Conclusion and Why It Should Matter To You

According to the U.S. Department of Health and Human Resources, “Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.” I, as a nurse, am a patient advocate that needs to take responsibility in teaching my patients about their health, their medications, their home health regimens, etc.

                The topic about health literacy, especially in the elderly population is so critical because a lot of times these patients have a lot of comorbidities, more medications, and more at-home procedures and routines that must be followed in order to keep them healthy and out of the clinics and hospitals. When nurses can teach a patient more about their health, they are empowering that patient to become as advocate for themselves and their health, rather than a passenger on the crazy ride through the medical field. Also, when patients are educated about their medications, their at-home procedures, and the reason for doing what they are instructed to do, their compliance with those medications and procedures greatly increase. When compliance with the health regimen increases, those patients are not subjected to avoidable hospital stays and procedures that need to be performed in order to regain their optimal health.

                If, as nurses, we can assess our elderly patient’s health literacy and teach them about their healthcare on their own level of understanding, we could decrease hospital readmissions greatly. If we could just prevent one out of every ten patients that we care for from having to be readmitted to the hospital, national healthcare costs could greatly decrease. And just imagine all of the money and resources that could be saved when national healthcare costs are lessened?

                Not only would the economy be impacted, but all of the stress and anxiety that patients may feel at home when they don’t understand their medications or how to perform their procedures could be decreased as well. With less stress and anxiety, patients are more likely to comply with the regimen that the doctor also creating less frequency of those patients in clinics and hospitals with complications. As nurses we do not want to educate our patients just to avoid complications and unnecessary hospitalizations, we want to promote wellness and allow our patients to live the fullest lives possible.

In this blog, I have examined what health literacy is, why it is important, gave an example of poor education combined with a patient’s low health literacy, and assessment and implementation skills that nurses can use when caring for patients with low health literacies. As a nurse, I am an advocate for the patient and have the responsibility to make sure that they are educated about their health and healthcare regimen. When nurses can assess the patient’s health literacy level, how they best learn, and make sure the patient understand any education given, the patient and their health is more manageable to them. When patients feel in control of their own healthcare plan, they have less stress and anxiety, which itself can lessen healthcare complications.

About Health Literacy. (n.d.). Retrieved September 21, 2015, from http://www.hrsa.gov/publichealth/healthliteracy/healthlitabout.html 

Assessing and Implementing Appropriate Education

As a nurse, one of the main focuses of our job is to educate our patients. We are responsible for teaching them about any procedures that they may be having, about any medications that we are giving, and side effects or symptoms from their diagnosis, and how to take care of themselves properly when they are finally in their own care.

                In nursing school, we are taught to assess. Assess everything. Always assess first. The word assess is drilled into our thought process so that we assess before taking any actions. The same type of assessment is used with patients that may have inadequate health literacy about the information that we are giving them. So, in the situation of teaching patients, we must assess first. We must assess how they may learn or attain information. Do they prefer hearing you give instructions, writing down instructions, drawing pictures to describe the instructions, reciting back the instructions to us? We, as nurses, need to find out the best mode of how to teach our patients. Is the patient going to have a spouse, a child, or another caregiver help them at home? If so, it is also wise to invite them to the learning session. Then, if they have questions at home, another ears heard what you said. But of course, always give them a phone number to call the healthcare facility if other questions arise later. According to Health.Gov, “Approximately one in sex Americans has a communications disorder or difference resulting in unique challenges. These individuals will require communication strategies that are tailored to their needs”. This means that when we are specifically talking to the elderly population who may not be educated in the area of medicine, we also need to account for any communicated disability that they may have. Again, we must assess.

                Although it is easy to assume that the elderly may have low health literacy, we have to assess each patient as an individual. Some elderly patients may know a lot about the medical field and some may know nothing. As an evolving world, technology is also becoming more and more prevalent. With the elderly population, they may have no use for a website address to go to or an app to download to help manage their health. According to The American Nurses Association, “the content of Internet information and the structure of this information are two additional obstacles for Internet users with low health literacy. Health information websites are notorious for using overly complex and scientific language that makes the content difficult to understand and use.”  We have to continue to assess what resources are appropriate for the particular patient and proceed from there.

                After we assess the best way to educate our patients, may that be listening, seeing, or repeating back the instructions, need to use words in a way that makes sense. If we go around using medical jargon such as “hyperglycemia” or “diabetic ketoacidosis”, such as in AJ’s situation, they might not know what we mean. If we use words like “high blood sugar” or “symptoms caused by excessive and prolonged high blood pressure” the patients may be able to better understand our education.

                After the information was given to the patient, the best way to make sure that the patient understood what was said would be to ask the patient to repeat back to the nurse what they just learned. This way, if they are unable to repeat the new information, the nurse can reteach it or else try another way of explaining things so that the patient can understand.

                In AJ’s situation, what would have been helpful for not only AJ, but for the nurse, would have been to include short teaching sessions throughout the hospital stay about his diagnosis and home health regimen. The nurse could also have given him written instructions about when to perform the blood glucose monitoring, how to read and interpret those results, and how the insulin should be administered. Explaining the reason behind the procedures is also important so that the patient knows why this should be important to them and that there are real risks if they are not done. Once all of the information was given to AJ, it would have been beneficial to ask AJ simple questions about how to take him blood sugar and even have him demonstrate it. If the nurse sees that he is able to do it himself a few times and interpret those results and how to go about self-administering insulin, the nurse now knows that the teaching was effective and that AJ comprehended and understood the education.

Egbert, N., & Nanna, K. (n.d.). Health Literacy: Challenges and Strategies. Retrieved September 21, 2015, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No3Sept09/Health-Literacy-Challenges.html

Health Literacy - Strategies: Improve the Usability of Health Information. (n.d.). Retrieved September 21, 2015, from http://health.gov/communication/literacy/quickguide/healthinfo.htm 

Case Story

As you can tell, I am a senior nursing student that is passionate about making sure that my patients understand the information that I am educating them about. I have many situations that I have come across, whether in clinicals, at work at the hospital, and from hearing stories from friends and family about time when an elderly person was hospitalized or had their health threatened because they didn’t understand what the doctor said to them at their appointment.

                Let me tell you about a patient that I once cared for. I will name him AJ. AJ was a 76 year old male who suffered from many comorbidities, which included hypertension, diabetes, kidney failure, and a new-onset cancer diagnosis that involved metastasis to the liver and pancreas. AJ came to the Emergency Department via Ambulance because he was at home when he started to feel sweaty, had the chills, felt lethargic, had frequent urination, felt weak and had abdominal pain. He lived alone at home and rarely saw his physician because he never really understood what they were saying anyways. He also had limits resources, so paying for medical bills was difficult for him.

                So what was wrong with AJ? AJ’s cancer has spread to his pancreas and his insulin production and diffusion into his blood system was abnormal. AJ was never really given a thorough explanation about his metastasis diagnosis, was never explained what the pancreas was and what it contributed to his body. AJ was also told to monitor his blood sugar and was given a “sliding scale” for insulin injections, but was never educated to the fullest of his ability about how to take an accurate blood sugar, how to use the sliding scale, and how to give himself proper insulin injections. The lack of education that AJ was given and then sent home with a complex diagnosis and complex at-home health regimen, made him feel overwhelmed and that he would just “skip it all and hope all went well”. AJ was admitted to the hospital with Diabetic Ketoacidosis. According to MayoClinic.org, “Diabetic Ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours”. “You may notice: excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, and confusion.” Basically, AJ had an extremely high blood sugar that his pancreas was not able to decrease because it contained metastatic cancer prohibiting its functioning.

                But why did this happen? AJ had a low health literacy in the first place, but also because the physician and the nurse that was teaching AJ about his condition and his health maintenance never fully explained what his diagnosis meant, how to avoid health complications, and why it is so important for AJ to keep up with his blood sugars, as Diabetic Ketoacidosis can be life threatening.

                This is why I am so passionate about teaching the elderly population correctly and effectively about their health and their health maintenance regimen. If we can effectively teach the elderly population, we can avoid life-threatening situations like AJ’s. AJ obviously didn’t understand many teaching points that may or may not have been brought up at his doctor’s appointments. If he had, he could have monitored his blood glucose better, gave himself insulin correctly, avoided Diabetic Ketoacidosis, and avoided a hospital admission that comes with expenses and exposure to other pathogens while the body is immuno-compromised.

Resources:

Diabetic ketoacidosis. (n.d.). Retrieved September 21, 2015, from 

http://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/basics/symptoms/con-20026470 

Introduction to my Blog about Health Literacy in the Aging Population

Have you ever gone to a doctor’s appointment and they drew blood, performed scans and then gave you the results as if you were a nurse or a doctor and understood everything that they said? I think that we all have been there. Fortunately for myself, I have a smartphone and could go back out to my car in the parking lot and could look up that information on resources such as Google. But wh does this even have to happen? Why don’t we ask more questions while the doctor is right there? Is the “white coat syndrome” real?

I am one of the lucky ones. I grew up with a computer in the house and at my school that I accessed almost every day. I grew up in a world where information was at my fingertips and all I had to do was take the time to find the answer I was looking for. I am also lucky because my mom is a Physician Assistant who knows a lot about medical information and I could always has her for help and she would explain things to be in a way that I could understand. Another reason I am lucky is because I have always had access to healthcare and have always had an interest in medicine.

But what about what seems like the other 99.9% of the world that wasn’t as lucky as I have been to have a good understanding of health literacy. Health literacy, according to the U.S. Department of Health and Human Services means “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Health literacy is huge! We can read articles, hear news stories on TV or radio, and even go to doctor’s offices and hear all types of medical information, but a lot of people don’t even understand what some of those words mean. In this blog, I want to focus on health literacy of the geriatric population.

As a future nurse, I find it extremely critical that my patients understand what I am saying to them as it is one of my primary duties to educate the patients about their health, their procedures, and their medications. In 2003, the Federal government did a study about all things involving the aging population and health literacy was a major topic in this study. As per the chart below, provided by the Federal Interagency Forum on Aging Related Statistics, “twelve percent of people age 50-64 have a proficient knowledge of health literacy”. The chart also shows that by ages 75 and older, there is only one percent of that population age range that has proficient health literacy.

This chart is outstanding to me. It really makes me want to put some thought and effort into myself and my colleagues to make sure that when we talk to our patients, all of their questions are answered. I never want me patients to leave my clinic or my hospital floor and be confused about what was just discussed. Health is necessary to living a longer and fuller life, so being able to understand what their healthcare team is educating them about, should be at the top of the list of importance. And that is why I want to write this blog. I want to inform other healthcare workers about the need for them to understand that the aging population and that they may not totally understand us when we are educating them about healthcare topics.

Resources:

Older Americans 2008: Key Indicators of Well-Being. (n.d.). Retrieved September 17, 2015, from

                http://www.agingstats.gov/Main_Site/Data/2008_Documents/Special_Feature.aspx

Quick Guide to Health Literacy and Older Adults - Health Literacy and Older Adults. (n.d.). 

Retrieved September 17, 2015, from 

http://health.gov/communication/literacy/olderadults/literacy.htm