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Janiw Alexandra; Woodrick, LuAnn MSN, BSN; Riek, Laurel PhD
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: December 2013
doi: 10.1097/01.SIH.0000441601.87286.0c
Abstracts: PDF Only


. A key aspect of patient-centered communication is situational awareness (SA)While researchers often consider team SA, patient SA is equally importantPatient SA is particularly important in acute care, when a patient may be awake yet lying supine, possibly unaware of what the clinical team is doing to them. To measure patient SA, we developed an interaction analysis system called the Patient Situational Awareness Coding Scheme (PSACS).1–3 The tool was adapted from Endsley’s model of SA for dynamic systems and healthcare teams.4,5 PSACS contains three dimensions: intra-team and patient-directed communication, patient safety practices and patient-directed haptic actions (touch)Collectively, these dimensions enable explicit and implicit measurement of patient-clinician communication. In this work, we apply the haptic-action dimension (PSACS-haptics) to ten simulations performed by three levels of BSN nursing students (4th, 5th, and 6th semester)Our primary research question is: Is there a difference in level of communication during haptic actions as nursing students advance in the program? We are interested in this question because as simulations increase in complexity throughout the curriculum, we would like students continue to exhibit best communication practices.


We analyzed ten single-patient simulations across three classes at the [Blinded] School of Nursing. Each simulation used a high-fidelity manikin, lasted approximately 20 minutes and involved a team of two students in the role of the nurse. A total of 20 students participated across the three classes (16 female/4 male). Three simulations were from a nursing fundamentals class (4th semester) and included basic care for a geriatric patient. Five simulations were from a Med/Surg I class (5th semester) and included care of a post-operative patient. Two simulations were from a Med/Surg II class (6th semester)and included care of a post-operative patient with diabetes. Using the ELAN annotation tool,6 two raters coded four types of haptic actions. For each action, they annotated how clinicians spoke to the patient – if they communicated with the patient, either by asking permission before acting or informing the patient the action was taking place or acted without communicating. The four haptic actions types were: 1) Interventions, which include administering IV medication, taking blood, caring for a surgical wound site, etc.; 2) Instrument-based assessment, which include checking blood pressure, checking breathing with a stethoscope, etc.; 3) Non-Instrument based assessment, which include observing and palpating the IV site for signs of complications, extremities for edema, etc.; 4) Gown movements, opening or closing the gown. The raters had high inter-rater reliability (Krippendorf’s α = 0.82).


In Table 1, we report communication rates per class and category. Communication rates are reported as the proportion of haptic actions with communication out of all actions in that category.


Our Results suggest that nursing students appear to be communicating less with patients during haptic actions the further along they are in their studies. There are several possible reasons for this. First, the Med Surg I/II simulations were more difficult, requiring students to accomplish more technical tasks. This greater cognitive load may have made it difficult for students to remember to keep lines of communication open with the patients as they treated them. Second, in Med Sug II, students had to handle a crisis, adding an additional cognitive burden. Nonetheless, we want our students to retain their patient-centered communication skills regardless of the task load, so we plan to conduct additional evaluations.


1–3. Blinded for review.

4. Van Servellen, G.: Communication skills for the health care professional: Concepts and techniques, 2nd edition. Jones & Bartlett Learning, 2008.

5. Wright, M. C., J. M. Taekman, and M. R. Endsley: Objective measures of situation awareness in a simulated medical environment. Quality and Safety in Health Care 2004; 13(1).

6. Wittenburg, P., Brugman, H., Russel, A., Klassmann, A., Sloetjes, H.: ELAN: a Professional Framework for Multimodality Research. Proceedings of LREC 2006; Fifth International Conference on Language Resources and Evaluation.



© 2013 by Lippincott Williams & Wilkins, Inc.