Introduction

The term communication comes from the Latin comunicare, which means to share. Communication is understood as the complex process that involves the exchange of information, data, ideas, opinions, experiences, attitudes and feelings between two or more people, playing an important role in the development of any human interaction. (¹) For nurses, interaction is essential, and one of its essential tools is communication. (²) To achieve interaction, several types of communication are known; the most used is verbal communication, since it allows immediate feedback. However, it is also important that the communication not only consists of words or tone of voice, but also body language, known as nonverbal communication, which corresponds to approximately 70 % of the language used; and it is there where the observation capacity of the nursing professional acquires a prominent role. It is made explicit that health care in critical units does not only consist of observing signs and symptoms caused by a given health alteration, but is also based on recognizing the response to the different actions performed by the health team, (³-⁴) by means of both verbal and nonverbal communication.

Thus, nurses working in such units face very difficult situations in their health care work, such as the delivery of care in patients whose life is at risk, contact with patients who died, and suffering of family members and loved ones of the patients admitted to an intensive care unit (ICU), among others. (⁵)

This highlights the importance of communication which improves the effectiveness and safety of health care, in which nursing professionals should communicate adequately, in order to assertively and safely work during their workday. (⁶) The nursing professional provides continuous care to patients and assists their needs of biological, technical, psychological, social and spiritual nature considering the needs of the patient and family. The complication that exists with critical patients is that, in most cases, they are with some degree of alteration of their state of consciousness, either pathophysiological or induced, so that their communication is limited, making the nurse-patient interaction difficult. (⁷)

For this reason, an integrative literature review was carried out with the purpose of analyzing how communication between critically ill adult patients and nursing professionals is carried out in the scientific literature that was reviewed.

Materials and Methods

An integrative review was conducted, using the structure proposed by Souza (2010), which proposes six phases: a) research question, b) literature search, c) information gathering, d) critical assessments, e) discussion of results, and f) presentation of the integrative review (⁸). The guiding question of this review was: How do critically ill patients communicate with nursing professionals for the delivery of care? This question emerged using an adaptation of the PICOT structure (⁹), which is explained in the table. Table 1

Table 1: PICOT Structure 

^Fuente:own development

The literature search was performed in several databases such as CINAHL complete and PubMed, using health sciences descriptors (DeCs): nurse communication, patients, critical care, ICU and intensive care, combining them with the help of the Boolean operators AND and OR. A total of 1724 publications were found. Subsequently, the following criteria were used to choose the proper publications that were published in recent years (2016-2019), of full-text articles written in English, Spanish, and Portuguese. After evaluating duplication of articles, those that met inclusion criteria were selected, namely, critically ill adult patient on mechanical ventilation, communication with the adult patient with altered level of consciousness, communication skills of the nursing professional and students; however, studies in pediatric population, non-critical patient-nurse communication, communication with other health professionals, communication, nurse and health team were excluded. For data collection, an instrument prepared by the authors of the document was used, which was comprised by 6 variables, described in Table 2. With the purpose of answering the guiding question of the review, 11 articles were selected and 2 were added by manual search, as shown in Figure 1. It should be noted that for the development of the three categories of arguments, a critical assessment of the evidence found was performed, according to Souza (2010), which is described in Table 3 and discussed in the discussion section of the results.

Figure 1: 2016-2019 scientific literature review flowchart 

Results

Of the total number of studies, 53.9 % correspond to the quantitative approach (¹⁰, ¹³, ^{14 - 17}, ²¹) and a 46.1 % report using the qualitative approach (⁸-⁹, ¹¹-¹², ¹⁸, ²²), which shows an homogeneous distribution in the research approach, reflecting levels, experiences, lived experiences, attitudes and needs of the patients and the nursing professionals from an integral point of view. Regarding the place where the studies were performed, 30.8 % were conducted in Europe (⁹, ¹²-¹³, ¹⁵), the same percentage of the studies were conducted in North America (¹¹, ¹², ²¹, ²²). Latin America is the only continent that does not report studies on this subject. Regarding the communication between the critically ill patient and the nursing professional, the following assessment of the research previously described in Table 2 is obtained, so it is possible to classify the communication between the nurse and the critically ill patient.

Table 2: Articles selected for the assessment 

^Source: own development

Discussion

To facilitate the understanding of this section, we developed a table that makes visible the three argument categories (Table 3), which emerged from the critical assessment conducted by the authors of the document, according to Souza (2010).

Table 3: Classification of studies according to the category of critical patient-nurse communication 

^Source: own development.

Conclusions

This document allows us to conclude that at the Latin American level there is no published scientific evidence on the communication between nurse and critically ill adult patients, which opens a gap to be researched for this type of professionals. The barriers that exist in the Latin American population, population who has its own idiosyncrasy, are unknown; thus, it is necessary to make more research and publications on the subject.

Moreover, it is evident that nursing professionals in ICU focus almost entirely on actions resulting from the diagnosis and medical treatment, putting on a second plane the aspects of interrelation with the patient and his family. This highlights the importance of the need of training on communication skills to improve the nurse-patient relationship, strengthening the participation of the patient and family in making care decisions, allowing nursing professionals to be active agents of change within the ICU, therefore, enhancing a humanized health care.

Finally, nursing professionals should consider family members or the patient's environment in their health care scheduling, given their importance for the recovery and communication of the critically ill patient.