Encouraging Change Through Effective Communication

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Nurse helping to educate coworker

by Fabiola Jimenez, RN, ACNS-BC, CWOCN

I consider the art of communication one of my greatest deficits as a health care professional. Learning about words and how we communicate sparks my interest. How amazing is it that someone can understand exactly what we are saying, since what we hear is influenced by perception, context, time, tone of voice, and so much more? I can easily relate to the Bible story about the Tower of Babel. At times I feel like I am living it. I am very interested in learning ways in which I can communicate better and share with everyone what I know and feel about wound care and the opportunity to do it all within the wound, ostomy, and continence (WOC) role.

A Passion for Wound Education

Please, do not get me started; sometimes you will not be able to shut me up if you get me talking about wound care. I love knowing about the various rationales for our actions and knowing how each of the dressings works and the research and trials that have gone into their development, and results. I enjoy teaching nursing staff and patients the "why" and evidence supporting each of the interventions. I believe that knowing "why" will facilitate understanding and compliance with wound care-recommended dressing regimens and wound prevention practices.

Because of my eagerness and desire to see everyone unrealistically interested in wound care and pressure injury prevention, it has been agreed among my coworkers that when I get too animated on a particular topic, such as the rebuttal against their request for continuous use of incontinence briefs, this agreed-on phrase will be used: "Fab, you are too passionate!" This is my cue and safe word to step off my soap box and cool off.

I have learned not to ask "Why?" to obvious observations.

For example: "Why are there six bottles of skin cleanser on this patient's shelf?" This comment would usually be met with denial and the classical response "I did not do it!" Then I would carelessly lose myself in the rationale for the cost of products, the waste, and the cost to the unit and the hospital. Instead, I have opted for pictures—is it true that a picture tells a thousand words?

skin_cleanser.png

I do not know. Because when it comes to rationales, I go into lecture mode; it usually goes like this:

Nurse or PCA: "I do not understand why we cannot use baby wipes to cleanse the perineum."

Fab: "Baby wipes are for babies, and let's compare the size of the baby wipes to the soft, disposable wipes that have been provided for patient care. Let's read the back of the package and you will see that there are many additives and words ending in 'ethanol' that usually mean alcohol. For skin care, and especially for perineal care, plain water is best along with the pH-balanced hydrating foam, followed by the barrier paste to buttocks inner thighs and groin. The University of Iowa has guidelines on vulvar skin care, and they do not recommend any soap. The guidelines specify not to use any soaps, lotions, gels, etc. that contain perfumes; do not use soaps directly on the vulvar skin. Just warm water and your hand will keep the vulvar area clean without irritating the skin."

I can repeat all these and many more facts about the skin, protection, and prevention without taking a breath and completely lose my audience. Because the inquiry is usually happening in the hallway, as we go about our work there is not much time to really discuss details. This is where the safe word comes in.

Nurse or PCA: "Fab you are too passionate."

Yes, this gets me to shut up, and instead I have learned to respond:

Fab: "Let's go together and clean the patient. I will show you how to properly use the products and we can teach the patient and family how to properly care for the skin."

We all need, at one time or another, that special someone who is watching over our shoulder, that guardian angel to keep our emotions in check and preventing a bad moment. I recommend that we all search for that particular word to trigger a soft and gentle reminder that it is all "good." With patience and perseverance and taking advantage of every occasion for continuous staff education, WOC nurses will continue to make a difference and press on for a focus to be placed on the importance of intact skin, pressure injury prevention, and moist wound healing.

Now, do not get me started on 4×4 gauze and paper tape for wound care.

About the Author
Fabiola Jimenez is a Wound Ostomy Continence Nurse and Adult Clinical Nurse Specialist at Detroit Medical Center Huron Valley Sinai Hospital. She has been a nurse since 1988, when she entered the field after graduating from the University of Oklahoma. Throughout her accomplished career, her work has demonstrated a dedication to caring for patients and a lifelong commitment to educating herself and others.

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.

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