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Adaptation of a Communication Interaction Behavior Instrument for Use in Mechanically Ventilated, Nonvocal Older Adults

Nilsen, Marci Lee; Happ, Mary Beth; Donovan, Heidi; Barnato, Amber; Hoffman, Leslie; Sereika, Susan M.

doi: 10.1097/NNR.0000000000000012
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Background: Valid and reliable instruments are needed to measure communication interaction behaviors between nurses and mechanically ventilated intensive care unit patients who are without oral speech.

Objectives: The aim of this study was to refine and evaluate preliminary validity and reliability of a Communication Interaction Behavior Instrument (CIBI) adapted for use with mechanically ventilated, nonvocal patients in the intensive care unit.

Methods: Raters observed nurse–patient communication interactions using a checklist of nurse and patient behaviors, categorized as positive and negative behaviors. Three-minute video-recorded observations of five mechanically ventilated adults (<60 years old) in the intensive care unit and their nurses were used to establish preliminary interrater reliability and confirm appropriateness of definitions (four observations per dyad, n = 20). On the basis of expert input and reliability results, the behaviors and item definitions on the CIBI were revised. The revised tool was then tested in a larger sample of 38 mechanically ventilated intensive care patients (> 60 years old) and their nurses (four observations per dyad, n = 152) to determine interrater reliability.

Results: For preliminary testing, percent agreement for individual items ranged from 60% to 100% for nurse behaviors and 20% to 100% for patient behaviors across the five pilot cases. On the basis of these results, 11 definitions were modified and four items were dropped. Using the revised 29-item instrument, percent agreement improved for nurse behaviors (73%–100%) and patient behaviors (68%–100%). Kappa coefficients ranged from 0.13 to 1.00, with lower coefficients for patient behaviors.

Conclusion: Preliminary results suggest that the revised CIBI has good face validity and shows good interrater reliability for many of the behaviors, but further refinement is needed. The use of dual raters with adjudication of discrepancies is the recommended method of administration for the revised CIBI.

Marci Lee Nilsen, PhD, MSN, RN, is T32 Postdoctoral Fellow; Heidi Donovan, PhD, RN, is Associate Professor; Leslie Hoffman, PhD, RN, is Professor Emerita; and Susan M. Sereika PhD, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania.

Amber Barnato, MD, MPH, MS, is Associate Professor, School of Medicine, University of Pittsburgh, Pennsylvania.

Mary Beth Happ, PhD, RN, FAAN, is Distinguished Professor, College of Nursing, The Ohio State University, Columbus.

Accepted for publication October 2, 2013.

The authors would like to thank the SPEACS team, including Judith Tate, PhD, RN, and Dana Divirgillo Thomas, MPH, for providing essential information and assistance with the data set. In addition, the authors extend a special thanks to Rebecca Nock, RN, for performing the second coding of the nurse and patient interaction behaviors and to Ann Kolanowski, PhD, RN, FAAN, for providing expert review of the behavior definitions.

The authors acknowledge that support for this research was provided by the National Institute of Child Health and Human Development (5R01-HD043988, PI: M. Happ), the National Institute of Nursing Research (K24-NR010244, PI: M. Happ), the National Institute of Nursing Research (F31 NR012856, PI: M. Nilsen), and the National Institute of Nursing Research (T32 NR 8857-6, PI: J. Erlen).

The authors have no conflicts of interest to report.

Corresponding author: Marci Lee Nilsen, PhD, MSN, RN, School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Bldg, Pittsburgh, PA 15261 (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.