Nursing students’ lived experiences with using AIDET in patient communication: A qualitative study in the Philippines

Abstract

Background

Effective communication is vital in nursing, influencing patient safety, satisfaction, and care quality. The AIDET framework is a proven tool for reducing patient anxiety and enhancing their experience. However, perceptions and experiences of Filipino nursing students with AIDET remain unexplored.

Objective

This study explored Filipino nursing students’ use of AIDET, focusing on benefits, challenges, and improvements.

Methods

A qualitative, interpretive phenomenological approach informed by the philosophy of Martin Heidegger was employed. This 2023 study, conducted at a university in Angeles City, Philippines, explored Filipino nursing students’ experiences with the AIDET communication framework. Thirty participants were purposefully selected to participate in facilitated discussions following a semi-structured interview guide. Thematic content analysis of the transcribed audio recording identified recurring themes in their narratives, focusing on the meanings they ascribed to their experiences using AIDET.

Results

Four themes emerged: (a) Streamlined nurse-patient interaction (organizes communication, rapport building, alleviate anxiety, acknowledgment, and empowerment as sub-themes), (b) Enhances patient-centered care (empathy and compassion, improved patient experience as sub-topics), (c) Challenges with specific patient populations (patient preferences, language barrier, patient condition, acknowledgment of cultural differences as sub-themes), and (d) AIDET in nursing education strengthening application through practice, optimizing frequency and timing, promoting deeper understanding, enhancing feedback mechanism) as student nurses’ recommendations.

Conclusion

Early integration of AIDET in nursing education is essential for student nurses to enhance communication, improve patient satisfaction, and deliver patient-centered care, equipping them with valuable communication skills.

Background

Effective communication is fundamental to quality nursing practice, playing a pivotal role in delivering safe, satisfying, and high-quality care, particularly in patient interactions (Ezennakwe et al., 2023). Nurses play a vital role as patient advocates, fostering strong, trusting relationships while adhering to professional guidelines (American Nurses Association, 2013). Developing strong communication skills is crucial for student nurses as they navigate interactions with patients in clinical settings. This aspect of their education directly impacts the quality of care provided.

Nurses can leverage communication tools like the AIDET framework (Acknowledge, Introduce, Duration, Explanation, and Thank You), developed by the Studer Group (2005), to enhance their interactions with patients. It has gained traction in recent training programs worldwide (Puppala et al., 2020). Studies, particularly in Thailand, have demonstrated the potential of AIDET to enhance patients’ experience and care delivery (Panchuay et al., 2023; Thangkratok et al., 2017). This easy-to-remember approach significantly improves interactions between patients and healthcare providers (Dhir, 2022; Kourkouta & Papathanasiou, 2014; Meehan, 2021; ODaniel & Rosenstein, 2008; Turner et al., 2016; Yang & Kim, 2022). Studies consistently report that AIDET leads to improvements in patient satisfaction, reduced anxiety, and a more positive overall hospital experience (Dhir, 2022; Li et al., 2022; Palombi et al., 2015). However, limited research explores how nurses and student nurses integrate AIDET into their practice, particularly in the Philippines.

Effective communication with patients and their families is essential for nursing practice, as it builds rapport, facilitates information gathering, supports patient education, and promotes care coordination (Arnold & Boggs, 2015). On the other hand, inadequate communication can lead to misunderstandings, anxiety, and lower patient satisfaction (Leonard et al., 2004). Studies have demonstrated links between poor satisfaction ratings and a higher incidence of errors (Baah et al., 2023; Stewart, 1995). Understanding how communication unfolds in the Philippines is particularly relevant, especially considering the potential influence of cultural nuances on patient interactions. While adaptations of the AIDET framework have been explored in Thailand (Panchuay et al., 2023), a gap remains in understanding how Filipino nurses and student nurses utilize this framework in their daily practice.

While some studies have explored student perceptions of AIDET, they often focus solely on its user-friendliness in communication (Kourkouta & Papathanasiou, 2014; Turner et al., 2016). These studies don’t delve into the challenges or areas for improvement in using the framework. This is concerning, given the documented issues with communication skills training worldwide. Studies highlight the need for training beyond specific methods and focus on developing a broader communication competence for nurses (Bullington et al., 2019). Challenges include a lack of frameworks tailored to specific tools like AIDET, limited training time, and integration throughout the curriculum (Deveugele, 2015). This study seeks to illuminate how and why Filipino nursing students learn and integrate AIDET during their clinical rotations.

Existing research often explores the “what” of communication using AIDET, focusing on the content delivered rather than the “how” and “why” it shapes experiences (Palombi et al., 2015). Thus, our study employs an interpretive phenomenological analysis (IPA) informed by Heidegger’s Being-in-the-world philosophy (Heidegger, 1927) to delve deeper. We examined how Filipino nursing students integrate AIDET into patient communication during clinical practice. Heidegger posits we are not separate from the world but rather co-creators of meaning through interactions (Horrigan Kelly et al., 2016; Neubauer et al., 2019). The AIDET framework, then, becomes a tool influencing these interactions and potentially the students’ relationships with patients (Being-with) (Heidegger, 1927). This IPA approach allowed possibilities to explore the essence of their experiences, including existential challenges that emerge as they navigate communication within the Philippine healthcare setting, a context often overlooked in current research. By focusing on the “how” and “why” of Filipino nursing students’ experiences with AIDET, we aim to address a critical understanding of its impact on nursing education in the Philippines.

Methods

Study Design

This research employed a qualitative, interpretive phenomenological approach (IPA) grounded in the philosophy of Martin Heidegger (Horrigan Kelly et al., 2016). IPA prioritizes understanding participants’ lived experiences within their social context and how they interpret those experiences (Smith & Nizza, 2022). This aligns with the idea of being in the world (Dasein), where we are inseparable from our surroundings, constantly influenced by and influencing our environment through interactions and self-awareness (Iwuagwu, 2017). By grounding our study in Heidegger’s philosophy, we aimed to gain a comprehensive understanding of how Filipino nursing students perceive and navigate using AIDET, considering the broader context of their academic and cultural environment.

Through the application of IPA, this study gained valuable insights into how they utilize AIDET in patient communication. The focus was on three key areas: (1) Perceived Benefits of Using AIDET: Participants’ perspectives on how AIDET enhanced patient engagement, trust, and comfort. (2) Challenges Encountered with Implementing AIDET: Experiences of difficulties and barriers faced when trying to apply AIDET in clinical practice. (3) Potential Areas for Improvement in AIDET Education: Suggestions and insights regarding the enhancement of AIDET training and education with nursing programs. The research aimed to illuminate these aspects to provide valuable insights for the potential earlier integration of AIDET into nursing education programs. This potential for earlier integration could serve as a focal point for further studies seeking to enhance patient communication skills among nursing students.

Participants

This study took place in 2023 at the Angeles University Foundation (AUF), Angeles City, Philippines. AUF is a private university renowned for its dedication to high-quality education and nurturing well-rounded graduates (Angeles University Foundation, n.d.). This study involved Filipino students enrolled in a nursing program that emphasizes developing both clinical skills and compassion to prepare graduates for success in the global healthcare landscape.

A total of 30 Bachelor of Science in Nursing (BSN) students at Angeles University Foundation participated in the study. Purposive sampling was employed, a technique commonly used in qualitative research to recruit participants with characteristics relevant to the research question (Patton, 2014). In this case, participants were selected based on their enrollment in the BSN program and their experience using AIDET in patient communication during hospital clinical rotations.

Baccalaureate nursing students at the Angeles University Foundation (AUF) who were actively enrolled in the program at the time of the study and have completed at least one clinical rotation in a hospital setting were included. This ensured they had the necessary educational foundation and practical experience to provide insights into using AIDET in patient communication. The study excluded freshmen students and individuals below 18 years of age due to their lack of clinical experience.

Data Collection

The study utilized semi-structured focus group discussions to explore how Filipino nursing students integrate AIDET into their patient communication practices. As described by Tindall (2009), this method allows for rich exploration and interpretation of participants’ perspectives within a group setting. A pre-developed interview guide facilitated the discussions, incorporating questions on student demographics alongside specific topics related to using AIDET: perceived benefits, challenges encountered, and recommendations for improvement in AIDET education. This format allowed participants to share their experiences, build upon each other’s insights, and explore the nuances of using AIDET in a collaborative environment.

The research team discussed and scheduled the focus group discussions at mutually agreeable dates and times to ensure participant convenience. Three separate focus groups, each consisting of nine to ten Filipino nursing students, were conducted during their clinical rotations in hospitals as part of their related learning experience. The discussions were audio-recorded with informed consent to allow for verbatim transcription later. Data collection spanned four weeks, from July 15th to September 30th, 2023, with each focus group lasting approximately 45-60 minutes and conducted in Filipino and English. Three researchers (authors R.M., J.E., and D.L.) facilitated the data collection.

We strive to reach a point of data saturation, where further data collection yields no new significant information (Polit & Beck, 2014). This study, designed with focus groups, surprisingly achieved data saturation after discussions with only the first three groups. This outcome highlights the effectiveness of focus groups in gathering rich data and potentially reaching saturation earlier than anticipated (Mack et al., 2005). To further clarify specific aspects of participants’ experiences, the decision was made to conduct repeat focus group discussions. Two additional discussions were held with each group, resulting in a total of five focus group discussions.

Trustworthiness

We employed various methods to enhance the trustworthiness of our findings. These methods targeted four main ideas for qualitative research: credibility, dependability, confirmability, and transferability (Noble & Smith, 2015). We compared emerging themes with the original data to enhance credibility and verify their internal consistency (within themes) and logical coherence (between themes). The themes were then analyzed in the light of the research questions and relevant literature to identify patterns, connections, and deeper meanings across them. Additionally, we employed member checking, a validation technique described in (Creswell & Poth, 2016). This involved sharing key themes with a group of participants. We emailed interview transcripts for review, and all 30 participants confirmed the accuracy of their transcriptions. Their feedback helped us determine if our interpretations aligned with their experiences.

To ensure dependability, we documented all research decisions made throughout data collection and analysis. The first two authors (R.M. & J.E.) collaborated on the primary analysis. Four additional authors (D.L, E.B., Z.F., & D.R.) with qualitative research expertise reviewed and verified the analysis for accuracy to enhance trustworthiness further. This comprehensive record allows future researchers to evaluate our methods and potentially replicate the study.

For confirmability, it is essential to acknowledge that all six researchers are affiliated with the College of Nursing at the same university as the participants. Furthermore, Authors 1, 2, 3, and 4 served as clinical instructors for some participating students. We recognized that this shared affiliation could potentially introduce bias. However, we strived to mitigate these potential influences through our commitment to reflexivity and ongoing discussions within the research team.

For transferability, the research report provides a detailed description of the study setting, the Angeles University Foundation, and the participant population, Filipino nursing students. We clearly outline the research questions and any underlying assumptions that guided the study. Furthermore, the rich contextual details included in this study enable readers to evaluate how relevant the findings may be to their own situation (Patton, 2014).

Data Analysis

Following each interview, the audio recordings underwent verbatim transcription. During this initial stage, a decision was made to translate the transcripts into English. This approach ensured that the analysis remained grounded in the participants’ original expressions while facilitating a wider audience for the research findings. This study adopted thematic analysis, a well-established qualitative method, to analyze the interview data. Thematic analysis aligns well with the goals of Interpretive Phenomenological Analysis (IPA) studies (Clarke & Braun, 2021). Both methods aim to identify recurring themes within participants’ narratives. Through this iterative process of coding and interpreting themes, researchers can glean deeper meaning from participants’ experiences and their perspectives on those experiences (Smith & Nizza, 2022).

Ethical Considerations

The University Ethics Review Committee granted ethical approval for this research (ERC code: 2023-CON-Faculty-003). Prior to participation, researchers provided participants with a comprehensive information sheet detailing the study’s purpose, data collection methods, and participant rights. The information sheet also included details about the research team, their qualifications, and potential conflicts of interest. Participants were free to ask questions about the research or the researchers. Written informed consent was obtained after participants understood the details and felt comfortable proceeding. Participant confidentiality was maintained throughout the study. All data and audio recordings were secured, and access was restricted solely to the research team. Participants were assigned pseudonyms in the final analysis to protect their anonymity further. The study emphasized voluntary participation, ensuring participant autonomy by guaranteeing the freedom to withdraw at any point (until data collection was concluded) without academic repercussions. The research team ensured participants understood the study procedures thoroughly. Audio recordings were used with their explicit consent and stored securely to prevent unauthorized access.

Results

Characteristics of Participants

Table 1 presents the characteristics of the 30 Filipino nursing students aged 19 to 24. Notably, the 21-22 age group was the most well-represented. The gender distribution was skewed towards females, with 22 female and eight male participants. In terms of clinical experience, the participants had completed between 2 and 10 clinical rotations. Eleven participants had completed 2-5 rotations, seven had 6-10 rotations, and twelve had more than ten rotations in hospitals. The study involved a group of Filipino nursing students. The majority (21 students) were in Level III (third year) of the program, divided into two groups: Group A with 11 students and Group B with ten students. The remaining nine participants, comprised of Group C, were level IV (fourth year).

Table 1.

Characteristics of student nurses

Characteristics		f	%
Gender category	Male	8	26.7
	Female	22	73.3
Age group	19-20	11	36. 7
	21-22	17	56. 7
	23-24	2	6.67
No. of clinical rotation	2 to 5	11	36. 7
	6 to 10	7	23.3
	> 10	12	40
Year level	Level III (Third year)	20	66. 7
	Level IV (Fourth year)	10	33.3
Group	A	11	36. 7
	B	10	33.3
	C	9	30

Main Findings

Theme 1: Streamlining Nurse-Patient Interaction

Focus group discussions highlighted a key theme: participants perceived AIDET as a valuable tool, especially for student nurses still navigating the complexities of patient communication. This aligns with, or perhaps even reflects, the philosophical concept of “being-in-the-world” (Dasein). Interactions with others shape how we see the world and ourselves, just as we influence their perspectives. For these student nurses, AIDET provides a structured framework within which they can develop their communication skills and navigate the healthcare environment.

Subtheme 1.1: Organizes communication

Participants expressed that AIDET simplifies nurse-patient interactions and provides a structured blueprint for communication. They explained how AIDET “eases or makes the patient-nurse interaction simple and smoother” in their early stages of learning. This highlights the students’ lived experiences and how AIDET offers a communication flow, potentially reducing anxieties about initiating interactions. One participant explained:

The use of AIDET is very helpful to us student nurses as it somehow eases or makes the patient-nurse interaction simple and smoother…It gives us a format on how the nurse-patient interaction should go, especially since we’re still in our early years of related learning experience. (Participant A-3)

Another student nurse highlighted:

AIDET simplifies nurse-patient interactions and provides a structured guide for communication that is hard to forget… AIDET’s systematic approach is helpful in the interaction process, making it more manageable. We admit that we have difficulty communicating with people, especially in a professional setting, and that using AIDET really guides us throughout the interaction. By doing so, we can avoid confusion, misunderstanding, or awkwardness when we convey the necessary information and expectations to the patients. (Participants A-8)

Further discussion included:

AIDET helps us to have an organized flow of how we’re going to interact with our patients and gives them a clue when we’re going to leave the room for them to do their thing after we do our assessments. (Participant B-1)

One participant shared:

AIDET is a very common type of nursing mnemonic and can be an additional part of our daily nursing management, which will guide us throughout our therapeutic communication and approach to our patients, a good skill to remember its essential components. For me, personally, as someone who has difficulty in communicating with people, it helps me to organize the flow of the interaction with patients. (Participant C-6)

Another student nurse provided a specific scenario:

I was assigned to care for Mrs. Luna, an old lady of more than 60 years of age who had a recent surgery. I introduced myself as a student nurse and explained that I would assist her with her daily activities and monitor her vital signs. I asked her regarding her pain as well as her goal and told her that I would work with her to achieve it. I also informed her about the plan of care for the day, which included a session of physical therapy, wound dressing, and medication administration. I estimated how long each intervention would take and asked her if she had any further questions or concerns. She said she was satisfied with all the information and thanked me for being attentive. I thanked her for her cooperation and assured her I would be back soon to check on her. AIDET was instrumental in assisting me throughout my communication with the patient on that day. (Participant B-8)

Subtheme 1.2: Rapport Building and Alleviating Anxiety

Using AIDET fosters a shift in student nurses’ interactions with patients, aligning with Heidegger’s “Being-with” concept. IPA allows us to see how AIDET’s structure might alleviate anxieties related to communication initiation (“Being-in-the-world”). This, in turn, facilitates rapport building, as evidenced by participants feeling patients were heard and less anxious. One student nurse shared her experience:

I was once assigned to the psychiatric unit in the Outpatient Department during my clinical rotation; I introduced myself as a student nurse and explained that I was there to provide support and guidance to the patient. I acknowledged the patient’s feelings and emotions and assured them they were not alone or judged. I also informed them about the benefits and side effects of their medications as part of our health teaching requirements and the resources and coping strategies available to them. I thanked the patient for sharing their thoughts and feelings with me and asked them if they had any questions or concerns about their treatment. The patient expressed their relief and gratitude for my respectful and compassionate communication and said they felt more hopeful and motivated about their recovery. (Participant A-1)

Another participant shared:

During the stay of the patient in the hospital, many of them experience anxiety. The use of AIDET is very helpful to ease that anxiety, especially when establishing rapport and explaining the procedures. Patients find clarity and reassurance, knowing that they are being cared for. (Participant C-3)

One commented, a sentiment shared by others in the group:

By giving an estimate of the duration of our encounter, we are reducing the patient’s uncertainty and anxiety. (Participant B-9 & B-1, 7, 8)

Subtheme 1.3: Acknowledgement and Empowerment

IPA allows us to understand the participants’ lived experiences and how acknowledging patients (a core element of AIDET) resonates with their developing sense of patient-centered care. This aligns with Heidegger’s concept of “Being-with,” where authentic encounters involve mutual recognition. Participants highlighted how acknowledging patients through greetings, listening to their concerns, and including them in care discussions fostered a sense of empowerment. This suggests that using AIDET goes beyond simply following a framework; it allows student nurses to develop a more patient-centered approach. One student nurse shared:

AIDET influenced the way I provide patient care by including them in the care through our communication, making them a part of the treatment management; thus, patients are empowered. (Participant A-10)

Another two participants highlighted:

It is very helpful since it is used during the initial communication or interaction between the patient and the healthcare provider. First, when we acknowledge them by greeting them and setting the conversation in such a way that they are informed and feel acknowledged, and giving information to the patients that is accurate and honest is a form of empowerment on their side. (Participant C-2)

By acknowledging the patient’s name, feelings, and concerns, we as nursing students can make the patients feel heard and valued (Participant B-7)

Subtheme 1.4: Trust and Confidence

Participants expressed feeling that using AIDET during interactions instilled trust and confidence in themselves and the patients. Its structure and clarity helped them feel more prepared for patient encounters. One participant discussed:

AIDET boosts our confidence as students. Initially, we were hesitant and afraid of how to approach and start conversing with patients, as we could see from their faces that they usually withdraw or stay quiet. But as we follow the steps, starting with acknowledging and introducing ourselves and informing them of how long we will be with them throughout the day, they start to engage in communication, leading to the expression of feelings, thereby building trust. (Participant B-1)

Another participant described:

AIDET encourages patients to be more open and trusting in expressing concerns because in the explanation part, sometimes we discuss while showing or acting the interventions that we do, giving them a chance to ask questions. (Participant B-8)

Another student nurse shared:

There was one patient who asked to talk to me only, according to the staff nurses working in the unit. Yet, that patient is well known to be problematic and refused conversations. This made me feel more needed and confident because I know the patient trusts me. The impact of using AIDET really boosts my confidence as a student nurse. (Participant C-10)

Additional comments were made:

By introducing ourselves and our roles as student nurses, we build trust and credibility. By thanking the patient for their cooperation and feedback, we can express appreciation and reinforce a positive relationship. (Participant A-5, 8, 10)

A student nurse voiced a sentiment echoed by others in the group:

We feel confident when patients trust us even though we are only students, especially when they ask us when we are coming back after saying thank you. (Participant B-7 & group B-1, 5)

Theme 2: Enhances Patient-Centered Care

Thematic analysis revealed that participants viewed AIDET as a valuable tool for emphasizing the importance of understanding patients’ feelings, practicing therapeutic communication, and actively listening to their concerns. The findings stressed the importance of student nurses developing emotional connections with patients and tailoring support to their unique needs. This aligns with the core tenets of patient-centered care. Further analysis within this theme led to the development of two sub-themes that capture the specific ways AIDET contributes to patient-centered care:

Subtheme 2.1: Empathy and Compassion

Participants’ statements demonstrated that utilizing AIDET in nurse-patient interactions fostered a more compassionate and empathetic approach. They felt it helped them understand the patient’s condition, provide relevant information, show empathy and compassion, make patients feel valued and understood, and convey gratitude. One student nurse mentioned this:

When I talk to my patients using AIDET, it helps me to understand the patient’s condition, distress, and pain better and to provide them with relevant information and reassurance, starting from the acknowledgment and, most especially, during the explanation. Through this method of communication, I am demonstrating professionalism and compassion as a nurse, even though I am still learning. (Participant B-1)

Another described:

Yes, by actually telling the patient how long we will be staying and providing care for them means a lot, and that is showing empathy and compassion. We also feel their loneliness of being away from their family since they are in the hospital. Make them aware that we are there to take good care of their health and well-being. (Participant B-9)

One revealed:

I had seen one patient smile and cry in between our conversations while actively listening from the very start when I introduced myself as a student nurse, explained the purpose of the vital signs that I would be doing, and asked about her concerns…I felt the importance of my presence during that moment. (Participant A-1)

Another reported:

Expressing gratitude at the end of an interaction, as the “Thank you” step of AIDET suggests, is an opportunity for us to convey compassion to our patients already. (Participant C-6)

Subtheme 2.2: Improved Patient Experience

The focus on clear communication, active listening, and patient-centeredness using AIDET was seen as leading to an improved patient experience. The student nurses felt that using AIDET allowed them to better understand and address patients’ concerns, ultimately leading to more positive interactions. A student nurse shared:

When I informed one of my patients about how long I’d be doing the intervention with her, which was the “D” part of AIDET (duration), I felt I was providing transparency and respecting her time. (Participant C-6)

Another student identified that:

One of the central elements of AIDET is the “E” part (Explanations). When we follow this step, we ensure that patients understand what is happening, why it is happening, and what they can expect… like during IV insertions, we always say the truth that the procedure is a bit painful but tolerable or ask for their consent verbally. This way, they are active participants in their care and promote shared decision-making, which is a key aspect of patient-centered care. (Participant C-1)

Another participant shared:

Expressing gratitude after nurse-patient interaction is mostly missed, and AIDET helped me to remember its importance to patients. When we thank patients for their time, cooperation, and patience, it shows that we acknowledge and appreciate their roles as patients. This final step fosters a respectful, positive, and patient-focused environment. Seeing them smile afterward is gratifying on our side as a student nurse since we made a difference just by saying thank you. (Participant B-8)

Theme 3: Challenges with Specific Patient Populations

Participants identified that these challenges often stemmed from communication barriers related to cultural background, age, language, cognitive abilities, or emotional state. These findings connect to Heidegger’s concept of “Being-with.” Authentic encounters require understanding the other, and these communication barriers can hinder that understanding. Through IPA, we deeply understood how student nurses experience and navigate these challenges. Further analysis within this theme led to four sub-themes that capture the specific challenges encountered by student nurses:

Subtheme 3.1: Patient Preferences

This sub-theme highlights the importance of considering individual patient preferences in healthcare. Participants acknowledged the diverse preferences patients may have regarding decision-making involvement, cultural and personal beliefs, and communication styles. These diverse preferences can be challenging, but student nurses often seek guidance from experienced healthcare professionals. One stated:

Yes, some patients may prefer to have more information and involvement in decision-making, while others may prefer to delegate that responsibility to their providers. Making it a challenge for us students to figure out how we’re going to interact with them. (Participant A-10)

Another one reported:

Sometimes, patients may have cultural, religious, or personal beliefs that affect their choices and expectations. Most of the time, we seek help from our clinical instructors or the nurses on duty. (Participant A-3)

One more participant identified:

Some patients may have different preferences for communication styles, such as formal or informal, direct or indirect, verbal or non-verbal. Like when I was explaining about medication, the patient just cut me off and said… “I know already” that left me with nothing to say. (Participant C-10)

Subtheme 3.2: Language Barrier

This sub-theme explores the challenges posed by language barriers in healthcare settings. Participants emphasized the need for strategies to address these barriers, such as simplifying communication, using visual aids, seeking interpreter support, adjusting voice tone, and maintaining eye contact. These strategies are crucial for facilitating effective communication for “Being-with” patients who speak a different language, which can significantly hinder this connection. One student nurse highlighted:

Most of the patients here speak Kapampangan, which is the mother tongue of most of the patients here in Pampanga; I don’t speak the dialect, so it is very hard for me to partake in any conversation with my patients since they prefer their own. So, mostly my classmates who speak their dialect will take over. (Participant B-7)

One described that:

It is important that we need to overcome the language barrier by using strategies such as speaking slowly and clearly, using simple words and phrases, avoiding jargon and slang, using gestures and visual aids, confirming understanding, and seeking the help of an interpreter if needed. (Participant A-1)

Another reported:

We need to tone down our voices in order for both parties to understand each other. And, of course, when we speak to our patients, we need to have eye contact in order to show respect and honesty. (Participant C-6)

Subtheme 3.3: Patient Condition

This sub-theme focuses on student nurses’ challenges when applying AIDET with patients in specific conditions. Examples include caring for older adult patients, mothers in labor, and pediatric patients. Quotes from participants illustrate the difficulties encountered when communicating with patients who may be grumpy, unable to respond due to pain, or easily distracted. Despite the challenges, participants emphasized the value of adapting AIDET communication to address the needs of these patients and their families effectively. One participant shared:

Usually, talking to geriatric patients is difficult even though we follow the AIDET format since they are sometimes grumpy and can’t comprehend what we are discussing; they usually calm down when we touch them. (Participant A-8)

Another identified:

We also face challenges when communicating with patients who are in labor or patients with pain since they are unable to respond or understand communication effectively. Their priority is not listening but for us to ease their agony, but still, we pacify them by reassuring them through our AIDET communication method. (Participant B-7)

One student nurse described:

Definitely, pediatric patients like toddlers are challenged when we apply AIDET since they don’t concentrate on the whole conversation, so, we usually converse with the parents and family members. Applying AIDET as well to the patient’s significant others is helpful, and they really appreciate how we find time to acknowledge, introduce ourselves, explain how long we will be there, and what do they expect. The acceptance and smile we see in them thereafter is gratifying. (Participant C-1)

Additional insights were mentioned:

Yes, interactions are easier with older children because they are attentive during discussions and with newly delivered mothers as they respond and interact more effectively with student nurses since they are happy. (Participant C-3)

Subtheme 3.4: Acknowledgment of Cultural Differences

This sub-theme emphasizes the importance of cultural competency in healthcare. The “Acknowledge” and “Introduce” steps of AIDET were crucial for promoting culturally sensitive care. Student nurses can provide more inclusive and patient-centered care by recognizing and respecting patients’ cultural backgrounds, adjusting communication and behavior accordingly, and expressing commitment to cultural diversity. Two participants shared:

The “Acknowledge” step in AIDET encourages student nurses to recognize and acknowledge the unique cultural backgrounds and perspectives of our patients since it gives us an initial recognition that sets the stage for culturally sensitive care. We have the chance to adjust the way we talk and behave according to our client’s preferences. But we need more techniques on how to implement them. (Participant A-4)

When we introduce ourselves to patients, we also express our commitment to providing care that respects cultural diversity. Statements like, “I’m here to provide care that respects your cultural beliefs and preferences; just let me know accordingly.” Though, at times cultural differences are a challenge that we need to address as student nurses since our country is considered one. Not only that, but the majority of Filipino nurses work overseas, where we encounter diverse cultures. (Participant C-2)

Theme 4: AIDET in Nursing Education

This theme highlights the importance of practical experiences, early introduction, and ongoing support for developing proficiency in using AIDET as a communication tool. Further analysis led to four sub-themes that captured the specific recommendations for improving AIDET education:

Subtheme 4.1: Strengthening Application through Practice

This emphasizes the importance of practical experience for developing proficiency in using AIDET. Participants highlighted that consistent practice allows student nurses to refine their skills, adjust communication styles, and ensure patient attentiveness during interactions. One shared:

I can say that AIDET is effective since experience plays a crucial role in effectively using it through constant practice as a student. It’s up to the student nurses how they apply everything they’ve learned, like adjusting the tone of voice to make AIDET more effective and use it in such a way that we can be assured that our patients are attentive during discussions through constant use. (Participant B-7)

Subtheme 4.2: Optimizing Frequency and Timing

Early introduction and frequent practice of AIDET during nursing education were seen as crucial for developing familiarity and confidence in real-world patient interactions. One shared:

I recommend using AIDET more frequently, especially in the early years of nursing education. When student nurses engage in real nurse-patient interactions, they won’t feel lost or confused about how to communicate with patients. (Participant A-5)

Another mentioned:

“AIDET must be taught by our clinical instructors every time we do OSCEs so that when the time comes that we encounter patients in the clinical areas, it’ll be routine for us to apply it since it really is a good method to follow for us students.” (Participant C-2)

Subtheme 4.3: Comprehensive Understanding and Application

This highlights the need for a deeper understanding of communication principles alongside the AIDET framework. Participants expressed that memorizing the steps is not enough; they need to understand the rationale behind them and how to apply them effectively. A comment by one of the student nurses:

Students should not only memorize AIDET but also understand and internalize it. We need to apply the key competencies and learn how to communicate properly. It’s not just about acknowledging or explaining; we should know the right way to communicate. (Participant B-9)

Another described:

We use AIDET and mimic it like a robot because it’s a mnemonic, but through constant use and application, I can now understand its use and importance for me as a student. I definitely agree that using this as a tool in nurse-patient interaction is essential since it helped me a lot! (Participant C-3)

Subtheme 4.4: Enhancing Feedback Mechanisms

Students emphasized the importance of receiving regular, constructive feedback on their communication skills and use of AIDET. This feedback, along with opportunities for reflection, allows them to identify strengths, weaknesses, and areas for improvement. A student specified:

We really need an established mechanism as students wherein regular feedback on our communication skills, emphasizing the importance of AIDET. (Participant A-8)

Another commented:

Yes, we need continuous feedback that is meant to be constructive and helpful rather than punitive every after-patient encounter while using AIDET so that we can focus on identifying our strengths and areas for improvement, and we can also offer suggestions for enhancement. (Participant A-4)

Another identified:

For us to hone our AIDET skills in communication, we really need regular and not limited to scheduled performance reviews or evaluations only, maybe on a daily basis or as needed. Or we can include the use of AIDET in our reflections. (Participant B-9)

Another replied:

True, definitely we can include AIDET use as part of our reflections, where we recall the discoveries, realizations, and challenges regarding its use…if it resulted in a positive or negative output. (Participant B-5)

Discussion

This study’s findings resonate with philosophical concepts of human existence and interaction. The way we experience ourselves and the world is inherently connected to our social experiences (Heidegger, 1927). This perspective aligns with the role of AIDET in fostering deeper patient communication. The AIDET framework goes beyond providing a communication structure; it encourages student nurses to engage with patients in a way that facilitates a more nuanced understanding of their needs and experiences. This deeper understanding can then serve as a foundation for building genuine connections with patients, a concept aligned with Heidegger’s notion of “being-with-others” (Heidegger, 1927).

The use of AIDET benefits both patients and student nurses. The structured approach fosters clear communication, reducing misunderstandings and contributing to a more positive and supportive patient journey (Register et al., 2020). Research underlines the importance of acknowledging patients’ emotions and providing clear explanations. Yang et al. (2023) found that these strategies can reduce anxiety and foster open communication. It underpins high-quality care and trusting patient relationships (Fu et al., 2020). Furthermore, AIDET empowers both parties. Students gain confidence in their abilities as they engage in meaningful communication using the AIDET framework. Patients, in turn, feel valued and heard by their caregivers, as highlighted by Yang et al. (2023). This aligns with Heidegger’s ideas of authenticity and “being-present-for-others” (Heidegger, 1927). Furthermore, AIDET empowers nurses to deliver patient-centered care. Therefore, integrating AIDET education and promoting its use in daily practice is crucial. Ongoing training and mentorship can strengthen its positive impact (Panchuay et al., 2022).

AIDET empowers both student nurses and patients. For students, following the AIDET framework builds trust and credibility with patients, fostering a more open communication environment (Li et al., 2022). This aligns with patient-centered care by encouraging empathy and understanding patients’ needs (Palombi et al., 2015). Patients benefit from feeling heard, respected, and engaged in their care through clear explanations and expressions of gratitude (Register et al., 2020). This focus on communication aligns with Heidegger’s concept of understanding in human existence (Heidegger, 1927). By effectively using AIDET, student nurses can build rapport, improve patient understanding, and create a supportive environment.

Building on patient-centered care, this theme emphasizes understanding patients’ emotional well-being. Communication methods like equipping student nurses to grasp patients’ conditions, distress, and pain with AIDET (Register et al., 2020). AIDET promotes active listening, empathy, and clear information sharing, fostering emotional connections with patients. This approach builds compassion and allows nurses to tailor support to individual needs, ultimately improving the patient experience.

While the AIDET framework offers substantial advantages, this study suggests its application can be hindered by various patient-related factors, including individual preferences, cultural backgrounds, language barriers, and specific health conditions (Amoah et al., 2019). These factors can hinder communication. However, nurses can address these challenges by adopting a flexible approach. This may involve adapting communication styles, speaking clearly for language barriers, or utilizing interpreters. By tailoring AIDET to individual patient needs, nurses can ensure it remains an effective communication tool.

This research investigated how to integrate the AIDET communication framework into nursing education in the Philippines, aiming to improve communication in practice. The findings align with the concept of authentic engagement (Heidegger, 1927), where true learning occurs through experience. Students highlighted key strategies for success, advocating for early introduction of AIDET concepts through simulations from the beginning of their education (Fisher et al., 2014). This approach allows for consistent practice, which refines communication skills and enables students to adapt AIDET to the specific needs of individual patients (Fisher et al., 2014). The study emphasizes that AIDET goes beyond memorization. Hands-on experience in clinical placements, crucial for developing skills (Saaranen et al., 2015), is key to effectively using AIDET and adapting it to individual patients. Students need a deeper understanding of the underlying principles to effectively adjust the framework to the diverse needs of Filipino patients.

Building on this idea of experience-based learning, this study suggests combining AIDET with reflective practice informed by formative assessments (Braverman et al., 2015). The emphasis on lived experiences in this study with the core principles of Interpretive Phenomenological Analysis (IPA) focuses on exploring the unique ways patients experience their situations and the meanings they ascribe to those experiences. By reflecting on their use of AIDET with diverse patients, Filipino nursing students can gain a richer understanding of communication within their specific cultural healthcare environment. This approach fosters a deeper understanding and more meaningful application of the framework, ultimately leading to more respectful care that prioritizes the patient’s needs and perspectives.

Limitations of the Study

Considering the sample, this study involved Filipino nursing students from a single Institution (Angeles University Foundation) in Angeles City, Philippines. While their experiences provide valuable insights, including participants from a broader range of institutions and geographic locations could enhance the generalizability of future research. Additionally, the specific context of AUF may influence findings. Future research in different healthcare settings could offer valuable comparisons and strengthen the transferability of the results to a broader audience. Future research could also benefit from longitudinal studies, comparative assessments with other communication frameworks, cultural competency evaluation, and investigations into patient outcomes. Implications for future research involve developing educational interventions, exploring interprofessional collaboration, incorporating patient perspectives, and studying implementation strategies to enhance AIDET’s role in nursing education and nurse-patient interactions for improved patient-centered care. Addressing these considerations will advance our understanding of AIDET’s implications for nursing practice.

Conclusion

This study investigated the integration of AIDET into Filipino nursing education. Aligning with Heidegger’s notion of authentic engagement, the research found that rote memorization has limitations. Students’ lived experiences highlighted the importance of a deeper understanding of successful AIDET implementation. By integrating AIDET with reflective practice, student nurses develop a deeper grasp of the framework, ultimately leading to more respectful and patient-centered care. This study opens doors for further research to investigate the lasting effects of AIDET training. Longitudinal studies could offer valuable insights into how AIDET training influences communication skills and patient experiences over time. Incorporating AIDET in Filipino nursing education and practice holds promise for improving communication effectiveness and promoting patient-centered care throughout the healthcare system.

Declaration of Conflicting Interest

The authors declared that there are no conflicts of interest regarding the publication of this paper.

Funding Statement

Funding No external grants were received to conduct this study. Researchers of this study bear all expenses related to the study.

Authors’ Contributions

The design of the study was conceptualized by author one. The collection and interpretation of data were done by the authors (first, second, third, and fourth). The fifth and sixth authors reviewed the final paper, and all authors approved it for publication.

Authors’ Biographies

Rudena A. Madayag RN, MAN, PhD(c), Assistant Professor, College of Nursing and Graduate School, Angeles University Foundation.

Jeffrey V. Esteron, PTRP, RN, MAN, LPT, Assistant Professor, College of Nursing and Graduate School, Angeles University Foundation.

Diane Anne Lozano, RN, MAN, Clinical Instructor, College of Nursing, Angeles University Foundation.

Evangeline C. Bautista, RN, MAN, Clinical Instructor, College of Nursing, Angeles University Foundation.

Zenaida S. Fernandez, RN, PhD, Professor, Dean, College of Nursing, Angeles University Foundation.

Debbie Q. Ramirez, RN, PhD, Professor, Assistant Dean, College of Nursing, Angeles University Foundation.

Data Availability

The document, data, materials, and results of this work are available at the College of Nursing, Angeles University Foundation. The corresponding author should be contacted if someone wants to request the data.

Declaration of Use of AI in Scientific Writing

Nothing to disclose.