Author: Kimberly Dudas, PhD(c), RN, ANP-BC, CNE
Title: Assistant Professor
Institution: New Jersey City University
Pre-Licensure ADN/Diploma, Pre-Licensure BSN
Classroom, Clinical Setting
- Examine common barriers to active involvement of patients in their own health care processes.
- Communicate patient values, preferences and expressed needs to other members of the healthcare team.
The goal of this learning activity is to promote patient-centered care as it relates to health literacy and health outcomes. It has been reported nearly half of the United States population experience difficulty in understanding and using health information. The toll of low health literacy not only translates into poorer health for the population, but significantly increases healthcare costs. Evidence suggests that low health literacy is a greater factor in chronic disease management than age, socioeconomic background, education level, or health status (NNLM, 2010). An exercise in health literacy can help students gain greater understanding of health literacy and its impact on quality and safety in patient care.
The Newest Vital Sign (NVS) is a screening tool for health literacy developed by Pfizer that is freely available. The instrument is available in English and Spanish. It can be administered in about three minutes. Results of the screening provide health care providers with information regarding patients’ health literacy, allowing health care professionals to adapt communication techniques to promote understanding of health issues.
Prior to completing the NVS, students are assigned a reading: Weiss, B., et al. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514-522, available at http://www.annfammed.org/cgi/reprint/3/6/514. The reading introduces the student to the concept of health literacy and its impact on the health of the public. The article also describes the development and testing of the NVS so that students are able to view the evidence supporting the validity and reliability of the instrument.
Students are asked to administer the NVS to a patient during the clinical experience, total the score and examine health education material presented to the patient in the clinical setting. Students are also asked to report their findings to the primary nurse. In post-conference, students discuss their results.
To administer the NVS, the patient is given the ice cream label (part of NVS) but is not provided the scoring sheet. The scoring sheet is retained by the student with each item read to the patient. At the conclusion of administering the NVS, the student scores the patient and sums to the total. Interpretation of scores is included on the answer sheet.
This is an ungraded assignment although student participation in post-conference is an expectation.
In post-conference, students are asked the following discussion questions:
- What barriers did you encounter in completing this assignment and how did you overcome them?
- Prior to completing this assignment, consider your perception of the patient’s level of health literacy. Were the results of the NVS different than you expected? Why or why not?
- How did you communicate your findings to the patient and primary nurse?
- What adjustments did you make with regard to your patient’s educational needs based on these results?
- What did you learn by completing this assignment?
This exercise was challenging for students. It only took a few minutes to administer as the NVS instructions suggest, but the students spent much more time explaining the results and what the interpretation of the score meant. Many students were surprised to find they overestimated the patient’s understanding of health literacy. Results were mixed as to the appropriateness of written health information – some students found the material was on target for a patient with limited health literacy while others found ample material that was written at too high a level for the patient. This learning activity generated great discussion in post-conference. After completing this exercise, student feedback indicated they were more attuned to health literacy and more patient-centered with patient education.
Reference: National Network of Libraries of Medicine. (2010). Health Literacy. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html