I was working at a teaching hospital and rounding with the neurology team when we came into J’s room. The medical student had done her research and put together a thorough history. She stood at the foot of the bed and proudly told the patient, family, and medical team, “J is a 66 year old female who has suffered a cerebrovascular accident of the right hemisphere caused by a thromboembolism. She now has dysphagia and hemiparesis of the left side. There is a 20 percent chance of a full recovery.” The group murmured amongst themselves about recommendations and as the attending turned to lead the group out of the room he paused a moment to ask the patient and family, “Any questions?” The patient struggled to speak, while the family looked blankly at the physician. “Very well,” he said, “we’ll see you tomorrow.”
The Affordable Care Act defines health literacy as, “The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.” Low health literacy is a widespread issue with recent studies showing that 88 percent of Americans have limited health literacy. People with low health literacy are more likely to skip preventative services, take medications incorrectly, and have less knowledge about their health. This leads to more visits to the ED, increased readmission rates, and low patient satisfaction.
Health literacy needs to be addressed in multiple ways. From the signage used in healthcare facilities to direct patients, to the format of educational materials, to our personal interactions, each patient touch point needs to be evaluated and altered so that the patient has an understanding of what is taking place. As nurses, we can address the issue by taking immediate steps to improve how we communicate with patients.
We can start by assuming all of our patients have limited health literacy skills. Even those who are highly educated prefer simple terms when it comes to health information so practice plain language by avoiding the use of medical terms and jargon. A patient is much more likely to understand that he cannot move his left side than the phrase “left hemiparesis”. Cerebrovascular accident is a term that had meaning to the medical team rounding on J but meant nothing to her and her husband.
Provide plenty of time for educating patients. Slow down the pace of your speech and use pictures to reinforce what is being said. Keep numbers to a minimum and reduce the need for calculations whenever possible. Telling J and her husband, “We don’t know how much function J will get back,” is simple, straightforward and easier to understand than a 20 percent chance of full recovery.
Take time to verify the patient’s understanding by using the Teach Back method. Return demonstrations are a great way to do this for physical skills the patient will need to master. Another way to do this without shaming the patient is to say, “I want to make sure I explained everything clearly, so please tell me (when you will call the doctor, what to do if your blood sugar is under 70, what you will do if your baby doesn’t have at least six wet diapers a day, etc.).
Finally, ask the right questions. “What questions do you have?” sets the tone that questions are expected and welcome. This encourages the patient to ask for clarification and a chance to repeat items that need more clarification. Stop frequently to do this so there is time to address the questions before moving on to the next item.
The day I was caring for J I finished rounds and returned to her room. Her husband asked if I could tell them what the doctors had meant earlier. I explained that J had suffered a stroke from a blood clot in her brain and because of that she was frozen on her left side and had difficulty swallowing. The doctors didn’t know if she would return to what she had been like before the stroke. He looked a little angry and said, “Well then, why didn’t they say it like that?”