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Health literacy is an ongoing issue in healthcare today. Low health literacy can be detrimental to a patient’s care. There are many interventions we can implement to improve patient literacy and empower them in their care.

Language

Imagine being in a different country where English is not the primary language. Maybe you are backpacking Europe and find yourself in a foreign country feeling pretty crummy. You head to the ER with a sore throat. You point at your throat, so they tenderly examine it. A nurse gestures to open your mouth and you do, expecting to have your throat inspected. You startle as they shove swabs in the back of your throat, checking for various illnesses.

Imagine being diagnosed with mononucleosis and being handed an “After Visit Summary” in a language you can’t speak or read. You can’t read that you should abstain from heavy lifting to your enlarged spleen and increased risk for splenic rupture. You don’t know how contagious it is, so you throw your heavy backpack onto your shoulders and hit the road with your friends. See the problem?

Columbus has the privilege of being home to countless diverse populations all over the world. Because many of our patients may have learned English as a second language, it is imperative to provide education in the patient’s primary language. Hospitals have many options in providing translations: in-person translators, phone translators, video robot translators, and more. I always make a point to introduce myself to my patient in their primary language with a translator so that I can explain their plan of care, provide education, and guide them through a physical exam. This allows them to be involved in their care. It is also an ideal time to perform an education assessment – what was their highest grade in education? How do they learn best – demonstrations or pamphlets?

Jargon

            Now that you are speaking the same language, you need to make sure you do not use lofty medical terms when speaking to a patient. First, most patients are not healthcare professionals and will not understand you. Second, patients tend to be less attentive and invested in conversations with healthcare professionals who use lofty, hard-to-follow terms. Figure out how to explain things in ways that make sense to the average, non-medical person. Instead of saying, “With your recent history of generalized malaise and weakness, the doctors’ differential diagnosis includes: Borreliosis, a demyelinating condition like RRMS, and hypovitaminosis D, so we will be performing phlebotomy tests and a magnetic resonance imaging study”, say something that sounds less scary. You could say “since you’ve been feeling tired and sick lately, we’re going to draw some blood to check for Lyme Disease and make sure you’re getting enough Vitamin D and get a scan of your brain to make sure there aren’t any changes that would make you feel this way.”

Education

            Now that your patient has a diagnosis, you have to explain this to them. This is crucial! You have a role in educating them about their illness and the interventions needed to get better. My grandfather returned from WWII and began working for the US Postal Service. As he aged, he developed many chronic illnesses, including atrial fibrillation. His doctor prescribed coumadin, but did not explain the rationale or importance to him. My grandpa did not understand the importance of having his INR checked frequently while on the medication and suffered an embolic stroke. I had been frustrated with him in his recovery period. I told him he needed to keep up with his appointments. After talking to him, I realized he had no idea why his INR needed to be checked or why he was on coumadin in the first place- “why would something for my heart affect my brain?” he asked. This conversation was the start of a long review of all of his medical conditions and treatments, in which I broke down each condition and told him why his medications and treatments were important.

Rapport

            Perhaps the most important factor in improving health literacy is the ability to build rapport with your patients. I try to build it with my patients as soon as I knock on their door in the morning. If you build a relationship, patients are more likely to express concerns or uncertainties with you.  I cannot count the number of times during bedside rounds the team asks a patient if they have any questions, to which they reply “no”, but quickly turn to me with questions as soon as the team walks away. Patients frequently express, “they were using words I’ve never heard before,” “I have no idea what they were talking about,” or “I was afraid to ask questions because I thought I’d look stupid.” I regularly make a point to check with my patients and their family members to ensure they understand their plan of care. Not only does it help them understand their disease, but it provides them with autonomy.

Kate Best is a 2015 graduate of The Ohio State University College of Nursing.

The last six months have held some of the most difficult moments in my nursing career. When Covid-19 began its conquest in March, I was recovering from a surgery and was on light duty. I spent March on light duty at the Covid-19 Call Center, where I triaged patients, students, and staff and determined if they required testing. While I thought that light duty would be easy work, this was far from it. Each day I spoke to healthcare workers exposed in the line of duty, panicked parents, and anxious students. I remember speaking with one woman for about a half hour, as she tearfully told me about her employer forcing them to come to the office for non-essential work and refusing to let staff stay home if they get tested. She shared her worry for her job, her fear of getting her family sick, and her feelings of helplessness. I wanted so much to reach through the phone and hug her, and I couldn’t. I felt helpless. I helped empower her; arranging for her to get tested, provided instructions for infection prevention at home, and gave her the Ohio Department of Health’s number to report the unsafe work environment.

When I was cleared to return to work, it was a huge shock. The hallways, once bustling with patients being wheeled to appointments by family and staff powerwalking to the cafeteria on their break, were empty. I imagined a tumbleweed blowing across the hallway, bringing a faint smile to my face under my mask.

Because I’m in the Critical Care Float Pool, I float to all of the ICUs and the ED. In the “Before Times”, before Covid, I was already taking care of the sickest patient populations in the hospital. Covid brought even sicker patients. Even patients who didn’t have Covid were sicker; they had been holding off on seeking care due to fear of catching the virus, finally arriving to the hospital sicker than ever. I will never forget one day when I was a resource nurse in the ED. When I resource, I help triage new patients, care for stroke alerts, traumas, and code blues. I am an extra set of hands. Within thirty minutes, I ran to help intubate a patient in status epilepticus, ran to help with a burn trauma that just arrived, but was pulled into another trauma bay to help code a patient with a probably pulmonary embolism who had gone unresponsive en route to the hospital. After stabilizing that patient, I was pulled to the other side of the ED to help with another intubation. I remember walking out of work that day letting tears quietly roll down my cheeks. When I reached my car, I released the sobs that had been growing inside me all day. I felt panicked; helpless. Was this what it would be like? Intubations, codes, traumas, strokes, all at the same time? How would we help everyone? I sobbed on the phone with my parents my entire drive home. I purged myself of my scrubs as soon as I got home and took a hot shower. I sat on my couch holding my cat, Bingley. He wrapped his paws around my neck and licked the tears from my cheeks. His constant purring calmed me. I reflected on that day, and I still do. I am so grateful that I was there in that role to help the patients and my coworkers. Most of the units have started having a resource nurse each day to help with the increased acuity and complex patient needs.

Withdrawing care on a Covid patient and not being allowed to bring family to the bedside was one of the most difficult things I’ve ever done in my career. I stayed with the physician while she called the family to tell them that the patient was Covid positive and would not be allowed visitors in her final hours. I cried with the physician as she told them- it was awful. We were determined to allow every family member time with the patient. I used a hospital tablet to contact family via FaceTime and Zoom, making sure everyone had a chance to say goodbye. Pastoral care provided the family with prayers, and we all prayed together. I used my Spotify to play classic gospel in the room, her favorite. I used lavender essential oil to calm the room. I was able to be singled with her for my shift, so I sat in the room with her and held her hand so she wouldn’t be alone. I was joined by the physician, who stayed after her shift to hold her other hand. That day, I felt overwhelming support; support from the physician who was so attentive  and involved in the patient’s care, the charge nurse, who allowed me to be singled with the patient, the floor staff, who frequently checked in on me in the isolation room to see if I needed supplies, and the management, who provided the tablets to call family.

I became an aunt on May 27^th. I have looked forward to being an aunt for so long; I pictured all of the amazing adventures I’d take my niece on- hiking, camping, kayaking. I love babies and I was so excited to place my finger in her tiny hand and feel her fingers curl around it. I was excited to brush my fingertip up the bottom of her foot and watch her tiny toes fan out in the Babinski reflex. I was excited to cradle her to sleep in my arms and guard her dreams as she slept. Last week, I met my beautiful niece for the first time. I gazed adoringly at her through the storm door at my sister’s house, hands pressed against the glass. I was outside, looking in at my sister, my brother-in -law, my parents, and our dog, Eddie. I wanted so badly to hug them all, but I couldn’t. It’s too risky right now. Despite the heartache, I am glad I went. I got to make sure my family was safe and healthy and meet my niece.

Back in May, I became unable to leave my bed or the couch on my days off work. I put in the bare minimum effort- going to work, completing schoolwork, and attending online meetings and lectures. I constantly took naps and wasn’t doing any of the activities I normally did. I was depressed. I started new medication to help my symptoms and it’s going well so far. I’ve started cycling more; putting in about 50 miles per week. I’ve been working on my garden and my patio, creating an oasis for days off work to relax. I don’t see having to start a new medication as a failure, I see it as an accommodation that is necessary under these circumstances. With my mental health back in check, I can take on most anything.

I’ve never felt closer to my coworkers. We see a side of Covid that most don’t.  We’re all going through the same experiences- the collective anguish and joy we’ve experienced brings us together. We cry together when we lose a patient and we smile together when our patients get better. We keep each other smiling throughout the day, through bad puns, quiet music at the nurses station, and perfecting the “air high five”. We’re in it together, and together we’ll overcome.

I have had the privilege of working among countless great nurses in my five years of Critical Care Nursing. I have benefited greatly from experienced nurses who trained me, passing along their knowledge and wisdom while also benefiting from the upbeat energy radiating from new nurses. Each brings unique skills that contribute to excellent patient care. I’ve decided to describe some of these qualities.

Compassion is the heart of nursing. We have compassion for our patients, finding ways to make them feel better on their worst day. We hold their hands when they’re scared and dab away their tears. We have compassion for their families, coming to console them when they break down in grief outside patient rooms. There are days that your heart breaks, and the compassionate understanding of your coworkers is the only thing that holds you together.

Inclusion means “to include”. A good nurse provides care to a diverse patient population, regardless of race, socioeconomic class, religion, sexual orientation, or gender identity. A great nurse actively seeks opportunities to learn about these populations and the disparities affecting their health and access to care. They acknowledge the existence of implicit bias and combat it. A great nurse sees the different cultures in their patient populations and celebrates them.

Innovation is an asset found in great nurses. Great nurses see weaknesses in processes and find ways to improve them. Great nurses scour medical journals and databases seeking high quality evidence to incorporate into practice to improve patient outcomes.

Sincerity A great nurse is sincere with patients and their families. They avoid the scripted responses so often heard and speak from the heart. They are authentic in their interactions with patients and their families.

Ownership is a quality found in great nurses. They understand all of their responsibilities and strive to surpass expectations. They take pride in their practice, endeavoring to improve shortcomings because it is a representation of themselves.

Wisdom comes with experience and is a quality shared by many great nurses. Wisdom is the knowledge accumulated over time. A great nurse can be presented with a patient and recall a similar situation and the treatment process. It needs to be shared among nurses, physicians, and other members of the care team.

Communication is a key quality of great nurses. Therapeutic communication must be used with patients and peers. Additionally, great nurses know when to be assertive; when to express concern to the care team. A great nurse communicates clearly and concisely, reducing error and mismanagement in delivery of care.

Critical Thinking is a hallmark of a great nurse. Critical Thinking skills are not developed overnight; they are learned over time with each new experience. Great nurses understand the effects of medications and treatments on their patients, noting potential hazards, interactions, and more. They think beyond an order and understand the ripple-effect it may have on their patient.

Humor is something all great nurses must have. There are many different types of humor I’ve encountered when working among great nurses. While sarcasm seems to be the international language of nurses, it is not the only type found in great nurses. Great nurses find ways to make patients smile, from drawing silly cartoons on patient’s doors to a running commentary on the Jerry Springer show. Laughter is, after all, the best medicine.

I’ve just reached my fifth year in Critical Care nursing. From day one, I was surrounded with great nurses. I’m inspired daily by my coworkers- the new grad who can always start conversations with the most guarded of patients; the nurses who are champions of wellness, doing twenty squats each hour at the nurse’s station; the Emergency room nurse who radiates hilarity with each breath they take; the nurse who singlehandedly researched and implemented a policy change; and the nurse who totes a shampoo bin throughout the unit to make patients feel a little bit more like themselves- They exemplify greatness and their example is invaluable to me.

Kate Best is a 2015 graduate of The Ohio State University College of Nursing.