Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

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Purpose: Increase health literacy and communication using a tool with a discharge checklist to facilitate communication and understanding among patients, physicians, and nursing staff.

Background and significance: In the United States, 90 million people are affected by low health literacy impairing their ability to understand and comprehend health information (Institute of Medicine et al., 2004). Another 40 million Americans have difficulty reading complex texts that makes reading health information difficult (Institute of Medicine et al., 2004). The Affordable Care Act emphasizes the need for increased self-care as a key strategy for improving health care costs and improving the quality of care (Kaiser Family Foundation, 2018). With low health literacy, patients cannot provide effective self-care strategies such as understanding when to go to the emergency room and how often to take their medication. Low literacy costs the United States $225 billion each year (Literacy Statistics, 2010). Successful implementation of the Affordable Care Act includes an aspect of health literacy such as: making successful adherence to medication regimens, understanding medical information, and successfully communicating with providers on medical decisions (Kaiser Family Foundation, 2018). Hematology oncology patients need to understand their complex health information to be able to manage their care outside of the hospital.

Intervention and Implementation Plan: Nurses were provided a brief training session on health literacy and the discharge education checklist project. After completion of training, nurses were instructed to provide leukemia patients the health literacy assessment quiz at the time of admission. Based on their health literacy score, the physicians, nurses, and other interdisciplinary team members adapted patient education to meet the patient’s needs. Discharge education was completed throughout the hospitalization and was documented in the patient's discharge checklist. At the time of discharge, patients are provided the same health literacy quiz to assess their level of health education provided during their hospital stay, and discharge checklist items are completed.

Results and Implications: As a result of the health literacy training, discharge education checklist, and health literacy toolkit, leukemia patients had an increase in their health literacy from the time of admission to the time of discharge. The increase in health literacy was achieved with an average of 2.1 points higher from pre and post-test scores. Future recommendations include the continuation of starting discharge education at the time of admission, implementation of health literacy interventions with the addition of in-depth training for nursing staff, and consideration of expanding this intervention to all patients on an inpatient oncology floor.

Conclusion: Providing patients early discharge education reduces their risk of mortality and improves their quality of life by allowing improvement in patient self-care through better understanding of their medical treatment. Leukemia patients are better educated about their health and early identification of low health literacy is screened so that interventions can be implemented by nurses, physicians, and other interdisciplinary team members.

Keywords: health literacy, discharge education, health information, literacy skills, health outcomes, communication, hematology-oncology.

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