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Cultivating Health Literacy Improve Outcomes Cheat Sheet (DRAFT) by [deleted]

Cultivating Health Literacy to Improve Outcome

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Health literacy has always been an essential component of successful transi­tions of care, partic­ularly at the point of discharge to the community. Limited health literacy is associated with a greater number of hospit­ali­zat­ions, more frequent emergency room visits, and an increase in adverse health behaviors.

The Knowledge Gap

Health literacy is defined as the level at which one is able to gather, process, and comprehend basic medical inform­ation that is necessary for making approp­riate choices about one’s health and treatment throughout life, according to the U.S. Department of Health and Human Services. Freque­ntly, however, the health care profes­sional providing discharge inform­ation to a resident or resident’s family member does not understand how best to commun­icate to that person, leaving him or her with a knowledge gap.

This gap can lead residents to poor outcomes, which often include hospital and emergency room visits within the 30-day window of discharge from a SNF.

The Role of the Nursing Staff

Especially given the new quality measures, nurse leaders need to support staff in asserting their role of helping residents to understand their discharge orders and to plan approp­riately to comply with them. Staff should be trained to recognize and minimize some of the challenges to health literacy that residents face.

Below are nine things that nursing staff should do:

Nine things that nursing staff should do:

1. Be attuned to cultural differ­ences. It is not uncommon for residents with certain cultural barriers to respond yes without unders­tan­ding, out of respect for the nurse. This is also true of residents who speak English as a second language.

2. Avoid elevated medical termin­ology when possible. Instead, staff should describe treatments and conditions to residents in a way that they will unders­tand, for example, by saying sugar level instead of blood glucose, or high blood sugar instead of hypogl­ycemia.

3. Explain the impact of risky behavior on health status. For example, if explaining salt restri­ctions to a resident with high blood pressure, staff should describe types of high-s­odium foods (such as individual frozen meals or canned foods) that the resident might be inclined to purchase but should avoid.

4. Ask how the resident plans to get prescr­iptions or travel to follow-up appoin­tments once discha­rged. Asking directly forces the resident to start planning. A resident may not have a close support person, and even if there is such a person, the resident may mention not wanting to be a burden. The answer can be very telling, indicating a possible need for additional support.

5. Explain what each medication does, especially for chronic condit­ions. Residents may be less inclined to take a medicine consis­tently if they don’t understand how taking it—or not taking it—impacts their well-b­eing.

6. Offer help in completing complex medical forms. If residents need to fill out complex forms to go see a specia­list, gain access to medical transp­ort­ation, or get discounted medica­tion, they may give up and not do it.

7. Stress the importance of preventive care. Often, older adults don’t think they need to be seen for preventive care, instead waiting until there is a problem. Nursing staff should give residents the best phone number for the approp­riate person at the facility and encourage them to call with questions.

8. Use teach-back methods. Residents should demons­trate that they have learned the inform­ation taught to them, for example, by demons­trating proper use of an inhaler or repeating medication instru­ctions back.

9. Consider resident home situat­ions, even when it’s difficult. It’s surpri­singly easy to turn a blind eye to challe­nging home situat­ions. Honing residents’ health literacy skills helps them identify personal challenges that may impede their completion of physician orders.