Undergraduate nursing students integrating health literacy in clinical settings.

BACKGROUND Analyzing students' performance and self-criticism of their roles in promoting health literacy can inform nursing education in a social environment that expects new graduates to be health promoters. OBJECTIVES The pilot study reported here aimed to a) analyze students' understanding of and sensitivity to issues of health literacy, (b) identify students' perceptions of structural, organizational, and political barriers to the promotion of health literacy in social and health care organizations, and (c) document students' suggestions for curriculum changes that would develop their skills and competencies as health-literacy promoters. DESIGN A qualitative pilot study. SETTING A collaborative undergraduate nursing degree program in the metropolitan area of Toronto, Canada. PARTICIPANTS Sixteen undergraduate, Year 4 nursing students. METHODS Signed informed consent was obtained from the participants. Participation was unpaid and voluntary. Recruitment was through an email invitation sent by the School of Nursing Student Affairs Coordinator. Three, one-time individual interviews and three focus groups were conducted. All were audio-recorded. Recordings were transcribed, and the transcriptions were coded using the qualitative software ATLAS ti 6.0. The interview data were submitted to thematic analysis. Additional data were gathered from the two-page self-assessments in students' academic portfolios. RESULTS Sensitivity to health literacy was documented. Students performed best as health promoters in supportive teaching hospitals. Their performance was hindered by clinical settings unsupportive of health education, absence of role models, and insufficient theoretical preparation for health teaching. Students' sensitivity to their clients' diversity reportedly reinforced the interconnection, in multicultural healthcare settings, between health literacy and other social determinants of health and a growing demand for educating future nurses in expanding their role also as health promoters. CONCLUSIONS Students recommended more socially inclusive and experiential learning initiatives related to health teaching to address education gaps in classrooms and practice.