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Loud and clear: Teach-Back enriches nurse-patient communication

Toronto, May 8, 2015

By James Wysotski

Vimy Barnard-Roberts uses the Teach-Back Method to instruct David Martin Watson
Vimy Barnard-Roberts, a nurse practitioner in the Heart and Vascular Program, uses the Teach-Back Method to instruct David Martin Watson about managing heart failure. (Photo by Katie Cooper)

When research shows patients immediately forget 40 to 80 per cent of medical information they hear, and nearly half of what they do retain is inaccurate, better methods of communicating are required. Three nurse practitioners at St. Michael’s think the Teach-Back Method is the solution.

Teach-Back is a health literacy tool some nurses use to teach a skill or present potentially complex medical information to patients by breaking it down into simple pieces and then having patients repeat back in their own words what they just learned. It can be individualized and research has shown Teach-Back to increase knowledge level and retention.

“The purpose of it is to validate patients' understanding,” said Vimy Barnard-Roberts, a nurse practitioner in the Heart and Vascular Program of St. Michael’s Hospital. It confirms “they truly understand what the content or the education point is.”

When dealing with information about medications or when patients should seek medical attention, confirming comprehension has the potential to improve patient safety.

Barnard-Roberts and two other nurse practitioners in her program, Ada Andrade and Haytham Sharar, learned about the method during an Institute for Healthcare Improvement webinar in 2010, and gained funding to research it through St. Michael’s Advanced Practice Nursing Research Advancing Practice Program. Their study followed six nurses and 32 patients, and while their results showed no significant impact on patient outcomes, such as less hospitalization, they observed an improvement in self-care scores and found that nurses liked how the method provided a framework for teaching patients and confirming comprehension.

Since then, the trio presented their findings at several international conferences, including the American Heart Failure Association where they hosted a workshop on how to do Teach-Back. The University of Ottawa Heart Institute also reached out with the intent to adopt the practice.

  Realities of the Teach-Back Method:
  • It’s more interactive than the traditional teaching.
  • Several interactions may be required for patients to demonstrate “mastery.”
  • The content should be individualized.
  • Teach-Back does not guarantee behaviour change and adherence.
  • The method can be used for any information patients must learn.

Awareness and adoption of the method is steadily on the rise at St. Michael’s thanks to an interprofessional practice forum on the topic and word of mouth.

“It has great potential,” said Andrade, who is working with Patient Education to explore opportunities to expand usage of Teach-Back. “It can be used by anyone for any piece of information at any time.”

“It can be used in an office, at bedside or in a clinic,” said Barnard-Roberts in agreement.

Full understanding might not happen on the first attempt, according to Andrade. Patients will repeat information right away, but are sometimes unable to do so again later. A second attempt at Teach-Back usually proves successful.

It might take a little more time than simply relaying detailed information and hoping it’s retained properly, but Barnard-Roberts said it’s worth it in the end. Not only has it helped staff improve communications by identifying standard explanations patients frequently have trouble grasping, but “it's less didactic and more interactive.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.