IMPROVIN

G COLONOSCOPY

OUTCOMES

THROUGH HEA

LTH

LITER

ACY

T R I C I A W I N Z E N B U R G

ISSUE IDENTIFICATION

Colorectal cancer is the third leading cause of cancer in the United States. With early detection, survival rate reaches 90% (Five myths, 2010).

It is one of the most preventable cancers

And the least talked about . . .

FINDINGS• Noncompliance- fear, inability,

financial, unawareness, inconvenience, apprehension, indifference

• Procedure preparation tolerability-fasting, laxative ingestion

• Patient understanding—dependent upon HEALTH LITERACY

WHAT ARE THEY SAYING?“Our most successful preps are seen in patients who have either had a previous procedure or

perhaps have had a family member die of colon cancer and understand the importance” (Archana Verma, M.D., 2012). “The closer to the time of the procedure the prep is finished, the greater chance we have of getting a clean look at the lining of the colon” (Raj Iyer, M.D., 2012). “I would say most of my preps are good, I believe prep success lies in allowing the patient to have a say in the prep they will be using” (Michael O’Brien, M.D., 2012).

“You can split the prep, but they may not finish it. Some come in frustrated waving their instructions, and only having followed half of what was written. If they have assistance in the home there is greater likelihood that they will be successful, especially if they are elderly. I worry about the diabetics, some manage their disease well, others present after a 24 hour prep in distress” (Endoscopy nurses, IDDC, 2012).“The first thing you’ve got to do is help

people understand that they need to do this in the first place. I have heard guys at the

HyVee having breakfast talk about this kind of thing. If they don’t think there is good reason for it, they’re not going to do it!”

(Nicholas Liffrig, personal communication, July 29, 2012).

ACTION PLANPURPOSE- To provide education and instruction to nursing staff pertinent to pre-procedure patient education and low health literacy. To initiate new, and revise current, patient written and oral communication tools, focusing on patient understanding. DEFINITION:- Health literacy is the degree to which individuals

have the capacity to obtain, process, and understand basic health

information and services needed to make appropriate health

decisions (About health literacy, n.d.).RATIONALE: Compliance with pre-procedure instructions is

necessary for optimal procedure outcomes, in the ability to

identify and treat potential disease. Patient understanding of pre-

procedure instructions is necessary for compliance and

dependent upon adequate health literacy. Over a third of adults

in the United States have basic or below basic health literacy skills

(The health literacy of America’s adults, 2009).

 

PRE-PROCEDURE INSTRUCTION COMMUNICATION TRAJECTORY MODEL

ETHICAL CARING THROUGH POLICY

Rooted in Benner and Wrubels’ theory, Primacy is Caring, “caring is the essential requisite for all coping” (Benner & Wrubel, 1989, p. 2).There can be only limited success in coping, if there is poor understanding.

It is the responsibility of the professional nurse, to educate and advocate from a body of evidence that can help achieve the outcomes we seek for the good of our patients.

WITHIN THE ARENA OF POLICY IS ONE OF THE NECESSARY

PLACES TO BE