Understanding communication challenges in nursing care of patients with limited health literacy: a qualitative study

Limited health literacy affects millions globally, impairing patient understanding, treatment adherence, and health outcomes. Nurses, as primary healthcare educators, navigate complex communication challenges with vulnerable patients. However, research examining nurses' lived experiences of managing these challenges remains limited, particularly regarding how organizational and systemic factors enable or constrain communication effectiveness. This study aimed to explore registered nurses' experiences, perceived barriers, adaptive communication strategies, and systemic factors influencing nurse-patient communication in acute care settings with diverse patient populations.

Descriptive qualitative study employing semi-structured interviews with 18 registered nurses across emergency, intensive care, medical-surgical, and specialized acute care units. Data were analyzed using Braun & Clarke's six-phase thematic analysis approach. Trustworthiness was enhanced through member checking, peer debriefing, comprehensive audit trail documentation, and prolonged engagement with data.

Four interconnected themes emerged: (1) Multifaceted Communication Barriers encompassing language limitations, cultural-epistemological incongruence, and foundational knowledge gaps; (2) Strategic Communication Approaches including simplified language, visual demonstrations, teach-back methods, and family engagement; (3) Systemic Obstacles comprising inadequate resources, time constraints, unclear policies, and institutional ambivalence substantially constraining communication effectiveness; and (4) Emotional Labor and Professional Resilience capturing nurses' psychological experiences, moral distress, and coping mechanisms.

Effective nurse-patient communication with individuals with limited health literacy requires interventions at individual, interpersonal, and organizational levels. Findings suggest that communication effectiveness is substantially shaped by organisational factors staffing, resourcing, policy, and accountability and that framing communication gaps as primarily individual competence deficits misrepresents what is, in large part, a structural problem. Individual skill and professional effort remain important; however, they operate within organisational parameters that participants frequently experienced as inadequate. Healthcare organisations must allocate dedicated resources, establish explicit patient education policies, and create accountability mechanisms to enable nurses to communicate effectively with patients with limited health literacy.