Qualitative Annotated Bibliography

Annotated Bibliographies of Qualitative Research Elizabeth Bright South University Online January 24, 2020

Annotated Bibliographies of Qualitative Research

For this qualitative descriptive study, Toronto and Weatherford sought to answer three questions regarding the experiences of practicing nurses with patients with low health literacy. First, what were nurses’ experiences with patients thought to have low health literacy? What interventions did nurses utilize with patients having low health literacy? And finally, what were the potential gaps in practice that might benefit from educational interventions? The researchers provided the Institute of Medicine (IOM) health literacy definition, along with several probe questions to a convenience sample (N=19) of RN-BSN students from a research class and asked them to write about their experiences with someone with low health literacy. The hand-written narratives were typed, coded, and put through a 4-step iterative process of analysis; first independently for validity, and then by each of the researchers. Sixteen of the 19 students agreed to participate in the study (84%). The participants worked in a variety of nursing settings and with diverse patient populations. Only 7 of the 16 participants reported any prior exposure to health literacy content. Five themes emerged from the written narratives describing the experiences caring for patients with low health literacy: building trust, recognizing gaps in learning, barriers, clear communication techniques, and evaluation of learning. Building trust came out of the need to establish therapeutic relationships, particularly with patients of other cultures and ethnicities. Gaps in learning were found to emerges at various points during provision of care and pointed to the need for ongoing assessment of health literacy needs and teachings. Barriers were found to exist in individual professional and system levels. Most of these barriers regarded perceptions of cultural differences and assumptions made. At the systems level, barriers were seen in the lack of written health information in languages other than English or containing too much medical jargon. Access to language interpreter services were also felt to be an impediment to both assessing and teaching health literacy content. Participants indicated clear communication techniques, such as simple language and concrete, simplified instructions were used with low health literacy patients, and this is within keeping with strategies described in the literature. The preferred “teach back” method or returned demonstration for evaluation of learning was only described by one participant. This study provided insight into the experiences of practicing nurses with health literacy. The research findings indicated a need for educational needs assessments and recommended training for nurses and other healthcare professionals for basic health literacy content and techniques to increase the health literacy of their patients. The Agency for Healthcare Research and Quality recommends that a “universal precautions” approach be applied to all patients regarding health literacy. This study also recommended future research of the health literacy and cultural training needs of nurses in the workplace. There were several limitations of the study There was the possibility of social desirability response bias because the participants were involved in a classroom with the instructor and researcher present. The narratives were post-experiential and could therefore, been misremembered. The analysis process attempted to reduce the possible subjectivity by having the data analyzed independently. The researchers’ perceptions and biases add to the subjectivity. This study lends evidence for this writer’s proposed research on practicing nurses’ knowledge and understanding of health literacy content and techniques and needs for education. Wittenberg, E., Ferrell, B., Kanter, E., & Buller, H. (2018, February 01). Nurse communication challenges with health literacy support. Clinical Journal of Oncology Nursing, 22(1), 53-61. http://dx.doi.org/10.1188/18.CJON.53-61 The purpose of this study was to investigate nurses communication and health literacy skills by measuring the how often nurses experience patient and family health literacy needs, how difficult the nurses perceive it is to work with low health literacy populations, and how comfortable they feel providing health literacy support. The study used a 30-item open-ended cross-sectional survey to measure nurse communication and health literacy support that was distributed to 74 oncology nurses attending a national nurse communication training program for oncology nurses called COMFORT (C-communication, O-orientation and options, M-mindful communication, F-family caregivers, Openings, R-relating, T-team). The participants were also presented with five low health literacy patient populations and asked to indicate the frequency with which they encountered these populations (rarely, sometimes, often, or always), and the degree of difficulty they experienced with each population on a scale of 0 = not difficult to 10 = very difficult. They were also asked how frequently they had to provide health literacy support by helping to complete hospital forms or read hospital materials to patients and family members, as well as how comfortable (1=very comfortable to 10=very uncomfortable) they felt providing health literacy support. A two-phase inductive data content analysis was used to put the open-ended responses into categories, and then abstracting the data into the categories. Of the 74 nurses surveyed, 70 nurses completed the open-ended items of the survey. The results of the study found that across all years of experience nurses were least comfortable identifying low literacy patients and assessing a patient’s health literacy level. The most difficult populations with health literacy needs were reported to be those with who did not speak English as a first language, ethnic minorities, and older adults. Nurses with the most experience reported the most difficulty with low literacy patients. The study suggested this was due to less exposure to health literacy concepts and education. Finally, this study also adds evidence for this writer’s proposed study on experienced nurses’ needs for health literacy education.