By Karen Zulkowski DNS, RN, CWS

I have talked about treating wounds, assessing wounds and care planning, but have not discussed the patient as a person. I always talk to the patient and family about options for care, how aggressive they want to be in their treatment plan and explain to them what I am doing and why I am doing it. The importance of this communication process is one of the reasons why I got involved in the Wound App project. I realized rural facilities don’t have wound expertise available and additional testing may mean many miles of travel. The consultation plan calls for patient/family involvement. But the communication with the patient and family is important regardless of how or where you are doing wound care.

This was really brought to my attention recently by several older gentlemen from rural areas in Montana. I received a call Sunday evening from a man we will call "Bill." He found my contact information in a Google search. Bill was concerned about the condition of his friend’s great toe. Bill also told me about a pressure ulcer his 80-something-year-old mother had developed during her last hospitalization. He even sent me pictures of it. Bill was quite unhappy with the way staff treated his mother and talked to him, so much so that he went online, researched dressings and treated her wound himself when she went home. He did a remarkable job of healing the wound. He had a lot to say about care and communication and just needed to hear what a great job he had done.

I recommended where his friend "Jack" could go for treatment of his toe and contacted the nurse at that facility and told her to expect them. She called Bill Monday morning to schedule an appointment for Jack but wasn't available to see him until later in the week. So to my surprise, Jack drove to my house. Jack has not adequately controlled his diabetes and has some social situational issues, but overall is motivated to have his toe heal. Jack's biggest issue with his former care was also with communication. The podiatrist he went to apparently wanted to amputate his great toe and he doesn't want that. He said, "From what I can tell, that will just be the beginning and I'll end up losing more than a toe." Jack wanted other options. I took a picture of his toe (he couldn't see the wound on the bottom of his toe) and showed him what was there and what the wound tissue/colors, etc., meant. We talked about treatment options and what other testing he should have. He talked to me about it and about his fears for almost an hour. This was what he needed even more than appropriate dressings for his wound. Hopefully he will follow-up with my friend at the clinic as he really needs someone to establish a trusting relationship with.

Communication — simple yet challenging. As health care providers, we often think we are talking to the patient but often we are talking at them. Assess the patient and family's needs for education. Give them options and never be judgmental even if they make a decision about their care that you don't agree with. Watch your body language and that of your co-workers. You might not be coming across as caring or interested even if what you are really thinking about is how much work you still have to do to heal the patient before you. Above all, hold the patient and family's hand and listen. Listen and hear the spoken and unspoken message they are telling you. You will become a much more effective medical provider by doing so.

About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.