Technology and communication in hospital care for chronically ill patients from the Habermasian perspective

Rich-Ruiz, Manuel; Martins, Maria-Manuela; Rodríguez-Borrego, María-Aurora

doi:10.1590/0104-07072014003390013

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Original Article • Texto contexto - enferm. 23 (3) • Jul-Sep 2014 • https://doi.org/10.1590/0104-07072014003390013 copy

Technology and communication in hospital care for chronically ill patients from the Habermasian perspective

Tecnologia e comunicação no cuidado hospitalar ao doente crônico na perspectiva de Habermas

Authorship SCIMAGO INSTITUTIONS RANKINGS

The objectives of the study were to describe situations involving instrumental and communicative actions that take place in nursing and to explore the difficulties in communicative action. It was an ethnographic study conducted among nurses from two large hospitals in Spain and Portugal. Data collection took place through participant observation and semi-structured interviews. It was then followed up by a survey. A discourse analysis and quantitative analysis were performed (on the survey). The nurses' work consisted mainly of instrumental actions. Among the social actions, those of a strategic type predominate, whereas communicative actions are scarce and non-specific. It was noted that difficulties in communicative actions were linked to "New Management" and "Encoded Knowledge". Nursing requires a more balanced distribution between the time dedicated to technology and communication. The difficulties involved in communicative action appear to coincide with Habermasian systems, although renewed forms are adopted.

Professional practice; Philosophy in nursing; Professional-patient relations; Communication; Knowledge, attitudes and practices in health

I think... is important
	When a patient arrives, talk with him or her (to take into account their particular needs).	1	2	3	4	5
	Administer the prescribed treatment.	1	2	3	4	5
	Pay attention to the preparation required for each diagnostic test (radiology, laboratory, etc.).	1	2	3	4	5
	Know all that needs to be done with each patient (tests and treatments) and check that it has been done.	1	2	3	4	5
	Monitor vital signs and other measures (drainage, etc.).	1	2	3	4	5
	Be mindful of the emotional state of each patient.	1	2	3	4	5
	Process all requests from physicians for tests and treatments (according to the rules established by the institution).	1	2	3	4	5
	Know each patient’s ability to perform daily activities (bathing, getting dressed, feeding, going to the toilet...).	1	2	3	4	5
	Know about the patient’s daily life outside the hospital (environment, social networks, habits, customs, etc.).	1	2	3	4	5
10	Do not forget any medical prescription.	1	2	3	4	5
11	Every time I go in the room, start up a conversation (so that the patient will tell me what he/she needs).	1	2	3	4	5
12	Meet the objectives of the unit/service.	1	2	3	4	5
13	At certain times (surgery the next day, a setback, etc.), spend time with the patient.	1	2	3	4	5
14	Convince the patient to follow the prescribed treatment.	1	2	3	4	5
15	When a patient is nervous, anxious, distressed or discouraged, administer a medication or notify the physician to work out the problem.	1	2	3	4	5
16	Know how the patient views his or her illness, the tests being done or the treatments being given.	1	2	3	4	5
17	In cases where the illness radically changes the person’s life, help the patient integrate the new situation into his or her daily life.	1	2	3	4	5
18	Provide help, as needed, so that the patient can obtain more specialized care (nutritionist, physical therapist, psychologist, social worker, etc.).	1	2	3	4	5
When I do (in my day-to-day)...it is important
The same actions are repeated
When I do records... it is important to collect
The same actions are repeated

Subjects	Descriptors	References
Non-social/instrumental actions	Prescriptions Administrative work Physical care	We have medication schedules at 9 am and noon [...]. In terms of position changes, we have a protocol where changes are performed every two and half to three hours more or less [...](PN6).
Social actions	Lack of time: difficulties in finding time for communicative actions	Times for communication exist if you look for them. If you aren’t looking for them, you can get by without them, because you can then simply dedicate yourself to your duties and nothing more (SN1).
		Unfortunately we don’t have time to indulge in conversation with patients (PN2).
	Informational-educational actions as manifestations of social action	[We] teach a little about everything [to patients or family members], so that when they’re discharged and continue to be dependent, they can take care of themselves at home (PN2).
	Systematization: communication as a disruption to the work pace	It’s not intentional. It’s just that my priority at the time is to give medication[...] if I stop with each patient, perhaps I’ll give the last medication at 11 in the morning when I should have given it at 9:00 (SN2).
	Communicative actions are ignored and even blocked out	[...] so many times you get the ‘hey!, I was waiting for you’ and ‘I was waiting for you’ it’s work, work, work […] that’s one of the reasons why I don’t ask ‘how are you doing’ [laughs] (SN1).
Economic system	Clinical management systems Bureaucratic control systems Economic incentives	[...] since I’ve been in a lot of places, eight months going here and there [referring to a period of time when the person was doing substitution work] I used to say: there’s a lot of desk work here, but no one does the front-line work. And when the new shift would arrive there’d be all these crummy situations. Sure, lots of goals were set, but as far as work, no one really works (SN3).
Bureaucratic system	Social sacralization of science Instrumental professional socialization Evidence-based practice Methodological tradition	When a patient comes here [to the hospital]all these [nasogastric] catheter insertion techniques must be performed [...] we do it for the sake of the patient, regardless of the family’s consent, because it’s something the patient needs at that time (PN3).

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Manuel Rich-Ruiz Departamento de Enfermería. Universidad de Córdoba Avda. Menéndez Pidal s/n, 14004 Córdoba, España E-mail: mrich@uco.es