Doctor of Philosophy (PhD)


Human Resource Education and Workforce Development

Document Type



The purpose of this phenomenological qualitative study was to describe rural care Registered Nurses’ interpretation of health literacy and its effect on patient care. Individuals who do not understand their disease and have poor management skills are at risk for low health literacy. The consequences of limited health literacy are poor healthcare outcomes and higher healthcare costs. Implications from this study are useful in educating practicing Registered Nurses in the development of the necessary skills to empower patients to actively participate in their healthcare. Education about health literacy should begin in grades Kindergarten through 12th, with the primary focus being on the development a personal definition of health and wellness. A phenomenological lens was used to examine the data collected in this study. Interviews were conducted with Registered Nurses working in a rural acute care setting. Data analysis was conducted according to Moustakas’s (1994), Van Kaam Method. The following themes emerged: health literacy, relationships, participatory decision-making, and empowerment. Findings from this study revealed that rural care Registered Nurses had limited knowledge of health literacy and were not aware of available health literacy assessment tools. Most of the participants in this study utilized nurse developed tools which assessed the literacy level of patients instead of health literacy and thus influenced their relationships with their patients. The majority of participants did not have an understanding of the essential relationship that exists between a patient’s health literacy and the patient’s participation in their own healthcare. There were limited examples that nurses were encouraging their patients to engage in participatory decision-making. Therefore empowerment of patients did not emerge from the study. Additional qualitative and quantitative research studies are needed in rural and urban healthcare settings which explore practicing Registered Nurses’ understanding of health literacy. Replication of this phenomenological study is essential in the urban acute care setting in order to determine if the findings of this study are consistent. Future research is also needed to evaluate the nurse-patient relationship in terms of health literacy, participatory decision-making and empowerment.



Document Availability at the Time of Submission

Release the entire work immediately for access worldwide.

Committee Chair

Krisanna Machtmes