Teach-back Training through Simulation with Standardized Patients and Online Education following ONS Chemotherapy and Biotherapy Course

Linda Dial,RN,MN,AOCN; Judith Johnson,RN,MSN,OCN; and Melissa Powell,RN,MS.Vanderbilt University Medical Center, Nashville, Tennessee

Interview Thematic Analysis Conclusions

Multi-Part Experiential Training Curriculum

Patient education and teach-back concepts introduced in ONS course

Practice scenarios included to promote prioritization and salient , actionable patient specific content for teaching plan

Preparatory homework for teaching session and written examples of priority content with clear, simple language

Teach-back practice with standardized patients (SPs) in chemotherapy experiential lab

Advocacy inquiry and self reflection with discussion following nurse learner video review during debrief

Standardized patient and faculty written feedback using performance checklists and targeted feedback

Online learning module with post-test on teach-back with chemotherapy teaching video exemplar

Pre-brief review of learning from module and modeling teach-back with student learners

Level 1: Learner satisfaction with learning expectations

I learned patient centered communication techniques that I will routinely employ in my practice.

“The realism of the scenarios and communication techniques were very helpful. Reinforced classroom instruction.”

I learned new patient education principlesthat I will routinely employ in my practice.

“ I now use teach-back for everything. It is part of my day and I use it with each patient several times a shift.”

Level 2: Declarative knowledge through passing test scoresLevel 3: Demonstration of teach-back and purposeful patient education improved with advanced organizersLevel 4a: Perceived value with stated intent to change practice

How valuable will this training be in your future nursing career?

Level 4b: Learner demonstrated skill as evaluated by objective checklists and video facilitated targeted discussion and reflective inquiry

References

1. Agency for Healthcare Research and Quality (2001). Making Health Care Safer: A Critical Analysis of Patient Safety Practices. From http://archive.ahrq.gove/clinic/tp/ptsaftp.htm

2. National Quality Forum (2009). Health literacy: A linchpin in achieving national goals for health and healthcare, Issue Brief, March 2009 (14),4.

3. Swartzberg JG, Cowett A, VanGeest J, Wolf MS. Communication techniques for patients with low health literacy: A survey of physicians, nurse and pharmacists. American Journal of Health Behavior, 2007: 31:S 96-104.

4. Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. Journal of Continuing Education in Health Professions, 2009 (1) 1-15.

Future Directions

Faculty and charge nurse observation of patient education and reliable use of teach-back in clinical settingLongitudinal review of learner practices by self report

Qualitative Interviews: N=23 Learners

•Most nurses appreciated the use of SPs for realism in training•Most nurses valued having an opportunity to learn hands on with equipment and protocols• Most nurses valued having an opportunity to synthesize the pieces of chemotherapy administration and education in an experiential learning environment•Nurses valued having an opportunity to view themselves on video and receive feedback about communication

Scale: 1=worthless 10=valuable Mean=9.2

Evaluation levels following simulation lab N=45 Learners

Training Evaluation

Disagree

Somewhat Disagree

Neither Agree or Disagree

Somewhat Agree

Agree

0 10 20 30 40 50 60 70 80 90

0

4.4

2.2

22.2

75.6

Communication Techniques

Percentage

Disagree

Somewhat Disagree

Neither Agree or Disagree

Somewhat Agree

Agree

0 10 20 30 40 50 60 70 80 90

0

4.4

2.2

13.3

80

Patient Education Principles

Percentage

•Teach-back is one of 11 top evidence-based safety practices recommended to influence patient engagement and health outcomes ¹,²

•Teach-back is used less than 39% of time to validate understanding of education³

•One-third of American adults are health illiterate

•Effective communication and patient education are paramount to ensure positive outcomes for patients receiving chemotherapy

•Observation of novice nurses during chemotherapysimulation demonstrated their need for patient education and teach-back training.

•Nurses will demonstrate effective communication when conducting chemotherapy education with standardized patients by: Assessing learning needs and emotional state Establishing climate for learning, rapport , eye contact caring tone and non-verbal cues Using closed loop communication Using clear and simple terminology Providing actionable, specific, relevant instructions Using short statements, 2-3 main ideas with “chunk and check”, applying teach-back principles Non-testing, non-shaming communication style Using open ended questions to solicit questions and concerns Engaging patient to indicate methods and ability or inability to follow recommendations•Nurses will value the practice of teach-back and evaluation of patient understanding for future nursing practice.

A special acknowledgement to the staff of the Center for Experiential Learning and Program of Human Simulation at Vanderbilt University School of Medicine.

Background and Learning Needs Assessment

Learning Objectives

Acknowledgements