A comunicação como ferramenta do cuidado centrado no paciente

Abstract

Effective communication in emergency departments is crucial for quality care and patient safety but faces challenges due to the high-pressure and complex nature of this environment. This study aimed to analyze the communication of a multidisciplinary team in an emergency unit of a large hospital in Belo Horizonte, investigating communication practices, the effectiveness of communication, and its impact on patient care and safety. A concurrent mixed-methods approach was employed, combining simultaneous collection of quantitative and qualitative data to enable triangulation of results. Data collection occurred between February 5 and March 28, 2024, involving 45 professionals (physicians, nurses, nursing technicians, and a social worker) selected through stratified random sampling to ensure representation of different professional groups. Inclusion criteria required a minimum of six months of experience in the unit, while professionals on medical leave, unavailable, or otherwise absent, were excluded from participation. For quantitative analysis, the Self-Efficacy in Communication Questionnaire (SEbr-12) and the Jefferson Empathy Scale, adapted to the Brazilian context, were utilized. Statistical analysis revealed significant correlations (p < 0.05) between empathy and communication self-efficacy, indicating that professionals with higher confidence in their communication skills demonstrated greater levels of empathy. However, challenges such as delivering bad news and coping with workload demands were identified as barriers to effective communication, negatively affecting patient safety. Qualitative analysis, based on semi-structured interviews and field journal entries, used Bardin's content analysis technique. Findings highlighted the benefits of effective communication, such as enhanced team cohesion and patient trust, alongside significant challenges. Barriers like rigid hierarchies, time constraints, and communication interruptions hindered the practice of patient-centered care, emphasizing the need for institutional and organizational improvements. Data triangulation, based on Creswell’s model, integrated quantitative and qualitative perspectives, providing a comprehensive view of the phenomenon. Quantitative data suggested positive perceptions of self-efficacy and empathy, while qualitative insights delved deeper into everyday challenges, including institutional pressures and fragmented communication. An analysis of adverse events (AEs) between 2019 and 2023 reinforced the link between communication failures and the occurrence of AEs, underscoring the importance of integrated practices for patient safety. The results highlighted the need for strategic interventions, such as interprofessional training focused on communication skills and empathy, to reduce adverse events associated with communication failures. Additionally, the study recommended the inclusion of training and simulations in academic curricula to foster empathy and effective communication from the outset of professional education. The study concluded that effective communication and empathy are interdependent in patient-centered care but face significant institutional and contextual limitations. Measures such as specialized training and organizational changes not only improve clinical practice and patient safety but also promote the well-being of healthcare professionals, contributing to a safer and more humanized care environment.