The implications of nursing diagnosis: impaired verbal communication to the client of high complexity in intensive care - Systematic Literature Review

Raquel de AP e Souza, Isabel CF da Cruz


Abstract: The unconscious or comatose patient is a challenge to effective communication; the patient’s neurological status creates doubts about the level of hearing and sensory perception and limits the communication of nurses. Objective: To identify the scientific production of nursing, the best evidence for nursing care in the sensory stimulation of the unconscious patient unable to communicate their needs verbally. Method: Literature review from electronic search in databases and virtual libraries. Data collection occurred between March and June 2014. It was selected 10 scientific studies for the sample to be analyzed. The results analyzed were of the thematic study and evidence-based practice. Results: The evidence resulted in conflicting findings about the effects of stimulation in unconscious patients. According to researchers, communication with unresponsive patients is described as limited, essentially related to nursing interventions to be performed only. However, there are sufficient evidences to support the assumption that there is an increasing mental activity and emotional awareness in unconscious patient stimulated. Findings described in the literature also clearly indicate a correlation between auditory stimulus and increases in arterial blood pressure, heart rate, respiratory rate, intracranial pressure, body and facial movement. Conclusion: The literature review revealed a lack of studies that investigated what nurses actually say to their patients, emerging the need for additional empirical research. The available studies suggest that intensive care nurses do not provide enough verbal communication to their patients and highlight several points of concern.


Unconsciousness; Communication; Coma; Nurse–Patient Relations

Full Text:



Morais GSN, Costa SFG, Fontes WD, Carneiro AD. Comunicação como instrumento básico no cuidar humanizado em enfermagem ao paciente hospitalizado. Acta Paulista de Enfermagem [Internet]. 2009 [acesso em 2014 mar 23];22(3):323-327. Disponível em:

Jesus LMT, Simões JFFL, Voegeli D. Comunicação verbal com pacientes inconscientes. Acta Paulista de Enfermagem [Internet]. 2013 [acesso em 2014 mar 23];26(5):506-513. Disponível em:

Universidade Federal de São Paulo. Classificação de evidências [Internet]. 2000. [acesso em 2014 out 14]. Disponível em:

Puggina ACG, Silva MJP. Sinais vitais e expressão facial de pacientes em estado de coma. Rev Bras Enferm [Internet].2009 [acesso em 2014 jun 20];62(3):435-441. Disponível em:

Takeshita IM, Araujo, IEM. Estratégias de comunicação e interação do enfermeiro com o paciente inconsciente. Revista Mineira de Enfermagem [Internet]. 2011 [acesso em 2014 jun 20];15(3):313-323. Disponível em:

Happ MB, Garrett K, Thomas DD, Tate J, George E, Houze M, Sereika S. Nurse-patient communication interactions in the intensive care unit. American Journal of Critical Care [Internet]. 2011 [acesso em 2014 jun 20];20(2):28-40. Disponível em:

Fleischer S, Berg A, Zimmermann M, Wüste K, Behrens J. Nurse-patient interaction and communication: A systematic literature review. Journal of Public Health [Internet]. 2009 [acesso em 2014 jun 20];17(5):339-353. Disponível em:

Haidet KK, Tate J, Divirgilio‐Thomas D, Kolanowski A, Happ MB. Methods to improve reliability of video‐recorded behavioral data. Research in nursing & health [Internet]. 2009 [acesso em 2014 jun 20];32(4):465-474. Disponível em: .

Radtke JV, Baumann BM, Garrett KL, Happ MB. Listening to the voiceless patient: case reports in assisted communication in the intensive care unit. Journal of palliative medicine [Internet]. 2011 [acesso em 2014 jun 20];14(6): 791-795. Disponível em:

Gordon C, Ellis‐Hill C, Ashburn A. The use of conversational analysis: nurse–patient interaction in communication disability after stroke. Journal of advanced nursing [Internet]. 2009 [acesso em 2014 jun 24];65(3):544-553. Disponível em:

Grossbach I, Stranberg S, Chlan L. Promoting effective communication for patients receiving mechanical ventilation. Critical care nurse [Internet]. 2010 [acesso em 2014 jun 24];31(3):46-60. Disponível em:

Vila VSC, Rossi LA. O significado cultural do cuidado humanizado em unidade de terapia intensiva: “muito falado e pouco vivido”. Rev Latinoam Enferm. 2002 mar/abr; 10(2):137-44.

Lucena AF, Crossetti MGO. Significado do cuidar na unidade de terapia intensiva. Rev Gaucha Enferm. 2004 ago; 25(2):243-56.

Zinn GB, Silva MJP, Telles SCR. Comunicar-se com o paciente sedado: vivencia de quem cuida. Rev Latinoam Enferm. 2003 mai/jun; 11(3):326- 32.

Happ MB, Garrett K, Thomas DD, Tate J, George E, Houze M, et al. Nurse-patient communication interactions in the intensive care unit. Am J Crit care. 2011;20(2):e28–40.

Lent R. Cem bilhões de neurônios: conceitos fundamentais de neurociência. São Paulo: Atheneu; 2005.

Puggina ACG, Silva MJP. Sinais vitais e expressão facial de pacientes em estado de coma. Rev Bras Enferm. 2009 Jun; 62(3). [Citado 2010 jul. 21]. Disponível em: .

Ferreira MA. A comunicacao no cuidado: uma questao fundamental na enfermagem. Ver Bras Enferm. 2006 Jun; 59(3): 327-30. [Citado 2010 jul. 21]. Disponivel em: .

Walker JS, Eakes GG, Siebelink E. The effects of familial voice interventions on comatose head-injured patients. J Trauma Nurs. 1998; 5(2):41–5.

Jones R, Hux K, Morton-Anderson KA, Knepper L. Auditory stimulation effect on a comatose survivor of traumatic brain injury. Arch Phys Med Rehabil. 1994;75(2):164–71.

Perrin F, Schnakers C, Schabus M, Degueldre C, Goldman S, Bredart S, et al. Brain response to one’s own name in vegetative state, minimally conscious state, and locked-in syndrome. Arch Neurol. 2006;63(4):562–9.

Baker C, Melby V. An investigation into the attitudes and practices of intensive care nurses towards verbal communication with unconscious patients. J Clin Nurs. 1996;5(3):185–92.

Oria MOB, Moraes LMP, Victor JF. A comunicacao como instrumento do enfermeiro para o cuidado emocional do cliente hospitalizado. Rev Eletronica Enferm. 2002; 6(2):292-97. [Citado 2010 jul. 21]. Disponível em: .


Share |