Barriers to care can have a huge impact on patients' trust in their healthcare teams and on their recovery.
But nurses help eliminate barriers to care by, for instance, assisting a patient who speaks a different language or helping patients gain a better understanding of their treatment plan. In doing so, nurses are preventing re-hospitalizations and improving health outcomes. So, what does it take to break down barriers to care?
It takes good communication skills
Poor communication is one of the top barriers to care. Ronda Hughes, PhD, MHS, RN, FAAN, knows how easily poor communication can interfere with a treatment plan. According to Hughes, misunderstandings between staff and patients can occur because of issues such as low literacy levels and language barriers.
Nurses might think patients understand the instructions they've been given, when the reality is patients are too embarrassed to admit they don't.
"We've implemented the teaching vs. telling protocol with our nursing students, new grads and those in residency programs," said Hughes, who is director of the Center for Nursing Leadership at the University of South Carolina College of Nursing in Columbia, S.C. "A lot of times when a patient isn't following instructions or taking their medication as directed, it's not because they're being difficult, it's because they don't understand." Hughes said nurses learn how to teach a procedure to a patient or give them instructions and then have the patient verbalize what they've learned. Teaching in front of a patient's family reinforces the messaging.
Referrals to other health professionals
When a patient is discharged from the hospital, they're given printed instructions with their medications, but sometimes that's not enough.
"Patients are often discharged with a lot of new medications, and they need help understanding how their prescriptions have changed and how they're taken," Hughes said.
"If the medications are complex, having a pharmacist consult with the patient makes sense since inappropriate use of medications is one of the leading causes of readmissions," he said. Robin Steaban, MSN, RN, a CNO at Vanderbilt University Medical Center in Nashville, employs patient flow nurses to complement the work of bedside nurses and handle discharge paperwork. "PFNs are assigned to units and have more time than bedside nurses to teach patients about how to manage their condition after discharge," Steaban said. "They make sure patients go home with the self-care resources they need and a plan of care." PFNs also address barriers to care that patients might face during discharge, such as making sure prescriptions are filled and determining who will care for the patient once they're home. "It can be validating for patients and their families to demonstrate an understanding of tasks, such as wound care, that they've been taught by nurses," Steaban said. "If a patient or their family seems to have difficulty due to language differences or low literacy levels, visual aids often work better than written instructions."
Focus on a patient's financial woes
Steaban said Vanderbilt's "Meds to Beds" program helps remove barriers to care by having a pharmacist deliver discharge medications directly to patients at their bedside. "Pharmacists talk to patients about how to take their medications, any potential side effects and help counsel patients if they require financial assistance to pay for their medications," Steaban said. Steaban explained this helps pressed-for-time nurses who want their high-risk patients that require multiple medications to get all the information they need. Beth Ann Price, RN, a nurse case manager in the San Francisco Bay Area, also finds it helps to follow up with patients the day after they've been discharged.
"Often questions will arise that patients or their families didn't think of when they're in the hospital," Price said.
Calling them gives patients the opening to ask more questions and give nurses peace of mind that their patients are correctly taking their medications. It's also an opening for other conversations. For instance, a patient could mention he or she is having financial issues or experiencing depression. Price said this can be an opportunity for nurses to call a social worker or another care team member to focus on this.
Language and literacy barriers to care
It can be problematic when patients and providers speak different languages. Price has found that rather than using phone interpreter services that often don't bode well in a noisy hospital, video remote interpretation works better. These on-demand interpreting services use web cameras and smartphones to help providers connect with interpreters who are fluent in several languages, including American Sign Language. "Patients seem to appreciate talking to an actual interpreter they can see and interact with on screen," Price said. "The interpreter translates what the patient says and then relays instructions from physicians and nurses to ensure the patient understands and receives the best possible care."
Take these courses to learn more about communicating with patients:
Effective Communication with Patients (1 contact hr) A growing body of research has shown a variety of patient populations experience decreased patient safety, poorer health outcomes, and lower quality of care based on race, ethnicity, language, disability, and sexual orientation. Effective communication with all patients is crucial to providing safe care. The healthcare team should aspire to meet the unique communication, cultural, and familial needs of all patients. Improving Patient Education for Poor Readers (1 contact hr) Inadequate health literacy can put patients' lives at risk, and it is a major driver of healthcare costs due to preventable complications. Health literacy is not limited to the ability to read letters and numbers. It requires many skills including reading, listening, analytical and decision-making skills, and the proficiency to apply these skills to health situations. This module provides information to help nurses ensure that their patients understand vital healthcare instructions. Health Literacy and Discharge Education: I Didn't Understand (1 contact hr) When a patient or client struggles with both basic literacy and health literacy, much support is needed to help facilitate understanding of health information. Join this webinar to help increase your understanding of the state of health literacy and learn how to educate more efficiently.
