Health LiteracyinNursing ... Providing Person-Centered Care, Terri Ann Parnell, 2015, New York, NY: Springer Publishing Company. Softcover, 302 pages, $70.
In a recent blog post in a JAMA Forum, Diana Mason recounts her personal challenges when caring for her husband after surgery. Even with her extensive education as a nurse, the care was challenging and the support minimal. Dr Mason's observations about the role of family caregivers make the need for a comprehensive approach to health literacy even more imperative. Dr Mason notes:
More than 43 million family caregivers in the United States are propping up the health care system. In the face of limits on payment for home care services and delays in service, family caregivers often provide complex medical treatments that would challenge the most adroit health care workers. A family caregiver may be frightened, depressed, and in declining health from the stress of caregiving, particularly when caring for a patient who has dementia or mental illness. (JAMA Forum: Family Caregiving: Realities and Policy by Diana Mason, PhD, RN, on May 18, 2016)
Dr Mason's experience should elicit questions from all of us who care. How many hospitals, emergency departments, surgery centers, primary care offices, and other centers follow up to learn what patients and their family members understand when they go home? As we focus our energies on what partners we want for our health care systems, how to garner market share, how to form Accountable Care Organizations, or how to be more efficient at managing patients in multiple settings, who is looking at the basics of patient-centered care? Do we truly engage the patient? Do we truly communicate important health information to patients and their family members? Do we truly see the patient as a person?
Our health care today is producing some promising discoveries. Our reorganization will help many more people and slowly close the gap in health disparities. Will it be less successful if patients and family caregivers do not comprehend their own care or the health care system as a whole?
For nurses who are advocating for better health literacy for both patients and their family caregivers, the book, Health Literacy in Nursing, provides an in-depth analysis on this critical "crosscutting priority in the delivery of safe, quality healthcare" (page 3). The author provides us with 10 definitions of health literacy. For purposes of this review, I'm using the one cited in the Patient Protection and Affordable Care Act of 2010 (ACA).
The ACA defines health literacy as "the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions" (page 9). (Dr Mason would most likely amend the definition to include family caregivers as well as individuals.)
Dr Parnell's book presents a very strong explanation of the magnitude of basic literacy issues that further complicate comprehension of health issues (such as not being able to read). Addressing health literacy and the ACA, the author states:
Given the changing language and cultural demographics of the United State and the recent reports that about 87 million adults are considered functionally illiterate (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007), the ACA, by extending health insurance coverage to close to 32 million lower-income adults, highlights the barriers faced by individual patients and therefore the critical need to incorporate health literacy into strategies for enrolling beneficiaries and delivering healthcare. (page 73)
The author's extensive research shows the uphill battle we have in addressing these issues. Multiple studies demonstrate the deficits we face in core competencies around literacy. The Institute of Medicine report of 2004 supports Dr Mason's personal experience as even the most educated struggle with today's explanation of diagnosis, treatment, and care. The report states that even "well-educated people with strong reading and writing skills may have trouble comprehending a medical form or doctor's instructions regarding a drug or procedure" (page 17).
Nursing has always had at the center of its roots the element of patient education. Could it be that nurse leaders, supported by our nurse researchers, need to take the lead in addressing health literacy in our patient populations? Whether on boards, in the c-suite, or on the front line, nursing is best poised to lead the effort in solving these challenges. Unfortunately, the author also notes research, showing gaps in nursing knowledge and experience in health literacy. The author encourages academia to include this topic in curricula. This book provides a strong foundation for supporting that lead role in both service and academia.
The author is supported by 7 contributors, whose field of work span multiple specialties including pediatrics, mental health, end-of-life and palliative care, and cultural diversity. Two of the 4 parts of the book are dedicated to oral and written communication. These particular sections give practical recommendations nurses on the front line can use with their patients and peers. Case scenarios and stories are used throughout the book. Many of these would make great discussion topics at an in-service, book club, or seminar. For example, the author points out that both nurses and doctors fall back on medical jargon when communicating with each other. We forget to translate this into plain language. The author also points out that communication is not always just about complex medical instructions. Some are even humorous. I particularly liked the story of one nurse calling down the hall to a colleague as to where the COW is? (Note: COW means Computer on Wheels). Imagine the patient's horror wondering what is meant by "Where is the 'cow'?" (page 117). Because units are busy and stays are short, health systems rely on a propensity of written material. The author devotes a large section to developing well-designed, health-literate material. The recommendations in this section are very practical.
I found this book to be scholarly, timely, and practical. Many can benefit from having it in their library. This includes nurse leaders making the case for health literacy as a priority and nurse educators writing curricula or patient education materials. It will be beneficial to the nurse at the point of care when providing education to patients and their family members. Nurses engaged in policy and legislative positions can use this book to support party platforms and/or laws that improve health literacy.
Errors of Omission ... How Missed Nursing Care Imperils Patients, Beatrice J. Kalisch, 2015, Silver Spring, MD: American Nurses Association. Softcover, 395 pages, $49.95 ANA members, $54.95 List.
A common concern of nurse leaders continues to be the ability of nurses to use critical thinking and in setting priorities. Dr Beatrice Kalisch's 2015 book names more than 20 specific elements of missed care (such as not ambulating or not turning a patient every 2 hours; not teaching patients and families; or not administering medications on time) that relate to critical thinking. This list could be used to teach priority setting.
I first heard Dr Kalisch speak in 2013 in Denver, Colorado, on the last day of the Annual Meeting of the American Organizations of Nurse Executives. The audience was spellbound. I turned to my friend and colleague and half joking said, "If I am ever hospitalized, please turn me." I never envisioned my having to make that request just as Dr Diana Mason did not expect to see herself as a family member not receiving instructions on how to care for her husband. (See preceding book review on Health Literacy.)
While the 1999 Institute of Medicine's report focused on Errors of Commission (like operating on the wrong limb or giving too high a dose of medication), Dr Kalisch focuses on 10 years of research on errors of omission (page xv). This book is rich in data, methodology, critical analysis, and, most importantly, directions and solutions. The author is very good at communicating research in language we can all understand. Her work is clinician-focused. Dr Kalisch identifies readers who could benefit from her book as coming from a wide range of audiences (staff nurses, nurses executives and managers in acute and long-term care, nursing faculty and students in nurse preparation programs, health care administrators and chief executives of acute and long-term care facilities, researchers, physicians and other healthcare providers such as pharmacist and others, and policy makers (page xviii). The information about errors of omission is helpful for nurse leaders to examine nursing practice no matter which setting they govern.
The author's research includes elements of missed care specific to the operating room as well as the occurrence of missed care in Magnet hospitals. She examines each element, exploring multiple reasons for why care is missed (eg, inadequate staffing, material resources, communication, documentation demands, and more).
Beyond what care is missed and why, Dr Kalisch digs into her data to answer the most important question: What happens if we do not provide basic care? Does it matter? For example, in her chapter on outcomes, the author cites the following research from multiple studies:
Failure to ambulate patients has been linked to new onset delirium, pneumonia, delayed wound healing, pressure ulcers, increased length of stay and delayed discharge, increased pain and discomfort, muscle wasting, fatigue, and physical disability. (page. 171)
This is just one example of outcomes addressed. To put it simply, missed care matters.
Get this book. In fact, get both books reviewed here. They will help you make informed decisions about nursing priorities you are setting for patients and help us all improve the care we give.
-Elizabeth (Betty) Falter, MS, BSN, RN, NEA-BC