Nurses frequently use medical jargon and mismatched language in patient encounters.5


Teach-back helps nurses be aware so they


can explain medical terms in words that patients understand. When you introduce necessary medical terms, put them in the context of the patient’s understanding. It is easier to know what words to use if you assess the patient’s understanding first, then teach-back using the terms the patient used.


Incorporating teach-back into practice Discharge teaching begins on admission and progresses with every interaction. It is not a separate task but integrated into practice. Many patients assume they will be fine and need no additional care after discharge. Let them know from admission that most healthcare is self-care. Nurse’s continuous narrative gives the patient and family opportunities to think about the care after going home and to ask questions as they come up. Explain tasks as you perform them. When you assess, explain


what you are looking for. These are the same signs the patient will need to recognize at home. When you give a treatment, explain it. The patient may need similar self-care skills at home. Explain the purpose of medications you administer. When the patient and family speak, listen for their understanding of the situation, treatments, and prognosis. This will help you individualize teach- ing to meet their capacities and needs. The nursing process provides the foundation for the four steps


used to incorporate teach-back into the patient education con- versation: assessment, individualize teaching (implementation), evaluate understanding, and if necessary, modify your teaching. Actively involve the patient in the process from the beginning.


Assessment Teach-back can be incorporated into patient interactions natu- rally. Nurses should begin by assessing knowledge before they teach. That assessment may reveal social determinants, such as language, socioeconomics, and psychosocial behaviors, that may impact your teaching. Start by telling the patient you don’t want to repeat what he


or she already knows, but rather build on that knowledge. Then say, “Tell me what you know about …” If the patient hesitates, nurses can say this is not a test but a timesaver. It’s OK if the patient knows nothing, but it would be disrespectful to assume the patient knows nothing. However, this direct method may not always be the most


appropriate or comfortable. Nurses need to pay attention to the patient’s cues to decide where to start. If the patient seems closed, nurses can start by asking if he or she knows anyone with this diagnosis. If the patient seems worried or anxious, ask “What are your concerns?” If the patient is trying to avoid thinking or feeling, ask him or her to describe his or her symptoms. It may take a few questions to get the conversation moving forward. During assessment listen for cues that will help you teach more


effectively. How sophisticated are the patient’s word choices? Are they simple words, acronyms, or medical jargon? Is the patient hesitant or confident? How complete is the understanding? If the patient’s understanding is accurate, acknowledge it. If the patient’s understanding is inaccurate, gently correct the misinformation.


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Individualize teaching The Joint Commission Provision of Care standard says the hospital provides patient education and training based on each patient’s needs and abilities.1


individualize their teaching. Listen and observe for cues on how the patient learns. Does


he or she ask questions or pull out a smartphone and search for information? If you are not sure, ask the patient, “The last time you wanted to learn something, how did you go about it?” Even people who are unaware of how they learn can tell you what they did to learn. They may have asked someone to show them, searched for a video, or read a book. When teaching, use supports that match the patient’s needs and abilities. If the patient prefers to get information from the Internet, refer him or her to reliable websites.10


If the patient uses applications


(apps) on a smartphone or tablet, refer him or her to appropri- ate apps, preferably those that are free. However, these are only supplements to teaching such as a handout or video would be. Nurses still need to assess knowledge of key self-care skills, teach, and then evaluate understanding through teach-back. Correct misunderstandings gently by acknowledging what the


patient got correctly before offering information that is different from what he or she thought. Some misunderstandings are the result of old information. Your patient’s misunderstanding may be the result of information that was accurate when learned but not accurate now. You can start to correct this misunderstanding by explaining to the patient that there are three types of facts: 1. Facts that do not change — such as this pencil is yellow 2. Facts that change all the time — such as the current temperature


3. Facts that change slowly over time, called mesofacts6 Many medical misunderstandings are the result of mesofacts.


The patient believes a fact he or she learned in school or when first diagnosed. However, with advances in science and research, knowledge has changed. What the patient learned was true at the time, but not now. For example, it was recommended that people having seizures should be given something to bite on. Guidelines today suggest that not only is it not necessary, it can be harmful. Presenting updated information within the context of a mesofact may help the patient maintain dignity when being corrected.


Evaluate understanding There are several ways to ask for teach-back; use what fits into the conversation easily: • “I want to make sure I clearly explained that and didn’t leave out anything important. Could you tell me, in your own words …”


• “How would you explain that to …” • “What would you do if …” If you are teaching a skill, you can ask the patient to show you


how he or she would do that skill. This form of teach-back is called return demonstration or show me. If the patient needs to learn how to change a dressing, have the patient demonstrate it several times over several days, if possible. This lets you see how well the patient can problem solve if something goes wrong, such as what to do if gauze is dropped on the floor.


Once you assess the patient, nurses can


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