1

Disclosures

2

The speakers here today have no conflict of interest to

disclose

Objectives

• Evaluate the impact Teach Back has had on patient outcomes since roll out

• Identify effective Teach Back methods utilizing elements of Adult learning theory , RBC and health literacy

• Utilize the available Teach Back tools and apply the Teach Back method to unit specific patient education topics

3

2

Objectives cont.

• Discuss and evaluate effective methods of Teach Back implementation and sustainability

• Review the medication card ordering process

4

5

Does Teach Back make a

Difference?

Jill Scherrey MSN,CCRN RN-BC

Nursing Professional Development Specialist

Santa Monica UCLA

Rose Healy RN, CNS

Diabetes Educator

Ronald Reagan UCLA

“There is no prescription more valuable than knowledge”

C.Everett Koops M.D.

Former Surgeon General of the United States

6

3

33 36

38

64

41

63

52

36

66

50 47 46

0

10

20

30

40

50

60

70

HCAHPS: Nurses Treat with Courtesy & Respect HCAHPS: Nurses Listen Carefully to You HCAHPS: Nurses Explain in a Way YouUnderstand

Ronald Reagan UCLA Medical Center HCAHPS: RN Communication

Percentile Rankings Q1 2015 - Q4 2015

Q1 2015 Q2 2015 Q3 2015 Q4 2015

HCAHPS Data: RRUCLA

8

9

4

10

11

0

12

5

13

The evidence that supports Teach Back

• Teach Back has been shown to:

• Reduce readmission rates in CHF patients

• Improve self-care behavior and heart failure related symptoms

• Improve glycemic control

14

Peter, D et al. JONA, 2015; 45:35

Schilinger, D. Arch Int Med; 2003; 162:83

Endorsed by: • National Quality Forum

• Agency of Health Care Research and Quality

• American Nurses Association

• American College of Surgeons

• American Medical Association

• Joint Commission

• Heart Failure Society of America

15

6

Our True North

• Our Mission is to deliver leading-edge patient care, research, and education. Our Vision is to heal humankind, one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness. Our Values ensure Integrity, Compassion, Respect, Teamwork, Excellence and Discovery in the work we do daily.

16

Professional Practice Model

17

Swanson's Theory of Caring - 5 processes

• Knowing-being with-doing for-enabling-maintaining belief

• Caring Process - Knowing

• Striving to understand an event as it has meaning in the life of the other; avoiding assumptions; centering on the one cared for; assessing thoroughly; seeking cues; engaging

• Caring Process - Being With

• Being emotionally present to the other; being there; conveying ability; sharing feelings; not burdening

18

7

Swanson's Theory of Caring - 5 processes

• Caring Process - Doing For

• Doing for the other as he or she would do for self if it were at all possible; comforting; anticipating; performing skillfully; protecting; preserving dignity

• Caring Process - Enabling

• Facilitating the others passage through life transitions (ex - birth, death) and unfamiliar events; informing/explaining; supporting/allowing; focusing; generating alternatives; validating/giving feedback

19

Swanson's Theory of Caring - 5 processes

• Caring Process - Maintaining Belief

• Sustaining faith in the other's capacity to get through an event or transition and face a future with meaning; believing in/holding in esteem; maintaining a hope-filled attitude; offering realistic optimism; "going the distance"

• Caring in Nursing Practice

• Providing presence; touch; listening; knowing the patient; spiritual caring; relieving pain and suffering; family care

20

Teach Back is:

•A method of instruction that asks the

learner to “Teach Back” the material.

•Evidenced based

•Simple

•Empowering

•Not a magic bullet

21

8

Teach Back and the Nursing Process

22

Assess

Analyze

Plan

Implement

Evaluate

Learner

needs

Analyze

barriers

Teaching

plan

Teach

Back What do

they know?

Enhancing Communication through Teach Back

Jill Scherrey MSN RN-BC

Nursing Professional Development Specialist

23

24

Patient teaching requires us to be effective communicators

9

25

Communication pathway

26

The Sender must assess the Receiver

27

• Cognitive ability to understand the message

• Literacy

• Health literacy

• Nonverbal message or cues of readiness

• Attitude and opinion of the receiver

• Language barriers

• Physical barriers like hearing and eye sight

10

The Impact of the Non Verbal

28

29

How you are messaging the receiver

30

Build a Relationship to Establish Trust

11

Your Non Verbal Messaging

•Position: sit down, position yourself towards your audience

•Posture: avoid arm crossing, soften/relax stance & shoulders

•Nodding: signals listening/understanding/agreement

•Eye Contact: look them in the eyes when addressing/listening,

•Gesturing: Touch is important but must be appropriate

• Multi-tasking: Looking at chart/screen/phone signals inattention

31

Communicating Caring

• Verbal Cues: Cues like “Uh huh” or “I see” show participation

• Re-Stating: Paraphrasing can show you understand

• Affirming Statements: Empathy vs. Sympathy

• Interruptions: Avoid them at all cost

• Silence: Give them time to talk, think, feel (3 Second Rule)

• Avoid judgment, it’s not your job!

32

What makes a good communicator?

• Build trust first by establishing a relationship

• Be informed and knowledgeable

• Listen to verbal and non-verbal remarks

• Don’t lecture

• Ask questions

• Listen more than you speak

• Don’t be distracted

33

12

How Adults Learn

• Adults need to see and understand the relevance of the material- they are problem centric

• Need to see the benefit of learning material

• Have ego involvement and need to feel safe learning

• Non shaming, non-threatening environment

• Shown respect

• Timing must be right, learner readiness

• They have past history that may impact how they learn

34

How to Engage the Learner

35

Think about the last thing you learned?

What is Active Learning?

36

• Involve the learner

• Individualize and personalize material

• Use handouts, videos, images with teaching

• Teach informally

• Get the learner participating through conversation

• Get the learner to return-demo skills

• Create a partnership with the learner and identify describe the roles (yours and theirs) in that partnership

13

Partnerships in Care

• Definition of partnership: A relationship resembling a legal partnership and usually involving close cooperation between parties having specified and joint rights and responsibilities

• What is it to partner with your patient?

• Why is valuable to both you and your patient?

• Partnerships require active and effective communication and trust

37

How to Partner With Your Patient Patient education

a. Safety/fall prevention

b. Pain management

c. Medications

d. Infection prevention

e. Mobility (U Move)

f. RN/MD rounding

g. Discharge instructions

38

Teach Back Goals in Communication

• Build knowledge

• Teach skills

• Change behavior

• Reinforce good behavior

• Create patterns

• When you have time vary the questions you ask to evaluate knowledge, attitude and behavior.

39

14

Assess Knowledge, Attitude and Behavior

• What they know: What is the name of your water pill/diuretic?

• What they believe: Why is it important to take your water pill every day?

• What they will do: How will you remember to take your water pill every day?

40

Narrating Care builds a relationship

• Always tell you patient what you are doing and why (adults need rationales)

• Explaining the rationales helps to develop trust and creates understanding

• Don’t let tasks stop you from engaging with your patient

• They need us to explain what we are doing

41

Don’t Assume Understanding: Narrate

• Example: Story of scanning the ID band

• “I always want to check your ID band and scan it to make sure this is the correct medication and dose for you”.

• “I always want to discuss your medications with you so you know everything you need to know to be able to manage at home”.

42

15

Focus on the Best Practices

• Make an introduction

• Be present and empathetic

• Narrate your care

• Involve the patient in the plan

• Pay attention to your own nonverbal communication and responses

• Listen and use Teach Back

43

PressGaney, 2015

44

Teaching to the AVS

45

The patient (Ms. Grey) is a 55 year old female S/P

CABG x 4 vessels. Post op day 5. Ms. Grey has CRF

and receives renal dialysis QOD. She lives with and

provides care for her mother who suffer from dementia.

16

Teach Back Tools

46

Teach Back Toolbox: Dept. of Nursing

47

Department of Nursing Website

48

17

Patient Care Initiatives

49

Teach Back Resources

50

MedUcation: medUcation video

51

18

Tools

52

Teach Back Pain Management video

53

Teach Back for Pain Management

54

19

Partnership for Pain Management

55

Teach Back for Fall prevention

56

A Tool for Your Unit Needs

57

20

Teach Back Coaching: manager video

58

Coaching staff to use the Teach Back

• Challenge staff to ask 1 open ended question

• Ask the patient after each instruction 1 open ended question

• Changing behavior takes time

• It doesn’t take more time than asking closed ended questions

• Coaching does require intentionality

• Stay positive change can be challenging

• Adults learn best when they feel safe and not judged

59

Getting Comfortable Using Teach Back

• Be honest with yourself

• Identify your barriers and seek out coaching

• Practice using a short script

• Ask open ended questions

• Identify the 1 thing

• Embrace it-

• Teach Back is here to stay

60

21

Break: Please be back at 1015

When you return pick up your unit data.

Please sit near others from your unit for the upcoming unit based exercise

61

Panel: Implementing and Sustaining

• What’s worked in rolling Teach Back out to your unit?

• What are the barriers you have encountered?

• How have you overcome those barriers?

• How have you made Teach Back part of the culture?

• What suggestions do you have for areas struggling to get teach back rolled out?

62

Unit Based Small Group Discussion

• Take out your unit specific handout

• Share this information with others from your unit

• Identify the greatest area of opportunity for improvement on your unit

• Create a plan for utilizing Teach Back around this topic

• What does plan that look like?

• Identify specific steps you can take to impact this topic

63

22

Medication Card Process Review

Tracy Guy, MPH,

RR/UCLA Analyst

64

Next Steps for Teach Back

• Today’s findings

• Unit leadership

• Make a plan

• Watch your data move

• Create a culture of Teach Back, partnering with patients, narrating care and addressing patient education needs every shift.

• Make the discharge and the AVS a review of material already taught.

• Peer to peer accountability at handover

65

Lasting Change Takes Time

• Build awareness

• Build desire

• Build knowledge

• Build ability

• Build reinforcement

• Acknowledge hard work and successes

• Acknowledge the challenges and continue to encourage

• Model the behavior

• People rise to the expectation

66

23

Questions

67

Evaluations

• New online process for your evaluations

• You will be emailed a link to complete the evaluation.

• Once the evaluation is completed you will be prompted to print your CE certificate.

68

References

• Cornett, S., (Sept. 30, 2009) "Assessing and Addressing Health Literacy" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 3.

• London F. (2009). No time to teach: The essence of patient and family education form health care providers. Atlanta GA. Pritchett Hall & Associates.

• Peter, D. (2015). Reducing readmissions using teach-back: enhancing patient and family education. Source: The Journal of nursing administration vol:45 iss:1 pg:35 -42

69

24