Date of Graduation

Spring 5-20-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project

First Advisor

Scout Hebinck



Problem: Effective and therapeutic communication in the health care setting is multidisciplinary,

complex, and has unique challenges for each microsystem. The perioperative setting is an

especially challenging environment for healthcare workers to provide therapeutic

communication, as uniquely high-risk and time-sensitive information must be disseminated in a

language that is understandable for the patient(Osborne-Smith & Kyle Hodgen, 2017). A

microsystem assessment of an outpatient pediatric perioperative setting reflected some of the

challenges the healthcare workers were facing when communicating with their patients and

family members. Upon evaluation of the monthly NRC (National Research Corporation) score

prior to implementation of two communication tools AIDET and Commit to Sit as a part of the

quality improvement intervention, the perioperative outpatient setting needed improvement in

several areas of communication. Patients reported low satisfaction scores regarding: trust

providers with care, care providers listened, was told when could leave, got help as soon as

wanted, care provider explained things, facility would recommend, and procedure began on time

(Appendix J).

Context: The pediatric perioperative outpatient setting in which the interventions were carried

out services pediatric population ranging from two to eighteen years of age. The racial and ethnic

background of both the staff members and patient population were diverse, with Hispanic, Asian

American, Caucasian, African American, and American Indians making up a vast majority of the

setting. The main population the two communication tools utilized for communication quality

improvement targeted was the healthcare staff members who interact with the pediatric

population and their family members as a routine part of the work. These healthcare staff


members included nurses, anesthesiologists, surgeons, child life specialists, and surgical


Interventions: Two communication tools, AIDET (Acknowledge, Introduce, Duration,

Explanation, and Thank you) and Commit to Sit, were taught and encouraged to use for all staff

members in the outpatient setting. Culturally competent care, the Acknowledge part of AIDET,

was also highlighted and strongly encouraged to take note of and utilize when providing care.

Information on how to utilize AIDET and Commit to Sit was disseminated through unit-wide

email as well as a presentation on what the two communications are and some examples on how

they can be used. Key points on the two communication tool utilization were emphasized

through roleplay simulation involving one staff member and two project group members. Three

roleplay scenarios, each with a different focus on culturally competent care and the two

communication tools in general, helped the staff members understand how AIDET and Commit

to Sit can become part of their patient communication going forward. Information on culturally

competent care for different patient populations and resources to measures one’s own biases were

introduced and encouraged to use as well.

Measures: The effectiveness of the communication tools were measured via monthly National

Research Corporation (NRC) patient satisfaction scores before and after implementation. These

scores are based on unit-specific questions that allow the patient and/or family member to rate if

specific parts of their care met their expectations. These survey answers are then collected and

analyzed to see if unit goals for the NRC scores are being met every month. Knowledge on

AIDET and Commit to Sit concepts were measured through pre and post-implementation survey

written by the project group. The pre-implementation survey measured the level of knowledge

the staff had on the two concepts, six months after they were introduced to them by the last


project group. A post-implementation survey was used to measure whether the

roleplay-simulation and sufficient time between the first and second presentation by the current

project group allowed increased understanding of AIDET and Commit to Sit.

Results: The goal of this project was to improve overall NRC scores in the pediatric

perioperative outpatient setting. AIDET with an emphasis on cultural competence and Commit to

Sit were two communication tools chosen to help the outpatient clinic staff improve certain areas

of their communication. Problems the staff were facing were evaluated and staff input was

encouraged throughout the process to better their learning experience. Staff pre vs.

post-implementation survey data showed 100% of those who answered believed education and

reinforcement on AIDET and Commit to Sit were useful in increasing patient satisfaction.

Overall NRC score from before any education on AIDET and Commit to Sit was 80.7. After all

education materials were disseminated, the overall NRC score was 83.3, an increase of 2.6

overall NRC score for the outpatient clinic.

Conclusion: AIDET, a communication framework, and Commit to Sit, a reminder for healthcare

professionals to provide eye-level communication whenever possible, helped increase overall

patient satisfaction NRC scores. AIDET allows for providers to remind themselves important

pertinent information patients find most important such as duration. Commit to Sit reminders

placed throughout the unit in the form of posters helps healthcare staff take a few extra seconds

to get to eye-level with the patient and their family members, making them feel more appreciated

and help them approach the healthcare professional more easily. These changes in the perception

of therapeutic communication with patients for healthcare providers showed to be effective in

increasing overall patient satisfaction.