22.2 | 9 | 20.0 | 2 | 4.4 | 69.52 | 0.0001 |
Experimental | - | - | - | - | 5 | 11.1 | 40 | 88.9 | ||
10. Pays attention to the speaker’s emotions | ||||||||||
Control | 10 | 22.2 | 21 | 46.7 | 11 | 24.4 | 3 | 6.7 | 56.97 | 0.0001 |
Experimental | - | - | - | - | 11 | 24.4 | 34 | 75.6 |
*1) χ2 test; 2) Test of Fisher-Freeman-Halton.
. Comparison of the nursing actions between the control and experimental groups concerning the evaluation of nurs- ing and closing. Fortaleza, CE, Brazil
Action | Terrible/Bad | Regular | Good | Excellent | Test* | P | ||||
---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |||
1. Counts on the cooperation of the patient | ||||||||||
Control | 14 | 31.1 | 17 | 37.8 | 12 | 26.7 | 2 | 4.4 | 58.45 | 0.0001 |
Experimental | - | - | - | - | 12 | 26.7 | 25 | 55.6 | ||
2. Strengthens the verbal communication | ||||||||||
Control | 33 | 73.33 | 7 | 15.6 | 3 | 6.7 | 2 | 4.4 | 43.15 | 0.0001 |
Experimental | 8 | 17.7 | 6 | 13.3 | 12 | 26.7 | 19 | 42.2 | ||
3. Says goodbye speaking and shaking the hands | ||||||||||
Control | 32 | 71.1 | 2 | 4.4 | 8 | 17.8 | 3 | 6.7 | 54.30 | 0.0001 |
Experimental | 3 | 6.7 | 9 | 20.0 | 5 | 11.1 | 28 | 62.2 | ||
4. Follows the blind patient to the door | ||||||||||
Control | 32 | 71.1 | 5 | 11.1 | 7 | 15.6 | 1 | 2.2 | 71.17 | 0.0001 |
Experimental | - | - | - | - | 8 | 17.8 | 37 | 82.2 |
*1) χ2 test; 2) Test of Fisher-Freeman-Halton.
When investigating the death of a terminal patient at home, some impotence and negative feelings were no- ticed by the nurses in the interactions with the family members. Actually the interpersonal communication was inexistent, due to the fact that they did not know how to cope with the situation, many times acting centered on the techniques which still permeate the care in the phases of the vital cycle from birth to death [
In order to reach a satisfactory and humanized communication the nurse must involve herself and believe that her presence is very important concerning the performers of technical procedures [
Communicating is not something simple, it requires several competences such as the abilities to listen, a val- uable instrument in the development of a relation of help, and the capacity to avoid directivity and let the person himself conduct the contents of his communication [
During the assistance to the blind patient it is up to the nurse to describe in detail the procedure before an in- tervention in an oral and clear manner. It is up to him to mention his name, function, which procedure he will perform, how he will do it and its purpose. This provides security, tranquility and familiarity to the patient.
The communication occurs more easily when there is clear and objective information; there are explanations on the condition of the patient and on the equipment being used. It is indispensable to the families and patients to communicate with the health team, in order to receive orientations and clarify doubts and also to have their needs of comfort attended to, and to receive caring words and attention [
A study investigated the opinion of the nurses on their communication when informing the diagnosis and prognosis of the serious disease to the patient and his family, and revealed that those have frequent difficulty to communicate that to the patient, with the family members this difficulty persists, but at a lower level. The ethical principles concerning integrity, dignity and autonomy of the patient were discussed, contextualized in the cul- ture of the patient and the health professional [
In this study, the statement of the blind patient was very interesting when they touched the instrument used for the consultation of screening. They reported that when they were assisted before, they had never touched the objects used by the health team; they did not understand the use of each one nor their functioning. Here the nurses explained how these instruments helped in the assistance in a ludic and simple language.
According to what was observed, the lack of effective communication implies in inadequate care, which is then defined as mere routines of procedures, the doing for just doing and so the nurses cannot reach all their po- tential [
Still analyzing the control group (
Concerning the diagnosis and the nursing plans (
The gestures indicate the way that the body speaks without words, attitude used frequently in the daily work of the professional nurse. But the blind patient does not perceive these gestures, and so this prevents him from evaluating the actions through the gestures. The literature reports that the silence, the mute space between one word and another, between a look and an action, can be an opportunity for something unprecedented to happen. In it, there might come the moment to make the encounter between the professional and the patient concrete [
So it is essential that the professional knows how to use silence therapeutically, considered one of the hardest techniques to be put into practice, once in general the nurse has a series of questions to ask the patient. The si- lence that is used by the professional, just by itself, encourages the patient to talk, transmits him the expectation that he can talk and is going to be heard; offers time both for the patient as well as for the nurse to organize and evaluate their thoughts and feelings [
Concerning the implementation of the intervention of nursing (
The persons who are able to see use non-verbal communication more predominantly, as it was noticed in a study of a communication of the HIV mother when taking care of her child up to six months of life, when she uses these forms of communication to show affection. Blind parents when describing what they did to breastfeed, bathe, feed, prevent domestic accidents and give medicine to their children they use the tact, the hearing and the smell. That is, the blind patients use predominantly hearing as verbal communication and complementary to tact, away from non-verbal communication. The health professional must have the abilities to perceive these differ- ences and intervene effectively [
During the performance of care it is important to perform all these actions found in the experimental group, so that both speakers get involved in the process of effective communication. When listening to the patient, the nurse must be aware not to judge the contents of the thought being expressed, it must concentrate on the state- ment of the blind patient, reflect and understand the contents of the message and be aware to his reactions and emotions. The nurse must encourage verbalization, listen, be comprehensive and provide information, which can relieve his concerns. According to what the literature mentions, the nurse must ask for clarifications on the meaning of the content expressed by the blind patient; once he has this knowledge and the knowledge of what was transmitted at the moment, the professional becomes more secure to stimulate the verbal manifestation of the feelings and other contents [
Caring is applying scientific knowledge in the day-by-day experiences, associated to the ability to use emo- tion and sensibility as the bases of communication to perform care considering the patient as a human being to be respected [
However, language can be a source of misunderstanding, above all the technical and scientific language be- cause it is not within the domain of the patient, he does not duly understand the language adopted by the health professionals. So he can make wrong interpretation of the care rendered [
When the nurse is inserted in the context, she is able to offer assistance according to the needs of the patient, using specialized reference which keeps and respects the sympathetic relations [
The analysis of the verbal and non-verbal communication among the mother, child and nurse triad shows the mother as the recipient with the nurse, that is, the nurse stimulates the mother to express herself and waits the necessary time for that, the contents of communication of the mother sometimes express doubts and requests orientations on how to take care of her child. In the non-verbal communication, the nearness between mother and child prevails and the personal distance between mother and nurse. It is worth highlighting that in this study the nurse has been prepared for the use of verbal and non-verbal communication with the blind patient [
Facing the practice of dialogue in all and any interpersonal relation language must be observed as a main form of communication and information on knowledge, ideas, beliefs and emotions. The dialogue in the process of social relationship must be manifested in a gentle and courteous way, once the way you speak brings compatible results to its nature; the collective experience is determined to assure health to the group and above all enrich the subject who is willing to dedicate himself to it, whether informal or informal meetings; conversation is used as a means to make yourself understood. All of this makes interpersonal relations easier whether they are technical, academic, social, it does not matter; conversations are the link which activates sociability [
Evaluating nursing consists in following the patient responses to the prescribed and implemented care, through notes, direct observation, as well as the report as the patient [
Spatial orientations occur from the corporal consciousness and the occupation of space happens through mo- bility [
In this study, it became evident that the nurse did not receive abilities to establish the effective communication with the blind patient in his education. The group which received specific training had a better statistically expe- rimental performance in all the points approached in the model, had excellent performance in following protocol (95.6%); taking notes informing the reason for silence (93.4%); and avoiding long silence (100%). In interven- tions, it presented excellence in all the items, in the evaluation stage, there were no bad/terrible actions. Through the results obtained, it is possible to confirm that the Model of Verbal Communication with the Blind patient is effective in a nursing appointment. Thus, it is recommended its use when taking care of the blind patient and the development of researches with the same in other contexts of professional practice in nursing appointment.
There was no conflict of interests.
*Corresponding author.