Running head: TEACHING PROJECT SUMMARY

Teaching Project Summary

Ashley Conner Stone
Old Dominion University

Teaching Project Summary

The learning need I plan to address with my teaching project is patient discharge
instructions given to patients in my workplace. My workplace is Womens Health unit within the
hospital. I have found that more and more patients are being re-admitted to the hospital due to
not following or knowing what they need to do when they return home from the hospital. I
began to assess the need for learning regarding this topic with causal conversation with coworkers (Bastable, 2014). Based on these conversations, I found that a large population of
patients were re-admitted after a recent discharge for the same reasons that brought them in the
last time and that a lot of them were re-admissions within 30 days of their last visit. This problem
had become very concerning for the nurses and the Nurse Practitioners that were caring for the

patients on the floor. The team as a whole reviewed documentation of patient encounters at the
time of re-admission via chart audits and subjective information form the patients. The
expectation is that we treat you for whatever symptoms have brought you in, teach you about
what to do to prevent the problem from reoccurring, what to continue to do for recovery, and
what to expect when discharged home. What is being found is that nurses are taking care of the
same patients that they had recently, and when the nurse ask the patient what brought them back
into the hospital, they are stating that they have the same issues that they had last time or that it
has become worse. Prior studies show that many patients (and in some cases a majority of
patients) do not fully understand or recall the instructions they receive (Zeng-Treitler, Kim, &
Hunter, 2008). The nurses have asked the patient if they followed their discharge instructions and
it has been a consistent answer that they either didnt understand them or didnt go to their
follow-ups due to not being sure where or when they should have gone. A number of studies
have shown that pictographs can improve patient comprehension of health information (ZengTreitler et al., 2008, para. 5). It is imperative that we find a way to provide the patient with
discharge instructions that they are aware of and fully understand.
Target Audience
The target audience for this needs assessment, are Registered Nurses (RNs) on the unit
that is 20-50 years of age. There were 10 nurses that participated in general conversation and
surveys. Their level of education varies from one to two years of experience to 18 years of
experience in womens health. This group of learners is part of the floor staff that is taking care
of the patients on the unit that are admitted to the hospital. This audience is in need of learning
how; they can improve on providing discharge instructions to the patients and prevent readmission to the hospital for the same problem(s). Informal conversations, a suggestion box, and

TEACHING PROJECT SUMMARY

a needs assessment survey took place to identify what the learning needs were as a whole.
Although there were several needs that were brought up, discharge instructions and re-admission
rates were number one. The RNs felt that discharge instructions were a major area that needed to
be addressed. Although, I started out with nurses and Nurse Practitioners I had to scale back my
audience due to having such a large group for this teaching project. I limited it to 10 RNs that
wanted to participant in the teaching session.
Standards of Practice
The standards of practice that I utilized are from the Association of Womens Health,
Obstetric, and Neonatal Nurses (AWHONN). Under Standard VIII: Education which requires
that the registered nurse participates in and maintain professional records of educational
activities required to provide evidence of competency, maintains licensure and certification as
mandated by state licensing boards, health care facilities, and accrediting agencies. Also I
incorporated standard V (b): Health Teaching and Health Promotion which includes that the RN
employs teaching strategies that promote, maintain, or restore health in the context of womencentered and family-centered care (AWHONN, 2009, p. 7). Even though these standards of
practice are not familiar to most, with the review of the standards of practice from my peers, they
are in agreement that the standards that I am utilizing for this project are appropriate for the care
of the patients. Health promotion and Education are important parts to making sure that patients
have proper instructions when they are discharged home.
Needs Assessment
The targeted group was provided with the needs assessment survey ("Survey," 2015), to
evaluate what was important to them and what was needed to provide them with the best
information. The majority of the staff have stated that they go over the discharge instructions

TEACHING PROJECT SUMMARY

with the patient and family that may be present, but feel that the patients verbalize understanding
without really understanding what needs to be done after they are discharged home. Some feel
rushed with the instructions, that they have limited time, and that the patients just want to get
their paperwork to get out as fast as they can. The target audience has also stated that they are
ready to learn new information that will provide them with information that they need to
decrease re-admission rates and help the patient to fully understand their instructions and what to
do if they experience signs, symptoms, or other complication after they return home. Almost all
of the staff said that they would like to have to information provided to them at work, in the main
conference room where the majority of meetings are held. It is a common meeting place that
would be easily assessable to all. I found that most either wanted to come in early before their
shift or on a day that they are off. There were very few that said that they would want to stay
after their shift is over due to having other obligations after work. They also have mentioned that
there be several sessions, so that they would have more than one option to be able to attend.
When assessing to see how the group would learn best, there was a mixture of all types of
learning styles. The two styles that most had, were visual and auditory. This group of learners
expressed that they would like to not only hear about new information but also have something
in writing that they would be able to follow along with and take notes if needed. Having an
interactive session with teach back from the group would be beneficial to all that are involved
during the teaching session. Also, I would leave copies of the information for those who would
like to be a part of the teaching but are unable to attend the teaching session.
In talking with the staff I have learned that they are very willing and ready to learn any
new information that will help better them as a staff member and what will help provide the best
care possible for their patients. Time seems to be the biggest issue that the staff struggle with,

TEACHING PROJECT SUMMARY

along with the patient agreeing to whatever is said, and that they do not really understand what is
being taught to them. The staff does not seem to have the adequate amount of time that they
need to be able to go over thoroughly all the aspects of the instructions and educate the patient as
needed on new medications and problem areas. Many are finding that they hit the highlights of
the instructions and have trouble with knowing if the patient is fully aware of what is imperative
that they know. It is pretty common across the board that when the discharge instructions are
given to the patient, they are expected to read the information and call their doctor, or go to the
emergency room if they have further complications. This is a major part of so many readmissions and an area that needs to be addressed thoroughly. Although, the staff is not
malicious in their actions, it is an area that needs improvement and education to try to rectify the
situation. The staff takes education very seriously and wants to make sure that their patients do
not have to come back to hospital and be re-treated for the same issues that they were previously
admitted with. Although time is a major part in everyones life, these staff members are not
resistant in coming to educational meetings, but embark on the opportunities to learn information
that is imperative to making them successful at their jobs. It is amazing to see how devoted they
are to insuring that patients are safe and well educated on their diagnosis, prognosis,
medications, allergies, follow-up appointments, etc. and being able to help answer and assist
patients with their needs.
Development of the Teaching Plan
After talking with the unit staff (RNs) I learned that there was a need for an improved
way to provide discharge instructions that would lead to a decrease in re-admission rates. After I
established the audience, need for teaching, and learning styles: I began to develop my teaching
plan. Through discussion I learned that patients had complained that the instructions were not

TEACHING PROJECT SUMMARY

easy to follow and the majority of the patients did not remember what was discussed at
discharge. I felt that I needed to provide a way to teach discharge instructions that were going to
help patients remember what is important, as well as making sure they fully comprehend what is
being discussed. The discharge instructions would need to be customized to each individual
patient. I know that we assume at times that all patients can read and that they comprehend what
is being said, but that may not always be the case. Therefore, knowing what comprehension
level that the patient has is extremely important to providing information. Also, I wanted to
focus on the patient teaching back what they learned from the nurse, in that they would be able to
tell the nurse for example, about a new medication that they are prescribed (side effects, dosage,
frequency, indication, etc.). These two issues alone were grand enough to focus on these for the
entire teaching session. There are a lot of different issues that can be addressed and improved
upon, but when I started putting my teaching plan together for my audience, I realized that there
was an abundance of information that could be discussed, but not enough time for one teaching
session. I did however scale it down to 2 topics for this teaching session and that included teach
back from the patient, as well as the comprehension piece. Health literacy, according to the
Institute of Medicine, is the degree to which individuals have the capacity to obtain, process,
and understand basic health information and services needed to make appropriate health
decisions. It may be deficient for any number of reasons, including limited education, cultural
factors, impaired short-term (working) memory, impaired capacity for learning, and difficulty
with language comprehension (Chugh, Williams, Grigsby, & Coleman, 2009, p. 12). With that, I
found a very educational power point about discharge instructions and teach back that I utilized
in my teaching session (Grace, n.d.).
Instructional Strategies

TEACHING PROJECT SUMMARY

The instructional methods that were used in my teaching session were lecture, discussion,
and role-play with my audience (Bastable, 2014). Lecture was the initial method used, and it
was accompanied by an educational power point (Grace, n.d.) with a print out of the power point
to be able to take notes. I knew based on my learning assessment of my group, that they liked
lecture, but also needed some extra things, including visual aids, and discussion. I structured the
layout to present the information and allow for open conversation with questions throughout the
lecture. At the end, we had a group discussion of the information and then performed role-play
to implement what was taught to the group. In the role-play portion, the group was able to take
the information given and implement it, to teach their patient and then receive teach back from
what they taught. The learning theory implemented is the Cognitive Learning Theory, supported
by the fact that I kept the groups attention during the presentation, stimulated the learners recall
of prior learning through discussion, assessed the learners performance and skill through roleplay, and provide a guide for the learner to take after the teaching session for future reference
(Bastable, 2014, p. 73-75). I felt that by using this learning theory, that the group as a whole
retained information that they will start to utilize in their everyday roles as a nurse.
Evaluation
The methods that were employed for evaluation of my teaching objectives were
observation of return demonstration, as well as group discussion with participation from the
entire group (Bastable, 2014). According to (Grace, n.d.) 40-80% of medical information that
patients receive is forgotten immediately and nearly of the information retained is wrong.
Healthcare providers have a duty to provide information in a simple, clear, and plain language,
and to check that the patients have understood the information (Grace, n.d.). Each member of the
group took turns reinforcing the information that was taught to them by telling me what areas

TEACHING PROJECT SUMMARY

they needed to improve upon as far as providing discharge instructions to the patient. Once they
had identified the areas to improve or incorporate in their routine, each member performed a
role-play of how they would teach an instruction to a patient and have the patient teach the
information back to them. Teach back is asking the patients to repeat in their own words what
they have learned, it is not a test for the patient, but to see how well you explained the
information to them (Grace, n.d.). I had one person as the nurse and one as the patient to
practice, and asked that they choose to have a lower comprehensive level than one of a nursing
degree. By doing this, it showed them how important it is to provide clear, simple, and
memorable information to the patient upon discharge home. This was an eye-opener for most
when they realized that they needed to change their verbiage depending on the comprehensive
level of the patient. Most realized that you cannot read off printed instruction based on what the
hospital or provider types out, most times these are instructions that have complex words or
meaning that the patient does not understand when given to them. I feel that the group met the
outcomes of the objectives and that they will change the way that they currently give instructions
to patients at discharge. I feel the teaching session was effective due to the fact that the group
could provide teach back to me, as well as demonstrate how to provided clear, easy to understand
instructions during our discussion time. I did have to shorten it down from the initial plan, but in
the end focusing on two main points was very effective for my audience. The feedback that I
received reinforced that teach back and comprehension of the patient was very educational and
was said that this should help to reduce the amount of re-admissions.
Summary
This teaching plan was an eye opener to me. In the beginning when I initially started out,
I thought that I would be able to cover a boarder area when it came to discharge instructions. As

TEACHING PROJECT SUMMARY

I went through this project I soon realized that I had more information than time allotted for and
had to scale back my plan. I know it would be ideal to have all nursing staff involved in the
teaching session, but again the large volume and time allotment did not allow for the initial
workup. I did however end up with 10 nurses that could attend the teaching class and I felt that
this was a decent size group to teach in one session. Having a smaller group, allowed for more
discussion time as well as skill time for practice. I feel with a bigger group, it would have been
chaotic and a lot of the information may have been lost throughout. I myself learned new ways
to implement discharge instructions for my patients and it gave me a sense that I would know
that my patients are going home with an understanding of what to do when they get home. By
understanding the learning styles of my audience, I felt prepared and confident that they retained
the information that was taught to them. In planning and implementing this teaching plan, I
learned that you have to take these important steps such as: a needs assessment, learning
assessment, and teaching tools (handouts, power points, etc.) to be successful at teaching new
information to a group of learners.

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10
References

AWHONN website (2009). Standards For Professional Nursing Practice in the Care of Women
and Newborns. Retrieved from https://AWHONN.org
Bastable, S. B. (2014). Nurse as Educator, Principles of Teaching and Learning for Nursing
Practice (4th ed.). Burlington, MA: Jones & Barlett Learning.
Chugh, A., Williams, M. V., Grigsby, J., & Coleman, E. A. (2009, April 2009). Better
Transitions: Improving Comprehension of Discharge Instructions. Frontiers of Health
Services Management, 25, 11-32. Retrieved from
http://www.caretransitions.org/documents/Frontiers%20April%202009.pdf
Grace, J. (n.d.). Improving Patient Education [Lecture notes]. Retrieved from
www.avoidreadmissions.com/wwwroot/userfiles/.../193/teach-back-1.ppt
Staff Education Survey [Resources comment]. (2015, June 21). Retrieved from
http://ple1.odu.edu/courses/201430/nurs402/uuid/93d97f8da461fbed3b2a52158a09f68ca
d7772e4e9a2f374a3071e827309f46a40f39d2c/_assets_/nurs402_sample_needs_assessme
nt_survey.pdf
Zeng-Treitler, Q., Kim, H., & Hunter, M. (2008). Improving Patient Comprehension and Recall
of Discharge Instructions by Supplementing Free Texts with Pictographs. AMIA Annual
Symposium Proceedings Achieve, 849-853. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656019/
The Honor Pledge:
I pledge to support the Honor System of Old Dominion University. I will refrain
from any form of academic dishonesty or deception, such as cheating or plagiarism. I am
aware that as a member of the academic community, it is my responsibility to turn in all
suspected violators of the Honor Code. I will report to a hearing if summoned."
SIGNATURE: Ashley Conner Stone

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11
Appendix A
Teaching Plan

Purpose: To provide information that will allow staff to provide effective discharge instructions.
Goal: For staff to be confident and effective when discharging patients and decreasing re-admission rates.

Objectives

Content
Outline *

Method of
Presentation

Time
Allotted
(In
minutes
)

Resources

Method of
Evaluation

Outcomes

At the end of
the teaching
session the
learners will
be able to
demonstrate
the correct
procedure for
discharging a
patient
(Psychomotor
Domain)

To provide
through
discharge
instructions
to the patient
per the policy
of the
hospital.

Demonstration
with return
demonstration

45

Hospital
policy

Observation of
return
demonstration

Each staff
member
was able to
teach back
the
discharge
information
and roleplay with a
partner.

Discussion

15

Written
handout-to
write areas
needing
improvement

Group
discussion with
all
participating

Each staff
member
was able to
identify the
areas that
needed
improveme
nt when
discharging
a patient
from the
hospital.

To be able to
identify areas
for
improvement
(easy to follow
instructions,
teach back
from patient).
(Cognitive
Domain)

Identify
areas that
need
improvement
after each
performance
is concluded.

References

Bastable, S. B. (2014). Nurse as Educator, Principles of Teaching and Learning for Nursing
Practice (4th ed.). Burlington, MA: Jones & Barlett Learning.
Work Policy: Patient and Family Education. Original date: Dec 1996. Revised date: Jan 08.
Owner: Nursing Education Council