By Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP
Quality patient education is essential for comprehensive health care and will become reimbursable under healthcare reform in 2014. However, it’s difficult to provide effective education when time for patient interactions is limited. You can enhance your instruction time—and make your teaching more memorable—by using the techniques of analogy and metaphor.
Powerful tools
Analogy and metaphor are figures of speech that have been used since the time of Aristotle and Plato. (See Comparing analogy and metaphor by clicking the PDF icon above.) Why are they so powerful for patient education? Because analogy and metaphor can make abstract concepts real, helping patients understand why they are ill and how suggested changes will help correct underlying causes.
Analogy and metaphor create a form of cognitive “scaffolding” on which patients can hook new material to information they already understand. Educational theorist David Ausubel suggests that learners (such as patients) require frameworks into which new information can be assimilated. An analogy or metaphor can act as an anchoring concept or an organizer for providing such a framework.
Research supports that analogies and metaphors can improve communication with seriously ill patients, such as those with advanced cancer. Casarett and colleagues conducted a cross-sectional study of audio-recorded conversations between patients and physicians. The results demonstrated that analogies and metaphors improved patient understanding and communication.
Using analogy and metaphor effectively
How can analogy and metaphor be used in patient education? The uses are limited only by the clinician’s creativity.
A primary care practitioner uses analogy to discuss good self-care practices. She tells patients that persons with quality self-care drive their bodies like Cadillacs while self-
neglecters drive their bodies like jalopies.
Even bad life circumstances can be used educationally. A psychiatric colleague uses the metaphor of a toaster: Acute illness is like a toaster. You put something in (the patient) and it comes out better than it was before (in terms of resilience). An oncology specialist colleague discusses the role of heredity (genetic predisposition) and environment in cancer development: Genes load the gun; environment pulls the trigger.
A metaphor for chronic wound healing is the light switch: The prolonged inflammatory process of delayed healing is similar to a light switch stuck in the “on” position. Interventions, such as debridement and other advanced modalities, aim at switching the light (inflammation) off. Another colleague specializing in GI disorders likens constipation to “not taking the garbage out enough.”
In a relatively recent systematic review of effective teaching strategies and methods of delivery for patient education, the analysis of published research studies found that the best patient education strategies were culturally appropriate, patient specific, and structured. Analogy and metaphor can address all three characteristics if well planned.
The literature also suggests that Humor (used appropriately) can augment the use of Analogy and Metaphor and allow teachers to HAM it up for better learning. Humorous analogies or metaphors that are relevant to patients’ interests offer maximum effectiveness. The vividness and active engagement that typify funny metaphors and analogies have the capability to instruct in ways beyond words alone. Laughter and humor may allow the patient to experience a “refreshing pause” cognitively and help “ha-ha” become “aha!”
Metaphors and analogies can describe the education or learning process itself. The clinical educator helps the patient “plant seeds,” “peel away the layers,” or “switch on a light bulb.” The educator can capture boring, lifeless lecture material and “bring it to life.” This outcome is particularly helpful in more abstract areas, such as mental health issues and science concepts.
Optimal outcomes
Understanding quality patient education is important for optimal patient outcomes. Techniques such as analogy and metaphor can help patients learn more effectively and create a positive, relaxed learning environment. More importantly, metaphor and analogy appeal to multiple learning senses and can instruct in ways eclipsing the limits of words.
Selected references
Ausubel DP. Educational Psychology: A Cognitive View. New York, NY: Holt, Rinehart, and Winston; 1968.
Casarett D, Pickard A, Fishman J, Alexander S, Arnold RM, Pollak K, Tulsky J. Can metaphors and analogies improve communication with seriously ill patients? J Palliat Med. 2010;13(3):255-60.
Clark AM. Getting street wise: a metaphor for empowering nurses for evidence-based practice [editorial]. Nurse Educ Today. 2013;33:3-4.
Friedman AJ, Cosby R, Boyko S, Hatton-Bauer J, Turnbull G. Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations. J Cancer Educ. 2011;26:12-21.
Garner R. Humor, analogy, and metaphor: H.A.M. it up in teaching. Radical Pedagogy. 2005;6:2. http://api.ning.com/files/R18274ktz-SL3T526y64FI7mTw3opCDMjU-8J46Cl13T8wN2hUNHWCJ5kAFXxo9LnoJzqHzBGM*qzYyjGFuedV09FP4crWmZ/
HumorAnalogyandMetaphor.htm. Accessed April 7, 2013.
Hume K. Unexpected connections: teaching through metaphor and analogy. Teach Magazine. May 3, 2011. http://teachmag.com/archives/3432. Accessed April 7, 2013.
Hydo SK, Marcyjanik DL, Zorn CR, Hooper NM. Art as a scaffolding teaching strategy in baccalaureate nursing education. Int J Nurs Educ Scholarsh. 2007;4(1):1-13.
Neibert K, Marsch S, Treagust DF. Understanding needs embodiment: a theory-guided re-analysis of the role of metaphors and analogies in understanding science. Sci Educ. 2012;96(5):849-77.
Sutherland JA. Teaching abstract concepts by metaphor. J Nurs Educ. 2001;40(9):417-19.
Janice M. Beitz is professor of nursing at Rutgers University School of Nursing in Camden, New Jersey.