Teach-back gives direction for clarification

Uncover reasons for noncompliance

Teach-back is a good method for every patient education program because frequently educators don't ask clarifying questions following an education encounter, says Paula Robinson, RN, BC, MSN, patient, family, and consumer education manager at Lehigh Valley Health Network in Allentown, PA.

Also the teach-back method engages the learner. This method helps them remember what they are taught, because studies show patients forget 40-80% of the information they hear, she adds.

Teach-back is not a test of the learner's knowledge as much as an exploration of how well the information was taught and what needs to be clarified or reviewed. Fran London, MS, RN, a health education specialist at Phoenix (AZ) Children's Hospital in the consumer library, The Emily Center, says, "We shouldn't just hand patients instructions but should find out if they know what it means to take their medicine twice a day, they understand why and are able to do it."

Asking the learner to teach-back essential points communicates the importance of the information as well as ensures it is understood and can be applied, says London. She asks: What is the point of prescribing treatments or lifestyle changes and not checking to see if the patient is able and willing to apply them? Just ordering a medication does not mean the patient will take it.

Teach-back can help clinicians determine if a patient is ready to comply. Consider this example: Debra Peter, MSN, RN, BC, CMSRN, a patient care specialist at Lehigh Valley Health Network, educated one heart failure patient on the reasons to avoid foods high in salt. Afterward, the patient stated that he salted his ham and had no intention of changing. That conversation sent up a red flag that additional interventions were indicated, says Peter. In this case, a nutrition assessment consult was place for the dietitian to follow-up with the patient. Also the patient received printed handouts with suggestions on how to reduce sodium in the diet and substitutions for foods that are high in sodium.

"Often we consult the case manager for assistance with patient adherence to the prescribed regimen," she adds. When a patient is non-compliant, the nurse documents that finding in the medical record. In this case, the patient's own words were used, says Peter.

London says, "We can only be sure our messages get through by having the learner teach-back to us what they understand needs to be done and show us how they would do it. This will reveal misunderstanding and challenges we can then address to optimize positive health outcomes."

Sources

For more questions about creating teach-back protocols for educational programs, contact:

• Peg M. Bradke, RN, MA, Director, Heart Care Services, St. Luke's Hospital, Cedar Rapids, IA. E-mail: bradkemm@crstlukes.com.

• Eileen Brinker, RN, MSN, Heart Failure Program Coordinator, University of California, San Francisco Medical Center, Cardiovascular Unit. E-mail: Eileen.Brinker@ucsfmedctr.org.

• Debra Peter, MSN, RN, BC, CMSRN, Patient Care Specialist – 5K, Lehigh Valley Health Network, Allentown, PA. E-mail: debra.peter@lvhn.org.

• Paula Robinson, RN, BC, MSN, Patient, Family and Consumer Education Manager, Lehigh Valley Health Network. E-mail: paula.robinson@lvhn.org.