Patient Literacy Level and Health Education Material
Ethical, Financial, and Legal Concerns In Nursing
Sources of PEMs (Printed Education Materials) include healthcare facilities, commercial vendors, government services, voluntary health agencies, nonprofit charitable organizations, pharmaceutical firms, and medical equipment supply companies. These materials are distributed primarily by nurses and other health professionals and are the major sources of information for clients participating in health programs in many settings.
Written health information materials are intended to reinforce
learning about health promotion, disease prevention, illness management,
diagnostic procedures, drug and treatment modalities, rehabilitative course,
and self care regimens. Unfortunately, many of these sources fail to account
for the educational level, preexisting knowledge base, cultural influences,
language barriers, or socioeconomic backgrounds of persons with limited
literacy skills.
Literacy and Low Economical Level
It is estimated that the total impact of low health literacy on the US economy is as much as $236 billion each year (Center for Health Care Strategies, 2013). A systematic review. done by Eichler et al. (2009) determined that a higher expenditure of financial resources is associated with low health literacy on both institutional and individual levels. Low health literacy can account for 3% to 5% of healthcare costs, and individuals with low health literacy incur additional charges from health service use.
The elderly and minorities specifically those who have English as a second language are especially vulnerable to low health literacy, which ultimately translates into higher healthcare costs for these groups (Levy & Royne, 2009). Unless patients are competent in reading and understanding the literature given to them, these instructional tools are useless as adjuncts for health education. They are neither a cost effective nor a time efficient means for teaching and learning.
Health Information Material and Understanding
Materials that are widely distributed, but little or not at all understood, pose not only a health hazard for clients but also an ethical, financial, and legal liability for health care providers (Ad Hoc Committee on Health Literacy, 1999; Agarwal, Shah , Stone, Ricks, & Friedlander, 2015; Gazmararian, Curran, Parker, Bernhardt, & DeBuono, 2005; Giorgianni, 1998; Ryhanen, Johansson, Salo, Salantera, & Leino Kilpi, 2008; Schultz, 2002; Vallance, Taylor, & LaVallee, 2008).
Materials that are too difficult to read or understand serve little
purpose. Health education cannot be considered to have taken place if the
written information that has been distributed to clients does not enhance their
knowledge and requisite skills necessary for self care. Ultimately,
indiscriminate or non selective use of PEMS can result in complete or partial
lack of communication between healthcare providers and consumers (Andrus &
Roth, 2002; Fisher, 1999, Villaire & Mayer, 2007; Weiss, 2007, 2014;
Winslow, 2001).
Initial standards for health education were put forth in 1993 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now known as The Joint Commission. Many of their current standards address health literacy as a component and require that patients and families receive information necessary for their care in a language and form that is best for their learning. Healthcare providers also need to ensure that patients and families understand the information provided (Health Literacy Consulting, 2015).
Emphasis on such standards has prompted healthcare agencies and providers to reexamine their teaching practices, educational materials, and systems of documenting evidence of teaching interventions to better match the reading levels and cultural diversity of the clients being served. Current Joint Commission standards further specify that education relevant to a person's healthcare needs must be understandable and culturally appropriate to the patient and/or significant others.
Therefore, PEMS must be written in ways
that are culturally relevant and assist clients in understanding their health
needs and problems to undertake self care regimens involving elements such as
medications, diet, exercise therapies, and use of medical equipment. Using the
patient's preferred language is optimal (Fisher, 1999, Health Literacy
Consulting, 2015; Weiss, 2007).
Furthermore, the federally mandated Patient's Bill of Rights has established the rights of patients to receive complete and current information regarding their diagnoses, treatments, and prognoses in terms they can understand (Duffy & Snyder, 1999). It is imperative that the reading levels of PEMs match the patients' reading abilities and vice versa.
Compounding the
need for appropriately written materials is the fact that people forget almost
immediately at least half of any instruction they receive orally (Parnell,
2014). Failure to retain information combined with inappropriate reading levels
of materials used to reinforce or supplement verbal teaching methods decreases
compliance, increases morbidity, and results in misuse of healthcare facilities
(Weiss et al., 2005).
Encouraging self care through client education for purposes of
health promotion, disease prevention, health maintenance, and rehabilitation is
not a new concept to either consumers or providers of health care. However, the
trends in the current healthcare system in the United States have hindered the
professional ability of nurses to provide needed information to ensure
self care that is both safe and effective. Patient education has assumed an
even more vital role in assisting clients to independently manage their own
healthcare needs given the following factors:
Early discharge
Decreased reimbursement for direct care Increased emphasis on
delivery of care in the community and home setting
Greater demands on nursing personnel in all settings
Assumption by caregivers that printed information is an adequate
substitute for direct instruction of patients
These constraints do not allow sufficient opportunities for
patients in the home or various healthcare settings to receive the necessary
education they need for self-management. Most outpatient care, such as that
given in clinics, physician and other health professional offices, and same day
surgery centers, requires patients and their families to understand both
written and oral instructions (Weiss et al., 2005). Consequently, professional
nurses are relying more than ever before on PEMS to supplement their teaching
(Horner et al., 2000; Vanderhoff, 2005).
Thus, the burden of becoming adequately educated falls on the shoulders of patients, their families, and significant others. Often unprepared because of shortened hospital stays or limited contact with healthcare providers, consumers are being asked to assume a greater role in their own recovery and the maximization of their health potential (Parnell, 2014; Weiss, 2003).
It is only recently that research on written health education materials
in relation to clients' literacy skills has examined and attempted to answer
even the most basic questions, such as the following:
Do consumers read the health education literature provided to
them? Are they capable of reading it?
Can they understand what they read? Are written materials
appropriate and sufficient for the intended target audience?
Patient Information and Consents
In this increasingly litigious and ethically conscious society,
growing attention is being paid by health professionals to informed consent and
teaching for self care via both verbal and written healthcare instruction
(Gazmararian et al., 2005). The potential for misinterpretation of instructions
not only can adversely affect treatment but also raises serious concerns about
the ethical and legal implications with respect to professional responsibility
and liability when information is written at a level incomprehensible to many
patients (Weiss, 2007, 2014). A properly informed consumer is not only a legal
concern in health care today but an ethical one as well.
Give your opinion if have any.