Related Experiment Video
Updated: May 4, 2026
Multi-Modal Home Sleep Monitoring in Older Adults
Published on: January 26, 2019
Adaptation of a communication interaction behavior instrument for use in mechanically ventilated, nonvocal older
Marci Lee Nilsen1, Mary Beth Happ, Heidi Donovan
1Marci Lee Nilsen, PhD, MSN, RN, is T32 Postdoctoral Fellow; Heidi Donovan, PhD, RN, is Associate Professor; Leslie Hoffman, PhD, RN, is Professor Emerita; and Susan M. Sereika PhD, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Amber Barnato, MD, MPH, MS, is Associate Professor, School of Medicine, University of Pittsburgh, Pennsylvania. Mary Beth Happ, PhD, RN, FAAN, is Distinguished Professor, College of Nursing, The Ohio State University, Columbus.
Background:
Valid and reliable instruments are needed to measure communication interaction behaviors between nurses and mechanically ventilated intensive care unit patients who are without oral speech.
Objectives:
The aim of this study was to refine and evaluate preliminary validity and reliability of a Communication Interaction Behavior Instrument (CIBI) adapted for use with mechanically ventilated, nonvocal patients in the intensive care unit.
Methods:
Raters observed nurse-patient communication interactions using a checklist of nurse and patient behaviors, categorized as positive and negative behaviors. Three-minute video-recorded observations of five mechanically ventilated adults (<60 years old) in the intensive care unit and their nurses were used to establish preliminary interrater reliability and confirm appropriateness of definitions (four observations per dyad, n = 20). On the basis of expert input and reliability results, the behaviors and item definitions on the CIBI were revised. The revised tool was then tested in a larger sample of 38 mechanically ventilated intensive care patients (> 60 years old) and their nurses (four observations per dyad, n = 152) to determine interrater reliability.
Results:
For preliminary testing, percent agreement for individual items ranged from 60% to 100% for nurse behaviors and 20% to 100% for patient behaviors across the five pilot cases. On the basis of these results, 11 definitions were modified and four items were dropped. Using the revised 29-item instrument, percent agreement improved for nurse behaviors (73%-100%) and patient behaviors (68%-100%). Kappa coefficients ranged from 0.13 to 1.00, with lower coefficients for patient behaviors.
Conclusion:
Preliminary results suggest that the revised CIBI has good face validity and shows good interrater reliability for many of the behaviors, but further refinement is needed. The use of dual raters with adjudication of discrepancies is the recommended method of administration for the revised CIBI.
Related Concept Videos
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:29Mechanical Ventilation I: Indication and Settings
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...