How Nurses Can Use the Teach Back Method to Increase Family Caregiver and Patient Comprehension

To celebrate National Family Caregivers Month, this November the Future of Nursing: Campaign for Action is teaming up with Nurses Improving Care for Healthsystem Elders (NICHE). NICHE is the leading, nurse-driven program designed to help hospitals improve the care of older adults. NICHE knows that family caregivers require support and guidance to help them understand and cope with their loved ones' hospitalization and transitions. NICHE also understands that nurses are uniquely positioned to help support family caregivers. In this series of posts, NICHE staff and others will share their perspectives on health care, caregiving, and the important role nurses play in supporting family caregivers. To learn more about NICHE, visit their website.

In this post, Frances M. Stokes, DNP, APRN, ACNP-BC,FCC,CMNL, Director of Nursing, NICHE at Renown Health in Reno, Nevada discusses the teach-back method and how nurses can use it to support family caregivers and patients.

Impacting patient safety is consistently in the forefront of medicine and nursing. A component of attaining safety is ensuring our patients and family caregivers understand why the education they are receiving is important and how it is relevant to them. Patient and family caregiver understanding is an essential element of the healthcare safety continuum. Patient and family caregiver understanding of health and medical conditions may also reduce anxiety while increasing adherence to medication and treatment plans and has the potential to decrease adverse drug events through omission and overdosing. 

Consider the phrase, “Message sent is not necessarily message received.” It is incumbent for nurses and others who work in health care to ensure essential information and knowledge is shared in a way that resonates with our audience. However, it is evident by the high numbers of elderly patient readmissions that we are missing the mark.  Elderly readmissions are often due to medication under or over usage and overall non-adherence to both medication and treatment regimes. Equally important is the non-recognition of worsening symptoms by the patient, family, and caregiver. As crucial support systems for our patients, making sure family caregivers understand and comprehend key safety issues is just as important as educating the patient. This is even more important in the cases of families caring for those with cognitive deficits and dementia.      
Information overload―sound familiar?  A barrage of written and verbal health and medical information flows throughout the health care continuum downward to the patient and family caregiver. From the perspective of the patient and family, the information may appear confusing and seemingly endless. The question we must ask ourselves is, “Why doesn’t anyone read our incredibly informative handouts? Why can’t they remember what we taught them? Is it possible patients, families, and caregivers can’t see the forest for the trees?” The answer is a resounding yes!  It is a simple case of too much information (TMI).
Nurses and other health care professionals should consider proven strategies for adult learning when communicating with patients and family caregivers. One such strategy is introducing key information at key times. Everyone on the health care team has a part to play in education, but problems often occur when there is a lack of communication among the members of health care team. Patients and family caregivers need to hear consistent and accurate messages.
Teach back is an example of an evaluation strategy for in-the-moment education to assess the recall and comprehension of the learner. This teaching strategy is a natural way for nurses to support family caregivers and ultimately patients. Essential considerations of teach back include:

  • Evaluation of language and language barriers;
  • Literacy levels;
  • Visual and hearing impairments;
  • Evidence of dementia, delirium, or depression; and
  • Use of key words at key times.

Nurses and health care professionals should carefully consider the information they present.  Ask yourself, “What is the essential message the patient and family caregiver should walk away with?” Once the information has been prioritized, health care team members should KISS, which stands for Keep It Simple-Simple. Using simple and basic language can be a bridge for literacy and fill education gaps for this vulnerable population. Introduce key concepts one at a time if necessary. Later, ask the family caregiver or patient to explain the concept you taught earlier. If they are not able to accurately verbalize or demonstrate the key points, repeat the process. This time, change how you present the information by using different wording, and consider adding pictures and diagrams to support the information to drive essential safety points home. 

Those of us in health care who are at the point of care have a huge responsibility for our patients’ safety, not only in the acute and post-acute setting, but also for a safe transition home. How we give directions and information to patients and caregivers can help alleviate burnout, increase confidence, and empower them to take charge of their health to help keep them safe and out of the hospital. To learn more about the teach back method, visit these websites:

by Fran Stokes | November 22, 2013

Tags: communication, practice

Monika Desai

Monika Desai As a nursing student, I found this article to be very educational. The message you put across of, “Message sent is not necessarily message received” is very familiar to me especially when we include elderly population. Although some patients are very well versed with technology and their health issues but it’s generally not the case. I feel like every time someone visits be it respiratory/physical therapist, nurse/doctor, everyone is trying to teach them something about their condition and more often than not it’s just too much information in too little time. And for this reasons I think as nurses we should take little more time and verify if the message sent is really what is being received. This would not only make ease to our patients but also build a trusting relationship with them. I also like how you incorporate some of the essential consideration and keeping it simple techniques.
Posted on: December 10, 2013, 4:14 pm

Fran Stokes

Monika-Your observations as a student are validation the older generation require an astute evaluation as to whether or not what we are educating is being understood and sustainable. Of course, this premise is really for all patients. Patient and family caregiver educational sustainability is important conceptual piece of patient and adult education. Which brings me back to the concept is it important to choose the education and messages the healthcare team want emulated once our patients and families are out of our sphere of direct influence. The healthcare team collaboration concept is one we must embrace and practice. As I eluded to in my blog, the healthcare team has much to contribute, not only to the care but the education of each patient. Getting everyone on board with these concepts can be challenging. Gaining the trust and buidling relationships with our patients and families also helps open communcation for crucial conversations.
Posted on: December 11, 2013, 2:23 pm

Ophelia Gyameraah

Hi Fran Stokes, as an accelerated BSN student, I find your message to be very informative and necessary to bring to people’s attention, especially nurses. One of the many significant roles endowed on nurses is providing education. Most often, health care providers are in a haste to discharge or move on to the next patient to the extent that they are unaware of their failure to successfully educate patients and their families to provide basic knowledge needed for a smooth transmission after discharge. Although it may seem like the material being taught is understood, most patients and their families on many occasions fail to comprehend. This may be due to lack of concentration, use of medical jargon, too much information in a small amount of time, or fast paced teaching. In order to effectively provide education, it is essential to first assess patients’ readiness to learn and other factors that can impede learning. By using the “Teach Back Method”, nurses can evaluate the effectiveness of the education provided. This will enable any necessary changes to be made to enhance teaching and learning. It will also promote patient safety and empowerment. Thanks for sharing this message. Ophelia.
Posted on: March 25, 2014, 5:44 pm


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