Presentation at International Conference on Patient and Family Centered Care describing content and program evaluation data using simulation to teach communication skills and partnering with patients as teachers.

1. Partnering with Patient and Family
Advisory Council Members to
Improve Patient Education Skills in
Nurse Residents
 Melissa Powell, MS, MHPE, RN-BC
Director of Education, Northside Hospital, St. Petersburg, FL
 Mary Ann Peugeot, CPA
Past Chair, Vanderbilt Patient and Family Advisory Council, Nashville, TN
The International Conference on Patient- and Family-Centered Care:
Partnerships for Quality & Safety, Vancouver, British Columbia, 2014

2. Presentation Objectives
 Describe the education process for new
nurses and opportunities for improvement
 Illustrate innovative use of PFAC members
in the education process for new nurses
 Define benefits of collaboration between
PFAC members and educators

3. The Vanderbilt
Promise

4. What did the patients say?
Survey question Percentage of patients reporting
“always”
“Before giving you any new medicine,
how often did hospital staff tell you
what the medicine was for?”
84.83%
“Before giving you any new medicine,
how often did hospital staff describe
possible effects in a way you could
understand?”
51.75%
How often did nurses explain things in
a way you could understand?
79%
I clearly understood the purpose of
taking all of my medication.
62%

5.  Dr House asthma inhaler - YouTube

6. Vanderbilt Center for Effective
Health Communication

7. Needs Identified
Call to action – Leadership at Vanderbilt was pushing for
more patient and family engagement and improved
readmission rates
 Leadership had initiated a Patient and Advisory
Council which delivered success in providing the
patient perspective on the patient experience and
improving processes and patient interactions.
 Leadership began asking clinicians to improve patient
education process to improve patient engagement in
their own healthcare and readmission rates.

8. Improving patient-nurse
communication at VUMC
 Goal: Nurses will use “teach back” to ensure understanding when
educating patients every patient every time.

9. Needs Assessment
GAP analysis: Observations for teach back during patient
education events -- nurses targeted as a group who has
multiple opportunities for patient education throughout
hospital stay.
 Nurse residents are new nurses entering Vanderbilt system.
They attend a year long program of teaching and learning
to become competent. The entry point training is the key
for forming expectations. These were targeted for pilot
intervention.
 Observations of all nurses all levels as a whole in December
(in this sample) was 35 out of 134 or 26%. This proportion is
lower than the population proportion reported in the
literature of 39% to a statistically significant degree.

10. Theoretical Basis for Question,
Intervention and Evaluation
 Experiential learning theory - We learn by doing and reflecting on
the doing.
 Social-Cognitive learning theory – We learn new behaviors through
models and the consequences of doing the modeled behavior.
Internal processes, the rewards given and perceived self-efficacy
influence the learning outcomes.
 Communication skills are best learned in the setting, situational and
require role modeling, practice with feedback to be acquired.
 Volunteer patients and learners attempt to come to shared
understanding and potential for social consequences improves.
 Commitment to use teach-back is key to internal motivation.

11. Perspectives from the patient

12. The Model

13. Content and Instructional Design
Development
 Constraints – financial and people resources
 EBP – publications Sunil Kripalani. Demonstrated that non-actors
can portray patients during patient education simulation. Thus
providing a precedence.
 Organizations –
 Institute for Patient and Family Centered care – Recognizes the
importance of the patent perspective in improving clinician
performance and involvement in local improvement improves care.
 Agency for Healthcare Research and Quality – the proven patient
education strategies used during patient education sessions.
 Subject Matter Expert – task analysis, checklist validation

14. Class Design
 Presentation of content.
 The Hook.
 AMA video demonstrating the identified gap between patients and clinicians
when communicating and teaching.
 Brief explanation (goal of less that 20 minutes) of patient education
principles including an example:
 Power point of the principles of teach back including a video of skill
demonstrated.
 Opportunity to practice with feedback
 An opportunity to practice educating “patients as teachers” who are
volunteers from the Patient and Family Advisory Council
 Feedback received from “patients as teachers” and trained coaches.
 Commitment to use teach back when educating patients.
 Self Evaluation and Tracking Log to continue the deliberate practice in
the clinical setting.

15. Practice &
Homework

16. Perspective from the patient
volunteer teacher eyes

17. Learning from patients

18. Level 2 & 3 – Satisfaction, learning
 I never realized how challenging discharge information can be to effectively
communicate and elicit patient understanding. I will take it much more seriously
now.
 The simulation was very nerve racking but effective in helping us communicate with
patients and learning how to effectively teach.
 I liked how outside sources/previous patients were brought in to give us a different
perspective on our communication skills.
 This was such a helpful topic and simulation. It's nice to hear feedback about
communication skills that were done well and need improvement.
 The patient-nurse simulation was a great way to learn. I enjoyed getting to practice!
 It would be more of a benefit to have more time with the simulated patients.
 So intimidating, but so informative!

19. The Committment
 Commitment to change

20. Before and after

21. Yellow went up from winter to
spring in all interactions
0
10
20
30
40
50
60
Winter Spring
Teach-Back Use Winter/Spring Cohort
No
Yes

22. Tell me – I forget.
Show me – I remember.
Involve me – I understand.
Confucius 450 BC

23. Conclusions
 More nurses who were trained used teach back than existing staff
nurses.
 More nurse residents who signed commitment and used self
evaluation and tracking log used teach back with real patients.
 The experience of simulated patients with patient advisory council
members improved the attitudes and seemed to affect the value
statements made during post class evaluations. This serves as a
proxy for affective learning domain.

24. For additional information, please contact:
 Melissa Powell
 Director of Education
 Northside Hospital, St. Petersburg, FL 33709
 melissa.powell2@hcahealthcare.com
 Mary Ann Peugeot
 Past Chair, Vanderbilt Patient & Family Advisory Council
 mapvuhpfac@earthlink.net