Educating Your Patients: the Value of Oral and Written Instructions

Providing instructions in a format that provides the patient the opportunity to hear your directives and have information as reference to review at a later point when they are in a comfortable atmosphere and more relaxed. Using the teach-back method helps cement the instructions in the patient's mind and gives them a sense of control.

We often talk about how important it is to educate your patients and most importantly to document the education you provide. 

Let me share a scenario with you of a 30-day-old infant given anti-seizure medication due to a skull fracture while in the hospital. The parents were provided a prescription to continue the medication at home for seven days. 

Two days after release from the hospital, a family member asked the mother whether the nurse described for her what a seizure looks like in an infant. Unfortunately the answer was  “no” — the mother had no idea what signs to look for or what to do if it happened. The nurse only had informed her “to bring the infant back to the hospital" if it occurred.

I would like to believe the mother was indeed advised about what to look for, how to respond and that information was documented in the records. In the chaos of the situation and after long hours of no sleep fretting over her infant and his condition, perhaps the mother just didn’t recall the details. Unfortunately, this scenario is not unusual regardless of the situation. 

The statistics are staggering. The common belief is that patients remember approximately 20 percent of what they hear from their healthcare providers. Of the 20 percent they do recall, 50 percent of that information is remembered incorrectly. It is difficult to say whether these statistics reflect only patients who are dealing with life threatening or traumatizing situations. However, any patient who is in pain, uncomfortable or stressed probably won't recall all of your oral instructions. 

This is where the teach-back method comes in handy. Teach-back is a verbalization by the patient of the instructions provided by the provider. It is simple and only takes minutes to help your patient to feel like they have some control over the situation. 

You know that old trick: you'll remember a new acquaintance’s name if you repeat it back. This repeating of the individual’s name reduces the likelihood of forgetting his name in the future. The teach-back method is similar. 

In the case of the infant scenario discussed in this article, the nurse may have said, “I want to make sure I covered what to look out for with regard to seizures and how you might handle a seizure if it were to occur. Please tell me what you will look for and what you will do?" With this type of dialogue, the mother may have felt more comfortable that she could take control if the situation was presented.

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