Date of Award

Spring 6-6-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Bomin Shim

Faculty Reader

Dr. Bomin Shim

Faculty Reader

Prof. Deborah Saknit

Executive Summary

Investigating Nurses' Perception of Teach-back method: A Quality Improvement Project

Background and significance: Due to inadequate discharge instructions by the healthcare team, approximately 89 million Americans have not comprehended their condition and prognosis (Scott et al., 2019). According to Centrella-Nigro and Alexander (2017), patients had challenges recalling complex material 80% of the time and had difficulty retaining accurate information 50% of the time. Insufficient knowledge about the disease and its management caused a deficiency in self-care management, poor understanding of the disease, frequent readmission, delay in seeing healthcare providers, and medication non-adherence (Rahmani et al., 2020). Teach-back method (TBM) is an educational tool to assist nurses’ assessment of an individual’s level of knowledge, identify misunderstandings, and increase health literacy (Burmeister, 2022). Teaching nurses how to use TBM effectively showed significant improvement (Scott et al., 2019; Burmeister, 2022). Thus, providing nurses with more information on TBM, in turn, enhances patient understanding.

Problem and Purpose Statement: SWOT analysis identified the problem that patients could not understand the discharge instructions despite both verbal and written communication about the hospital stay. The practice of verifying if patients retained the information after discharge instructions was minimal. Patients were given basic information, yet they still had difficulty understanding due to repeated questions asked for clarification. The barriers for nurses unable to verify were due to short staffing, inappropriate nurse to patient ratio, burnout, and new protocols to follow. As an educational approach, TBM was proposed for nurses to deliver discharge instructions accurately and effectively. Furthermore, the project aimed to investigate whether nurses' perception changed after receiving the education on TBM, including how frequently they used it, and which components they utilized. Moreover, the project’s purpose was to check nurses’ response on patient’s experience when nurses provided discharge instructions using TBM.

Methods: This quality improvement project utilized a pre-and-post survey design that was conducted on the medical/surgical and tele units at a local healthcare agency in the Pacific Northwest. The project was divided into three phases: pre-implementation phase, implementation phase, and post-implementation phase. Participants were nurses from both units, who participated voluntarily and anonymously. The project was completed in 7 weeks with 2 surveys (pre- and post-survey). A five-item questionnaire was used to evaluate the independent variable, which was TBM education among nurses, and the dependent variable, which was nurses' perception of TBM. The first and second questions measured nurses' conviction and confidence in TBM use. The third question assessed how frequently nurses asked patients to repeat their discharge instructions. The fourth question assessed whether nurses used the 10-elements of TBM. Finally, the fifth question solicited nurses' feedback on the patient experience using TBM. The implementation phase was completed in three weeks-time. This involved watching the two TBM videos as well as the 10 TBM elements that were delivered via email. The non-parametric testing was used to analyze quantitative data and thematic analysis was used to analyze the qualitative data.

Results/outcomes: Of the 50 nurses from the two units, data was collected. 17 (34%) nurses participated in the pre-survey and 21 (42%) nurses participated in the post-survey. The mean test score for nurses' conviction (13%), confidence (36%), 10-elements utilization (14%) increased and input on positive patient experience also increased. However, there was no statistically significant difference found between pre- and post-survey. Furthermore, nurses' feedback on the patient experience while using TBM improved from pre- to post-survey. In the pre-survey after learning about the QI research on TBM, several of the nurses immediately incorporated the use of TBM with their patients. The nurses' remarks in the post-survey revealed a consistent theme: patients could repeat the information and stated their satisfaction with understanding their education.

Sustainability: The teaching materials were delivered to the unit managers and were freely available from the TBM website. The website had additional resources that the units could use if needed. Additionally, the project results were shared with the quality improvement (QI) director and both unit managers. As a result, the project raised the leadership’s awareness within the agency on the necessity of incorporating TBM to improve patient experiences. Additionally, no funding was used to complete the project. Thus, it could be easy to replicate it in the future for additional research. Moreover, the pre- and post-survey thrilled the nurses and there was a high likelihood that they would integrate TBM into their daily practice.

Implications: This DNP project highlighted that nurses using TBM with patients would improve understanding, as seen by nurses' positive remarks in the post-survey. Furthermore, the project’s insights could be used by the nurse leadership team to select future TBM strategies that would work well with nurses. Although the project was conducted on the units, the results offer a chance to execute it in a virtual setting (online admission and discharge duties). At the same time, this study points to opportunities for improvement for similar interventions in the future to mitigate barriers to incorporate TBM in the practice.


Burmeister, S., Nickasch, B. (2022). Promoting the teach-back method during hospital admissions. Nursing 2022, 52(7), 52-56.

Centrella-Nigro, A., Alexander, C. (2017). Using the teach-back method in patient education to improve patient satisfaction. The Journal of Continuing Education in Nursing, 48(1), 47-51.

Rahmani, A., Vahedian-Azimi, A., Sirati-Nir, M., Norouzadeh, R., Rozdar, H., & Sahebkar, A. (2020). The effect of teach-back method on knowledge, performance, readmission, and quality of life in heart failure patients. Cardiology research and practice, 2020, 8897881, 13 pages

Scott, C., Andrews, D., Bulla, S., Loerzel, V., (2019). Using nursing education intervention to improve discharge instructions on an adult oncology unit. Clinical Journal of Oncology Nursing, 23(3).