How Can a Nurse Practitioner Improve Patient Compliance and Patient Education in a Perioperative Setting?

Jane C. Rothrock, DNSc, RN, CNOR, FAAN


January 07, 2008

Health Literacy

Literacy, in and of itself, is a problematic issue for a surprisingly large proportion of the population of the United States. Nearly a third of the population has only basic (or below) mathematical and writing skills; close to 50% have difficulty reading text material necessary to accomplish routine tasks. A large segment of the population is not literate in English. Issues of health literacy pose significant challenges to the effective use of adherence-enhancing interventions with surgical patients.

The Joint Commission's Speak-Up campaigns are safety initiatives that encourage patients to take an active role in their healthcare. The Joint Commission launched Planning Your Recovery in 2005, noting that patients who understand and follow directions about follow-up care are likely to heal faster and require fewer readmissions.[4] Planning Your Recovery advised patients to:

  • Know their condition, including when they should expect to feel better, when to resume normal activity levels (eg, walking, climbing stairs, driving, returning to work), and when activity progression is appropriate. Patients should recognize warning signs and symptoms and should know what to do if they have them. Patients should make sure they have the correct phone number to call should they experience any problems after leaving the hospital. They should arrange for a family member or friend to be with them when they first get home. The home should be set up to accommodate any physical restrictions or limitations the patient may have.

  • Find out about new medications and how to take them. Patients should make sure they have an up-to-date list of all medications, new and old, along with complete instructions. Patients should find out about any specific precautions (eg, foods, sunlight, alcohol) as well as possible side effects and what to do if they occur.

  • Find out about follow-up care, such as wound care, special equipment, further tests, and postoperative visits and check-ups. Discuss transportation problems. Plan ahead for any necessary insurance coverage of home care or other services.

The Joint Commission, in a recent white paper, "What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety," [5] adopted the Institute of Medicine's definition of health literacy: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.[6] Domrose[7] offers this definition from Dr. Gwen van Servellen, a professor at the University of California, Los Angeles School of Nursing: "Health literacy is the knowledge and fundamental ability to manage illness as well as navigate the healthcare system."

Clearly, then, health literacy encompasses more than the ability to read, write, or perform a mathematical computation; it even involves more than being able to read and understand health information. Because health literacy also encompasses educational, social, and cultural factors that influence the expectations and preferences of the patient, APNs (and all healthcare practitioners) need to understand the beliefs, values, cultural norms, and health traditions that influence how healthcare information is received and shared by their patients. Only in this context can the APN begin to understand and meet expectations and preferences for adherence education for preoperative and postoperative surgical patients.

The Joint Commission report on strategies for addressing health literacy and protecting patient safety contains 35 specific recommendations that cover a wide range of important improvement opportunities. The report is part of a continuing series of white papers on key public policy issues that influence patient safety and healthcare quality, offering important information on solutions regarding health literacy and its impact on health outcomes.


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