When Paul Moffat was recovering in the hospital from open-heart bypass surgery, he was given a breathing exercise that would help his lungs start working properly again.
"Every hour I had to take 10 deep breaths," he recalls. "But, I would listen to the patient doing the same exercise beside me and he was getting all sorts of phlegm. Because I wasn't getting any phlegm, I thought I wasn't inflating my lungs so I tried even harder, doing it more than once an hour."
When his respiratory therapist tested his breathing, Paul was surprised to hear that his lungs were recuperating very well. But because he wasn't given clear cues to tell him whether he was doing the exercises properly, his misinterpretation of the instructions put him in a lot of pain.
"I'm thinking, wow, where did I lose the interpretation at the beginning where that (not getting any phlegm) may not happen?" Paul says. "It was a painful misunderstanding because those new sutures were killing me every time I was trying to breathe."
Teaching others the importance of health literacy
Today, Paul is a proud graduate of Toronto Rehab's Cardiac Rehab program and a UHN Patient Partner, passionate in his commitment to health literacy and patient education initiatives. He regularly shares his experiences as a former UHN patient to help clinicians learn how to clearly communicate so that their patients understand their care.
As a Patient Partner, Paul has had the opportunity to co-facilitate sessions for UHN staff on teach-back, an important strategy for health literacy and patient safety. Teach-back is a method that includes asking patients to demonstrate or repeat back in their own words what they've been told. Teach back is
not a test of the patient's knowledge, but a way to confirm how well the healthcare provider taught information and what content needs to be reviewed with the patient again.
Through this work, Paul has come to realize the importance of health literacy strategies.
"Being able to explain something to a patient in layman's terms and then have the patient explain it back so that you know they have a full understanding, I think it's fantastic," he says. "It's now more important than ever for patients and their family members to understand what is expected of the patient before they go home.
"Having that all laid out in simplistic terms takes away the anxiety level, and I think that means there will be less people a day or two later coming back because they didn't understand what you meant."
Paul's message for clinicians
"I know you're extremely busy and I know your patient load is extreme these days, from my own family members who are retired nurses," says Paul. He realizes that sometimes it can be difficult to spend those extra minutes making sure each patient has understood the most critical safety information.
Here are Paul's tips that will save time for everyone in the long run and, more importantly, will help ensure patients receive safe care that they understand:
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Ask open-ended questions and incorporate teach-back – Don't ask, "Do you understand?" after you give health information to a patient. Instead, ask them to explain back what you just told them in their own words.
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Inform patients and their families about educational resources as soon as possible, such as the UHN Patient & Family Libraries – Have as many members on the healthcare team repeat and reinforce these resources so that patients and their families will remember.
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Provide patients with health information in their preferred learning style – Some patients are comfortable with using the internet to find health information, but many also prefer written materials or videos. For help finding reliable information, call or email one of the UHN Patient & Family Libraries – they're for staff, too!
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Arrange for an interpreter if English isn't the patient's first language – As Paul has observed, "in the city that we live in now, where there are so many different ethnic groups, people are afraid to say that they don't understand, so having an interpreter present is an important way of getting information across."
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Use a universal precautions approach for health literacy – It is not always clear who is health literate. Even though Paul had a good understanding of health and physiology from being a firefighter, there were times when he misunderstood health information as a patient.
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Approach every patient as a family member or friend – Give every patient that extra attention, like how you would want your family member or friend to have a good understanding of what's happening and what's going to happen to them. As Paul explains, "too often, in the work world, we get caught up in what we're doing from our perspective and we forget the endgame person – in this case, happens to be the patient, and that's supposed to be the most important thing, and sometimes that gets lost."
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Provide information on the days leading up to discharge – On discharge day, patients are excited to go home, or may be overwhelmed with information, and may not be able to process information properly. Have a checklist of things that should be done way before discharge day while patients are still engaged, such as making sure patients understand possible medication side-effects or that they know about their next steps, like rehabilitation programs. This gives people time to ask questions and to understand what is to be expected before they go home and will lessen concerns when they're actually at home.
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Recruit a Patient Partner to your unit – Input from Patient Partners can help improve how your clinic or program delivers care, such as helping you refine which terminology to use when explaining health information to patients and their families. Learn more about UHN Patient Partners or email
patientexperience@uhn.ca.
Start building your health literacy skills today
It's never too late to start incorporating some of Paul's tips to your practice. For more information about how you can improve your health literacy, visit
www.uhnpatienteducation.ca or contact your nearest UHN Patient & Family Library.
