Teach-back technique must be taught

Provide education for staff

The fundamentals of teach-back need to be taught to staff members who educate patients, says Eileen Brinker, RN, MSN, heart failure program coordinator at the University of California, San Francisco Medical Center. Brinker learned these fundamentals at the Institute for Healthcare Improvement in Cambridge, MA.

The educator should enter the patient's hospital room with three or four main points to teach. The heart failure program at UCSF Medical Center has four teach-back questions for which the answers are taught. Once teaching is completed, the patients are asked to repeat the lesson in their own words. For example a patient might be asked: "Would you explain to me how you should weigh yourself so I can make sure I explained correctly?"

"It's a different way of teaching, so it takes practice," says Brinker. She and a colleague teach staff the basics of teach-back with a computerized graphic presentation followed by role playing. Also they have taught nurses who work with heart failure patients in homecare and skilled nursing facilities.

In 2010, four nurses were trained to evaluate nurses on the units in the teach-back technique. However, the focus on teach-back must be ongoing to make sure staff members continue to take the time to use the method to assess teaching, says Brinker. Plans are in place to do more teaching on the technique at staff meetings, and she hopes to make teach-back competency part of the annual review for nurses.

At St. Luke's Hospital, teach-back has been used as part of the annual competency validation for nurses. Stations are set up to cover different areas of review, and for two years, teach-back was combined with health literacy, explains Peg M. Bradke, RN, MA, director of Heart Care Services. For example, nurses worked in pairs with one teaching from a scenario that was provided and the other acting as patient. The "teacher" might be asked to read material with technical terms very fast, and the "patient" would then repeat what they learned. The "patient" would describe how they felt in the situation, what information made sense, and what didn't.

In 2010 a video was made of staff using the teach-back technique with actual patients, says Bradke. Two nurses and a respiratory therapist took part, and the topics covered heart failure, discharge instructions, and inhaler use. Testimonials of the patient's perception of the teaching session were added at the end. For example, the man being educated on discharge instructions said he was glad the nurse had him go back and point out where the important information was located on the sheet because he just wanted to go home and was not paying attention.

In 2011 teach-back was used at the end of a divisional staff meeting. People attending the meeting were asked to teach-back what they had learned.

"Teach-back is simple but it must be practiced," says Bradke. "You can't do it by reading about it."