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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
Promote a reflection on social skills in the work of primary care nurses from the perspective
of Habermas’ communicative action.
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.
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.
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.
Primary Care; Communication; Nursing; Philosophy in Nursing; Interpersonal Relations.
Aline Loiola Moura Bianconi1
Sonia Silva Marcon2
Tatiana da Silva Melo Malaquias3
Maria do Carmo Fernandez Lourenço Haddad4
1Nurse. PhD in Nursing. Graduate Program in
Nursing, State University of Londrina, Londrina,
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
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
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.
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.
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
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
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
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
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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