My Scope of Practice: A Champion for Health Literacy

Life's most persistent and urgent question is, What are you doing for others? —Martin Luther King, Jr.

  Feleta L. Wilson, PhD, RN, has more than 36 years of experience in public health and nursing. If you ask what served as her greatest source of inspiration, Feleta immediately praises her supportive mother and the neighborhood public health nurses who diligently administered shots to all the local kids when she was young. Struck by their compassion and professional poise (or was it their bright blue uniforms?), Feleta was intent on, and later successful in, following suit.   Feleta’s educational journey began at the School of Nursing at the North Carolina Agricultural and Technical State University (Greensboro, SC). She immediately was drawn to the nurses on campus, igniting an interest in disease prevention and health promotion and inspiring her to pursue a master’s degree in Public Health, with a concentration in nursing, at the University of Michigan (Ann Arbor, MI). She initially practiced throughout Detroit’s urban communities in efforts to expand her clinical skills and address the vast inequities based on geography, economics, race, and availability of services among underprivileged communities.

  After completing her degree, Feleta worked for state health departments as a Public Health Nursing Consultant in a nursing-based program, Early Prevention, Screening, Diagnosis, and Treatment (EPSDT). While doing consulting, Feleta felt compelled to continue her education; she enrolled in Wayne State University’s (Detroit, Michigan) doctoral program and later obtained the DPhil with an emphasis in education.

  Today, Feleta is both nurse and educator. Her duties as an academician include (but are not limited to) teaching, research, managing a graduate public health nursing program, and directing the distance learning graduate program. Her essential responsibilities as an educator include recruiting, advising, encouraging, and counseling students at both the undergraduate and graduate level.

  Community service remains one of Feleta’s most satisfying pursuits. She is a member of the Board of Directors of the Detroit Community Health Center, which provides care to more than 15,000 medically underserved, uninsured, and underinsured individuals in the community. “I develop partnerships with community-based healthcare agencies, schools, church-centered organizations, and local businesses,” she says. “What is most important to me is how the decisions I make—whether they involve a nursing program or the curriculum—affect the community as a whole.”

  Feleta has found particular fulfillment in three aspects of her career. The first pertains to her passion for patient health literacy. Recent studies show that 44 million US adults are functionally illiterate and 55 million are considered marginally illiterate, adding an estimated $32 to $58 billion in healthcare costs. Poor literacy and poor health literacy result in negative health outcomes. Feleta was struck by the fact that a disproportionate amount of minorities from low-income, poorly educated backgrounds are illiterate. She explored ways to address the unmet needs of low-literacy patients who struggled with everything from failing to comprehend printed health information to the inability to effectively care for themselves. She attended intensive trainings and workshops by Dr. Jane Roots, a pioneer in health literacy, and eventually developed and disseminated culturally appropriate, easy-to-read educational materials. She travels the globe to consult with and inform pharmacists, physicians, dentists, social workers, and nurses who seek to develop similar appropriate reading materials for practice and research. She presents a model of a community-based, interdisciplinary approach to health literacy in the book she co-edited, Medical Library Association Guide to Health Literacy.

  The second most gratifying aspect involves her work as a recipient of the 2009–2010 J. William Fulbright Foreign Scholar at the University of the West Indies School of Nursing in Kingston, Jamaica. Feleta taught more than 250 public health nurses ways to educate patients with low or poor literacy skills and she was the primary lecturer to 150 undergraduate public health nursing students. Her presentations focused on healthcare disparities, health promotion, and self-care abilities for communities in developing countries.

  Feleta’s third greatest achievement has been addressing access to care and the nursing shortage in medically underserved urban and rural areas in Michigan. She was awarded a Health Resources Services Administration (HRSA) training grant to promote advanced practice public health and psychiatric nursing programs. “After only 2 short years, we have increased enrollment in these graduate nursing programs from nine to 65 persons,” she says. “Students are recruited from economically depressed urban and rural communities in Saginaw, Marquette, Kalamazoo, and Detroit to help reduce health disparities and address the ever-increasing nursing shortage.”

  Some of the barriers Feleta has faced include convincing providers to change their pattern of delivery and care and encouraging them to alter their communication style. “Nurses and physicians who are not sensitive to the needs of their patients may overlook the fact that patients may feel intimidated by the them and as a result will avoid asking questions or admitting they don’t understand something,” she says. Feleta’s solution is to impress upon providers that modifying their approach with patients can improve the quality of care. With that understanding, she finds most providers are willing to make some changes.

  An additional barrier to optimal healthcare is the stigma of mistrust. “Patients with low literacy often are mistrustful of the healthcare system and afraid their reading deficit will be discovered by the providers,” says Feleta. “Some patients have difficulty relating to providers who have no regard for their cultural beliefs.” Despite the cumulative evidence on the consequences of poor literacy, many healthcare providers may not recognize the problem and lack the skills to address them. Feleta believes providers must be taught to develop efficient strategies tailored to address family needs. “Poor family health literacy is a public health problem that requires intervention and cooperation at all government levels.”

  Ethnicity and wound care as they correlate with urban literacy is another of Feleta’s passions. The relationship between ethnicity/race and inequities in healthcare has been well documented. One study reported that African Americans with spinal cord injury experienced more discrimination and racism within healthcare than their Caucasian counterparts. Another study found that whites were more likely to receive revascularization and limb salvage, whereas black patients received more amputations. Other studies examining outcomes for injury in children consistently demonstrated far worse clinical and functional outcomes for minority children compared with white children, with the African-American race an independent predictor of mortality. “Wound care costs the US healthcare system more than $20 billion annually and more must be done to improve the quality of care for these patients,” Feleta says. “Despite improvement in care for the general population, ethnic and racial minority groups continue to face higher rates of mortality and morbidity than non-minorities regarding diabetes, cardiovascular diseases, obesity, and poverty. Moreover, minority groups are uninsured or underinsured with limited ability to pay for healthcare services. As a public health nurse, I find satisfaction assisting patients with minimum personal resources in efforts to increase their access to quality healthcare.”

  Feleta’s work has taught her to respect individuality. “Nurses are taught the premise of individualized care, but what that actually means comes to life when working directly with diverse patients,” she says. “Assessing and evaluating the health of communities has allowed me to see the many dimensions of human nature, some positive and some less than positive. I have learned that many times patients who appear hostile are only reacting to the fear of the unknown.” For Feleta, knowledge is key. Serving as a resource for information as well as being respectful, pleasant, and (most of all) professional toward patients and their families are necessary to developing a good rapport. “Patients want some level of guidance from the provider, and we should be able to deliver,” she says.

  Feleta’s work also has taught her to respect differences in race, attitudes, and cultural beliefs. It is imperative to understand the patient is equally important in the nursing care equation—there can never be a care plan without input from the patient.

  Feleta’s most humbling professional experience was when two of her patients whispered to her, “Dr. Wilson, I can’t read any of the words on this sheet of paper.” That “ah-ha” moment made her realize how lost and vulnerable patients can be. Sadly, out of the dozens of patients struggling with illiteracy, only a few brave souls will speak up. Feleta advises persons considering nursing as a career to keep in mind that, “Nursing is a profession that serves the needs of people. Regardless of the practice setting, the people are our business.” This phrase has become Feleta’s personal mantra in her scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.