Caring about care communication

A blog by Alison Wilkinson, Physiotherapist and It's All About People team member and Champion.

I had an experience this week that, in my 25 years of working as a physiotherapist, I've not come across as often as I would have expected: I worked with a person who was deaf from birth - Joanne.

Alison and Joanne

Being able to communicate effectively with Joanne required some thought, and I needed her to tell me how to do this in the best way for her.

The referral paperwork process had alerted me to Joanne's hearing impairment, but it wasn't until I had a conversation with her that I really started to understand her needs.

The referral process also enabled us to book a British Sign Language (BSL) interpreter to be present during my meeting with Joanne.

So far, so good.

During our meeting, however, Joanne told me that accessing support 'is just too difficult.” And this naturally got me thinking...

Are we doing our best to support people with additional needs when they attend appointments, where decisions about their care are being discussed? Or are we instead creating or reinforcing barriers to the help they need, with the result that they aren't able to fully take part in discussions about their care? In some cases, people simply give up.

Fortunately, in our case, Joanne's BSL interpreter was excellent at explaining what I needed to do to communicate effectively with Joanne. This included;

• That I speak first, allowing Joanne to lip-read, before I demonstrated the care I would be providing. 
• That I ensure that I was positioned, at all times, facing Joanne, with the BSL interpreter behind me signing for Joanne.
• That I demonstrate visually what we needed to do, using models and aids to help to explain.

While that all sounds fairly straightforward, in practice, it's a very different approach to the one I use day in, day out. Normally, I talk and demonstrate simultaneously. But I wanted Joanne to understand everything I was saying - and to take part fully in our conversation - so I needed to work differently.

Joanne explained that at other health and care appointments, not much thought had been given to her hearing impairment and how best to communicate with her. This led to her coming away from appointments without fully understanding what had been said and agreed, which caused unnecessary anxiety about future treatment. 

Working together, Joanne and I had a conversation about how best to deliver the information she needed. She used her phone to take photos of the exercises I had suggested, and together we came up with a plan so that if she needed to contact me she could. Ordinarily, communication between us would happen over the phone, but this wasn't suitable for Joanne. And, thinking about it, the phone is not a suitable means of communication for lots of people.

Since meeting with Joanne, I have contacted the United Lincolnshire Teaching Hospitals NHS Trust (ULTH) Patient Experience Team for ideas on how to more effectively communicate - and have conversations - with the people I support.

I have also revisited the ULTH Purple Communication Folder. It's packed with helpful guidance to aid conversations when communication is challenging. It's a resource I had not previously explored in depth, but I have now - and I've also encouraged the other members of my team to do the same.