Paper
Sunday, November 13, 2005
Strengthening an Investigator-Developed Instrument for Observing Behavioral Interactions of Nurses in Clinical Settings
Mary M. Hays, DSN, RN, College of Nursing, University of Alabama in Huntsville, Huntsvile, AL, USA and Aurora Torres, PhD, Psychology Department, University of Alabama in Huntsville, Huntsville, AL, USA.
| Learning Objective #1: Explain the implementation of a Rater Training Program with students from another discipline |
| Learning Objective #2: Recognize selected interaction behaviors that impact dyad communication in the clinical setting |
Nurses' verbal and nonverbal communications have an impact on the safety and continuity of patient care, on nursing errors, and even staff retention. Effective communication between nurses during shift report in their leader-follower roles is compromised by the lack of supporting behaviors, an air of negativity, and a reduced cohesiveness (Hays, 2002; Hays, 1995). This study aimed to strengthen an investigator developed Target Behavior Instrument (TBI) by establishing a Rater Training Program (RTP). The RTP used role-playing dyads, videotaped while demonstrating scripted interaction behaviors of nurses in shift report with the goal of establishing interobserver agreement through true and observed values (Johnston & Pennypacker, 1993). Students enrolled in a psychology department course played the role of nurses in scripted routine and crisis shift report vignettes. Two other students acting as raters coded the tapes. Twenty-six dyads were videotaped. The TBI, based on Hersey and Keilty's (1980) Interaction Influence Analysis, was used to identify the 10 communication behaviors. Following training sessions, the two raters coded 10 vignettes, 5 with dyads using the crisis scenario and 5 with dyads using the routine scenario. Preliminary findings suggest that the message content affects the frequency and type of dyad communication in directing, listening, accepting, and supporting behaviors. Supporting behaviors were the fewest. Chi square analysis shows that significantly more behaviors were exhibited during the crisis script. Data are being analyzed to establish interobserver agreement. Knowledge of the appropriate leader-follower behaviors will be used to develop simulated clinical situations with nursing students in undergraduate and graduate programs in preparation for entering or remaining in the work force in any setting. A future study will develop behavioral interventions linking nurses' actions in report to their practice and performance. The target will be nurses in diverse settings who are experiencing variations in collegial relationships and turnover rates.