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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Constantly learning

A little while back, while I was still a STICU nurse, I decided to start a little notebook where I would right down new diseases/diagnoses/medications I came across during my shifts so I could look them up and learn about them. I was afraid when I transitioned into an imaging nurse I was not going to really be “learning” anything new. I’m just going to start IV’s and monitor for contrast reactions.

I was wrong.

People get MRI’s for all kinds of reasons. I have probably come across more diseases that I have never heard of in this position than I had the whole time I was in the ICU.

It’s been a constant learning experience. I start looking up the disease the patient is diagnosed with (which is the reason they are coming to MRI in the first place), and that leads me to another related disease, which leads to a new study, which leads to a med I have never heard of, and so on.

I’d never heard of MGUS, plastic bronchitis, or a syrinx. Came across all of those in MRI. I assumed that I need to be bedside to learn anything new in nursing. That’s not the case at all. As long as you are providing patient care you never really stop learning…

On my own

This was my last week of orientation in MRI nursing. Starting Monday I’ll be on my own.

I’m nervous.

It’s not that I don’t think I can do the job. Compared to getting my ass handed to me in the STICU, this is going to be somewhat less stressful. It’s the fact that procedural nursing is new for me. I’ve been bedside for 8 years now. I’ve always been in charge of the patient because they were “mine”. Now I’m dealing mostly with outpatients. I also deal with kids. As you all know, I don’t do kids, they make me uncomfortable. I will still have inpatient contact but while I am responsible for their safety while in MRI, they aren’t mine. I have to remember that my contact with them is as a MRI nurse and not as their primary nurse.

That’s a little weird for me.

It’s also kind of nice. Patient being a douche? I can send them on their way. Patient too confused to hold still for the MRI? Back to the unit for you buddy.

Not going to lie, it’s fabulous not going home with back pain everyday.

I think I’m going to like finally being on my own, you know, once I get over the initial shock of it.

So many diseases!

I had no idea there were so many diseases until I became a STICU/transplant nurse. Our unit takes care of surgical and trauma patients of all different types (except cardiac, we have dedicated units for that). While trauma is not easy, it can sometimes be a little more straightforward. Most of the time, if it’s bleeding make it stop. If it’s broken, fix it. Every trauma case is different of course but the path you take is typically easier to identify.

Surgical cases are a whole different story. I have come across so many different diagnoses that I have never even heard of. My first time hearing about Budd-Chiari syndrome was with a liver transplant patient we just treated. I have had to spend so much time looking up things on the internet trying to figure out why my patient has 70cm of small bowel left. I have learned about spinal disorders, blood disorders, neurologic disorders. I spend a lot of time asking our specialties to explain this diagnosis or that surgical procedure.

I love it!

Granted, I can’t tell you half of what the hell was explained to me. I can’t remember a majority of the diseases I have looked up. I have “nurse brain”. I know it for as long as I need to know it and then I purge it with alcohol to make way for the next round of sh*t I need to know. No shame. I plan on doing what I see some of our med students and residents do. I am going to get me a small notebook that I can leave in my locker at work and document the diseases that I come across. I haven’t decided if I am going to just list the name of the diseases or try and include a description with each so I can look back through the notebook and learn. It’ll probably be the latter.

Hopefully, I can start sharing some of these diagnoses and diseases with you all.

Know your meds

Nursing school will lead you to believe you need to know every medication, ever. You should have your pharmacology book memorized.

That’s a damn lie.

There are new medications being advertised every month. There’s no way you can possibly keep up. There absolutely nothing wrong with that. However, know the medications you are giving to your patient!

Before passing meds take a moment to look and see if you know what medication you are giving and why. If you don’t know a med, look it up. Medscape, Epocrates , even Google are only a few clicks away. Your pharmacy is only a phone call away.

Let’s say you notice that your patient is on midodrine and propranolol. You know the midodrine is to help your patient maintain their blood pressure since they tend to run lower. You’re not familiar with propranolol but you know that suffix. You remember that “olol” was rammed into your head as a beta blocker for hypertension. Wait, what? Why is your patient on meds to raise and lower their blood pressure?! Better hold that propanolol right? This is the perfect moment to stop and look up your meds. A few minutes of research and you learn that propanolol is also used for tremors. Nevermind, guess that med might need to be given.

This is why I keep Medscape on my phone. I take a few moments and look up a med I don’t know just to make sure I know what and why I’m giving something. It doesn’t take much time at all and I feel safer giving my meds. Also, if you have that family member in the room that questions everything, you look like a genius when you can answer each question they throw at you about what you’re giving. They don’t need to know that you just looked all of this up before walking into the room! A few moments of pause can make you much safer.

Dear medical student…

Dear med student,

Hi. I’m the nurse that had been taking care of this patient for the last 12 hours. I am the nurse that charted every med given or not given over this shift. I’m the nurse that verified all those vital signs. I’m the nurse that put in that progress note last night. I drew the labs this morning. Yes, I know my patient.

You do not. That’s ok.

While I do not mind you asking me about my assessment, I will not do your assessment for you. You need to check the pupils. You need to check a neuro status. You need to check the lab results. You need to look over the vital signs. You need to look at the meds. You need to know this patient so that you can give your information during rounds.

Walk in. Introduce yourself to the patient and I, the nurse. Put on your gloves and get hands on. Ask questions, we don’t mind. We nurses understand that you are still trying to get your footing. We were there at one time as well.

Understand that ultimately, you still have to assess your patient yourself. Take these moments to build your communication and assessment skills. Each moment of patient contact is a potential moment for learning. Get all up in there!