Health Literacy Tips: Speak Plainly, Teach Often

When admitted to a hospital, a patient and their loved ones are given a generous amount of information. The patient's condition, treatment plan, prognosis, discharge instructions, lab reports, and more are a lot to digest. Health literacy is key to helping everyone understand what is happening and make informed, shared decisions about health care.

America's health literacy challenge

According to reports based on research by the U.S. Department of Education, nearly 130 million American adults read below a sixth-grade level, and only 12% of Americans have proficient health literacy skills. Healthy People 2030 defines health literacy as the extent to which "individuals have the ability to find, understand, and use information and services to inform health-related decisions for themselves and others."

The challenge in health literacy is that it can be impacted by several factors, including age, reading level, language barriers, religious beliefs, culture, ethnicity, socioeconomics, disabilities, and more. And if all of these factors are not considered by nurses and other members of the healthcare team, then health literacy will be inadequate.

Inadequate health literacy can affect timely access to care, continuity of care, and patient satisfaction. It can also contribute to low compliance with discharge instructions, which can increase the chances that a patient will be readmitted. Knowing how to promote health literacy with patients and their families is key to helping patients recover in-hospital and continue healing post-discharge. Here are some tips that can help.

Start trust building on day one

[caption id="attachment_106363" align="alignright" width="250"] Shalla Newton, RN[/caption] Don't delay. Start promoting health literacy when you first meet the patient and family. Assure them that they are in an inclusive care environment and that staff will be respectful of their cultural and spiritual beliefs and sexual or gender orientation, as well as their communication preferences. Encourage them to participate in their care. Identify the patient's decision makers, and include them in any discussions throughout the hospital stay and during discharge planning.

Assess your patient, then act

Do a full assessment of the patient's ability to understand health information and participate in treatment decisions and plans. Determine if any hearing, speech, language, or cognitive issues could affect their ability to communicate or understand health information. Be prepared to address any barriers you encounter. Identify the patient's preferred language for discussing health care, note it in the medical record, and communicate it to all staff who will be caring for the patient. If the patient's preferred language is not English, plan for language services to help with interpretation and for educational materials and consents to be available in the proper language.

Choose teaching materials wisely

Use teaching materials that supplement your explanations about diagnoses and treatments. These materials should be appropriate for each patient's reading level and preferred language.

Use the primary nursing model

In the primary nursing model, the primary bedside nurse assumes most of the role of educating the patient and family and ensuring they understand and can comply with the diagnosis and ongoing care. This nurse serves as the point person for collaboration among interdisciplinary teams for the patient's care plan. Two primary nurses may care for the patient due to shift changes, but the primary nurse gives report to all other nurses on the care team, defining not only the action plan for care, but also further literacy needs.

Practice the teach-back method

With the teach-back method, nurses first ensure the patient and family understand the diagnosis, treatment plan, and next steps, including continuity of care. The patient or family (if the patient is not able to respond or understand or is a pediatric patient) then must show they understand what they were taught and teach it back to the nurse. This is an ongoing process that happens multiple times throughout a patient's hospital stay, especially prior to discharge. Research shows the method can reinforce patient education and improve patients' knowledge of their condition, comprehension of discharge instructions, and medication adherence.

Speak carefully, then listen

Medical terms, treatments, and diagnoses don't have to sound so complicated. Leave the medical jargon for conversations with other healthcare professionals. Each time you provide updates to patients and their family members, do so without rushing through your presentation. A patient does not -- and shouldn't have to -- care that you were assigned too many patients and are pressed for time. Exclaiming "Everything looks good!" may be music to a patient's ears, but it's not very specific. Take a few extra minutes to explain what that means. Likewise, if you find cause for concern or more testing, explain what the tests are called (without medical jargon), what the purposes are, and what the tests are looking for. If you're waiting for the physician to explain in more detail, provide as much information as you can and keep the family updated. If a new development occurs, let them know as soon as possible. Trust can diminish if, for example, a recently discovered complication such as an infection is not thoroughly explained. To the best of your ability, explain the origin of the infection, the treatment method (IV med? Topical solution? Both?), when you expect to see results, and if the infection will affect the patient's recovery in any way. Providing detailed information is something that should be done for every patient -- even if that patient is also a nurse, said Shalla Newton, MSN, RN, NE-BC, a subject matter expert and medical writer for Relias, and a passionate advocate for health literacy. Newton shared an experience she had during a recent hospitalization.

"I was not informed my labs and vitals indicated potential sepsis, as I was half asleep in the middle of the night," Newton said. "At 4:00 a.m., a nurse came in and said they will be in here every 30 minutes checking my vitals and labs and increasing my IV antibiotics. I asked why, and she assumed I knew I was on a sepsis protocol. She assumed as a nurse myself, I just knew."

Be thorough when providing instructions during hospitalization or when providing discharge instructions, but be careful not to sound patronizing. This could cause the patient or family to lose trust, stop communicating, or become angry. Allow patients plenty of time to ask questions or take notes. Summarize your explanation and the next steps in treatment.

Use carefully curated visual aids

Visual aids, such as videos, photos, or illustrations can help patients better understand health information. But not just any health video or photo will do -- choose visual aids that are not only culturally sensitive, but are very specific to what you are trying to teach or demonstrate.

Caution patients about the internet

According to the Centers for Disease Control and Prevention, 74% of all U.S. adults use the internet, and 61% have looked for health or medical information online. Given that patients and their families are likely to search online when they have questions, steer them away from websites that provide inappropriate, unfounded advice or treatment methods.

Send them home prepared

Explain discharge instructions carefully, and let them know who to ask if they have follow-up questions. If the hospital makes follow-up phone calls, the patient and family should be told to expect a call and what the call will entail. Prepare a list of providers who offer services to meet the patient's needs. Newton, who emphasizes that education and health literacy begin at admission, but do not end at discharge, cited the California-based Nurse-led Discharge Learning Collaborative, or the CANDLE Collaborative, as an example. The collaborative aims to improve discharge care delivery in pediatric centers across the country for children with medical fragility diagnoses or complex and rare diseases. Newton said in the discharge care delivery model preferred by the collaborative each patient and family has a dedicated team that sees to their needs. "Continuity of care is a must," she said. "The patient must have a primary care physician or specialist who will be the gatekeeper and assume care if the patient doesn't have one already." In this model, teams use the primary nursing model and teach-back methods to help "ensure the continuity of care upon discharge," she said. Newton, who has two rare diseases driving aggressive systemic diseases that make her immunocompromised, shared her personal experience as a patient to emphasize the importance of health literacy and the need for nurses' commitment to these efforts. "Our healthcare system is so siloed and fragmented and not meant to care for patients with complex and rare conditions like me," she said. "I circumnavigated my own complex care by curating a document that discusses my extremely rare and complex diseases, treatment plan, baseline norms, and standing orders when hospitalized, which helps both the hospital and any new outpatient providers on my care team. When your care team feels at ease and more comfortable with treating complex cases by increasing their health literacy about your disease, the trust and shared decision-making only become easier." Read more about Newton's personal journey on the website sdthe411.com. Take these courses on how to enhance your communication skills:

Improving Patient Education for Poor Readers

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