by Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP
By Janet Wolfson PT, CLWT, CWS, CLT-LANA
I was recently listening to one of my favorite news sources, NPR, enjoying an interview with James E. Ryan, the author of "Wait, What? - and Life's Other Essential Questions". The premise was that asking the right questions can lead to a happier and more successful life. A physician called in to relate that this was something he had been doing in his medical practice. I couldn't have agreed more – the questions I ask my patients (and then listening to their answers) can go a long way toward making an intervention in their health care more successful.
I'd like to roll all the patients with diabetes I've seen over the years into one, and use them as the "poster child" for this blog. The first question in my interview is if the patient even knows they have diabetes. Some have been on Metformin or another oral medication, and have not connected that it is for diabetes. Asking for a medication list is routine these days, and I am sure you can agree with why. Compliance with a wound plan of care can go nowhere if the client is unaware of what the cause could be.
Examples of Questions to Ask Your Wound Patients
"So, tell me what has changed in your life since you learned that you have diabetes?"
Activity changes and amount of effort invested in learning about their condition are good indicators of goals and the complexity of intervention choices. Will the patient be diligent in non-weight bearing activities? Would they change a dressing every day and be detail-oriented enough to be compliant? This can mean, as a wound PT, that I will teach the patient to walk with a walker or crutches to maintain non-weight bearing or apply a diabetic offloading boot (and perhaps lock it on). Should I choose a wound dressing that will mean daily changes by the patient (e.g, Regranex), or something that the client will come to the clinic for changes (e.g., a cellular and/or tissue-based product)?
"How can I help you deal with this sore on your foot?"
Here we find out what the patient sees as the main problem, which may be very different from our opinion that the issue is the sore on their foot. This may help us figure out that the patient can't bathe or cook since the sore has impaired their mobility. Perhaps an Occupational Therapy consult would upgrade their hygiene and decrease risk of infection, as well as allow them to eat healthier foods to manage their blood glucose. A Functional Home Assessment by a therapist familiar with the adaptations required by this patient may improve their weight bearing and "please-wear-shoes" compliance. Looking at the whole patient (and not just the foot) can lead to success for both caregiver and client, as well as wound healing.
So... Wait, What? The Downside of Not Asking Questions
These are the sometimes unbelievable things that our self-reliant patient has been doing to deal with the wound before ever showing up at a doctor, podiatrist, or wound specialist's office:
- Trimming calluses with a hunting knife
- Applying ashes to the wound
- Staying barefoot (as they can feel the floor better)
Or the things they routinely do that should no longer be part of their routine:
- Letting the dog nibble on their toes
- Walking barefoot on a hot pool deck with neuropathic feet
- Wearing pretty shoes a size too small
If I come out with a shocked "Wait, what?" instead of "Ok, go on..." I may reinforce compliance or non-adherence, depending on the patient. Will they need an authoritarian, or partner in care to reach a mutual goal of a wound healing? The bottom line is, ask questions of your patients to know which side they fall on so you will know how to respond to these shockers.
The question for us is, how can we modify our patient questions to improve adherence and wound healing outcomes?
About the Author
Janet Wolfson is a wound care and lymphedema educator with ILWTI, and Lymphedema and Wound Care Coordinator at Health South of Ocala with over 30 years of field experience.
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.