Improve patient education skills by making them part of annual competencies

Use the stand-alone method or weave them into other evaluations

For the best health outcomes, clinical staff need to have good teaching skills. One way to make sure they are competent educators is to develop patient teaching competencies that must be met when staff members are given their annual job performance evaluation.

A few years ago the patient education office at the University of Texas M.D. Anderson Cancer Center in Houston formed a multidisciplinary committee to look at patient teaching competencies and determine the minimum standard staff would have to meet.

Following brainstorming sessions, the group developed themes and came up with a list of competencies, says Nita D. Pyle, MSN, RN, associate director of the patient education office and head of the committee. They also developed teaching plans for each competency and a checklist that management used during the evaluation. (To view the list, see article, below.)

It is difficult to know if staff members who are involved with teaching patients practice good education methods unless their skills are evaluated.

During the annual employee assessment at Children's Healthcare of Atlanta staff members are tested via computer-based training modules on a variety of topics pertaining to regulatory standards, such as safety, and patient education is included. Each topic has about 10 questions that change yearly. There is a booklet for each test that staff can read in advance.

The patient education module covers everything from doing a learning needs assessment to evaluation techniques and health literacy questions, says Kathy Ordelt, RN-CPN, CRRN, patient and family coordinator. Staff members must score 80% on each test in order to pass and retest on the modules when their score is lower.

"The module doesn't contain tons of information that will make staff experts, but it is a reminder that patient education is part of patient care, and it is important," says Ordelt.

This year The Children's Hospital of Philadelphia is creating a patient and family education on-line critical thinking module that addresses the key concepts of teaching a patient and family at the bedside. This is one of several on-line modules nurses work through at their own pace and take a post-test when finished.

In addition, teachable moments will be embedded in the skills revalidation portion of the competency review process, says Evie Lengetti, RN, MSN, director of nursing education, community programs and co-director for the Office of Simulation and Innovation at The Children's Hospital of Philadelphia.

For example, for the skills revalidation for caring for a patient with a central line, a manager would discuss the educational opportunities available when changing the dressing, such as the steps involved. "Wherever we see a teachable moment that is appropriate for patient and family education, we will embed that into the technical portion of our skills revalidation of the annual competency review program," says Lengetti.

Making patient education part of annual competencies and job evaluations helps staff members realize that education is part of good patient care. However, many health care institutions are discovering that a good way to incorporate teaching into clinical practice is to blend teaching into other competencies, rather than making it separate. That is the case at M.D. Anderson Cancer Center.

"We took about a year and a half to develop the patient teaching competencies. With the teaching plans, resources, and checklists, it was a whole notebook that was given to every unit and outpatient area. Once the validation was done, we began to incorporate the information into existing competencies so it would become part of the expectation," says Pyle.

Now the annual nursing competencies at M.D. Anderson are reviewed by a committee to make sure they include a teaching portion when appropriate. For example, part of the nursing competency for a patient-controlled analgesia pump would be to demonstrate how the patient would be taught to use the device in addition to demonstrating personal skills on its operation, explains Pyle.

Design and evaluation process

The best steps to take when developing a competency is to look at high-risk skills, says Pyle — those skills that could cause risk or harm to a patient if performed incorrectly. Also look at skills for which all staff must have a minimum level of proficiency, she adds.

It is always good to look at available data, according to Lengetti. Work with the department for quality of care and patient safety review data to determine where people are having the most difficulty in practice or where people need to improve proficiency at a skill or technique.

"Those data are what drive the content and the focus of the competencies for the year," she explains.

In addition, it is good to look at key external drivers such as Joint Commission initiatives or in-house patient safety initiatives; also assess whether there are any critical thinking skills or technical skills that need to be addressed and then determine the best teaching method based on what needs to be taught.

"Competencies are very much driven by data and initiatives. We take pride in making sure our competency review program does that every year," says Lengetti.

Part of the incentive for the original patient teaching competencies at M.D. Anderson Cancer Center were chart audits that revealed problems that lent themselves to teaching as a solution but there was no documentation to support that the issue had been addressed, says Pyle. While teaching might have been done, it was not documented, so that prompted formation of a competency committee.

Establish evaluation process

In order to determine if people have mastered a particular competency, some sort of an evaluation process must be set in place. At M.D. Anderson the notebook of materials for patient teaching competency included a checklist for evaluation. For example, under communication skills a manager would check the "met" column if an employee demonstrated good listening skills when teaching a patient.

Observation is the best way to evaluate patient teaching skills, says Pyle. However, managers don't always have time to use this method. To give more evaluation options, a guided inquiry was provided with questions the evaluator could ask the staff person. These questions were related to a patient in that staff member's care. For example, the evaluator could pull a patient chart and ask how the staff member determined the patient had no barriers to learning.

The manager of clinical nutrition at M.D. Anderson took the time to observe staff once based on the checklist and then a second time to determine if the mistakes being made were corrected.

This manager determined that most of her staff talked too much and needed to listen more when teaching patients. Pyle says this is a common flaw because professionals have a lot of information; when they go into a patient's room, they usually want to share everything. Also the manager observed that the dietitians would automatically teach the female in the room about diet even if the patient was a male. They needed to learn to include the patient if possible.

Before implementing patient teaching competencies for a new year, step back to assess if past efforts have been effective.

"It's good to step back every year and ask if the competency improved practice," says Lengetti.


For more information about creating patient teaching competencies, contact:

  • Evie Lengetti, RN, MSN, director of nursing education, community programs, and co-director of the Office of Simulation and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. Phone: (215) 590-2534. E-mail:
  • Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator, Children's Healthcare of Atlanta, 1600 Tullie Circle, Atlanta, GA 30329. Phone: (404) 785-7839. Fax: (404) 785-7817. E-mail:
  • Nita Pyle, MSN, RN, associate director, University of Texas M.D. Anderson Cancer Center, patient education office, Houston, TX. Phone: (713) 792-7128. E-mail:

Patient teaching competency for staff

Following is a competency list for evaluating patient teaching skills that was designed by a multi-disciplinary committee at The University of Texas M.D. Anderson Cancer Center in Houston.

Competencies integral to teaching

  • communication skills
  • shows respect
  • demonstrates good listening skills
  • reports to other members of team to ensure continuity of care

Diversity competency

  • knowledge of how culture impacts patient teaching process
  • demonstrates sensitivity and awareness
  • demonstrates age-specific competencies

Content expert

  • determines what needs to be taught to patients/caregivers

MDACC policy/standards pertaining to patient education

  • locates the policies
  • knowledge of content

Patient teaching competency Introduction

Teaching/learning Process

  • knowledge of teaching/learning process
  • uses principles of adult learning and principles of learning for pediatric patients Assessing patients and caregivers for learning needs
  • uses the Interdisciplinary Patient Teaching Record as a guide for assessing the patients: barriers to learning; learning needs; preferred learning style
  • provides opportunity for patient/caregiver to voice needs and concerns (What are the patient concerns?)
  • asks the right questions through the use of open-ended questions
  • identifies the patient's skills and current level of understanding and ability
  • identifies the appropriate caregiver to teach

Other assessment tools: admission assessment, patient history database, follow-up progress note Planning effective patient education

  • determines what is important to teach
  • formulates appropriate and measurable objectives for learning
  • selects teaching resources appropriate for the objectives:
    • teaching plan
    • on-line education materials such as patient education on-line database
    • videos such as those on MDA-TV
    • consultation with other experts/disciplines
    • department-specific resource

Identifies relevant resources for the patient/caregiver to access such as:

  • the learning center
  • place of wellness
  • established patient-focused classes

Implementing the education plan for patients/caregivers

  • provides appropriate learning environment
  • reviews learning goals/objectives
  • prioritizes content of teaching based on patient needs and readiness
  • addresses the identified patient concerns and learning barriers
  • demonstrates ability to use appropriate resources/media — use of mixed media to reinforce
  • provides patient/caregiver with opportunity to demonstrate learning
  • completes documentation in the Interdisciplinary Plan of Care and Teaching Record (IPOCTR)

Evaluating effectiveness of patient education

  • assures that patient/caregiver can demonstrate required skills
  • assures that patient/caregiver can verbalize required knowledge
  • plans follow-up as needed
  • reports status of teaching to interdisciplinary team, e.g. documents in the IPOCTR, shift reports, team meetings
  • evaluates own teaching effectiveness
    • patient/family
    • peers