Table 2.

Patient Interaction Behaviors and Definitions

Positive Behaviors (9)
Acceptance	After the nurse offers/performs a health related or comfort providing function, the patient says “yes”, “mmhm”, thank the nurse, nods affirmatively with the head, eyes or hand, expressing agreement, acceptance or satisfaction. Patients can utilize AAC strategies (ex: writing, alternative yes/no signals, communication boards, or speech generating devices) to demonstrate agreement, acceptance, or satisfaction *May receive a “present” if the nurse provides a plan of care for the rest of the shift (ex: Nurse offers to change patient’s bed/linens after the physicians comes back and finishes a procedure. The patient nods yes to accept the plan)
Following Instructions	Engaging a behavior (within the patient’s actual capabilities) in response to an appropriate request or instruction by the nurse, within ten seconds of the request. Ex: posture changes, answering questions. *If patient’s response is ambiguous and not interpretable to the nurse, then this behavior is absent.
Visual Contact	Looks the nurse in the eye when the nurse asks a question or addresses the patient while the nurse is at the bedside (unless the nurse is engaged in incompatible technical procedures, assessment of monitor, or interrupted by family, clinical or other healthcare professionals), regardless of whether the nurse is looking at her/him. *Patient may receive a “present” if the nurse is out of the frame but it is clear that the patient is focused on and responding to the nurse.
Physical Contact	Touches, pats or hugs the nurse. Includes attention-getting touch and touch for comfort. Ex: reaching out to nurse to pat their arm or shake their hand. Does not include grabbing for support during position changes.
Request	Verbal, digital or manual indications initiated by the patient to express a need or request, followed by the corresponding nurse appropriate behavior. Ex: requesting a glass of water, pain medication, etc.
Smiling	Lifting lips corners while looking the patient in the eyes *Exceptions may be made if the patient has a neurological deficit (facial droop) or other impediment that doesn’t allow one corner of the mouth to raise
Maintaining Attention	Keeps sustained eye contact while the nurse provides an explanation, information, instruction or appropriate comment. *may receive a “present” if the nurse is out of the frame but the patient is still focused on and responding to the nurse.
Laughing	Lifting the lips corners or congruently opening the mouth. Patients may appear to take an extra breath while their chest and shoulders rise. It may appear to be more of a chuckle.
Praise	A clearly distinguishable gesture or message expressing gratefulness or approval of an action by the nurse.
Negative Behaviors (3)
Disagreement/Negativity	Verbalization or actions expressing opposition to nurse’s, includes threatening gestures, striking or refusal.
Disgust	Gestures or facial expressions indicating disgust, exasperation, annoyance, or frustration. Examples: head shaking, turning away, upward eye movement or eye roll *In order to determine if the eye roll/movement is an expression of disgust, the rater must take into account verbal context, and other nonverbal indicators.
Ignoring the Nurse	Same definition as the category for nurses in absence of a justifying situation such as being asleep or unconscious.

Note. These definitions have been revised from previous by de los Ríos Castillo, J.L. and Sánchez-Sosa, J. (2002). Changes to the original definitions are identified with italics.