PICOT: In pediatric patients, how does having low health literacy compared to those with

improved health literacy affect their amount of ER visits over a 6-month period?

The emergency room (ER) that I work for serves many individuals from many walks of

life related to wealth, educational, and cultural backgrounds. Poor health literacy is a common

denominator for many of our patients and their families regardless of their background. In

addition, given the time constraints that exist in the busy ER setting, it is sometimes difficult for

the staff to find time to assess health literacy levels. However, health literacy is an important

component of education. Working with children and their families already possess its challenges

for providing care and education. The challenges are additive depending on the childs cognitive

capabilities and the parent or caregivers health literacy. After reviewing multiple studies, the

CDC echoes that limited health literacy can affect self-care abilities, readmission, and early

death for people diagnosed with heart disease (Centers for Disease Control and Prevention

[CDC], 2016).

Low health literacy negatively influences understanding of medical information

(Stanhope & Lancaster, 2016, p. 150). The problem is further compounded because many

patients or caregivers do not readily admit to their lack of understanding. Parents and guardians

with low health literacy may have misconceptions about their childs disease, and in turn,

communicate ineffectively (Harrington & Engelke, 2016, p. 15). Health care providers must

take the time to assess health literacy status. There are health literary measurement tools

available to guide providers on how to assess their patients and families (Agency for Healthcare

Research and Quality [AHRQ], 2014). Furthermore, any additional barriers that may exist should

be addresses, such as language barriers for those patients whose primary language isnt English.

In our ER department, we begin educating patients even as we triage them: their initial nurse
contact. In an effort to help minimize any misunderstanding for our patients, we have many

easy to read pamphlets for multiple illness and procedures. We utilize I pads to show videos in

multiple languages for varying diagnoses and procedures as well. Our hospital utilizes trained

employee translators/interpreters to assist patients prior to discharge, admissions, and surgical

interventions. In our pediatric emergency room, we initiated a pilot study in attempts to decrease

the number of returning ER visits related to knowledge discrepancies or lack of discharge

education.

After the doctor has cleared them discharge, we conduct a teach-back session in

which the caretaker (in their own terms), tells us what they understood about their discharge

diagnosis, what signs and symptoms to monitor for, when to follow up with their primary doctor

or the emergency room, what medications they are taking and what they taking them for. The

nurses reinforce any gaps noted in their understanding and provide resources or interpreters as

necessary. We want empower our patients and their families with the ability be productive team

members of their health management and outcomes.

Working with children of varying cognitive levels requires health care providers to

provide highly, individualized care and education. It is just as important to assess health literacy

levels of the parent or caregivers of this population. Gaining an understanding of a parents

health literacy capacity and then providing targeted resources could significantly reduce the risk

of adverse health events (Johnston, Fowler, Wilson, & Kelly, 2015, p. 276). Gaining an

understanding of a parents health literacy capacity and then providing appropriately targeted

resources could significantly reduce the risk of adverse health events.

 References

Agency for Healthcare Research and Quality. (2014). Health Literacy Measurement Tools

(Revised). Retrieved June 28, 2017, from https://www.ahrq.gov/professionals/quality-

patient-safety/quality-resources/tools/literacy/index.html

Centers for Disease Control and Prevention. (2016). Health literacy: Evidence reviews and

research summaries. Retrieved June 28, 2017, from

https://www.cdc.gov/healthliteracy/researchevaluate/evidence-research.html

Harrington, M., & Engelke, M. K. (2016). Health Literacy: Perceptions and experiences of

pediatric nephrology interprofessional team members. Nephrololgy Nursing Journal, 43

(1), 15-25. Retrieved from http://content.ebscohost.com.ezproxy.fau.edu/EbscoContent

Johnston, R., Fowler, C., Wilson, V., & Kelly, M. (2015, March 27). Opportunities for nurses to

increase parental health literacy: A discussion paper. Issues in Comprehensive Pediatric

Nursing, 38 (4), 266-281. http://dx.doi.org/10.3109/01460862.2015.1074318

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered Health care in

the community (9th ed.). St. Louis, Missouri: Elsevier.