Health Practice Relationships


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Core principles

Thus, various questions emerge and converge on the need to deepened knowledge with respect to the network of relations and inter-relations in the health team. Among them: Which are the dimensions and characteristics of the relations and inter-relations among the members of health teams? What is the scope of these networks and their repercussion on the field of nursing?

In order to meet the amplitude of these questions, it was endeavored to conduct documental study with the aim of characterizing the network of relationships and inter-relations in the health team in Primary Care and its implications for nursing. For this purpose, it was sought to get to know the health team in primary care, demonstrate its characteristics and potentialities, to enable better use to be made of it and its articulation in health actions. This was an Integrative Literature Review 8 to identify productions about networks of about relationships and interactions between health team members in Primary Care and their implications for nursing.

All the stages of the Integrative Literature Review are based on a formal and strict working structure that allows the simultaneous inclusion of data from theoretical and empirical literature, with a view to the definition of concepts, review of theories or methodological analysis of the studies 9.

In addition, it includes the establishment of well defined criteria for data collection, analysis and presentation of the results, starting from the beginning of the study, based on a previously prepared and validated research protocol. From this aspect, six stages 8,9 indicated for the constitution of an Integrative Literature review were adopted, as follows: 1 selection of the research question; 2 definition of the criteria for inclusion of studies and sample selection; 3 representation of the selected study in table forma, considering all the characteristics in common; 4 critical analysis of the findings, identifying differences and conflicts; 5 interpretation of the results; e 6 report the evidence found in a clear manner.

The inclusion criteria adopted considered studies available free of charge in the complete format, published in the period between January and July , in the Portuguese, Spanish and English languages, resulting in 80 articles. In possession of all the studies, in accordance with the protocol, all duplicated productions, letters, editorials and productions not related to the scope of the study were excluded. Thus, reading of the publications began, and considering the criteria of pertinence and consistency of the contents, 14 complete studies were selected for in depth analysis, as they answered the research question.

In agreement with the third items of the stages established in the Integrative Literature Review, a table was constructed for the extraction of data from the selected sample, containing columns discriminating the following sets of information: authors, title of the study, year of publication, type of study, characteristics of the networks of relationships and inter-relationships and contributions to practice. It is emphasized that the analytical process was not based on the frequency of citation of the studies; to the contrary, data were aggregated according to the identification of similarities and differences, composing a finding that was interpreted and sustained by other pertinent literature.

From the process of analysis, four categories emerged: Context and characteristics of the network of relationships and interactions in Primary Care health teams; The relationships of power and need for leadership in the health teams; The relationships and interactions in the community context and the Network of relationships and interactions as health promoter: needs and directions , which were supported by 14 studies presented in the data in Chart 1 :.

Chart 1 - Click to enlarge. Context and characteristics of the network of relationships and interactions in Primary Health Care Teams. To consider the characteristics of the networks of relationships in team work and talk about something harmonious In personal relationships and interactions, moments of conflict occur, which may be considered "negative", "bad", or something to be avoided.

However, these are aspects inherent to team work dynamics, and may be transformed into possibilities for growth, if one goes about it the right way.

Clinical-Community Relationships Measures (CCRM) Atlas

Conflicts between team members arise due to the variety of opinions and postures; some professionals try to control the entire organization of work and others accommodate themselves, and do not perform their functions adequately Moreover, the non existence of collective responsibility for the results of the work generates discontinuity between the specific actions of each professional, showing disarticulation between curative, educational and administrative actions, as well as a low degree of interaction among doctors, nurses and Community Agents Thus, many of the barriers in the interactive process are particularly related to the challenges of human relationships and the peculiarities of personality of each team member 12, The lack of solidarity on the part of some professionals, who do not support the others, is also emphasized Such disarticulation and obstacles in the network of relationships and interactions may be related to indefinition as regards the functions of some team member.

One study pointed out the Community Health Agent as the team member that geneerates discomfort among the other professionals, due to being a new participant that has joined the family health team, without necessarily having previous training in the area Whereas, certain studies have indicated other sources of weakness in teamwork, however, envisage the importance of integrated work and how gratifying it is to see the result of actions when experiences are shared and problems are solved as a result of knowledge about the situation of each user Thus, the distinction is shown between the two notions to cover the idea of a team: the team as a group of agents, and the team as the integration of different tasks Therefore, associations between persons are considered as an extremely complex system that "self-and co-organizes" itself in a set, in which there is no absolutely correct truth, but continual dialogue with uncertainty The work environment, a stage that provides the development of sustainable human relationships, favors the establishment of inter-relationships between attitudes and knowledge that promote "shared decisions, unconventional approximations, conviviality among different persons" 6.

Relationships of power and need for leadership in the health team. Historically, the health team was governed by the polarity between people - those who could do more and those who could do less, their actions were directly linked to the domain of knowledge. Thus, medical professionals held the power in teams, which could now make it difficult to include them in a different position, other than in the highest part of the hierarchical pyramid The break with the classical model and the structuring of family health teams, horizontal dialogue has been proposed between professionals and workers, with a view to interdisciplinary and harmonious action.

This transitions was perceived when the figure of the doctor, pointed out as the only and central figure in the coordination of care and services 16 was replaced by the nurse, indicated as a coordinator, with the function of promoting integration among the team members, encouraging professionals to offer integrated assistance with quality, which makes their work recognized and appreciated 11, In addition nurses were indicated as a possibility of leadership by someone outside the team, capable of helping the team to discuss things and find answers to problems In a team at the initial stage of being formed, due to fears and insecurity, there is a tendency to expose difference - how much more one knows than the other - and consequently, how much more this one "can" do than the other It is by means of establishing relationships between team members that the worker strengthens the notion of the movement of information and actions that enable learning, teaching, exchanging, preparing, giving meaning to, re-allocating meaning and transforming knowledge of their health and care practices 18, As the team members get to know one another, accept each other, understand their differences and similarity in a broader manner, considering that the relationships of power are complementary and interdependent, it will no longer have dictators and submissive elements, as one does not exist without the other Relationships and interactions in the community context.

Health team professionals perceive that the relationship with the community is dynamic, and goes through and initial stage of distrust that develops into effective participation Some studies have pointed out that this process is favored by the presence of the Community Health Agent, who establishes tie with the population, facilitates adherence to the program and approach to the team.

Close contact with the family creates the opportunity form a tie of confidence with these workers, allowing users to confide in them.


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Thus, the success of communicating with the families creates opportunities for the development of preventive actions and organization of demand. Nevertheless, communication may also be a barrier, when problems in relationships and cultural differences between the heal team and users make it difficult not only to provide assistance, but access to the service as well Moreover, in one of the studies it was verified that doctors preferred to communicate with other professionals by formal written means, instead of doing so verbally.

Although this type of communication appears to be impersonal and limited, within the context of the study it was well used Both verbal and non verbal communications are basic elements for health activities; and it behooves the professional to be alert to these aspects, and propose the establishment of a therapeutic communication that is suitable for the individual 23 , leading to the establishment of effective interactions that broaden health actions and strengthen the ties between those involved. Network of relations and interactions as health promoter: Needs and directions.

Understanding the network as a complex system, with its intertwined aspects, presupposes meeting points in which it is difficult to act individually and independently from the other elements. Thus, establishing joint dialogue between the different sectors appears to be a necessity, when approaching the quality of life and health of persons. Suiting the network of relationships to the conceptual changes of the Family Health Strategy FHS when considering the user's health as a whole, implies interdisciplinary work that comprises the construction of new practices and knowledge, from different points of view, including the users'.

The new dynamics between the parts that make up the whole, as well as their constant rearrangement, reveal that the "web" of relationships that coexist between the health team members goes beyond the limits of health units and advances towards the community. Moreover, secondary networks are pointed out as being fundamental for the success of care, especially of children's health Today, there is no way to attend to the complexity of problems that affect society, without association between Primary Care professionals and other institutions - whether they are governmental or not, acting in a closer manner and with open dialogue.

Breaking down the barriers of communication, information and dialogue is put forward not only as a necessity, but as a directive for putting collaboration and solidarity into practice. Educational activities are indicated as facilitators for establishing and strengthening the networks of interpersonal relationships, such as health teams.


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  6. Investment in the formation of ties between health teams and users also tends to improve relationships and broaden the search for solutions in a shared manner The inclusion of nurses, doctors and users in a daily clinical practice, without any guidance whatsoever, does not favor the consolidation of collaborative practices Therefore, financing for inter-professional education should be increased, as a way of potentiating health actions which need to be centered on the aspects of communication between groups 19, This practice could facilitate the development of care-giving in partnership, characterized as a complementary and interdependent action However, educational actions along the lines of qualification; that is to say introductory training for the work, with instructions that provide integration among the team members and organization of the work, frequently do not add anything new and are not sufficient to prepare persons for action, because they do not offer a more practical visualization Therefore, other initiatives linked to institutions, such as: Clear goals, measurable results, clinical and administrative systems, division of work and training, allied to effective communication are characteristics that contribute to clarity and confidence of the professionals, competing for their development in collaborative relationships in the team 13, In addition, periodical meetings with group discussions are pointed out as being a useful way to encourage reflection on the team's practice, favoring the sharing of information and experiences 19, Human relationships are placed as a challenge to teamwork, comprising the main barriers to the individual conduct of each member and inclusion of workers with a new function, here represented by the Community Health Agent.

    The texts indicated dialogue, effective communication, courses and qualifications as resources for resolving the obstacles to the interactive process of team work. Integrated and interdisciplinary action is appreciated as a practice to be cultivated in the services. As strategies to strengthen the heal promotion networks in Primary Care, the practice of interdisciplinary and intersectoriality are pointed out as ways of articulating knowledge and differentiated sectors, with a view to practicing collaboration and solidarity. Health care is permeated by different actions and instances, with different degrees of opening between professionals, groups and communities that are reflected in health practices.

    It demands relationships in which interactions occur, based on exchange, which only happens when persons are involved in true and genuine encounter, which is progressively achieved among the actors involved. Living with and having relationships is a continuous process of learning, considering the difference between subjects and flexibility of actions, a process of constant changes in relationships that are established an based on ethical values and commitment between human beings.

    Healthy Relationships

    This process therefore, consists of a challenge to health and nursing professional faced with the new composition of health teams. The registered nurse who delegates activities to be undertaken by another person remains accountable for the decision to delegate, for monitoring the level of performance by the other person, and for evaluating the outcomes of what has been delegated Nursing and Midwifery Board of Australia Criteria in this document means the actions and behaviours of the RN that demonstrate these standards for practice.

    Delegation is the relationship that exists when a RN delegates aspects of their nursing practice to another person such as an enrolled nurse, a student nurse or a person who is not a nurse.

    The RN who is delegating retains accountability for the decision to delegate. They are also accountable for monitoring of the communication of the delegation to the relevant persons and for the practice outcomes. Both parties share the responsibility of making the delegation decision, which includes assessment of the risks and capabilities. In some instances delegation may be preceded by teaching and competence assessment. Enrolled nurse is a person who provides nursing care under the direct or indirect supervision of a registered nurse. They have completed the prescribed education preparation, and demonstrate competence to practise under the Health Practitioner Regulation National Law as an enrolled nurse in Australia.

    Enrolled nurses are accountable for their own practice and remain responsible to a registered nurse for the delegated care. Evidence-based practice is accessing and making judgements to translate the best available evidence, which includes the most current, valid, and available research findings into practice. These individuals will sometimes be health care consumers, at other times they may be colleagues or students, this will vary depending on who is the focus of practice at the time. The registered nurse has professional relationships in health care related teams. Person-centred practice is collaborative and respectful partnership built on mutual trust and understanding through good communication.

    Person-centred practice recognises the role of family and community with respect to cultural and religious diversity. Registered nurse is a person who has completed the prescribed education preparation, demonstrates competence to practise and is registered under the Health Practitioner Regulation National Law as a registered nurse in Australia.


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    8. Scope of practice is that in which nurses are educated, competent to perform and permitted by law. The actual scope of practice is influenced by the context in which the nurse practises, the health needs of people, the level of competence and confidence of the nurse and the policy requirements of the service provider. Standards for practice in this document are the expectations of registered nurse practice.

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      They replace the previous National competency standards for the registered nurse Supervision includes managerial supervision, professional supervision and clinically focused supervision. Therapeutic relationships are different to personal relationships. The professional nature of the relationship involves recognition of professional boundaries and issues of unequal power. To continue using this website, please upgrade your browser. For more information see ' Using this site '. Contact us Office locations. Search term Search.

      Toggle navigation. Introduction Expand. How to use these standards Expand. The Registered nurse standards for practice consist of the following seven standards: Thinks critically and analyses nursing practice. Engages in therapeutic and professional relationships. Maintains the capability for practice.

      Therapeutic relationships, risk, and mental health practice.

      Comprehensively conducts assessments. Develops a plan for nursing practice. Provides safe, appropriate and responsive quality nursing practice. Evaluates outcomes to inform nursing practice. Standard 1: Thinks critically and analyses nursing practice Expand. The registered nurse: 1. Standard 2: Engages in therapeutic and professional relationships Expand. The registered nurse: 2. Standard 3: Maintains the capability for practice Expand.

      The registered nurse: 3. Standard 4: Comprehensively conducts assessments Expand.

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      The registered nurse: 4. Standard 5: Develops a plan for nursing practice Expand. The registered nurse: 5.

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