Let the patient interrupt your teaching

I just got a question via social media from a nursing student.  She didn’t understand why I said: when you are teaching, you should let the patient interrupt you rather than say, “Wait until I am done and then you can ask questions.”

Because the evidence shows: Adults learn in conversation, not lecture.

When you’re teaching and the patient interrupts you, it’s either with a question or comment.  The patient may need clarification, or share an observation on how what you said fits or doesn’t fit into what he or she knows or does.  This is called engagement.  This is a teachable moment.  You have the patient’s attention and involvement.  This is where learning occurs.

If you are lecturing and do not let the patient interrupt, learning is stifled.  The patient may continue to think about the question or comment while you speak, trying not to forget it for later.  Or the patient may focus on the emotion of feeling frustrated or confused.  The teachable moment is lost.

Teaching is an interactive process. The ultimate goal is to help the patient change self-care behaviors to improve health outcomes.  Transferring information is only one small part.  If you are to help the patient change self-care behaviors, you need the patient to understand what needs to be done differently, and why, and commit to making the effort to change.  Conversations are the process by which this happens.

This example also shows why patient-centered care is more effective.  A lecture followed by an opportunity to ask questions, which would be provider-centered teaching, takes the equality and collaboration out of the relationship.  The subtext is, “I know stuff and you don’t, so listen to me.” However, in reality, the patient is an adult who had the knowledge and skills to function in life just fine until this health situation appeared.  The patient does know stuff, and uses that knowledge every day.  The patient may hear you, but choose not to do what you propose, and you have no power to change that.  If your work is to be effective, you need to help this patient understand the new health situation, learn what needs to be done differently, and facilitate the change of behaviors (like take medicine or change lifestyle) to improve health outcomes.  If you don’t let the patient interrupt, to share his or her concerns or experiences, you are stopping the patient from processing and internalizing the new information.  You are showing disrespect for the patient’s autonomy and discounting his or her responsibility in addressing the situation.

Lecturing is not an efficient or effective way to teach.  It may take less time, but it doesn’t work.

©2017 Fran London, MS, RN

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