PROGRAMA DE EDUCAO CONTINUADA A DISTNCIA

Portal Educao

CURSO DE

INGLS PARA PROFISSIONAIS DE

SADE

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CURSO DE

INGLS PARA PROFISSIONAIS DE

SADE

MDULO II

Ateno: O material deste mdulo est disponvel apenas como parmetro de estudos para este
Programa de Educao Continuada. proibida qualquer forma de comercializao ou distribuio
do mesmo sem a autorizao expressa do Portal Educao. Os crditos do contedo aqui contido
so dados aos seus respectivos autores descritos nas Referncias Bibliogrficas.

MDULO II

COMUNICAO EFICAZ COM O PACIENTE

Objetivos de aprendizagem:
Ao final deste mdulo, esperamos que voc seja capaz de:
interagir de forma eficaz com os pacientes
criar um clima de confiana e de compreenso
ajudar a preencher formulrios
fazer anamnese e interpretar sintomas
lidar com situaes de emergncias
dominar os hesitation fillers, as conversation starters e os verbal clues
oferecer ajuda e orientar sobre procedimentos, rotinas hospitalares e
medicaes
lidar com as reclamaes de pacientes
reconhecer os sinais da comunicao no-verbal
lidar com diferenas culturais de pacientes estrangeiros

2 COMMUNICATING EFFECTIVELY WITH PATIENTS

Raras so as pessoas que no tenham qualquer histria de insatisfao em

relao aos profissionais de sade. Na maioria das vezes, as queixas sobre o
atendimento dizem respeito a falhas de comunicao com o profissional: a
inabilidade em acolher e escutar o suficiente para tirar concluses; a utilizao de
jargo excessivamente tcnico e pouco compreensvel ao ouvinte; ou mesmo certa
frieza demonstrada pelo profissional diante da situao global de vida do paciente.
Os profissionais de sade, em geral, encorajam pouco as perguntas por
parte dos pacientes, no escutam, nem se interessam por conhecer as

preocupaes e expectativas deles. Por outro lado, os pacientes acabam por

adoptar com frequncia atitudes passivas e dependentes, concordantes com o
modelo biomdico, que valoriza excessivamente as tcnicas de diagnstico e
tratamento e desvaloriza o sofrimento e a comunicao.
hoje largamente aceite que a promoo da relao profissional de sadepaciente conduz a um incremento na qualidade dos cuidados de sade pois contribui
para melhorar o processo de entrevista mdica, facilita a compreenso e
memorizao das recomendaes mdicas e, consequentemente, aumenta a
adeso ao tratamento, melhora o prognstico, aumenta a satisfao e diminui
denncias e processos contra profissionais de sade.
Certos questionamentos passam a fazer sentido:

O que uma boa comunicao?

Do que precisamos para nos comunicar melhor?

Que aspectos da minha forma de me comunicar podem ser

transformados para melhorar a qualidade do nosso atendimento?

2.1 FILLING OUT FORMS

FIGURA 33 FILLING OUT FORMS

FONTE: Disponvel em http://innovate.pharmacy.pitt.edu/communitydwelling.html

Acesso em 10 jun.

2013

Uma das problemticas principais enfrentadas por um estrangeiro na

entrada no hospital o preenchimento dos formulrios. Vamos analisar junto como
Pedro, nosso estudante de medicina, ajuda o senhor Vong no procedimento.

PEDRO: Hello, Mr. Vong. I'm here to help you fill out the form.
Mr. VONG: Hi. Thanks. My printing's not so good these days.
PEDRO: O.K. What is your middle name?
Mr. VONG: X. My middle name is Xavier.
PEDRO: Well, that's an interesting name. Now, what's your address, and zip code?
Mr. VONG: 1320 Garden Street. That's in Riverside. The zip code is 92505.
PEDRO: All right. What's your date of birth?
Mr. VONG: June 1st, 1946.
PEDRO: Oh, my father was born on June 1st, too. It's a small world! Now they need
to know what medications you're taking. We can get that from your chart. How about
smoking?
Mr. VONG: I smoke about a pack a week not much.
PEDRO: O.K., well, we can fill out the rest of the form based on your chart. We'll
submit the form as soon as possible.
Mr. VONG: Thanks.

Melhorar a qualidade e a humanizao do atendimento em sade pressupe

a escuta ativa do paciente, a empatia e a resposta partilhada pela soluo do
problema e tambm a acessibilidade. Sem a ajuda do nosso Pedro, o Mr. Vong teria
enfrentando varias dificuldades em preencher o formulrio sozinho.
Antes mesmo de comear a analisar essa conversa, vamos lembrar como de
acordo com as tradies do mundo anglo-saxnico, o sobrenome do patriarca o
que domina. A diferena do costume brasileiro de manter as origens do pai e da me
em seu filho, o norte americano tende a usar simplesmente o sobrenome do pai.
Assim quando uma mulher se casar, normalmente ela abre mo do seu sobrenome
para levar o do marido. Em tempos mais modernos, muitas mulheres acabam
optando por no mudar seus nomes aps o casamento ou por acrescentar o
sobrenome do parceiro depois de um hfen, por exemplo, Mary Smith-Anderson.

DID YOU KNOW? H muitos famosos que resolveram fazer diferente e quem
escolheu adotar o sobrenome da outra pessoa foi o marido. John Lennon adotou o
sobrenome de Yoko Ono e seu nome legal antes de morrer era John Winston Ono

Lennon. Jay-Z foi outro, juntou o sobrenome de Beyonc ao seu e passou a se

chamar Shawn Knowles-Carter.

Em pases de lngua inglesa usa-se somente o primeiro e o ltimo nome

quando algum se apresenta ou apresenta a algum. Mesmo que haja nomes
intermedirios (middle names), geralmente constam em documentos, reservas e
qualquer tipo de cadastro apenas o primeiro e o ltimo nome (muitas vezes o
sobrenome vem antes do nome em cadastros). Ento se algum se chama "Joo
Oliveira da Silva" deve se apresentar como "Joo Silva" e seu nome aparecer em
cadastros como "SILVA, Joo" ou simplesmente "Silva, J.". Lembramos que o uso do
primeiro nome geralmente restrito a situaes informais, ou seja, com amigos,
familiares e pessoas de tratamento ntimo.
Em situaes formais, como no relacionamento professional de sadepaciente, deve-se sempre dirigir-se e apresentar a pessoa com um pronome de
tratamento (title) mais o sobrenome (last name). Para homens, usa-se sempre "Mr.",
para mulheres geralmente "Ms." Antigamente, "Miss" era apenas usado para
mulheres solteiras, e "Mrs." para mulheres casadas com o sobrenome do marido.
Hoje em dia muitas mulheres no se sentem bem com esse tratamento, pois pode
dar a conotao de velhice. O uso de "Mrs." ento ficou praticamente restrito a
senhoras idosas casadas que pedem de ser chamada dessa forma. Ento, se um
homem se chama "Joo Silva", ser chamado formalmente de "Mr. Silva". Se uma
mulher se chama "Jlia Pereira" ser chamada de "Ms. Pereira". Se for idosa e
casada, muito provavelmente "Mrs. Pereira".

Resumindo:
Mr. + last name (for men)
Ms. + last name (for women)
Mrs. + last name (for married women who ask you to call them Mrs.)
Note: For children and young people, no address term and no last name is needed.
Note: If patients or family members want to change the formality of the relationship,
they will ask you to use their first name.

Por exemplo,
A nurse meets a patient.

NURSE: Good morning, Mrs. Smith. My name is Mary and I'm going to be your nurse
today.
Mrs. WALKER: Oh, please, call me Helen.
NURSE: O.K., Helen, it's nice to meet you.
Mrs. WALKER: It's nice to meet you too.

Se por algum motivo houvesse a emergncia de interagir com uma pessoa no

hospital sem conhecer ou lembrar o sobrenome dela, podemos usar:
Sir (for men)
Ma'am (for older women, especially in the US)
Miss (for very young women)
Chaplain / Father / Reverend / Pastor (por figuras religiosas)
Note: Doctor and Nurse may also be used without a last name.

Vamos analisar juntos agora um possvel formulrio em ingls, comeando pelos

dados pessoais.
PERSONAL INFORMATION:
1. Name (first, middle, last name) _____________________
2. Gender:

MALE

3. Marital Status:

FEMALE

SINGLE

4. Birth Date: ___/___/___

MARRIED

DIVORCED

WIDOWED

Age: ________

5. Country of Citizenship: ___________

6. Passport Number: ___________ Passport Expiration Date: ________________
7. Address while in Brazil: ____________________________
City: ______________State: __________ Zip Code:______________
8. IN CASE OF EMERGENCY, CONTACT: ________________ Phone: __________
1. Name: lembra-se de escrever seu nome, como est escrito no passaporte,
prestando ateno s indicaes pedidas: first name (primeiro nome), middle name
(nome do meio) e last name ou family name ou surname (sobrenome)
2. Gender or Sex: male (masculino) or female (feminino)
3. Marital Status (estado civil): single solteiro(a) - ou married - casado(a) ou
divorced - divorciado(a) ou widowed vivo(a).
4. Birth Date (data de nascimento): confirmar se est em DD/MM/AA (dia/ms/ano)
e preencher. Lembra-se que existem apenas duas formas abreviadas de usar as

datas, a do ingls britnico, que igual brasileira, mas cuidado com a do ingls
americano onde o ms seguido de dia e ano, se for preciso.
Por exemplo,
15 July 2013 ou 15/7/2013. (IB data seguida de ms)
July 15th, 2013 ou 07/15/13. (IA ms seguido de data)
5. Country of Citizenship (pas de cidadania): Brazil (se for brasileiro).
6. Passport Number (nmero do passaporte) e Passaport Expiration Date (Data
de Vencimento do Passaporte): esto escrito nas primeiras pginas de seu
passaporte.
7. Address while in Brazil: o endereo enquanto no Brasil. Lembramos que o zip
code uma expresso em ingls que significa Zone Information Postal e
corresponde mais ou menos ao CEP brasileiro. A nica diferena que o zip code
formado por 5 nmeros, um hfen seguido de mais quatro nmeros, que
identificam o endereo do destinatrio.
8. IN CASE OF EMERGENCY, CONTACT: em caso de emergncia, contate. Tente
conversar com o paciente e ver se h algum que possa ajud-lo no Brasil.

ACTIVITY 8 (part 1): Mach the information items on the left with the category on
the right.
Gonzles
04/11/1987
2345 Broadway
Long Beach

last name
date of birth (DOB)
address
city

ACTIVITY 8 (part 2): Mach the information items on the left with the category on
the right.
California
Rodrigo
90806
(562) 123-45677

state
first name
zip code
telephone number

2.2 PATIENT-CENTERED INTERVIEWING

FIGURA 34 PATIENT-CENTERED INTERVIEWING

FONTE: Disponvel em http://www.thedentalelf.net/2012/10/05/motivational-interview-as-a-prelude-toperiodontal-treatment-had-limited-impact-on-oral-health/ Acesso em 10 jun. 2013

Pedro est agora na sala de triagem do hospital, onde ele acompanhar os

pacientes aos consultrios mdicos.

HEALTH CARE WORKER: Good morning. Have a seat, please. What seems to be
the problem?
PATIENT: Well, I have a rash on my arm.
HEALTH CARE WORKER: Uhm, how long have you had the rash?
PATIENT: It's been about a week.
HEALTH CARE WORKER: Are you taking anything for it?
PATIENT: I put some cream on it but it doesn't seem to be helping.
HEALTH CARE WORKER: I see. Are you allergic to any medications?
PATIENT: Not that I know of.

ACTIVITY 9: Choose the correct answer to these questions based on the

dialogue.
How long has the patient been having a rash?
A week.
A week ago.
A month.
About a week.

Is the patient taking any medications?

No, nothing.
Yes, she put some cream on the rash.
Yes, she put some aloe vera on the rash.
She doesn't know.
Is the patient allergic to any medications?
Yes, she is.
No, she isn't.
Maybe.
She doesn't know.
2.2.1 Hesitation Fillers
Por sua grande surpresa, Pedro repara que at os nativos, em conversas
formais, usam pausas e hesitaes. Falar rpido no significa automaticamente falar
fluente e s dificulta o entendimento da mensagem pelo interlocutor. Pelo contrario,
pausas e hesitaes em momentos oportunos well / uhm / I see - tm o propsito
de tornar a fala mais natural e fluente. Em comeo de enunciado os hesitation fillers
esto ligadas ao planejamento global do discurso enquanto que as que ocorrem no
interior do enunciado tm relao com a busca por vocbulos ou termos especficos.
s vezes iniciamos um enunciado, mas precisam interromp-lo para organiz-lo a
fim tornar clara a mensagem.
Podemos at no ser to fluentes como um nativo, mas se sabemos como
usar esses hesitation fillers, muito provavelmente evitaremos muitos momentos
frustrantes de silncios constrangedores. Poderemos assim ganhar tempo precioso
para lembrar aquela palavra ou organizar a nossa mensagem de forma mais clara e
eficaz. At um simples "I don't know" soa bem mais natural se comeamos com
"Well ... I don't know."

Vamos analisar agora os hesitation fillers mais comuns.

WELL: provavelmente a palavra mais popular em ingls usada para ganhar tempo,
Ento, se temos o hbito de dizer um simples "eh ..." ou "ah ..." para preencher
pausas, vamos comear usando 'well ...' no lugar.
I SEE: literalmente significa "I understand" e funciona como um mantra para
assegurarmos que est tudo bem e que sabemos como lidar com a situao.

YOU SEE: esta expresso perfeita quando preciso explicar algo para algum e o
nosso interlocutor est hesitando um pouco ao pensar em como explicar tudo em
detalhes.
ALL RIGHT: usado normalmente como resposta afirmativa mas as vezes tambm
como hesitation filler para ganhar mais tempo e encontrar as melhores palavras e
estruturas para explicar determinado conceito em detalhes.

2.2.2 Office Visit

FIGURA 35 DOCTOR-PATIENT OFFICE VISIT

FONTE: Disponvel em http://www.epilepsy.org.au/gpepilepsyeducation Acesso em 10 jun. 2013

PATIENT: Good afternoon.

HEALTH CARE WORKER: Good afternoon. Have a seat, please. So, what have you
come in for today?
PATIENT: I've been having some pain in my joints, especially the knees.
HEALTH CARE WORKER: I see. How long have you been having the pain?
PATIENT: It started 3 or 4 weeks ago. It's been getting worse recently.
HEALTH CARE WORKER: Are you having any other problems like weakness, fatigue
or headaches?
PATIENT: I'm not feeling very well.
HEALTH CARE WORKER: Right. How much physical activity do you get? Do you
play any sports?
PATIENT: Some. I play soccer about once a month and I take my dog on a walk
every evening.

HEALTH CARE WORKER: OK. Let's have a look. Can you point to the area where
you are having pain?

Pedro fica muito confuso quando questionado sobre quais so as diferenas

entre fatigue e tiredness. Vamos ler juntos as definies.

Individuals who are tired still have a fair amount of energy, so although they
may feel forgetful, and impatient, and experience gradual heaviness or weakness in
muscles following work, this is often alleviated by rest. Fatigue, on the other hand, is
characterized by difficulty concentrating, anxiety, a gradual decrease in stamina (=
decrease in physical and/or mental strength), difficulty sleeping, increased sensitivity
to light and the limiting of social activities once viewed as important. Individuals with
exhaustion report frank confusion that resembles delirium, emotional numbness,
sudden loss of energy, difficulty both in staying awake and in sleeping and complete
social withdrawal.

Como podemos reparar, muito importante reconhecer a diferena entre

tiredness (cansao) e fatigue (fadiga fsica e mental) e levar a srios os sintomas
que podem esconder problemas bem mais graves.

ACTIVITY 10: Choose the correct answer to these questions based on the
dialogue.
What seems to be the patient's problem?
Broken knees
Fatigue
Tiredness
Joint pain
Which joints are bothering him the most?
Elbow
Wrist
Knee
Hip
How long has he been having this problem?
Three or four years
Three or four days
Three or four months
Three or four weeks

Which phrase best describes the amount of exercise the patient gets?
He works out a lot.
He gets some exercise, not a lot.
He doesn't get any exercise.
He goes to the gym every day.

Vamos agora acompanhar Pedro na prxima consulta.

DOCTOR: How long have you been having this pain?
PATIENT: It started in June. So for more than five months now. My stomach hurts
after some meals, but not always.
DOCTOR: You should have come in earlier. Have you changed your eating habits
during this period?
PATIENT: No, not really. Well, that's not true. I'm eating the same food, but less. You
know, the pain seems to come and go.
DOCTOR: How strong is the pain exactly? On a scale of one to ten, how would you
describe the intensity of the pain?
PATIENT: Well, I'd say the pain is about a two on a scale of one to ten. Like I say, it's
not really bad. It just keeps coming back
DOCTOR: How long does the pain last when you get it?
PATIENT: It comes and goes. Sometimes, I hardly feel anything. Other times, it can
last up to half an hour or more.
DOCTOR: Is there a type of food that seems to cause stronger pain than other
types?
PATIENT: Hmmm heavy food like steak or lasagna usually brings it on. I've been
trying to avoid those.
DOCTOR: Does the pain travel to any other parts of your body chest, shoulder or
back? Or does it remain around the stomach area?
PATIENT: No, it just hurts here.
ACTIVITY 11: Choose the correct answer to these questions based on the
dialogue.
How often does the patient have this pain?
After every meal.
After some meals.
Between meals.
At lunch.

How long has the patient been having stomach pains?

For less than five weeks.
For more than five months.
For less than five days.
For more than five days.
Has the patient changed his eating habits during this period?
No, not at all.
He doesn't know.
Yes, he's eating different types of food.
Yes, he's eating the same food, but less.
How severe is the pain?
Not very severe.
Extremely severe.
Not at all severe.
He doesn't have any pain.
What types of food causes stronger pain?
Vegetables and fruits.
Sweets.
Cold beverages.
Heavy food like steak and lasagna.
Depois de escutar com ateno outras vrias consultas, Pedro encontra um
certo esquema com alguma perguntas padro. Vamos ver juntos as anotaes dele.

Good morning / Good afternoon / Good evening

Have a seat, please.

#1- What have you come in for today? / What brings you in today?
What seems to be the problem? Does something hurt? Have you been having some
unusual symptoms? Are you pregnant? Did you fall?

#2- What are your symptoms? / What is hurting?

What is going on with your body? What have you been feeling?
Common symptoms: dizziness, cough, stomach ache, diarrhea, head ache, stomach
ache, vertigo, constipation, sore throat, sleeplessness, feeling bad, etc.

#3- How long has this been going on?

How long have you been having this pain? How many days or months have your
symptoms been going on? Have you had the symptoms before? If so, what was done
about it last time?

#4- How strong is the pain exactly?

How bad is the symptom? On a scale of one to ten, how would you describe the
intensity of the pain? Can you point to the area where you are having more pain?
Does it come and go or is it constant? Does it affect your feelings, home life or work
life? If so, to what degree are these parameters affected? Does it hurt when I push
here?

#5- Has the pain been getting better or worse?

When do you feel the worst? Is it always the same time of day? Does it hurt all of the
time? After you do a certain activity? Do you have any idea what may trigger your
symptom? Do you have any idea what may make your symptom better or worse?

#6- Have you noticed any other symptoms?

Are you having any other problems? Do you have a family history of ...? You may ask
about a list of diseases like: cancer, diabetes, hypertension, depression, anxiety,
heart problems, etc.
Do you have any current medical problems? Have you ever been hospitalized? Have
you ever had a test such as an X-ray or CAT scan?

#7- Have you had any previous surgeries?

Have you ever been operated on and if so, when? Were there any complications?

#8- Do you take any medicines, supplements or herbal remedies?

If so, what dose, how often and what is it meant to be treating?

#9- Are you allergic to any medication?

Have you ever had an allergic or adverse reaction to any medicines?

#10- SMOKING, DRUG AND ALCOHOL HISTORY

Have you ever, or do you currently smoke? How often and how much alcohol do you
drink? Do you or have you ever taken any recreational drugs?

#11- Are you pregnant?

Have you had any pregnancies? Were there any abnormalities or complications
during any of the pregnancies? When was your last period?

#12- Are you sexually active?

Do you have more than one sexual partner? Do you use any method of protection?
Have you ever had an STD? Have you recently had any screening tests such as a
breast examination or a Pap test?

DID YOU KNOW? What are the differences between medicine and medication?
In a sense, medicine and medication are synonymous yet they are also two different
words depending on how they are used. The term medicine is more commonly
used, but medication would be the first choice used by medical professionals.

2.3 HANDLING EMERGENCIES

Apesar de haver sempre planos de emergncias, sempre bom saber como

se comunicar com clareza e eficincia em todas as circunstancias. Vamos ver como
Pedro consegue lidar com uma situao onde um dos visitantes perde
completamente o controle.
FIGURA 36 EMERGENCY ROOM

FONTE: Disponvel em http://www.regroup.com/welcome/boston-hospitals-give-tips-on-handlingpatient-surges-resulting-from-terrorist-attacks/ Acesso em 10 jun. 2013

PEDRO: We have a Code Gray in Room 601!

SUPERVISING NURSE: Did you say Code Gray?

PEDRO: Yes, Code Gray!
SUPERVISING NURSE: Is the patient under control?
PEDRO: Yes, the patient is under control. The visitor is out of control.
SUPERVISING NURSE: Instruction: Maintain visual contact. We will get security
there A.S.A.P.*
PEDRO: O.K., I will maintain visual contact.
SUPERVISING NURSE: Is the visitor violent?
PEDRO: Yes, he's violent. He's breaking things in the room.
SUPERVISING NURSE: Help is on the way. Stay calm.
PEDRO: I'll do my best.
*A.S.A.P (= as soon as possible)

Ao dar entrada, o paciente avaliado na triagem de prioridades para

assegurar, de uma forma cientfica, que o doente mais grave seja atendido num
prazo de tempo que no ponha em risco a sua situao clnica. Como Pedro
aprende logo, essa prioridade baseada na situao clnica apresentada e no na
ordem de chegada e normalmente representada por cores. Infelizmente estes
cdigos ainda no foram padronizados nos Estados Unidos, por isso essencial que
cada profissional de sade seja familiarizados com os cdigos da prpria instituio.
Ficou muito claro tambm como em situaes de emergncias a
comunicao precisa ser sempre simples e eficaz. uma boa ideia repetir sempre
as informaes mais importantes quando a hora de responder instrues
especificas. Como por exemplo quando Pedro questionado sobre a condio do
paciente. Is the patient under control? Se a resposta for positiva, Yes, the patient is
under control, se for negativa, No, the patient is not under control.
Por outro lado, se a informao pedida no disponvel ou no pode ser
recolhida no momento, vamos usar expresses como Stand by (= Wait and be

ready to do something) ou No information available. Vamos ver juntos uma possvel

situao de emergncia.
NURSE: Chemical spill and fire near the activities room!
EMERGENCY WORKER: Location?
NURSE: Between the south end exit and the elevator.
EMERGENCY WORKER: Is the pathway clear?
NURSE: No information.
EMERGENCY WORKER: Are there injured people?
NURSE: Stand by. We'll know in a few minutes.

2.3.1 Emergency Codes

Embora muitos hospitais usem o mesmo cdigo para o fogo (code red),
existe ainda uma diferena enorme entre vrias estruturas. No satisfeito, Pedro
pesquisou e encontrou uma tabela da American Hospital Association, onde h uma
serie de cdigos recomendada para ser usada nos hospitais estadunidenses. Vamos
ver esta tabela juntos.
Emergency Code Recommendations:
Emergency Situation

Code Name
CODE RED

Fire, incoming life-threating trauma

CODE BLUE

Heart or Respiration Stopping, a patient

needs immediate resuscitation

CODE ORANGE

Hazardous Material Spill or Release, a

biohazardous contamination

CODE GRAY

Combative Person, an unruly patient or

visitor

CODE SILVER

Person with Weapon/Hostage Situation,

a violent situation

CODE AMBER

Infant and Child Abduction (rapto)

CODE GREEN

Evacuation

CODE PURPLE

Psychiatric Emergency

CODE YELLOW

Bomb Threat

CODE NAME CLEAR

To Clear a Code

Note: It is important that location be included with any code announcement.

ACTIVITY

12:

What

code

would

A patient's heart has stopped.

A patient with mental problems needs
help.
Four rival gang members are fighting in
the ED.
A fire in the cafeteria.
Everyone needs to leave the facility.

you

call

for

each

situation?

Code blue.
Code purple.
Code silver.
Code red.
Code green.

2.3.2 Useful Phrases

Importante tambm revisar algumas expresses rpidas para lembrar

como alertar de perigos, reportar acidentes e pedir assistncia.

DANGEROUS HAPPENINGS
Danger!
Look out! (said or shouted in order to tell someone that they are in danger)
Get back!
Move out of the way!
Watch out! (used to warn someone of danger or an accident that seems likely to
happen)

HAZARDS
Be careful!
Be safe.
Go slowly, please.
That's dangerous!
Please, stay calm.

REPORTING AN ACCIDENT OR EVENT

Accident in room ________
Accident in ________ (space/area)
Accident on the ________ (first/second/third ) floor.
Explosion/Fire in ________

REPORTING INJURED PEOPLE

No people injured.
Number of people injured: _______

REQUESTING ACTION
Provide first aid immediately
Take immediate action to _______

REQUESTING ASSISTANCE
Medical assistance required
No assistance required.
Technical assistance required.

2.4 INTERACTING WITH PATIENTS

FIGURA 37 HEALTH CARE WORKER AND PATIENT

FONTE: Disponvel em http://blog.bluegoosemaine.com/the-gaggle/ Acesso em 10 jun. 2013

Apesar dos avanos tecnolgicos, a comunicao continua sendo a

ferramenta primria e indispensvel com a qual profissional de sade e paciente
trocam informaes. Elementos como a empatia, compreenso, interesse, desejo de
ajuda e bom humor so indispensveis para conseguir um ambiente de conforto
emocional.

necessrio

tambm

que

profissional

de

sade

considere

individualidade, os valores e crenas dos pacientes, e utilize uma linguagem clara,

de acordo com o nvel de instruo dos mesmos, permitindo assim uma avaliao
mais fidedigna de suas necessidades.

2.4.1 Conversation Starters

Estamos conscientes de como comear uma conversa com um paciente

pode s vezes ser muito estressante. difcil dizer, "how are you", "are you having a
good day?" e "have a nice day", porque o paciente est em um hospital e a resposta
ser muito provavelmente negativa.
Vamos ver agora alguns conversation starters que podem ser muito teis
em quebrar silncios desconfortveis e comear uma conversa procurando fazer,
por alguns momentos, com que o paciente esquea que ele est no hospital e
sorria.
Beautiful day, isn't it?
Can you believe all of this rain we've been having?
It looks like it's going to rain.
Talking about the
weather

It sure would be nice to be in Hawaii right about now.

I hear they're calling for thunderstorms all weekend.
We couldn't ask for a nicer day, could we?
How about this weather?
Did you order this sunshine?
Did you catch the news today?

Talking about
current events

Did you hear about that fire downtown?

What do you think about this strike?

 I heard on the radio today that they are finally going to

start building a new mall.
How about those Corinthians? Do you think they're
going to win/lose tonight?

Lembre-se que quando usamos small talk com um paciente, alguns assuntos
podero no ser considerados seguros. Evite falar de assuntos muitos pessoais ou
altamente controversos como poltica ou religio, porque podem degenerar
rapidamente em discusses ou conversas deprimentes. Use assuntos amenos para
estabelecer ligaes e no para discutir opinies. Abstenha-se de compartilhar sobre
si mesmo, a menos que no se senta confortvel em responder.

2.4.2 Verbal Clues

Outra ferramenta muito til para mostrar ao paciente que voc est
prestando ateno e est interessado conversa consiste em usar verbal clues, ou
seja, sinais verbais. H muitas expresses que podem ser empregadas:

MEANING: I'm listening.

Uh-huh.
Mm-hmm.
Right.
Go on.

Ex:

Pacient: Let me tell you about my grandson.

Nurse: Uh-huh. Go on.

MEANING: I'm happy. (That's good news.)

That's nice.
Great!
Congratulations!
Good for you!

Pacient: I walked 50 steps yesterday.

Health Professional: Congratulations! Good for you!

MEANING: I'm sad. (That's bad news.)

That's too bad.
Oh, no!
That's terrible/awful.
I'm sorry to hear that.

Pacient: My children won't be able to visit me before the operation.

Nurse: Oh, no!

MEANING: I'm surprised.

Really?
You're kidding!
Wow!

Pacient: All 10 of my childen were born in this hospital.

Health Care Worker: You're kidding! Wow!

2.4.3 Providing Assistance

FIGURA 38 HEALTH CARE WORKER AND PATIENT

FONTE: Disponvel em http://www.obsmedical.com/ Acesso em 10 jun. 2013

Vamos ver como o Pedro lida com a senhora Carr que est com dificuldade
motora e precisa de cuidados especiais na sua higiene quotidiana.

PEDRO: Good morning, Mrs. Carr! How are you today?

MRS.CARR: Oh, fine, I guess.

PEDRO: I intend to change your disposable briefs and then clean you up a bit. I'll
wash your hair and clip your nails. Is that O.K. with you?
MRS. CARR: Yes. Thank you. I think I did some business last night.
PEDRO: Fine. Do you need some assistance sitting up?
MRS CARR: No, thanks. I can manage.
PEDRO: All right, now, may I please help you take off your robe?
MRS CARR: Yes.
PEDRO: I'm going to bathe you now. Did you sleep well last night?
Reparamos como o Pedro usou com naturalidade os hesitation fillers All
right - verbal clues - Fine e conversation starters - Did you sleep well last night?
na sua conversa com a senhora Carr. Ele tambm usa estratgias de comunicao
muito gentis e delicadas para deixar a paciente mais a vontade com uma situao
que poderia ser considerada muito constrangedora - Is that O.K. with you? / Do you
need some assistance? / May I please help you?
Vamos ver agora algumas outras estruturas em situaes formais e
informais para oferecer ajuda de forma no invasiva.
FORMAL
(How) may I help you?
May I be of service to you?
Would you like me to help you?

INFORMAL
Can I help you?
Do you need some help?
How about letting me help you?
Let me give you a hand
Let me help you.

2.4.4 Dealing with Complaints

A instaurao de um clima de confiana e de compreenso entre o paciente

e os profissionais passa por gestos, atitudes e palavras acessveis e simples, pelo

dilogo e pela comunicao com o outro, exigindo o conhecimento da cultura e o

respeito pela diversidade, mas tambm por ateno, sensibilidade, disponibilidade e
empatia, em relao ao individuo e s situaes, na sua singularidade e
especificidade.
FIGURA 39 DEALING WITH COMPLAINTS

FONTE: Disponvel em http://www.principalinternational.co.uk/property/elmhurst-nursing-home

Acesso em 10 jun. 2013

Agora vamos ver como o Pedro enfrenta e resolve com educao e

elegncia uma situao problemtica com a senhora Smith.

Ms. SMITH: I am ready to go home today. I feel wonderful!

PEDRO: I hate to disagree with you, but we have to run a few more tests. You
might have to stick around for a couple more days.
Ms. SMITH: It really surprises me because I thought the doctor was finished.
PEDRO: You can never be too careful, right? Dr. Mullen will be here in the morning.
O.K.?
Ms. SMITH: Well, I guess I'm in good hands.

Quando h reclamaes da parte do paciente, sejam elas gentis ou rudes,

verdadeiras ou falsas, o primeiro passo estar pronto para ouvi-las e, se necessrio,
se desculpar respeitosamente. Como viemos no caso anterior, Pedro precisa
discordar da opinio da paciente de forma educada e formal. Vamos ver juntos
algumas outras formas para evitar situaes de conflitos.
Formal
I hate to disagree with you, but I believe
I respect your opinion, but I think

I understand what you are saying, but in my opinion

I'm not sure if I agree with you.
You could be right, but I don't think that.

Menos formal
I may be wrong, but
I'm sorry, but I disagree / don't agree with what you're saying.
That really surprises me because I think

Informal
I don't think so.
Well, I think that
Yes, but

Alguns pacientes ou visitantes podem tambm reclamar sobre vrias

condies ou servios do hospital de forma um tanto rude. A melhor maneira de se
comportar de responder de forma educada e gentil. Vamos ver como o Pedro lida
com as reclamaes dos pacientes.

Mr. WALKER: Would you mind not handling me this way? It's killing my back.
PEDRO: I'm terribly sorry, I will be gentler. It won't happen again.

Ms. SMITH: I've had just about enough of this terrible food.
PEDRO: I'm really sorry, Ma' am. What is it about this meal that's bad?

H algumas outras expresses que os pacientes podem usar ao reclamar.

Indirect Complaints
Could you please not
I hate to complain, but
I hate to have to say this, but
I'm afraid I'm going to have to complain about
I'm not (exactly) sure how to put this, but
I thought / believe that we had asked you to

Would you mind not

Direct Complaints
I'm tired of dealing with this situation!
I'm very disappointed with this hospital / clinic.
I've had just about enough of this!
This situation is unacceptable.

Quando

recebemos

uma

reclamao,

precisamos

saber

responder

respeitosamente. Alm de pedir desculpas, precisamos assegurar ao paciente que o

problema ser sanado em curto prazo.

Complaint Response Beginnings

I apologize for the inconvenience.
I'm very / awfully / terribly / extremely sorry.

Complaint Response Endings

I'll look at it right away.
I'll look into it.
It won't happen again.
We are committed to solving this problem.
We will fix the situation immediately.

2.4.5 Explaining Procedures

Ao esclarecer dvidas e explicar os procedimentos tcnicos a ser realizado,

o profissional de sade precisa fazer uso de frases descritivas claras e diretas.
Devem-se oferecer apenas as informaes necessrias para o paciente, falar
pausadamente, com tom de voz adequado e com um vocabulrio que corresponda
ao nvel cultural do paciente. O uso de poucas palavras resultar em menos
confuso.

FIGURA 40 HEALTH CARE WORKER-PATIENT RELATIONSHIP

FONTE: Disponvel em http://digitalcatharsis.wordpress.com/2010/04/

Acesso em 10 jun. 2013

Vamos acompanhar agora o Pedro que precisa ajudar um paciente com uma
contuso no quadril (hip injury) a se virar na cama.

PEDRO: Hello, Mr. Smith. How is your hip doing?

Mr. Smith: I still feel some swelling here.
PEDRO: Well, it's time to roll you over. We don't want you to get bed sores from lying
in one position, right?
Mr. Smith: Is it going to hurt? Last time I felt a sharp pain.
PEDRO: Don't worry. We will take it easy and do it together, step by step. First, I'll
have you cross your arms across your chest. Good. Next, I'll gently move your upper
body toward me. Then, I'll do the middle part and lower part. Are you following me?
Mr. Smith: Yes, I am. Are you then going to flip me?
PEDRO: Not yet. I need to get some assistance for that.
Mr. Smith: Oh, boy. I'm really nervous.
PEDRO: Everything will be fine. Here comes Penny. We will be very gentle. Here we
go, Mr. Smith. Please take a deep breath and relax.

O intercambio de informaes engloba no apenas aquilo que o paciente

necessita saber como tambm inform-lo apropriadamente e reassegurar de que ele
tenha compreendido a informao. Assim, necessrio que se trabalhe em dois
polos: verificar que a informao seja compreendida corretamente e se necessrio
corrigi-la (com nfase na tarefa) e preocupar-se com a reao afetiva envolvida na
passagem da informao.

, portanto importante ressaltar como Pedro explica o procedimento a ser

realizado de maneira clara, concisa e em um tom de voz audvel - Well, it's time to
roll you over. We don't want you to get bed sores from lying in one position, right?.
Pedro j entendeu como o humor um mecanismo teraputico que pode ajudar a
aliviar sentimentos como medo e ansiedade.
Pedro busca tambm a cooperao do senhor Smith We will take it easy
and do it together, step by step e sempre verifica se as instrues foram
compreendidas - Are you following me?. Alm disso, Pedro oferece continuamente
esperana e encorajamento Don't worry - tranquilizando o senhor Smith Everything will be fine - e dando feedback sobre o passo-a-passo do procedimento
- Here comes Penny. We will be very gentle. Here we go, Mr. Smith.

Resumindo, vamos lembrar alguns momentos muitos importantes na hora de

comunicar ao um paciente um determinado procedimento:

explain the procedure

check for understanding

seek cooperation

encourage the patient

reassure the patient

give feedback

2.4.6 Giving Clear Instructions

Vamos ver como o Pedro explica com muita pacincia e em detalhes como
far um curativo ao senhor Wilson.

PEDRO: Hello, Mr. Wilson. We need to change the dressing on your wound.
PATIENT: Can you tell me what you will do?
PEDRO: Sure. First, I'll place the supplies on a sterile metal tray. Second, I'll open
the packages and lay the bandages out. Then, I'll put on a pair of latex gloves. Next,
I'll gently peel back and remove the old dressing and throw it away using tweezers.
Then, I'll check your wound to see if it healing well. Next, I'll apply a sterile nonstick

gauze pad and more dressing with tape. Finally, I'll throw away used material and
wash my hands again.
PATIENT: Thanks.

Como j reparamos, muito importante usar um tom de voz suave, pausado

e informar os procedimentos de maneira clara e direta. Uma boa dica usar frases
ou conectores que deixem bem claro o passo-a-passo do procedimento e o verbo
auxiliar will (contrao 'll) antes do verbo principal em sua forma natural.

Resumindo:
Beginning

Second

Finally

First

After

At last

At the beginning

Next

The final step

At first

Then

The last step

Step 1

The next step

Middle

End

2.4.7 Checking for Understanding

Para verificar se a compreenso da mensagem emitida est correta,

importante lembrar sempre de trs tcnicas:
1)

repetir a mensagem

2)

pedir ao paciente para repetir o que foi dito

3)

resumir com pacincia o contedo.

Vamos exemplificar.

HEALTH CARE WORKER: I need you to roll over to the side, please.
PACIENT: Hmm.
HEALTH CARE WORKER: Sorry. Are you following me?
PACIENT: Oh, yeah. Something the side?
HEALTH CARE WORKER: Right. I need you to roll over to the side.

Verificamos agora juntos algumas tcnicas de clarificao e validao.

Can you understand what I said?
Can you understand me?
Sorry. Are you following me?
Is that clear?
Is it O.K. with you?

2.4.8 Giving Medications

Medicar pacientes requer um processo de comunicao eficaz para que

obtenha sucesso. preciso muito cuidado e clareza, sobretudo quando lidamos com
termos tcnicos especficos que s vezes so de difcil compreenso.
FIGURA 41 HEALTH CARE WORKER

FONTE: Disponvel em http://medcitynews.com/tag/connecticut/ Acesso em 10 jun. 2013

Vamos acompanhar o Pedro enquanto orienta o paciente na administrao

de uma nova medicao.

PATIENT: Hey, Austin, tell me about the time you slid off the roof.
VISITOR: Well, there I was on the top of the roof. I was balancing
PATIENT: Why were you up there in the first place?
PEDRO: [entering the room] May I interrupt for a moment?
PATIENT: Oh, yeah. Hello.
PEDRO: Good afternoon, Mr. Ryan. I just need to explain something to you.
PATIENT: O.K. Is it about my new medication?
PEDRO: Yes. It's a transdermal morphine patch.
PATIENT: Transdermal means under the skin, right?

PEDRO: Actually, it means through the skin. Your skin will absorb the medication
through the surface of your skin.
PATIENT: Oh, thank you.

O profissional de sade deve reconhecer a ocasio adequada para

explicaes ou conversas com o paciente, esperando o momento certo. Durante a
conversa, muito importante no mudar de assunto rapidamente, porque isso
bloqueia a comunicao e revela atitudes de desinteresse, incompatvel com a
responsabilidade do profissional de instruir corretamente o paciente.
Vamos ver agora algumas expresses teis para interromper de forma gentil
e educada quando o paciente est ocupado ou no meio de outra conversa com
familiares e amigos.

FORMAL
Excuse me for interrupting, but ...
May I interrupt for a moment?
Please excuse the interruption.
I'd like to say something, if I may.

LESS FORMAL
Can I ask you a question?
Excuse me.
Sorry.

Algumas outras vezes somos interrompidos e precisamos voltar e terminar o que

estamos dizendo. Podemos usar algumas frases do tipo
Anyway
Where was I?
To get back to what I was saying, ...

Na ocasio, Pedro percebeu como muitos termos tcnicos podem ser de

difcil compreenso e pensou de revisar juntos com os colegas alguns dos tipos de
remdios mais comuns, tentando explicar os conceitos na maneira mais simples
possvel.

antacid drug used to decrease acid in stomach

antiseptic substance used externally to stop or slow down growth of germs
depressant drug that slows down the action of the central nervous system
tranquilizer drug used to control anxiety
hypodermal under the skin
intramuscular (I.M.) injection injection of a substance into a muscle
intravenous (I.V.) injection injection of a substance into a vein
sublingual under the tongue
topical application medication directly on the skin
transdermal through the skin

ACTIVITY 13: Match the type of drug in the left column with a condition or
problem in the right column.

antibiotic
antiseptic
antacid
depressant
tranquilizer

internal infection from germs

cyst on skin exposed to germs
bad stomach ache
over active nervous system
nervousness

2.5 NON-VERBAL COMMUNICATION

Os profissionais de sade no devem nunca esquecer que suas mensagens

no so interpretadas apenas pelo que fala, mas tambm pela forma como se
comportam. Uma maneira contraditria de emitir mensagens pode dar interpretao
dupla ou distorcida da mensagem enviada. Alm disso, reconhecer a importncia da
comunicao no-verbal permitir compreende os pacientes melhor, estando atento
aos gestos, s mmicas faciais, s posturas corporais, que nos podero dar
indicaes, pistas, sobre os estados emocionais deles. Por isso, o Pedro pede
ajuda ao seu professor, o qual sugere um artigo muito interessante.

NON-VERBAL COMMUNICATION is a subtle form of communication that takes

place in the initial three seconds after meeting someone for the first time and can
continue through the entire interaction. Research indicates that non-verbal

communication accounts for approximately 70% of a communication episode. Nonverbal communication can impact the success of communication more acutely than
the spoken word.

a) EYE CONTACT: maintaining eye contact throughout a conversation can help

create some comfort as by doing so, the health care worker shows that all
attention is devoted to the patient and that the patient is being fully listened to.
b) TOUCH: a little pat on the shoulder or some other comforting gesture can
engender trust and break the physical distance that exists between two people
who do not know each other.
c) DISTANCE: putting too much physical distance can create personal distance
between two individuals. Being too close is not very comforting either. A fair
distance needs to be placed between patient and health care worker to allow a
safe bubble to be created, yet without trespassing private space.
d) TONE OF VOICE: A strong, aggressive tone is more likely to create a tense
atmosphere, whereas a softer, gentle tone is more likely to create a more
relaxed environment for both communicators.
e) FACIAL EXPRESSIONS: facial expressions are often unconsciously made,
and some may lead to unwanted results. Thus, trying to stay aware of what
facial expressions you make is important, and avoiding the expressions that can
show negative feedback such as expressions of anger and tension, among
others, will help create more positive results. Smiling, for instance, is a facial
expression that can only enhance the communication process and indirectly
help the care provided.
Resumindo, na dimenso no-verbal fundamental estarmos atentos:
a) ao contato visual, aos movimentos dos olhos. Manter contato ocular pode ser
entendido como prova de interesse, deixando claro que o paciente o centro da sua
ateno;
b) maneira como tocamos as pessoas, lembrando que a interpretao do toque
varia de acordo com a parte do corpo tocada, o tempo que dura esse contato, a
fora aplicada ao tocar, a frequncia com que o toque ocorre;
c) distncia que mantemos da pessoa, o uso adequado do espao interpessoal,
sabendo se nos aproximamos mais ou menos e a forma como nos aproximamos

(respeitando seu espao pessoal e entendendo os gestos que mostram desejo de

isolamento e distanciamento: fechar os olhos, virar o corpo para a parede, cobrir o
rosto com o lenol, por exemplo);
d) ao tom de voz e entoao (qualidade, velocidade e ritmo da voz). Uma voz
calma geralmente transmite mensagens mais claras do que uma voz agitada.
e) linguagem do corpo, como ns expressamos atravs dos gestos, das nossas
posturas corporais, das nossas expresses faciais, sobretudo das quais no temos
nem conscincia, nem controle. Sorrir, por exemplo, uma expresso facial que s
pode melhorar o processo de comunicao e, indiretamente, ajudar o atendimento
prestado.

2.6 CULTURAL MISUNDERSTANDINGS

Escutando com ateno a aula do seu professor, Pedro aprende que o que
considerado um comportamento normal ou educado em uma cultura pode ser visto e
interpretado como anormal ou mal educado em outra. Quando as diferenas
culturais interferem na correta interpretao dos cdigos no-verbais, isso pode criar
serias barreiras de comunicao.

2.6.1 Touch and Gender

Ao se tocar um paciente, importante que se observem suas reaes, visto

que h diferenas na aceitao e interpretao do toque. Alm disso, h limitaes
fsicas em muitas culturas, onde as mulheres so relutantes em ser consultadas por
profissionais de sade de sexo masculino.
No Brasil, por exemplo, a gente se cumprimenta com um abrao e um beijo
ou dois na bochecha. Mas, em alguns pases, a forma de cumprimentar algum
pode ser bem diferente e, s vezes, nem envolver o contato fsico.
- In the USA, it is normal for men to shake hands when they meet, but it is quite
unusual for men to kiss when they greet each other. Greetings are casual a
handshake, a smile and a hello will do just fine.
- The British often simply say hello when they meet friends. They usually shake
hands only when they meet for the first time. Social kissing, often just a peck on the

cheek, is common only in informal situations, when people know each other very
well.
- In Japan, greetings are given great importance. It is considered rude to fail to greet
someone or even to greet them in a lazy or offhand manner. People in Japan
normally greet each other by bowing. A small head nod is a considered casual and is
used when greeting family or friends. When greeting a superior, it is a sign of respect
to use a deep, longer bow: roughly a 90-degree bend at the waist.
- Chinese tend to be more conservative. When meeting someone for the first time,
they would usually nod their heads and smile, or shake hands if in a formal situation.
- In Arab countries, close male friends or colleagues hug and kiss both cheeks. They
shake hands with the right hand only, for longer but less firmly than in the West.
Contact between the opposite genders in public is considered obscene.
- People from France, Spain, Italy, and Portugal shake hands with their friends and
often kiss them on both cheeks, both upon meeting and leaving

DID YOU KNOW?

Entre os indianos, o costume juntar as mos, como se fosse fazer uma prece, e
dizer Namast, que significa O Deus que existe em mim sada o Deus que existe
em voc. O povo maori da Nova Zelndia, ao contrario, encosta o nariz no nariz
para se cumprimentar. Mas a mais interessante forma de cumprimento encontra-se
em algumas tribos do Tibete, onde as pessoas mostram lngua uma a outra. que,
segundo uma lenda, demnios tm lngua verde e quem exibe a lngua rosada
mostra que do bem!

STUDY CASE:
An international student was taken to the hospital with a serious illness. After a week,
the student's recovery was going well. Her parents arrived in the United States and
went straight to the hospital. As they met the head nurse, they gave her a big hug
and kissed her on both cheeks. The nurse was quite surprised and quickly excused
herself. She was embarrassed that other hospital staff members saw what happened.
The student started to speak excitedly to her parents in their native language.

Why was the nurse embarrassed?

Physical contact (hugging and kissing) with people you have just met is not
normal in the United States. The student is from a culture where hugs and even
kisses are normally used in introductions and greetings. The student's parents were
so relieved that their daughter was recovering that the hugs were meant to show their
appreciation. This had never happened to the head nurse before. The student quickly
explained proper greeting customs to her parents.

O professor continua sua aula lembrando como o contato fsico pode reduzir
a ansiedade, a dor e o estresse em determinadas circunstanciam, mas pode tambm
criar apreenso e ansiedade em outras, sobretudo durante consultas e/ou exames.
Mesmo na cultura ocidental, aceitamos melhor o toque nos membros superiores
(braos e mos) do que em qualquer outra parte do corpo (mesmo o toque em
pernas e ps pode ser percebido como invasivo).

Adult Orthodox Jewish and Muslim men do not touch women of reproductive age,
even their daughters, even to shake hands. Muslim women prefer not to be
examined by male physicians. A female nurse or physicians concerned pat on the
shoulder could cause awkward discomfort. Buddhist Southeast Asians for entirely
different reasons do not want to be touched, especially on the head, unless it is part
of an exam.

Em seguida algumas sugestes para evitar conflitos ou situaes de

constrangimento.
- Ask if your patient requires a physician or nurse of the same sex. If you cannot
accommodate this, explain why and ask if a chaperone (= an older female
companion) is required during the exam and who this should be.
- Explain necessary physical contact through the interpreter. Be especially careful of
draping. The interpreter may remain behind the curtain or discreetly turn their back
during an exam.

As situaes mais complexas envolvem a comunidade rabe, como bem

explicado neste caso, onde um rabe de 27 anos no permite a um profissional de
sade de sexo masculino de coletar uma amostra de sangue da sua mulher.
A 27 year-old Arab man refused to allow a male lab technician to enter his wife's
room to draw blood. When the staff finally convinced the husband of the need, he
reluctantly allowed the technician in the room. However, he took the precaution of
making sure his wife was completely covered. Only her arm stuck out from beneath
the covers.
Como bem lembrado pelo professor, em casos similares, possvel respeitar
o valor do honor e da privacidade do paciente com pequenos cuidados. Por
exemplo, se for possvel, tentar no atribuir a pacientes muulmanas profissionais de
sade do sexo masculino. tambm muito importante se comunicar sempre,
explicando em detalhes que tipo de contato preciso para seguir determinados
procedimentos ou exames, evitando assim mal interpretaes e conflitos
desnecessrias.

STUDY CASE:
An infant girl was going to be discharged from the hospital. While the mother was
filling out paperwork at the nurses' station, two nurses in the child's room started to
explain to the father how the parents needed to provide child care when they
returned home. Please don't tell me anything, the father said, and he left the room.
The nurses were surprised. When the mother came back to the room, she explained
why her husband had left.

Why did the father leave?

When the mother came back to the room, she explain why her husband had left.
They come from a culture in which child care is basically a woman's job. The
husband was happy that his son was being discharged, but he did not want to hear
any details about his care at home since he would not be involved. In a Muslim
society, men have a more important role in their children's education only when they
become teenagers.

2.6.2 Personal Space

Personal space is culturally determined. Most people have had the experience of
backing away from someone who approaches too close. Generally speaking, people
of Northern European origins become uncomfortable in conversation at about 2 feet
and begin backing up at 18 inches. On the other hand, Mediterranean and southern
Chinese people are comfortable until nearly touching face-to-face.
SUGGESTIONS
Ease into the patients personal space. If there are any concerns, ask before
entering the three-foot zone. This will help ease the patients level of
discomfort and avoid any misinterpretation of physical contact.
In the case of a Muslim female patient, put a simple sign on the door that says
"Please, knock before entering, this patient observes modest dress and
requires the announcement of your presence."

2.6.3 Eye Contact

In general we think making eye contact is good, it shows you are paying attention.
We interpret avoiding eye contact as either attempting to conceal something, not
paying attention or possibly depressed mood. This is NOT universal.

In fact, direct eye contact can be interpreted as hostile or at least rude in some
cultures, e.g., African American men, Arabian and Chinese women, Native Americans
of either sex. When dealing with high status medical professionals, lowered eyes may
signify respect. If there is mistrust of medical professionals, avoiding eye contact may
signify conflict avoidance. If you are not sure what to do with your eyes, looking
just past the patients ear is usually safe.

Para esclarecer, o professor prope o caso de John, um estudante, que ficou

muito frustrado em lidar com uma paciente de origem asitica, a qual no parecia
estar interessada nas suas explicaes e orientaes sobre como enfrentar o
diabete.

John was trying to teach his Chinese patient how to live with her newly diagnosed
diabetes. He soon became extremely frustrated because he felt he was not getting
through to her. She asked very few questions and never met his eyes. He reasoned
from this that she was uninterested and therefore not listening to him.

Para a maioria das comunidades indianas, rabes e sobretudo asiticas

considerada uma falta de respeito manter o contato visual com uma pessoa mais
idosa ou em posio de autoridade, como por exemplo o profissional de sade.
Pode at ser considerada como uma forma de agresso social, se for um homem
que insiste em manter o contato visual com uma mulher. O mesmo tipo de mal
entendido cultural ocorre muito quando estudantes de origem asiticas no olham
diretamente para os professores enquanto eles esto falando.

2.6.4 Smiling

Como mencionamos anteriormente, o sorriso normalmente conhecido

como um sinal de felicidade e de aceitao. Enquanto sorrir universal, o seu
significado no .
While smiling is perceived as a positive emotion most of the time, there are many
cultures that perceive smiling as a negative expression and consider it unwelcoming.
Too much smiling can be viewed as a sign of shallowness or dishonesty. Japanese
people may smile when they are confused or angry. In other parts of Asia, people
may smile when they are embarrassed. In Southeast Asian and Indian cultures, a
smile is frequently used to cover emotional pain or embarrassment.
STUDY CASE:
Nurse Mary was teaching a patient how to give himself injections. Mr. Vong was not
doing a very good job. He seemed to be too much nervous to learn. Mary saw that he
was smiling. She thought that he was not concentrating enough and didn't really want
to learn. Their conversation follows.
MARY: Mr. Vong. You need to be serious. It's very important for you to learn how to
give yourself these injections.
MR. VONG: I'm sorry, Ma'am (smiling).
MARY: Maybe you need to try with a different nurse.

Why was Mary so frustrated with Mr. Vong?

Mr. Vong is from a culture where a smile can mean many things, including an
apology. Mary thinks that Mr. Vong smiled because he did not understand how
important the injections were. Unless someone tells Mary what a smile can mean,
she will misinterpret some patients' reactions.

FIM DO MDULO II