Have you ever had one of those ohmigosh moments at work?
When you realize the patient you thought understood what he/she was supposed to
do was in fact doing nothing of the sort? I felt completely ridiculous and
somewhat horrified, when a very educated patient had mixed up his short and
long acting insulins FOR AN ENTIRE MONTH. He was taking his basal dose at
bedtime in rapid acting insulin. Talk about overnight hypoglycemia. Despite all
the explanations, conversations, repeating back and writing down……a potentially
disastrous outcome could have occurred. How could I have missed it? What could
I have done differently?
As a result, I have gotten a little smarter about asking
patients what they are doing. Instead of saying “tell me” I ask them to “show
me” what they are doing with their insulin or smbg. With some shocking
outcomes—another person who was injecting his insulin intradermally, like a
ppd, to his forearm. It brings to question all the educational materials we
use, and how we are verbally presenting the information at my institution.
Where is the educational failure taking place?
We have made a conscious effort to include more pictures on
our educational flyers, and limit the reading level to 5th grade. I
may have a master’s degree, but if I have to put any electronics together
pulleeze have lots of pictures on the directions or it’s not happening. Many of
our patients must feel the same way when we are asking them to engage in new
medical skills.
Personally, I like to give out targeted information. In other
words, just give out printed literature for the topics being discussed that
day. The “diabetes encyclopedia” is daunting, and probably goes on a shelf and
doesn’t get read. There probably is a place for it somewhere in diabetes
education, but it’s not usually my first choice. What are you doing in your
practices?
The underlying issue is health literacy. The US Department
of Health and Human Services defines health literacy as the degree to which
individuals have the capacity to obtain, process, and understand basic health
information and services needed to make appropriate health decisions (2000).
Low health literacy interferes with an individual’s ability to self-manage
their diabetes. Persons with low health literacy are less likely to use
preventive healthcare services, and more likely to use healthcare services for
complications of chronic disease. Low health literacy is associated with higher
rates of hospitalization and emergency department use. Only 12 percent of
adults have proficient health literacy, according to the National Assessment of
Adult Literacy (HHS, 2013). If this is true, then 88% of the people coming
through our doors may need some extra help learning the necessary diabetes
skills. It’s time to get creative about assessing a patients’ level of health
literacy, and the adaptive education methods available.
U.S.Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S..
U.S. Department of Health and Human Services (2013). Quick Guide to Health Literacy.
Retrieved January 18, 2014 from http://www.health.gov/communication/literacy/quickguide/factsliteracy.htm