TABLE 2.

Grading Rubric

Skill	Poor	Good	Excellent
Tone/cadence	Not all words are legible, tone is rushed	Speech is clear, tone is calm	Speech easy to hear and all words are legible, tone is calm and reassuring
Rhythm/pace	Speaks at a normal pace without awareness that sedated patients may need longer time to process speech	Speaks at a slower pace than normal	Speaks at a slower pace than normal. Pauses in between sentences
Rapport management	Does not observe patient’s response if any, does not address patient by name	Manages rapport building: e.g., by Using patient’s name in communication	Handles rapport formation, maintenance and termination well. E.g., by uses patient’s name in communication. Uses “we” language, introduces colleagues
Active involvement, providing sense of control	Speaks to patient as passive recipients of treatment	Speaks patient (including sedated or comatose patients) as active recipients	Emphasizes that patient is a key part of the treatment team. Explains what patient can do to help the team and what patient can do during a procedure to make sure it goes smoothly if applicable. Provides choices whenever is possible
Positive (but realistic) language	States “you are safe” without additional explanations	Uses suggestions of safety such as “catheter is increasing the safety and comfort”; some suggestions are formulated well	Uses situation-specific suggestions of safety and expands them to the treatment team; well-formulated suggestions
Future orientation	Forgets to discuss temporary nature of things that cause discomfort in the ICU. Does not discuss future goals	Emphasizes that endotracheal tube/other limitations are temporary	Emphasizes that endotracheal tube/other limitations are temporary, explaining their role from the perspective of treatment/future recovery. Provides patient with suggestions on recovery, talks to the patient about the day when they would recover and do something they really look forward to doing
Suggestive techniques	Does not apply suggestive techniques. The text is purely informative, based on “dominant mode of consciousness”	Applies some techniques, but mostly for the sake of implying the technique. The focus is not on the “message” but the technical elements of the communication	Applies flexibly many techniques (yes-set, metaphors, reframing, implication, illusion of alternatives, modeling, etc.). The communication is flexibly moves on the continuum of “dominant-alternative” modes of consciousness
	Does not recognize the negative suggestion in the communication
Reframing conditions	Forgets to discuss the reason for ICU admission. Forgets to reframe essential aspects of care (endotracheal tube, machine noises, etc.). Does not preframe upcoming procedures	Discusses reason for ICU admission. Reframes some not all aspects of care and sounds. Preframes upcoming procedures	Discusses reason for ICU admission. Reframes basic facts, procedures, lines, medications. Lists multiple sounds when reframing ICU environment; links sounds to the care team and suggestions of safety. Preframes upcoming procedures including the reason why they are important
Touch	Does not warn the patient or ask permission before touching them	Provides touch once rapport has been established but does not inform the patient	Provides touch once rapport has been established and informs the patient that she would touch their hand if ok. Uses touch appropriately for rapport maintenance
Communication patterns	Introduces self by name, does not use phrases that would be used in a normal conversation such as “thank you,” ”good morning,” and so on	Introduces self by name, occasionally uses routine phrases that would be used in a normal conversation such as “thank you,” ”good morning,” and so on	Introduces self by name and function, routinely says ”good morning,” “thank you,” “please,” and “good bye” even when patient is sedated
Self-reflection	Does not reflect on the impact of the process on herself	Briefly reflects on the interaction	Regularly and appropriately reflects on the emotional aspect of the process (“detached concern”). Manages evoked emotions well. Asks for supervision if necessary
Overall impression	Not yet advised to communicate with the critically ill	Ok to interact with patient while being aware of the areas that need improvement	Ready to interact with the critically ill, speaking from the heart and not just repeating a model text