Health Literacy Inclusion in Undergraduate Nursing Education: Integrative Review

A major nursing responsibility is to educate patients with diverse literacy levels using understandable health communication. Inadequate or poorly communicated health information may adversely impacts patient-provider interactions and health outcomes.  The purpose of this integrative review was to evaluate support for and inclusion of health literacy evidence based practices in undergraduate nursing education using Whittemore and Knafl’s integrative review methodology.  Search strategies included general, health related and educational computerized database searches, ancestry reference review and use of expert recommendations.  The keywords “literacy”, “health”, “nurs*”, “education” and “student” were used for the primary search. A review of 159 relevant abstracts was refined to analyze eight primary nursing education studies:  three descriptive surveys, two quasi-experimental and three qualitative phenomenological reports. Health literacy definitions, health literacy inclusion, population characteristics, research design, student and patient outcomes and implications were extracted for comparison.  Four subthemes emerged: curricular access, course content application, student engagement in learning and patient involvement in self care. Integration of health information appear to be minimally represented in baccalaureate nursing curriculum and course content. Content assessment occured through specialized projects or in senior level  courses at the baccalaureate level.  Functional health literacy information was used to characterize current health literacy course content.  Students were engaged in functional health literacy interventions to increase patient health knowledge with improved patient self-care as the goal. None of the studies linked direct measurements of improvements in patient outcomes to student health literacy knowledge or practices.
Inconsistencies in health literacy knowledge and nursing education practice may limit the effectiveness of future nurses as communicators, patient educators and advocates. Increased inclusion of health literacy quantity and quality throughout nursing education should occur to bolster nursing student knowledge and evidence based practice. The impact of student interventions on patient outcomes and health care quality should be evaluated to determine areas for improving health literacy inclusion in current and future nursing educational practices.