NUR 545 Module 5 Teach-Back Script Example

Teach-Back Script: Teaching Metformin and Glucose Checks to a Night-Shift Worker With Low Numeracy

[Student Name]

Southern New Hampshire University

NUR 545: Advanced Health and Literacy Assessment

Teach-Back Script

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Teach-Back Script: Teaching Metformin and Glucose Checks to a Night-Shift Worker With Low Numeracy

Teach-back is a way of checking understanding in which the clinician asks the patient to explain or show, in their own words, what they need to know or do, and then clarifies and checks again until the patient can do so correctly. It tests the teaching, not the patient. A systematic review of 20 studies found teach-back effective in 19 of them, across outcomes from knowledge and recall to readmissions and quality of life (Talevski et al., 2020), and the AHRQ toolkit recommends it for every patient as part of health literacy universal precautions (Brega et al., 2015). This paper plans and scripts a teach-back session for a patient with limited numeracy, and argues that the script's value lies in its re-teach loop: the point where a misunderstanding surfaces and the nurse changes method rather than repeating the same explanation.

Planning the Session

Three facts shaped the plan. The patient's Newest Vital Sign score of 2 and his difficulty with calculation meant the session could not depend on numbers he had to work out (Weiss et al., 2005). He learns best by being shown. And he works nights, so every instruction had to be anchored to his shift rather than to morning and evening.

The session was limited to three need-to-know actions, since packing more into one visit lowers recall. First, take one metformin tablet with the 3 a.m. work meal. Second, check glucose before that meal three nights a week and write the number on a card. Third, know when to call: a reading above 300, or vomiting, or feeling very unwell. For the target, the plan used the pre-meal range recommended for most adults with diabetes, 80 to 130 mg/dL (American Diabetes Association Professional Practice Committee, 2025), but presented it as a green zone printed on his card rather than as numbers to remember. His daughter attended at his request, but the nurse addressed him directly.

The Script: Opening

Nurse: "We're going to go over three things today, and then I'm going to ask you to show me how you'll do them. That's so I know I explained it well, not to test you."

Patient: "All right."

Nurse: "First, the tablet. This is metformin. It helps your body use the sugar in your blood. You take one tablet with your big meal at work, the one around three in the morning. With food, because on an empty stomach it can upset your stomach."

The Script: First Teach-Back

Nurse: "So tell me, when are you going to take this tablet?"

Patient: "When I get up. Before work."

Nurse: "That's my fault; I wasn't clear. When you get up, around two in the afternoon, you're taking the blood pressure tablet. The metformin goes with your food at work. Let's put it in your lunch bag." (The nurse places the tablet bottle next to the patient's lunch bag and shows him the picture schedule, where the metformin sits beside a plate and a clock showing 3 a.m.)

Nurse: "Now show me, with the bag, when this one gets taken."

Patient (touching the bag): "This one goes in here. I take it when I eat at three."

Nurse: "Exactly."

The Script: The Meter

Nurse: "Second thing, checking your sugar. I'll do it first, then you do it." (Demonstrates: wash hands, put strip in meter, prick side of fingertip, touch blood to strip, read the number.)

Nurse: "Now you try it, and talk me through it as you go."

Patient does each step, forgetting to wash hands first.

Nurse: "Good. One thing before the strip: wash your hands, because sugar from food on your fingers can make the number wrong." (Patient repeats the check from the start, washing first.)

Nurse: "Your number is 164. Look at the card. Is 164 in the green part or not?"

Patient: "Not in the green. Higher."

Nurse: "Right. That's expected this week. The tablets will bring it down over time. Write it here."

The Script: When to Call

Nurse: "Third thing, when to call us. If the meter shows a number that's in the red part of the card, over 300, or if you're throwing up and can't keep food down, you call this number, day or night." (Points to the number printed on the card.)

Nurse: "Tell me what you'd do if you checked and it said 320."

Patient: "It's in the red. I call that number on the card."

Nurse: "And if you were sick to your stomach all night?"

Patient: "Call. Even if the number's okay?"

Nurse: "Yes, even then."

The Script: Closing

Nurse: "Last thing. Tomorrow at work, what are the three things you'll do?"

Patient: "Tablet with my three o'clock food. Check my sugar before I eat, wash my hands first, write it down. Call if it's in the red or I'm throwing up."

Nurse: "That's all of it. Bring the card and the meter in two weeks, and we'll look at the numbers together."

Why the Script Works

The script follows the core principles of teach-back as a method. It uses plain language, avoiding terms such as glycemic or hyperglycemia. It asks open questions that require explanation or demonstration rather than yes-or-no answers such as "Do you understand?" It places responsibility for any misunderstanding on the nurse, which protects the patient's dignity. And when teach-back revealed an error, the nurse changed the method, moving from words to a physical cue, instead of repeating the same explanation louder or slower (Brega et al., 2015). The meter was taught with a show-me approach because it is a skill, and the numbers were taught through a color-coded card because the patient's difficulty was calculation, not reading.

Documentation and Evaluation

The session is documented as follows: topics taught (metformin timing, glucose self-monitoring, when to call); method (demonstration, show-me, color-coded card, picture schedule); teach-back result (initial error on metformin timing corrected with lunch-bag cue; missed hand washing corrected; patient restated all three actions correctly at close); learner (patient, with daughter present by his choice); plan (review card, meter technique and adherence in two weeks). Evaluation will occur at the follow-up, when the patient will be asked to show his card, perform a glucose check and describe how he has taken his tablets. Improvement in his A1C over three months will be the clinical measure, but understanding and correct technique are the immediate ones.

Conclusion

A teach-back session is only as good as its willingness to discover what the patient did not understand. This script limits content to three actions, anchors each to the patient's night shift, teaches skills by showing, replaces numbers with colors and, when a misunderstanding appears, changes the method rather than the volume. Written out word for word, it shows that teach-back is not a question at the end of teaching but a loop running through it.

References

American Diabetes Association Professional Practice Committee. (2025). 6. Glycemic goals and hypoglycemia: Standards of care in diabetes 2025. Diabetes Care, 48(Suppl. 1), S128-S145. https://doi.org/10.2337/dc25-S006

Brega, A. G., Barnard, J., Mabachi, N. M., Weiss, B. D., DeWalt, D. A., Brach, C., Cifuentes, M., Albright, K., & West, D. R. (2015). AHRQ health literacy universal precautions toolkit (2nd ed., AHRQ Publication No. 15-0023-EF). Agency for Healthcare Research and Quality.

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

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514-522. https://doi.org/10.1370/afm.405