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 themto think more
about time, the culture of nursing, and the tension between task-focused and patient-centered care. They cameto
value cue-responding in communication as oneway of learning about communicatingwith patients. Focusing on
cue-responding in communication also provided uswith insights on the students' understanding of communication
and the need for educators to re-emphasize person-centered communication and to dealwith 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.