Teach staff easy-to-read writing techniques
Seminars increase literacy awareness in health care
One goal of the patient and family education committee at Carney Hospital in Boston is to increase literacy awareness and skills among staff. As part of the project, members of a Literacy Task Force offer workshops on how to assess readability, create easy-to-read materials, and test for comprehension.The skills workshops are routinely promoted at departmental meetings. "We ask to be put on the agenda, then do a presentation on literacy and have a sign-up for a skills training session," says Osborne. As soon as 10 people sign up for a workshop, it is scheduled. More than 60 people from 15 departments have attended the sessions.
The 31¼2 hour session covers the following:
• What to do before creating written materials.
"We tell people who attend the workshop to know their literacy demographics and appreciate that not everyone can read at a high school level or beyond," says Helen Osborne, MEd, OTR/L, director of health education at Carney.
A 1993 Adult Literacy Survey done by the U.S. Department of Education found that 47% of the U.S. adult population can be considered to have marginal literacy skills. Marginal literacy skills can lead to considerable difficulty integrating information from complex or lengthy texts or difficulty performing quantitative tasks that involve two or more sequential operations. In addition, the stress of an illness or hospitalization may compromise an individual’s ability to comprehend written information, adds Osborne.
Although pamphlets should be targeted at a fifth- to eighth-grade reading level, the main focus should be clarity, explains Osborne.
"Readability tests are not a perfect science. They only measure sentence length and syllable length. It doesn’t measure meaning to the reader or personal relevance," she says. (For a resource for assessing readability see source box, above.)
The sessions also teach that the author of the material should determine why he or she is writing the piece and when it will be distributed along the continuum of care. "People need to work on limiting the amount of information. They should determine the key points and focus on those," explains Osborne.
• What to do during the writing process.
Sentence structure, word choice, and layout all fall into this category. Health care workers must understand that one word can mean many things. For example, the word dressing not only describes the bandages on a wound but also a bread mixture stuffed into a turkey, topping for salad, and the process of putting on clothes.
"Pictures help explain the words," says Nancy Borden, RN, BSN, CETN, Enterostomal Therapy nurse clinician at Carney and a member of the Literacy Task Force.
They also cut down on the need for words, she says. For example, in a teaching sheet on tube feedings, the authors wrote long descriptions of the two types. A picture would have made each type of tube feeding easier to explain.
• What to do before the material is distributed to patients.
All material needs to be field-tested or given to people who are not familiar with the health care industry, says Borden. In this way, words or descriptions that people don’t understand can be corrected. When she was editing an infection education sheet for vancomycin resistant enterococcus, she found that no one could pronounce the word. Therefore, she used the word once on the sheet and then used its acronym when it was mentioned again on the sheet. Also, she broke the word into syllables so people would know how to pronounce it.
"With medical terms, there are some words that you have to use. By substituting another word you may change the focus or the intent. So you use the word, explain how to pronounce it, and what it means in the beginning of the piece," she explains.
The workshop is not restricted to people who are writing educational materials. The Literacy Task Force wants literacy to be an issue for everything written at the hospital, including directions to clinics or letters inviting the public to workshops.
"We hope we are raising people’s awareness about how they present documents and how they write them," says Osborne.
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