This example describes the delivery of tailored exemplary care to a service user in line with NICE guidance for diagnosis and management of chronic obstructive pulmonary disease (COPD) in over 16's (NG115). The individual user was referred to the Pulmonary Rehabilitation Service for assessment and inclusion upon the programme. It was noted from referral the individual is registered deaf and communicates using British Sign Language (BSL).
Aims and objectives
Unfamiliar territory for the service it was imperative to ensure appropriate communication to achieve equal access to pulmonary rehabilitation and to receive an equitable service of patient centred care, integral to ensuring delivery of NG115, where pulmonary rehabilitation is accessible for all. Although an expectation by legislation to ensure this occurs it went deeper with a true desire to ensure this individual would;
• Have a full understanding throughout their whole experience with the service.
• Be included and at the centre of their care.
• Feel valued and empowered to make informed decisions.
• Have the confidence to attend the programme in which they were entering a large group of people.
• Maintain their independence within the group.
• Achieve their own individual goals .
• Have a positive experience.
Reasons for implementing your project
This was a new initiative by the service to improve equal access to pulmonary rehabilitation to all, including those who use BSL to communicate.
How did you implement the project
Direct responsibility was taken by the Physiotherapist, Kelly, and the Physiotherapy Technician, Joshua, in planning the assessment and subsequent programme attendance by the individual. With minimum experience of how to support advice was sought from the Trust’s accessible information (AI) lead. Three key steps were followed;
1). Find out what the individual needs were.
2). Find out how to support these needs.
3). Share this learning to support other services.
As a consequence a BSL interpreter was sourced and utilised at each session. They were available to assist with assessment to ensure the individual was empowered, included and programme tailored to all of their needs. They assisted within the exercise and education components, for which the team needed to reposition to ensure visible communication.
Beyond the interpreter both Kelly and Joshua independently learnt beginner level BSL, often learning from the individual, which they also shared with the group to enable rapport and conversation between everyone. Joshua also took the steps to learn how to share his exciting news of his engagement, in BSL, to the group, demonstrating the genuine intent to include the individual showing just how human all interactions were.
The individual saw an improvement in their physical scores, but most importantly significant improvement in their COPD assessment test score (CAT) regarding the impact of the condition upon their life as well as an improved Hospital Anxiety and Depression score (HAD) their mental wellbeing following completion of the course.
The individual also shared appreciative feedback, “It was really good and feel better for doing it. The team learning some sign language helped with my confidence in the group. My breathing is so much better now and I can walk further and longer without my breathing stopping me.” From this direct experience it has directly affected further support of those with communication needs to ensure they also have access to this service.
Key learning points
Numerous lessons were learnt;
• English language does not always directly translate, especially medical terminology requiring staff to consider language and comprehension in much greater depth. This has impacted on communication with all patients.
• The layout and organisation of sessions can isolate and present barriers for patients. Greater awareness enables staff to address these proactively with awareness.
• Collaborative work with service users enables learning in reciprocal. Bothe the individual and staff valued greatly.
• Undergoing this process has direct impact on future care for those who require communication support. Often the importance of this can be underestimated and important equity of service can be provided.
Solent actively shares good practice to improve the experience of all service users. Mindful of this the communication team has supported the production of a video interviewing Kelly and Joshua. The video shares the key learning and top tips for support of other service users who use BSL, but with clear extrapolation that will aid others with accessible information needs beyond pulmonary rehabilitation and through other service lines.