Why Communication Skills are Critical to Wound Management

Right now, there’s more information than ever before about what it means to practice effective wound management. From therapeutic innovations to advances in our knowledge of wound dressings, professionals in the field have a wealth of new options.

That said, one of the most critical factors in high-quality wound care isn’t related to any scientific breakthrough. In fact, it isn’t a treatment at all—though it certainly has the potential to make life better for patients. We’re talking about communication.

Of course, most health care practitioners are well aware of the importance of communication. And now the data is revealing just how big its impact can be.

Consider this. According to an American study, miscommunication was linked to 1,744 patient deaths over a recent five-year period.

While this isn’t a Canadian figure, there’s no doubt that poor communication is a problem here, too. Health care practitioners should work to ensure that their interactions with one another and their patients are productive. Those working in rapidly-evolving fields such as wound care may need to be especially cautious.

If you’re an enterostomal therapy (ET) nurse, your knowledge is highly specialized. As a result, you’ve probably witnessed your share of confusion—both from patients and health care professionals outside of your field.

There’s only one way to overcome this confusion and prevent the poor healing outcomes that can result. In this post, we’ll look at how clear, direct communication can lead to better wound management.

It takes a village

When service provider organizations don’t fully understand wound care, they rely completely on the relationships between specialists and patients. As an ET nurse, you may have experienced this before.

The truth is, while you have a lot of specialized knowledge, the best wound management is provided by circles of care.

Care coordinators and primary care physicians play critical roles in wound healing. Often, so do nutritionists, physiotherapists, and pharmacists, among others. The Canadian Home Care Association (CHCA) notes that interdisciplinary teams can be especially helpful in the treatment of “hard to heal” wounds.

Of course, patients are also an integral part of the ongoing wound management process—as are family caregivers. These circle of care members may require frequent contact with care professionals in order to access support and instruction.

Together, an informed and supportive circle of care can help patients achieve a higher quality of life—and in many cases, better health outcomes. It’s clear that communication is the glue that holds these circles together. But all too often, breakdowns occur.

Have you ever seen an infection or complication that you could have prevented? Have you encountered an incorrectly applied dressing? Perhaps you’ve been surprised to find that a patient doesn’t understand a set of basic instructions related to her wound care.

Situations like these can often be avoided through clear, direct interactions between circle of care members. But that’s not always possible—at least not yet.

At the moment, health care is becoming more complex. Large, interdisciplinary teams are working together across vast geographical areas. Often, patients are receiving care outside of controlled hospital environments.

In many ways, these are positive developments. They represent big strides toward more patient-centred care. But there are also downsides. Complex communication processes—including those related to wound care—need to be managed carefully.

Back to basics

At the most basic level, health care communication is about how one professional transfers important information to another—or to a patient. It’s about ensuring that interactions lead to comprehension, which in turn leads to the highest quality care possible.

There’s a commonly held belief that 93% of communication is non-verbal. While this number is very much up for debate, we know that body language and tone of voice count for a lot. Unfortunately, we sometimes rely on these cues when what we really need is to process complex information.

Interpreting health care information incorrectly can have a very real impact on patients. This risk may be especially high when specialists get involved, since their concepts and terms are often unfamiliar to other care professionals.

For this reason, clear and direct communication—whether it’s spoken, written, or recorded—is absolutely critical in wound management.

Like many ET nurses, you may be used to coaching or educating home care nurses. You may also play a role in explaining how wound measurements and other observations should be documented.

During these exchanges, it pays to employ a few basic tips to ensure you communicate clearly. Be very specific about what you need. Subtly prompt the person you’re speaking with to repeat what you’ve told him to ensure he understands. Listen attentively—an action that requires you to move away from distractions, whenever possible.

Of course, these principles don’t only apply to interactions between professionals. Communicating clearly with patients can help you provide them with care that’s in line with their goals and preferences. Plus, studies show that high quality communication leads to higher levels of patient satisfaction.

Methods such as Teach-Back make connecting with patients—and ensuring they understand what you tell them—easier than ever before.

Creating an efficient system

Home care is a relatively new delivery method. Across many organizations, the workflows that support it are still being established. In many ways, Ontario is ahead of the pack.The province’s government has explicitly stated its home care commitment—and provided funding to back up that claim. But inefficiencies are still bound to crop up.

Now consider wound management as a component of home care. The wound care field is still developing—and developing rapidly. With so much growth and change occurring, there’s a lot of potential for complications—including miscommunication.

The CHCA sums it up best. According to a recent report from the organization, “the absence of a clearly articulated standardized and systemic approach to wound care in the home care sector promotes inconsistency, diminishes the likelihood of sustainability and increases care costs.”

But how can leaders set up such a system? And what role can ET nurses play?

Developing and maintaining a set of guidelines for communication within care teams can go a long way. And technology can help.

For decades, telemedicine has helped patients connect with health care providers. Electronic medical records have made it easier to centralize patient information, allowing practitioners to communicate sensitive health information.

But as digital communication becomes a bigger part of our lives, more convenient and intuitive solutions are emerging. Today, mobile apps can connect entire circles of care at the touch of a button—from the wound care expert to the patient with mobility issues. They can also make it possible for practitioners to exchange images, videos, and other forms of information securely.

In essence, that’s what high quality wound management—and good communication—is all about. Ensuring that the right information is always accessible to the right person at the right time.

Feature image courtesy of Paul Hudson

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COPD Education – Onboarding


To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Patient, Educator (Nurse, RT, the Physician could also be the educator)

One 60-90 min session with the Educator

  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
COPD Education – Continuous Maintenance


To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Patient, Educator (Nurse, RT or Physician)

A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
COPD Respiratory Status Follow-up


Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Patient, Educator (Nurse, RT or Physician)

Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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