Personal Angst

I just love that word "angst". My personal belief is "since I am old and wandering through my life" much like teen agers do, I can bring a new perspective to the term and make it my own.
Three things that are becoming apparent in my literacy search and personal experiences:

first: My research building through professional observations take on a special meaning of communication between health care providers. Weaknesses, strengths, biases, and personalities appear to intertwine with time, tasks, facilitiy mission, best practices, needs of the patient, and continuity.
If we as professionals can not communicate between ourselves, how can we communicate to patients and families. Importantly, after the communication, how is implimentation to be encouraged and expected?

Second: How will we as professional deal with those patient's who have needs that we might not recognize? The purpose of a literacy test(based on a very informal discussion) seems threatening to even the "educated". I do not know if the Ask me 3* is all that we need for all levels of literacy. Other tools such as STOFHLA, REALM, Newest Vital Sign,and others appear to provide a guide-ONLY and ONLY IF the participants are willing.
What is my main problem?
What do I need to do?
Why is it important for me to do this?
These three questions seem to transform the needs of the patient and the words of the health care provider into daily function for life.

Third: Using the Teach-Back/Show-Me Method (from Doctor D. Schillinger's work in health care literacy) appears a best practice method. The weakness lies in utalizing ONLY this method in complex medical instructions with limited time resources seems to require perfection.

Speaking personally, my MD will talk to you following all the standards, sitting at equal level, telling and asking, repeating, etc. ...but forgetting specific needs of a specific known patient while in the examining room. Then when the patient leaves a copy of the front page is given as a receipt...all instructions are on the flip side. Go figure?
Then there was one time in a rushed, crowded waiting room (where was HIPPA?) personal infomation and instructions were given without time for contemplation.

Interesting discoveries

First, it has been great speaking with my advisor...great to share my thoughts and receive some clarification from Dr. J.

So moving right along two things:

Storyboards as education tools for nursing staff pose some unique challenges. There are set forms provided by the individual facility. Many topics for education either are for new information or as reviews. The audience includes RNs, LPNs, and CNAs. There might be specific protocol for each hospital that needs to be examined. Most facilities even have a set form for the introduction of why,how, and what of expected outcomes. Storyboard (self-learning packets) require a post-test.
Technical writing places an important part in the presentation of the material. At my meeting Dr. J. offered some valid and welcomed suggestion. For my dry run storyboard, I had been most concerned with clarity of the information, content, and the who, what, how, and why...she added more detailed application (why)into the mix. Also the use of color might be more effective co-ordinated differently with more visuals and varied fonts.
I nixed the idea of statistics because practical experience has shown me statistics BORE us nurses.

I have been looking at tools for evaluating the content of patient education materials as well as tools for evaluating health care literacy.

For the material evaluation, SMOG (simple measure of gobblydegook)and Lextile will require more evaluation over the next few weeks. This may prove useful for my evaluation of patient information pertaining to Coumadin(my selected topic for evaluation because of its importance to Joint Commission and my frequent responsibility in my work.

Preliminary research on literacy tools, Newest Vital Sign and REALM appear to have very limited, specific audience. NVS requires math and critical thinking skills along with reading. For NVS, the patient does not look at the questions and is offered no scrap paper. While looking at an ice cream label, 5 questions are scored by the tester. REALM appears to correlate word recognition with familiarity of the definition of the word spoken. I believe the label reading would be very important for patients with specific medical conditions such as diabetes, renal failure, congestive heart failure. The REALM in my experience of vocabulary and meanings might be limited. (This is even more apparent with a review of Clear Language and AMA recommendations of words to avoid). Both are English oriented, although I believe NVS now has a Spanish version. How will the needs of cognitively and developmentally challenged placed. How about those with learning, speech, and hearing difficulties? I do want to contact Dr. TD regarding these lackings.

Interesting sidebar: many hospitals are now using a special translation phone to provide access to many languages taking the place of in-house translators or the regular phone translators where the nurse states the question to the translator on the phone, then the translator addresses the patient, finally the patient can ask questions of the nurse through the translator on the phone. This would not be a very efficient or safe method for use of the "Teach Back" method.

All of these issues will be continued to be investigated as well as work on annotated bibliography.