THE GOAL OF THIS TEACH-BACK CONTINUING EDU- CATION MODULE is to provide nurses with the knowledge to incorporate teach-back into the patient education process. After studying the information presented here, you will be able to:

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Define and give the rationale for teach-back Identify the skills needed to use teach-back

Discuss how to individualize patient education based on the results of teach-back By Fran London, MS, RN

Too often, patient education consists of a lecture, a handout, and a conversation. Such a conversation might go like this: Nurse: While you’re taking warfarin, you must have regular blood tests. You want to get enough medicine to stop blood clots, but not so much that you bleed. Do you understand? Patient: Yes. Nurse: Do you have any questions? Patient: No. Nurse: Are you ready to go home? Patient: Yes.

Can you tell from this conversation if this patient understands your instructions? If so, how can you be sure?


he Joint Commission Provision of Care standard states “The hospital evaluates the patient’s understanding of the education and training it provided.”1

Other accrediting

agencies, such as The National Integrated Accreditation for Health- care and the Healthcare Facilities Accreditation Program, have similar standards. The Joint Commission further describes how to evaluate understanding: “… patients may be asked to demonstrate their understanding of information provided by explaining it in their own words.”1

This process is called teach-back. The concept of teach-back appears in the literature as far back

as 1996, highlighting active involvement as more effective when teaching adults than passive methods. Conversation actively involves the learner, which builds brain connections.2


than asking patients if they understand your instruction, ask them to tell you — in their own words — about the instruction. Ask

them to tell you how they will carry out the instruction and what problems they may face to comply.”2

Teach-back is the process of

evaluating understanding by asking the learner to teach-back to you, in his or her own words, what was taught. While teach-back may seem simple or basic, it is a powerful tool. In 2001 the Agency for Healthcare Research and Quality led

efforts to promote patient safety by developing evidenced based, best safety practices.3

Based on strength of evidence, AHRQ’s

report found that asking patients to recall and restate what they have been told — using teach-back — was one of 11 top patient safety practices based on the strength of scientific evidence. Pa- tients have expressed high satisfaction with the use of teach-back, even when used for surgical informed consent.4

What is teach-back?

Teach-back is not a test of the learner’s knowledge, it’s part of the teaching process. Teach-back is an evaluation of understanding. When the patient explains something in his or her own words, nurses learn how much the patient knows or understands and the detail and sophistication of that knowledge. What nurses hear when the patient teaches back provides cues that help determine how to modify their teaching to help the learner understand. Carefully listen to what the patient says, what words he or she uses, and what emotions are behind the words. Listen for what has been left out and or misunderstood. Teach-back is a way for nurses to check if their teaching was clear to the learner and how well the information was communicated. If it was not clear, nurses need to present the information in a different way. For example, you tell the patient after surgery to “return to

a normal diet.” When you ask the patient to teach-back your instructions, the patient happily reports she can finally return to a normal diet. When you ask her to explain in more detail, she says she no longer has to be on that awful low-fat, low-sodium diet the heart doctor put her on. In this example, teach-back showed you how the patient misunderstood. You then clarify by explaining that because of her medical condition, a low-fat, low-sodium diet is now her normal diet. This is the diet she is to return to after surgery. Note the defining moment in this example is asking the patient

to explain her response in more detail. It is not enough to have the patient repeat what you said. You are evaluating the patient’s understanding rather than testing her.


1. Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk

2. Use of perioperative beta-blockers in appropriate patients to prevent periop- erative morbidity and mortality

3. Use of maximum sterile barriers while placing central intravenous catheters to prevent infections

4. Appropriate use of antibiotic prophylax- is in surgical patients to prevent periop- erative infections

5. Ask that patients recall and restate what they have been told during the informed consent process

6. Continuous aspiration of subglottic se- cretions to prevent ventilator-associated pneumonia

7. Use of pressure relieving bedding ma- terials to prevent pressure ulcers

8. Use of real-time ultrasound guidance during central line insertion to prevent complications

9. Patient self-management for warfarin (Coumadin) to achieve appropriate outpatient anticoagulation and prevent complications

10. Appropriate provision of nutrition, with a particular emphasis on early enteral nu- trition in critically ill and surgical patients

11. Use of antibiotic-impregnated central venous catheters to prevent catheter-re- lated infections

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