Week 6 Assignment: Reading Research Literature (RRL) Worksheet

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. Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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). Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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. Wk6 Assignment: RRL Worksheet

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

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

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

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

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. Wk6 Assignment: RRL Worksheet

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 Balik, B., & Dopkiss, F. (2010). 10 years after to err is human: Are we listening to patients and families yet? Focus on Patient Safety, 13(1), 1-8. Week 6 Assignment: Reading Research Literature (RRL) Worksheet

Becker’s Hospital Review (2017). CFOs: The new ‘executive champions’ of patient satisfaction. https://www.beckers hospitalreview.com/finance/cfos-the- new-executive-champions-of-patient- satisfaction.html

Bodie, G.D. (2011). The active-empathic listening scale (AELS): Conceptuali – zation and evidence of validity within the interpersonal domain. Communication Quarterly, 59(3), 277-295. https://doi. org/10.1080/01463373.2011.583495

Bodie, G.D., St. Cyr, K., Pence, M., Rold, M., & Honeycutt, J. (2012). Listening competence in initial interactions I: Distinguishing between what listening is and what listeners do. International Journal of Listening, 26(1), 1-28. https://doi.org/10.1080/10904018.2012. 639645

Centers for Medicare & Medicaid Services (CMS). (2020). HCAHPS hospital survey. https://www.hcahpsonline.org

Centers for Medicare & Medicaid Services (CMS). (2018). CAHPS® Hospital Survey (HCAHPS): Quality assurance guidelines. Version 13.0. http://www. hcahpsonline.org/globalassets/hcahps/ quality-assurance/2018_qag_v13.0.pdf

Clementi, P.S. (2006). Patient expectations during health care encounters theory: A grounded theory study (Doctoral dissertation). ProQuest Dissertations Publishing.

Comer, L.B., & Drollinger, T. (1999). Active empathetic listening and selling success: A conceptual framework. Journal of Personal Selling and Sales Management, 19(1), 15-29. Week 6 Assignment: Reading Research Literature (RRL) Worksheet

Drollinger, T., Comer, L.B., & Warrington, P.T. (2006). Development and validation of the active empathetic listening scale. Psychology & Marketing, 23(2), 161- 180. https://doi.org/10.1002/mar.20105

Fenniman, A. (2010). Understanding each other at work: An examination of the effects of perceived empathetic listening on psychological safety in the supervisor-subordinate relationship (Doctoral dissertation). George Washington University.

Jonas-Simpson, C., Mitchell, G.J., Fisher, A., Jones, G., & Linscott, J. (2006). The experience of being listened to: A qualitative study of older adults in long- term care settings. Journal of Gerontological Nursing, 32(1), 46-53. https://doi.org/10.3928/0098-9134- 20060101-15

Myers, S. (2000). Empathetic listening: Reports on the experience of being heard. Journal of Humanistic Psychology, 40(2), 148-173. https://doi. org/10.1177/0022167800402004 Week 6 Assignment: Reading Research Literature (RRL) Worksheet

Press Ganey®. (2013). The rising tide measure: Communication with nurses [White paper]. http://images.healthcare. pressganey.com/Web/PressGaney AssociatesInc/Communication_With_ Nurses_May2013.pdf

Press Ganey®. (2018). Consumerism: The role of patient experience in brand management and patient acquisition [White paper]. https://www.pressganey. com/resources/white-papers/ consumerism-the-role-of-patient- experience-in-brand-management

continued on page 266

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

salesperson listening behavior on relationship outcomes. Journal of the Academy of Marketing Science, 25(2), 127-137. https://doi.org/10.1007/BF02894348

Rodak, S. (2013). Investing in nurse communication pays dividends in HCAHPS scores. Becker’s Clinical Leadership & Infection Control. https://www.beckersasc.com/asc-quality- infection-control/investing-in-nurse-communication-pays-dividends-in-hcahps-scores.html

Studer Group. (2012). A focus on nurse communication: The most powerful composite of all. https://www.studergroup.com/resources/articles-and-industry-updates/insights/may- 2012/a-focus-on-nurse-communication-the-most-powerful-c

Wolf, J.A. (2018). Consumer perspectives on patient experience 2018 [White paper]. Beryl Institute. https://www.theberylinstitute.org/page/PXCONSUMERSTUDY

Wolf, J.A. (2019). 2019 The state of patient experience: A call to action for the future of human experience [White paper]. Beryl Institute. https://www.theberylinstitute.org/page/PXBENCH MARKING

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