Many thanks to Karen Mellon, NHS Fife Lead Podiatrist for Learning Disabilities and Care Homes, for this guest blog describing our exciting Fife Health Charity funded Talking Mats Consultancy project, aimed at supporting patients with a learning disability (LD), or dementia, to be more involved in decisions around their care.
I was initially introduced to Talking Mats by my Learning Disability SLT colleagues who were using the resource to support patient engagement. I could see the real benefits of how it could support our interactions with patients with a LD or dementia and empower people to be more involved with decisions around their care. Our SLT colleagues had undertaken the Talking Mats Train the Trainer program and were then able to train our podiatrists in using the resource. Having used the existing resources we found that we weren’t able to discuss/explore people’s views deeply enough, for example, when they developed a foot ulceration, or were at risk of ulceration. This was the spark that ignited the idea to look at developing a specific podiatry resource to enable these conversations.
The aim was to promote patient engagement in their care – both in preventative care and when specialised input is required. By creating the resource we aimed to explore what really mattered to the person and what for them were acceptable goals and outcomes. By developing a specific Talking Mats resource we were able to explore treatments options and impact of conditions and actively engage the person in expressing their views thus creating a person centred care plan. Evidence shows us when people are involved in decision making they are more satisfied with their care, which in turns improves their quality of life.
Having consulted with Talking Mats we jointly created an initial resource which we piloted within NHS Fife over a 6 week period. People living within care homes and people with a learning disability were the target audience for the pilot. Using the resource, we were able to understand more about the impact that foot ulceration was having on patients, and patient’s views on treatment options.
One example of this positive impact involves a 60 year old patient with learning disabilities and dementia. She lives independently with one hour support each day to assist with personal care. She has been known to podiatry for some time due to repeated ulceration. Specialist footwear has been supplied and regular input is in place to reduce the risk of re-occurrence, however at times the foot does break down.
In May the patient experienced a break down on her foot. She is a very pleasant lady who always comes across as if nothing bothers her and everything is fine; she doesn’t like to “cause a fuss”. It was felt the use of a Talking Mat might give us greater insight into the impact the wound was having.
As a result of completing the Talking Mat we were able to discover the patient was in fact experiencing difficulties with the type of dressing and was experiencing pain. We were able to address this and change the dressing type to an adhesive dressing, which took up less room in her shoe, and started her on Paracetamol 4 times a day to address her pain. Follow up discussions reveal the patient was much more satisfied with the dressing, it was more comfortable and easier to keep dry when showering. She also reported to be experiencing much less pain.
As a result of the mat, we were able to identify concerns she had, but didn’t want to share as she didn’t want to be a burden. We were able to address this and create a plan which was acceptable to the patient and improved her wellbeing.
I hope this resource will go on to benefit other professionals and carers working with people who may be impacted by their foot health. By using this resource, we can help our patients explore their views and wishes, therefore enabling co-production in care. The resource promotes preventative care as well as specialist intervention. Going forward there are many other areas of foot health that could potentially be explored in developing further resources – such as paediatrics, nail surgery, musculoskeletal.
Following the feedback from the pilot, the Podiatry Talking Mat Resource set is now being finalised, and we are exploring the best ways to take this to wider Podiatry Services. Please get it touch with us at firstname.lastname@example.org if you are interested.
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