Knowledge of Medical Terminology Among Clients and Families Celeste M. Spees
This descriptive currelationalstudyreplicated ByrneandEdeani 5 (1984)investigation of hospitalized clients ’(N=25)knowledge of50 common medical terms. The present study also included 25 family membm. The mean number of correct responses was 46 (of50) w’th no difference between clients and families. Only nine terms were correctly understood by all respondents. Olderpersons with higher education and moderate h g t h of illness had higher scores. Participants in the present study scared significantly higher than those in the @brresearch especial4 on terrns related to breast cancer and heart disease. Clients and family members may not understand mdical terms as well as nurses think t h q do and may need consistent assessment of knowledge in t h context of patient teaching.
*
*
*
his descriptivecorrelational studywas designed to determine hospitalized clients’ and families’ knowledge of medical terminology used in conversationsabout their illness, its course and treatment. Demographic variables were examined to determine if they significantly related to a client’s or
T
Volume 23, Number 4, Winter 1991
family member’s knowledge of medical terms. This investigation was conducted as a replication of Byrne and Edeani’s (1984) study to determine if there was a difference in clients’ knowledge of medical terms in the past five years. Lastly, the results were examined to see if a relationship existed between clients’ and family members’ knowledge of medical terms.
Review of Literature Imogene King’s (1981) Theory of Goal Attainment serves as the conceptual framework for this study. King’s model conceptualizes the family as “an interpersonal system, a group of individuals interacting to meet their basic needs” (Gonot, 1986, p.34). In developing an interpersonal system with the client and family, the nurse purveys information through purposeful communication (King, 1981).
Celeste M. Spees, RN. Y.S.N., C.C.R.N.. Delta Omega is instructorof Nursingat FrancesPayne BOltOnSchool of Nursing.Casewestern Reserve university. Correspondence to 10370 Wright RU., uniontown,OH 44685. Accepted for publication March 18,1991. ~
225
effectiveness. Through effective communication the nurse can increase clients’ and families’ understanding of illness and decrease perceived stress (Lore, 1981). Moreover,when nurses communicate effectively and provide vital information to clients and families, they create an environment in which goal attainment can be achieved (King, 1981). Health professional’slack of communicationwith clients or a failure on the part of the client to understand what was communicated have caused some of the most stressful events associated with hospitalization (Volicer, 1974). Unfortunately, health professionals often fail to use terms the client can understand, and the client or family member may not be assertive enough to ask for a clearer explanation. Clients and their families need a thorough understanding of the “health problem and the implications of the illness for their lifestyle. . .to regain and maintain optimal health” (Pender, 1974, p.263). Because nurses coordinate the client’s care, they have the primary responsibility of planning and implementing effective health teaching (Pender, 1974). As the incidence of chronic disease continues to rise and as more health care services shift to the outpatient setting, increased responsibility will be placed on the nurse to provide the client and family with the necessary information for continuing selfcare at home (Byrne & Edeani, 1984). Hence, purposeful client education directs the responsibilityfor home health care from nurses and the hospital to clients and their families (Crane, 1985). Therefore, a client’s and family member’s ability to recognize and comprehend medical terms used by the nurse may greatly influence the effectiveness of health education. Communication barriers between the nurse and client/ familyimpede mutual understanding and may cause confusion, anxiety, and even antagonism (Petrello, 1976). A barrier to clients’ and family members’ comprehension of the health problem is misunderstanding of medical terms used by hospital personnel (Samora,Saunders, & Larson, 1961). Several investigators (Byrne & Edeani, 1984; Samora et al., 1961; Streiff, 1986; Waldman, Hall, & Weiner, 1984) recognize that the possibility of misunderstanding on the part of the client is due to vocabulary deficiency. In a study to identify hospitalized clients comprehension of medical terms used by physicians,residents and fourth-year medical students, Samora et al. (1961) found that 125clients comprehended medical terms at a lower rate than the panel of medical personnel expected. No respondent gave an adequate meaning to all 50 words and no single word was adequately defined by all respondents. Further, investigators found that age, level of education, and ethnic background were associated with medical terminology comprehension. Similar findings were reported by Petrello (1976) who found that only 46 percent to 68 percent of the terms and abbreviations used by nurses to communicate with clients about their illness were actually understood in a sample of 200 hospitalized clients. As words (medical terms) become more abstract, their meanings become increasingly obscure to the client and family (Satir, 1983). In studying a group of patients with diagnosed hypertension, Smeltzer (1980) found that common terms were more effective than medical terms in communicatingwith clientsabout their illness. Further, the fact that hypertensive clients recognized some terms but 226
could not define them may indicate that clients did not comprehend the information they were given. Quittenton (1987) suggests that nurses can eliminate or reduce communication barriers by improving their communication skills with clients and families. Information related to the client’s health status should be given in non-medical terms that are easy for the client and family to understand. Pastore and Berg (1987) further suggest that nurses use “shortsentences, simple words, ... and minimal use of words with more than two syllables” (p.217) to enhance the readability of patient education materials. Byrne and Edeani (1984) conducted an extensive study on the knowledge of medical terminology among hospitalized patients and patients of an outpatient clinic. Alist of 125 common medical terms was compiled from interviews with clients, health care personnel, and from health information booklets used within the hospital. Fifty medical terms from this list were randomly selected and submitted to a panel of physicians, staff nurses, nursing instructors, and patient educators who approved the list as those that they would usually use when communicating with clients. Clients (N=125) had been admitted to the medical unit and outpatient clinic of a 325 bed county general hospital. The medical terms were used in simple sentences and read to clients by an interviewer. The meaning of the keyword as defined by the clientwas scored by the interviewer as correct, incorrect, or no knowledge. None of the respondents correctly understood all 50 words and no single word was correctly understood by all respondents. The range of correct individual responses was from 4 to 48. Byrne and Edeani (1984) concluded that the level of comprehension of medical terminology among hospital and outpatient clients was significantly different than staffs’ perception. Age, educational level, and perceived knowledge of medical terms were significantlyassociated with actual knowledge of medical terms. The literature suggeststhat in any instance of nurse-client communication there is the possibility of misunderstanding or non-understanding on the part of the client due to a vocabulary deficiency. While past studies have examined clients’ knowledge of medical terms, families’knowledge of medical termshas not been addressed. Tierneyand Eisenberg (1986) described a need to further consider the role and importance of clients’ families when health education materials are developed. An increased focusshould be directed toward “providing patients and their families with similar, appropriate, and comprehensive information” in order to increase understanding of the treatment regimen (Tierney & Eisenberg, 1986, p.29). The following hypotheses were tested: 1.There is a significant difference between nurses’ percep tion of clients’ and families’ knowledge of medical terms and their actual knowledge of medical terms. 2.There is an association between a participant’s age, sex, marital status, level of education, ethnic origin, type of illness, length of illness, number of times hospitalized, and/orperceived knowledge and their actual knowledge of medical terms. 3.There is adifferencein clients’knowledgeofmedical terms between the years of 1984 and 1989. 4.There is a difference between a client’s level of knowledge and famiiy member’s level of knowledge of medical terms.
IMAGE: Journal of Nursing Scholarship
Knowledge of Medical Terminology Among Clients and Families
Methods The setting for this research was two surgical units of a voluntary nonprofit hospital in Northeastern Ohio. This acute-care facility had a capacity of approximately 500 adult beds, and each surgical unit had a capacity of approximately 35 beds. Data for this research were gathered weekdays during visiting hours over a one-month period. The researcher was granted permission to interview any surgical client or family member who gave verbal consent to participate. A convenience sample of 25 clients and 25 family members was obtained. All participants were 18years of age or older, and were able to read and write English. Family members sampled identified themselves as either the client’s spouse or the client’s son or daughter. Disoriented and seriously ill clients were excluded. Participants in this investigation ranged in age from 18 to 78 years (mean age of 42); 62 percent were female and 38 percent male. The majority (82 percent) were Caucasian. Eight percent of the sample had 1to 8years of education, 52 percent had 9 to 12 years, and over 1/3 (40 percent) had 13 or more years of education.
Instruments The instrument used to collect the data was a 50-item questionnaire designed by Edeani (1981). The instrument was developed from a list of 125 common medical terms compiled from interviews with hospitalized clients, health care personnel, andvarious medicalbooklets used for patient education. These terms were submitted to five physicians, five staff nurses, two nurse instructors and two patient educators for screening. Any medical terms which at least five members of the health care staff deemed highly technical were eliminated. Also deletedwere terms that at least five members of the health care team stated that they do not normally use in talkingwith their clients. Of the 90 remaining medical terms, 50 were randomly selected and used in developing the questionnaire (Edeani, 1981). The questionnaire consisted of 50 statements, each containing a medical term. The medical term was underlined followed by three responses. Only one of the responses was the correct response that indicated the meaning of the medical term. If participants did not know the meaning of the medical term underlined, they were instructed to choose option (D) “I don’t know.” All 50 statements reflected common usage of the medical terms. For example: The doctor tells you to get your pfesm$tzunfrom the nurse, you should expect to get: (A) A written order for medicine signed by the doctor (B) A list of instructions for your activity at home (C) A bottle of pills (D) I don’t know
Content validity of the instrument was established by having five patient educators from the participating hospital verify that all 50 items as well as the entire instrument adequately represented the content area (common medical terminology) specified. All 50 terms were approved as terms used by the agency’s nurses to educate clients and families about their illnesses. Although Byrne and Edeani (1984) did not establish reliability of the instrument for their study, the split-half reliability of the instrument for this investigation was 0.85 and using the Spearman-Brown Prophecy formula Volume 23, Number 4, Winter 1991
the estimated reliability of the entire test was 0.92. After a preliminary introduction, the client and family member were given a brief explanation of the study. Consent to participate was obtained verbally from each participant. Confidentiality was assured by explaining that participation or nonparticipation would not jeopardize the client’s care. To insure confidentiality the questionnaires were distributed and collected only by the investigator. The client’s age, diagnosis, and admission date were obtained from the nursing kardex. Participants were first asked to rate themselves in one of three categories: (a) very knowledgeable, (b) fairly knowledgeable, or (c) not knowledgeable about medical terms. Participants were read each question by the investigator. Because health professionals expect clients and their families to comprehend not only what they hear but what they read, the researcher also provided participants with a copy of the questionnaire. The client and family member were asked to read each question silentlywhilethe investigator read each question aloud. The participants were then given time to circle the one response which best described the meaning of the medical term underlined. Self-reported data were collected from the client and family member regarding type of illness, length of illness, and number of times hospitalized. Clients and their family members reported a variety of illnesses with varying degrees of duration and all participants reported being hospitalized at least one time. When asked to evaluate their knowledge of medical terms, 12 percent of the sample perceived themselves as being very knowledgeable, 70 percent fairly knowledgeable, and 18 percent not knowledgeable.
Results The range of client scores was 30 to 50 with a mean score of 46.28 (sd=4.69). Family scores ranged from 38 to 50 with a mean score of 46.20 (SD=3.78).Only nine questions were correctly understood by all 50 respondents. A test of the difference between means was utilized to determine the difference between nurses’ expectation of clients’ and family members’ knowledge of medical terms and their actual knowledge. The mean score of all respondents was 46.24 compared to an expected score of 50 since the 50 terms were approved as terms used by the agency’s nurses to educate clients and families about their illnesses. Clients and family members comprehended medical terms at a lower rate than nurses expected (t=6.3, p=.OOl). Kendall’s Coefficient of Concordance was used to test for an association between a participant’s age, sex, marital status, level of education, ethnic origin, type of illness, length of illness, number of times hospitalized, and/or perceived knowledge and their actual knowledge of medical terms. Participants’ age, level of education, length ofillness, and perceived knowledge of medical terms were associated with their actual knowledge of medical terms (Table 1). Participants receiving the highest scores were high school or college graduates, 36 years of age or older, who reported illnesses lasting greater than six months, but less than seven years, and perceived themselves as more knowledgeable about medical terminology. There was no significant difference between client and family scores. Participants in this study scored significantly higher than participants sampled in by Byrne and Edeani (1984) (mean 46.24 vs 36.00) (Table 2). Only one of the 50 LL I
Knowledge of Medical Terminology Among Clients and Families
Table 1 : Kendall’s Coefficients of Independent Variables and Level of Knowledge Variable Coefficient 0.248 Age 0.201 Sex Maritial status 0.071 Education 0.307 Ethnic origin 0.082 Type of illness 0.089 Length of illness 0.288 Times hospitalized 0.135 Perceived knowledge 0.236
Significance
0.013* 0.052 0.275 0.005**
0.247 0.221 0.006** 0.124* 0.024”
*p
This descriptive currelationalstudyreplicated ByrneandEdeani 5 (1984)investigation of hospitalized clients ’(N=25)knowledge of50 common medical terms. The present study also included 25 family membm. The mean number of correct responses was 46 (of50) w’th no difference between clients and families. Only nine terms were correctly understood by all respondents. Olderpersons with higher education and moderate h g t h of illness had higher scores. Participants in the present study scared significantly higher than those in the @brresearch especial4 on terrns related to breast cancer and heart disease. Clients and family members may not understand mdical terms as well as nurses think t h q do and may need consistent assessment of knowledge in t h context of patient teaching.
*
*
*
his descriptivecorrelational studywas designed to determine hospitalized clients’ and families’ knowledge of medical terminology used in conversationsabout their illness, its course and treatment. Demographic variables were examined to determine if they significantly related to a client’s or
T
Volume 23, Number 4, Winter 1991
family member’s knowledge of medical terms. This investigation was conducted as a replication of Byrne and Edeani’s (1984) study to determine if there was a difference in clients’ knowledge of medical terms in the past five years. Lastly, the results were examined to see if a relationship existed between clients’ and family members’ knowledge of medical terms.
Review of Literature Imogene King’s (1981) Theory of Goal Attainment serves as the conceptual framework for this study. King’s model conceptualizes the family as “an interpersonal system, a group of individuals interacting to meet their basic needs” (Gonot, 1986, p.34). In developing an interpersonal system with the client and family, the nurse purveys information through purposeful communication (King, 1981).
Celeste M. Spees, RN. Y.S.N., C.C.R.N.. Delta Omega is instructorof Nursingat FrancesPayne BOltOnSchool of Nursing.Casewestern Reserve university. Correspondence to 10370 Wright RU., uniontown,OH 44685. Accepted for publication March 18,1991. ~
225
effectiveness. Through effective communication the nurse can increase clients’ and families’ understanding of illness and decrease perceived stress (Lore, 1981). Moreover,when nurses communicate effectively and provide vital information to clients and families, they create an environment in which goal attainment can be achieved (King, 1981). Health professional’slack of communicationwith clients or a failure on the part of the client to understand what was communicated have caused some of the most stressful events associated with hospitalization (Volicer, 1974). Unfortunately, health professionals often fail to use terms the client can understand, and the client or family member may not be assertive enough to ask for a clearer explanation. Clients and their families need a thorough understanding of the “health problem and the implications of the illness for their lifestyle. . .to regain and maintain optimal health” (Pender, 1974, p.263). Because nurses coordinate the client’s care, they have the primary responsibility of planning and implementing effective health teaching (Pender, 1974). As the incidence of chronic disease continues to rise and as more health care services shift to the outpatient setting, increased responsibility will be placed on the nurse to provide the client and family with the necessary information for continuing selfcare at home (Byrne & Edeani, 1984). Hence, purposeful client education directs the responsibilityfor home health care from nurses and the hospital to clients and their families (Crane, 1985). Therefore, a client’s and family member’s ability to recognize and comprehend medical terms used by the nurse may greatly influence the effectiveness of health education. Communication barriers between the nurse and client/ familyimpede mutual understanding and may cause confusion, anxiety, and even antagonism (Petrello, 1976). A barrier to clients’ and family members’ comprehension of the health problem is misunderstanding of medical terms used by hospital personnel (Samora,Saunders, & Larson, 1961). Several investigators (Byrne & Edeani, 1984; Samora et al., 1961; Streiff, 1986; Waldman, Hall, & Weiner, 1984) recognize that the possibility of misunderstanding on the part of the client is due to vocabulary deficiency. In a study to identify hospitalized clients comprehension of medical terms used by physicians,residents and fourth-year medical students, Samora et al. (1961) found that 125clients comprehended medical terms at a lower rate than the panel of medical personnel expected. No respondent gave an adequate meaning to all 50 words and no single word was adequately defined by all respondents. Further, investigators found that age, level of education, and ethnic background were associated with medical terminology comprehension. Similar findings were reported by Petrello (1976) who found that only 46 percent to 68 percent of the terms and abbreviations used by nurses to communicate with clients about their illness were actually understood in a sample of 200 hospitalized clients. As words (medical terms) become more abstract, their meanings become increasingly obscure to the client and family (Satir, 1983). In studying a group of patients with diagnosed hypertension, Smeltzer (1980) found that common terms were more effective than medical terms in communicatingwith clientsabout their illness. Further, the fact that hypertensive clients recognized some terms but 226
could not define them may indicate that clients did not comprehend the information they were given. Quittenton (1987) suggests that nurses can eliminate or reduce communication barriers by improving their communication skills with clients and families. Information related to the client’s health status should be given in non-medical terms that are easy for the client and family to understand. Pastore and Berg (1987) further suggest that nurses use “shortsentences, simple words, ... and minimal use of words with more than two syllables” (p.217) to enhance the readability of patient education materials. Byrne and Edeani (1984) conducted an extensive study on the knowledge of medical terminology among hospitalized patients and patients of an outpatient clinic. Alist of 125 common medical terms was compiled from interviews with clients, health care personnel, and from health information booklets used within the hospital. Fifty medical terms from this list were randomly selected and submitted to a panel of physicians, staff nurses, nursing instructors, and patient educators who approved the list as those that they would usually use when communicating with clients. Clients (N=125) had been admitted to the medical unit and outpatient clinic of a 325 bed county general hospital. The medical terms were used in simple sentences and read to clients by an interviewer. The meaning of the keyword as defined by the clientwas scored by the interviewer as correct, incorrect, or no knowledge. None of the respondents correctly understood all 50 words and no single word was correctly understood by all respondents. The range of correct individual responses was from 4 to 48. Byrne and Edeani (1984) concluded that the level of comprehension of medical terminology among hospital and outpatient clients was significantly different than staffs’ perception. Age, educational level, and perceived knowledge of medical terms were significantlyassociated with actual knowledge of medical terms. The literature suggeststhat in any instance of nurse-client communication there is the possibility of misunderstanding or non-understanding on the part of the client due to a vocabulary deficiency. While past studies have examined clients’ knowledge of medical terms, families’knowledge of medical termshas not been addressed. Tierneyand Eisenberg (1986) described a need to further consider the role and importance of clients’ families when health education materials are developed. An increased focusshould be directed toward “providing patients and their families with similar, appropriate, and comprehensive information” in order to increase understanding of the treatment regimen (Tierney & Eisenberg, 1986, p.29). The following hypotheses were tested: 1.There is a significant difference between nurses’ percep tion of clients’ and families’ knowledge of medical terms and their actual knowledge of medical terms. 2.There is an association between a participant’s age, sex, marital status, level of education, ethnic origin, type of illness, length of illness, number of times hospitalized, and/orperceived knowledge and their actual knowledge of medical terms. 3.There is adifferencein clients’knowledgeofmedical terms between the years of 1984 and 1989. 4.There is a difference between a client’s level of knowledge and famiiy member’s level of knowledge of medical terms.
IMAGE: Journal of Nursing Scholarship
Knowledge of Medical Terminology Among Clients and Families
Methods The setting for this research was two surgical units of a voluntary nonprofit hospital in Northeastern Ohio. This acute-care facility had a capacity of approximately 500 adult beds, and each surgical unit had a capacity of approximately 35 beds. Data for this research were gathered weekdays during visiting hours over a one-month period. The researcher was granted permission to interview any surgical client or family member who gave verbal consent to participate. A convenience sample of 25 clients and 25 family members was obtained. All participants were 18years of age or older, and were able to read and write English. Family members sampled identified themselves as either the client’s spouse or the client’s son or daughter. Disoriented and seriously ill clients were excluded. Participants in this investigation ranged in age from 18 to 78 years (mean age of 42); 62 percent were female and 38 percent male. The majority (82 percent) were Caucasian. Eight percent of the sample had 1to 8years of education, 52 percent had 9 to 12 years, and over 1/3 (40 percent) had 13 or more years of education.
Instruments The instrument used to collect the data was a 50-item questionnaire designed by Edeani (1981). The instrument was developed from a list of 125 common medical terms compiled from interviews with hospitalized clients, health care personnel, andvarious medicalbooklets used for patient education. These terms were submitted to five physicians, five staff nurses, two nurse instructors and two patient educators for screening. Any medical terms which at least five members of the health care staff deemed highly technical were eliminated. Also deletedwere terms that at least five members of the health care team stated that they do not normally use in talkingwith their clients. Of the 90 remaining medical terms, 50 were randomly selected and used in developing the questionnaire (Edeani, 1981). The questionnaire consisted of 50 statements, each containing a medical term. The medical term was underlined followed by three responses. Only one of the responses was the correct response that indicated the meaning of the medical term. If participants did not know the meaning of the medical term underlined, they were instructed to choose option (D) “I don’t know.” All 50 statements reflected common usage of the medical terms. For example: The doctor tells you to get your pfesm$tzunfrom the nurse, you should expect to get: (A) A written order for medicine signed by the doctor (B) A list of instructions for your activity at home (C) A bottle of pills (D) I don’t know
Content validity of the instrument was established by having five patient educators from the participating hospital verify that all 50 items as well as the entire instrument adequately represented the content area (common medical terminology) specified. All 50 terms were approved as terms used by the agency’s nurses to educate clients and families about their illnesses. Although Byrne and Edeani (1984) did not establish reliability of the instrument for their study, the split-half reliability of the instrument for this investigation was 0.85 and using the Spearman-Brown Prophecy formula Volume 23, Number 4, Winter 1991
the estimated reliability of the entire test was 0.92. After a preliminary introduction, the client and family member were given a brief explanation of the study. Consent to participate was obtained verbally from each participant. Confidentiality was assured by explaining that participation or nonparticipation would not jeopardize the client’s care. To insure confidentiality the questionnaires were distributed and collected only by the investigator. The client’s age, diagnosis, and admission date were obtained from the nursing kardex. Participants were first asked to rate themselves in one of three categories: (a) very knowledgeable, (b) fairly knowledgeable, or (c) not knowledgeable about medical terms. Participants were read each question by the investigator. Because health professionals expect clients and their families to comprehend not only what they hear but what they read, the researcher also provided participants with a copy of the questionnaire. The client and family member were asked to read each question silentlywhilethe investigator read each question aloud. The participants were then given time to circle the one response which best described the meaning of the medical term underlined. Self-reported data were collected from the client and family member regarding type of illness, length of illness, and number of times hospitalized. Clients and their family members reported a variety of illnesses with varying degrees of duration and all participants reported being hospitalized at least one time. When asked to evaluate their knowledge of medical terms, 12 percent of the sample perceived themselves as being very knowledgeable, 70 percent fairly knowledgeable, and 18 percent not knowledgeable.
Results The range of client scores was 30 to 50 with a mean score of 46.28 (sd=4.69). Family scores ranged from 38 to 50 with a mean score of 46.20 (SD=3.78).Only nine questions were correctly understood by all 50 respondents. A test of the difference between means was utilized to determine the difference between nurses’ expectation of clients’ and family members’ knowledge of medical terms and their actual knowledge. The mean score of all respondents was 46.24 compared to an expected score of 50 since the 50 terms were approved as terms used by the agency’s nurses to educate clients and families about their illnesses. Clients and family members comprehended medical terms at a lower rate than nurses expected (t=6.3, p=.OOl). Kendall’s Coefficient of Concordance was used to test for an association between a participant’s age, sex, marital status, level of education, ethnic origin, type of illness, length of illness, number of times hospitalized, and/or perceived knowledge and their actual knowledge of medical terms. Participants’ age, level of education, length ofillness, and perceived knowledge of medical terms were associated with their actual knowledge of medical terms (Table 1). Participants receiving the highest scores were high school or college graduates, 36 years of age or older, who reported illnesses lasting greater than six months, but less than seven years, and perceived themselves as more knowledgeable about medical terminology. There was no significant difference between client and family scores. Participants in this study scored significantly higher than participants sampled in by Byrne and Edeani (1984) (mean 46.24 vs 36.00) (Table 2). Only one of the 50 LL I
Knowledge of Medical Terminology Among Clients and Families
Table 1 : Kendall’s Coefficients of Independent Variables and Level of Knowledge Variable Coefficient 0.248 Age 0.201 Sex Maritial status 0.071 Education 0.307 Ethnic origin 0.082 Type of illness 0.089 Length of illness 0.288 Times hospitalized 0.135 Perceived knowledge 0.236
Significance
0.013* 0.052 0.275 0.005**
0.247 0.221 0.006** 0.124* 0.024”
*p
