A Picture Is Worth a Thousand Words: Pictographs to Improve Understanding of Discharge Instructions

Poor comprehension of ED discharge instructions has been reported. Discharge instructions often include written information. Identification of home-care practices that were different from recommended discharge instructions among multiple clients led nurses at a community emergency department to evaluate health literacy among specific clients.

A bilingual translator administered the Newest Vital Sign-a 6-item validated scale that assesses health care literacy-to 150 English and Spanish-speaking parents of pediatric patients admitted to the fast-track area.

Although mean scores for both groups indicated participants were, on average, "at risk" for health literacy problems, English speakers had a significantly higher mean total score (3.82, standard deviation [SD] = 1.60) than did Spanish speakers (2.61, SD = 1.71), indicating better literacy.

Study findings of low levels of health literacy in many parents led to a practice change of using nurse-developed pictographs, along with discharge instructions, for specific common ED diagnoses. Postdischarge calls to parents or patients receiving the pictographs documented positive postdischarge client feedback. The pictograph strategy is transferable to other institutions.