2 Final Practicum Proposal Table of Contents Introduction 3 Aligning with Organization’s

2

Final Practicum Proposal

Table of Contents

Introduction 3

Aligning with Organization’s Mission and Vision 4

Background of Project Impetus 4

Literature Review/Synthesis: Patient Teach-Back Method for Positive Patient Satisfaction and Positive Patient Outcomes 5

Background of the problem 5

Process and outcomes of patient teach-back methods 6

Gap Analysis 8

Project Charter, Scope, and Objectives 8

Implementation Plan and Best Practices 9

Tasks, Actions, and Deliverables 11

Evaluation 11

Timeline and Schedule 11

Budget 11

Cost-Benefit Analysis 11

Resources Needs 12

Risk Management Plan 13

References 14

Appendices 15

Appendix I: Implementation Plan Worksheet for Best Practices 15

Appendix II: Table of Budget 17

Appendix III: Table of Risks and Mitigation solutions 18

Introduction

It is often an evidence-based practice to involve patients in their plan of care to promote maximum success and benefits from patient care. Patients receive the intended care, but gaps in implementation hinder their optimal recovery against the principles of evidence and value-based care (Chen et al., 2016). Adverse medical occurrences, such as incorrect drug dose, are a major public health problem because they have negative social, economic, and health consequences. (Geiger et al., 2015). The increased mortality, morbidity, hospitalization, and medical costs strain the organization’s resources and reputation. The presence of communication gaps indicates that most adverse events are caused by non-compliant patients. Some errors occur in patient, while others happen post discharge due to misunderstanding discharge teaching. Social-economic aspects like education, employment, access to care, and communication barriers between patients and providers portray crucial aspects that trigger the disparities in adverse event implications (Chen et al., 2016; Geiger et al., 2015). Identifying the trigger factors and creating evidence-based interventions that create equitable platforms for communication between patients and providers could reduce the disparities.

Patients require socially and culturally sensitive education and communication techniques to raise awareness about the need to understand and implement care protocols (Chen et al., 2016). Using evidence-based approaches like the teach-back method could ensure individual patient needs are met and the principles of autonomy, justice, beneficence, and non-maleficence are optimally utilized. The problem presented in the assessment platform reflects a global image of aspects or disparities that affect the overall state of wellness by increasing the burden of disease. Based on existing evidence, the patient teach-back method equips patients to be an effective part of the care delivery process.

Aligning with Organization’s Mission and Vision

The Montefiore Medical Center has a vision in promoting equitable health care outcomes among all patients with a vision to promote health of the community. The purpose of the project is to improve the awareness and understanding of the importance of using the patient teach-back method in improving patient care and patient satisfaction among all staff at the facility. This project significantly aligns with the mission and vision of the facility in the use of evidence-based practice to promote patient care outcomes and improve on the health status of the community.

Background of Project Impetus

It is very important for all health care providers to ensure that patients understand all health-related information provided regardless of their health literacy levels. The teach-back method is an excellent evidence-based intervention that is used by nurses to check the understanding of their patients concerning health information given. The project seeks to ensure that all patients are adequately informed and understands the information given during discharge by stating the message in their own words what is required from them. Teach-back method is a form of patient education that is required to ensure that patients are adequately informed to participate in their own health promotion after discharge from the hospital.

Literature Review/Synthesis: Patient Teach-Back Method for Positive Patient Satisfaction and Positive Patient Outcomes

Background of the problem

Healthcare organizations requires patients to actively engage in the care delivery process through shared decision-making, informed consent, and self-managed care (Talevski et al., 2020). Due to a limited understanding of healthcare language, protocols, and guidelines, diverse patients face complications in applying self-managed care. Such patients continually depend on family, friends, or providers’ support to implement the procedures and guidelines (Dinh et al., 2016). The ability to comprehend health information determines the efficiency of self-managed care and the reduction of adverse events among target populations (Talevski et al., 2020). Healthcare providers overestimate their abilities to communicate with patients, leaving patients open to misinterpreting discharge instructions and resulting in poor outcomes. For instance, 75% of surgeons believe they offer optimal information, and their patients understand, but only 21% understand and apply the communication (Laws et al., 2018; Links et al., 2019). Taleveski et al. (2020) revealed that 77% of doctors believed their patients understood their diagnosis, but only 57% understood and related the diseases they had (Osuna et al., 2018; Talevski et al., 2020). The increased likelihood of harmful consequences and social and economic burden is due to a breakdown in communication between patients and providers, necessitating reassessment and patient reeducation.

The frequent use of medical terminologies by care providers and limited patient clarification opportunities creates a communication gap (Feinberg et al., 2020; Links et al., 2019). Patients misunderstand their providers and implement wrong instructions, increasing the risk of adverse events that could lead to death, disability, readmission, and higher medical costs (Feinberg et al., 2020). Patient safety and quality of life are jeopardized by the adverse occurrences. Patients also have difficulty remembering information given to them after discharge. The lack of a quality communication platform to consult what the provider advised the patient forces the patient to engage in inappropriate processes (Dinh et al., 2017; Osuna et al., 2018). Research findings show that patients (Links et al., 2019) recall only 50% of the information given by nursing staff about diet and medication. In addition, patients with lower educational levels may have a reduced comprehension rate. Providers offer insufficient information to patients being discharged from the emergency department 17-42% of the time, as Mahajan et al. (2020) indicated. Therefore, the adverse events and likely medical errors experienced among diverse patients arise from multiple communication factors between patients and providers. Effective communication tools portray a reliable approach for health promotion, meeting the legal, ethical, and professional standards of safety, quality, and timely care delivery.

Process and outcomes of patient teach-back methods

In Iran, an experimental study applied the teach-back technique to evaluate life quality after postpartum experiences (Ghiasvand et al., 2017). The teach-back method on postpartum was applied on days 2-3 and 10-15 using individual and face-to-face sessions until the patient optimally understood the target information (Ghiasvand et al., 2017). The sessions took approximately one-hour covering physical aspects consisting of breastfeeding, signs of postpartum depression, and psychological care focusing on coping mechanisms, relationships, and communication (Ghiasvand et al., 2017). The study’s findings confirmed a significant improvement in the life quality of the mothers exposed to the teach-back technique compared to those who used the traditional care (Ghiasvand et al., 2017). The teach-back technique improved self-esteem, physical health, and interaction with spouses, infants, and family members (Ghiasvand et al., 2017). The author reveals ways of applying teach-back as an evidence-based approach for health promotion.

The findings are supported by Mollazadeh & Maslakpak (2018) determined the role of the teach-back technique in reducing adverse effects among kidney transplant patients. The teach-back intervention in the clinical trial study involved at least five sessions of 60 minutes each (Mollazadeh & Maslakpak, 2018). Patients responded and showed efficiency in at least 75% of the taught content before progressing to another session (Mollazadeh & Maslakpak, 2018). Sessions one to five comprised self-management, self-monitoring alongside healthy behavior, detection and coping with abnormalities after the transplant, stress management, and emphasis on poorly understood topics (Mollazadeh & Maslakpak, 2018). Findings indicated that patients in the treatment group exposed to the teach-back technique had a significantly better understanding of self-management in kidney transplants with fewer risks for adverse events than the control group (Mollazadeh & Maslakpak, 2018). Adopting the teach-back technique among vulnerable patients provides a platform for optimal self-care and shared decision-making as part of value-based care.

Disease-specific education programs cause improved outcomes but face poor recall and understanding (Dinh et al., 2016). An experimental study determined the role of teaching back technique in enhancing adherence to diet, exercise, medication, and screening guidelines among patients with chronic conditions (Dinh et al., 2016). The target patients require optimal self-managed care to reduce over-dependence on providers and the associated costs and physical strain (Dinh et al., 2016). The interventions applied included face-to-face sessions, brochures, health information technology platforms, and apps delivering quality information and assessing understanding among the patients (Dinh et al., 2016). The study’s findings confirmed a significant increase in disease-specific knowledge among the intervention groups and better adherence to drugs and diet schedules in the experimental group compared to controls (Dinh et al., 2016). The findings align with the analyzed results of Paterick et al. (2017). The teach-back method offers a broad scope for patients to capture their diagnosis and apply care interventions and self-management from the intervention point. Adopting the principles of teaching back techniques to an emergency, chronic and acute condition patients portray a promising aspect of health promotion and eradicating adverse health effects among vulnerable populations globally.

Determination of patient satisfaction, quality of life outcomes, and health after discharge in adults aged 18 years and above revealed a significant trend after using the teach-back technique (Yen & Leasure, 2019). The teach-back approach aligns with increased health literacy hence making informed decisions and reducing risks of legal and ethical implications that would arise from preventable medical errors (Yen & Leasure, 2019). The reduction in post-discharge readmission due to the teach-back technique enhances patient experiences and reduces the disease burden on individuals, families, and communities (Yen & Leasure, 2019). Support of the teach-back technique by diverse literature advocates for culturally and socially sensitive teaching guidelines and assessments that meet optimal patient needs.

Gap Analysis

The identified gap in the poor patient education during discharge resulting in knowledge gap among patients. Poor education results in increased risk of readmissions following discharge as patients are not empowered to followed instructions as needed.

Performance measures description

Baseline

Goal

Explanation of the process of chunk and chuck as a best practice of patient teach-back method

Most staff at Montefiore medical center outpatient clinic have little information about chunk and chuck practice

Staff are aware of chunk and chuck practice and use it in their patient teach-back approach with patients.

Identification of the skills of show-me together with handouts as an essential practice of the teach-back method

More than half of the healthcare practitioners at Montefiore medical center outpatient clinic do not use the skill of show me nor provide handouts in their patient teach-back approach

Staff members master the use of show-me techniques and buy in the idea of complementing the teach-back approach with handouts where necessary.

Identification of ways of asking questions to ensure proper teach-back method

Some staff members, the healthcare providers at Montefiore medical center outpatient clinic, have little understanding of how to ask questions that ensure the best teach-back method

Staff members can describe at least three ways to enhance patient teach-back using indirect and direct questions.

Explanation of strategies to remain consistent in using the teach-back approach

Staff members who currently use the teach-back approach do not use it consistently with everybody, more so with the learned patients

Those who have who use the teach-back approach understand the importance of remaining consistent for the benefit of all patients.

Project Charter, Scope, and Objectives

Purpose: This project’s aim is to improve the awareness and understanding of the importance of the use of patient teach-back in improving home care and patient satisfaction of the staff at Montefiore medical center outpatient clinic for its patients.

Charter and Scope: The project seeks to implement other aspects of this evidence-based practice that ensure that patient quality of care post discharge. The patient teach-back method, as understood through research, involves providers asking patients to explain the given information on their own terms. This will provide the nursing staff with the opportunity to ensure that the patients, 100% of those that visit Montefiore medical center outpatient clinic, understand their home-care processes. The plan involves ensuring that the nursing staff is taught and buy-in the steps involved in the teach-back method: Chunk and check; ensuring that the misunderstandings realized due to patient teach-back are clarified using other means; using the teach-back approach consistently; adopting the show-me method when communicating with patients; using handouts when communicating with patients about medication regimens; and asking questions to ensure that the patients understand instructions. At the end of the project, the staff at the Montefiore medical center outpatient clinic will not only be aware of the patient teach-back method but start to practice it consistently. The project will be implemented only at the Montefiore medical center outpatient clinic and will be compulsory for all the nursing staff.

SMART Objectives

By the end of project implementation, nurses will utilize chuck and check teach-back method to ensure that patients understand information given correctly.

By the end of the project implementation, nurses will be given handouts and other reading materials for use as reference materials after discharge.

By the end of the project implementation, nurses will design a way of asking questions to patients to clarify if information given is understood.

Implementation Plan and Best Practices

The implementation plan worksheet attached in Appendix I. The implementation plan include four best practice or evidence-based practices that could be useful in promoting the patient teach-back intervention. They include the chunk and check. Chunk and check involve the breaking down of complex information to be discussed, which is required to the taught to the patient into smaller and more simplified forms, allowing the patient to understand better. It involves breaking down complex information into more meaningful and manageable chunks. Chunk and Check process includes subdividing heavy information into simple segments, informing the patient or family of the simplified information, and later allowing the patient to state back on the information provided (Avery et al., 2019).

The second best practice is using a consistent teach-back method. It includes explaining information to the patient then asking them to state or teach back the information as they understand it in their own words. The steps include using the teach-back method consistently on every patient and using the teach-back method diligently. The potential risk for this best practice in patient education includes lack of enough time, especially in situations where there are nursing shortages and poor nurse to patient staffing ratios.

The third best practice include the use of show-me method and handouts in reinforcing the information given. It is often very important for the nurse to provide all required information to ensure that the patient understands their quality of care. It will include demonstrating to the patient the processes of home care, such as medicine administration and physical exercise. Use of handouts is also very important as a reference for the health information to be given to the patient (Anderson et al., 2020).

The fourth best practice is the use of questions in attracting the teach-back intervention from the patients. The health care providers will be required to formulate indirect questions that could be useful in attracting a proper teach back. The questions are formulated in a way to give the patient an opportunity to present to the nurse the information that they have already captured concerning the discharge instructions (Nickles et al., 2020). These questions besides, promotes a healthy patient-nurse therapeutic relationship as the patient feels respected to be involved in the plan of care.

Implementation Measures

Best practice #1: Chunk and Check practice

Divide large amounts of information into segments.

Inform the patient or the family of the various segments of information

The patient teaches back the information given

Best practice #2: Consistent teach-back method

Use teach-back with family members

Use teach-back method for every patient at discharge

Best practice #3: Use of show-me method and handouts

Demonstrate the processes of home care like medication regimens and dieting, side effects

Use of handouts for patients to use at home

Best practice #4: Using questions to attract the teach-back from patients

Formulating indirect questions that can attract proper teach-back (e.g., “I know we talked about how to take this medication; if asked by your family at home, what will you tell them?)

Use of direct questions to attract teach-back (e.g., “I know we talked about how to take this medication, but could you explain everything to me so I can make sure I explained thoroughly?)

Please check the response that best describes completed discharge teaching with patients

Completed teaching

Taught

Not taught

N/A

Medications

Side effects

Diet

Signs and symptoms to look for

When to call the MD

Handouts

Please check off how much time was spent with patients for teaching for each caregiver

Caregiver

No time

5 mins or less

5-15 mins

15 mins or more

Physician

Nurse

Pharmacist

Dietician

Care Coordinator

Please date and initial completed check list

Day

Date

Type of teaching completed

Return Demonstration

RN signature

Nurse manager signature

1

2

3

4

5

Tasks, Actions, and Deliverables

Deliverables: Among the deliverables of the project are:

Strategies to enhance chunk and chuck practice

Approaches to enhance show-me and use of handouts when carrying out patient teach-back method

Various strategies to use when asking questions to ensure the patients have understood the given information on their own terms.

Metrics for Evaluation

The project will be evaluated first through observation on how nurses complies to the required patient-teach back interventions. Increased use of teach-back interventions by nurses indicates a clear success in project implementation. Secondly, the project will be evaluated by evaluating patient satisfaction during discharge. Patients will be involved in describing their perspectives on discharge information. Increased satisfaction and understanding of the information given is another indicator for the success of the project. Also, decreased rate of 30-day readmission following discharge indicates the compliance and adherence of patients to information given during discharge.

Timeline and Schedule

Timeline and schedule attached in appendices. GANTT tool Attached.

Budget

The budget was created based on the most vital resources that are required for the success of the educational project to facilitate increased use of teach-back method in patient education during discharge from the facility. The budget bas been attached in the appendices.

Cost-Benefit Analysis

Principles guiding in the cost analysis of the project.

Increased education among nurses on the teach-back methods in patient education promotes consistency.

Teach back method will help in ensuring that the patients have the right information in the management of the presenting health related needs.

Improved self-management of patients following proper health education reduces the risk of re-admissions based on better disease management.

The project seeks to improve patient management after discharge from the hospital based on evidence-based patient education. Potential benefits include improved quality of life especially among patients living with chronic diseases such as type 2 diabetes and hypertension (Prochnow et al., 2019). The project will also help in improving patient satisfaction. As mentioned earlier, excellent patient education often promotes a healthy therapeutic relationship between the patient and the nurse as they feel respected and empowered in promotion of health (Hong et al., 2020). Decrease number of visits to the clinic will reduce overall cost of health care and, therefore cost-effective. It will also improve provide morale based on quality patient care outcomes (Hong et al., 2020).  

Resources Needs

There are various resources needed in the success of the project. These include human resources of all stakeholders. Stakeholders will include nursing staff, patients, families, and leadership in the health care organization. Other resources include incentives for nurses that fully adopt the best practices of patient teach-back method. Resources are not limited to materials alone. Computers and financial assistance from the management will be needed to track the progress of teaching and application of best practices.

Risk Management Plan

There were a number of risks noted that may hinder the success of the project as planned. The risks include lack of enough time for the project especially in offering teach-back to all patients as needed. Lack of time will be managed by creating an effective GANTT tool that provides schedule as required. Other risks include resistance to change among nurses which is mitigated by including all persons and stakeholders in the project. Other risks and mitigation solutions have been illustrated as shown in Appendix III.

References

Anderson, K. M., Leister, S., & De Rego, R. (2020). The 5Ts for teach-back: an operational definition for teach-back training. HLRP: Health Literacy Research and Practice, 4(2), e94-e103. https://doi.org/10.3928/24748307-20200318-01

Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical care, 54(2), 140. DOI: 10.1097/MLR.0000000000000467.

Dinh, T. T. H., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Evidence Synthesis, 14(1), 210-247. DOI: 10.11124/jbisrir-2016-2296

Feinberg, I., Ogrodnick, M. M., Hendrick, R. C., Bates, K., Johnson, K., & Wang, B. (2019). Perception versus reality: the use of teach-back by medical residents. HLRP: Health Literacy Research and Practice, 3(2), e117-e126. https://doi.org/10.3928/24748307-20190501-01

Geiger, H. J. (2015). Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes. Unequal treatment: Confronting racial and ethnic disparities in health care, 417.

Ghiasvand, F., Riazi, H., Hajian, S., Kazemi, E., & Firoozi, A. (2017). The effect of a self-care program based on the teach back method on the postpartum quality of life. Electronic physician, 9(4), 4180. doi: 10.19082/4180

Klingbeil, C., & Gibson, C. (2018). The teach back project: a system-wide evidence based practice implementation. Journal of Pediatric Nursing, 42, 81-85. ttps://doi.org/10.1016/j.pedn.2018.06.002

Laws, M. B., Lee, Y., Taubin, T., Rogers, W. H., & Wilson, I. B. (2018). Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology. PloS one, 13(2), e0191940. https://doi.org/10.1371/journal.pone.0191940

Links, A. R., Callon, W., Wasserman, C., Walsh, J., Beach, M. C., & Boss, E. F. (2019). Surgeon use of medical jargon with parents in the outpatient setting. Patient education and counseling, 102(6), 1111-1118. https://doi.org/10.1016/j.pec.2019.02.002

Mahajan, M., Hogewoning, J. A., Zewald, J. J. A., Kerkmeer, M., Feitsma, M., & van Rijssel, D. A. (2020). The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study. International journal of emergency medicine, 13(1), 1-8. https://doi.org/10.1186/s12245-020-00306-9

Mollazadeh, F., & Maslakpak, M. H. (2018). The effect of teach-back training on self management in kidney transplant recipients: A clinical trial. International Journal of Community Based Nursing and Midwifery, 6(2), 146. The Effect of Teach-Back Training on Self Management in Kidney Transplant Recipients: A Clinical Trial – PMC (nih.gov)

Nickles, D., Dolansky, M., Marek, J., & Burke, K. (2020). Nursing students use of teach-back to improve patients’ knowledge and satisfaction: A quality improvement project. Journal of Professional Nursing, 36(2), 70-76.

Osuna, E., Pérez-Carrión, A., Pérez-Cárceles, M. D., & Machado, F. (2018). Perceptions of health professionals about the quality of communication and deliberation with the patient and its impact on the health decision making process. Journal of public health research, 7(3). doi: 10.4081/jphr.2018.1445

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. In Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis. doi: 10.1080/08998280.2017.11929552

Slater, B. A., Huang, Y., & Dalawari, P. (2017). The impact of teach-back method on retention of key domains of emergency department discharge instructions. The Journal of Emergency Medicine, 53(5), e59-e65. https://doi.org/10.1016/j.jemermed.2017.06.032

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLoS One, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350

Yen, P. H., & Leasure, A. R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes. Federal practitioner, 36(6), 284.

Appendices

Appendix I: Implementation Plan Worksheet for Best Practices

Best practice #1: Chunk and Check practice

Detailed tasks/actions associated with implementation of best practice

Team Members assigned to each task

Target implementation start date

Communication and/or training required? Yes/no

Communication and/or training scheduled dates

Actual implementation start date

Divide large amounts of information into segments

Nurse manager and nurses

[06/02/2022]

Yes

[06/02/2022]

[06/12/2022]

Inform the patient or the family of the various segments of information

Nurse manager and nurses

[06/02/2022]

Yes

Second or third weeks

Second or third weeks

The patient teaches back the information given

Nurse manager and nurses

[06/02/2022]

Yes

Second or third weeks

Second or third weeks

Best practice #2: Consistent teach-back method

Detailed tasks/actions associated with implementation of best practice

Team Members assigned to each task

Target implementation start date

Communication and/or training required? Yes/no

Communication and/or training scheduled dates

Actual implementation start date

Use teach-back with family members

Nurse manager and nurses

[06/02/2022]

Yes

[06/02/2022]

[06/12/2022]

Use teach-back method for every patient at discharge

Nurse manager and nurses

[06/02/2022]

Yes

Second or third weeks

Second or third weeks

Best practice #3: Use of show-me method and handouts

Detailed tasks/actions associated with implementation of best practice

Team Members assigned to each task

Target implementation start date

Communication and/or training required? Yes/no

Communication and/or training scheduled dates

Actual implementation start date

Demonstrate the processes of home care like medication regimens and dieting, side effects

Nurse manager and nurses

[06/02/2022]

Yes

[06/02/2022]

[06/12/2022]

Use of handouts for patients to use at home

Nurse manager and nurses

[06/02/2022]

Yes

Second or third weeks

Second or third weeks

Best practice #4: Using questions to attract the teach-back from patients

Detailed tasks/actions associated with implementation of best practice

Team Members assigned to each task

Target implementation start date

Communication and/or training required? Yes/no

Communication and/or training scheduled dates

Actual implementation start date

Formulating indirect questions that can attract proper teach-back (e.g., “I know we talked about how to take this medication; if asked by your family at home, what will you tell them?)

Nurse manager and nurses

[06/02/2022]

Yes

[06/02/2022]

[06/12/2022]

Use of direct questions to attract teach-back (e.g., “I know we talked about how to take this medication, but could you explain everything to me so I can make sure I explained thoroughly?)

Nurse manager and nurses

[06/02/2022]

Yes

Second or third weeks

Second or third weeks

Appendix II: Table of Budget

Name of Item

Quantity

Price ($)

Total Cost per year

Utilities

Electricity

$ 2.10 x 100 sq =210 $ per month

Per year 210 x 12= 2520 $

Zoom

149$

Equipment

LCD Projector

1

$ 1000

$1000

Projector screen

1

$450

$450

Laptops

1

$1500

$1500

Printer

1

500

$500

Teaching materials (handouts and pamphlets)

4000

$4000

Personnel

Nurse educator

1

45 $ per hour

$95,000

Staff education meetings

Average of $100

$1200

Miscellaneous

3000

$3000

Total cost of the project

$109,319

Appendix III: Table of Risks and Mitigation solutions

Description

Rank

Trigger

Mitigation

Contingency

Status

Example: Understaffing

2

Flu season

Staff on call to cover shifts when employees call out sick.

Have more experienced employees scheduled to provide better coverage when understaffed

Ongoing

Lack of enough time.

2

Increased number of patients

Create a GANTT chart to schedule appropriately.

Manage time effectively and efficiently with the help of nurse manager.

Ongoing

Resistance among providers in adopting new change.

1

Negative culture of change

Involve the team in the project from planning to implementation.

Continue to teach and inform the stakeholders on the role of the teach back method in educating patients.

Ongoing

Poor communication that leads to confusion.

3

Lack of collaboration

Listen actively and communicate compassionately and clearly.

Communicate actively and clearly with the stakeholders

Ongoing

Stretched or limited resources

1

Economical losses

Create a resource allocation plan while maximizing available resources.

Ensure the project have maximum financial and human resources before implementation.

Ongoing

Scope creep

4

Lack of excellent and timely communication.

Create clear project parameters and communicate vision

Get support from other stakeholders to create an excellent scope for the project.

Ongoing

The project does not go as planned.

3

Poor patient follow-up

Use project management software to follow the project effectively.

Follow-up patients as needed to ensure that the health education given adequately promotes health.

Ongoing

Lack of clarity

2

Poor communication

State clear goals in the plan.

Ask all stakeholders if the stated goals and understood.

Ongoing

Negative organizational culture

1

Interpersonal conflicts.

Emphasize on a common organizational goal.

Get leadership buy ins to manage conflicts while creating a common goal for the organization.

Ongoing

Lack of support from stakeholders.

2

Failure to involve them in planning

Involve the stakeholders throughout the project

Have all stakeholders within the project to provide support

Ongoing

Poor leadership

2

Incompetent nurse leaders.

Employ transformational leadership to inspire and motivate for change.

Seek for help from transformational leaders who understand the need to empower others for change.

Ongoing

Appendix IV: GANTT tool

Patient Teach Back

► Watch How to Make a Gantt Chart in Excel

Montefiore Medical Center

Project Start:

Tue, 5/3/2022

Patient teach back

Today:

Mon, 7/25/2022

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F

S

S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phase 1 Proposal design

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Present the need to educate patients to the project instructor

100%

5/3/22

5/3/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discuss with nurse leader

100%

5/3/22

5/3/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Develop project proposal

100%

5/3/22

6/6/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval in the clinic

100%

5/3/22

5/10/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Present proposal to facilitator

100%

6/13/22

6/15/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phase 2: Educating Nursing staff

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chunk and Check practice

50%

5/25/22

5/25/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 2 Consistent teach-back method

50%

5/26/22

5/27/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 3 Show-me method

 

5/25/22

5/26/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 4 use of handouts

 

5/25/22

5/27/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 5 Questions to attract teach back from patients

5/25/22

5/28/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phase 3 provider Discussions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 1 Design PowerPoint Presentations

5/16/22

5/21/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 2 Teach nurses

 

6/4/22

6/10/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 3 Allow open discussions

6/4/22

6/10/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 4 Answer issues of concern

6/4/22

6/10/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phase 4 Implementation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 1 Use of teach-back method in patient education

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 2 observe for consistency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phase 5 Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 1 evaluate for consistency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Task 2 Analyze patient satisfaction