Improving clinician-patient communication skillsMELISSA POWELL, MS, RN-BC

Presentation Outline

I. Needs assessment II. Content development III. Class design IV. Evaluation V. Workplace behavior change and performance improvement

Needs Assessment

Call to action – Leadership at Vanderbilt pushing for more patient and family engagement and improved readmission rates

Leadership initiated a Patient and Advisory Council - formed and delivered success in providing the patient perspective on the patient experience and improving processes and patient interactions.

Leadership began asking clinicians to improve patient education process to improve patient engagement in their own healthcare and readmission rates.

GAP analysis: Observations for teach back during patient education events -- nurses targeted as a group who has multiple opportunities for patient education throughout hospital stay.

Nurse residents are new nurses entering Vanderbilt system. Attend year long program of teaching and learning to become competent. Entry point training key for forming expectations. Targeted for pilot intervention.

Observations of all nurses all levels as a whole in December (in this sample) was 35 out of 134 or 26%. This proportion is lower than the population proportion reported in the literature of 39% to a statistically significant degree.

Improving patient-nurse communication at VUMC

Goal: Nurses will use “teach back” to ensure understanding when educating patients every patient every time.

Theoretical Basis for Question, Intervention and Evaluation

Experiential learning theory - We learn by doing and reflecting on the doing.

Social-Cognitive learning theory – We learn new behaviors through models and the consequences of doing the modeled behavior. Internal processes, the rewards given and perceived self-efficacy influence the learning outcomes. Communication skills are best learned in the setting, situational and

require role modeling, practice with feedback to be acquired.

Volunteer patients and learners attempt to come to shared understanding and potential for social consequences improves.

Commitment to use teach-back is key to internal motivation.

Content and Instructional Design Development

Constraints – financial and people resources

EBP – publications Sunil Kripalani. Demonstrated that non-actors can portray patients during patient education simulation. Thus providing a precedence.

Organizations – Institute for Patient and Family Centered care – Recognizes the

importance of the patent perspective in improving clinician performance and involvement in local improvement improves care.

Agency for Healthcare Research and Quality – the proven patient education strategies used during patient education sessions.

Subject Matter Expert - Lynn Webb, (expert in health professional-patient communication) – task analysis, checklist validation

Class Design Presentation of content.

The Hook.

AMA video demonstrating the identified gap between patients and clinicians when communicating and teaching.

Brief explanation (goal of less that 20 minutes) of patient education principles including an example:

Power point of the principles of teach back including a video of skill demonstrated.

Opportunity to practice with feedback

An opportunity to practice educating “patients” who are volunteers from the Patient and Family Advisory Council

Feedback received from “patients” and trained coaches.

Commitment to use teach back when educating patients.

Self Evaluation and Tracking Log to continue the deliberate practice in the clinical setting.

Evaluation

Level 1 – Participation (compulsory)

Level 2 – Learner satisfaction (post class evals)

Level 3 – Learning, Declarative and Procedural Knowledge (self report of knowledge gain)

Level 4 – Competence (Demonstration in class)

Level 5 – Performance (Patient Teaching Observations)

Level 6 – Patient Health (we will measure readmission rates)

Level 7 – Community Health (we may measure key outcomes, such as life expectancy rates)

Level 2 & 3 – Satisfaction, learning I never realized how challenging discharge information can be to effectively communicate and elicit

patient understanding. I will take it much more seriously now.

Teach-back was helpful, but will take time to practice fully.

The simulation was very nerve racking but effective in helping us communicate with patients and learning how to effectively teach.

I was really absorbed with the content that I forgot to be empathetic.

I liked how outside sources/previous patients were brought in to give us a different perspective on our communication skills.

This was such a helpful topic and simulation. It's nice to hear feedback about communication skills that were done well and need improvement.

The discharge education was confusing at first. Maybe make a little more organized. Otherwise it was a great experience and practice.

The patient-nurse simulation was a great way to learn

It would be more of a benefit to have more time with the simulated patients.

I enjoyed the interaction.

Thank you to the people who volunteered their time! Role-play was useful

So intimidating, but so informative!

Level 2 & 3 – Satisfaction, learning

The role play was very helpful. The video clips were really effective, especially the AMA clip. PowerPoint was a bit disorganized.

I enjoyed getting to practice! Really helped

I really liked the presentation - easy to follow. Great examples provided and the activity with the "patient" was very helpful & encouraged creative thinking & exposed areas for improvement. Very effective presentation!

Presentation presented information in an effective and interactive manner.

Great lecture!

A bit too long, too many examples of simple topics. Great video from AMA!

Good topic and information. Really liked the education group breakout, very helpful!

I liked the use of videos during the presentation.

I love that the lecture was varied: lecture, videos, demonstration, Q&A, and practice/application.

She was very interactive with us and gave good examples. The video clips and demonstration was helpful.

Level 4 Observations

The Null Hypothesis : The Proportion of nurse residents in cohort July 2012 Winter TB using teach back during observations of patient education sessions is equal to the Proportion of nurse residents in cohort Feb 2013 Spring TB using teach back during observations of patient education sessions.

The Alternative Hypothesis: The Proportion of nurse residents in cohort July 2012 Winter TB using teach back during observations of patient education sessions is NOT equal to the Proportion of nurse residents in cohort Feb 2013 Spring TB using teach back during observations of patient education sessions.

Winter Spring0

10

20

30

40

50

60

Teach-Back Use Winter/Spring Cohort

NoYes

RN1 RN2 3 40

10

20

30

40

50

60

Teach-Back Use RN Levels

NoYes

1 2 3 4 5 6 70

5

10

15

20

25

30

35

Teach-Back Use Location

No Yes

1 2 3 4 5 6 (blank)0

5

10

15

20

25

30

35

40

Teach-Back Use Teaching Type

NoYes

Conclusions

More nurses who were trained used teach back than existing staff nurses.

More nurse residents who signed commitment and used self eval and tracking log used teach back with real patients.

The experience of simulated patients with patient advisory council members improved the attitudes and seemed to affect the value statements made during post class evaluations. This serves as a proxy for Affective learning domain.

The class with commitment and self eval and tracking log seemed to improve use of teach back with patients.