Use teach-back every time you teach essential information,

and whenever you suspect the learner does not understand. When using a language interpreter, it is especially important to use teach-back. You can even ask the interpreter before the teaching session to let you know if he or she suspects the learner doesn’t understand. It may seem that teach-back makes teaching take longer, but it

actually makes the time you spend teaching more efficient and effective. Lecture wastes teaching time. In lecture, the patient may not learn anything because: • It is presented at too high a level • It does not fit in with what the patient already knows, so he or she rejects it

• The patient already knows some of it, so he or she stops listening

Lecture is not effective or efficient. When you lose the learner

in a lecture, you are wasting time talking. This also hurts the therapeutic relationship because the patient may feel unintelligent or feel you are being disrespectful for not recognizing he or she already knows it. By teaching through conversation with frequent teach-back

interludes, the teaching session is continuously productive. It keeps the learner engaged by keeping the teaching relevant, and it involves the learner in the process. Teach-back shows the patient that you believe the information is important to improve health outcomes and self-management, and you want to be sure the learner understands. Evaluate understanding after each chunk or session of teaching, or when you sense the learner may not be understanding. This reinforces learning right after it happens, or clarifies before you go too far, and the learner is lost.

If necessary, modify your teaching When teach-back shows you the patient did not understand, you need to return to assessment to figure out how to better present the information. When a nurse asked the patient, ‘‘Why is it important to reduce

the sodium in your diet?’’ the patient announced that he or she had every intention of continuing to add salt to his or her food. Until this point, the healthcare team did not know the patient did not plan to follow the prescribed diet.7

Bringing his plan out

into the open gave the team an opportunity to further assess, and to find out why the patient feels the action proposed is not possible, or his or her quality of life would be adversely impacted. This gives you something to work with. If you need to clarify or correct the information, you can

respond to the patient with, “I don’t think I explained that clearly to you” then reteach the content in another way.8

When re-teach-

ing, use the terms the patient uses to help him or her connect what he or she knows with what you are adding. If the patient seems to have trouble visualizing, use pictures to illustrate the concept. If the patient seems to have trouble remembering the order of steps, use a handout to reinforce content or teach in smaller increments. When teaching is complete, ask, “What other questions do This cannot be answered with “yes” or “no.” This

you have?”8 encourages the learner to think, what other questions do I have?

This might bring up additional misunderstandings that did not arise during teach-back.

After teach-back: Next steps Teach-back lets you know how well the patient understands the condition, self-care skills, and how to recognize and respond to problems. There are three possible results: 1. The patient understands and applies the information; 2. Despite your individualized teaching, the patient does not have the capacity to understand or the ability to apply the information; and

3. The patient understands but has difficulty consistently applying or chooses not to apply the information.

Patients who fit into the first group need routine follow-up.

Patients who do not have the ability to understand or apply the information need support systems put in place to ensure their self-care needs are met. The healthcare team needs to identify who those support people are and engage them in care. If they are inadequate, community support may be sup- plemented. Patients who choose not to apply the information can benefit from use of health coaching and motivational interviewing approaches. Healthcare professionals should respect the rights of adults and be minimally disruptive to accommodate their values related to quality of life. Health coaching considers the patient’s goals and facilitates patient achievement of them over time.

Organizational system integration of teach-back AHRQ has recommended that asking patients to recall and restate what they have been told — using teach-back — as one of 11 top patient safety practices based on the strength of scientific evidence.3

Most patient education is through con-

versation, so while teach-back is used between people, there needs to be organizational recognition of its value. The use of teach-back is endorsed by multiple government, professional, and credentialing bodies.


• Agency for Healthcare Research and Quality (AHRQ) • American Academy of Family Physicians • American College of Surgeons • American Hospital Association • American Medical Association • American Nursing Association • The Joint Commission • National Quality Forum

There are many ways teach-back can be integrated into or-

ganizational systems to encourage and cue its use. Examples of how Phoenix Children’s Hospital has successfully integrated teach-back into practice follows. General orientation includes an overview of the patient edu-

cation program at the hospital, including the use of teach-back. Every staff nurse is trained in how to use teach-back.

2016 • Visit us at 27

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