{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:54:12Z","timestamp":1774331652135,"version":"3.50.1"},"reference-count":24,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","jenonline.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Emergency Nursing"],"published-print":{"date-parts":[[2019,9]]},"DOI":"10.1016\/j.jen.2019.01.007","type":"journal-article","created":{"date-parts":[[2019,3,7]],"date-time":"2019-03-07T22:31:48Z","timestamp":1551997908000},"page":"531-537","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":17,"title":["A Picture Is Worth a Thousand Words: Pictographs to Improve Understanding of Discharge Instructions"],"prefix":"10.1016","volume":"45","author":[{"given":"Elizabeth J.","family":"Winokur","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana N.","family":"Rutledge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juleene J.","family":"McGowan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"9","key":"10.1016\/j.jen.2019.01.007_bib1","doi-asserted-by":"crossref","first-page":"e1035","DOI":"10.1111\/j.1553-2712.2012.01425.x","article-title":"Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest?","volume":"19","author":"Engel","year":"2012","journal-title":"Acad Emerg Med"},{"issue":"10","key":"10.1016\/j.jen.2019.01.007_bib2","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1111\/acem.12476","article-title":"Is low health literacy associated with increased emergency department utilization and recidivism?","volume":"21","author":"Griffey","year":"2014","journal-title":"Acad Emerg Med"},{"issue":"2","key":"10.1016\/j.jen.2019.01.007_bib3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3122\/jabfm.2010.02.070278","article-title":"Health literacy instrument in family medicine: the \u201cnewest vital sign\u201d ease of use and correlates","volume":"23","author":"Shah","year":"2010","journal-title":"J Am Board Fam Med"},{"issue":"3","key":"10.1016\/j.jen.2019.01.007_bib4","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3122\/jabfm.2011.03.100212","article-title":"Time, costs, and clinical utilization of screening for health literacy: a case study using the Newest Vital Sign (NVS) instrument","volume":"24","author":"Welch","year":"2011","journal-title":"J Am Board Fam Med"},{"key":"10.1016\/j.jen.2019.01.007_bib5","series-title":"Improving the emergency department discharge process: environmental scan report. (Prepared by Johns Hopkins University, Baltimore, MD, under Contract No. HHSA 2902010000271.)","year":"2014"},{"issue":"9","key":"10.1016\/j.jen.2019.01.007_bib6","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/PEC.0b013e3182a269ec","article-title":"Parental language and dosing errors after discharge from the pediatric emergency department","volume":"29","author":"Samuels-Kalow","year":"2013","journal-title":"Pediatr Emerg Care"},{"key":"10.1016\/j.jen.2019.01.007_bib8","series-title":"National Assessment of Adult Literacy","year":"2017"},{"issue":"5","key":"10.1016\/j.jen.2019.01.007_bib9","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.acap.2013.03.001","article-title":"The relationship between parent health literacy and pediatric emergency department utilization: a systematic review","volume":"13","author":"Morrison","year":"2013","journal-title":"Acad Pediatr"},{"issue":"suppl 1","key":"10.1016\/j.jen.2019.01.007_bib10","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.5993\/AJHB.31.s1.5","article-title":"Literacy and its relationship with self-efficacy, trust, and participation in medical decision making","volume":"31","author":"DeWalt","year":"2007","journal-title":"Am J Health Behav"},{"key":"10.1016\/j.jen.2019.01.007_bib11","unstructured":"The Patient Protection and Affordable Care Act (PPACA). 2010. Public Law No. 111-148, 124 Stat 119. https:\/\/www.congress.gov\/111\/plaws\/publ148\/PLAW-111publ148.pdf. Accessed February 28, 2019."},{"issue":"1","key":"10.1016\/j.jen.2019.01.007_bib12","first-page":"1","article-title":"Attaining global health: challenges and opportunities","volume":"55","author":"Ratzan","year":"2000","journal-title":"Popul Bull"},{"issue":"6","key":"10.1016\/j.jen.2019.01.007_bib13","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1370\/afm.405","article-title":"Quick assessment of literacy in primary care: the newest vital sign","volume":"3","author":"Weiss","year":"2005","journal-title":"Ann Fam Med"},{"issue":"5","key":"10.1016\/j.jen.2019.01.007_bib14","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1080\/10810730.2014.999893","article-title":"Comparison of brief health literacy screens in the emergency department","volume":"20","author":"Kiechle","year":"2015","journal-title":"J Health Commun"},{"issue":"3","key":"10.1016\/j.jen.2019.01.007_bib15","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.acap.2014.01.004","article-title":"Low caregiver health literacy is associated with higher pediatric emergency department use and nonurgent visits","volume":"14","author":"Morrison","year":"2014","journal-title":"Acad Pediatr"},{"issue":"3","key":"10.1016\/j.jen.2019.01.007_bib16","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.acap.2017.06.010","article-title":"Why parents seek care for acute illness in the clinic or the ED: the role of health literacy","volume":"18","author":"May","year":"2018","journal-title":"Acad Pediatr"},{"issue":"8","key":"10.1016\/j.jen.2019.01.007_bib17","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.nurpra.2014.06.014","article-title":"Intervening at the intersection of medication adherence and health literacy","volume":"10","author":"Jones","year":"2014","journal-title":"J Nurs Pract"},{"issue":"11","key":"10.1016\/j.jen.2019.01.007_bib18","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1017\/S1368980017000787","article-title":"Cross-cultural adaptation and validation of the Newest Vital Sign (NVS) health literacy instrument in general population and highly educated samples of Brazilian adults","volume":"20","author":"Rodrigues","year":"2017","journal-title":"Public Health Nutr"},{"issue":"4 suppl 1","key":"10.1016\/j.jen.2019.01.007_bib19","first-page":"124","article-title":"The first Italian validation of the most widespread health literacy assessment tool: the Newest Vital Sign","volume":"39","author":"Capecchi","year":"2015","journal-title":"Epidemiol Prev"},{"key":"10.1016\/j.jen.2019.01.007_bib20","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1186\/s12889-015-2056-z","article-title":"Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)","volume":"15","author":"Beauchamp","year":"2015","journal-title":"BMC Public Health"},{"key":"10.1016\/j.jen.2019.01.007_bib21","doi-asserted-by":"crossref","first-page":"467","DOI":"10.2147\/AMEP.S110177","article-title":"Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?","volume":"7","author":"Stoneking","year":"2016","journal-title":"Adv Med Educ Pract"},{"issue":"2","key":"10.1016\/j.jen.2019.01.007_bib22","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.annemergmed.2011.10.023","article-title":"Effective discharge communication in the emergency department","volume":"60","author":"Samuels-Kalow","year":"2012","journal-title":"Ann Emerg Med"},{"issue":"4","key":"10.1016\/j.jen.2019.01.007_bib23","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.1745-7599.2012.00767.x","article-title":"Patient comprehension of discharge instructions from the emergency department: a literature review","volume":"25","author":"Alberti","year":"2013","journal-title":"J Am Assoc Nurse Pract"},{"issue":"23","key":"10.1016\/j.jen.2019.01.007_bib24","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.2146\/ajhp060162","article-title":"Use of pictorial aids in medication instructions: a review of the literature","volume":"63","author":"Katz","year":"2006","journal-title":"Am J Health Syst Pharm"},{"issue":"5","key":"10.1016\/j.jen.2019.01.007_bib25","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1002\/rnj.101","article-title":"Improving discharge education using pictographs","volume":"38","author":"Choi","year":"2013","journal-title":"Rehab Nurs"}],"container-title":["Journal of Emergency Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099176718304860?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099176718304860?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T19:38:21Z","timestamp":1758829101000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0099176718304860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":24,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,9]]}},"alternative-id":["S0099176718304860"],"URL":"https:\/\/doi.org\/10.1016\/j.jen.2019.01.007","relation":{},"ISSN":["0099-1767"],"issn-type":[{"value":"0099-1767","type":"print"}],"subject":[],"published":{"date-parts":[[2019,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"A Picture Is Worth a Thousand Words: Pictographs to Improve Understanding of Discharge Instructions","name":"articletitle","label":"Article Title"},{"value":"Journal of Emergency Nursing","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jen.2019.01.007","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}