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The comfort communication simulation instrument (Sim-Comfort): A relationship-centered approach to assessing

Leah Burt¹, Elaine Wittenberg², Joy Goldsmith³

¹University of Illinois Chicago, College of Nursing Department of Biobehavioral Nursing Science, United States of America.

Journal of Professional Nursing : Official Journal of the American Association of Colleges of Nursing

|February 12, 2026

Abstract

Background:

Although the importance of person-centered communication was recently recognized in both updated nursing and medical education accreditation standards, few instruments exist to assess relationship-centered communication competency in simulation.

Purpose:

This study describes development, content validity testing, and interrater reliability of the Comfort Communication Simulation Instrument (Sim-Comfort), meant to assess communication competency during simulation-based education. Sim-Comfort emphasizes holistic and relational person-centered communication, aligning with current competency-based education standards.

Methods:

The instrument was iteratively developed by an interdisciplinary team representing advanced practice nursing, medicine, and communication studies. Content validity was explored through a standardized patient (SP) simulation scenario, followed by focus groups. Preliminary inter-rater reliability was established by SP raters.

Results:

The Sim-Comfort instrument consists of seven competency domains to be scored during simulation. Feedback from SPs resulted in significant revisions to increase item clarity yet no new domains were identified, supporting content validity. In the context of interrater reliability, the intraclass correlation coefficient was 0.59, indicating moderate rating consistency.

Conclusions:

Findings support Sim-Comfort as a promising instrument for structured assessment of relationship-centered communication in simulation. Sim-Comfort represents a novel, theory-based approach to integrating relational communication skills assessment into simulation-based curricula for nursing learners. Future validity and reliability testing is needed.

Keywords:

Assessment Communication Competency-based education Nursing education research Psychometrics Simulation training

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