The Comfort Communication Simulation Instrument (Sim-Comfort): A Relationship-Centered Approach to Assessing Communication Competency
Overview
The Comfort Communication Simulation Instrument (Sim-Comfort) is an assessment instrument with evidence of validity and reliability that was designed to evaluate person-centered, relational communication competency within healthcare simulation-based education. It offers a structured, theory-based approach to measure and enhance communication skills aligned with competency-based education standards. By addressing a critical gap in simulation assessment, Sim-Comfort supports educators in promoting effective, relational communication across advanced nursing education.
How to Use
- There are seven competency domains to be scored. Each domain includes identifiable communication behaviors that are ranked as ‘not done’, ‘partial’, or ‘complete.’ The learner needs to achieve all bullet point descriptions (“concepts for feedback”) to score complete. Learners who achieve ‘partial’ on a domain perform some but not all bullet point descriptions. Learners who score ‘not done’ have not performed any bullet point descriptions.
- If educators determine that a communication behavior is not able to be assessed in a specific simulation scenario, the bullet point may be preemptively excluded from assessment.
- The notes column should be used to describe outstanding moments or dimensions of performance as well as descriptions for areas of improvement. 4) Learners and SPs should engage in feedback conversations grounded in objective “concepts for feedback” to foster competency progression.
Integrative Learning Strategies
- Standardized Patients (SPs) who engaged in the scenario with the learner should rate performance.
- Learners and SPs should engage in feedback conversations grounded in objective “concepts for feedback” to foster competency progression.
- To maximize impact, feedback conversations should occur close to the time of the simulation-based learning experiences.
- Students should be provided with verbal feedback as well as written copies of the tool with corresponding ratings.
Assessment Strategies
Sim-Comfort is an instrument with evidence of validity and reliability intended to assess NP student progression of relational communication performance within AACN Essentials Domain 2 (2.2, Communicate Effectively with Individuals) and Domain 9 (9.2, Employ Participatory Approach to Nursing Care).
Learning Objectives and Exemplars
Exemplar Learning Objective
- By the end of the simulation, nurse practitioner (NP) students will demonstrate advanced communication techniques while counseling the patient on the diagnosis of hypertension, as assessed using the Sim-Comfort communication competency tool.
Exemplar Curricular Placement
- Formative simulation based education integrated into a diagnosis/ disease management course. Simulation geared towards the diagnosis and management of hypertension, in addition to communicating about this chronic illness to the patient.
Possible Courses
- Advanced health assessment
- Disease management
- Diagnostic and clinical reasoning
- Clinical rotations
Additional Resources/Publications
Burt, Leah, Elaine Wittenberg, Joy V. Goldsmith, Bob Kiser, and C. Park. 2026. “The COMFORT Communication Simulation Instrument (Sim-Comfort): A Relationship-Centered Approach to Assessing Communication Competency.” Journal of Professional Nursing 62: 98–104.
Goldsmith, Joy V., and Elaine Wittenberg. 2024. “The COMFORT Model: Moving the Initiative Outside of the Academy.” Health Communication 39 (14): 3514–3519.
Wittenberg, Elaine, Joy V. Goldsmith, Chiahui (Kate) Chen, Mary Prince-Paul, and B. Capper. 2021. “COVID-19–Transformed Nursing Education and Communication Competency: Testing COMFORT Educational Resources.” Nurse Education Today 107: 105105.
Wittenberg, Elaine, Hanna G. Lee, Joy V. Goldsmith, Chiahui (Kate) Chen, Jennifer Maffucci, and Leah Burt. 2026. “Exploring the Use of the COMFORT Model for Nurse Communication About Social Determinants of Health.” Palliative Medicine Reports 7 (1): 114–119. https://doi.org/10.1177/26892820261417606.
Sub-competencies for advance-level professional nursing education:
2.1d Promote caring relationships to effect positive outcomes
2.1e Foster caring relationships
2.2g Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences
2.2j Facilitate difficult conversations and disclosure of sensitive information
2.3h Demonstrate that one’s practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice
2.8h Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management
9.2h Foster opportunities for intentional presence in practice.
9.2i Identify innovative and evidence-based practices that promote person-centered care.
9.2j Advocate for practices that advance diversity, equity, and inclusion.
9.2k Model professional expectations for therapeutic relationships.
9.2l Facilitate communication that promotes a participatory approach.
Posted: April 15, 2026
Submitted by:
Leah Burt, PhD, APRN, ANP-BC, CHSE, FAANP, Clinical Assistant Professor, University of Illinois
If you would like to cite this resource in your own work, please use the following citation:
Burt, L. (2026). The Comfort Communication Simulation Instrument (Sim-Comfort): A Relationship-Centered Approach to Assessing Communication Competency. Excerpted from the Essentials Teaching Resource Database. American Association of Colleges of Nursing, Washington, DC. Available at https://www.aacnnursing.org/AACN-Essentials/Implementation-Tool-Kit.