Week 6 Assignment: Reading Research Literature (RRL) Worksheet (graded)

 

  • Read over each of the following directions, the required Reading Research Literature worksheet, and grading rubric.
  • Review the following video which contains a tutorial for your Week 6 Assignment. Tutorial may look slightly different session to session. Grading criteria and rubric will be the same. Access the transcript via this link: Week 6 Assignment Transcript (Links to an external site.).Week 6 Assignment Tutorial: https://lms.courselearn.net/lms/video/player.html?video=0_jhxsfia6
  • Download and complete the required Reading Research Literature (RRL) worksheet (Links to an external site.). This must be used. 
  • Your required article is available to you in an announcement: IMPORTANT: Assigned Article for Week 6 Assignment. Please go to your announcement to locate the required article assigned for this session.
  • This assignment contains:

    Purpose of the Study:  Using information from the required article and your own words, summarize the purpose of the study.  Describe what the study is about. 
    Research & Design:  Using information from the required article and your own words, summarize the description of the type of research and the design of the study.  Include how it supports the purpose (aim or intent) of the study.
    Sample:  Using information from the required article and your own words, summarize the population (sample) for the study; include key characteristics, sample size, sampling technique.
    Data Collection:  Using information from the required article and your own words, summarize one data that was collected and how the data was collected from the study.
    Data Analysis:  Using information from the required article and your own words, summarize one of the data analysis/ tests performed or one method of data analysis from the study; include what you know/learned about the descriptive or statistical test or data analysis method.
    Limitations:  Using information from the required article and your own words, summarize one limitation reported in the study.
    Findings/Discussion:  Using information from the required article and your own words, summarize one of the authors’ findings/discussion reported in the study. Include one interesting detail you learned from reading the study.
    Reading Research Literature:  Summarize why it is important for you to read and understand research literature.  Summarize what you learned from completing the reading research literature activity worksheet.

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  • You are required to complete the worksheet using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the ” x” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.). Click on the envelope at the top of the page.

  • Submit the completed Reading Research Literature Worksheet to the Week 6 Assignment.
  • September/October 2020 | Volume 38 Number 5 267

    Nursing Economic$

    Patients spend more time with nurses than any other healthcare
    professional. The primary
    conduit of information between
    the patient and healthcare team
    are nurses; therefore, nurses
    need to be good
    communicators. Careful listening
    is at the core of good
    communication and is a key
    element of patient safety and
    experience (Balik & Dopkiss,
    2010). A key component of
    nurse-patient communication is
    the patient’s perception of their
    experience with the nurse
    listening. Despite the known
    importance and impact on
    patient experience, quality
    outcomes, and reimbursement,
    there is a gap in research on
    effective nurse communication
    from the patient’s perspective.

    Healthcare’s shift from
    volume to value requires
    hospitals to focus on
    performance and quality
    outcomes, such as patient
    experience, as measured by the
    Hospital Consumer Assessment
    of Healthcare Providers and
    Systems (HCAHPS) survey. The
    nursing communication domain

    within the survey has the
    greatest impact on the patient’s
    overall experience score (Studer
    Group, 2012). The first series of
    HCAHPS survey questions focus
    on patient care received from
    nurses (Centers Medicare &
    Medicaid Services [CMS], 2020).
    It asks about being treated with
    courtesy and respect, nurse
    listening, and the nurse’s ability
    to explain things in a way the
    patient can understand.

    Patient experience, a key
    hospital performance metric, is a
    component of value-based
    purchasing (VBP), which holds
    providers accountable by linking
    Medicare reimbursement to
    outcomes. For FY17, the VBP
    program affected 2% of the base
    operating payments to hospitals.
    This resulted in $1.7 billion in
    Medicare payments being
    withheld from hospitals because
    of poor performance on the
    HCAHPS survey measuring
    patient experience (Becker’s
    Hospital Review, 2017).
    Research by Press Ganey®
    revealed hospitals focusing on
    improving the nurse
    communication metric could
    potentially influence 15% of

    Nurses’ Active Empathetic Listening
    Behaviors from the Voice of the
    Patient
    Karen K. Myers
    Rebecca Krepper

    Ainslie Nibert
    Robin Toms

    Effective nurse communication,
    including listening skills, is
    essential to a positive nurse-
    patient relationship. This two-
    group comparative study
    identified how adult hospitalized
    patients perceived effective and
    ineffective nurse active
    empathetic listening (AEL)
    behaviors. Participants identified
    the AEL behavior most important
    to them, providing guidance to
    prioritize interventions to
    enhance the perception of being
    listened to.

    September/October 2020 | Volume 38 Number 5268

    their VBP incentive payment
    (Rodak, 2013). The financial
    consequences of poor patient
    experience influenced by nurse
    communication further support
    the need to address the gap in
    nursing science.

    Press Ganey (2013)
    conducted a hierarchical variable
    clustering analysis on all eight
    HCAHPS dimensions. The
    variable clustering analysis
    identifies multiple measures that
    “hang together” consistently,
    while the hierarchical analysis
    identifies the measure that leads
    the others in the cluster. Five of
    the eight dimensions clustered
    with nurse communication,
    which is also the dominant
    dimension. Based on this
    analysis, it is probable the other
    four dimensions in the cluster
    (responsiveness of hospital staff,
    pain management, communi –
    cation about medication, and
    overall rating) would experience
    an improvement in performance
    if hospitals focused on improving
    the nurse communication
    dimension. Identified as the
    “rising tide” measure, the
    findings of this study support
    hospital prioritization of
    strategies focused on improving
    nursing communication, with
    potential positive impacts
    beyond VBP (Press Ganey,
    2013).

    Three qualitative studies
    involving the patient/client
    viewpoint of being listened to
    were performed in Canadian
    outpatient settings (Jonas-
    Simpson et al., 2006; Myers,
    2000) and one in the United
    States (Clementi, 2006). The
    consistent finding from these
    studies was that the feeling of

    being listened to is gratifying.
    The common listening observed
    trait was facial expression of the
    caregiver during caregiver-
    patient dialogue. Students
    enrolled in communication
    studies who participated in a
    quantitative study (Bodie et al.,
    2012) identified
    characteristics/behaviors
    perceived as demonstrating
    listening competence. Actions
    such as head nods, focused
    body language/position, eye
    contact, extended responding,
    and subject-appropriate
    responding indicated competent
    listeners (Bodie et al., 2012).
    The common themes across
    these four studies can be
    categorized into verbal and
    nonverbal responses. The use of
    questions and subject/content
    responses were verbal
    behaviors. The nonverbal
    responses included body
    language described as head
    nod, body position, eye contact,
    smiling, and facial
    expressions/emotions.

    Limited research has been
    conducted in nursing science on
    the topic of listening, with the
    majority of prior research
    focused on listening from the
    nurse’s perspective. Drollinger
    and coauthors (2006)
    incorporated the terminology of
    active empathetic listening (AEL)
    as a form of listening. The
    active listening process is
    combined with empathy to
    attain a higher form of listening.
    The researchers confirmed AEL
    supported salespeople in a
    deeper understanding of their
    customers while separating their
    personal feelings from the
    messages (Drollinger et al.,

    2006). The purpose of this study
    was to distinguish between
    effective and ineffective nurse
    AEL behaviors as perceived by
    adult inpatients from an acute
    care hospital.

    Methods

    A nonexperimental
    quantitative two-group
    comparison descriptive study
    was used to assess patients’
    perceptions of nurse listening.
    The study sought to explore the
    following research questions:
    1. Do patients admitted to an

    acute care hospital perceive
    a difference between nurses
    who exhibit AEL behaviors
    and those who do not?

    2. Is there a difference in the
    demographics of patients
    who perceive that nurses
    employ AEL behaviors
    versus nurses who do not?

    3. Which of the characteristics
    of AEL behaviors are
    perceived by patients as
    most important?
    The study setting was a

    large metropolitan hospital in
    the south-central region of the
    United States. Approval for the
    study was obtained from the
    hospital’s Institutional Review
    Board (IRB), Institutional Privacy
    Office, and the university IRB.
    The study invitation and survey
    tools were distributed to
    qualifying patients to their email
    or home addresses provided at
    the time of hospital admission.
    The informed consent was
    incorporated into the
    introductory section of the
    electronic survey or enclosed
    with the paper copy if sent to a
    home address.

    Nursing Economic$

    September/October 2020 | Volume 38 Number 5 269

    Study Participants
    Study participants were

    adults who experienced
    inpatient acute care
    hospitalization and were
    discharged from one of the pre-
    selected medical and surgical
    patient care units. Inclusion
    criteria were patients who were
    at least 18 years of age; English-
    speaking, reading, and writing
    (query at admission: “What is
    your preferred language” with
    response of English); and
    discharged to home from the
    hospital from the units included
    in the study. Exclusion criteria
    included patients unable to
    provide a physical or virtual
    address that could be used by
    the researcher to mail or email
    study instruments.

    Instruments
    Two instruments were used

    in the study: a demographic
    data form and the AEL scale.
    The demographic data collected
    from participants included age,
    ethnicity, gender, hospital length
    of stay (LOS), type of
    hospitalization (surgical or
    medical), English as first
    language, and recent hospital
    readmission(s). These variables
    were selected to determine if
    participants were a
    representative sample of the
    inpatient medical-surgical
    population being studied.

    The AEL scale was initially
    designed to measure active
    empathetic listening of
    salespeople (Drollinger et al.,
    2006) and permission was
    obtained to use it in this study.
    Drollinger and colleagues (2006)
    used exploratory factor analysis

    to refine the scale from 21 items
    to 11. The 11-item tool is
    grouped in the three subscales
    of listening, representing sensing
    (items 1-4), processing (items 5-
    7), and responding (items 8-11).
    Each item is scored using a 7-
    point Likert scale: score of 1 is
    defined as never or almost never
    true to score of 7 always or
    almost always true and 4
    occasionally true. Participants
    scored each of the 11 items
    individually based on the
    perception of the nurse’s
    listening behaviors. Sensing is
    the receipt of both verbal and
    nonverbal communication/cues
    from the speaker (Comer &
    Drollinger, 1999). The receiver’s
    cognitive processing of the
    information through
    understanding, interpreting,
    evaluation, and remembering is
    the processing phase of listening
    (Comer & Drollinger, 1999).
    Responding acknowledges
    information has been received
    through verbal and nonverbal
    responses to assure speaker
    listening has occurred (Comer &
    Drollinger, 1999).

    Reported internal
    consistency levels range from
    0.74 to 0.94 for the three
    subscales (Bodie, 2011;
    Drollinger et al., 2006;
    Fenniman, 2010). Construct
    validity levels range from 0.81 to
    0.85 (Drollinger et al., 2006).
    The internal consistency with
    Cronbach’s alpha at 0.86 and
    0.94 for the total scale for
    Bodie’s two studies is consistent
    with the resulting alpha of 0.93
    for the pilot study conducted by
    the primary investigator (PI).
    The studies’ subscales ranged
    from 0.66-0.89 (Bodie, 2011;

    Drollinger et al., 2006;
    Fenniman, 2010) and were also
    consistent with the pilot study
    results of alpha 0.84-0.87. The
    reliability of the AEL instrument
    applied across salespersons,
    supervisors, and communication
    students further supports Bodie’s
    hypothesis that the tool can be
    used to study a variety of
    interpersonal relationships. The
    levels of internal consistency at
    the subscale and total scale
    support the conceptual model
    that sensing, processing, and
    responding work together to
    produce a higher-order listening
    construct (Ramsey & Sohi,
    1997).

    Based on the literature, the
    AEL scale has been used to
    evaluate listening behaviors of
    salespersons (Drollinger et al.,
    2006), supervisors (Fenniman,
    2010), and communication
    students (Bodie, 2011). The AEL
    scale was adapted for this study
    to determine patients’
    perceptions of nurse listening.
    Two questions were added. The
    first question, “Did your nurses
    listen to you throughout your
    hospitalization?” served as a filter
    to create two groups for
    comparison. Patients were asked
    to respond on an 8-point Likert
    scale with 1 being not at all and
    8 being the most possible. The
    final question on the survey
    asked patients to identify the
    one item from the AEL 11-item
    tool that was most important to
    them.

    Data Collection
    After IRB approvals were

    obtained, the PI contacted the
    hospital’s Health System
    Information Systems Department

    Nursing Economic$

    September/October 2020 | Volume 38 Number 5270

    to initiate daily reports for
    patients meeting inclusion
    criteria. The reports were sent to
    a password-protected computer
    accessible only by the PI. The
    list of patients meeting criteria
    included the patient’s address
    provided at the time of hospital
    registration. If both an email
    address and home mailing
    address were provided, the PI
    used the email address to
    distribute the survey via the
    PsychData® web-based
    encrypted survey software. Data
    were collected over 8-months in
    2019. The researcher sent over
    3,000 email surveys and an
    additional 2,000 were sent via
    U.S. postal service. A total of
    305 surveys were returned (4.7%
    electronically and 8.6% via the
    mail). A cover letter/message
    was sent with the surveys
    explaining the purpose of the
    survey and inviting patients to
    participate in the voluntary
    research study. The participants
    who provided only a mailing
    address were also sent a pre-
    addressed and stamped return
    envelope addressed to the PI.
    The study invitation and survey
    were distributed within a
    minimum of 15 days after
    discharge. This time lag was
    required to comply with the
    CAHPS® Hospital Survey
    (HCAHPS) CMS (2018) Quality
    Assurance Guidelines intended
    to limit survey burden and
    prevent potential bias to the
    HCAHPS survey results.

    Upon receipt of the
    completed surveys, all data were
    loaded into a database.
    Individuals who responded to
    the first question (“Did your
    nurses listen to you throughout

    your hospitalization?”) with a 7
    or 8 rating were placed in
    Group A (patients who perceive
    nurses exhibit AEL behaviors).
    Those who responded with a
    score of 6 or less were placed in
    Group B (patients who perceive
    nurses did not exhibit AEL
    behaviors).

    Data Analysis
    Data were analyzed using

    the IBM® SPSS® Statistics V25
    and a significance level of
    p<0.05. Descriptive statistics were calculated for all demographic and outcome variables (means and standard deviations for continuous variables; frequencies and percentages for categorical variables). An independent t-test (two-tailed) for unequal variances was used for all but two of the AEL scale questions to determine if there was a significant difference between the two groups (those who perceived nurses had positive empathetic listening behaviors vs. those who did not). To assess if there was a significant difference in the demographic variables of patients in the two groups, cross-tabulation using chi-square test (Pearson chi- square and Cramer’s V) was applied to the categorical data (gender, ethnicity, whether they were a medical or surgical patient, whether English was first language, and if they have had any recent hospital readmissions). An independent t- test (two-tailed) was used for the age demographic. The Mann- Whitney U test was applied for LOS in the hospital due to the skewed distribution. Rank order

    of response item frequency was
    calculated to answer the third
    research question on which of
    the characteristics of active
    empathetic listening behaviors
    were perceived by the patients
    as most important. Also, the
    internal consistency of the AEL
    scale was evaluated by
    calculating the Cronbach’s alpha
    for the subscales (assessing,
    processing, and evaluating) and
    total score.

    Results

    Demographics
    A priori power analysis

    using G*Power 3.1.9 was
    conducted using an alpha of
    0.05, effect size of 0.5(d), and
    power of 0.8, resulting in an
    estimated sample size of 102
    participants for an independent
    t-test (one-tailed) and 128
    participants for a two-tailed t-
    test. Some of the 305 surveys
    returned were not completed,
    so the final sample consisted of
    244 participants. Using the
    responses to the first question of
    the survey, 194 (79.5%)
    participants were placed in
    Group A (positive perception)
    and 50 (20.5%) in Group B
    (negative perception). The
    average age of the total sample
    was 59.77 (range 18-95). Males
    (50.8%) and females (49.2%)
    were evenly distributed. The
    majority were White (62%),
    surgical patients (62.4%), with
    an average LOS of 4.77 days
    (range 1-74). Forty participants
    (16.7%) experienced
    readmission after the
    hospitalization in which they
    met inclusion criteria for the

    Nursing Economic$

    September/October 2020 | Volume 38 Number 5 271

    study. No statistically significant
    differences were found in the
    demographic characteristics of
    the two groups (alpha 0.05; see
    Table 1).

    Survey Results
    The t-test (two-tailed)

    revealed there was a significant
    difference in the AEL scale total
    score for Group A (M=6.12,
    SD=0.88) and Group B (M=3.89,
    SD=1.45); (t=10.36, p<0.001).

    Each of the AEL subscales of
    sensing, processing, and
    responding also had statistically
    significant differences between
    the two groups (Group A’s mean
    scores were 6.01, 5.98, 6.32, and
    Group B’s were 3.94, 3.56, 4.08).
    The subscale with the highest
    mean was responding (Group A;
    µ=6.32) and the lowest subscale
    mean was processing (Group B;
    µ=3.56) (see Table 2). In
    addition, statistically significant

    differences were found between
    Group A and B for each of the
    11-items composing the AEL
    scale (see Table 3). Results were
    confirmed with nonparametric
    Mann-Whitney U tests because
    the groups were of unequal size.

    The last question on the
    survey asked participants to
    identify which characteristic from
    the 11-item AEL scale was most
    important to them as a patient.
    The characteristic identified the

    Nursing Economic$

    Table 1.
    Demographics Characteristic by Group and Overall

    Characteristics

    Total**
    N=244
    n (%)

    Group A
    N=194

    Positive
    Perception Nurse

    Listening n (%)

    Group B
    N=50

    Negative
    Perception Nurse

    Listening n (%)
    p*

    (two-tailed) Cramer’s V

    Gender

    Male 123 (50.8) 97 (50.3) 26 (53.1)
    0.726 0.023

    Female 119 (49.2) 96 (49.7) 23 (46.9)
    Ethnicity

    White 150 (62) 122 (62.9) 28 (58.3)

    0.435 0.106
    Hispanic 40 (16.5) 31 (16.0) 9 (18.8)
    Black 38 (15.7) 28 (14.4) 10 (20.8)
    Other 14 (5.8) 13 (6.7) 1 (2.1)

    Surgery

    Yes 151 (62.4) 125 (65.1) 26 (52.0)
    0.088 0.110

    No 91 (37.6) 67 (34.9) 24 (48.0)
    English as First Language

    Yes 225 (92.6) 177 (91.7) 48 (96.0)
    0.302 0.066

    No 18 (7.4) 16 (8.3) 2 (4.0)
    Readmission after Hospitalization

    Yes 40 (16.7) 34 (17.8) 6 (12.5)
    0.379 0.057

    No 199 (83.3) 157 (82.2) 42 (87.5)
    Age µ (SD) 59.77 (16.93) 60.68 (17.07) 55.98 (15.93) 0.091
    Length of Stay (days)

    µ (SD) 4.77 (6.28) 4.34 (3.95) 6.47 (11.42) 0.873

    *c2 used for dichotomous and categorical data; t-test used for age; Mann-Whitney U test used for length of stay due to
    lack of normal distribution
    **Not all participants answered every demographic survey item

    September/October 2020 | Volume 38 Number 5272

    Nursing Economic$

    Table 2.
    Group Comparison: Subscales and Total Score for Active Empathic Listening Scale

    Subscales and
    Total Tool Group n M SD t*

    p

    (two-tailed)

    Sensing
    Positive (A) 194 6.0064 1.02298

    9.180 <0.001 Negative (B) 50 3.9433 1.50193

    Processing
    Positive 193 5.9810 1.17578

    10.557 <0.001 Negative 50 3.5633 1.50468

    Responding
    Positive 194 6.3174 0.85376

    9.547 <0.001 Negative 50 4.0783 1.60086

    Total Tool
    Positive 194 6.1170 0.88223

    10.360 <0.001 Negative 50 3.8941 1.44960

    * Independent t-test

    Table 3.
    Group Comparison: Perceived Difference Between Nurses Who Exhibit Active Empathic Listening

    Behaviors and Those Who Do Not

    Characteristic/Behavior
    Listening

    Perception n M SD t*
    p

    (two-tailed)

    Sensitive to what I was not saying
    Positive 190 6.06 1.24

    8.405 <0.001 Negative 48 3.71 1.83

    Aware of what I implied but did not say
    Positive 190 5.66 1.49

    7.254 <0.001 Negative 45 3.56 1.80

    Understood how I felt
    Positive 190 6.31 0.93

    8.417 <0.001 Negative 48 4.27 1.61

    Listened for more than spoken words
    Positive 192 6.05 1.15

    9.203 <0.001 Negative 47 3.91 1.49

    Assured me they would remember what I said
    Positive 191 5.86 1.53

    8.699 <0.001 Negative 50 3.68 1.73

    Summarized points of agreement and
    disagreement when appropriate

    Positive 188 5.99 1.40
    10.231 <0.001

    Negative 47 3.62 1.51

    Kept track of points I made
    Positive 190 6.08 1.14

    10.922 <0.001 Negative 47 3.40 1.58

    Assured me they were listening by verbal
    acknowledgments

    Positive 194 6.43 0.89
    10.255 <0.001

    Negative 49 3.98 1.61

    Assured me they were receptive to my ideas
    Positive 188 6.16 1.06

    7.934 <0.001 Negative 49 3.92 1.90

    Asked questions that showed they understood
    my positions

    Positive 192 6.34 0.95
    9.181 <0.001

    Negative 48 3.98 1.72
    Showed me they were listening with their
    body language (e.g., head nods)

    Positive 192 6.31 0.98
    7.429 <0.001

    Negative 50 4.30 1.84

    * Independent t-test

    Note: AEL Scale adapted from Drollinger et al., 2006.

    September/October 2020 | Volume 38 Number 5 273

    most (21.6%) was “The nurses
    understood how I felt,”
    belonging to the sensing
    subscale. The second, third, and
    fourth highest made up 41.4% of
    the responses and were all
    characteristics of the responding
    subscale (see Table 4).

    The AEL scale overall
    internal consistency using
    Cronbach’s alpha reliability was
    0.965. All the item-item
    correlations were positive and
    ranged from 0.564 to 1.000. The
    Cronbach alpha coefficients for
    the AEL subscales were 0.915 for
    sensing, 0.901 for processing,
    and 0.949 for responding. The
    subscale item-item correlations
    were all positive. Reliability for
    the AEL scale total score and
    subscales was strong with all
    Cronbach alpha coefficients
    exceeding 0.90.

    Discussion

    With patient experience
    driving financial, quality, and

    safety performance, nurses at
    the core of patient interactions
    need to understand better the
    impact their communication has
    on meeting patients’ needs. No
    significant differences were
    noted in the demographics
    between those participants who
    perceived their nurses listened
    to them throughout their
    hospitalization (score of 7 or 8
    on the first survey question) and
    those who did not (score of 6
    or below). This finding suggests
    that age, gender, ethnicity,
    surgical or medical, LOS, or
    readmission do not impact how
    patients perceive listening. This
    is important given the diversity
    of patients and the fundamental
    need to be listened to. In a
    study conducted by The Beryl
    Institute (Wolf, 2018), 91% of
    the respondents believed patient
    experience was either extremely
    important or very important to
    them. Being listened to was
    consistently ranked as the top
    factor influencing patient

    experience across all age groups
    and internationally (Wolf, 2018).

    To establish excellence in
    the focused area of patient
    interactions, a foundation of
    communication skills to meet
    these needs is essential.
    Effective listening is the most
    essential part of good
    communication (Drollinger et
    al., 2006). The AEL survey
    instrument captures the main
    characteristics of listening. This
    was confirmed by the results of
    this study. There was a
    significant difference in the two
    groups not only in the total AEL
    score but for each of the
    subscales and each of the
    individual behaviors. These
    results begin to fill the gap on
    what is important from the
    patient’s perspective in
    achieving effective
    communication.

    With listening behaviors
    from the patient’s perspective
    poorly understood, this study is
    the first to identify effective AEL

    Nursing Economic$

    Table 4.
    Active Empathic Listening Scale Behavior Most Important to Patients

    Characteristic: The nurses… Frequency Valid % Subscale

    …understood how I felt. 45 21.6 Sensing
    …asked questions that showed they understood my positions. 39 18.8 Responding
    …assured me they were listening by using verbal acknowledgments. 27 13.0 Responding
    …showed me they were listening by their body language (e.g., head nods). 20 9.6 Responding
    …were sensitive to what I was not saying. 19 9.1 Sensing
    …listened for more than just my spoken words. 15 7.2 Sensing
    …kept track of points I made. 11 5.3 Processing
    …assured me they would remember what I said. 10 4.8 Processing
    …summarized points of agreement and disagreement when appropriate. 10 4.8 Processing
    …were aware of what I implied but did not say. 6 2.9 Sensing
    …assured me they were receptive to my ideas. 6 2.9 Responding

    Note: AEL Scale adapted from Drollinger et al., 2006.

    September/October 2020 | Volume 38 Number 5274

    behaviors through the patient’s
    lens. The last question on the
    survey asked participants to
    identify the nurse listening
    behavior they perceived as most
    important. The rank order of
    importance to the patient may
    guide the priority of intervention
    to enhance the perception of
    being listened to. Prior research
    (Bodie et al., 2012; Clementi,
    2006; Jonas-Simpson et al., 2006;
    Myers, 2000) identified common
    verbal and nonverbal
    characteristics of effective
    listening. The verbal
    characteristics of using questions
    and content-appropriate
    responses may be comparable
    to the AEL scale items “The
    nurses asked questions that
    showed they understood my
    positions” and “The nurses
    assured me that they were
    listening by using verbal
    acknowledgments.” These AEL
    behaviors ranked second and
    third as most important to
    patients.

    The AEL scale included a
    similar nonverbal behavior “The
    nurses showed me they were
    listening by their body language
    (e.g., head nods).” In this study,
    this behavior ranked fourth most
    important. “The nurses
    understood how I felt” was the
    AEL behavior ranked as most
    important to the participants
    based on rank order response
    frequency. This behavior is
    similar to the findings in Myers’
    study (2000) with participants
    who associated being
    empathetically understood and
    heard. These assumed
    commonalities align earlier
    results with this study to further
    support them as priority

    behaviors to be addressed in
    nursing practice.

    The AEL scale has been
    used to evaluate listening
    behaviors of salespersons,
    supervisors, and communication
    students with established
    reliability. The Cronbach alphas
    calculated for the total score, as
    well as each of the subscales,
    exhibited strong reliability. The
    reliability of the AEL scale
    suggests it can be effectively
    applied across a variety of
    interpersonal relationships.

    The focus on patient
    experience has gained
    momentum as a priority in
    health care over the last decade
    (Wolf, 2018). In a recent survey
    by the Beryl Institute (Wolf,
    2019), patient experience was
    identified as one of the top
    three organizational priorities in
    the next 3 years. According to
    Press Ganey (2018), “Patient
    experience is five times more
    likely to influence brand loyalty
    than other marketing strategies”
    (p. 1). The cost of poor
    performance is negatively
    impacting hospitals’ financial
    bottom lines through pay for
    performance and consumer
    loyalty. To address this hospital
    economic impact, it is
    imperative to enhance nurse-
    patient communication and,
    more specifically listening, from
    the patient’s perspective. The
    growing body of evidence
    demonstrating the influence
    nurse communication has on
    patient experience outcomes
    further substantiates the need
    for research to narrow the gap
    in nursing science.

    Limitations

    The primary limitation of
    this study was the use of a
    convenience sample, limiting
    the generalizability of the
    findings. The sample was
    limited to patients whose
    discharge destination was home.
    Another limitation was the low
    response rate from both the
    email and paper surveys that
    included a small sample size for
    the negative perception group.
    After patients are discharged
    from a hospital, they can receive
    multiple surveys from the
    hospital and other sources,
    resulting in the potential for
    survey fatigue. The volume of
    email communications with the
    ever-increasing use of electronic
    methods to communicate could
    have also resulted in the survey
    being overlooked. The sample
    size required for statistical
    analysis was achieved only
    through a commitment to
    distribute numerous surveys
    with the response rate so low.
    Personal contact with the patient
    before discharge from the
    hospital to inform them of the
    study and to expect the survey
    may have resulted in a higher
    response rate.

    The Likert scale used for the
    response to the filter question
    “Did your nurses listen to you
    throughout your hospitalization”
    ranged from 1 not at all to 8 the
    most possible might have been
    interpreted differently by
    participants. With the complex
    hospital environment where
    multi-tasking is common, the
    patient’s observation of busy
    nurses could have been
    interpreted as doing “as much

    Nursing Economic$

    September/October 2020 | Volume 38 Number 5 275

    as possible” given the
    circumstances resulting in a
    more favorable score.

    Implications for Practice

    With the growing evidence
    of the importance and impact
    on patient experience focused
    on nurse-patient interactions,
    each of the 11 listening
    behaviors included in the AEL
    scale is a behavior that should
    be an essential component of
    nursing education and
    incorporated into nursing
    practice. AEL behaviors can be
    taught and validated in skills
    labs, simulation, or clinical
    settings and may favorably
    influence the patient experience.
    The rank order of importance to
    the patient may be a starting
    point to focus on educational
    resources.

    Conclusion

    Essential to a positive nurse-
    patient relationship is good
    nurse communication, including
    listening skills. With the absence
    of empirical evidence, the
    accepted practice of nurse
    listening is based on
    assumptions and not the
    patient’s reality. The findings
    from this study begin the
    journey in addressing the
    nursing science gap to
    understand the complex skill of
    listening from the patient’s
    perspective. This study suggests
    effective active empathetic nurse
    listening skills will influence a
    positive patient experience. The
    correlation between the AEL
    total score and HCAHPS
    responses associated with nurse

    communication (listening)
    should be explored further.
    Further research needs to be
    conducted in other hospital
    settings and locations across the
    country to fill the gap in
    knowledge on this critical
    element of nurse-patient
    communication impacting
    quality, safety, and patient
    experience. $

    Karen K. Myers, PhD, RN, NEA-BC
    PhD Graduate
    Texas Woman’s University, College of Nursing
    Houston, TX

    Rebecca Krepper, PhD, MBA, RN
    Professor
    Texas Woman’s University, College of Nursing
    Houston, TX

    Ainslie Nibert, PhD, RN, FAAN
    Associate Dean
    Associate Professor
    Texas Woman’s University, College of Nursing
    Houston, TX

    Robin Toms, PhD, MN, RN, NEA-BC
    Professor
    Texas Woman’s University, College of Nursing
    Houston, TX

    Acknowledgment: The authors thank the
    Memorial Hermann Health System-TMC for
    their support.

    References
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    Press Ganey®. (2013). The rising tide
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    Nursing Economic$

    September/October 2020 | Volume 38 Number 5266

    Voice of the Patient
    continued from page 275

    Ramsey, R.P., & Sohi, R.S. (1997). Listening to your customers: The impact of perceived

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    MARKING

    Reproduced with permission of copyright owner. Further reproduction
    prohibited without permission.

    Chamberlain College of Nursing NR439: Evidence-Based Practice

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