is also helpful for the visual learner, as they can see someone else perform the required actions (Holt, 2022; Maryniak, 2019). Patients who relate to the auditory learning style need to hear and talk about information. The healthcare professional needs to focus on clear speech, pace, and tone, as well as use of plain lan- guage. These learners may need time to process, so time may be needed after presenting information. Auditory learners should ask questions as well as work it out aloud and answer their own ques- Visual aids and written information As previously discussed, the use of visual aids and written infor- mation can enhance patient teaching. There are key factors to consider when developing and using these materials. Visual aids are recommended when they can make content more easily understood. These aids should reinforce the content being discussed but not distract from it. Visual aids need clear titles and captions and should use images that are obvious and organized. If tables are used in a visual aid, they should be short, with clear headings for rows and columns (AHRQ, 2020c). Patient and family educational strategies Most of the time, healthcare professionals perform patient educa- tion on an individual basis, or with the patient and family together. Teaching can be formalized and planned or can be spontaneous during a teaching or teachable moment (see Chapter 4 for further discussion of this point). Healthcare professionals should structure their approach to patient teaching so that it is performed in the same way each time, with individualization to the patient. Planning for patient and family education is done by incorporating all the considerations discussed earlier, such as health literacy and learning styles. The topics and potential topics should be thought out before the discussion, visual aids should be found, and plans for any demonstrations should be considered (AHRQ, 2020b). If the patient is suspected or known to have a lower level of literacy, then factors previously discussed should be kept in mind during preparations (AHRQ, 2020a). The patient may have higher health literacy, such as those who are healthcare professionals them- selves. Plain language should still be used rather than assuming those patients will comprehend all the information taught. Teach-back is a method of patient teaching that is highly recom- mended, as it confirms the patient has understood the informa - tion presented by telling it back in their own words and showing it through their own actions (AHRQ, 2020b). Using teach-back doesn’t test patients’ knowledge, but rather how effectively the healthcare professional presented the information to them. When planning for teach-back, healthcare professionals must determine how patients will be asked to teach back the information. It is important to remember that teach-back is used for techniques as well as concepts (AHRQ, 2020b; Maryniak, 2019). When using teach-back, it’s important to perform “chunk and check,” which means information should be presented in small sections and then verified with the patient. After providing some information to the patient, the healthcare professional asks the patient to repeat it back in their own words. This ensures the pa- tient understands the information thus far and gives the health- care professional an opportunity to clarify if needed and teach it back again. It is recommended that important information be limited to three to five points when using the teach-back method (AHQR, 2020b). Asking patients to teach back through stating in their own words or showing how to perform a procedure may be seen as difficult. Group Educational Strategies Patient and family teaching can also be done in group settings. Patient classes can cover content specific to procedures, disease processes, and self-care. Opportunities for learning arise when patients ask other questions. In addition to the content present- ed, the group setting allows for social interaction and support. Re-
tions. Discussions are helpful for this learning style and including others may be a good strategy (e.g., including family or teaching in a group setting; Holt, 2022; Maryniak, 2019). Patients who have a tactile learning style need to feel and do for best results. Hands-on experiences, such as demonstrations and then return demonstrations, can be effective. Use of real-life ex- amples is useful so that the learner can apply the information. Tac- tile learners have a need to practice (Holt, 2022; Maryniak, 2019). Written information such as handouts can also reinforce patient teaching. These materials should not just be given to patients without reviewing with them. On their own, many patients do not read or completely read written information that is handed to them. Materials must include plain language and be in the language that the patient uses for learning. The healthcare pro- fessional indicates the most important points by highlighting, cir- cling, or underlining. The material should be regularly evaluated to ensure the content is current. In addition, patient feedback is essential (AHRQ, 2020b). Healthcare professionals should focus on indicating they are using teach-back to meet their own needs—it is not being used to test the patient. For example, beginning the question with “I want to make sure I explained this clearly. Please tell me how . . .” or “I want to make sure I showed you correctly. Please show me how . . .” The teach-back should focus on a single topic rather than multiple concepts (AHRQ, 2020b; Maryniak, 2019). Healthcare Consideration : Some examples of ways to ask for teach-back are: ● “I want to make sure I explained it correctly. Please tell me in your own words how you understand the plan we have to manage your pain.” ● “I want to be sure that I explained your medication right. Please tell me how you are going to take this medicine at home.” ● “As we discussed earlier, you will need to get up and walk so that you don’t get blood clots. Please tell me how many times a day you need to do this.” ● “We covered a lot of new information today, and I want to make sure that I explained things clearly. Please show me how you will use your incentive spirometer.” Teach-back should be used consistently in all settings and with every patient as appropriate. Teach-back may not be appropriate with pediatric patients, or those with developmental or cognitive challenges. Family should also be included in teach-back, particu- larly if they are caregivers at home (Maryniak, 2019). Another strategy for individualized education is using a “brown bag” medication review. These sessions are generally open to any patients who would like to participate. The brown bag review is usually seen in ambulatory settings but can also occur with inpa- tients. Patients bring in their medications from home to review with a healthcare professional, which can assist in identifying mis- understandings and errors with medications. During the review, the healthcare professional will have the patient hold each medi- cation bottle and answer questions. The questions to be asked should include “What do you take this medicine for?” “When do you take this medicine?” and “Show me how you take this medi- cine.” The review can also assist with medication reconciliation, which is often incorrect. An updated medication list is to be given to patients after each brown bag review (AHRQ, 2020b). inforcement of key concepts may result from group classes, which are typically done with standardized didactic content. This type of learning may be especially effective for patients who are auditory learners. Group education should not replace one-on-one teach- ing but can enhance it. Examples of successful group educational
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