Journal of Nursing
The Importance of Communication and Education toward Patient Literacy:
The Importance of Communication and Education toward Patient Literacy: The Relationship of Functional Health and Patient’s Knowledge of Their Chronic Disease and Metabolic Disorder Part Two: The Importance of Understanding Hypertension… by Gary D. Goldberg, PhD Clinical Professor of Medical Education Angeles College of Nursing, Los Angeles, Ca. [email protected]
ABSTRACT
Background -
Objective -
Keywords: efficiency of care, health literacy, communicator, educator, assessment skills, clear with simplified language, and direct involvement.
Health Literacy -
Over 90 million American adults cannot read complex text or have difficulty understanding complex instructions; this means over 90 million American adults, close to one-half of the US adult population have limited health care literacy. [2]
Chronic metabolic conditions such as ‘essential’ hypertension (i.e., HT) and diseases such as diabetes (i.e., DM) require patient education to achieve adequate control and prevent adverse health outcomes. Patients with HT may need to understand how to properly take multiple medications and modify their lifestyle (e.g., low salt diet, weight control, and/or exercise) to achieve adequate B/P (HbA₁с) control. The intricacies of the diabetic diet, insulin therapy, and home glucose level (A₁с) monitoring, place even greater educational requirements on the patients. As a healthcare provider, you are aware that patient education also plays a critical role in facilitating patients’ acceptance of their diagnosis and understanding behavioral changes required for active participation in treatment. [3]
Traditional patient education relies heavily on written material about disease processes, medical management, and self-care instruction guides. Despite the availability of extensive health-care education materials with relatively consistent content, many are written at too high a level for low literate patients to comprehend essential points. [4]ʹ[5] Today, patients with inadequate literacy may not benefit from such educational efforts. This may explain why some patient education programs have been unsuccessful. [6]ʹ[7]
Current demographic trends make health literacy increasingly significant for today’s primary care providers (i.e., RN’s LVN/LPN’s, Nurse Practitioners), who treat older adults. Older individuals are more likely to develop chronic medical illnesses and functional limitations that may profoundly affect health literacy. For example, inadequate health literacy (i.e., essential HT and/or with DM), has been linked to increased prevalence of several chronic conditions (i.e., age-related sensory changes, vision, hearing loss, and cognitive impairment), to name a few. Also, problems with the use of preventive services and glycemic control in diabetes mellitus in older adults. [9] Other consequences can include errors in self-administration of medications. [10]
Communicator -
Note: A teach-back and/or show-me technique is particularly important because they involve asking the patient to explain or demonstrate what the nurse and/or practitioner has discussed. Teach-back techniques ask the patient to explain what he/she understood and show-me techniques have the patient demonstrate a skill level learned during the healthcare encounter.
It would be almost a ‘given’ to say that as a practicing nurse, you will come across patients with metabolic X syndrome and idiopathic secondary disorders or diseases such as chronic kidney disease (i.e., CKD), cardiovascular disease (i.e., CVD), and respiratory disease (i.e., RD). Just addressing the medication therapy alone would do an injustice for the patient and his/or her family members. There must be a willing spirit to grasp and maintain life changing ways. Due to the fact that we live in a non-perfect world, each patient will not obey or follow the recommended guidelines set forth through the AHA and/or the ANA. For these special patients you may need a follow-up visit by the social worker, care-giver, or a state-funded agency that would enter the home and talk with the patient and/or with family members.
Note: It may not be enough to assume that effective communication will occur just because a shared language of communication was established. A patient’s perception of articulation extends beyond ‘correct’ language usage (i.e., Spanish language for a Spanish speaker), to include dialects (i.e., Hispanic versus Cuban or South American), and often critical, non-verbal aspects such as the presence or absence of eye contact, physical contact, and body posture. The message conveyed by a primary care nurse or clinician looking at the patient and leaning forward is strikingly different than the message conveyed if looking at the medical record chart and sitting back against the wall.
Nearly all patients prefer medical advice that is simple and easy to understand. In many cases, advice can be simplified by reducing the content to what the patient truly needs to know to follow essential instructions, because adult education theory points out that adults are most interested in information that helps solve their problems, rather than in background information. [11]ʹ[12] For example, most patients are more interested in learning what they need to do to manage their diabetes so they can resume their daily activities, and less interested in disease pathophysiology.
Improving Communication levels -
Educational Indicators -
Today in the US according to the New York Times and the Washington Post, the national average reading and comprehended levels are between the 7th and 8th grade level of learning. [16] Of the adult US citizens close to 25% cannot read with full comprehension the news print. [17] {Please see footnote 17, for complete NALS findings}. Have your Nursing Education Department seek out health materials that are written at or below the 8th grade level. Remember that patients will probably not want to read pages and pages of words alone, so have pictures or diagrams, that can be translated in a culturally and linguistically appropriate manner; such materials are preferred for all literacy levels because they provide a baseline of information about the medical condition. There will also be patients able to function at a higher literacy level and may wish to seek out further information on their own.
Engaging Your Patients -
· Have a provision of printed leaflets and health information packages on living with HT and DM.
To Improve Clinical Decision Making -
To Offer and Improve Self-Care -
Relevant outcome -
Health Behavior and Health Status -
The Nurse Can Only Teach ‘That What She/he Knows’ -
Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Insulin, independent of its effects on B//P and plasma lipids, are known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells.
Note: physiological maneuvers, such as calorie restriction (e.g., found in overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower B/P in both normotensive and hypertensive patients. [21]’ [22]
The nurse practitioner should be aware of this highly important study on chronic HT, that insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including non-insulin-dependent DM, obesity, HT, lipid abnormalities, and atherosclerotic cardiovascular disease. In order for the patient to understand that a change in life-style must start now, the practitioner too must have a plain of action for his/her patients.
The Joint Commission on Accreditation of Health Care Organizations have mandated that hospitals and other health organizations provide instruction understandable to patients, assess patients’ knowledge, and document such educational efforts. [23] Set goals of having at least 95% of patients with HT take action to control their B/P, and of having 75% or higher, people with DM receive education on DM. Patients’ functional health literacy must be considered when attempting to reach these goals. It appears that there are no simple methods of identifying low-literate patients and the significant shame or embarrassment associated with comprehension often makes them hide their disability.
As a nurse, using your assessment skills may lead your patients to open up to you, rather than the treating physician. Consider ‘direct involvement’ of the patients in developing educational materials, this action may empower them to improve their health while ensuring that the content effectively educates them. The future of patient education requires ingenuity and commitment of necessary resources to improve the outcome for patients with chronic diseases.
Clinical Recommendations -
· Recognition that limited patient literacy is a barrier to effective medical diagnosis and treatments.
Conclusion -
Preliminary studies indicate inadequate health literacy may increase the risk of frequent hospitalization. [26] Professional and public awareness of the health literacy issues must be increased, beginning with education of medical students and physicians plus improved patient-physician communication skills. The nursing institutions have seen a need for this out-reach from the community within. The continued support from the ANA will only enhance the nursing skills from student to graduates. This support is what the author would like to call the “art of medicine.”
Further Readings on Current Research in Essential and Idiopathic Hypertension with Diabetes:
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Short Bio of Dr. Gary D. Goldberg, PhD
Over 30 years experience in the Medical field, At UCLA and Pacific Hospital of the Valley, as a Chief Technologist and Analyst, Visiting Professor and Instructor for continuing education at UCLA School of Nursing and Writer/Speaker at the School of Medicine from 1978-2008.
From 2003-2008 Dr. Goldberg has collaborated and published through Blackwell Publishing Co. (Medical Division) and Journal of Americana College of Cardiology plus 15 published abstracts with UCLA Dept. of Bio-Medical Engineering and the Dept. of Cardiology.
Current title: Clinical Professor of Medical Education with Angeles College of Nursing, in Los Angeles, Ca.
Dr. Goldberg has written two major academic course textbooks for Angele College of Nursing and has represented advanced nursing education course curriculum through the State Dept. of California and approved by the ANA for CEU(s) and the AMA CMU Level 1 Credit for physicians.
In addition, Dr. Goldberg is currently an adjunct Professor for Kaplan University, e.g., through the Washington Post Inc., South Florida. Department of Health and Science plus the Dept. of Humanities.
His wife, Cindy L. Capute, has been a registered nurse for over 17 years and has managed a 200-bed acute care facility, with over 100 professional nurses from RN’s through CNA in the Los Angeles area. She keeps her ear in-tune with up-to-date nursing data and advancements in medical education. She has co-authored with Dr. Goldberg in 2005, paper presented to the Cardiology-Electrophysiology Research Group that has changed the dynamics of elector-static reading with regards to acute atrial anomalies.
This finding allowed Dr. Goldberg, to publish the “Goldberg Protocol” for Cardiac placements in the field and under clinical supervision using a tilt-table and the 12 +3 Leads or the vector positioning for additional cardiac patient information.
To reach Dr. Gary D. Goldberg, for comments and/or professional consultation, please use e-mail address: [email protected]
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