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Implementation and Evaluation of Teach-back as a Pedagogical Method for Delivering Fall Prevention Education to Older Adults in an Inpatient Hospital Setting Elizabeth Bosley Background: In the United States, the most common cause of both nonfatal injuries and accidental deaths for people older than 65 is falls. In the hospital setting, 700,000 to 1,000,000 falls occur annually resulting in increased cost and reduced reimbursement. There exists a critical need to explore potential interventions for effectiveness in reducing both the incidence and severity of falls. Teach-back is a patient education methodology that is a highly recommended safety practice and may be an effective intervention to reduce patient falls in the hospital setting. Objectives: 1) To increase the use and documentation of a validated patient education methodology by registered nurses to decrease falls in patients 65 years of age and older in a specific hospital unit. 2) To decrease the rate of falls and falls with injury in patients 65 years of age and older in a specific hospital unit through implementation of the Teach-back patient education methodology. Method: A quasi-experimental design was used employing a combination of parametric and non-parametric tests to analyze the data for both objectives. Objective One: Two hundred and forty older adult patients comprised the sample. The independent variable was Teach-back education for nurses. The dependent variables were using a caring tone of voice and attitude, displaying comfortable body language, using plain language, providing falls prevention patient education using Teach-back, using open-ended questions, avoiding using yes or no questions, taking responsibility for making sure instructions were clear, explaining instructions again if patients could not Teach-back and documenting the use of Teach-back. Nurses were observed teaching 120 patients about falls prevention prior to Teach-back education and then observed teaching 120 patients about falls prevention following Teach-back education. Objective Two: The independent variable was falls prevention patient education using Teach-back. The dependent variables were falls and falls rate with injury per 1000 patient days. These rates were compared for February, March, and April of 2015 (pre-education) and February, March and April of 2016 (post-education). Results: Objective One: Analysis of the data indicated no association existed between the independent variable (Teach-back education for the nursing staff) and the dependent variables of using a caring tone of voice and attitude, displaying comfortable body language and using plain language. Statistically significant associations did exist between the independent variable and the remaining six dependent variables. Objective Two: Analysis of the data indicated that there was no significant difference in falls or falls with injury per 1000 patient days between the two timeframes. Conclusion: Nurses consistently used and documented Teach-back for falls prevention education once provided with the procedure and rationale thereby utilizing an evidence-based methodology to improve communication with the patient. Although there was no significant relationship between Teach-back and falls and falls with injury per 1000 patient days, the simplicity and potential efficacy of Teach-back warrants further study. Dedication This work is dedicated to my wonderful husband Tom who chose to embark on this journey with me 38 months ago. I could not have possibly made it through without his patience, advice, and superbes et magnifiques editing skills! His support, whether praise or tough constructive criticism, always came from a place of love and I’m a better person for it. I also dedicate this work to my mother Dorothy Sowards, who has always been my greatest cheerleader. Her unflagging interest in my progress exemplifies what a mother will endure to help their child achieve their dreams. Finally, I thank my family, especially my siblings, Bill, Marty, and Louise for always pitching in to make sure life went on so I could devote my time and energy toward my education, and to our wonderful daughters, Meghan and Jennifer, I thank you for listening and supporting me.

Implementation and Evaluation of Teach-back as a Pedagogical Method for Delivering Fall Prevention Education to Older Adults in an Inpatient Hospital Setting