OR7. Health Literacy and the Inpatient Nurse: Defining Core Competencies at an Academic Medical Center

Background Limited health literacy is a national health crisis contributing to poor health outcomes including increased hospital readmissions, increased healthcare cost, decreased use of preventive services, and increased morbidity and mortality. Efforts to improve the health literacy of the nation hinge on healthcare provider-level interventions to address social determinants of health. However, these strategies represent an area of care which inpatient providers may not be prepared. Despite cascading poor outcomes associated with limited health literacy, staff nurses at a large urban medical center are not professionally prepared with integral health literacy competencies, skill sets, or screening tools to identify and support their patients. Setting: A large, urban medical center with a 720-bed specialized acute and critical care hospital serving a racially and socioeconomically diverse population. The Nursing Strategic Plan integrates social determinants of health and health literacy goals into the framework of nursing operations in efforts to demonstrate commitment to health equity initiatives. Purpose To evaluate staff nurse competencies in the care of inpatients with low health literacy and complete compulsory groundwork for future health literacy programing at the medical center. Objectives (1) Evaluate staff nurse knowledge, attitudes, and skills pertaining to health literacy; (2) test-run the Brief Health Literacy Screen tool on inpatient acute care units; (3) quantify rates of limited health literacy among adult inpatients; (4) design patient education care algorithms and staff training in health literacy; and (5) disseminate findings to the Health Equity Council. Methods Pilot goals were developed by a steering group of key stakeholders. Staff nurses in acute care units were surveyed to assess baseline knowledge, attitudes, and skills of health literacy concepts. The Brief Health Literacy Screen was introduced to staff nurses as an option to objectively identify individuals with limited health literacy. A 4-week pilot of the tool was completed. Rates of health literacy level were tallied and analyzed. Statistical analysis of survey responses and pilot results was shared with the Health Equity Council at the medical center. Results Despite demonstrating proficiency in health literacy concepts, staff nurses lack clinical skills and resources to effectively identify patients with low health literacy and address these patient's unique clinical needs. Staff nurses are ambivalent about their role as patient education providers. The Brief Health Literacy Screen is a clinically feasible tool to identify patients with limited health literacy and is ideal for the busy inpatient environment. Using this tool, 256 adult inpatients were screened and 57.8% were identified as having insufficient health literacy. Care plans derived from health literacy best practices can serve as a guide for future health literacy training for inpatient nurses. Conclusions The medical center has the opportunity to adopt routine health literacy screening for all adult inpatients and professionally prepare staff nurse with clinical skills essential to the care of the patient with limited health literacy via comprehensive health literacy programming.