Patient Teaching and Safety: Exploring Health Literacy

Submitter Information

Author: Judy Young, RN, MS
Title: Lecturer
Institution: Indiana University School of Nursing
Coauthors: Pam Ironside, PhD, RN, FAAN Associate Professor Indiana University School of Nursing 1111 Middle Dr., NU 478 Indianapolis, IN 46202-5107

Competency Category(s)
Patient-Centered Care, Safety

Learner Level(s)
Pre-Licensure ADN/Diploma, Pre-Licensure BSN

Learner Setting(s)

Strategy Type
General Strategy

Learning Objectives

Provide patient-centered care with sensitivity and respect for the diversity of human experience
Examine common barriers to active involvement of patients in their own health care processes
Describe strategies to empower patients or families in all aspects of the health care process
Examine nursing roles in assuring coordination, integration, and continuity of care
Demonstrate effective use of strategies to reduce risk of harm to self or others
Participate appropriately in analyzing errors and designing system improvements

Strategy Overview

The goal of the strategy is to promote patient-centered care by
increasing students’ awareness of safety issues related to illiteracy,
specifically (health care illiteracy)*. The exercise a) facilitates
students’ assessment and planning of patient-centered teaching
activities, and b) raises the level of awareness and sensitivity of the
experiences of patients who have low literacy or are illiterate.

Exercise Students are paired and instructed to sit back-to-back. One
student (the Informer) is given a cue card with a drawing and the second
student (the Receiver) is given a blank cue card and pencil.

The Informer is to a) describe the drawing to the Receiver without observing the work-in-progress, and b) answer all clarifying questions.
The Receiver is instructed to a) draw what is described and b) ask clarifying questions as needed to complete the work.
When the drawing is complete (5-10 minutes), student pairs compare the original drawing to the drawing completed by the Receiver.

Faculty/Student Discussion:
The Informers are asked to tell about their experience. (Frequently Informers describe being frustrated, for instance, contending that “I thought I was really clear, but she kept asking questions.”)
The Receivers are then asked to share their experience. (Frequently Receivers describe frustration as well, for instance, contending that “I didn’t understand what he was trying to tell me. I thought I was doing exactly what he told me!”)

After this initial discussion, the faculty member can correlate these frustrations to those experienced both by nurses trying to provide health care information to clients who are illiterate and by patients trying to assimilate health care information without relying on printed information. Discussion focuses on how nurses assess illiteracy and adapt approaches to patient teaching.

Possible Follow-up Exercises:
Students are provided literacy data for the United States and asked to seek information related to illiteracy in their state/city/county, specifically that related to health care literacy. After analyzing this information, students identify the implications for patient safety, recidivism and health care costs stemming directly from low literacy and illiteracy at their assigned organization. Discussion focuses on adapting approaches to patient teaching on individual and system levels.

Students are instructed how to assess patient education materials for reading level and examine available materials in their assigned organization. Discussion focuses on a) how to assess health care literacy (including how to discuss topics such as literacy that carry a high degree of social stigma) and b) how approaches to patient teaching can be adapted for those who have low levels of literacy or are illiterate.

*this exercise can also be used to focus on teaching patients who speak English as a second language.

Submitted Materials

Additional Materials

Evaluation Description

This is an ungraded experience, although feedback is solicited relating to what students learn from this experience. Before leaving class, students are asked to respond to the following:

What did you learn about the impact of literacy on patient teaching and safety?
How and in what ways is health care literacy a nursing/health issue?
What insights have you gained from this experience that will influence your nursing practice?
What did this experience mean to you as a student nurse?

Through this exercise, students have gained an appreciation of the impact health care literacy has upon health and patient outcomes—particularly when it is unrecognized. Outcomes of this exercise include 1) student recognition of prior clients for whom they have provided care who may have been illiterate without accommodations being made in their care or patient teaching, 2) student awareness of the importance of assessing literacy when planning patient education activities – including instances of low literacy and illiteracy, 3) student creativity – students enthusiastically explored creative ways to provide health information and instruction without relying on printed materials and identified related safety issues that may easily be overlooked by health care professionals (such as color blindness).