Applying ordered network analysis to video-recorded physician-nurse interactions to examine communication patterns associated with shared understanding in inpatient oncology care settings.

OBJECTIVES: The main aim of this study was to demonstrate how ordered network analysis of video-recorded interactions combined with verbal response mode (VRM) coding (eg, edification, disclosure, reflection and interpretation) can uncover specific communication patterns that contribute to the development of shared understanding between physicians and nurses. The major hypothesis was that dyads that reached shared understanding would exhibit different sequential relationships between VRM codes compared with dyads that did not reach shared understanding. DESIGN: Observational study design with the secondary analysis of video-recorded interactions. SETTING: The study was conducted on two oncology units at a large Midwestern academic health care system in the USA. PARTICIPANTS: A total of 33 unique physician-nurse dyadic interactions were included in the analysis. Participants were the physicians and nurses involved in these interactions during patient care rounds. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the development of shared understanding between physicians and nurses, as determined by prior qualitative analysis. Secondary measures included the frequencies, orders and co-occurrences of VRM codes in the interactions. RESULTS: A Mann-Whitney U test showed that dyads that reached shared understanding (N=6) were statistically significantly different (U=148, p=0.00, r=0.93) from dyads that did not reach shared understanding (N=25) in terms of the sequential relationships between edification and disclosure, edification and advisement, as well as edification and questioning. Dyads that reached shared understanding engaged in more edification followed by disclosure, suggesting the importance of this communication pattern for reaching shared understanding. CONCLUSIONS: This novel methodology demonstrates a robust approach to inform interventions that enhance physician-nurse communication. Further research could explore applying this approach in other healthcare settings and contexts.

Analytics of self-regulated learning scaffolding: effects on learning processes.

Self-regulated learning (SRL) is the ability to regulate cognitive, metacognitive, motivational, and emotional states while learning and is posited to be a strong predictor of academic success. It is therefore important to provide learners with effective instructions to promote more meaningful and effective SRL processes. One way to implement SRL instructions is through providing real-time SRL scaffolding while learners engage with a task. However, previous studies have tended to focus on fixed scaffolding rather than adaptive scaffolding that is tailored to student actions. Studies that have investigated adaptive scaffolding have not adequately distinguished between the effects of adaptive and fixed scaffolding compared to a control condition. Moreover, previous studies have tended to investigate the effects of scaffolding at the task level rather than shorter time segments-obscuring the impact of individual scaffolds on SRL processes. To address these gaps, we (a) collected trace data about student activities while working on a multi-source writing task and (b) analyzed these data using a cutting-edge learning analytic technique- ordered network analysis (ONA)-to model, visualize, and explain how learners' SRL processes changed in relation to the scaffolds. At the task level, our results suggest that learners who received adaptive scaffolding have significantly different patterns of SRL processes compared to the fixed scaffolding and control conditions. While not significantly different, our results at the task segment level suggest that adaptive scaffolding is associated with earlier engagement in SRL processes. At both the task level and task segment level, those who received adaptive scaffolding, compared to the other conditions, exhibited more task-guided learning processes such as referring to task instructions and rubrics in relation to their reading and writing. This study not only deepens our understanding of the effects of scaffolding at different levels of analysis but also demonstrates the use of a contemporary learning analytic technique for evaluating the effects of different kinds of scaffolding on learners' SRL processes.