| 89
Pensar Enfermagem / v.28 n.01 / October 2024
DOI: 10.56732/pensarenf.v28i1.316
Quantitative Original Article
How to cite this article: Souza SP, Silva LB, Rosa DVL, Ferreira GCS, Reis GAX. Health Communication:
in the Voice of Hospitalized Patients. Pensar Enf [Internet]. 2024 Oct; 28(1): 89-95. Available from:
https://doi.org/10.56732/pensarenf.v28i1.316
Health Communication: in the Voice of
Hospitalized Patients
Abstract
Introduction
Health communication plays a crucial role in the therapeutic process for patients in inpatient
units. It is essential developing a strong bond between healthcare professionals, patients,
and/or their companions. Poor communication can lead to treatment complications,
affecting the patient and the healthcare team.
Objective
To investigate patients’ perceptions of health communication.
Methods
This study used a quantitative approach with patients over 18 hospitalized for more than
24 hours in a high-complexity hospital in the northwest region of Paraná, Brazil.
Results
A total of 98 patients participated, 58% of whom were women, with an average age of 66,4
years and 6,6 years of education. The average length of hospital stay was four days. Patients
rated communication as satisfactory with the medical team (93,9%) and nursing staff
(96,9%), 63,3% understood the reasons for laboratory tests, and 77,6% were questioned
about allergic reactions. Areas identified for improvement include scheduled treatment
(16,3%), the need for laboratory tests (59,2%), and information about possible medication
side effects (31,6%).
Conclusion
Patients’ perceptions of communication were generally positive. However, we identified
some weaknesses that could lead to care failures.
Keywords
Health Communication; Medical Assistance Team; Nursing Team; Patient Perspective.
Sonia Prates de Souza1
orcid.org/0009-0004-6699-2505
Letícia Botelho da Silva2
orcid.org/0009-0008-6148-6522
Daielle Vitória de Lima da Rosa3
orcid.org/0009-0006-5354-4513
Gabriele Caroline Sposito Ferreira4
orcid.org/0009-0000-1069-7241
Gislene Aparecida Xavier dos Reis5
orcid.org/0000-0002-6232-1905
1 Nursing student. Centro Universitário Ingá, Maringá-
PR, Brazil.
2 Nursing student. Centro Universitário Ingá, Maringá-
PR, Brazil.
3 Nursing student. Centro Universitário Ingá, Maringá-
PR, Brazil.
4 Nursing student. Centro Universitário Ingá, Maringá-
PR, Brazil.
5 PhD in Nursing. Centro Universitário Ingá, Maringá-
PR, Brazil.
Corresponding author:
Sonia Prates de Souza
E-mail: soniapratessouza@hotmail.com
Received: 18.03.2024
Accepted: 20.08.2024
90 | de Souza, SP.
Quantitative Original Article
Introduction
Communication is a fundamental skill in healthcare
settings, directly influencing the quality of care and enabling
a humanizing approach to patient care.1 Poor
communication can lead to anxiety, fear, distrust, and non-
adherence to treatment among patients and their families,2
while also weakening the relationship and bond between
healthcare professionals and patients.3 Communication
must be individualized, addressing each patient’s needs and
expectations, and should be clear and understandable, using
accessible language.4
According to Trindade,5 patients’ perceptions in a hospital
setting are evaluated through three components: 1)
technical, which relates to elements involved in healthcare
delivery, such as the appropriateness of care, scientific
advancements, and professionals’ abilities; 2) interpersonal,
which refers to the professional-patient relationship,
conveying information with kindness and ethics; and 3)
comfort, which pertains to the conditions provided in a
healthcare unit, enabling patients to feel at ease. Addressing
doubts, listening, engaging in dialogue, and promoting
autonomy through self-care improve the hospital
experience and significantly enhance patient care.
However, there are also barriers to overcome.5
Santos6 identifies inadequate communication as one of the
main causes of adverse events, serving as the primary factor
behind poor-quality patient care. Clear and objective
communication can promote high-quality care, reducing
the occurrence of preventable and undesirable harm. This
communication must be effective among healthcare
professionals and between professionals and
patients/companions.6 Numerous factors can affect
communication quality, including human factors like
communication breakdowns among caregivers,
interruptions, failures or deficits in established clinical
protocols, neglect in care, and inadequate communication
systems.7
Evidence also indicates that nonverbal communication is
crucial in healthcare communication, conveying emotions
and feelings that patients and companions can interpret.8
Empathy and sensitivity from healthcare professionals are
equally important in communication, as patients need to
feel welcomed and understood.9 Thus, studying effective
communication between patients and nursing staff can
contribute to improving healthcare quality by utilizing best
communication practices, active listening techniques,
constructive feedback, and conflict resolution.
Given this context, our study addresses the following
research question: What is the patient’s perception of
health communication? To answer this question, we aim to
investigate patients’ perceptions of health communication.
Methods
We conducted an exploratory, descriptive study using a
quantitative approach in a high-complexity public hospital
within the surgical and medical clinic units. The study took
place from June 26, 2023, to July 31, 2023, involving
hospitalized patients from these units.
We interviewed patients at their bedside using
a 37-question survey developed by the authors, which
included sociodemographic data such as sex, age, reason
for admission, and length of stay. Additionally, 33 questions
focused on health communication, covering topics like
medication, imaging and laboratory tests, medical
diagnoses, and nursing care.
We included patients over 18 years old who had been
hospitalized for at least 24 hours in the surgical and medical
clinics. We excluded patients with cognitive impairments,
diagnosed psychological disorders, or those under contact,
droplet, aerosol, or surveillance isolation at the time of the
interview.
Before data collection, we informed participants about the
study’s objectives, data collection methods, and voluntary
nature, addressing any questions. After obtaining verbal
consent, we requested participants to sign the Informed
Consent Form, leaving one copy with the patient and
retaining another with the research team. We analyzed the
data using relative and absolute frequency.
We adhered to all ethical guidelines for research involving
human subjects, and the Research Ethics Committee
approved the study under approval number 6.133.311.
Results
The study included 98 patients, of whom 56 (58%) were
women. The mean age was 66,4 years (SD = 19,29; median
= 71; min/max: 21/98) and the average education was 6,68
years (SD = 5,49; median = 5). Forty-three patients (44%)
self-identified as white, and 49 (50%) were admitted to the
medical clinic unit, with an average hospital stay of four
days (SD = 3,51; median = 3).
As shown in Table 1, the most common reasons for
hospitalization were diseases of the respiratory system
(n=41; 41,84%), digestive system (n=18; 18,37%), and
genitourinary system (n=14; 14,29%).
Pensar Enfermagem / v.28 n.01 / October 2024 | 91
DOI: 10.56732/pensarenf.v28i1.316
Quantitative Original Article
Table 1 – Reasons for hospitalization by chapter of the International Classification of Diseases (ICD-10) among patients
admitted to surgical and medical clinics. Paraná, Brazil – 2023.
n
% ≅
41
41,8
18
18,4
14
14,3
11
11,2
06
6,1
06
6,1
02
2.0
≅ Approximate value. Source: Authors’ data, 2023.
In terms of communication with the medical team, most
patients felt comfortable asking questions (n=92; 93,9%)
and expressing their feelings (n=91; 92,9%). However, as
shown in Table 2, there was a noted weakness in
understanding the scheduled treatment (n=16; 16,3%).
Table 2 – Patient perception of communication with the medical team during hospitalization. Paraná, Brazil - 2023.
Analyzed variables
Yes
n
% ≅
No
n
% ≅
Information about the reason for hospitalization
89
90,8
09
9,2
Understanding of the reason for hospitalization
88
89,8
10
10,2
Information about the treatment to be administered
84
85,7
14
14,2
Understanding of the treatment information
82
83,7
16
16,3
Felt comfortable asking questions
92
93,9
06
6,1
Felt comfortable expressing feelings
91
92,9
07
7,1
Received the attention they expected
90
91,8
08
8,2
≅ Approximate value. Source: Authors’ data, 2023.
Regarding patients’ perceptions of communication with the
nursing team, the vast majority reported feeling attended to
(n=95; 96,9%) and comfortable expressing their feelings
(n=92; 93,9%), as shown in Table 3.
Table 3 – Patient perception of communication with the nursing team during hospitalization. Paraná, Brazil - 2023.
Analyzed variables
Yes
n
% ≅
No
n
% ≅
Information about the necessary care for treatment
80
81,6
18
18,4
Understanding of the care provided
80
81,6
18
18,4
Felt comfortable expressing feelings
92
9,9
06
6,1
Received the attention they expected
95
96,9
03
3,1
≅ Approximate value. Source: Authors’ data, 2023.
As for the communication related to laboratory and
imaging tests, we observed that information about the
reasons for laboratory tests (n=62; 63,3%), X-rays (n=47;
47,9%), and CT scans (n=50; 51%) was predominantly
conveyed. However, patient understanding did not match
this proportion, with lower comprehension rates (n=58;
59,2%, n=46; 46,9%, n=48; 48,9%) respectively, as
presented in Table 4.
Table 4 - Patient perception of communication during laboratory and imaging exams. Paraná, Brazil - 2023.
Analyzed variables
Yes
n
% ≅
No
n
% ≅
Not applicable
n
% ≅
Information about the reason for laboratory tests
62
63,3
28
28,6
08
8,2
Understanding of the reason for laboratory tests
58
59,2
30
30,6
10
10,2
Information about the reason for X-rays
47
47,9
11
11,2
40
40,8
Understanding of the reason for X-rays
46
46,9
12
12,2
40
40,8
Information about the reason for CT scans
50
51,0
08
8,2
40
40,8
Understanding of the reason for CT scans
48
48,9
08
8,2
42
42,9
≅ Approximate value. Source: Authors’ data, 2023
Concerning the communication received during the
medication administration process, participants reported
being asked about allergic reactions (n=76; 77,6%).
However, they were not frequently informed about
possible medication side effects (n=31; 31,6%), as shown
in Table 5.
92 | de Souza, SP.
Quantitative Original Article
Table 5 - Patient perception of communication during medication administration. Paraná, Brazil - 2023.
Yes
n
% ≅
No
n
% ≅
Not applicable
n
% ≅
59
60,2
32
32,7
07
7,1
34
34,7
41
41,8
23
23,5
76
77,6
22
22,4
--
--
70
71,4
28
28,6
--
--
72
73,5
26
26,5
--
--
31
31,6
66
67,3
01
1,0
18
18,4
80
81,6
--
--
82
83,7
14
14,3
02
2,0
≅ Approximate value. Source: Authors’ data, 2023
Participants identified several key pieces of information
they wished to receive from the nursing team, including
updates on their clinical progression, explanations of vital
sign measurements, guidance on home and hospital care,
positive affirmations about their treatment, test results, and
discharge plans. They also emphasized the importance of
the nursing team listening attentively to their concerns.
Concerning the communication with the medical team,
patients highlighted the importance of being informed
about the duration of antibiotic use during hospitalization,
their clinical progression, hospital discharge plans,
treatment duration, the possibility of a cure for their
condition, detailed explanations about their disease and
required treatment, referrals for social support, and
receiving truthful information in a comprehensible
language. They also expressed a desire for more frequent
conversations with the medical team.
Discussion
According to the User Rights Charter of the Unified Health
System, all citizens have the right to receive clear, objective,
respectful, and comprehensible information about their
health.10 Health communication serves as a cornerstone for
providing quality care. Effective communication between
patients and healthcare professionals fosters bonding,
improving treatment adherence and reducing the likelihood
of adverse events.6
In this study, we observed satisfactory results regarding
communication with the medical team, aligning with the
findings of Witiski,11 who reported that these professionals
understand that effective communication leads to safer
patient care, while its absence can result in care failures.
Most patients in our study expressed satisfaction with the
care received during their hospital visit. Similarly, in a study
that evaluated hospitalized patients’ perceptions of the
medical team in a university hospital, patients reported
satisfaction and feeling understood through special
attention given to their symptoms and during physical
exams.12
Conversely, other research identified a communication gap
between doctors and patients, highlighting the importance
of incorporating communication skills training into medical
education to enhance this critical competency, resulting in
more humanized care.13
Our study also found that patients felt comfortable
expressing their feelings to the medical team,
demonstrating an effective process of communication,
which is consistent with findings from another study.
Additionally, research has shown that effective
communication regarding diagnosis and therapeutic
conduct fosters trust, contributing to collaborative care
planning.12
However, some patients reported weaknesses in the
information provided about treatment and difficulties
understanding the information conveyed by the
professional. In a study aiming to assess hospitalized
patients’ perceptions of communication with surgeons and
physicians in a university hospital, patients expressed
dissatisfaction due to using incomprehensible technical
terms and insufficient information.13 Similar findings were
reported in Corrêa’s study, where patients felt dissatisfied
with the lack of information provided.14
Regarding the medical team’s performance, patients
generally reported receiving the attention they expected,
considering factors such as attention, respect, empathy, and
sensitivity to their complaints and situations. Another study
concluded that the physician-patient relationship was
strengthened because professionals sensitively addressed
patients’ reported needs and problems, leading to
satisfaction with the care received.12
Participants indicated a positive perception of
communication with the nursing team during
hospitalization. Effective communication from the nursing
team regarding procedures, interventions, and treatment
plans is crucial for patients to understand and actively
participate in their care.15 Patients who do not receive
adequate information may struggle to understand the
importance of certain care practices and feel less involved
in their treatment process.16
We infer that these positive results stem from patients’
understanding of the care provided, feeling comfortable
expressing their feelings, and receiving the attention they
expected. These factors contribute to emotional well-being,
reduced stress, and anxiety associated with
hospitalization.16 Moreover, we believe that the nursing
team responsible for caring for the patients in this study
strives to listen and respond to patients’ needs, which is
fundamental for building a relationship of trust and mutual
respect.16
Pensar Enfermagem / v.28 n.01 / October 2024 | 93
DOI: 10.56732/pensarenf.v28i1.316
Quantitative Original Article
Regarding communication during laboratory and imaging
tests, we observed generally positive evaluations of this
process. A similar study found that 93,6% of participants
understood the reason for their tests.16 It Is important to
note that hospitalization often puts patients in a vulnerable
state, where undergoing tests can create a sense of being
cared for, blending genuine understanding of the need for
the test with passive acceptance.17
Understanding the purpose of tests is a crucial aspect of
effective communication, as effective communication is
not something tangible, requiring commitment from the
healthcare professional involved.17 Another study showed
that effective communication also demands that
professionals are willing to engage with patients.18 This
engagement enhances patient satisfaction, fosters treatment
acceptance, and contributes to patient safety and the
provision of high-quality care.1
More than half of the patients who underwent CT scans
reported receiving information about the procedure, which
is a favorable outcome. As information availability
increases, patients gain more knowledge about the care they
receive.17 This understanding enables patients to develop
appropriate perceptions and fosters effective
communication between patients and healthcare
professionals.10
In terms of communication during the medication process,
we mostly found positive results in patient reports.
However, areas for improvement include the lack of
information about medication discontinuation. Inadequate
or absent communication within the multidisciplinary team
is one of the greatest deficiencies affecting care quality,
directly impacting the safety of patients and healthcare
providers.19
A lack of information can lead to adverse events related to
care,20 making it crucial to ensure accurate and appropriate
communication.21 Medication prescriptions are medical
documents created based on patient needs and treatment
plans,22 and the nursing staff administers medications.
When they are discontinued, this must be communicated
to the patient to ensure safe care.
Our findings emphasize that health communication goes
beyond merely transmitting information; it involves
understanding, empathy, and building trust between
patients and healthcare teams. Improving communication
in all these aspects is essential for ensuring effective, safe,
and patient-centered care. The areas for improvement
identified in this study provide a clear path for interventions
that can transform patient experiences and
healthcare quality.
From this study, we recognize the need to consider cultural
and linguistic barriers in health communication. In a high-
complexity hospital where patients may come from diverse
cultural and socioeconomic backgrounds, adapting
communication to overcome these barriers is essential to
ensure that all patients receive understandable and
equitable care. Furthermore, the importance of ongoing
communication education and training programs for all
healthcare professionals is highlighted. These programs
should focus not only on technical skills but also on
interpersonal and empathetic skills, which are crucial for
effective communication and creating a patient-centered
care experience.
Conclusion
We conclude that the patients’ perceptions of health
communication were satisfactory, as they felt comfortable
expressing their concerns and received the attention they
expected. This communication contributes to building a
relationship of trust and mutual respect between patients
and healthcare teams. However, we identified
communication weaknesses regarding information about
possible medication side effects. The ability to convey
information clearly, listen attentively to patients’ concerns,
and respond empathetically enhances the patient
experience and contributes to the safety and effectiveness
of care provided.
Authors’ Contributions
Souza, Sonia P: Data collection; Data analysis and
interpretation; Statistical analysis; Manuscript writing;
Silva, Letícia B: Data collection; Data analysis and
interpretation; Statistical analysis; Writing of the manuscript;
Rosa, Daielle VL: Data collection; Data analysis and
interpretation; Statistical analysis; Writing of the manuscript;
Ferreira, Gabriele CS: Data collection; Data analysis and
interpretation; Statistical analysis; Writing of the manuscript;
Reis, Gislene AX: Data analysis and interpretation;
Statistical analysis; Critical revision of the manuscript.
Conflicts of interest and Funding
No conflicts of interest have been declared by the authors.
Sources of support / Financing
The study was not funded.
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