NU108 Unit 6 Seminar Reflection Example

Nothing by Mouth Meant No Pills to Her: A Seminar Reflection on a Composite Family Who Understood a Fasting Instruction Differently Than It Was Meant, Examined Through Teach-Back and Plain Language

[Student Name]

Purdue University Global

NU108: Health Professions Transitions

Unit 6 Seminar Reflection

[Instructor Name]

[Date]

The patient, family and classmate are composite; the classmate is identified by role only.

The Moment We Discussed

In this week's seminar on communication with patients and families, a classmate who works as a patient care technician described a moment from her unit. An older woman, [Mrs. P.], was scheduled for a morning colonoscopy. The evening before, a nurse told her daughter that her mother should have "nothing by mouth after midnight." The team intended for Mrs. P. to take her morning blood pressure medicine with a sip of water, as written in the procedure instructions. Her daughter, careful and wanting to follow the rules, withheld everything, including the pills. In the morning, Mrs. P.'s blood pressure was [184/96], and the procedure was delayed while it was brought down.

My first reaction was that the daughter had misunderstood. By the end of the discussion, I saw that the instruction itself had been unclear. "Nothing by mouth" is a phrase health workers use so often that it feels plain, but to a family member it can reasonably mean exactly what it says: nothing at all.

The Principle: Plain Language and Teach-Back

Our instructor connected the moment to two related practices. Plain language means using common words, short sentences and specific instructions, so a person does not have to interpret what is meant. Teach-back means having the listener restate the plan as they understand it, so the speaker can check understanding and correct it before it matters. A systematic review of teach-back found it in use in hospitals, clinics and homes, generally linked to better understanding and some improved outcomes, while noting that how it was carried out varied widely (Talevski et al., 2020). A second systematic review, of people with chronic disease, found teach-back was linked to better adherence and self-management in several of the included studies (Ha Dinh et al., 2016).

Applied to Mrs. P., plain language would have meant naming what to stop and what to continue: "Do not eat or drink anything after midnight, except take your blood pressure pill at 6 a.m. with a small sip of water." Teach-back would have meant asking the daughter, "Can you tell me what your mother will take in the morning?" Her answer would have shown the misunderstanding the night before, when it could still be fixed.

The instruction was accurate and the daughter followed it exactly; the gap was between what the words said and what the team meant by them.

Why This Changed My Thinking

I recognized myself in the nurse's phrase. In my job as a pharmacy technician I have told patients to take medicines "with food" or "on an empty stomach" without checking what they thought those meant. A patient once told me she took her empty-stomach medicine after a glass of milk because milk was not food. I had blamed her at the time. The seminar showed me that I had been treating the patient's understanding as the patient's responsibility, when checking it is part of giving the instruction.

I also learned that teach-back is not a test of the patient. Our instructor suggested framing it as a check on the speaker: "I want to be sure I explained this well. What will you do with this medicine tomorrow?" That wording protects the person's dignity, which matters especially with family members who are anxious about getting things right.

What Remains Difficult

I am unsure how to use teach-back when time is short, such as during a busy discharge with several new instructions. One classmate suggested choosing the two or three most important instructions and checking only those. Another pointed out that written instructions should match the spoken ones word for word, because families compare them later. I want to practice both in clinical settings. I also wonder how teach-back works through an interpreter, where a misunderstanding could come from the translation rather than the instruction; the classmate who raised the original story said her unit uses the interpreter to ask the teach-back question directly, which I had not thought of.

What I Will Say Differently

I will avoid shorthand such as "nothing by mouth," "PRN" or "with food" when talking with patients and families, and will say instead exactly what to take, when and with what. I will name exceptions out loud rather than assuming they are understood. And for any instruction that could cause harm if misunderstood, I will have the person walk me through what they plan to do. The nursing code of ethics describes respect for a patient's ability to make informed decisions (American Nurses Association, 2015), and a decision cannot be informed if the instruction behind it was misunderstood.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.

Ha Dinh, T. T., 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. https://doi.org/10.11124/jbisrir-2016-2296

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), Article e0231350. https://doi.org/10.1371/journal.pone.0231350