Developing competent teachers among staff

Research can uncover targets for improvement

To improve patient education, institutions must develop competent teachers. Some patient education coordinators have found that a survey tool is a good strategy for improving patient education competency among staff members.

Not your average tool, but one that measures "personal skill level" and the "importance of the skill."

Doris Doherty, BSN, RN, patient/family education coordinator at Franciscan Skemp Healthcare in LaCrosse, WI, helped implement such a tool in the fall of 2005 after returning from a Health Care Education Association conference.

She says while her institution would look at different competencies each year, they had not surveyed nursing staff to find out what the nurses wanted to know. The survey helped identify a focus for creating a plan. Also, the use of a survey adhered to the adult learning methods. "If adults can identify what it is they would like to know more about, they will easily learn it," she says.

A survey with nine statements was mailed to about 800 RNs and LPNs in the health care system that includes multiple clinics, three hospitals, sub-acute and rehabilitation facilities, and nursing homes.

The statement that showed measurements of lowest proficiency and highest importance was: "Determines the patient's ability to read, understand, and act on health care information (health literacy), and adjusts teaching methods accordingly."

Those responding were asked to rate the importance of each statement in the survey by marking one of the following: not at all; of little importance; important; very important; critically important. They also were asked to rate their personal skill level for each competency as: little or none, basic, adequate, proficient, or expert.

The presentation that prompted Doherty to form a task force to conduct a survey to identify competencies for nursing staff was delivered by Jean Just, RN,C, MSN, director of staff development and patient education at The Ohio State University James Cancer Hospital and Solove Research Institute in Columbus.

Just was part of a professional development committee initiated within the Cancer Patient Education Network (CPEN). One of its charges was to identify competencies for cancer patient educators.

To develop the survey tool, the CPEN committee looked at the literature to see what staff members needed to know to facilitate learning among cancer patients.

"Based on our review of the literature, we compiled the competencies and then we had the competencies further reviewed and refined by the members of our professional development committee. We came up with 38 competencies," Just says.

The task force that Doherty helped form at Franciscan Skemp Healthcare included members from the staff development and patient education committees and a market analyst who had expertise in setting up a survey tool and analyzing data. This team chose eight statements from the 38 identified by the CPEN committee. It created one statement of its own pertaining to diagnosis-related patient care standards.

The task force determined that 38 statements were too many because they did not have staff to handle the analysis of extensive data and some of the statements were unique to cancer nurses.

The purpose of the CPEN survey was to identify competencies for those who provide education for cancer patients. "We thought there were perhaps some things that were a little different with educating a patient with a cancer diagnosis," says Just.

The survey was distributed via a listserv to cancer patient educators. When the results were evaluated, the CPEN committee found the most important competency for cancer patient education is to consider the impact of a cancer diagnosis on learning.

Patient educators must be able to assess where the patient is emotionally and then take steps to reduce the emotional impact so the patient can retain information.

"We all know anxiety is a big barrier to taking in and retaining information," Just says.

Creating a plan for competency

Once the results of a competency survey have been tallied, a plan to target the learning needs identified is the next step.

Doherty says the task force at Franciscan Skemp Healthcare is in the process of putting together an education plan for 2006 and will follow up with an evaluation in 2007 to determine if the plan was successful.

The team used the statement from the survey that showed lowest proficiency and highest importance to form a focus, which is "nurses will demonstrate assessment skills in determining the patient's ability to read, understand and act on health care information, and adjust teaching methods accordingly."

In the process of assembling a self-learning packet the committee has looked at a lot of information and is developing education around a video produced by the American Medical Association titled "Health Literacy, Helping Your Patient Understand."

A plan to improve patient teaching competency can be simple or quite extensive. The work at University Health Network, a large health care organization in Toronto, began in 2002 and still is a work in progress.

It began with a competency survey to establish baseline teaching skills, similar to the one CPEN created. Audrey Jusko Friedman, AC MRT(T), MSW, director of oncology patient education and survivorship at Princess Margaret Hospital within University Health Network, was part of the CPEN committee creating the competency survey.

In addition to a survey, committees established to work on the program as part of an interdisciplinary task force benchmarked evidence-based practices and competencies about patient teaching. They also looked at identifying a target audience, developing a curriculum, determining how to provide delivery of information or a strategy for teaching staff, and evaluating patient teaching competency.

Several strategies have been put in place to improve patient teaching competency. One committee did an extensive literature review, and from the information gathered, developed annotated bibliographies and summaries of all the material they found. From these findings, they created a document titled "Teaching Effectively to Advance Care and Health by Educating Staff."

These evidence-based guidelines provide six steps for creating a teaching plan and are available via the institution's Intranet to people throughout the organization. The steps include identifying a problem, conducting a needs analysis, developing goals and educational objectives, sequencing instruction, instructional strategy design, and evaluating learning outcomes. Each step has a detailed bibliography on the evidence to support the execution of each step, says Friedman.

Curriculum also was developed to improve patient teaching. "Maximizing Your Patient Education Skills" has three parts and people can enroll in one or all of the sections.

The first part of the course is designed to enhance the delivery of patient education by focusing on principles of adult learning and identifying communication styles. It helps staff become competent at recognizing the different learning styles of patients and families and adjusting their teaching style to those different learners.

Use hands-on approach

While part of the class is a lecture, the students also do an exercise that provides hands-on learning. During this exercise, class participants are divided into small groups and they take turns working with four different patients, portrayed by trained actors, who have a particular learning style and communication preference that must be identified. The groups must interact with each patient and develop a teaching plan.

The second part of the course is based on the six-step strategy for developing a patient teaching plan. Participants in this course receive a sample teaching plan and learn how to identify educational objectives, the sequence of instruction, the instructional message including materials that could be used, and ways to evaluate the instructional message.

The third part of the course focuses on leadership development and mentoring skills to facilitate patient education competency among one's colleagues. People participate based on the recommendation of a supervisor or manager.

Friedman says the first two courses will eventually be delivered on-line as well as face-to-face instruction so those who cannot find the time to attend a class will be able to participate.

The next step in the process to improve patient teaching competency across the organization is to develop a way to evaluate whether the curriculum is on target. Some have suggested conducting a pre- and post-test using the trained actors posing as patients. They could interact with the "patient" in a preplanned scenario before taking the course and then after they have taken the course and worked in the field for six months.

Another evaluation strategy being considered is to look at changes in patient behavior after teaching. For example, with more competent teaching is the patient better able to use a particular device or participate more successfully in a treatment plan?

"This is a work in progress. Intuitively, we believe it is improving patient teaching but, we now need to know more about that," says Friedman.


For more information on strategies for improving patient teaching competencies, contact:

  • Doris Doherty, BSN, RN, Patient/Family Education Coordinator, Franciscan Skemp Healthcare, LaCrosse, WI. Phone: (608) 785-0940. E-mail:
  • Audrey Jusko Friedman, AC MRT(T), MSW, Director, Oncology Patient Education and Survivorship, Princess Margaret Hospital, University Health Network, Provincial Head Patient Education, Cancer Care Ontario, Chair, Cancer Patient Education Network, 610 University Ave. 5-319, Toronto, Ontario, Canada M5G 2M9. Phone: (416) 946-4501, ext. 5340. E-mail:
  • Jean Just, RN,C, MSN, Director of Staff Development and Patient Education, The Ohio State University James Cancer Hospital and Solove Research Institute, Columbus, OH. Phone: (614) 293-3258. E-mail: