Key Takeaways
- Trust is built by listening, not talking.
Patients with chronic wounds often arrive frustrated or discouraged, so spending more time listening helps uncover their real concerns, goals, and barriers to healing. - Wound care requires treating the whole patient—not just the wound.
Healing depends on addressing underlying factors like nutrition, mobility, social support, and environment, making a holistic and team-based approach essential. - Set expectations early and reinforce them often.
Wound healing is slow and unpredictable, so consistently preparing patients for setbacks and repeating key information improves understanding, adherence, and long-term outcomes.
Transcript
Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text.
Catherine Milne:
Hello and welcome to Wound Conversations, the podcast where we share actionable insights from leaders in wound healing. I'm Cathy Milne, an adult wound care nurse practitioner. And today we are pleased to welcome Dr. Maria Goddard for a spinoff on our wound care rounds to discuss valuable pearls for your practice. Maria is a wonderful colleague of mine and a very good friend, and I'm so pleased she's here with us today. Dr. Maria Goddard is a board certified wound care specialist in the Midwest. She is board certified in wound care by both the American Board of Wound Management and the American Board of Wound Healing. She is an instructor for Advanced Burn Life Support and a member of the Global Health Committee of the American Burn Association. Dr. Gardner also currently serves as the chair of the communications committee and the member of the Education Steering Committee of the Association for the Advancement of Wound Care.
She won't tell you this, but she received an award from the AAWC as the most valuable volunteer. She has practiced in a multiple care settings, including long-term care and her extensive training, research, and clinical experiences provide a unique perspective of wound management. Her mission is to bridge the gaps that exist among care settings because of differences in regulations and resource availability. Her interests include burn care, geriatrics, global health, telemedicine, and reducing disparities in healthcare. Of note, she is also a wound source editorial advisory board member and has been a wound con faculty member. Welcome, Dr. Goddard.
Dr. Maria Goddard:
Thank you so much, Cathy. I'm really looking forward to our conversation together.
Catherine Milne:
Me too. But first, we need to let you know that Wound Conversations is brought to you by WoundSource, the trusted resource for wound care professionals and WoundCon, your connection to global virtual education and wound management. So let's get started with the episode. Remember our mantra, listen today and apply tomorrow. So Dr. Goddard, everybody comes to wound care for a different reason, and I'd like to hear from you what makes you get up and be so passionate about wound care every single day.
Dr. Maria Goddard:
Well, as most people who are wound care clinicians, I fell into this field by accident and it is the happiest accident of all time. I started out in the burn unit and as part of our burn fellowship training, we ended up taking care of a lot of wound patients as well. And what you realize is you're not just taking care of that person in front of you who has a wound, you end up taking care of their entire family as well because you're trying to get them back to work, improve their pain, improve their overall quality of life. And so that makes me really passionate about doing wound care and taking care of people and getting them better.
Catherine Milne:
So the patient clinician relationship, when I hear you lecture and when we talk informally, you always put the patient first and that whole relationship is just paramount to how you practice. Why do you think wound care and burn care are different than other specialties that we see in medicine?
Dr. Maria Goddard:
So I think that we have a really unique insight into all aspects of an individual when they've sustained a burn wound or a regular wound. That is not the reason why they're there. Something else has caused the injury that we're currently treating, and if we want it to get better, we have to address all of those factors. We're also really fortunate in wound care and in burn care that we see our patients on a regular basis. And so we start to foster these really fantastic bonds that lead us to understanding their medical conditions, their challenges that they have in getting to clinic, getting their medicine. And so I really don't understand how we could practice other than putting the patient at the forefront because that's why they're there. That's who we're taking care of.
Catherine Milne:
Interesting to note that your wounds will heal if you have everything together, like their nutrition and their environment and their medicine. And if you don't address those things, then your wound doesn't heal or it's very slow to heal. I have heard you talk about the family connection. You know what their kids do and their grandkids do and their dog's name. What do you really like to find out about a patient?
Dr. Maria Goddard:
So it's so funny that you should mention the dog's name. I had a new patient today who I was seeing in their home for the first time, and I said goodbye to her. And I said goodbye to the dog by name. And she was just floored. She was like, how do you already remember my dog's name? But that's an important part of their family. That's how they get better. And also, it's a really genuine way to show that you care about them as a human being, as a person. And so I just love learning all of those little tidbits and you find them out by accident. Sometimes it's not me. Sometimes it's their favorite nurse or their favorite CNA when they're spending time with them changing them. And so when we gather all of those bits of information, that's how we're better able to take care of the entire person from head to toe, mind, body, and soul.
Catherine Milne:
So I'm glad you brought up this first interaction with patients because I think that first visit is probably the most important to start building trust. So can you share with our listeners how trust is built or any techniques that you use that somebody might find helpful?
Dr. Maria Goddard:
That first visit, as you mentioned, Cathy, is so important. And what I always try to tell new clinicians is it might be your first visit with that patient, but that probably isn't their first visit with a wound care professional who's promised them this miraculous healing. And so they're usually frustrated, understandably, they're apprehensive, they're depressed. If they've been dealing with this wound for a long time, and so it's actually something that I learned from my parents. When people are talking, spend more time listening than you do talking because that's where all of the secrets come out. They're true fears, they're true concerns, and you can have one goal of care to close the wound. Maybe that person just wants to get back to work three days a week. And so when you spend more time listening than talking, that's how you build that trust when you know that their point of view matters.
Catherine Milne:
I have another question for you. So that first visit, do you sit on a chair and are eye to eye level with them or is it they're in bed and you're above them? Or what about those nonverbal cues?
Dr. Maria Goddard:
So it depends on the setting. If I'm in their home before we get started, I have them sit with me either on their sofa, at their dining table, whatever the setting is. In long-term care, before they roll over to have me look at their bottom, I'm like, no, we have to talk face-to-face first. And I try to raise the bed to my level since I'm usually standing or get closer to them if they're hard of hearing and just letting them know that this moment is about them. It's really challenging when you're trying to chart and document, maintaining eye contact just in a meaningful way. Not that you're trying to stare at them, but just letting them know that you're listening to them, moving to the side of the bed that's more comfortable for them, different really simple things that let people know that they're your focus and that they're important right then.
Catherine Milne:
And that really builds a lot of trust that first visit. So those are wonderful, wonderful tips. So wound healing can be slow and it can be unpredictable and sometimes it doesn't really go the way we hope. How do you have that conversation with the patient that things are not going as either they had planned or you had planned?
Dr. Maria Goddard:
I set the expectation for the unexpected and slow wound healing at the beginning. And I reiterate it at every visit, even when things are going well, because as human beings, we tend to focus on the positive as both the clinician and the patient. There was a study that showed that when you're having a conversation with patients, they hear a very small percentage of what you're actually telling them. And that's just because we give them so much information, what the dressing is, what we think it is, what the tests are. And by the time they walk out of our office or we leave that clinical setting, they're completely overwhelmed and only remember a small percentage. And so repetition is really important. I always set the expectation that wounds are challenging. There's more going on than just what we're looking at at the surface. There's normally things going on underneath that we need to address, and that things will sometimes look worse before they look better.
But I remind them that we are a team, that we're in this together and that they're not alone. And I make sure that they know how to get in touch with me. If we're in long-term care, I make sure that the staff is with me and they're talking to them about it, letting them know that if they have a concern, let someone know because it is a long journey. And there are times when, despite all of our best clinical efforts, when we have done everything absolutely right, infection wears its ugly head, they have a fall, they develop a respiratory illness, their A1C, there's so many unpredictable things in this, which is one of the challenges and what makes it enjoyable, but also letting patients know that they're not alone. Connecting with family members is also important. If there is a loved one who is helping to change those bandages, even if it's a child who is coming with them to the appointment or present with them, making sure that everyone is on the same page and knowing that we're all working together towards the same goal.
Catherine Milne:
Wow. It's so refreshing to hear this. I think a lot of people are working in environments that do not value this at all because it's more of a time-based environment rather than a relationship building place. So if you were to give advice to somebody who is working in a time-based environment, what can you say to them?
Dr. Maria Goddard:
So that is a challenge and we're getting less and less time as clinicians. But again, you are not alone. There are many people interacting with that individual. My favorite and long-term care are the CNAs. They spend the most time with the residents. They talk to them, they're in a low stress environment normally when they're communicating with them. And so I ask them, "Is there anything I need to know before I go in here? Did anything happen last week?" Or they'll come find me and let me know things that they're worried about so you're not alone. Just because your time is limited, you really need to access the other members of your team, physical therapists. That's another fantastic opportunity because that gets you into mobility, flexibility, their motion. That's another great way as well. Your nutritionist or the cook, are they actually eating the things that you're providing for them and then really knowing that you don't have to carry that full relationship.
You're all building that relationship together.
Catherine Milne:
Excellent. So I do want to thank you for coming today. You've shared some really wonderful valuable tips. I wonder if you have another practical pearl for our listeners before we sign off.
Dr. Maria Goddard:
Absolutely. My favorite is always ask why. This goes from if you're a new clinician on your very first day or if you've been practicing for 40 years. If you keep asking why, you will always get to the deeper source. That's, why is the wound there? Why isn't it getting better? Why did my patient not show up? Why aren't they changing their bandages? Those answers will really, really open up your clinical practice and your connection with your patients and their caregivers.
Catherine Milne:
This section is really called Wounds to the Whys, and it's really Wound to the Why. So thank you very much, Dr. Goddard. It's been a great pleasure to speak with you today.
Dr. Maria Goddard:
Thank you so much for having me, Cathy. This was great.
Catherine Milne:
We've got plenty more to come in future episodes, so stay tuned on WoundCon.com, SoundCloud, Spotify, and Apple Podcasts. Until then, make sure you browse the content available on woundsource.com and explore the accredited educational opportunities available from WoundCon. Thank you again for joining us, and as we say, listen today and apply tomorrow.