Join Mon and Don as we burrow into our journey's to wound consultancy. We hope you learn a little more about what has shaped us as individual wound clinicians, as we share some of our defining professional experiences as nurses.

Timestamps:

00:00 Get to know us

00:56 Mon’s journey

02:38 High value education and training

02:38 Benefits of lymphoedema education and training in wound management

03:09 How the podcast started

03:59 Alternative pathways to wound consultancy

07:20 The complexities of wound management across the sectors

09:52 Don’s journey

10:33 The fundamentals of wound care

10:45 Advanced practice in the community setting, going back to basics and helicoptering

12:25 High value, low-cost benefits of washing legs

14:36 Takes time to save time

15:25 Advantages and opportunities in community nursing and wound management

17:01 The value of the helicopter view in wound consultancy

17:22 Workplace culture as a barrier to best practice wound care

18:30 More benefits of lymphoedema education and training in wound management

19:19 Trauma-informed and weight-neutral care

19:58 Can’t get to the wound unless you go through the head

20:24 Wound management is not about the dressing and it’s not even about wound care

20:59 I should be a psych nurse with skills in chronic disease

23:00 Changing the language of wound consultancy

24:08 Recommended PhD topics for hard-to-heal wounds

25:19 The trauma stories of wounding

25:29 Misunderstanding the term non-concordant

26:23 Wound care is not always about looking at the wound

28:44 The importance of networking and future episode topics

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Disclaimer:

The views expressed in this podcast are our own. This podcast is intended specifically for healthcare professionals. Always follow your organisation's policies and procedures. Please consult your own healthcare provider for individual wound advice.

Welcome to the 2Echidnae podcast.

You're with Mon and Don, two advanced.

Practice nurses with decades of experience in hard to heal wounds burrowing into prickly conversations.

Welcome back to episode four of the two Echidnae Podcast with Mon and Don talking about prickly things in wound management.

So we've got a couple of episodes under our belt belts and we felt as though we probably should talk about ourselves because not everyone's going to know us and that helps give context.

So we've talked about why we're doing the podcast, but just to give that little bit more depth about who we are, how we've got here, what our journey has been, maybe individually and corporately.

So would you like to kick us off?

Okay.

All right.

So I work in, in a advanced practice wound nurse consultant role and I consult in the public sector across a number of health services, particularly in the community and aged care space.

And my background leading up to that was that I have got a critical care background, worked in critical care for about 10 years and then became a general nurse clinical consultant and also worked as a acute pain pain management consultant.

And whilst I was a general clinical nurse consultant and I consulted across acute serve, acute service, critical care, the, the psych ward, aged care, 90% of my workload as a general nurse clinical nurse consultant was being approached for wound care wound management.

And so by default, I started learning more and more about wound management and that's evolved to me being in this current role.

And of all the things that I've done, I'd say that's probably the most influential and career changing education and training that I've ever done.

And it's really changed the way I practice.

So as you know, you and I worked together for a few of those years and we used to always gas bag and gas bag and gas bag and often we talk about topics that we probably felt a bit uncomfortable about talking with our peers, or we did talk with our peers, but we didn't always take up those opportunities just because of the way our workloads were structured.

But time and time and time again we'd be on the phone, start talking about topics and I don't know, I think you raised the topic of, well, why don't we podcast?

How about you talk about that?

So essentially I think that my skills in pain Management and critical care have really informed the way I practice wound management.

And I believe that I'm a bit of an outlier there in wound management because I haven't done any formal training, well, no degree in wound management and yet I've published internationally, I've spoken internationally and I've just had an ethics approval as a chief investigator to conduct some research.

So I'm actually an outlier in wound management.

I read a lot of literature, I've done my honours nursing and the reason why I did my honours in nursing was because I didn't want to lock my working in regional role.

I was always a generalist and I needed generalist skills and I remember talking to a, a nursing professor who was potentially going to be one of my supervisors and she advised that maybe I don't do a topic specific ph.

Topic specific grad dip and that maybe I do an honours understand research a bit more and then work out where I want to progress from there.

And what the honours degree gave me was a real appreciation of research and critiquing research.

And I'm really going off topic here but I think for me I sometimes see people who have done formal programs, masters grad dips and they are still blindly following research and that's going to be one of our topics.

Research that's been published that has been really poor quality but I really question their ability to really critique that research.

And, and I, you know we've so, so going right off topic and yeah, I'm trying to be, yeah.

So I think for me the two most important things that I've done in my career have been doing my honours degree and doing my lymphoedema therapy course.

I've done critical care as well but yeah, they've been the two most pivotal.

The critical care course enabled me to look at things very holistically and I remember when I was being interviewed for my application for the critical care course I was asked why do I want to do critical care?

And I, and I still remember this, I said you go, you, you do everything for the patient from doing their personal hygiene, you know, and personal hygiene is next level in critical care to liaising with the doctor, planning care, directing care.

So it was a really holistic approach to health care in that environment and then also managing and working with grieving families and grief stricken families.

And so, and I remember when I worked in critical care at one day going out onto the general ward, just that we were quiet in critical care and someone had a gastric bleeding and I just remember you know, and everyone used to say, oh, it's, you know, aren't you wonderful?

You work in critical care.

But I remember on this occasion, the first thing that happened when the person was hemorrhaging, I just quickly looked up at a monitor to see what their rhythm was and there was no monitor and the suction tubing wasn't working and it was really a hot.

And that person subsequently cardiac arrested.

And I always thought at that moment, yeah, working in critical care.

Yeah, that's all good and wonderful.

I've got really broad assessment skills, but in each nursing environment we work in, and I'm going to bring community into that, I think each environment has its own complexities and simplicities and so going, you know, extrapolating that now to community care.

Oh, boy.

Going into a person's home and trying to unpack and burrow and burrow into the complexities of someone living in their home with chronic illness.

Chronic illnesses with a wound, that's next level.

So, yes, had a critical care background, but I just want to make a shout out to all those nurses who work in all those other environments and think the grass is greener or the grass is browner on the other side.

But we all have our challenges within our specific environments and I think.

So going from critical care to the community and everything in between has given me a really generalist approach to health, wellbeing and also and working with people with wounds.

Boy, that was a ramble.

But that's me.

That's sort of my background.

I just love listening to that because I find.

Yeah, no, absolutely dry the tears off.

They're emotional journeys, they really are.

And I think when we've been nurses for such a long time, those things are going to come out and shows a lot of self awareness and self reflection and a lot of that in particular resonates with me.

And as you were speaking about your experiences, you know, I have often described my journey to get to where I am and people will often ask, how did you get there?

I have.

That's a really common question that I have on my socials and I don't really like describing it chronologically because it just seems quite unsexy and it doesn't give the punch and the guts of why you're in it.

And you've just articulated that so well.

But what I really resonate with that.

And as I get onto my journey, I'll just pick it apart in pieces a piecemeal as well, becoming more of that generalist and coming back.

And I often Come back to, I'll say the basics of the fundamentals, whatever you want to say, in wound care, in nursing and health care, I think the more advanced, the more senior roles that we go through, it's about solving more of the basic problems and you do become much more of that generalist and more interested in the helicopter view of healthcare, the helicopter view of the client and their family.

And there's no more wonderful place in my personal and professional and clinical opinion than doing that in a client's home.

I really resonate with that.

It's that absolute privilege going to a home.

And I guess if I think about my journey, I've been a nurse just over 30 years and to those, you know, younger nurses, that sounds like a lifetime.

It doesn't feel like a lifetime.

But I knew very early on, deep down that an acute environment didn't give me that professional fulfillment and I don't, I didn't feel them.

But I have experience since then and been able to reflect that.

My skill set is much more in tune with that community generalist, community nursing.

And I've discovered that as I've navigated and I originally trained as an enrolled nurse in a hospital and that must sound like, you know, a long way away.

And I went back as a mature age student into registered nursing.

But you know, time and time again I have relied on my original training so, so much.

I was thinking about when you were talking mon about the intricacies and the skill set required for different places in that shout out you did.

It can be quite tricky to even just wash someone's leg.

Hell yes, yes.

I'm sure we'll unpack that further down the track in many episodes.

So I really look forward to that.

I've got some great stories, I'll tell you one now that I really come back to because I think it certainly embodies my practice and I'll talk a little bit more about my experience to cap that off.

I love nothing more than getting down washing between someone's toes at the first visit when you're doing a full assessment and we might do all the technical things but gee, you yield some fantastic information when you start washing people's feet.

I think it's like that personal hygiene, as you said, it's intimate bodily care and feet are quite precious to people.

I've discovered that, that people had a, a limb amputated on the other side when I started washing their feet.

I asked, can I wash. Have a.

Look at your other leg.

Can I assess your other leg?

And this was A client who had been seen by the district nursing service that I was consulting to for over a year.

And they weren't aware her contralateral leg wasn't there.

And yet she had a lower limb wound, a mixed vessel disease wound on the leg she had left.

Hugely fascinating.

But the other story that I've come back to is people often divulge a lot of information when you're doing intimate bodily care.

And I have had a lot of nurses say to me, when I say, can I actually get down and do the leg care right now?

You know, happy for me to do it.

They said, no, no, you don't have to do that.

I actually really want to.

And the back part of my brain is going, I kind of want to show you how to do it.

Cause I'm looking at the leg thinking, you haven't had a great wash for a while, you know, So I would like you just to observe how I do it.

That's what I'm thinking in my head.

But I actually don't want someone to take that privilege away from me.

I really enjoy that.

And people, I've had people tell me all kinds of things when you're washing their legs and you're just taking your time because, you know, I don't have time to do all of that.

Well, actually, you don't have time not to.

You know, I've left houses where the nurses said to me, I've been coming here for two years and they've never told me that before.

Well, I just created some space.

Yeah.

You know, but I'm not downplaying some of those skills.

I. I think sometimes we have a white, bit of a white coat syndrome.

We don't wear white coats.

But, you know, if they know you're the specialist there too, and you can get that rapport with them, they'll often, you know, naturally give up more information.

But I just find that's where my skill set lies.

So I, very quickly in my career, after I became a registered nurse, went into community nursing.

And that's where I found I just loved wound cares.

I found it very practical and problem solving and that's probably how my brain functions.

So in the community, have a lot of opportunities to be that primary nursing type of model of care we did a long time ago.

And there's a lot of opportunities to learn about wounds and professional development and really good quality courses.

And so I'd done that.

And then I very quickly was identified.

I was very good at it and networked quite heavily.

I found that was something that I've just done quite naturally in my career and I struggle when people don't do that.

But they keep asking you what courses they can do to learn.

You've got to talk to people as well.

You've got to get out there in the community and you've got to, you know, you know, have relationships with people and talk to people and ask questions and be curious.

I find that doesn't come naturally to everybody.

That's come, you know, more naturally to me.

I think that's something we have in common a lot of as well.

I've just.

I've learned so much in the last.

Well, I, you know, left after about nine years to pursue different opportunities and actually go back into acute, which was a whole new set of skills again.

So that really broad base where I've been able to look at wound care in all kinds of sectors, but always maintaining that helicopter view.

And I guess I take that helicopter view for granted, particularly when I'm educating, whether that's face to face or on social media.

I'm surprised by people's responses because they don't have a helicopter view.

And it always just keeps me humble.

Don't assume everyone's got that helicopter view.

And I just lately have had a lot of, you know, queries and people responding to some of the education that we've been running, very prickly.

And I've.

I've had to have a reminder that there's cultures that exist that people are really embedded in, in nursing that affect wound care.

And I've had the benefit of.

I go into cultures and I can come out and I have a helicopter view, but I.

A lot of people have been at one workplace or one organisation for most of their professional lives and they haven't experienced those things.

And I think there's a lot of cultures in nursing.

But anyway, I'm going down a whole Echidna Borough hole there that we'll unpack culture another time.

But.

So I find that a lot of my experiences too, and where I've got to professionally have come out of, as I said, networking and great professional development opportunities.

I've done a lymphoedema course.

We did house at a similar time together in which has been wonderful and I would completely agree, it has changed my practice.

I don't look at any wound the same, even a wound that's not on the lower limb.

Agree.

You know, you just look at this body system so differently and we'll, we'll talk about that later too.

But I also have not done postgraduate studies per se in wound care and I'm often challenged by others who have, who perhaps don't have that practical application or as much of a wider experience than I have had and therefore they can't consolidate them as much.

So, you know, my experience is broad there.

I'm very informed by some of my own personal experiences as well, particularly now as I've gone into private practice in a regional capacity and I work in a variety of sectors.

I've been very informed by trauma informed care paradigms and weight neutral care paradigms.

And you've influenced my practice so much because of that.

Absolutely.

And thank you for saying that.

I know you have.

Yeah.

So we'll, I'm sure we'll get to those topics down the track, I often feel.

So you can't.

I'll leave you with this.

As far as my, you know, experience, one of my, my driving forces is that you can't get to the wound.

People will talk about the wound and we talk about people being dressing focused, task focused all we want, but you can't get to that wound unless you go through the head.

And there's so much in the psychology of wounds and you've got to deal with the person first.

So those things drive me in my professional practice and that's often where I sit in my professional development.

And I'll say, I do a lot of professional development.

It's not always directly in wound care.

Oh.

I actually think as an advanced practice in wound management, we actually do 5% wound management per se and 95% chronic care, disease case management, clinical governments, escalating care.

And.

Can I just, I want to.

Can I just add to that bit too?

The challenge I had because I worked across, again at a macro level view, across a number of health services.

I had to communicate to clinical or to decision makers and executive managers and CEOs about my role and they all thought that I was this nurse that put groovy band aids on people.

And I used to say to them, I don't put groovy band aids on people.

I'm essentially a nurse who works in chronic disease and these people happen to have a hole.

And in the last, say, six, seven years, I've been saying, ah, ah, I'm actually not a chronic disease nurse.

I'm actually, I should be a psych nurse of that with skills in chronic disease with people who happen to have a hole.

But I think especially just prior to Covid, I had another epiphany and that is.

And you were saying we've got the privilege to spend time with people, but I think what you touched back and going back to the leg thing, that hit the nail on the head, we actually use our time quite efficiently.

People on the outside may think we're just washing a leg, but what we're doing is a complex psycho bio social assessment.

And so it just seems simple that we're washing the legs.

And so, yeah, I think we do have time at our hands.

But also we use that.

We get the max benefit, we get the bang for our buck whenever we do a clinical consult.

And so over the time I've changed that up a bit.

And I said, actually,.

I.

And you're talking about this trauma informed care.

Actually, unfortunately I'm called a wound management consultant because I don't even get me started.

I hate calling myself a wound management consultant because really that's the full stop at the end of the sentence.

It is.

And I think we've got to change, you know, change the marketing or I think the language around what we do has to change.

But that's maybe another topic.

But I.

It's not only that I work with people with chronic illness and with mental illness, but when you actually.

And again, this is my pain piece, this is my pain experience coming in because even though I worked in acute pain service, most of those people had persistent pain phenomena or acute on persistent pain phenomena formerly called chronic pain, no longer called persistent pain.

I still do a lot in pain.

And, and anyway, so that's another topic.

Another, another thing.

I was going to write pain on our list,.

But.

I actually work with a lot of people who've been sexually assaulted as children.

When you actually have that privilege.

If.

You really stop to take the time.

So, yes, there's the wound way, way, way down there.

But when you really dig deep, when you really, really dig deep, they've had some childhood trauma and look, this is a body of research.

You know, I wish I could.

You know, anyone who watches Harry Potter will think of Hermione Granger, who, you know, she's got a Time Turner and she can be at 10 places at the one time.

I'd love to be.

I'd love to be a fly on the wall in a few places just for 24 hours.

That's all not selfish.

Yeah.

So.

So I think that's just.

I would.

If anyone's out there looking for a PhD to do, I'd be looking at that and really drilling down to the childhood experience of people who have persistent wounding, hard to heal wounds.

There's usually.

Well, I would say 95% of my clients have got a story that's still affecting them.

Yeah.

And we'll come in and say we'll talk about this later too.

They're non concordant.

Oh they're non compliant.

But we'll.

That's another.

That's on our list.

Please.

Absolutely.

And I'm sure some people listening to this are probably going to say oh yes, and what about this?

What about that?

Put that in the comments.

Put that in what you want us to talk about and tease out because we've touched on a lot of stuff here.

One thing, one thing is there's no such thing as a human being non concordant.

There's no such thing.

It's a misuse of the word anyway completely.

It's a misunderstanding of what it actually is and I think it abdicates a lot of responsibility and people are having trauma in the healthcare system that we are part of because we are reacting that way and we'll often be the last portal.

I know in my private practice I often am the last person called there at the end of the rope and it might take a while to unpack that stuff but gee, we can really unpack it.

One of the things you challenged me with earlier on and I just want to touch on it because it's come up for me now how we're talking about it and people misunderstanding perhaps what we do and the roles and the titles for our roles.

It is a huge area and I've gone back to using wound care but I as a term.

But I still for a variety of reasons and I'm sure we can talk about that another time too.

But I still, I'm not.

It's not fantastic.

Doesn't sit that well with me.

What I do.

However, I can have people come out with me on the road and I don't do it very often.

I'll do it for some, some people who'll approach me where there's, you know, where there's benefit and they're the right type of person.

But I can go and see people and not even look at the wound and do a full wound consult.

And that was one of the things as I was saying you had challenged me with or said, you know, can you do A wound consult with your hands behind your back or without looking at the wound.

And it's one of those things we always have when you're in a consult and the first thing that people want to show you before you've met them is their wound is like, actually, no, first of all, I just want to read half.

I want to spend half an hour reading your notes.

I want to talk to you first.

I want to talk to everyone else and I want to talk to the whole allied team.

Often people, big teams are calling me and there might be five or six people in the MDT team who are calling in and they're all very desperate.

You get in there and you unpack the issues and it's not as desperate as what you realize or perhaps you uncover things that are even more desperate.

And often people haven't looked at the wound, but everyone wants you to look at the wound.

But I've had people who come out with me and they're really challenged when I stop looking at the wound.

And in the consults for some of these longer term people who are dealing with a lot of.

They're complex.

Absolutely.

A lot of abis and traumas and behavioral issues for sure.

But I don't always look at the wound.

But it's still a very much a wound focused consult.

And they'll say to me, oh, yeah, but you know, we're not looking at the wound.

Like, yeah, absolutely.

But we've made a difference this visit.

We've moved along this visit.

You don't have to always, you know, poke at that thing and look at that thing.

That's that very task oriented, task focused, whole as in hole focused thinking.

And we're not there for that to affect that wound.

We're dealing with the whole package.

People are packages.

Yeah.

And that's another topic I think we should talk about people with spinal cord injury and wounds.

Huge topic.

We'll add that to our list for sure.

That'll take.

So you did need a pen?

I did need a pen.

I did need a pen.

That's a whole season.

I think we're going to venture into sea.

Yeah, yeah, yeah, yeah.

I think we've done pretty well here.

I think we didn't put a timer on us, but I'd say that's nearly.

Do you reckon half an hour?

Yeah, I think we're there.

So we've had a great exposition.

Yeah.

Want of a better word.

Thank you for sharing and.

Oh, thank you too, Donna.

I've learned more about you even today and I thought I knew you pretty well, so it's great.

So there's the importance of talking to people and it improves your practice.

Oh, yeah.

I mean, I think.

Well, I don't know about you, but you've improved my practice so much.

And because we've just often just rubbed heads together, you know, and we don't.

Agree all the time either.

Oh, absolutely.

It's not about.

It's not about that.

And there'll be other podcasts where we demonstrate that as well.

Fantastic.

All right, well, let's leave that one there.

We'll come out with more later and stay tuned for the next episode of To A Kidney.

Okay, bye.

See you later.

We are so grateful to have this opportunity to share our learnings and challenges with you today.

Hopefully it has inspired you to be more curious in your clinical practice and burrow down to issues that bug you.

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We will see you in the next episode.

And in the meantime, go forth, be curious and burrow into some ant nests.

That won't stop me coming through I give it all give it over you.

What would you do What I do.

Take around cover you would you do what I do.