Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. I also produce and host this podcast series, Health Literacy Out Loud.
Today, I’m talking with Joi Canton, who is a nurse and Manager of Community Outreach for Boca Raton Regional Hospital in Florida. In addition to many years in clinical practice, Joi brings experience as a clinical educator, clinical instructor, nurse leader and preceptor/mentor for novice nurses.
Joi sees how hard it can be for new clinicians to apply health literacy best practices in all their work. Joi is finding ways to help.
Joi Canton: Thank you very much, Helen. I appreciate your invitation to this wonderful and well-needed form of information. I can only see how this could make the community of healthcare stronger.
Helen Osborne: Let’s talk about that. You came to me with an intriguing topic about novice nurses, nurses at the start of their career, and how that intersects with health literacy best practices.
Let’s start at the beginning, Joi. Why is health literacy such a challenge for people at the start of their careers?
Joi Canton: In my experience as a nurse leader, educator, preceptor and mentor, the expectation of the new clinician, even if it’s not a nurse, who is now transitioning to practice is to be a good health promoter.
Although this is not an abnormal expectation of a healthcare organization, we have to consider what our role is in assessing the new clinician’s knowledge and sensitivity to the question of “Can this person, the patient, navigate, manage and advocate for themselves when it comes to healthcare?” which is basically the definition of health literacy.
Helen Osborne: Let me get this straight. You’re dealing with people from whatever profession they’re in, nurses or others. I had new occupational therapy students coming to me when I was in practice. People fresh out of school who now have their first job.
We all know what patient care is about and the ultimate goal, but you’re saying that that can be a bit of an awkward match sometimes for new clinicians. Is that correct?
Joi Canton: Yes. This is not their normal. They know how to have these conversations in a school setting. They’re basically very task-oriented.
Helen Osborne: Oh, okay.
Joi Canton: They may not consider health literacy as a problem because they are still working on how to clinically reason and critically think about the whole patient care.
Helen Osborne: Can you give an example? My brain is spinning as we’re talking about this and I’m thinking of the interns or new employees I had. I want to hear from you a more up-to-date example of how this can be a problem.
Joi Canton: In the healthcare world, we have certain things we say that only we know what it means. For an example, if a patient is not to eat prior to any procedure, we call it NPO, or nothing by mouth.
I worked with a young lady that was a brand new nurse, and the patient was extremely hungry. She said, “I’m sorry, sir. You are NPO.” The patient felt that they were sicker or they had some type of disease, and they became anxious. We were able to explain what it really means. That was a learning part for that new nurse.
Helen Osborne: I’m curious. How did you even know that? If it was just that new nurse with that patient, how would anyone have known that this misunderstanding was happening?
Joi Canton: That’s why I say it’s a challenge. In healthcare, especially in the emergency room, it’s such an acute care setting. That’s not something that maybe leaders or other more experienced nurses will stop and say, “Wow, we have to do something about it.” Our primary focus is caring for the patient and the acute issue.
Health literacy is not necessarily considered an acute issue. It is, to me, the starting point or foundation.
It’s going to be up to experienced and seasoned clinicians in any discipline to notice those moments of learning, not just for the patient but for the new clinician that’s transitioned to practice.
Helen Osborne: Wow. I love that term, “moments of learning.” Were you the one that observed what was going on, or did you hear second-hand about this issue, about NPO? Were you there at the moment?
Joi Canton: Yes, I happened to be there. It was a new nurse to the emergency room setting, and she was learning. She was trying to keep herself organized. I was the one that heard it and interrupted it.
Helen Osborne: Did you see from the patient’s perspective what happened? That this person got concerned they were sicker because they heard an acronym they’d never heard before?
Joi Canton: Yes. He actually said, “I didn’t know I had that.”
Helen Osborne: Oh my goodness.
Joi Canton: He looked a little afraid. That’s when I was able to interrupt and say, “No,” and explain what it was. I also allowed the new nurse to listen to my explanation, and then we talked about it later. That is a true learning moment for both of them, but to me, more importantly, for the new clinician so that she’s aware of how this seems.
Helen, when novice nurses are in school, before school, they never knew what anything was when it comes to nursing and how we speak and the different things that we say. They absorb it, and they want to be good at this craft and they want to be knowledgeable, so they adopt that language as their primary when it’s time to talk to the patient.
Helen Osborne: Probably she was trying to look good in front of you. You’re her mentor, her preceptor.
Joi Canton: Sure.
Helen Osborne: She wants to use those official medical terms.
When you have to reassure the patient what this all means, you also have to deal with that new nurse–whether now or later.
How can you do it in a way that does not embarrass her or make her feel even worse about this situation in the moment? I know later you talked with her about it, but what can you do to resolve this from both of their perspectives in the moment?
Joi Canton: I didn’t address the nurse right then and there in front of the patient. I just helped the patient understand. Then to the nurse, I just brought her back to prior to, like, “Remember before you became a nurse you might not have understood what NPO was? When you first heard it, you probably said, ‘What? NPO? What does that mean?’ Just imagine where the patient is, and now add on illness or uncertainty.”
Helen Osborne: Or facing surgery, as this person is, or a procedure.
Joi Canton: Right. It was easy. It was accepted. The last thing you want to do as an educator or mentor is to make the recipient of your knowledge feel like they are less than.
I watched her grow into a person that took the time to educate the patient, to allow the patient to ask questions and understand what’s going on with them so they could make these decisions.
Helen Osborne: What a beautiful story.
Joi Canton: Thank you.
Helen Osborne: I’m so glad you shared that, and that you’re also raising this issue, because it’s vital.
In healthcare today, we have many people coming fresh out of school with enthusiasm for their new career. I know from my clinic days it was a jolt sometimes to students who learned in school how to do these great assessments that might take an hour or more and to do all their book smart stuff. Then they’d come to me in an in-patient psychiatric unit. We don’t have an hour to interview each patient.
Joi Canton: Everything has to happen now.
Helen Osborne: Right. It’s just not the way it was. The essence is there, and I could see, hear and feel their disappointment, their discomfort. But if they can find a mentor like you that can help them turn this into moments of learning, how beautiful for everyone.
Let’s move to what can listeners do. Podcast listeners can come from all professions, all countries, all levels of experience. But what we have in common is we want to communicate more clearly today than we did yesterday.
What lessons have you learned that you might share with all of us who are facing and working with newcomers in the field or might be newcomers themselves?
Joi Canton: Let’s just think about this. We can do easy things. The first thing we all have to do is to know and understand the definition of health literacy and have plans in place to allow the easy instructions and information. Even in their organizations, if there’s a television channel that educates the patient on the third- to fifth-grade level.
Follow a standard of ensuring that your information is easy. We provide information to bedside clinicians, and that’s the starting point in a hospital. But just say we’re in management. We have to provide those that are providing this health literacy the tools to do it. We have to get rid of barriers.
Helen Osborne: Let’s talk about that higher level up, whether it’s a manager of a department or even an administrator of the facility. What can that person who doesn’t work with the newcomer do to make this a little bit easier?
Joi Canton: In a lot of places and organizations, and I can only speak for a hospital, there are tools in place when you’re doing an assessment of the patient’s condition. One of the tools in the electronic health record is asking the clinician, “What are some barriers to the patient’s understanding?” Sometimes clinicians are just checking what they feel.
But what happens is the tools to provide the clinician the question, “How do we approach the patient to ask them, ‘Do you have any barriers to understanding what’s going on with your health today?’” is where there’s a gap.
Helen Osborne: Of course, there’s a gap. You’ve got this yes/no question and people might just be guessing at the answer.
How would somebody know that deeper understanding of how to approach a patient? Is that where role-playing would come in or mentoring?
Joi Canton: It would be role-playing. If you give a patient something like, “Can you read this with me?” you have little clues. If a patient says, “I don’t have my glasses,” or, “Usually my daughter reads this,” those are some of the cues that we need to stop, take a moment and find out how best this patient learns.
We can ask them, “Tell me, would you like me to explain something to you or give you some stuff to read? What do you like best?”
Helen Osborne: I have a question about this one. I would assume these days that many people going into health professions have taken a course or had a lecture at least on health literacy. I don’t know if they do more than that. I think it’s growing in acceptance, but that’s not the focus of their work. They need their anatomy and physiology and all of that. So they’ve somehow learned this, but it’s just one of many things that they’re absorbing in all their years as a student.
For you, on-site, in practice, how can you help them remember that that has value, too, as much as it is to know the scientific end of things?
Joi Canton: That comes with, as an educator, being very creative. As an educator with student nurses in the university setting, I would do some role-playing. At the end of the day after when we’re sitting down and recapping the day, I would do a little role-playing and challenge them to speak to me in layman’s terms, say, to describe pneumonia.
Right now, I also still educate some of the new grads even though I’m not in that position. I am giving them a health literacy class. At the end of the class and presentation, we’ll be playing a game of “Can you get the other person to say what this is?”
If the word is pneumonia, what other words can we use without using the word pneumonia to get that person to say it? That means that using other words in medical jargon, the person is aware. They can make a decision. They feel comfortable in understanding what’s happening.
Helen Osborne: You mean the new clinician needs to describe pneumonia in words not saying pneumonia?
Joi Canton: Yes. We’re describing it to another new clinician. It’s a game, like the game Pyramid or some of the show games that we used to use. Instead, I insert a little twist to it with medical terms to get them to really have this communication. How well can you communicate without using the new words that you’ve learned in healthcare?
Helen Osborne: That reminds me, Joi. I’ve got a big grin on my face. I don’t know if you can hear it in my voice. I do a lot of in-person health literacy training and teaching different principles about health literacy. I created a game that we sometimes use.
I’ve got a set of cards on health topics and a set of cards that describe people in a very general way. People work in small groups and they randomly pick a health topic and a person, like “So-and-so is new to the country,” or new to the language or something like that. Then they have to, in small groups, figure out ways to explain that topic to that person. It makes it a little bit real, but not overly real.
They come up with all these different ways, just like you’re coming up with all these different ways. You’re talking about games, role-playing, mentorship, that caring tone and explanation later. What a model for all of us.
Joi Canton: Thank you.
Helen Osborne: I could keep talking with you, but podcasts don’t go on for very long and I want to honor that. I would love to hear about your vision for years ahead.
What would it look like if all of us help people as they transition from the classroom to the clinic? I’ll say clinic, but it’s not always a clinic. To their professional worlds. What would this look like, or what’s on your wishlist?
Joi Canton: Say it’s in a university setting with nurses. I would like to see specific classes that are just about health literacy and how to manage that, how to manage your task versus understanding that the patient is truly in the center.
Healthcare promotion and education is individualized. It cannot be one-stop shop for one for all. It is individualized, and that has to be honed in with specific education with a class like Health Literacy for Healthcare Providers.
I think this would make an extremely big impact, especially now in the world of coronavirus. We’re focused on that, but there’s still chronic disease management that was there prior to and will be exacerbated even after.
We still have to get this message out to the patients about their care and they have to be able to be well informed to make the best decision for themselves and their family members. That would be my dream.
Helen Osborne: On your wishlist is for universities to be doing more and promoting health literacy and making it real.
On this wishlist for mentors or on the hospital/clinic side or the organizational side. Anything on that wishlist as we have newcomers coming in all the time?
Joi Canton: Yes. Take a course. Do a webinar. Follow your podcast. Look at your website. Read your book.
Helen Osborne: Please do.
Joi Canton: We have to have an invested interest in that. It has to be a primary. The foundation of good health is understanding health. We can’t make a change without that foundation.
My father’s favorite saying, and he brought us up with this, was, “Build the foundation for the position you want in life.” As a healthcare provider, our position is to provide care. Our foundation has to be everyone has to understand what that means, not just us.
Helen Osborne: I can’t top your father’s words. Those are beautiful.
Joi Canton: Thank you.
Helen Osborne: Joi, you bring the joy, humanity, wisdom and experience for how we really can start putting health literacy in all our practices.
Thank you so much for approaching me with this topic and topping it off with this wonderful conversation on Health Literacy Out Loud. Thank you, thank you, thank you.
Joi Canton: Thank you as well. Thank you for replying. Thank you for taking the time and having a conversation with me. This is such an important topic. Helen, I’m so grateful to you for all you’re doing to highlight this topic. We cannot have good patient outcomes without this topic. I appreciate you.
Helen Osborne: I thank you. Let’s continue this conversation, but for now, thank you for being a guest on Health Literacy Out Loud.
Joi Canton: You’re welcome.
Helen Osborne: As we just heard from Joi Canton, it’s important for all of us, those who have been working in our roles and professions for many years and our newcomers to the professions, too, to communicate in ways the patients, public and people we care about can understand. But doing so is not always easy.
For help clearly communicating your health message, please take a look at my book Health Literacy from A to Z. You might be especially interested in the chapter about empathy and humanity.
New Health Literacy Out Loud interviews come out every few weeks. You can get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.
Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters. Until next time, I’m Helen Osborne.