Support and reinforce teaching best practices

Focus on better evaluation of understanding

When Lorene Payne, EdD, MSN, RN, CNE, a senior nursing instructor in the Nursing Professional Development Department at MD Anderson Cancer Center in Houston, TX, began work on her doctorate, she decided to focus on the question: "Are we as nursing professionals actually putting into practice the methods that help our patients best understand information even though many of them are low health literate?"

Payne found nurses were doing a fairly good job on many of the elements of best practice of teaching, such as speaking slowly and only presenting one or two concepts at a time. However many techniques that evaluated understanding were not being used as frequently, such as asking how a patient will follow the instructions at home.

To determine best practice, Payne searched the literature. During this process, she came across a survey created by the American Medical Association (AMA) that was issued at a health literacy conference in 2007 to those in attendance. The AMA suggested someone repeat the study on a bigger scale and on a random basis; therefore, she decided to take on the project.

Working with educators and nurses, Payne refined the list of teaching techniques to better reflect the nursing profession. At the AMA conference, the survey had been distributed to physicians, nurses, and pharmacists. Also she added a couple of techniques to the list used by the AMA. She added assessing what the patient knows on the topic before teaching, and referring the patient to an educator/class for additional teaching if more in-depth education is required.

Payne said the last technique on the survey did not test well. Because of the way it was written, she was not sure what the results indicated. It could be nurses were referring 100% of patients who needed additional education to a class 33.2% of the time, or only using the practice one-third of the time.

Survey achieves good results

In January 2009, Payne obtained a list of registered nurses in Texas and narrowed the field to those working full time in a patient care role. Although she wanted to conduct the survey via e-mail, the Texas State Board of Nursing cannot provide e-mail addresses, so she used regular mail. To obtain at least 200 responses, she selected a pool of 1,000 nurses through random number generation. A total of 259 surveys were returned, or 25.9%.

Nurses were asked how often they used the 14 techniques listed on the survey within the previous week. Choices included never, rarely, occasionally, most of the time, and always. The last two categories were considered frequent use of the teaching technique. (To see how survey respondents answered, see p. 81.)

Payne said the real surprise was that nurses only used visual aids such as pictures, models, or videos 28.8% of the time. "With all our resources I expected that one to be used more frequently," she says.

As a senior nursing instructor, she is working on a video that will model and demonstrate these best practices of teaching to use for staff education purposes.

Her advice to patient education managers is to create lists of classes within the healthcare institution and community nurses might refer patients to when they need more education than can be provided in a teaching session or two. Also make sure there are visual aids available in the inventory of teaching aids.

Payne says a good question to ask is: "Are we connecting people with the resources they need?"


For more information on the survey and the findings, contact:

• Lorene Payne, EdD, MSN, RN, CNE, Senior Nursing Instructor, Nursing Professional Development, MD Anderson Cancer Center Houston, TX. Telephone: (713) 563-1273. E-mail: