Guest Contributor: Marta Patrícia Marques Lameiras
Masters student in Medical-Surgical Nursing at the Catholic University of Portugal School of Nursing in Lisbon
Thought: “Education, whatever it may be, is always a theory of knowledge put into practice.” Paulo Freire
Health literacy is a fundamental pillar for patient empowerment, especially in outpatient surgery contexts, where hospitalisation time is reduced and responsibility for self-care falls largely on the patient and their family. Nurses play a key role in involving and empowering patients in decisions and self-care. Based on my experience in outpatient surgery and perioperative care, I have found that patient literacy is still a gap in the healthcare system.
When we talk about health literacy, we are also referring to people’s ability to understand information about their own health and healthcare, to understand how this information relates to their daily lives, how it can be used to make relevant decisions and act accordingly. Shared decision-making in healthcare stands out as a collaborative process that allows people and their healthcare providers to make decisions together, taking into account the best available scientific evidence on the subject, as well as the person’s values and preferences, as a fundamental mechanism for people’s participation in health decisions and as a fundamental action for promoting health literacy (Pedro, 2018).
The conceptual model of health literacy identifies four main competencies: access, comprehension, evaluation and use of health-related information. Access relates to the patient’s ability to search for, find and obtain health information; comprehension is the ability to understand that information; appraisal is the ability to interpret, filter, judge and evaluate the content; and finally, application/use is the way of communicating and using that information, enabling decision-making, always with the aim of improving or maintaining health (Ferreira, 2023).
In daily nursing practice, the interpersonal relations theoretical model is used. It explains the interpersonal process involving the patient and nurse by relating the causes and effects of this interaction and presenting how and why the constituent elements of the theory are related (George et al, 2000). Nursing theories recognise nursing as a science and discipline, in addition to establishing the foundations that guide nursing thought and practice (Alligood and Tomey, 2004). Knowledge and understanding of nursing theories is essential for nurses in the future to provide quality care and more humanised care, with the aim of promoting the well-being of patients and respecting their cultural, personal and social specificities (Oliveira and Rivemales, 2021).
Hildegard Peplau’s interpersonal relations theory is a theory centred on the relationship between the nurse and the patient. In her theory, Peplau addresses the notion of personal growth, shared between nurse and patient, based on the establishment of an interpersonal relationship between the two in the care process. Hil degard Peplau’s interpersonal relations theory highlights the nurse as a facilitator of learning and promoter of autonomy. In its phases (orientation, identification, exploration and resolution), the nurse establishes a therapeutic relationship that can be applied in a concrete way to reinforce health literacy (Franzói et al, 2016
In outpatient surgery, during the orientation phase, nurses welcome patients, answer questions about the surgical procedure and explain it clearly, adapting to the patient’s level of literacy. During the identification phase, nurses recognise individual needs, fears and expectations. In outpatient surgery, nurses ask patients about their concerns and adjust accordingly. In the exploration phase, the nurse teaches and reinforces self-care skills. In the resolution phase, the nurse promotes autonomy, motivating the patient to feel capable of managing their recovery process. In outpatient surgery, a telephone number for the service is provided so that questions can be answered and any warning signs can be addressed. In this care process, it is accepted that nurses help patients to reduce their insecurity and anxiety, converting them into a beneficial action in the therapeutic process, which influences both the personal and professional development of the nurse and the patient (George et al, 2000).
With the growing emphasis on the effective involvement of people in their own healthcare, there is also a growing need to determine effective ways of involving them in the process through which healthcare decisions are made. The effects of adequate levels of health literacy include better health, reduced healthcare costs, increased health knowledge and less frequent use of health services (Pedro, 2018). The risk of mortality in the elderly is clearly higher, as they have low health literacy. The reasons for this relationship centre largely on the elderly’s reduced ability to take medication correctly, their reduced ability to interpret labels and health messages, and the existence of poorer overall health conditions in this population group (Pedro, 2018).
Depending on whether or not they acquire these skills, individuals may relate differently to the three domains of the health process: healthcare, disease prevention, and health promotion (Almeida and Fragoeiro, 2023).
Nurses play an important role in communicating with patients, empowering them. Effective communication is one of the best ways to facilitate a relationship with patients and their families, making them active participants in their care and feeling that they are valuable members of the healthcare team. Adherence to prescribed treatment plans and patient satisfaction increase when there is effective communication between the provider and the patient. In the nurse-patient relationship, nurses play a significant role in helping patients to be autonomous in their daily lives. Nurses use communication tools such as clarification, listening, acceptance, teaching and interpretation to provide patient care. (Parnell, 2015).
Reflecting on this topic, in practice, it is clear that patients with lower levels of health literacy have more difficulty understanding, assimilating information and using health support resources. Investing in health literacy is investing in people’s dignity, autonomy and quality of life. Every educational gesture by a nurse has the power to transform the patient’s experience, making them not only a recipient of care, but also a protagonist in their own health. May every encounter with a patient be an opportunity to teach, inspire and empower, because an informed patient is an empowered patient.
References
Almeida, C. V., & Fragoeiro, I. (2023). Health literacy manual: Principles and practices.
Social Sciences Editions.
Alligood, M. R., & Tomey, A. M. (2004). Introduction to nursing theory: History,
terminology and analysis, nursing theorists and their work: Nursing models and theories.
Autodidata.
Ferreira, A. J. (2023). The great challenge of contemporary health: Monograph on health
literacy in Portugal [Master’s thesis, University of Beira Interior]. University of Beira
Interior.
Franzói, M., Fernandes, M. F. P., & Cruz, D. A. L. M. (2016). Peplau’s theory of
interpersonal relations: An evaluation based on Fawcett’s criteria. UFPE Online Nursing
Journal, 10(9). https://doi.org/10.5205/reuol.9205-80279-1-EDSM1009201624
George, J. B., et al. (2000). Nursing theories: The foundations of professional practice.
Artmed.
Oliveira, L. L. C., & Rivemales, M. C. C. (2021). Articulating nursing practice with the
theories of Nightingale, King, and Peplau: Experience report. Journal of Nursing and
Health,11(4).https://periodicos.ufpel.edu.br/ojs2/index.php/enfermagem/article/view/18
421
Parnell, T. A. (2015). Health literacy in nursing: Providing person-centred care. Springer
Publishing Company. https://doi.org/10.1891/9780826161727
Pedro, A. R. (2018). Health literacy: From information management to intelligent
decision-making [Doctoral thesis, National School of Public Health, New University of
Lisbon].New University of Lisbon
About Marta Patrícia Marques Lameiras
Hi, I’m Marta. I’ve been a nurse since 2004 and earned my Master’s degree in pain management in 2010. I work at the Portuguese Institute of Oncology in Lisbon. I’m currently pursuing a Master’s in Medical-Surgical Nursing at the Catholic University of Portugal School of Nursing in Lisbon. This post was originally published in the Nursing Theories course. During my professional practice, I promote improved patient care and patient empowerment.