Any nurse would be dreaded to hear that a patient that was recently discharged is readmitted due to medication errors or complications. Several research studies have shown that when a patient does not fully conform to the knowledge of discharge, they become exposed to the risks of medication errors and complications thus their chances of readmission increases ( Kornburger et al., 2013) . For the chronic obstructive pulmonary disease (COPD) patients, there is a need for self-care. It is the responsibility of the nursing staff to ensure that the patient is well versed with the knowledge by educating them. The teach-back method is one method that has proven to be an effective tool in patient education in matters concerning self-care. Also known as “closing the loop,” the method is used in patient education to check whether the patient or member of the family has understood the information they have been given ( Tamura-Lis, 2013) . They are required to explain to the educator what was communicated, in their own words. This leads to an effective communication between the client and the provider. The patient is given chance to explain, express themselves, and ask questions related to personal care.
By educating the patients, teach-back strategy enhances their adherence to the management of their conditions and makes them accountable for their health ( Dinh et al., 2016) . Especially for patients with chronic diseases, the enhancement of self-management skills through effective communication is an important part of the entire healthcare specifically after discharge. In order for them to effectively manage their health, the client must understand that specific condition, its signs and symptoms, the reasons behind its treatment, side effects of medications, and the signs of wrong medication ( Dantic, 2014) . It also helps them understand the correct period to seek professional healthcare services. For those patients with chronic diseases who need to stay at home to manage themselves, they have to learn how to independently manage the disease in the long run. The technique of teach-back thus puts the client, not the caregiver, in the primary role of disease management ( Caplin & Saunders, 2015) . Effective communication increases the confidence of a patient in managing their health, especially when performing specific tasks like adjusting medication, correct use of medical equipment such as inhalers, and knowing when to seek medical advice. This paper will look at the ways in which the teach-back technique has helped in the improvement of patient outcomes and satisfaction ( Centrella-Nigro & Alexander, 2017) .
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Methodology
For the case of this literature review, the methodology employed included searches via Google Scholar on the online scholarly articles and journals. Also, there was the use of university online library to look up for literature concerning patient-provider communication. The searches were done using keywords like teach-back, patient education and patient literacy, effective patient communication and patient outcomes. The resulting documents were narrowed down and the selection was done on the basis of age, with the ones less than five years but no more than ten years old being picked. Another rationale used to choose the documents were on the relativity to the subject matter and the availability of full-text version or free access. Thirteen documents were selected by their relativity to the content and the full-text availability. Of these, ten were utilized to develop this literature review.
Literature review
COPD is one of the most notorious chronic diseases that account for about a third of the deaths worldwide. The complications that result from the chronic diseases are due to misinformation or improper interpretation of the instructions from the patient side. This calls for the employment of techniques that see the patients taking primary role of their self-care. They must fully understand and effectively execute the management of their care. This comes as the present time sees lesser face-to-face time between the clients and the health care providers as COPD can be a lifelong disease due to its lack of a cure. Thus the only intervention is a treatment that can be expensive from the facility. This gives way to the effective communication tools that can be used to disseminate information on self-care. In this case, teach-back has proved to be effective in maintaining high memory for the instruction and treatment.
Teach-back is a technique that is used as a communication tool to assist medical clients to recall and understand the essential information that was addressed during their diagnosis, treatment, or medication. This technique involves the nurse or the educator asking the patient to remember and explain or show through demonstrations the important information that was discussed with the caregiver team. This technique is not limited to COPD setting alone as it can be employed to any area, and any time a health care team member is interacting with a patient. The closing the loop may increase the chances that the client will understand the information shared and the instructions for medication.
It is a commonplace to see there rising a problem due to poor communication between the healthcare providers and the clients. The result may be lack of understanding by the patient about the diagnosis and treatment. In most cases, the health care provider encounters a situation whereby the patient does not understand the presented information. In one of the many surveys, 47 percent of the patients indicated that they had forgotten the instruction that the doctor gave by the time they were leaving the facility ( Dantic, 2014) . In another study, when the health care providers asked the patients to explain the instructions that were given before they were discharged, almost 50% reported the information incorrectly. This means there exist a disparity and gaps between the information that the doctors give, what the patient grasps, and what they recall correctly.
In one study to determine the effect of teach-back technique as compared to the conventional briefs in COPD settings, the misuse of metered-dose inhalers were lower in the case of patients that received the teach-back technique ( Mathew et al., 2017) . The briefer instruction is always given to asthma and COPD patients with regards to the use of their inhalers ( Press et al., 2012) . In this survey, the patients showed no difference in inhaler misuse 30 days after instruction. However, the patients that received the teach-back technique reported much lower acute-care events (17 percent) of COPD in the month following discharge from the hospital as compared to the group that received a briefer instruction (36 percent) ( Mathew et al., 2017) .
Discussion
The aim of the teach-back technique is to ensure patient adherence to the medication and treatment procedure and to ensure the self-management is sufficiently executed. Through this empowerment, the patient is able to improve their coping with the disease. The teach-back technique ensures the patient has enough confidence in controlling and the conditions and making them capable to cope with the situation. Another aim is to see that they have control of their lives and are a part of their path to the management of the chronic illness. When a patient is taught how to properly handle and use the inhaler, they feel confident that they are part of the solution and that their health is in their hands. Thus, there arise fewer cases of readmission after education ( Peter et al., 2015) . As a matter of fact, the interventions that promote self-management have been linked with providing the patient with enough knowledge and encourage them to learn the necessary skills required in the reduction of symptoms of the condition and achieve a higher quality of life.
However, before the nurse or the educator administers the teach-back technique, he or she should consider several factors which are connected to the patient ( Melzer et al., 2017) . First, the nurse must have in mind that the clients do not mostly understand medical jargons thus their use should be minimal or avoided as much as possible. Also, there is the likelihood that the elderly have a lower health literacy and cognitive ability, thus there should be a family member to take the education. In some instance, there might be a language barrier especially when English is not the first language of the patient. To avoid the futile work, the nurse must ensure that before administering the education, the client or a family member understands English.
The patient can at times exhibit malaise or lack of focus due to the disease. Finally, there are cases whereby the emotional response to the diagnosis of COPD affects the patient’s concentration and thus the stability is essential ( Melzer et al., 2017) . When a person is diagnosed with a chronic disease like COPD, the overall reaction is that there must be changes in lifestyle, psychology, and emotions as they are now living with an incurable disease. This can disturb the patient mentally and thus require consolation. Through patient education, they feel they are not isolated and that their input is considered important thus a degree of contentment arises.
In most of the literature documents reviewed, the teach-back technique helped in the improvement of patient outcome in the short run ( Centrella-Nigro & Alexander, 2017) . In this case, the clients learned the correct ways of using the inhalers, the doses are taken, and the overall self-management ( Press et al., 2012) . Therefore, there lacks statistical evidence on the long term effect of the technique. Thus, more research is required to assess the importance and how teach-back can be to these patients in the long term.
The above literature shows that there is an improvement in patient outcome after the administration of teach-back technique in patient education. COPD patients have to learn ways in which they can take care of themselves at home and this is entirely the work of the nursing team or the health care provider to ensure that they do it with the goal of helping the patient in self-management. This should be done profoundly as it has been found that patients forget 50 percent of what they are briefly taught after being discharged.
References
Caplin, M., & Saunders, T. (2015). Utilizing teach-back to reinforce patient education: a step-by-step approach: Orthopaedic Nursing , 34 (6), 365-368.
Centrella-Nigro, A. M., & Alexander, C. (2017). Using the teach-back method in patient education to improve patient satisfaction The Journal of Continuing Education in Nursing , 48 (1), 47-52.
Dantic, D. E. (2014). A critical review of the effectiveness of ‘teach-back ‘technique in teaching COPD patients self-management using respiratory inhalers: Health Education Journal , 73 (1), 41-50.
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 database of systematic reviews and implementation reports , 14 (1), 210-247.
Kornburger, C., Gibson, C., Sadowski, S., Maletta, K., & Klingbeil, C. (2013). Using “teach-back” to promote a safe transition from hospital to home: an evidence-based approach to improving the discharge process: Journal of Pediatric Nursing: Nursing Care of Children and Families , 28 (3), 282-291.
Mathew, M. R., Mohan, L., Paul, M., Maideen, M., Jose, L., & Ommanakuttan, M. (2017). Evaluating effectiveness of patient counseling, teach back versus standard method. International Journal of Basic & Clinical Pharmacology , 7 (1), 87-92.
Melzer, A. C., Ghassemieh, B. J., Gillespie, S. E., Lindenauer, P. K., McBurnie, M. A., Mularski, R. A., ... & Au, D. H. (2017). Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD: Respiratory medicine , 123 , 124-130.
Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015). Reducing readmissions using teach-back: enhancing patient and family education. Journal of Nursing Administration , 45 (1), 35-42.
Press, V. G., Arora, V. M., Shah, L. M., Lewis, S. L., Charbeneau, J., Naureckas, E. T., & Krishnan, J. A. (2012). Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: a randomized trial: Journal of general internal medicine , 27 (10), 1317-1325.
Tamura-Lis, W. (2013). Teach-back for quality education and patient safety: Urologic Nursing , 33 (6), 267.
