DEIB Case Study: Impact of Health Literacy on Patient Outcomes (Nursing)

00:01 Hi. I'm Jacqui. Let's do a case study.

00:04 The case study today is called Presentation Challenges: The Impact of Health Literacy.

00:10 Let's meet Joe. Joe is on the unit.

00:13 He was given his scheduled dose Albuterol inhaler by his nurse.

00:17 This is how he used it.

00:19 He was observed inhaling the medication really quickly, and then, immediately exhaling.

00:24 And then, he immediately administered his second dose.

00:28 Hmm, the nurse then went over the proper technique for using the inhaler.

00:33 She also explained how to use a peak flow meter and tried to review this with him a couple times.

00:38 Joe nodded his head throughout the entire explanation but he didn't ask any questions.

00:44 And when he was asked to actually show the nurse how to use the medication, he said, "Oh, I'll do it later. I'm hungry right now. I want to eat." Hmm, so, the nurse then, responded by providing a pamphlet and asking Joe to really talk about what's in the pamphlet while he was waiting for his breakfast.

01:05 Then, Joe said, "No, I don't have my glasses right now, so, maybe I'll do it later." So, the nurse actually noticed that while Joe was reading the pamphlet, he was pointing to the words while he was reading it. Hmm, something's definitely going on here.

01:22 So, that brings us to our very first question. And this is what I'm going to ask you to do.

01:26 I want you to take the assessment findings from the first column and drag the findings that are most concerning to the nurse over to the right side.

01:36 We'll go through each one of these individually and let's see what we come up with.

01:40 Here's the first assessment finding. The observed administration of the meter dose inhaler.

01:45 Did the nurse see Joe do this well or is this an area of concern? Definitely an area of concern. Didn't seem like he was using the correct technique at all.

01:57 The next assessment finding. The client being provided with the pamphlet to reinforce teaching.

02:03 Well, this is okay. This is not a bad option.

02:07 Joe had trouble with it but the fact that he had a pamphlet was actually okay.

02:13 So, this is not a concern. The client stating, "I don't have my glasses right now, so, maybe later." When asked to read the pamphlet.

02:23 Hmm, well, not unusual not to have your glasses but in this case, it might be a stalling technique.

02:30 So, this might be of concern. It might indicate there's some issues with reading.

02:36 Client has a low level of interaction during teaching and declines to repeat teaching instructions.

02:43 Well, one of the reasons that we might be reluctant to repeat the instructions is because we don't understand them.

02:49 And in this particular case, since we're worried about health literacy, this would be of concern.

02:55 The client is observed pointing to the words while reading.

02:59 Sometimes when reading is difficult, someone might point to the words as a way to help with literacy.

03:06 So, this might be a point of concern. So, we'll move this one as well.

03:10 And finally, the client declines to perform a teach-back to the nurse to show how they would use the medication.

03:18 Again, one of the reasons why we may have difficulty with teach-back is because we don't understand the instructions.

03:24 So, let's look at our answers. Here they are.

03:29 Before we go to the next question, I want to give you a few definitions.

03:35 The first one is low health literacy.

03:38 This is commonly defined as an individual's ability to obtain, process, and understand basic information in order to make health decisions.

03:50 Low reading literacy.

03:52 This refers to challenges comprehending the written language, not spoken language, but written language. And finally, language barrier.

04:01 And this occurs when an individual is unable to speak the same language and this makes understanding the information that's provided by the healthcare team very difficult.

04:12 Those are our definitions. Now, we're ready for the question.

04:16 Which client findings are consistent with each of these barriers? The first client finding, avoidance in demonstrating understanding of learning.

04:26 Someone who has difficulty understanding health conditions or information about health might not be able to demonstrate understanding.

04:34 Someone who's experiencing low reading literacy, if you're asking them to read something and then, explain it, they may not be able to demonstrate their understanding.

04:44 And finally, someone who has a language barrier who doesn't understand the language at all may absolutely have difficulty demonstrating understanding.

04:52 They may have literacy in their own language.

04:54 They may be able to read in their own language but they have difficulty because they don't speak the same language as the provider.

05:01 Let's look at the second client finding. Points to words while reading.

05:06 Well, again, this could qualify for all three, someone who doesn't understand complicated medical terms might point to the words.

05:14 Someone who has trouble reading the words at all might point to the words and someone who has a language barrier might point to the words because they're having a hard time understanding what's on the page.

05:26 Let's look at the final client need. Frequently nods in agreement while receiving education without asking many questions.

05:34 Overall, this indicates that someone does not understand that they're not asking questions, then, we need to figure out if they truly know what they're being asked to do.

05:45 This can happen in the case of low health literacy. This can happen in the case of low reading literacy and it absolutely can happen with someone who's experienced a language barrier.

05:55 So, all of these client findings are consistent with each of these three barriers.

06:01 Now, we're ready for another question.

06:04 We're going to drag the options to complete the sentences.

06:08 Keep in mind, we're talking about Joe and the nurse.

06:12 The nurse determines that the client, Joe, is most at risk for blank due to the blank of the client.

06:21 Let's look at the options, delayed discharge, non-adherence, a compromised therapeutic relationship or vision acuity problems.

06:31 So, what is Joe most at risk for? A delayed discharge? Well, the nurse is certainly thinking about what Joe may need before he goes home but unless he has a need for substantial help, his discharge is not going to be delayed.

06:46 That is not a risk.

06:49 Non-adherence, well, if he doesn't understand the healthcare risk or the recommendations, there's a good likelihood that he won't be able to follow through.

06:58 That sounds like it might be the right answer but let's look at the last two options.

07:03 A compromised therapeutic relationship, although Joe might be making contradictory statements, there's really no signs that the relationship has been compromised between he and the nurse, so, that's not the answer.

07:18 And finally, vision acuity problems, well, he might have vision acuity problems, he might not, but that doesn't seem to trump non-adherence.

07:28 So, non-adherence is definitely what Joe is most at risk for.

07:33 Now, let's look at option two. Why is he at risk? Is he making contradictory statements? Yes, he has made contradictory statements for sure but is that the very best answer? Let's see what else is available. Health literacy, hmm, we had contradictory statements, he was nodding at agreement, he was pointing at the words, this definitely goes along with signs of lack of health literacy.

08:05 That's a pretty good answer but, again, let's look at some of the other options.

08:09 Language barrier, well, so far, Joe has been able to follow all the rest of the instructions and answer questions. So, it doesn't seem like Joe has an issue here.

08:20 So, language barrier is not the answer and poor participation.

08:25 Well, he might not be participating but is that the real issue or is the overall issue health literacy? Exactly. It is. So, let's put it altogether.

08:39 The nurse determines the client is most at risk for non-adherence due to the health literacy of the client.

08:49 Let's try another question.

08:52 Witch interventions does the nurse plan to include in the client's plan of care to eliminate the risk for non-adherence? This is a select all that apply, so, there's going to be more than one answer.

09:05 Let's see how we do. Determine the client's level of health literacy.

09:10 Well, we definitely need to determine the client's level of health literacy in order to eliminate or at least, reduce the risk of non-adherence.

09:19 So, we'll check that one.

09:21 Consult with the healthcare provider for the need for an extended hospital stay.

09:26 If we extend the hospital stay, it's going to cost more money. It's not necessarily comfortable.

09:32 We want to get Joe home as soon as we can, so, definitely don't want to ask for an extended stay if we don't need one.

09:39 So, let's not check that. Use a variety of ways to present educational materials.

09:45 Well, this is just true for any kind of teaching. Everyone learns a different way.

09:50 Some people are visual, some people are auditory.

09:53 The more ways we present something, information and we individualize it, the better someone understands.

10:00 So, we'll check this one. Include medical terminology in the client's education.

10:05 Well, I don't know about you but sometimes, medical terminology is very difficult to understand and if I'm trying to be universal in my approach, I want to use plain language, laymen terms, not medical technology, so, we won't check that.

10:21 Minimize pausing during educational sessions.

10:25 Well, I need a lot of pausing when someone's explaining something very complicated, so, I can think about it and take it in. So, actually, I want to maximize the pausing.

10:35 I'm not going to check that one. And finally, provide specific and detailed instructions.

10:40 This is not the time to be general.

10:43 We want to be as specific as we can to make sure clients understand what the recommendations are.

10:49 So, we will absolutely check that one. Here are your final answers.

10:55 Let's try another question. We're going to look at client needs.

11:01 There are two. Let's look at the needs first.

11:05 The first one, a determined level of health literacy by the healthcare staff.

11:10 That's need number one.

11:11 Need number two, individualized information to their low literacy level.

11:17 This is what we're going to do with the question.

11:19 For each client need, we're going to click to specify the nursing interventions that would be used in that care.

11:27 We might need more than one intervention to support the client need.

11:32 It's a lot, so, how about we take these one by one.

11:36 The first need, a determined level of health literacy by the healthcare staff.

11:41 We're looking for interventions.

11:44 So, should the nurse ask, what is the highest level of school you completed? We're talking about health literacy.

11:53 So, even if you have a college degree or a terminal degree, you still may not understand the needs to make healthcare decisions, so, this wouldn't help.

12:03 We won't check that one. Utilizing tools such as the newest vital sign.

12:08 Well, the newest vital sign really helps to specially determine health literacy, so, yes, we would check that. What about the last one, the nurse asks, how confident do you feel filling out medical forms by yourself? Well, we certainly could ask this but we could also ask, would you like some help filling out the medical form? And that would work, too.

12:34 Either way, we'll check this last answer.

12:37 Let's look at the second client need. Individualized information to their low literacy level.

12:45 What should the nurse do? Should they state, "Let me tell you about the gas exchange at the capillary membrane when carbon dioxide cannot be expelled from the lungs." No, they should not say that.

12:57 That's very complicated and that wouldn't help anybody with low literacy.

13:02 Presents material with a photovena using pictures to depict explanations.

13:07 Well, pictures would certainly help especially, if someone is experiencing low literacy, that might make it more clear. So, yes, the nurse should do that.

13:16 And finally, the nurse states that fluticasone/salmeterol inhaler was prescribed for your condition.

13:22 You know how to use it, right? Well, they may not know what fluticasone/salmeterol is first of all and second of all, just asking someone a closed-ended question, you know how to use it, right? After I said that. I would be like, "Yeah." But maybe the answer is, "No." So, we wouldn't check that one. So, here are the correct answers.

13:43 Okay. Ready for the last question? Here we go.

13:47 We're going to select three client statements that indicate successful teaching is accomplished when considering the client's low-literacy level.

13:57 So, how will we know that Joe has it down and he's got it right.

14:01 Let's check out these statements. Here's the first one.

14:05 I will prime my inhaler before I use it and then, shake it for about five seconds.

14:10 Would you like me to show you? Ah, Joe is reaching out.

14:13 He's going to demonstrate how to use it. That's a great answer.

14:18 Demonstration really shows that someone understands. Fantastic, not that.

14:24 Next one, I don't understand when to use my inhaler, can we talk about that again? Ah, Joe is saying, you know what? Our relationship is good.

14:34 I want to make sure I understand. I'm going to ask a question.

14:39 Oh, yeah. This sounds great, too. Let's look at the next one.

14:44 "Can you just talk to my wife when she gets here, she will understand earlier and she lives with me.

14:49 This does not indicate that Joe really understands what's going on.

14:54 He's letting someone else take care of him in this case, so, that does not indicate success.

15:00 We won't check that. The other nurse told me my lungs swell, making it hard for air to move.

15:06 Joe is breaking down physiology. He's understanding. This is definitely a success.

15:14 And finally, can you just dose my inhaler for me, so, I don't mess it up.

15:18 Well, Joe might want to do that but it doesn't indicate that he understands how to use the inhaler and how to dose it. That's what he's going to do when he goes home, so, this does not indicate success, so, we won't check that. Here are your final answers.