Return-demonstration — for motor skills and devices
The patient or caregiver performs the skill in front of the nurse. Used for insulin injection, inhaler/spacer, glucometer, wound care, ostomy, suctioning, oxygen titration, tube-feeding setup. Documentation includes: the specific skill; the steps observed and corrected; the final accuracy as a fraction or percent (e.g. “8/10 steps correct on second attempt”); and a re-evaluation plan if accuracy is under 100%.
Return-demo documentation
Patient performed insulin injection with a pen device. First attempt: dialed the dose correctly and primed appropriately, but used the same site as the prior injection (no rotation). Re-instructed on the rotation pattern (clock-face method on the abdomen). Second attempt: 100% accurate including dose, prime, angle, 10-second hold, site rotation, and safe needle disposal. RN judgment required to detect the technique error preventing lipohypertrophy and erratic absorption.
The audit-defensible teaching pattern
Topic + Method + Audience + Mastery measure + Reinforcement plan. All five elements. Skip any and the teaching note is incomplete. When mastery is partial, the note must show what to do about it — “teach-back 50% — will re-teach next visit” is acceptable; “teach-back 50%” alone is not.
