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Pensar Enfermagem / v.27 n.01 / August 2023

DOI: 10.56732/pensarenf.v27i1.269

Theoretical Article

How to cite this article: Bianconi ALM, Marcon SS, Malaquias TSM, Haddad MCFL. Social skills of primary

care nurses and the communicative action of Jürgen Habermas. Pensar Enf [Internet]. 2023 Aug; 27(1)79-83.

Available from: https://doi.org/10.56732/pensarenf.v27i1.269

Social skills of primary care nurses and the

communicative action of Jürgen Habermas

Abstract

Objective

Promote a reflection on social skills in the work of primary care nurses from the perspective

of Habermas’ communicative action.

Method

This is a reflection article that proposes a discussion about social skills in the work of

primary care nurses, based on Habermas’ theory of communicative action.

Development

Social skills refer to the behaviors in the individual’s repertoire to deal with the demands

and social situations that occur in everyday life. In the work process, the nurse, being the

team manager, must develop their potential to expand the skills relevant to the management

of care, especially in terms of effective communication.

Conclusion

The research concluded that the theory of communicative action of Jurgen Habermas

contributes to the managerial practice of nurses and supports a positive social performance

since, by submitting their attitudes to a communicative action, nurses will be in search of

greater interaction with their team, patients, family and other professionals who constitute

the care networks.

Keywords:

Primary Care; Communication; Nursing; Philosophy in Nursing; Interpersonal Relations.

Aline Loiola Moura Bianconi1

orcid.org/0000-0002-1470-2164

Sonia Silva Marcon2

orcid.org/0000-0002-6607-362X

Tatiana da Silva Melo Malaquias3

orcid.org/0000-0001-5541-441X

Maria do Carmo Fernandez Lourenço Haddad4

orcid.org/0000-0001-7564-8563

1Nurse. PhD in Nursing. Graduate Program in

Nursing, State University of Londrina, Londrina,

Brazil.

2Nurse. Doctor in Philosophy. Department of

Nursing, State University of Maringá, Maringá, Brazil.

3Nurse. PhD in Nursing. Department of Nursing, State

University of the Midwest, Guarapuava, Brazil.

4Nurse. PhD in Nursing. Department of Nursing, State

University of Londrina, Londrina, Brazil.

Corresponding author:

Tatiana da Silva Melo Malaquias

E-mail: tatieangel@yahoo.com.br

Received: 30.03.2023

Accepted: 04.05.2023

80 | Bianconi, A.

Theoretical Article

Introduction

Primary Health Care (PHC) is the set of individual, family,

and collective health actions that include promotion,

prevention, protection, diagnosis, treatment, rehabilitation,

harm reduction, palliative care, and health surveillance,

conducted through integrated care practices and qualified

management, developed by a multidisciplinary team for the

population in a defined territory, over which the teams

assume health responsibility.1,2

The PHC actions are based on four pillars: first contact

care, continuity of care, comprehensive care, and

coordination of care. It is necessary to carry out

management compatible with the needs of the population

to achieve these objectives, following the principles and

guidelines of the Unified Health System (SUS), and have

trained professionals to lead the teams.1,2

In this perspective, nurses represent the principal actor in

health actions, as they have assumed leadership positions in

current scenarios that can define the quality of care

provided. The work of nurses in Brazilian PHC has been

configured as a tool for changes in health care practices in

the SUS, providing a new care model that is not centered

on biologicism but on the integrality of care, intervention

against risk factors, disease prevention, and promotion of

health and quality of life.1,2

Authors affirm that the work of nurses in PHC is based on

two dimensions: a) production of care and management of

the therapeutic process, and b) management activities of

the health service and the nursing team. Thus, the nurse, as

manager of the nursing team, in addition to articulating the

activities of several other professionals in the health team,

must develop the potential to expand the skills relevant to

the management of the work process, especially in effective

communication, interpersonal relationships, and

development of a positive climate for the exercise of

leadership.3

Thus, in this scenario, the nurse’s performance involves

several dimensions of clinical practice, such as care,

assistance, teaching, research, and management,

incorporating health promotion and disease prevention

actions. It is necessary to be a professional who constantly

seeks to develop their social and interpersonal skills to

achieve the objectives of this type of care.3

Social skills (SS) encompass classes of behaviors valued in

a given culture, with a high probability of positive results

for the individual, his group, and community that can

contribute to socially competent performance in

interpersonal tasks. Such skills are divided into self-

monitoring, communication, civility, coping: rights and

citizenship, empathy, SS of work and SS of expression of

positive feeling.4, 5

This repertoire of behaviors can be born with the person,

be acquired throughout their life, through training

programs, or by experience. In this way, it is possible that a

socially incompetent person can competently perform a

particular task.6

Considering that interpersonal relationships and SS need

vigorous and non-reductionist treatment, and considering

the nurse’s work process, recognized as a social practice

that promotes the construction of complex group

relationships, this study will use Habermas’ theory of

communicative action for the development of this

reflection.7, 8

Thus, the objective is to promote reflection on social skills

in the work of primary care nurses from the perspective of

Habermas’ communicative action. Such review is

significant since it will contribute to the (re)construction of

efficient communicative practices and, thus, can make this

space of action more effective in caring for people, families,

and communities.

Method

This is a reflection article that proposes a discussion about

social skills in the work of primary care nurses, based on

Habermas’ theory of communicative action,8 considering

that the work of nurses is recognized as a social practice

that promotes the construction of group relationships of a

complex and non-reductionist nature.

Development

Jürgen Habermas’ Theory of Communication Action

Jürgen Habermas, a German philosopher and sociologist

born in 1929, is one of the most important philosophers

and sociologists of the twentieth century and is considered

one of the last representatives of the Frankfurt School of

social theory and philosophy. His whole his work highlights

three fundamental ideas: the first lies in the construction of

a theory of communicative action; the second supports the

existence of a public sphere in which citizens, free from

political domination, could expose ideas and discuss them;

the third idea defends that the natural sciences follow an

objective logic.9

Habermas argues that societies are complex and deficient

in social integration. Consequently, they constitute

potential spaces of conflict, hinder studies on moral values,

and harm the freedom of individuals. Considering the

aforementioned, “human beings, in general, are often

searching for their own interests, mirrored through

calculations of advantages and arbitrary decisions. One acts

on the other and not with the other, i.e., a rational action

directed to merely strategic ends.”10 (p177)

The theory of communicative action seeks a

communicative concept of reason and a society in which

the community actively participates in both individual and

collective decisions, consciously and responsibly. This

theory understands the individual as a participatory being

who, before acting, evaluates the possible consequences,

considering the rules, norms, values, and laws. Therefore,

he should not act mechanically.10-11

The present theory concerns two types of actions:

instrumental action and communicative action. The

societies that have places where instrumental action is

prevalent are identified by the philosopher as a systemic

Pensar Enfermagem / v.27 n.01 / August 2023 | 81

DOI: 10.56732/pensarenf.v27i1.269

Theoretical Article

world, and those in which the prevalence is of

communicative action are named as lifeworld.12

The systemic world would be that in which instrumental

and reparative rationality predominates. Therefore, the

critique of instrumental reason is related to an expansion of

the concept of rationality. Thus, Habermas develops the

concept of communicative rationality, which is

fundamental to the world of work or communicative

reason, where the main objective is the search for one’s

own interests.9

The lifeworld would be the private sphere of family and

friendships and the public sphere is where the subjects can

understand the other spheres of the social system through

the communicative process and communicative action,

which in turn brings better decisions for individuals. The

world of communicative action is the lived world or the

lifeworld.10

Chart 1 represents aspects that underlie the mutual

understanding and the interface between the lifeworld and

acting based on norms, i.e., the systemic world.13

Chart 1 - Theoretical pillars of the Theory of Communicative Action,

Londrina/PR, Brazil, 2021

THEORETICAL

PILLARS

Guidelines for mutual understanding

versus guidance for success

Mutual understanding as a mechanism

for coordinating actions

Action situation and speech situation

The background of the lifeworld

Process of mutual understanding

between the world and the lifeworld

References to the world and validity

claims

World perspective

Source: Adapted from Habermas (1989)

Therefore, communication must be intelligible, considering

the universe of the receiver when elaborating a speech since

the main objective of communication is understanding. The

emphasis given by Habermas is the paradigm that dialogical

reason is the result of the process of intersubjective learning

because the subjects, historically situated, through speech,

establish an interpersonal relationship in which one can try

to understand that the contemporary world is governed by

communicative reason.13

Interfaces between social skills in the performance of nurses

in primary care and communicative action

The activities of nurses in PHC promote actions between

the health system and people through the production of

care, the management of the nursing team, and management

staff. “Care management is related to the private activities

of the nurse concerning planning, executing, coordinating,

supervising and evaluating nursing care, considering the

ethical-legal point of view”.14(p1)

Nurses, in daily practice, by exercising a leadership position,

need to provide their team with moments of integration that

favor the thinking, reflection, feeling, and action of all those

involved in activities related to patient care and community.

Given this, this professional must be skilled in

communication and relationship processes, as they are

inherent to their managerial performance. To this end, he

must have an accurate repertoire of social skills.15

In this scenario, the nurses’ daily practice permeates the

mechanistic and reductionist aspects. Therefore, an

appropriate communication process is essential, considering

the diversity of actions under their responsibility, besides

articulating the activities between their team and other

professionals, health sectors, and care networks as a whole,

with the common intention of serving the community.

Thus, it is necessary to implement effective communication

in the daily work of nursing, especially by nurses as leaders

of this team.15,16

According to Habermas, it is essential to provoke constant

and renewing learning “since consensus exists until the

moment of dissent,” when something or situations can be

renegotiated. He explains that “consensus does not occur

when the lifeworld is very different” because, in situations

where cultures are quite different, there may not be the

motivation of one or both parties to investigate, to search

for understanding through communication. Therefore,

communication is not restricted to what is said or written

since it turns into action, and this is how individuals interact

with each other “in an argumentative back and forth”. 15,16

The ideas mentioned above permeate the universe of SS

since skill classes encompass behaviors related to the

individual’s repertoire for a positive performance in society.

Therefore, SS are interdependent in the social daily life of

man, and communication is a skill that passes between all

others and is strictly intertwined with communicative action.

When an action requires the mutual understanding and

cooperation of peers for a common goal, there must be an

understanding of the individual contexts and positioning of

the recipient in front of the speech act.16

Through language, nurses can reduce weaknesses and

enhance common strengths in the relationships between the

health team members. The understanding of the relevance

and the capacity of communicative action make the

individualities, which form the heterogeneity of the team

and the particularities of their entities, stop being pieces that

harm communication and become contributions of the

consensus built by the participation of all.17

It is fundamental to have self-monitoring as a principle to

put into practice the behavior repertoire of the SS and

obtain a positive social performance for the individual to be

considered socially skilled and, for this, self-knowledge is

indispensable. Thus, according to Habermas, it is essential

to believe that people who behave irrationally are mistaken

in their self-knowledge, and people who manage to have a

reflective attitude about their subjectivity, through self-

reflection, can achieve their dreams and goals through their

own experience.16-18

82 | Bianconi, A.

Theoretical Article

However, it is essential to transcend the communicative

process characteristic of the lifeworld to enter the process

of reflective and critical rationality. In the managerial

language of the universe of attributions of socially skilled

nurses, it is crucial to use reflective rationality for an ideal

scenario reading and solution of critical issues in the care

process. It is necessary, through the argumentative

procedure, that the group seeks consensus based on

principles that seek to ensure its validity. Thus, truth does

not come from isolated reflection but is exercised through

dialogue guided by rules established by the group members

in an ideal dialogical situation. The excellent speech situation

consists in avoiding coercion and providing conditions for

all participants in the speech to exercise speech acts. For

Habermas, the criterion of truth does not consist in the

correspondence of the statement with the facts but in the

discursive consensus. 16-18

Some weaknesses found in the communication process can

affect the communicative action of nurses and their team,

such as inadequate data records, extremely fast information

dissemination speed (fake or not), generating complications

of various proportions and making it difficult to control the

communicative process.19

Thus, it is necessary for nurses, as team managers, to

ascertain whether strategic action is only guiding their

actions, so as not to face a lack of understanding. Thus, to

subsidize their actions, they must search for elements of the

social sciences and become aware of the importance of

communication in the process of care and management, so

that it can transform nurse-client, nurse-team and team-

client relationships. When nurses act according to their

social skills and based on communicative action, they can

provide understanding and great social transformations.15, 18

Effective communication is essential for teamwork. It is

necessary to establish effective communication between all

those involved, that is, managers, workers, patients, and

families to provide quality and more humane health care.17

Thus, it is essential to focus more on the communicative

action of the nurse’s work process to allow a better

performance and interpersonal relationship, with the

autonomy of its agents and mutual construction of usual

goals among the health team as a whole. In this way, the

members of the process recognize themselves as actors of a

social world amid cultural divergences, knowledge, and

subjectivities to provide an effective relationship.17

Finally, the study emphasizes that, in the Habermasian

theory, a communicative action is an act that aims at mutual

understanding through help between those involved,

corresponding to an effective strategy for other actions, and

it develops from an annular process in which the actor is the

initiator and product of the process.20

Conclusion

Jurgen Habermas’ Theory of Communicative Action

contributes to the nurse’s managerial practice and supports

a positive social performance since, by submitting their

attitudes to a communicative action, the nurse will be in

search of closer interaction with their team, patients/clients,

family and other professionals who constitute the care

networks. Health professionals, in general, need to be

committed to developing their social and communication

skills in order to promote more humanization and reduce

mechanistic acts.

Whereas Habermas suggests that interaction is

indispensable for social organization, everyone must

understand that the objective will always be the search for

consensus without duress. Nurses’ actions with their team

aim to promote the health and well-being of all, including

internal and external clients. Communicative action should

be a concern of all professionals.

Furthermore, the conceptions about communicative action,

in the habermasian view, can be implemented by managers

and nursing staff in their daily work, as they stimulate the

involvement of all, considering the particularities of each

one to build the whole, overcoming adversity and

maximizing the capabilities.

Finally, this reflection contributed so that nursing, especially

nurses who act as health service managers, can be instigated

to seek means capable of transforming strategic and

instrumental actions into a communicative action.

A limitation of the study was that few studies use Habermas’

philosophy of communicative action for a better basis of

effective communication in nursing. The article identified

the need for new studies that address this theme in greater

depth, which is one of the basic pillars of nursing care.

Authors’ contributions

ALMB: Conceção e desenho do estudo; Recolha de dados;

Análise e interpretação dos dados; Redação do manuscrito;

Revisão crítica do manuscrito.

SSM: Conceção e desenho do estudo; Análise e

interpretação dos dados; Redação do manuscrito; Revisão

crítica do manuscrito.

TSMM: Conceção e desenho do estudo; Análise e

interpretação dos dados; Redação do manuscrito; Revisão

crítica do manuscrito.

MCFLH: Conceção e desenho do estudo; Recolha de dados;

Análise e interpretação dos dados; Redação do manuscrito;

Revisão crítica do manuscrito.

Conflicts of interests

No conflict of interest declared by the authors.

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