Communication Tips - Updated

Conversations about pressure ulcers

Practical tips for service users, advocates and health professionals

Service users

Professionals

Advocates

Tips for service users

Preparation

Difficult conversations

During appointments

Tips for carers and other advocates

What is an advocate?

Advocacy is supporting someone to seek help and have their voice heard. Family, friends, carers and personal assistants can all make good advocates. You can also find trained advocates through social care, charities and advocacy organisations. More information here.

Preparation

After

During appointments

Tips for health professionals

Adapting your approach

Laying the foundations

Knowledge gaps

Language

Understanding their perspective

Sharing decisions and plans

Before the appointment

Make a list: Think about what you want to get from the appointment. It might be helpful to make a list of things to discuss. Consider ICE (Ideas, Concerns and Expectations): Think about your Ideas, Concerns and Expectations (ICE).

• Ideas: What do you think is happening? E.g. I think I have a pressure ulcer
• Concerns: Is anything worrying you? E.g. I don’t want it to get worse and end up in hospital.
• Expectations: What do you want to get out of the appointment? E.g. I want someone to check the sore area and help me make a plan so that it doesn’t happen again.

Use this website: It may be helpful to take all or part of this guidance with you, to share with health professionals. For example, the ‘what puts you at risk of pressure ulcers’ section could help you to describe why you believe you are at a high risk. Your ‘safe routine’ plan could help you discuss your usual routine, equipment and what matters most to you. You could print out relevant sections or have them ready on your phone.

If you are worried you have a pressure ulcer: Make a note of any changes to your skin. Think back to when you first noticed the changes. What was happening in your life around that time? Think about any changes in your risks or routine. Support: Would you like to chat to someone before the appointment? Would you like someone at the appointment with you? For example, a carer, family member, personal assistant, friend or advocate. If you are bringing someone with you, talk to them about what you need. See our advocacy tips for more ideas. How are you feeling? Notice how you are feeling before the appointment. It may be helpful to share how you are feeling with the health professional so that they can support you in the right way.

After the appointment

Check in with the person you are supporting:

• How do they feel? Did they understand everything?
• Did they get what they need?
• Are the next steps clear?

You may want to chat through the pros and cons of different approaches, to help them make decisions about their care. Take care: Supporting others can be challenging. Notice how you are feeling and take care of yourself.

Difficult conversations

Planned phrases: Have phrases ready that you can use if an appointment is not working for you. For example, ‘I’m sorry I don’t understand what you mean’, ‘I don’t think that would work for me because…’ ‘I’d like to discuss alternatives’. The SEWR technique: SEWR is a simple structure for getting your point across.

• S – State the facts: stick to what has happened
• E – Express your feelings: share the impact
• W – What you want: say what you would like to happen
• R – Reinforce the benefit: explain why it helps

This technique was developed by Epilepsy Action and Vital, who have more information about communication on their websites. Use this website: You can tell health professionals that this is “evidenced based guidance”. For example, “According to this evidence based guidance, I am at a high risk of pressure ulcers.” Still unhappy?: Remember, you can ask for a second opinion. You can also contact PALS (the Patient Advice and Liaison Service), who can help to resolve problems in the NHS.

Language

Working together: Using ‘we’ rather than ‘I’ language can reinforce a partnership approach. Blame: DO NOT use language like ‘compliance’ or ‘concordance’. Some people find these terms offensive as they can imply blame. Find more positive phrases. For example:

• ‘can we talk about the difficulties of fitting prevention into your routine?’
• ‘It sounds like you have struggled to find time to take pressure off the area, shall we try and come up with a new plan together?’

Judgement: Avoid describing people’s actions as ‘poor’ or ‘bad’ e.g. ‘a bad transfer’ ‘poor diet’ or ‘poor posture’. Try and find less judgemental phrases. For example:

• ‘it sounds like you had a difficult transfer and caught your skin’
• ‘some small changes to your posture might help’

Knowledge gaps

Acknowledge gaps in your expertise: If you lack experience of pressure ulcer prevention and/or someone’s underlying condition, then be honest. You don’t have to know a lot to take a good history, and this will really help your discussions with other professionals. Seek help: Be clear about what the next steps will be. For example, who are you going to speak to? When will you get back to the patient? Will someone else be in touch? Does the patient need to do anything?

Understanding their perspective

Consider ICE (Ideas, Concerns and Expectations):

• Ideas: Ask people what they think led to their current situation.
• Concerns: Is anything worrying them?
• Expectations: What are they hoping to get from the appointment? Be honest if there are things you can’t provide.

Routines: Try to understand people’s lives and routines. Ask if there have been any changes to their normal routine that could have led to skin changes or a pressure ulcer. Ask if they have a written ‘safe routine’ or prevention plan that you can look at together. Support: Find out what support people have at home. Is there anyone they would like to be involved in their care or appointments? Discuss additional support that might be needed while treating the pressure ulcer. What matters to them: Find out what matters most in people’s lives e.g. work, family, caring responsibilities, wider self-care routines. Remember that people are often trying to balance pressure ulcer prevention / treatment with busy, complex lives and other health conditions.

During the appointment

Support during appointments may include:

• Taking notes
• Asking questions when things aren’t clear
• Adding information if something is missed
• Filling out forms
• Asking for specific equipment (e.g. pressure relieving mattresses in hospital)
• Helping someone to get their point across if they are not being heard
• Helping to explain someone’s normal routine and any changes

Find out more

• MOVES: Your safe routine to prevent pressure ulcers

During the appointment

Getting started: At the start of the appointment, check how much time you have, so that you can make sure you cover the things that are most important to you. Reasonable adjustments: Tell the health professional if you have any access or communication needs. For example, if you need extra time to process information or if you are hard of hearing. Pause if needed: Don’t be afraid to pause the discussion if you don’t understand something. Ask the health professional to explain it in a different way. Notes: Some people take notes to help them remember things. If there is someone with you, they could take notes. Endings: At the end of the appointment, check what will happen next. You can also ask for written information.

Preparation

Discuss what people need: Every relationship will be different. If someone asks you for support, talk to them about what they need. Advocates should only act when they have the permission of the person they are supporting. Seeking help: The NHS can be complicated. Advocates can help find the right services and make appointments. There is more information about pressure ulcer services below.

Find out more

• Pressure ulcer services

Adapting your approach

Reasonable adjustments: Long-term neurological conditions can cause issues that affect people’s communication. Talk to people about what they need and adapt your approach. For example, people may have hearing problems; they may need longer to process information and get their point across; they may find it harder to remember things; they may be struggling with fatigue and concentration. Meet people where they are: People will be at different points in their patient journey. For example, if someone is newly diagnosed, they may be feeling overwhelmed by lots of new information and life changes. If someone has lived with a condition for a long time, they may feel more confident managing it. People will need information presenting in different ways. Assumptions: Don’t make assumptions about people’s pressure ulcer knowledge. Explore what they know about pressure ulcer development and prevention. Studies have shown that health professionals often think they have discussed prevention, but they may not have communicated it clearly.

Sharing decisions and plans

Prioritise: If you have limited time, try to understand what success would look like for the patient. Work on their priorities first. If you think something is clinically urgent and needs prioritising (e.g. a severe infection), then explain your reasoning. Demonstrate that you have heard their concerns and will come back to them. Use this website: IIf appropriate, work with people to plan a safe routine to prevent pressure ulcers, using the template. You could also highlight other sections that might be relevant to their specific situation. Discuss treatments options together: Discuss the pros and cons of each option so they can make informed decisions. Disagreements: Sometimes, patients might make decisions that you don’t agree with. Discuss this gently and respectfully. Try and understand their reasoning. This may provide an opportunity to offer alternatives or adapt care for their specific situation. For example, if someone is unable to do long periods of bedrest, they may be able to incorporate shorter periods in their daily routine.

Respect their decisions: If someone has capacity, they can make decisions that you don’t agree with. Document these conversations in your records. Avoid blame or judgement when talking to people and when writing notes.

Laying the foundations

People with long-term conditions have told us these things are important and can be forgotten. Good verbal and non-verbal communication can help people feel supported and build trust. Introductions: Introduce yourself and give people your full attention. Let people know how much time you have together. Check your understanding of why they have come to see you. Listening: Actively listen to the information people provide, seek clarification where needed, summarise what you have taken from the conversation, so they know you have listened and understood, ask if you have missed anything. Endings: Summarise your discussions and actions. Let them know what the next steps are. For example, plans about equipment, extra support at home, if / when they will see you again, any referrals. Check they are happy with the plan.