Assessing & Evaluating Communication Competency in Nursing

Karenna Glover (00:02):
Hello everyone and welcome to today’s presentation. We are so glad you joined us. We realize what a busy time it is for most people beginning their semesters, so thank you for carving out some time for us today.

Karenna Glover (00:17):
My name is Karenna Glover and I’m with the GoReact team. And if you are not familiar with GoReact, we are a cloud-based video assessment and feedback solution that’s used primarily in higher ed institutions in the U.S. and across the UK. And we’re excited to show you a little bit of the tool this afternoon in our presentation.

Karenna Glover (00:42):
Special thanks to our presenters today who have also carved out a lot of time to join us today. And before I hand it over to them, I’m going to go over just a little bit of housekeeping. We do expect today’s presentation to last about 45 minutes, so that’s 30 minutes of presentation and then about 10 minutes for Q&A. So we welcome your questions. You’ll see a Q&A function at the bottom of your screen and we invite you to ask our presenters any questions that you might have. And if you see questions from other attendees that you also are interested in, please up vote those, and we will take the most popular questions and put those at the top of our list and try to get to all of your questions. But if we don’t cover all your questions, we will follow up. And we are recording today’s session in its entirety, so if you have to pop out early or you want to share this with colleagues, we will be sending the full presentation by email later today. So be on the lookout for that.

Karenna Glover (01:49):
Finally, there is a chat function that you can use if you have any technical hiccups. We have Abby from the GoReact team on standby to help troubleshoot that. And you’re welcome to introduce yourselves, let us know where you’re from, what programs you’re attached to and share any resources that are relevant to our topic today. So use the chat function for that and use the Q&A for our questions for our presenters.

Karenna Glover (02:19):
So with that, I am going to… We’re going to launch a poll question real quick and then hand it over to our presenters. So we want to know, are you currently teaching communication in your program? You are, or you are not. We’ll give you a couple seconds to answer that.

Karenna Glover (03:01):
All right. And the results are in. So it looks like the majority of you are teaching communications. So that’s terrific. Hopefully you leave here with some new tips and insights on how to assess and evaluate the communication competency in your students. That is our hope. So with that, I’m going to hand it over to Elaine Wittenberg and LoraLynn Allen to introduce themselves and get us started.

Elaine Wittenberg (03:31):
Thanks, Karenna. My name is Dr. Elaine Wittenberg. I’m a professor of communications studies at California State University in Los Angeles. I served on the AACN work group committee for developing a toolkit for teaching and assessing communication in nursing education. I have a PhD in communication. I’ve been teaching and training bedside nurses, nursing students and nursing faculty like yourself for the last 15 years. I am so glad you are here. And LoraLynn, if you could please take a moment to introduce yourself.

LoraLynn Allen (04:04):
Thank you. So my name is LoraLynn Allen. I am currently the simulation skills and clinical coordinator for the Utah State University Department of Nursing and I have been a nurse educator since 2017 in the formal setting here in the university, and then a nurse educator at the hospital for a few years prior to that. Been a bedside nurse for 10 years as well. My experience is between the emergency department and the neonatal intensive care unit and a few others throughout there with a lot of heavy emphasis in simulation education. So I really love to practice a lot of these different skills and components and bring these into hands on practice for our nursing students.

Elaine Wittenberg (04:44):
We’re going to be your guide today for the next 30 minutes or so.

Elaine Wittenberg (04:49):
First, we’re going to aim to identify the three types of learning objectives for nurse instruction and communication. Second, we’re going to explain how to link a communication learning objective to a competency domain. And then third, LoraLynn’s going to describe how to use GoReact for your own teaching and assessment. So let’s get started.

Elaine Wittenberg (05:13):
Last year, academic nursing moved to a new model and framework for nursing education based on a competency based approach. And the AACN Essentials really shifted the focus to student demonstration of skills as they develop across the program of study. And that’s really applicable to what we’re looking at today, is the demonstration of skills. So this document was super wonderful, because it identified communication. And communication is identified as a concept for necessary curriculum content and expected competencies. So while it’s not a domain area, it is a concept area. So, really great news, and I’m sure most of you will agree that communication is essential and vital to quality nursing care. But there’s one problem and actually there’s many problems.

Elaine Wittenberg (06:13):
My team’s research which involved a national survey of BSN programs found that schools… You might be one of them… have limited resources that really limit the way that we assess for communication. So primarily communication has been assessed through looking at communication knowledge. And in our survey of courses, we found that less than 1% of the courses surveyed included communication content. So currently there is no competency based outcome measurement tool for assessing communication instruction and there’s no evidence base for health communication materials for teaching communication. So you are in the right place and that’s really where I come in. As I mentioned earlier, I’m a communication scholar.

Elaine Wittenberg (07:09):
So if we think about when it comes to teaching communication skills, you’re asking a student to do a couple of things. You’re asking a student to become aware of their own communication, you’re asking them to learn about a new way of communicating and then you’re asking them to change something about the way they communicate or to have a new behavior. So this process really involves three aspects of development. First is nursing students need to learn the value of communication, because you have to value it in order to be able to adopt a favorable attitude. Second is that nursing students need to be taught about communication processes, so that they have a knowledge and understanding of how their communication behaviors affect others. And then finally, new communication skills should be practiced in a safe environment and assessed according to the competency based approach outlined in the Essentials document.

Elaine Wittenberg (08:13):
So a competency based approach to teaching the concept of communication as outlined in Essentials domains, should address three different types of learning objectives. We encourage all programs to teach and conduct competency assessment for communication attitude in the first year of study, because that is the incremental year where you would be developing a favorable attitude, not just towards communication, but towards being open to learning more about communication skills. And then in subsequent years you would teach and assess for communication knowledge, which would then lead up to communication skills. So it wouldn’t make sense to just jump into a first year course and be assessing for communication skill, and you probably don’t do that already.

Elaine Wittenberg (09:05):
Now in terms of thinking about communication knowledge, my work is based on what we call the COMFORT Model. And the COMFORT Model offers content for teaching communication and really drilling down to that communication knowledge component. COMFORT is an acronym that stands for the seven basic principles of nurse communication. The model is based on empirical research in hospice and palliative care, including observation of teams, team meetings, many years of interviews with patients and families. And since 2010, we’ve taught it to more than 12,000 nurses and nursing students nationwide. The model is based on our theoretical frameworks in communication and evidence based in terms of instruction and improving patient outcomes, such as satisfaction.

Elaine Wittenberg (10:00):
Now I want to really introduce the Comfort Communication App. This is a quick and easy resource for learning about the COMFORT Model. So if you are in a low resource institution, this is a great tool to use for your own communication instruction. The best news is, it’s free, absolutely free. It includes communication strategies, such as, things to look for, non-verbal communication, questions to ask and things to say in clinical situations. So it really identifies and gives you the content for communication knowledge. The app is available at the website here. It is not an app in terms of downloading onto your device. It is a web based platform, so you can use it on your phone or your desktop or your iPad. It doesn’t matter. And this screen on the left shows the menu options and they spell COMFORT, Connect, Options, Make Meaning, and so forth. Today, I’m going to be providing an example that comes from the lower right hand corner, the COVID-19 communication resources.

Elaine Wittenberg (11:13):
So I want to briefly show you an example of how the learning objectives should be linked to the AACN Essentials domains. So remember, communication is a concept and not a domain. Later, I will introduce you to the toolkit that we developed that shows you the different Essential domains and communication as a concept. But here first, we want to decide which type of learning objective you will assess and I’m giving you an example from an article published in Nurse Education Today. In this example, we were assessing communication skill and we decided to focus on plain language, which is covered in the COMFORT Communication App, which was our knowledge based resource for students. We defined plain language in the learning objective and then matched it to the Essentials, and this is the key component. Take note of this, that this learning objective actually crosses two different domains, domain eight and domain nine.

Elaine Wittenberg (12:20):
So we took the learning objective and decided to write a case study, and then asked students to write down exactly what they would say. Competency was defined as meeting the learning objective definition of plain language. So this provides you with the assessment tool and the competency criteria. But let me show you just a simple way of looking at it, which is a grading rubric that shows that the criteria is about communicating in plain language. And then we’ve just simplified whether or not they meet or almost meet criteria by dividing it between the two aspects of plain language, as indicated in the instructions.

Elaine Wittenberg (13:05):
So before I turn this presentation over to my colleague, LoraLynn, I just want to point you to two resources. First is the AACN Essentials Toolkit Concept on communication. And if you just simply download it… And it’s all based on COMFORT Communication Model, again, of which you can use the app for free and then link it to the AACN Essentials. The second is my website, Communicate Comfort, in which we offer two free nursing faculty teaching guides for teaching COVID-19 communication resources. It was a grant funded project, so they’re free teaching guides with clinical case studies and instructions for using the app and instructions for doing competency assessment in line with AACN Essentials. So if you’re looking for kind of last minute tools for things to use this semester, it’s a great toolkit. And now, LoraLynn will describe how to use GoReact in this process.

LoraLynn Allen (14:09):
Thanks, Elaine, and I’ll take over screen sharing if you’re okay with that.

LoraLynn Allen (14:15):
All right. So, as Elaine mentioned, when we reflect on how we implement our communication competencies in our program, a lot of us are limited to that knowledge assessment method, where we provide questions for students and we have them identify which method of communication is most effective. But sometimes we are limited in that way, again. As educators when the time comes to make adjustments to our curriculum based on new competencies like this, or making updates based on evidence based practice, changes based on credit hours, the process can be very lengthy and difficult a lot of times to make sure we’re following guidelines for institutions and our governing bodies as well. I know that we’re all too familiar with a lot of these barriers that I’ve listed here, that we encounter on a regular basis, and I’m sure that there are some that I missed as well. But as we think about the communication competency in particular and how we incorporate these, we also need to consider our focus. So looking at this quote here on the side, why is it that we do what we do? As healthcare providers and as educators of healthcare providers, we are working towards, as a team, providing the best outcomes for our patients, and this does directly relate to communication. Excuse me.

LoraLynn Allen (15:35):
So when we looked at this visual that Elaine had presented, it really does make perfect sense. One of the challenges that I’ve seen in nursing education over the years, is that broadening the focus from simply teaching a concept or a rubric based skill and also bringing in that overlap into both health communication and nursing practice, can be a challenge. Oftentimes, we are just focused on that education component itself. We can forget sometimes as instructors that teaching the student to perform a skill, like inserting an IV or a nasogastric tube, while it is important to perform that correctly for best patient outcomes, it also does include more than just plain competency with the skill. It also includes the “how” we communicate and the “what” at the same time. So as we are considering some different and varied delivery options, as that quote from the previous slide mentioned, how often are we choosing and developing activities that deliberately do focus on how to effectively communicate within our roles? So this is a really great driving thought as we start to look at methods of bringing this into our programs.

LoraLynn Allen (16:42):
So coming back to these specific learning objectives for communication… Excuse me… I’d like to show you all an example of a learning activity that can be used to help reinforce these. So again, thinking back to some of the barriers that I initially began with, we’ll discuss a variety of different methods for incorporating this activity that could help overcome some of those barriers, make it possible for each of you to do that within your own programs.

LoraLynn Allen (17:10):
Okay. So this is an example of a rubric, a sample rubric using some of the similar components and objectives that were mentioned. When you consider this rubric, I’d like to show a short clip from a simulation exercise that took place on our campus here at USU several years ago, and this is the same clip that I will use to demonstrate a couple of varieties on the exercise. Within the simulation activity itself, the communication objectives for the students are to effectively provide patient education, utilizing plan language, and to demonstrate effective teamwork and communication. Now, for this specific rubric, we’re asking the students to observe and identify communication practices in teamwork and the methods of communication used during a patient education experience. Then we ask the students to demonstrate a measure of their own competency in communication. This rubric specifically cites written communication by providing some narrative feedback. And bear with me for just one quick second while I fix this. All right.

Speaker 4 (18:25):
So, right now your doctor would like you to get an ultrasound on your calf, okay?

Speaker 5 (18:33):
Okay.

Speaker 4 (18:33):
He’s worried that you might have a blood clot in your calf and we wouldn’t want that to move up into your lungs, okay? He’s also ordered some medications [inaudible 00:18:42].

Speaker 6 (18:41):
Hello.

Speaker 7 (18:41):
Hi.

Speaker 6 (18:42):
We [inaudible 00:18:42] call you.

Speaker 4 (18:47):
Okay. Do you have any [inaudible 00:18:49]?

Speaker 5 (18:50):
Not that I know of.

Sarah (18:52):
I’ve got that Lovenox for you and the Warfarin right here. Do you know how to administer Lovenox?

Speaker 6 (18:54):
Subcutaneous.

Speaker 4 (18:55):
[inaudible 00:18:55].

Speaker 5 (18:55):
I just don’t know what medications. I don’t know.

Speaker 4 (18:55):
Okay. So let me tell you what medications [inaudible 00:18:55].

Speaker 7 (18:55):
[inaudible 00:18:55].

Speaker 6 (18:55):
[inaudible 00:18:55].

Speaker 7 (18:55):
[inaudible 00:18:55].

Speaker 5 (18:55):

[inaudible 00:18:55] very slight, so that will also help with that.

Sarah (19:18):
Hi, honey, my name is Sarah. I’m the charge nurse. I’m just going to grab some blood from you today. Is that okay?

Speaker 5 (19:22):
Sure. Sure.

Sarah (19:22):
We’re going to get that [inaudible 00:19:24].

Speaker 7 (19:28):
Is it okay if I ask her if she [inaudible 00:19:30]? What would you [inaudible 00:19:32].

Sarah (19:32):
[inaudible 00:19:32] take that to the lab.

Speaker 4 (19:34):
[inaudible 00:19:34] right now.

Speaker 7 (19:34):
Okay. Sorry.

Speaker 4 (19:36):
Just give me one second.

Speaker 7 (19:37):
Okay. No, you’re good.

Speaker 4 (19:40):
And then he’s also ordered some Warfarin. Have you heard of that before?

Speaker 5 (19:43):
No.

Speaker 4 (19:44):
Okay. Have you heard of Coumadin?

Speaker 5 (19:44):
No.

Speaker 4 (19:44):
Okay. That is a blood thinner. So what it’s going to do, is it’s going to thin out your blood, so that in case you do have a blood clot, it’s a better chance that it’s not going to hurt you. Does that make sense?

Speaker 5 (20:00):
Okay. Yeah. Yeah.

Speaker 4 (20:02):
And then the Enoxaparin, I’m not sure.

Speaker 7 (20:07):
So Enoxaparin, another word for Lovenox and that’s also a blood thinner.

Speaker 4 (20:11):
Oh, thank you. Oh, are those dangerous? Is that bad? What if I fall or get a cut? If my blood thins…

Speaker 5 (20:20):
We will watch you for that. We’ll watch you for any bleeding. So if you did somehow get a cut, would you let us know?

Speaker 4 (20:28):
Okay. Sure.

Speaker 5 (20:29):
Okay. And then we’ll just make sure that you make it to the bathroom okay. And we’re here if you have any problems.

Speaker 4 (20:38):
Okay. Okay. So do I get to go home now, though, because I think I need to get back to work? We just can’t afford for me to miss work.

Speaker 5 (20:46):
I understand that, but this is really important for us to get you checked out. Is there anyone… Can your husband go home and take care of your children?

Speaker 4 (20:55):
He can, but I’m worried about the money. Yeah.

Speaker 5 (20:58):
I totally understand that.

Speaker 4 (21:03):
And just the bills. I know that being here is really expensive and I just am really worried that I can’t afford it and I’m missing work. He’s going to be mad.

Speaker 5 (21:11):
Okay, honey, this is really important… Look at me… because this is your health that we’re talking about, okay. Do you want to be healthy for your family and take good care of them, like you have been doing?

Speaker 4 (21:23):
I do. I do.

Speaker 5 (21:25):
Okay. So, right now, how about if we worry about your health and try not to worry about the other things. They’ll all work out. Our hospital, somebody will come and talk to about the finances. We always work with people and help them through. Okay.

Speaker 6 (21:44):
[inaudible 00:21:44].

Speaker 4 (21:45):
I just don’t want to. I just don’t want to leave the house. I [inaudible 00:21:47] so hard to give my kids a good life.

Speaker 5 (21:50):
I totally understand that.

LoraLynn Allen (21:58):
Okay. So coming back to this rubric here, there are a few different options for implementation. So depending on what your available resources are, some of those barriers, again, you might be working with. And this was just a small-

Karenna Glover (22:11):
LoraLynn?

LoraLynn Allen (22:12):
Yes.

Karenna Glover (22:12):
I’m so sorry to interrupt you.

LoraLynn Allen (22:15):
Please.

Karenna Glover (22:16):
I just wondered if you are able to share full screen?

LoraLynn Allen (22:21):
Let see if it will [inaudible 00:22:23].

Karenna Glover (22:22):
Perfect.

LoraLynn Allen (22:29):
Did that work?

Karenna Glover (22:30):
Yes, that’s perfect.

LoraLynn Allen (22:30):
Okay. It looked full screen on my side. So please let me know if that happens again.

Karenna Glover (22:34):
Okay. Thank you.

LoraLynn Allen (22:37):
Okay. So again, going back to some different options for implementation, utilizing that same video there, and again, some of those barriers you might be working with. So one of the first options that we do that we’ll utilize pretty often is an in-class activity with a case study approach. So the way that I do this with my students is to put them into groups. We’ll watch that prompt video as a large group, but put them into groups, whether at different tables or pair them up with a partner and provide them with a grading rubric similar to this one that they’re completing in class. So as they are watching and reviewing the activity, they’re identifying their own feedback here. They’re identifying, “How do I think that this student did at utilizing that plain language?” “How do I think the team did at communicating back and forth with each other.” And this one, doing case study style, we will do verbal feedback with each other.

LoraLynn Allen (23:26):
So after they’ve gone through, graded them themselves, in those small groups, I will have them discuss the feedback. What are some things that they would do differently, if they were in that scenario? What do they think that the team or the performers in that video really excelled at, that they appreciate that they feel like met those competencies? And what are some things that they felt like were less effective that they might address in a different way in the future? Once they’ve done this in their small groups, then I’ll come together as the full group and we’ll have that discussion altogether. We’ll talk about some things that really jumped out at us and we’ll bring in the discussion about putting things into practice.

LoraLynn Allen (24:05):
Another variation on this one is in a simulation environment. Excuse me. So using the same scenario that was done in the video, we’ll actually have the students complete that scenario in small groups within simulation. After they’ve completed the scenario, completed the full scenario, not just the few minutes that we viewed here, we utilize these same concepts in our debrief conversation. And we give our students a chance to actually discuss this in an open forum. The best part about that simulation discussion is that the students are in an environment that is non-threatening and non-judgmental. So they are able to practice that dialogue between each other and provide feedback, letting each other know, “I really appreciated how you had your focus on that patient while you were providing education. Maybe next time it might be a little bit better if you were to sit down at the bedside at eye level with the patient while you’re providing that education,” and give suggestions like this. And it provides for really open conversations where that narrative feedback is in the form of dialogue versus a written piece of feedback.

LoraLynn Allen (25:12):
Now, this last piece that I want to show you, this last variety, is utilizing GoReact. This is something that our program used quite heavily when our clinical sites were restricted in 2020. And this can be done either as a post simulation activity where you provide them the recorded video of their own experience to evaluate, or as a stimulus video, where we provide the video from someone else that completed that scenario. So that’s what I show you all. So I’m going to switch my screens here just again. Oh, hold on one second.

LoraLynn Allen (26:05):
All right. Okay. So we utilize canvas as our learning management system. And I want to start off first with the student view, so what they see when they submit the activity. So when we first open up our GoReact, we have this embedded as a tool within our LMS system, so it’s really easy for the students to access. So I’ve already started my own submission here that you guys can see or will be able to see here. So when I click into this one, I’m going to resume my work. It will auto play. I have it set to auto play the video when it comes in, so it’ll be exact same thing that we watched. And areas for comments. We can also look at the rubric here. Now I have the rubric that’s built in, the same thing that I would provide for the students. And as I go through and I watch this video, then I can make my grading. I can do some marks here on my grading. I’ve gotten to the end of my video here.

LoraLynn Allen (26:58):
Throughout the activity, I feel like she does a pretty good job at using plain language, but sometimes it’s a little bit ineffective. I feel like maybe she could explain the word blood thinners a little bit more. What does that actually mean for this patient? So I’m going to mark that as a “needs improvement.” Now with our team communication, I feel like they did a really great job on this one. So I’m going to mark, “met,” for what I think there. As part of the instructions for this assignment… Because this was in process already, you didn’t see the pop up here with the instructions. But the instructions here included, providing a minimum of two comments, using full sentences and specific examples from the video. So coming back in here, I can see my comments that I added. I’m going to go back in and add one while you guys are with me, so you can watch how this works.

Sarah (27:47):
Hi, honey, my name is Sarah. I’m the charge nurse. I’m just going to-

LoraLynn Allen (27:50):
So with this one, I’m going to comment on using the word, honey, to address my patient. So rather than using nicknames, like honey, sweetheart and similar, I’m going to suggest to the student that we use the patient’s full name or their actual name when she’s addressing her to build that respect there. So when I start to type this comment, it pauses my video so that it can timestamp. So, when you first address the patient, instead of using a nickname, like honey, it may be better to use her real name. And hit enter, and it will timestamp that comment there.

Sarah (28:34):
[inaudible 00:28:34].

LoraLynn Allen (28:34):
So this is the student feedback there. Now going back to my rubric view, I’ve selected what I want to. I think I’m good there. So I’m going to exit and I’m going to post my rubric. So this is me saying, “I’m done. I’ve evaluated my video,” as the student here. Okay. So I’ve submitted this. So I’m going to go back to my activity on that LMS page, leave student view, which will take me now to the instructor view.

LoraLynn Allen (29:04):
And as the instructor, my view’s a little bit different as far as the rubric itself that I’ve built in. I’m going to pause the video when it starts here, but I can see my test student that has submitted their assignment. That’s ungraded. So as I go into this… Again, I’ll pause my video. Immediately, I can see the comments that were left. And within the rubric field, under my dropdown menu here, I can look to see the student’s test rubric and I can see my rubric as the instructor with the different markers on the side. My rubric, as the instructor, lists check marks for communication and teamwork. “Was this review item completed.” And then a rubric item for me to evaluate the narrative feedback, “Was it given in full sentences?” “Were specific examples from the video included?” And this is one that I can customize, however I want, within here with these rubrics, which I’ve really appreciated being able to do with my different activities.

LoraLynn Allen (29:57):
So as I’m going through… I’m going to go back to the student rubric here and look to see. Yes, my student evaluated communication. They evaluated teamwork. And then I want to go back to my comments and I’m looking to see, what did we address? So we have the opportunity to discuss what the term blood thinner means, why it’s important for this patient. When you first address the patient, the comment we just left, “Might be better to sit at eye level when you provide education,” and so on there. So going back to my rubric, I’m coming in and marking each of these. Yes, we did a great job. These are specific. You can go as in depth as you want to these rubrics. And I’m posting my rubric the same as the student did.

LoraLynn Allen (30:38):
Okay, I’m going to stop sharing this screen here, but I like to include a variety of these different activities in education and in our environment here to emphasize the different methods of communication that we really utilize in practice. As a practicing nurse myself, I have to be prepared to communicate in a variety of ways between both written and verbal communication, whether it’s documenting my care, whether it’s communicating with my patients, with their family members, with management, anything there. So I like to be able to bring in this variety for my students as well.

LoraLynn Allen (31:18):
All right. So coming back to this rubric that I shared earlier, even though there’s a variation on the different activities between the approach from the instructor and the learner, we were still able to accomplish each of these items, while deliberately addressing those learning objectives for communication that Elaine had introduced earlier. In each variation, we provided opportunities for the student to reflect on and discuss each of these objectives for best communication practices, while also giving opportunities for their own development in communication competencies as well. So I hope that this was beneficial for each of you and we really appreciate you taking time to join us today.

Karenna Glover (32:05):
Thank you so much, Elaine and LoraLynn. I’m sorry, I was on mute, stuck on mute for a minute there. But this presentation has been so helpful. It’s great to hear about the learning objectives and then see it in action of how you evaluate them and the tool up close and personal. So thank you for walking us through that and thank you to our attendees for being here.

Karenna Glover (32:27):
We currently have no questions that have been asked. So I am going to go ahead and just close out with one question to both of you. And if anybody else has any questions, feel free to pop them in while we’re going through that. But just, given that we’re all beginning new academic years and new semesters, do you offer one or two must have tips on teaching communications this semester? And we can start with either one of you, whoever wants to go first.

Elaine Wittenberg (33:05):
I’ll jump in, I’ll jump in.

Karenna Glover (33:06):
Awesome.

Elaine Wittenberg (33:08):
It’s a great thing. And now remember, I’m coming at it from a communication specialist, a scholar, the science of communication, understanding what impact our words and actions, non-verbal communication, has on another person. I’m not a nurse, so that’s my caveat. I would say the most important thing missing from nurse communication instruction right now is a very clear definition of the communication skill, based on communication knowledge. So I would highly encourage you to think about, what is the specific skill that you are trying to teach? What does it look like? And defining it based on evidence, based what we know about that skill in clinical settings.

Elaine Wittenberg (33:54):
And then the second thing I would say is, consider measuring communication attitude before instruction. This will make your instruction more robust. Department chairs and higher up are looking for numbers, and it’s a real easy way to do it. You can contact me. I can show you. There’s a lot of different ways to measure communication attitude, which can really make your assessment more robust overall. Thanks.

Karenna Glover (34:25):
Thank you, Elaine.

Elaine Wittenberg (34:28):
You’re welcome.

Karenna Glover (34:28):
LoraLynn, do you want to give a couple of tips?

LoraLynn Allen (34:32):
Yes. I think, as a simulation educator, specifically, a lot of my job and my experience has been to try to find innovative ways to practice things and to bring them in, in a various level of fidelities, if you will, with simulation. We look at high fidelity where we have to… We use fancy mannequins and these really elaborate scenarios, but this is something that can be done without those pieces. You don’t have to have anything expensive to be able to utilize this. You can bring it into a classroom setting. So my biggest tip is don’t be afraid to be creative within the restrictions that you have. You can do this, again, in a classroom setting, or just utilizing a YouTube video example to address those barriers there.

Karenna Glover (35:19):
Fantastic. All right. Well, it looks like a couple questions have trickled in while we’ve been talking. So I’m going to go ahead and start asking those. I’m going to start with you, LoraLynn. And Elaine, feel free to jump in on the responses as well. So the first one, I will note that we have lots of people saying, “Thank you” and “It was a really interesting and valuable presentation.” So thank you both for that. But the first question is, can you expand on the communication specifics on what you are testing, such as difficult conversations, frustrated patients, bad news, et cetera?

LoraLynn Allen (35:58):
Elaine, do you want to touch on that one at all? Or do you want me to go with that?

Elaine Wittenberg (36:02):
I don’t understand the question. So if you do, you go ahead.

LoraLynn Allen (36:04):
Okay. Karenna, can you rephrase, or can you say that again for me?

Karenna Glover (36:09):
Sure. Please expand on the communications specifics as to what you are specifically testing, difficult conversations, frustrated patients, bad news, et cetera.

LoraLynn Allen (36:23):
Okay. So this is something that we actively do within our program. And we do this one in… We do it more low stakes, so not exactly testing, but in low stake scenarios where we are practicing the competency. And so with this one, we are focusing… Within one of our courses, I teach a workplace violence prevention simulation for our students. So we talk a lot about therapeutic communication, reflective listening, deescalation techniques for our students. And this is something where we will address things like the difficult conversations. So we’ll do a lot of case study style with this one, where we give them scenario examples and have them practice some of their suggestions, come together as a group, discuss what is effective, what’s not and what research has said is most effective for these types of conversations. So not exactly testing, but it is a way of evaluating our students and seeing how did they feel at the beginning of this, with their comfort level and how do they feel at the end of this experience with their comfort level.

Karenna Glover (37:27):
Super, thank you for that. And the next question again to LoraLynn. The rubric that you shared earlier, do you give that to the students before their evaluation?

LoraLynn Allen (37:42):
It depends on the exercise. Most of the time I do provide them with that rubric or a form of that one, maybe in checklist form as they’re watching, so that they have the tool as they’re looking and seeing. So they’re not behind when they actually get to watch the video or the stimulus piece.

Karenna Glover (37:57):
Super. Okay. Next question. Is there a validated tool to measure communication attitudes?

Elaine Wittenberg (38:06):
There are several. There are many. And it should align with what you’re teaching. So there’s a communication attitude scale, very general. There’s willingness to communicate in large groups, small groups. There is an interpersonal communication competency scale. There is effective listening scale. You really need to define what aspect of communication and what skill you’re looking at. But yes, there are numerous attitude scales in the area of communication.

Karenna Glover (38:39):
Anything you want to add, LoraLynn? Okay. Perfect. All right. Up next. Can virtual learning on a computer screen without a live instructor be helpful for learning good communication with patients or is it only achieved through practice with a human watching and evaluating?

LoraLynn Allen (38:59):
Oh, okay. Go for it, Elaine.

Karenna Glover (39:02):
I’ll let LoraLynn do the particulars, but I want to remind everybody, not everybody comes from a high resource institution, as LoraLynn mentioned. And so when you have limited resources, you have to be creative and it doesn’t mean that you can’t still provide communication instruction and assessment. So yes, you can simply have a student record what they would say and then provide feedback on that, if that’s one way to do it. You don’t necessarily have to have a live instructor there. And I’m sure LoraLynn will be able to provide more specifics.

LoraLynn Allen (39:35):
Yes. I love this question. This is a wonderful question, because it really does… You guys have already seen, I really like to address how we overcome barriers with this and how we utilize really good tools. One of the things that we did try as well was using that virtual learning environment. We had a piece that we used that we were able to trial out with our students, that very first semester of our pandemic restrictions. And the students were given these exercises and we had a variety, between providing written feedback that we went back and graded afterwards and then video feedback, exactly like Elaine said, where it is, “Show me what you would do.” But we didn’t have the resources to be able to synchronize that learning at the same time. And so we found that it was just as effective that way. Our instructors going forward preferred the synchronous interaction, so that’s something we’ve tried to incorporate there. But it’s absolutely possible. You just need to be very aware of what you are looking for, what you are going for with that learning activity, exactly like Elaine mentioned, and making sure that it actually does meet the objectives that you’re going for with that exercise.

Karenna Glover (40:43):
Super, thank you for that. And there’s one final question. I think we’ve answered some of this, but are there any other specific communications assessment tools that you might recommend? This seems like it might be targeted more to the graduate level students, but anything else you each want to share?

Elaine Wittenberg (41:04):
I think I addressed that earlier.

Karenna Glover (41:08):
All right. Well, wonderful. We had one more pop in. Let’s see. School uses their own video equipment with GoReact to give feedback. I think that’s the question. LoraLynn, do you want to touch on that, how you use GoReact and what video tools you use?

LoraLynn Allen (41:29):
Sure. So I’ve been using GoReact for several years, so I’ve tried a lot different methods with this one. My favorite part with it is that I can use whatever I’ve got. So I can either record a video response on my phone. I can use my webcam on my laptop and record back and forth. So it’s a really easy thing to use without actually having to have formal video equipment, to be able to interact back and forth with the student. So I hope that answers the question there.

Karenna Glover (41:57):
I think so, that’s great. All right, so that closes out our questions session. And thank you so much for popping in some questions, all the attendees who stuck around. It was great to have some additional dialogue. And I just want to thank everybody for attending and certainly Elaine and LoraLynn for this great presentation. Again, we know this is such a busy time for everyone, so thank you for carving out some time. Hopefully, you have some inspiration and some takeaways to begin your semester and we hope to see you on a future presentation. So thank you all so much and have a great rest of your week.