Maximizing your teaching moment
Once you have assessed your patient and selected the education materials and methods you will use to teach them, you will need to:
- Set up a good learning environment. This can range from making sure the lighting is good to ensuring your patient has privacy, if needed.
- Pay attention to your demeanor. This includes your tone of voice, making eye contact (or not, based on cultural needs), being nonjudgmental, and not rushing the patient.
- Keep assessing your patient’s concerns and readiness to learn by listening well and reading patient signals, which will likely be non-verbal.
- Break through barriers, which may include feelings like anger, denial, anxiety, or depression; beliefs and attitudes that are not aligned with learning; pain; acute illness; language or cultural differences; physical limitations; and learning differences.
Partner with Your Patients
As best you can, involve your patient and their support person (when appropriate) as partners with the health care team. Ultimately, what your patient learns from you -- both information and skills -- will help empower the patient and optimize their ability to make the best choices fortheirhealth.
Encourage your patient to learn how to describe their medical history and their current condition, and what they need to do to feel better or manage their health. When your patient knows what to report, what to focus on, and how to ask questions when talking with a health care provider, they can become a more active partner in their care.
Making the Most of the Moment
Once you develop a plan based on your assessments and input from your patient, you are ready to deliver patient teaching. Keep in mind that the best results happen when you are meeting the patient’s needs, including selecting the right time -- that teachable moment. If you teach at a time to fit your schedule, your efforts may not be as effective.
You will likely never have all the time you’d like for patient teaching. It may help to provide written material or an audiovisual resource prior to a patient teaching appointment. This may help reduce the patient’s anxiety and save you time when you teach them. Using this method will depend on what the patient needs to learn, the resources you have available, and your patient’s needs.
Help your patient know that you are working toward goals. Alert your patient about all of the topics that will be covered and set timeframes. For example, you may say: “Over the next few days or visits we will cover these 5 topics, and we will start with this one.” Your patient may agree, or the patient may express a strong desire to go out of order, based on a perceived or real concern.
Deliver patient teaching in small chunks. Avoid overloading your patient. If your patient is willing to try only 2 of the 4 lifestyle changes you are teaching about, leave the door open for further teaching or resources about the remaining changes.
If you are teaching skills, check for the patient’s mastery of the first skill before you move on to the next one. And, stay alert to barriers your patient may face in their home environment. Remember, small steps are better than none.
Let your patient know what to do if their condition changes. This way they will feel more in control and valued as a partner in their care.
Teach-Back or Return Demonstrations
When teaching a new skill, ask your patient to demonstrate the new skill so you can check for their understanding and mastery.
Use teach-back to evaluate how you are doing as a teacher. The teach-back method is also called the show-me method, or closing the loop. It’s a way to confirm that you have explained to your patient what they need to know in a way that they understand. This method can also help you identify the strategies that patients most commonly understand.
Keep in mind that teach-back is not a test of the patient’s knowledge. It’s a test of how well you explained or taught the information or skill. Use teach-back with every patient -- the one you feel certain has understood as well as the patient who appears to be struggling.
As you are teaching, provide reinforcement for learning.
- Tell your patient they are doing a good job.
- Acknowledge when your patient has overcome a challenge.
- Offer hints, tips, and strategies that you have gathered from other patients.
- Let your patients know who they can call if questions or concerns come up later.
- Share a list of trusted websites, and provide referrals to organizations, support groups, or other resources.
- Review what you have covered, and always ask if your patient has other questions. Ask: “What are your other questions?” You will likely learn more about areas that need reinforcing than you will if you ask: “Do you have any other questions?”
Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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