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Fostering Civility in Learning Conversations

Introducing the PAAIL Communication Strategy

Clark, Cynthia M. PhD, RN, ANEF, FAAN; Fey, Mary K. PhD, RN, CHSE-A, ANEF

doi: 10.1097/NNE.0000000000000731
Nurse Educator: PDF Only

Background Civility, psychological safety, and effective stress management are essential for meaningful learning conversations.

Problem Incivility triggers fear and humiliation, impairs clinical judgment and learning, reduces psychological safety, and increases cognitive load. These factors converge to make learners less likely to incorporate feedback, speak up when there is a problem, and discuss practice errors and patient safety issues.

Approach The authors combined the Basic Assumption and the PAAIL (Preview, Advocacy1, Advocacy2, Inquiry, and Listen) conversational strategy to help surface (rather than obscure) both educators' and learners' thinking. The synergy of these 2 strategies allows educators to identify individual learning needs and develop the learners' clinical judgment skills. This process improves learning by reducing incivility and cognitive load, improving psychological safety, and strengthening clinical judgment skills.

Conclusion This conversational strategy can minimize stress and anxiety in learners and optimize learning.

Author Affiliations: Strategic Nursing Advisor (Dr Clark), ATI Nursing Education, Boise, Idaho; Associate Director (Dr Fey), Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts.

The authors declare no conflicts of interest.

Correspondence: Dr Clark, ATI Nursing Education, 279 E Danskin Dr, Boise, ID 83716 (

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Accepted for publication: June 25, 2019

Published ahead of print: September 5, 2019

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