Susan E. Mazer, Ph.D. Blog

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Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.

5 Ways to Optimize the AHRQ Teach-Back Technique

January 8, 2016

Nurse speaking to PatientAre you using the Agency for Healthcare Research and Quality (AHRQ) Teach-Back technique of asking patients to repeat what they have been told and/or explain their understanding of their condition?

Named one of its top 11 safety protocols, AHRQ outlines in detail the exact methodology of doing its Teach-Back technique — the “when” and the “what.” No doubt, this transactional exchange is critical for patients, families, and their long term health.

However, there are critical details that are missing about “where” and “how.”

Picture an elderly female patient, who may be disoriented, medicated, or anxious in an environment that is distracting and stressful. Her capacity to comprehend what is being said to her, let alone remember, is compromised.

As a means of evaluating how much patients understand about their condition, the Teach-Back technique can be helpful. It can also be intimidating and uncomfortable.

But, it can also be a learning moment — a point when patients can regain personal power in taking care of themselves. A passing of the torch, actually.

The context in which this passing happens needs to be as carefully considered as the content of the information being exchanged. Here are 5 suggestions that may help you more fully engage with your patients using the AHRQ Teach-Back technique:

1. Pick the Right Time

Make sure the patient is awake, calm, and able to engage. He/she should not be eating or watching a television program or movie. Is the patient comfortable? Does his/her pillow need adjusting or his/her room cleaned? Is he/she too hot or too cold? In visible pain?

Unless the patient is cared for in the immediate moment, his/her trust in your intention has little ground. Also, if the patient is ambulatory, consider moving the discussion to a consultation room.  Doing this moves the information beyond the hospitalization.

2. Minimize or Eliminate Immediate Distractions

Turn the television down (almost all the way). Close the door (or not — just make sure there are no distracting noises so confidentiality is protected).

Ask visitors to give you this time with the patient, or, if appropriate, involve the family member who will be the caregiver at home. Any extraneous noise from anywhere can be enough to challenge the comprehension of an already tense patient.

3. Make Sure You Can Easily See Each Other

This is about lighting, but not only lighting. It’s also about shadows. About sunlight and  glare. This is about eliminating things that get in the way of direct and personal communication.

4. Be at Peer Level

Handing the power of recovery back to a patient is critical to long term health. Stand close enough to your patient to engage in a personal conversation so that you can easily be both seen and heard.

While AHRQ mentions “eye contact,” how that occurs remains a challenge. In her Notes on Nursing, Florence Nightingale wrote the following:

when a sick person is talking business to you, show no signs of hurry, give complete attention and full consideration if your advice is wanted…

Always [be] within the patient’s view, so that when you speak to him he has not painfully to turn his head round in order to look at you. Everybody involuntarily looks at the person speaking. If you make this act a wearisome one on the part of the patient you are doing him harm. So also if by continuing to stand you make him continuously raise his eyes to see you. Be as motionless as possible, and never gesticulate in speaking to the sick.

The challenge is to make sure that the patient is not straining or uncomfortable in his/her effort to engage with you. Again, Nightingale is specific when she writes, “show no signs of hurry, give complete attention and full consideration.”

Further, the entire environment and all that surrounds your patient needs to show no signs of hurry, complete attention, and full consideration!

5. Listen and Ask Again

Even if the patient does not understand or cannot repeat what was told to him/her, whatever he/she says must lead to the next step. And, for you to really hear what is said, the whole environment must support the exchange.

Once information is clarified (or re-clarified), ask the question again — so the patient can have success rather than failure.

Being sensitive to the environment in which you meet your patient is essential to using the Teach-Back technique effectively. And, being aware of and responsive to the patient’s condition and circumstances is a sure path to authentic learning.

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