How Do You Teach Your Patients?
For this teenage mother, it's her worst nightmare.
Her prematurely-born daughter is struggling with pneumonia. The nurses around her babble in incomprehensible English, shaking their heads. The mother can see the nurses are trying to tell her something important, but what? "Si, si," she murmurs in response.
Finally, a Spanish-speaking nurse enters. The young mother smiles with relief, but her smile fades as the nurse explains that she is leaving some important pamphlets for her to read. "Don't worry, they're all in Spanish," says the nurse interpreter. "This information will help you care for your baby so she doesn't get sicker."
All evening, the materials sit untouched next to the mother's bed. Late that night, exhausted and in pain, she props the bottle to feed her daughter.
The nurse interpreter is back. "Didn't you read about how to hold your baby while you feed her?"
"No puedo leer," whispers the mother, finally. She droops in shame. "I didn't understand...the big words you used...I never learned to read."
The baby survives--but at a financial and emotional cost that could have been easily avoided.
Later, the nurse interpreter confesses on a nursing forum,"I don't think I ever failed a patient more miserably in my patient teaching."
The Role of Patient Teaching
As a practicing nurse, you know that patient teaching is a vital part of your responsibilities. On the Bureau of Labor Statistics website, the description of an RN's duties begins with teaching, prioritizing this aspect of nursing over direct care: "RNs teach patients and their families how to manage their illness or injury, explaining post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication and physical therapy...."
However, the effective teaching of healthcare to patients is not an innate ability. As you can see from the story above, the nurses involved tried their best to convey important information. The teaching failed because they made the assumption that the patient could read in her native language. And before you write off the nurses for making such a dangerous assumption, ask yourself how many assumptions you make in your nursing practice every day. Do you assume that patients understand what is said to them? Do you assume that your patients learn best aurally--or visually--or kinetically? Do you assume that your patient is being accurate when he assures you that one of your colleagues has already provided discharge instructions?
The good news is that effective patient teaching methods can be learned and mastered. Not every nurse is equally skilled in the same areas. For example, you may know a geriatric nurse who is particularly good at asking open-ended questions to get accurate information. You may know a pain management nurse who has a knack for teaching alternative methods like guided imagery. You may know a nurse midwife who creates powerpoints and interactive tools to educate her patients. It's up to you to assess your own teaching abilities and work to improve your weaknesses--and to help your colleagues by sharing your strengths.
Transcending Failures in Patient Teaching
The nurse interpreter who failed to ask the mother if she could read took the experience to heart. Now, she tells her story to students and peers to underscore an important lesson: "Teaching demands feedback that is more than just having the patient shake their head and say they understand. The patient needs to verbalize understanding or state back to you in their own words what you have taught them."
Later in her career, this nurse encountered another non-English speaking patient, who had been admitted to the emergency room in diabetic ketoacidosis. The nurse remembered the young mother's reluctance to admit her illiteracy...and this time, she asked the right questions. Sure enough, the patient could neither read nor understand numbers.
"I made sure he had picture charts of appropriate foods and amounts," the nurse reports. "We spent hours with him on learning to draw up insulin and check blood sugars and understanding what the numbers meant. Hours making sure he had access to insulin and syringes through a pharmacy. Patient teaching is not something that can be accomplished in 5 minutes just before discharge."
Nor is patient teaching something that can be standardized. "Children learn differently than adults," writes Beth Ulrich, EdD, RN, CHE, FAAN, in her November 2006 editorial for the Nephrology Nursing Journal. "Young adults learn differently than older adults. Members of Generation X and the Millennial Generation, who were exposed to educational television and computers since birth, have even been shown to process information differently than members of previous generations."