Teach back

Get your patients to “teach back” what you have taught them. Get them to repeat what you have taught them. You may be surprised at how little information your patient has absorbed from the education you have given. Using the “teach back” or “repeat back” method can help you gauge just how much information your patient is retaining.

With the “teach back” method, it’s exactly as it sounds. You get your patient to teach you what you taught them. This method is really effective for education that involves hands on training. Things like changing a colostomy bag at home, changing a wound dressing, giving tube feeds, doing peritoneal dialysis, etc all require a lot of teaching. These are thing you want to make sure your patient understands before they return home. When you get them to teach it back to you then you know that they have an understanding of the information they have received. As they are teaching it back, you can correct them if necessary and give them little hints to help them with the process.

“Repeat back” works well with information that may not require as much hands-on work. I found that it works well with my patients that are being sent home with multiple prescriptions, especially different inhalers. I had a patient with COPD and asthma (and yes, she still smoked, how did you know?) that had both Symbicort and an albuterol inhaler. She ended up on our unit from a bad asthma attack. When she started to get wheezy I took her the albuterol inhaler to help open her up and she refused. I couldn’t understand why. She said “that’s not the one I need for my asthma, I need the other one”. Confused, I asked her if she was referring to her Symbicort. She said yes, that’s the one she takes when her asthma flares up. She took her Symbicort whenever she felt tight or wheezy and took her albuterol twice a day. OH, nooooooow I know why you’re in here. I tried explaining to her that the Symbicort is for her COPD, not asthma. She argued with me for a good 10 minutes that I was wrong. I had to not only print out information on Symbicort but also have the doctor talk to her before she accepted that she has been using her meds wrong this whole time and that is why she was in the hospital. Upon discharge I made her repeat the education I had given her and show me which inhaler was her twice daily inhaler for COPD and which inhaler was for her asthma. I felt comfortable that she understood her meds upon discharge.

I think this teaching our patients about their health is where the medical system is lacking. Often, we are in such a rush to get people out so we can get people in that we just assume the patient understands because they didn’t ask any questions. Often, it’s the opposite. Some are embarrassed to say they don’t understand. Some can tell we are in a rush and don’t want to bother us by asking us to repeat what we have told them. It is up to us to make sure our patients are leaving with a full understanding of their health and their medications.

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TJC

So The Joint Commission is here this week…

Yay.

If you don’t know, TJC is an accrediting body for hospitals that makes sure we are doing things according to acceptable standards. In all honesty, it’s a good thing. It makes sure we are on our sh!t. I am okay with that.

However…

When TJC visits it turns every unit into chaos! What do I mean? Well, each hospital gets a “heads up” that TJC may be visiting within a date range. This sends every manager and compliance officer into a panic. Typically it goes a little something like this:

“Is this dated?”

“When does that expire?”

“Move this stuff out of the hallway and even though we have no true place to store it, FIND SOMEWHERE!”

“Do you know where the evacuation plans are for this unit?”

“Where are the fire extinguishers located?”

“How long does it take the purple wipes to disinfect?”

“What about the gray wipes?”

“And the red ones?”

“What is the temp on the fridge?”

“Where is the temperature log?”

“Where is the check sheet for the code cart?”

“Is there an expiration date on the Accucheck controls?” 

“All cups must have a lid on them or I am throwing them away!”

This continues for the entire week that TJC is in the hospital. All those things that we should have *technically* already been doing, we are going to do them all RIGHT NOW. I have been lucky. For eight years I worked 1900-0700. TJC is not in the hospital at night and neither is management so I avoided most of the shenanigans. Now I work days and evenings. I am now in the line of fire. I have been on my toes all this week just waiting to see the group of them come around the corner. So far I have avoided them. Let’s hope my luck continues!

Holier than thou

Hello holier that thou nurse and/or doctor on med Twitter.

We are so glad you came to join us and tell us how wrong we are for sharing our experiences when they aren’t all “rainbow and unicorny”. Let me see if I can explain something to you:

Sometimes it can suck being a nurse. Sometimes it sucks being a doctor. Sometimes it sucks being a CNA. Sometimes, the medical field just sucks.

I know this is shocker for you since your days are only sunshine and blue skies. For the rest of us, however, we deal with patients every day. We see death, abuse, addiction, cancer, and disease progression on a daily basis. We see tears, we get hit, we get verbally abused, we witness (and then somehow get involved in) family drama, we get spit on, we get called racial slurs, we go THOUGH it. Sometimes, we take to “med Twitter” to vent to those that understand us. We don’t do this because we get a kick out of bashing patients. Majority of us in the medical field are in this field because it’s what we love and we couldn’t see ourselves doing anything else. We love what we do but sometimes it’s a bad day and we need to talk about it to other people that have been through what we are going through. We get encouragement. We get advice. We get a picture of a puppy to melt away the stress. It’s our own little online bar where we get to sit and talk to the bartender. We need an outlet.

What we don’t need is your pretend internet holiness and your pretentious “I’m more of a patient advocate than you are” attitude. We would never do or say anything to harm or patients. We are, contrary to your belief, compassionate and caring medical professionals. We use these outlets to keep from losing our minds. So how about you hop on down from atop that high horse, ok?