Patient Darcy came to the med line with his KOP medication card totally empty. The medication nurse was frustrated that he had not come last week so that an order could be placed before he was out of medication. She reminded him about the written instructions reviewed with him when he was started on the KOP program.

Verbal and written instructions are the most common forms of patient education used to help patients understand health information. Unfortunately, this information is often complicated and difficult to understand. Correctional nurses cannot rely on a patient’s simple nod or verbal affirmation to confirm they fully understand the explained information.

The teach-back/demonstrate-back process can improve the ability of patients to fully understand the new information and subsequently use it to make health care decisions, self-medicate, perform a treatment, or determine if symptoms warrant a return to the health unit.

Steps of the Teach-Back Process

The teach-back process involves asking the patient to verbally repeat back the information shared during a health care encounter to confirm an accurate understanding. A modification of the process for skills is to have the patient demonstrate the new health skill, such as self-injection of insulin or a dressing change. Consistent application of the teach-back process in patient teaching has been found to reduce readmissions and improve comprehension of informed consent and privacy issues.

Open-Ended Questions

During the teach-back process, it is important to use open-ended questions to initiate patient answers. For example, you can ask the patient to describe how they will share what they learned with a friend or family member. Be sure they respond with all critical steps/points of information.

Most frequently, nurses ask questions like “Do you understand?” or “Do you have any questions?” These questions make it easy for a patient to nod or say yes, when actually they really don’t understand the information or are unclear about what needs to be done. Instead, we should be asking them to teach us what they have learned. In the situation above, patient Darcy could have been asked (during the discussion about the KOP program) to explain to the nurse when the blister card needed to be brought to medpass so that medication could be ordered without a lapse. In addition, the medication nurse could have asked him to point to how many pills needed to be on the card for him to come to pill line for the reorder.

Practice Makes Perfect

Any new practice can be hard to incorporate into your normal routine. It takes effort to change our usual modes of care delivery. Here are some suggestions from a health literacy program about how to do this for the Teach-Back Method of patient education.

• Start slowly – It can be hard to change your nursing routine. Decide to slowly add in this new behavior, possibly in the beginning with patients with whom you will have a longer appointment time.
• Plan your approach – Decide in advance for which patients you will use the method. For example, you may find it easier to use the Teach Back Method with patients who need to learn a skill like using an inhaler.
• Use handouts – Handouts can still be helpful, so don’t abandon them. Use the information on a handout to ask for an explanation from your patient. However, remember that not all patients can read, and it is important to identify this before deciding that the use of a handout would be the best method of instruction for a patient.
• Clarify – If your patient does not get it right the first time, review the important parts again using a different example or descriptors. Sometimes the information might have to be repeated multiple times with different words before the patient understands.
• Practice – Don’t give up if you have difficulty using the Teach-Back Method. Keep practicing and you will soon be incorporating the Teach-Back method into your daily practice.

While it can take effort to use the Teach-Back Method, consider that your patients will have a better understanding of their health and an improved ability to self-care, and ultimately, will take this knowledge with them wherever life may lead.

Do you use a form of the Teach-Back process in your correctional practice? Share your tips in the comments section of this post.

This information is taken, in part, from The Correctional Nurse Educator class entitled Patient Education for the Correctional Nurse.