Narrator: This podcast is intended to support UK health

care professionals with education.

The information provided in this podcast is not a substitute for professional

medical advice or treatment, and patients are encouraged to consult

healthcare providers, including nurses, for any medical questions or concerns.

Hannah: Welcome to stoma and continence conversations from Coloplast Professional

where healthcare professionals and experts by experience discuss the latest

hot topics in the worlds of stoma, continence care and specialist practice.

I'm Hannah Patterson.

I've worked in specialist care and I'm currently the ostomy care associate

education manager at Coloplast.

This time we're looking at revolutionizing specialist care and

the power of patient centered practice.

Hello and welcome to the podcast.

I am delighted once again, as they behave themselves, to be joined by my

wonderful colleagues Paul and Emma.

Hi both, how are you?

Good, thank you.

Paul: How you doing?

I can't believe you let us back on.

Hannah: Yay!

I can't, to be honest, I can't, to be honest.

I'm feeling you could well be on your last warnings at the moment, but there we go.

Paul: I promise I'll be on, I promise I'll be on my best behavior and I won't say the

word ditto throughout the entire thing.

Hannah: So, as I say, thank you so much for joining me.

I am really enjoying this.

I, I suppose it's like a mini series within our podcast isn't it about

specialist nurses and I'm really enjoying it and this one I think is

a really interesting subject with the power of patient centered practice.

I'm going to start off by really just throwing it out there.

How would you both define that?

What is patient centered care?

What is patient centered practice?

Go on Paul, I know you're dying to.

Paul: You know what, you don't want me, that's because you

just don't want me to say ditto.

Um, patient centered practice, like anything in nursing, we love models.

And that really is all patient centered practices.

It's a model of patient care.

It's a model where we put the patient like, it's almost a case

of, does what it says on the tin.

It puts the patient in the center of the care that they are receiving.

And I think the emphasis should be on want to receive.

And I think, you know, it really involves five key kind of pillars.

You've got the personalized care, which is very different

to sent patient centered care.

It's part, and it's an aspect of it.

So.

Personalized care is tailoring the care to the patient's preferences.

Yeah, you've then got another aspect, which is collaborative care.

So that's working with patients to design that care plan in, you know, working

collaboratively with that individual.

That kind of goes hand in hand with the third pillar of shared decision making.

So that's not just saying, this is what is going to be happening to you.

It's not going to be that tiered kind of thing.

So it's involving the patients in those decisions.

And fourth, I would say it's respectful communication.

And I think there is a big difference between communication,

respectful communication.

And it's about providing accurate information.

being responsive to those patient care needs and actually acting

on those patients care needs in that respectful communicative way.

And then it's supporting self management.

You know, it's these individuals, we use the term expert by experience

a long time, uh, for a lot of time.

And by specialist nurses, we do have these incredibly long standing

patients with chronic conditions and we all know that chronic conditions

does lead to chronic homework.

It's these permanent conditions and it's this self management and supporting

that self management is the final kind of pillar in that self care and that

patient centered care approach to nursing.

Hannah: Now, Emma, anything to add at all to that?

Just ditto.

Emma: You didn't say I wasn't allowed to say ditto.

You just said he wasn't allowed to say ditto.

But no, I think, I think patient centered or person centered, you

know, people can say different things.

I think it's all about that holistic care.

It's, it's that increased trust and compliance with your patients.

So building that rapport and involving them in, as you said, the shared decision

making, because I think it's really important, especially in our areas.

with intimate healthcare needs, where these are going

to be affecting their lives.

We need to make sure that it's going to fit into their lives.

We need to make sure how we can best support them.

And, you know, it's just that enhanced patient engagement.

Hannah: Yeah, and I really like that, what you've said there Emma.

It's, it's almost putting the patient back in control really, isn't it?

And as you say, with intimate health care conditions, one of the things, and

I can certainly put my hands up and say it's how I felt, and it's something we

hear a lot, out of control, you'd feel out of control, you don't feel like you

are part of your life anymore almost, I think that's the best way of saying it.

All of a sudden there's this whirlwind going on around you, and to actually

have nurses around you That are trying to bring that back, bring

that back, put you back in control.

It's like the old British gas advert, wasn't it?

Do you remember, with either thumb, you're in control or something like that.

I feel like I'm a British gas advert writer.

That leads me on to my next point.

That almost kind of self explanatory on what we're saying.

That is why it is so important to prioritize those patient

needs and preferences.

It's because of that individualized and that lack of control that people can feel.

Are there any other reasons?

I'm going to come to you first, Emma, on this one.

Why else do you think it's so important to prioritize?

So we talked about that individualized and the benefits for the patients, but

I'm presuming there's actually benefits for The healthcare professional as well.

Emma: Oh, completely.

I mean, in the end, in the day, hopefully we're going to sort of

be more cost effective because, you know, patients are going to be

looking after themselves better.

I think you get a lot of job satisfaction out of it as well.

There's better health outcomes.

And especially when we start to think about, um, using technology as well

within those, those areas, um, it can really sort of improve that side of it.

And I think enhancing that patient engagement can.

actually decrease health care costs when you look at, you know, sort of

less tests, less procedures, um, it gives them a better quality of life.

And, you know, I think that health coaching that goes alongside that

patient centered care can really sort of increase that trust and compliance.

Hannah: Absolutely, really good point there.

And it's about, I know it's something myself and Paul have spoken about

a lot, is patient empowerment.

And an empowered patient is more likely to take control and

be involved within their care.

Paul: A lot of it is, I love the word concordance, acting in concordance

with health care recommendations.

And, you know, I think people can sometimes confuse concordance with

doing what people say, you know, doing what your nurse says, doing

what your doc, you know, doing what the doctor, what the consultant says.

And I think by having a patient or person centered approach

to care actually facilitates.

an individual's concordance with care, actually acting in a way that

best suits their healthcare needs.

And it's whether it is through this patient centered approach,

building this therapeutic relationship with an individual.

And again, that is the power of the specialist nurse.

We're able to build those therapeutic relationships.

We're able to encourage and support concordance with care, not just wag

fingers and say, you're catheterizing too much, you're using too many bags, you will

be doing this, you will be doing that.

It's taking that individual on the journey and actually getting them to

make those decisions and by having a person centered approach to care.

that's what really does facilitate that best practice and specialist

nurses really are at the heart of that approach to nursing.

Hannah: So how can I suppose not just specialist nurses but healthcare

professionals in general, are there any ways and means that they can

ensure that patients are active within their own care, because I know

that there is also that element of a lot of patients who almost become

reliant in some ways on a healthcare professional, that they have to be told

exactly what to do and when to do it.

Are there any ways, I mean, we can help support that?

Paul: I think, me personally, it really comes down to agendas, and I think

I've spoken about agendas before in previous podcasts, Where as a healthcare

professional, we have an agenda.

We know that we need to talk about X, we know that we need to talk about

Y because it's part of the pathway.

It's part of this.

We know that it's best practice.

But if you have a clash of agendas, if you have, when you look at

the, what the patient wants, say out of a counseling session.

You know, we know from even from a stoma point of view that we have to

talk about potential complications.

We need to talk about essential stoma care.

We need to talk about X, we need to talk about Y, because if we don't, we're not

providing them with informed consent.

We're not giving them that balance discussion.

And I always use a canary as a fine example, you know, I actually had a

patient that was really concerned that she couldn't look after a neighbor's canary.

Because her neighbors went to Spain every week, every winter.

And she was like, but if I have a stomach and I'm going to be able to look after it,

we sit there, we might sit there and go, you know, have a little, you know, smirk.

But it's like for her, that was so important.

It wasn't about individualized care.

It wasn't about changing.

It wasn't about leaks.

It was supporting her neighbors.

And it's like, And I, when I was counseling her, I could just

see that there was something else going on in her mind.

And we had this clash of agendas.

And it was a, I had to completely change my perspective and view.

And for me, that was a catalyst about actually saying, well, hold on, I need to

put the patient's wants and needs first.

I thought I was doing it, but it was only that time of reflection where I went, it

looks like there's something on your mind.

What is it?

And that was kind of like a spark for me.

Hannah: Yeah, it's going beyond the obvious almost, isn't it?

Yeah.

Emma: I think it comes from the start of that relationship with your patient.

I think building that rapport to start with, finding out about

the patient, understanding their lifestyle, understanding their

preferences, I think goes a long way.

I think if you get that, that trust and rapport at the start, then you're more

likely to be able to build on that and actually coach them into being a little

bit more sort of competent, concordant and confident to manage their condition.

Hannah: And I think that's a really important word that you say that it's,

it's that confidence, not just in what they're doing, but actually with

their healthcare professional as well.

Really, really good point that you make there, that overall confidence in what

they're doing, who they're listening to.

I suppose that it's an additional skill in a way, isn't it?

And what, what skills are required to.

Get that outcome.

I know that's so tricky to ask.

It's a real life.

Oh, how do you even, I'm trying to make your life tricky so that I can ban you.

That's what it is, the pair of you.

So Emma, I'm going to come to you first.

Sorry on that one.

Is that the trickiest one I've asked yet?

Emma: I think the skills you need, I think firstly you need to have.

Excellent communication skills, which I think we all do as specialist nurses,

as nurses in general, I think so much more to the communication than just

talking to your patient is the reading in between the lines, the active

listening is picking up on those cues, that body, um, the sort of, that sort

of the image of, you know, how they're taught, how they're, that nonverbal

communication, um, you know, when you get a patient that comes in, that's

just like a closed book and it's really difficult to get anywhere with them.

I think.

That is a huge stepping stone there when you, when you pass

that barrier, having the time.

I know it's not a skill, but I think you need the time to be

able to offer this sort of care.

Training.

I think, you know, we need, we need special training in maybe coaching, health

coaching, motivational interviewing.

These are all sorts of skills that we can, we can learn on the job.

And it really does help to improve things there.

Paul: The only one I would add to that list, and I completely, I love

motivational interviewing, I think for me it's such a powerful art form, and

it really is an art form when it comes to communication, and the communication

skill is motivational interviewing.

But, And Emma, I'd almost like to get your, your thoughts on this

comment as well, which is being willing to hand over some control.

And it's that thing of as specialist nurses, as I say, especially when

potentially when you were in post, and it's that thing of, I'm the specialist,

I know what the correct pathway, I know what the process is, I know, you

know, and I think sometimes it takes.

Skill and it take personal understanding sometimes to be able to give up some

of the rain, some of that I'm trying my hardest not to say power, but that could

giving up some of that control back over to the individual and again, putting them

at the center and saying, I know what I've got to do, but actually, do You take the

reins for a while, what you know, with that support, with that understanding,

with that education, and I think sometimes that can be a really, really challenging

thing for some, some individuals do, and I know I've been there personally.

Hannah: It almost goes back to what you said earlier, that we as nurses

have an agenda and sometimes you've got to be willing to go off that

agenda and off that track slightly to get the results that you want.

And I do like the fact that you said power, I mean, after all the name of

this podcast is The Power of Patient Centred Practice, so actually we are

talking about how that is a power.

It is.

It's such an important thing to have.

Did you have those same experiences as well, Emma, that you had to kind of

change the way you thought at times?

Emma: I think it's more the fact that, you know, you, you're saying

sort of relinquishing that power, so to speak, Paul, but that actually,

you, you mentioned it earlier about empowering the patient.

And I think that's where, um, follow up.

And I think following up your patients, you know, on, on a

ward, you see your patients.

they go, they might come back, they might not.

You don't get to see how they're getting on, but I think in specialist

practice, we are so fortunate to be able to review our patients.

We can follow them up.

Um, we can keep empowering them.

We can keep reassuring them.

We can keep encouraging them.

But yeah, there is a point where you have to sort of say, okay, it's your turn now.

And it is, it's that letting go, isn't it?

But I think slowly you can do that via sort of your follow up and you know, what

with this patient initiated follow up now that we have to do in the NHS, um,

it sort of does help in a way, I think.

Hannah: I'm going to throw another skill out there that I think And

it's not just special, I think every healthcare professional

needs it, no matter what area.

Patients, and I'm not talking about patients with a TS, I'm

talking about patients with a CE.

I think we don't underestimate the amount of patience that you need to

get the sort of achievements out there.

And it's something that you almost take for granted really, that you, how many

times have we all been there where you've done like, right, I need to just stop.

Count to 10 almost, 100 in some cases, and go again.

Would you agree as well?

Patience there, Emma?

Emma: Oh, completely.

And actually, I was going to start with patience, but then I thought,

oh no, I'll start with communication.

But no, I think, I think patience.

And I think you're right.

You're so spot on.

We need it in all aspects of healthcare.

And I think maybe even doctors maybe need some more patients sometimes because

there are those patients that have these chronic conditions that will go

round and round the houses explaining the same thing over and over again.

You just think, okay, I need to bring it back.

Hannah: Well, I'm looking back at Paul's canary story there.

Canary was not the issue, but by having that patient and the communication,

Paul got to what the overall.

problem was.

Paul: And I think that's it.

And I think, you know, and again, you know, I, I've got, and I'm sure all

specialist nurses, all nurses have got a myriad of, of these stories where non

healthcare professionals go, you're what?

But as I say, I'm sure Emma's got a story.

I, you know, I've got one with, you know, as I said, the canary and she

was so, bless this lady, she was so concerned that she wouldn't be able to

look after this canary for, uh, for, for her when they went to Spain, but.

Personally, I think that lots of people assume that patience, having more

patience with an individual equates to needing more to spend more time.

Patience doesn't necessarily Take time.

Patience takes skill.

And sometimes if you have the patience to actually just let a conversation

progress, you will save time.

Because you haven't got these clashing of agendas, you haven't got this kind of,

I need to speak, they need to speak, are we both speaking about the same thing?

They want to get their point over.

And sometimes just having the patience to let things ride can actually save a nurse

time, save that time in what you're doing.

So don't just think, You know what?

I'm in a rush.

I've just got to get this done.

I can almost guarantee that over 50 percent of the time you're going to

spend more time by not being patient than if you actually say, do you know what?

I'm just going to.

Let this happen.

Let's do this.

Let's take those skills and you will, you will incredibly quickly find

out what those key aspects of care are important for that individual.

And then you will power through at a much faster rate to what

is important for the patient.

And like, like you said, the title of the podcast is putting the,

you know, patient centered care.

Patients.

doesn't equate to more time.

Hannah: Really good point.

Now, on the subject of time, I'm not going to allow either of you to say the word

time as an answer to this next question.

Because that is, we know.

This is an issue within healthcare in general.

Barriers and challenges to providing patient centered care.

And I say you are not allowed to say time because that,

yes, we know time is an issue.

So, Emma, go on, give me another one.

I'm so mean today, aren't I?

Emma: Right, I'm going to throw it out there.

Organizational culture.

Hannah: I

Emma: am going to throw it.

I'm going to be brave and I'm going to say the culture within healthcare, I think

can really be a barrier in ways, because if you're trying to do something for the

patient, if you're trying to make things better, if you're trying to improve things

for them and there's barriers there.

I think when there's a lack of resources, your lack of training, uh,

we know that there aren't specialized trainings within, uh, within NHS.

And I think that's a really, really big part, uh, because we're not prepared.

We haven't got the, the, the skills, the knowledge to be able to put that

into place and resistance to change.

Oh, yes.

I think that's a big one.

I think if people aren't wanting to change their ways or change ways of working.

to improve that or to, you know, put patient centered care at the forefront.

That's where we can, uh, have issues.

Hannah: And here was me thinking that we might struggle when

I wasn't able to say time.

And there's Emma with the finger snap, mic drop.

And she's, she's blown it out of the water.

And this is what I'm really looking forward to now, because at the start of

the podcast, I do believe Paul promised that he wouldn't say the word ditto.

So this is going to be the point where I now come to Paul and

say, Paul, any extra thoughts?

Paul: Right, Hannah, can you do me a favor?

Can you do a little bit of filling while I go on to Google

and find an online thesaurus?

Because I've got to find another word for the word.

The, the, the D word that I'm, that I'm not actually allowed

to, allowed to, to, to say,

Emma: just embellish mine.

It's fine.

I'm just gonna,

Paul: I'll pick one of yours and I'll embellish.

Um, yeah.

What, what can I actually say?

I wanna say Dito, but I'm not gonna say Dito.

No.

What I would say is.

It's confidence.

For me, it's that thing, and it, and I talk about confidence an awful lot,

and it's that personal confidence, and it kind of ties everything

that Emma's said together as well.

It's that confidence to question yourself, confidence to question the organization

confidence to question historical practice confidence to question the latest research

just because research is there doesn't mean it's correct question question

question question and all of that comes with confidence and only by having that

personal confidence to question yourself And question the actions of others.

Are we able to take that forward?

So one for me, taken on board everything that Emma's said, I would add confidence

to it and just say, have the confidence.

We know that we don't know everything.

And lots of, like everybody says, you know, the day you think, you know,

everything in nursing is the day you need to hang up your tunic, but have the

confidence in yourself, in your skills.

But also have that confidence to say, what do I need to change?

Do I need to change and who do I need on board to drive that change?

If there, but have the confidence to say, sometimes say, I don't

know, absolutely no idea.

Hannah: Thank you so much.

And believe it or not, we've actually run out of time.

Again, it's amazing how quickly these sessions go.

I cannot believe we, but it just shows that the last 25 minutes has just

flown by and the importance and that power of patient centered practice.

I think, I probably speak for you guys as well, we could probably talk about

this for another hour or so quite easily.

The importance of it.

But, thank you so much guys for joining me again.

You did behave yourselves.

I'll, I'll give you both a gold star afterwards.

Well done.

I suppose I'll let you come back again.

Yay!

And

Paul: I only said ditto once.

Hannah: Let's see if it lasts into the next one.

Paul: Sounds good to me.

Hannah: Thank you guys for joining me, and thank you to everyone listening,

and we will see you next time.

Thank you for listening.

To see more of the wide variety of education we offer, please

visit coloplastprofessional.co.Uk.

See you next time.

Narrator: StomaContinencenants Conversations is a Vibrant Sound Media

production for Coloplast Professional.