This document describes a training program that used simulation and standardized patients to teach nurses effective communication techniques for patient education, including teach-back. Nurses participated in an online module on teach-back and chemotherapy education, then practiced their skills with standardized patients in a simulated chemotherapy lab. Nurses' communication was evaluated using checklists and video review. Feedback was provided. Surveys found nurses agreed the training would help them better educate patients in their practice. The goal was to improve nurses' patient education and use of teach-back to validate patient understanding.

1. 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
Background and Learning Needs Assessment
Multi-Part Experiential Training Curriculum
•Teach-back is one of 11 top evidence-based safety practices
recommended to influence patient engagement and health
outcomes ¹,²
Evaluation levels following simulation lab
•Effective communication and patient education are
paramount to ensure positive outcomes for patients receiving
chemotherapy
•Observation of novice nurses during chemotherapy
simulation demonstrated their need for patient education and
teach-back training.
Learning Objectives
•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.
Acknowledgements
A special acknowledgement to the staff of the Center for Experiential
Learning and Program of Human Simulation at Vanderbilt University
School of Medicine.
N=45 Learners
Level 1: Learner satisfaction with learning expectations
•Teach-back is used less than 39% of time to validate
understanding of education³
•One-third of American adults are health illiterate
Training Evaluation
I learned patient centered communication
techniques that I will routinely employ
in my practice.
Communication Techniques
Agree
Somewhat Agree
Practice scenarios
included to
promote
prioritization and
salient , actionable
patient specific
content for
teaching plan
Online learning
module with posttest on teach-back
with chemotherapy
teaching video
exemplar
Teach-back
practice with
standardized
patients (SPs) in
chemotherapy
experiential lab
Pre-brief review of
learning from
module and
modeling teachback with student
learners
Advocacy inquiry
and self reflection
with discussion
following nurse
learner video
review during
debrief
Preparatory
homework for
teaching session
and written
examples of
priority content
with clear, simple
language
Standardized
patient and
faculty written
feedback using
performance
checklists and
targeted
feedback
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.
2.2
Percentage
Somewhat Disagree
communication techniques were very
helpful. Reinforced classroom instruction.”
4.4
Disagree
0
0
20
40
60
80
100
Patient Education Principles
I learned new patient education principles
that 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.”
22.2
Neither Agree or Disagree
“The realism of the scenarios and
Patient education
and teach-back
concepts
introduced in ONS
course
75.6
Agree
80
13.3
Somewhat Agree
Neither Agree or Disagree
2.2
Percentage
Somewhat Disagree
4.4
Disagree
0
0
20
40
60
80
100
Level 2: Declarative knowledge through passing test scores
Level 3: Demonstration of teach-back and purposeful patient
education improved with advanced organizers
Level 4a: Perceived value with stated intent to change practice
How valuable will this training be in your future nursing career?
Scale:
1=worthless 10=valuable
Mean=9.2
Level 4b: Learner demonstrated skill as evaluated by objective
checklists and video facilitated targeted discussion and reflective
inquiry
Future Directions
Faculty and charge nurse observation of patient education and
reliable use of teach-back in clinical setting
Longitudinal review of learner practices by self report
Interview Thematic Analysis Conclusions
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