NU702 Unit 4 Equity Analysis Example

Seven Percent for Patients Who Need an Interpreter: A Unit 4 Equity Analysis of Insulin Discharge Teaching

[Student Name]

Purdue University Global

NU702: Translating Evidence into Nursing Practice

Unit 4 Equity Analysis

[Instructor Name]

[Date]

The hospital, units, patients and figures are composite and illustrative; the sources cited are real.

The Data, Split

Over twelve months, 214 patients on 5 West and 6 West at a composite Dubuque hospital were discharged on an insulin regimen they had never used before. Of these, 187 preferred English, 18 preferred Spanish and 9 preferred Marshallese, reflecting the city's Marshallese community. Patients aged 80 or older made up 41 of the group.

Return demonstration was documented for 20 percent of English-speaking patients and for 7 percent of those who needed an interpreter, two of 27. A qualified interpreter was documented during any part of discharge teaching for 11 of the 27, or 41 percent. Glucose-related returns within 30 days, to the emergency room or a ward, ran at 13 percent for English speakers and 22 percent, six of 27, for those needing an interpreter. Among patients 80 or older, it was 20 percent, eight of 41. With groups this small the percentages wobble, yet every comparison points the same way.

What the Literature Predicts

These patterns match published evidence. In a study of patients discharged from a general medicine service, those who needed language help understood the category of their new medicines less often than fluent English speakers did, and understanding was low for everyone (Karliner et al., 2012). In a study of primary care patients with type 2 diabetes, inadequate health literacy was associated with poorer glycemic control and more retinopathy after adjustment for other factors (Schillinger et al., 2002). National surveillance found that insulin-treated patients aged 80 or older were more than twice as likely as middle-aged patients to visit an emergency department for hypoglycemia or insulin errors (Geller et al., 2014).

The unit's teaching works least well for the patients most likely to be harmed when it fails.

Why the Differences Exist

Three causes appear when the charts are reviewed.

Language access is inconsistent. Video interpreters are available on both units, but nurses report using them mainly at admission. On discharge day, teaching is often given in English with a family member translating, and a return demonstration is skipped because coaching through a family member feels slow.

Written materials are in English only. The insulin dose card and the hypoglycemia handout exist only in English, in standard print, at about a tenth-grade reading level.

Teaching is aimed at the patient alone. For older patients, a son, daughter or spouse often manages the insulin at home but is not present during teaching, which usually happens on the morning of discharge.

Health literacy is not assessed. The units do not screen for it, so nurses cannot tell which English-speaking patients need a different approach.

Proposed Changes

Each change is tied to one of those causes.

Interpreter use at teaching moments. The bundle's supervised self-injection on the second day and the return demonstration will require a qualified interpreter for each patient who asked for a language other than English, documented in the same field as the demonstration result. Family members may support but not replace the interpreter.

Translated, plain-language materials. The dose card and hypoglycemia handout will be redrafted in sixth-grade language with pictures of the patient's own pen, translated into Spanish and Marshallese by the hospital's language services and printed in large type for patients with vision problems.

Caregiver teaching by appointment. When a patient reports that someone will help with insulin at home, the nurse will schedule the caregiver's return demonstration at a time the caregiver can attend, including evenings, rather than waiting for discharge morning.

A literacy screen. A single validated screening question about confidence filling out medical forms will be added to the admission assessment, and patients who screen positive will receive the picture-based materials and extra supervised doses.

Measuring Equity

All outcome and process measures will be reported by language group and by age group, not only overall. The goal is that return demonstration rates for patients needing an interpreter and for patients 80 or older reach at least 85 percent, the same target as for all patients, and that the gap in 30-day returns narrows. Because the groups are small, results will be reviewed as rolling twelve-month figures, alongside individual case review of every return visit in these groups.

Limits of the Analysis

The data come from documentation, which may undercount teaching that happened but was not recorded, and small groups make rates unstable. Race and ethnicity were not analyzed separately because the data were incomplete; collecting them reliably is itself a recommendation. Patient voices are also missing, so two short interviews per language group with recently discharged patients are planned before the pilot begins.

Conclusion

Splitting the unit's data shows that the current practice works least well for patients who need an interpreter and for the oldest patients, the groups the literature identifies as most vulnerable. The proposed changes address language access, materials, caregivers and literacy directly, and stratified measurement will show whether the gap closes.

References

Geller, A. I., Shehab, N., Lovegrove, M. C., Kegler, S. R., Weidenbach, K. N., Ryan, G. J., & Budnitz, D. S. (2014). National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Internal Medicine, 174(5), 678-686. https://doi.org/10.1001/jamainternmed.2014.136

Karliner, L. S., Auerbach, A. D., Napoles, A., Schillinger, D., Nickleach, D., & Perez-Stable, E. J. (2012). Language barriers and understanding of hospital discharge instructions. Medical Care, 50(4), 283-289. https://doi.org/10.1097/MLR.0b013e318249c949

Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan, G. D., & Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. JAMA, 288(4), 475-482. https://doi.org/10.1001/jama.288.4.475