What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients.

AIM: To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients. BACKGROUND: The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful. DESIGN: An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication. METHODS: Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken. FINDINGS: Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication. CONCLUSION: This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.

The effects of acute exercise bouts on hepcidin in women.

PURPOSE: To investigate the effects of acute exercise on serum hepcidin and iron (sFe) in active women. Changes in interleukin-6 (IL-6), hepcidin, ferritin, and sFe in response to 2 different exercise durations were compared. METHODS: Twelve women age 19-32 yr performed 2 treadmill runs (60 and 120 min) at 65% of VO2max. Blood samples were obtained before, immediately after, and 3, 6, 9, and 24 hr after exercise. Two-way repeated-measures ANOVA was conducted to examine changes in measured variables. Significance was accepted at p < .05. RESULTS: Significant effects for trial were observed for hepcidin (60 min: 1.15 ± 0.48 nmol/L; 120 min: 2.28 ± 1.44 nmol/L) and for time, with hepcidin significantly increased 3 hr postexercise in both trials (60 min: 3 hr - 1.99 ± 2.00 nmol/L; 120 min: 3 hr - 4.60 ± 4.61 nmol/L). Significant main effects for time occurred for sFe, ferritin, and IL-6. sFe was significantly decreased 9 hr postexercise compared with 3 and 24 hr postexercise. IL-6 was significantly increased immediately postexercise. CONCLUSIONS: Both runs resulted in significant increases in hepcidin 3 hr after exercise. Increases in hepcidin were preceded by significant increases in IL-6 immediately postexercise and followed by significant decreases in sFe 9 hr postexercise. It was concluded that endurance exercise increases the production of hepcidin, which affects sFe. The 2-hr exercise bout stimulated greater changes in serum hepcidin than the 1-hr bout.

Rasch techniques for detecting bias in performance assessments: an example comparing the performance of native and non-native speakers on a test of academic English.

The use of common tasks and rating procedures when assessing the communicative skills of students from highly diverse linguistic and cultural backgrounds poses particular measurement challenges, which have thus far received little research attention. If assessment tasks or criteria are found to function differentially for particular subpopulations within a test candidature with the same or a similar level of criterion ability, then the test is open to charges of bias in favour of one or other group. While there have been numerous studies involving dichotomous language test items (see e.g. Chen and Henning, 1985 and more recently Elder, 1996) few studies have considered the issue of bias in relation to performance based tasks which are assessed subjectively, via analytic and holistic rating scales. The paper demonstrates how Rasch analytic procedures can be applied to the investigation of item bias or differential item functioning (DIF) in both dichotomous and scalar items on a test of English for academic purposes. The data were gathered from a pilot English language test administered to a representative sample of undergraduate students (N= 139) enrolled in their first year of study at an English-medium university. The sample included native speakers of English who had completed up to 12 years of secondary schooling in their first language (L1) and immigrant students, mainly from Asian language backgrounds, with varying degrees of prior English language instruction and exposure. The purpose of the test was to diagnose the academic English needs of incoming undergraduates so that additional support could be offered to those deemed at risk of failure in their university study. Some of the tasks included in the assessment procedure involved objectively-scored items (measuring vocabulary knowledge, text-editing skills and reading and listening comprehension) whereas others (i.e. a report and an argumentative writing task) were subjectively-scored. The study models a methodology for estimating bias with both dichotomous and scalar items using the programs Quest (Adams and Khoo, 1993) for the former and ConQuest (Wu, Adams and Wilson, 1998) for the latter. It also offers answers to the practical questions of whether a common set of assessment criteria can, in an academic context such as this one, be meaningfully applied to all subgroups within the candidature and whether analytic criteria are more susceptible to biased ratings than holistic ones. Implications for test fairness and test validity are discussed.