Cue-responding during simulated routine nursing care: A mixed method study

Background: Failure of nurses to recognize, acknowledge, and/or explore patient cues/concerns may result in patients' unrecognized psychosocial and information needs that could have untoward consequences. With the continuous evidence of the need for nurses to improve their communication, a greater emphasis is needed in the undergraduate nursing curriculum on training students in such skills. Objective: This study is to explore the cue-responding behaviors of nursing students during their routine care of patients in a simulated setting. Design: A mixed methods approach. Participants: Senior year students. Method: Data was collected by video-taping the students' cue-responding behavior performance, through individual debriefing interviews, and from the student-patient actors' written comments and the focus group. Results: Of the 110 cues in the conversation, 47% were acknowledged, only 12% were explored, and 53% were responded to with distancing behavior. Students' cue-responding behavior was a negative 21.8% with more cues being responded to through distancing behaviors than were acknowledged. Their pattern of communication was characterized by a focus on task completion, the use of predominately close-ended questions, and the giving of explanations and information based on unchecked assumptions. Conclusions: Learning from their individual video-taped performance and debriefing with facilitators helped the students to not only develop a deeper level of self-awareness and reflection but also caused them to think more about time, the culture of nursing, and the tension between task-focused and patient-centered care. They came to value cue-responding in communication as one way of learning about communicating with patients. Focusing on cue-responding in communication also provided us with insights on the students' understanding of communication and the need for educators to re-emphasize person-centered communication and to deal with issues that go beyond technical skills. Future research is critical to examine its transferability to practice with continuous coaching and role modeling for students in clinical settings.