Despite their best efforts to communicate well, healthcare providers often struggle to explain concepts to their patients. It can be a challenge to ensure that patients and their families understand their treatment plan. Nurses sometimes struggle to answer questions in a way that is easy for those in their care to understand. Many nurses wrongly assume that their patients understand more than they do, and many patients are too embarrassed to ask clarifying questions. Unfortunately, these errors in communication coupled with a poor baseline of health literacy can result in poor outcomes for the entire healthcare system.
Related: Health Literacy: Bridging the Language Gap
What Is health literacy?
Health literacy means that a person has the ability to obtain and process health information well enough to make an informed decision about their care. Research shows that at least 88% of adults living in the United States do not have high enough health literacy to navigate the healthcare system and understand how to choose the best treatment plans, get the right preventative care, or avoid dangerous and expensive health problems.
According to the Milken Institute, patients with low health literacy may spend up to $7,798 more per year on healthcare compared to those with a better understanding. Poor healthcare literacy is estimated to cost over $200 billion annually in the United States.
Health literacy and patient outcomes
Low health literacy correlates strongly to poorer patient outcomes. Patients without a good understanding of their own health and healthcare may experience:
- Medication mistakes including taking the wrong medication or the wrong dose
- More frequent visits to the emergency department
- More frequent readmissions to the hospital
- Higher rates of infections
- Missing important healthcare screenings
- Missed follow-up appointments
- Faster progression of chronic diseases
- Higher rates of post-surgical complications
Healthcare providers have a duty to ensure that their patients have a good understanding of how to take care of their health. Many “non-compliant” patients simply do not have the knowledge they need to maintain their health and need better education.
Related: Communication in Health Care, 2nd Edition
Barriers to learning in healthcare
One of the most important things a person can understand about themselves is how to maintain good health throughout their lifetime. Unfortunately, healthcare can also be one of the more difficult topics for people to understand. There are many barriers to learning in healthcare that nurses should be aware of.
Language
Language barriers can cause confusion and frustration for both the healthcare provider and the patient. While many healthcare providers offer translation and interpretation services, there are still many who do not. In addition, some providers rely on technology that may not interpret medical terms correctly, leading to even more confusion for patients and their families.
In addition, even native English speakers may misunderstand English medical terms and acronyms. While medical terminology is easily understood by nurses and doctors, many terms used in the hospital are unfamiliar to patients. Healthcare professionals should be careful to speak plainly around the people they care for and avoid using complex terms or acronyms while teaching or explaining.
Stress
Everyone knows how much harder it is to focus and learn while under stress. Patients are often stressed out during visits to their doctor or while receiving treatment in a hospital. Feeling unwell, worrying about the cost of healthcare, and being embarrassed about medical conditions all make it more difficult to focus and learn new concepts.
Assumed understanding
Nurses often make the mistake of assuming that their patient has a better understanding of their illness, condition, and treatment plan than they actually do. This can lead the nurse to omit information or explain things in terms that are too complex for the patient to understand.
To make matters worse, patients are often too embarrassed to ask clarifying questions. Patients who don’t understand what the nurse is trying to teach may turn to friends, the internet, or other unreliable sources to get more information.
Low literacy levels
About 43 million adults in the United States have low literacy skills, meaning that they do not have the skills needed to determine the meaning of sentences, read relatively short texts to locate a single piece of information, or complete simple forms.
Patients with low literacy are at a high risk of misunderstanding instructions, making medication errors, and missing appointments.
Teaching strategies
Nurses can combat low health literacy by using better teaching strategies and assessments for understanding. The most effective strategies include:
- The teach-back method: After completing patient teaching, the nurse can ask the patient to reverse roles with them. Having the patient explain something back to the nurse is one of the best ways to identify gaps in learning and solidify the information in the patient’s mind.
- Use a variety of teaching tools: Some patients learn better by listening, others by observing, and others by practicing. Nurses can explain something verbally, demonstrate an action, and provide an opportunity for the patient to practice a skill like changing a dressing or measuring a medication dose.
- Involve a support system: Patients stressed in the hospital may have a hard time retaining information. If the patient feels comfortable, have a loved one participate in patient teaching. A family member or friend can offer support to the patient and may be able to ask clarifying questions that the patient does not think about.
- Offer resources: Some patients can manage complex health problems at home, while others need extra assistance. Nurses who have questions about their patient’s ability to care for themselves at home or follow instructions should get social work, case workers, and home health involved.
