Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

Committee Chair

Gayle Casterline


Effective nursing communication considers health literacy, the person’s ability to understand and make health decisions based on the information given. Health professionals often overestimate the health literacy of patients, thereby affecting patient outcomes. In a hospital environment, patients rate the ability of the nurse to explain things in a way patients understand by completing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) after discharge. The HCAHPS results are converted to a score which is used in a formula to determine hospital reimbursement; the lower the score, the lower the reimbursement. The purpose of this project was to improve nurse communication skills and facilitate patient understanding of care. A literature review revealed the teach-back method as a best practice strategy. Teach-back is a communication technique designed to improve patient understanding about what was said by healthcare providers. Teach-back is a way of presenting information, then asking patients to repeat what was said in their own words. An education module designed to improve nurse communication skills was implemented on a 14-bed hospitalist medical unit for the registered nurse staff (N=13). The education included content on health literacy and the teach-back method of communication. Nursing staff was surveyed before (61.5% response rate) and six weeks following (50% response rate) the educational offering, using the Health Professionals Communication Skills Scale (HP CSS), an 18-item tool measuring empathy, informative communication, respect, and social skills. In addition, patient responses to the HCAHPS question, the nurse explained things in a way you could understand were compared before and after the educational offering. Overall, the post-survey responses were lower than the pre-survey responses in each domain, indicating a decreased perception of communication by the nursing staff. The aggregate mean score for informative communication decreased from 5.01 to 4.83 (p = 0.37) and social skills decreased from 3.85 to 3.75 (p = 0.87) on the post-survey, with significant aggregate mean score decreases for respect 5.46 to 4.76 (p<.05) and empathy 5.32 to 4.77 (p<.05) post-survey. All patients discharged home from this facility receive the HCAHPS survey; the average response rate is 12%. During the pre-implementation period (September – November) 22 patients completed the survey and during the post implementation period (January–March) only three patients completed the survey. Outcomes will be monitored as communication between nurses and patients improves over time. Education on the best practice strategy of the teach-back method of communication has been implemented for all bedside staff within the organization, including newly hired nurses. A teach-back module had been placed in the electronic learning management system for mandatory completion by all staff. With this multi-level approach to implementing teach-back, patients should have greater opportunities for understanding their care.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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Nursing Commons