Part C

podPart C Podcast


Voices from Students and Newly Qualified Practitioners 

OSCEs – Sarah Parkes, learning disability nursing student

It is natural to get nervous about any exams and OSCEs are no different, make sure beforehand that you understand what will be required of you. Seek extra support from your personal advisor or similar person, stay off social media sites where everyone is talking about it as it will just confuse you and worry you and finally if you have completed all the practical revision work then all you can then do is your best. 

CQS inspections – Charlie Clisby, newly qualified nurse

CQC inspections can be stressful – no one wants to receive a bad report or criticism – but just remember that they are there to help improve the quality of care your clinical area provides. See any points for improvement made by such inspection as positive as they ultimately ensure that your patients receive the best quality care. 

Reflections on communications – Laura Grimley 

Reflection on communication has helped me develop small things which I believe has given me a more professional flow when dealing with patients or relatives. Things like not assuming who is accompanying a patient, but instead asking them who has come with them. The ‘#hello my name is’ campaign has made a massive impact on my style. I never forget how important this is, and to repeat it with people may have met a week ago, just in case they have memory problems. ‘Hello my name is . . ., I met you last week, today I’m helping to assist with your care. How are you today?’ Simple engagement like asking how someone is while you complete a basic care task, once you have asked, explained and gained consent for this, increase a positive care relationship, trust and knowledge about the patient.

The main thing I have struggled with is firmly encouraging someone to take control of their care and empowering them to be more independent. People fall into this patient mode thinking they shouldn’t do anything for themselves. This is particularly negative with elderly patients who can go ‘off their legs’ within 48 hours.  – Laura Grimley, Adult 

Media coverage – Sarah Parkes, learning disability nursing student

No one likes to hear or read about when safeguarding goes wrong but at times it’s the system that lets people down, not just the nurses or social workers. Throughout my training I have learnt that nurses, social workers and other professionals try their best for patients and due to the red tape their hands get tied with what they can do until certain steps have been taken which all takes time.

Reliable sources – Samantha Vanes 

I will look for organizations that I know are legitimate so using NICE guidelines or resources from the department of health. Also within mental health there are charities that are well known and will provide well-researched resources such as mind or rethink. I would be more cautious about using information that have come from chat sites or forums or wikipedia on the internet as I would be questioning their evidence base. I would be looking for a reputable publisher or organization. – Samantha Vanes, MH nq 

Terminology-- Hannah Boyd, adult nursing student  

I have found terminology and abbreviations very hard to understand. What I have started doing is writing down terminology and abbreviations down for each placement that I go on to help me learn them. The biggest hint I can give is to ask the other nurses what they mean.


cwCompassion, caring and dignity pg 171

These elements are essential in the care we deliver. It ensures the patient has a positive experience. Having spoken to patients they have confirmed these are one of the most important aspects of their care. The patient will feel relaxed and we can build rapport with them. I have always used a person-centred approach in my professional relationships with patients. One experience stands out for me. I had a patient with dementia who often had problems with her bowels which lead to discomfort and embarrassment for her. I came on shift to find her standing confused and disorientated by her bed. Her clothes were soiled and she was a little distressed. As she saw me she smiled and asked for a shower saying she had been waiting for me to arrive as she always felt refreshed when I supported her with personal care. I proceeded to do this and she was then relaxed and happy once more. I showed care, compassion and an awareness of her dignity each time I helped her shower and she remembered this and appreciated it. It enabled me to build a trusting relationship with her and enabled me to work closely with her when she was confused or upset resulting in her health and emotional needs being met and her stay with us a happy one.

Julie Davis, learning disabilities nursing student

When people are in hospital, they are more vulnerable than when they are well at home due to being in an unfamiliar environment and being with unfamiliar people. It is therefore important that nurses show compassion to their patients to make them feel at ease and promote recovery. It is also vital to observe someone's dignity; nurses may require patients to unveil more of themselves than they would usually feel comfortable with, especially to a stranger. Nurses need to understand patients’ preferences regarding personal hygiene so they know how best to respect people's privacy. 

Michelle Hill, newly qualified RNLD

Dealing with an unpopular patient in A&E with multiple admissions in so many days. This patient had poor hygiene and therefore was creating a negative impact in the environment for other patients. After many attempts with staff to address this aspect of this patient’s care, given that this department doesn’t often deal with this, I was able to get a member of staff to help me assist addressing this patient’s hygiene needs. This resulted in a positive mood in the patient, removing the unpopular label and a positive environment for patients. This required compassion to care for this patient in this way, doing an aspect of the job that others did not want to do. This gave the patient their dignity back. They had concealed their incontinence with plastic bags for several weeks and had not washed in that time. Learning this meant help could be put in place for the patient.

Laura Grimley, adult nursing student

I incorporate compassion, caring and dignity in all the care that I deliver and I believe if I’m not doing this I’m not fulfilling my role as a nurse. If a person is experiencing mental health problems they can be feeling very vulnerable and experiencing very low self worth. If they are not being treated with care and compassion and their dignity not protected then this can be very detrimental to their recovery and continue to make them feel worthless. By being available, non-judgemental and showing unconditional positive regard then I can show that I care about those I’m working with.

Samantha Vanes, newly qualified mental health nurse

In my ward placement I worked with patients that had had a stroke, some of these patients had temporary lost the use of their voice and ability to complete tasks of daily living. I had to try to understand what they needed and were trying to say as these patients were relying on me for their care. I could only try to understand how frustrating it must be, to not be able to communicate their needs to me and others, and when they got irritated I accepted that and tried to make things better.

Sarah Parkes, learning disability nursing student

I always treat everyone as individuals and they are my main focus when caring for them, I think helping to bath someone is a prime example of promoting dignity in the care I have delivered. I have cared for someone who needed complete care, so when we bathed him I spoke to him throughout the whole process, firstly asking him whether he would prefer a bath or a shower. Explain what I am going to do ‘I am now putting some soap on the flannel to I can wash your back’ for example. Never have a conversation with colleagues over the patient, you are there to care for them so they should be involved in the care you do. Even if they unconscious in ITU for example. And when individuals can do things for themselves, no matter how small, let them, or encourage and support them to be as independent as they can be.

Siân Hunter, child nursing student

I always try to involve patients in their own care, especially with elderly patients. I feel it can be quite un-dignified having someone making assumptions and doing everything for you, if that patient wants a shower rather then a wash by the bed, why not? and if they want to get dressed into their normal clothes rather then a hospital gown (circumstances permitting) surely that is a lot more dignified.

 Charlie Clisby, newly qualified adult nurse 

cwUsing passports pg 215 

Passports are brilliant way to help highlight a snap shot into the life of a person that at that time may be too unwell to speak or communicate their needs. Used a lot in LD and it talks about all sorts of things, the name the person likes being called, what the person likes and dislikes, medications, how they communicate, and what the person may need assistance with.

Sarah Parkes, learning disability nursing student

A communication passport has helped me care for several patients on my last placement. These patients had required all aspects of care and were unable to communicate in any way. Some patients had Parkinson’s and some had hypoxic brain injuries. The passports enabled me to have a conversation with the patient, knowing their likes and dislikes. It avoided them becoming objectified, which could very easily happen with care staff talking over the patient while giving care. It allowed further engagement with the relatives.

Laura Grimley, adult nursing student

Reflecting on communications pg 216 

Communication is very difficult as everyone needs to communicate their wishes and when someone does not understand what you are saying it can cause anger and aggression. Having learnt from first-hand experience of basic communication it has made me very aware of how I speak, stand and more about my facial, body and hand expressions.

Sarah Parkes, learning disability nursing student

Reflection on communication has helped me develop small things which I believe has given me a more professional flow when dealing with patients or relatives. Things like not assuming who is accompanying a patient, but instead asking them who has come with them. The ‘#hello my name is’ campaign has made a massive impact on my style. I never forget how important this is, and to repeat it with people I may have met a week ago, just in case they have memory problems. ‘Hello my name is . . ., I met you last week, today I’m helping to assist with your care. How are you today?’ Simple engagement like asking how someone is while you complete a basic care task, once you have asked, explained and gained consent for this, increase a positive care relationship, trust and knowledge about the patient.

The main thing I have struggled with is firmly encouraging someone to take control of their care and empowering them to be more independent. People fall into this patient mode thinking they shouldn’t do anything for themselves. This is particularly negative with elderly patients who can go ‘off their legs’ within 48 hours. 

Laura Grimley, adult nursing student

Reflecting on communication has helped me to in many ways to improve my practice. For example during my first placement I worked with a patient with Huntington’s disease, I was required to support her to eat her meal. Her communication was limited and she needed time to respond to my questions. When I reflected on this experience I concluded I needed to ensure I was aware of the communication difficulties of some of my patients and how important it is to adapt my own communication to enable us to understand each other. In her case I needed to ask clear, concise questions and wait for a time for her to respond before taking action. This has improved my practice as, now I am able to meet my patient’s needs by adapting my listening and communication skills to respond to them.

Julie Davis, learning disabilities nursing student

I have learned that communication is a skill that you need to work on all the time in order to get better at it. I was once communicating with a patient that is living with a diagnosis of dementia and she was finding it hard to understand what I was meaning. I reflected on this experience and realised that I could have spent more time with this patient to help her understand what I was meaning better. 

 Hannah Boyd, adult nursing student

It is important that nurses are aware of their style of communication when talking to a variety of different people. For example, it is necessary to use different language when communicating with different colleagues, such as doctors, nurses, other professionals, healthcare assistants, as well as with patients. There are also numerous forms of communication, such as speech, sign language, makaton and Braille.

Michelle Hill, newly qualified RNLD 

cwTips for communicating in challenging situations pg 223

Communicating with a deaf patient on a spinal board in A&E, was challenging. This was difficult, however the simple aspects like looking at the patient when you speak, was missed by other health professionals. Luckily I knew some signs from previous training and youtube videos. The patient then had a friend to interpret. –

Laura Grimley, adult nursing student

I worked closely with a woman with the end stages of Huntington’s disease. Her communication was limited and she would hit and kick out when given personal care or attention to her peg feed was given. I would spend time prior to these tasks being carried out chatting to her and explaining the need for us to help her. I also held her hand so she would recognize my touch and become accustomed to it. I learnt to recognize what she was trying to communicate to me and we were then able to give her the care she needed. She was relaxed and so were we.

Julie Davis, learning disabilities nursing student

I was working with a scared man who was mentally unwell and was going through medication changes, would not eat or drink had been incontinent of urine and had refused to wash or change with or without assistance as it was his right. Staff member had been in and tried and I went in as the only option. I just explained that it was his right to stay in bed and not eat or drink I just explained that all I wanted to do was make sure he did not get sore. I could at least change and clean his bed and help him have a quick wash. He was very angry and agitated and I was scared however I knew the team was behind the door ready to come in if I needed them to. While I was cleaning his bed I asked if he would like a drink and sweets while he waited which he accepted, then agreed to come out of his room when I had finished making his bed. 

Sarah Parkes, learning disability nursing student

cwUsing pacing techniques pg 228

This is particularly important when communicating with people with memory problems. When I have communicated with patients with dementia it has been important to be clear with what is said and to give the person plenty of time to respond.

Laura Grimley, adult nursing student

When I use pacing techniques I usually start with a few closed questions about themselves or about anything unrelated to what you need to talk about to put the person at ease has always worked for me. You need the person to be relaxed and feel they can trust you. Time is also a must give the person time to speak.

Sarah Parkes, learning disability nursing student

cwKnowing when to apologize pg 229

I was in the day room at a care home and there was a woman sitting by herself, I thought she looked a bit lonely so I went over to her and started to ask her about her life. However I never knew that she didn’t like talking about her childhood as her father was involved in the Second World War and he unfortunately died. As soon as I asked her about her childhood she started to get upset and told me to go away. I didn’t know what I had done wrong and went and asked one of the clinical support workers. When they told me about her childhood and that she didn’t like to be reminded of it, I felt so bad. I went back to the woman and apologized to her. She said that it was ok because I didn’t know. This improved the situation because the woman trusted me again. I learned that it is important to ask if there is anything that patients don’t like talking about before I ask them about their lives.

Hannah Boyd, adult nursing student

While working in a minor injury unit there was an extended delay to those in time order due to three emergency patients. One of these patients was a child in anaphylaxis shock. A father of another child was very angry about being kept waiting. Once we apologized and stated there was a severely ill child, the situation was somewhat defused.

Laura Grimley, adult nursing student

I have experienced a situation whereby I have had to apologize to patient. The person was an individual that was suffering from anorexia and needed to have a nourishment provided to them via an NG tube. In this situation I mistakenly informed them that they were receiving a certain amount which was less than what was actually being administered. As soon as I realised I had misinformed them I apologized to them straight away. For an individual experiencing anorexia this would have been very distressing for them and they would have being feeling a range of emotions from guilt to anxiety during this time. It is important to be able to build a trusting relationship with them and if they feel that they have been misled during this time it can be very detrimental to their progress in overcoming this disease. I feel that during the time the procedure was being done me apologizing would not have eased their distress but I feel that there was an element of trust in their care that was preserved as they knew that the mistake was not intentional and that they were not being lied to. To be able to have trust in the care you are receiving is essential and if that trust is destroyed it is very difficult to build it up again but if you can be open and honest about the care they receive then the mistakes can be overcome hopefully without having implications on the trust that the individual holds in those that are involved in their care.

Samantha Vanes, newly qualified mental health nurse

I would say that I apolozise to patients every day, mainly for little things like not understanding something said or if I got something wrong due to misunderstanding as it shows that we are all human.

Sarah Parkes, learning disability nursing student

cwUsing de-escalation techniques pg 234

When I was in placement in an accident and emergency department there was a patient in reception who was very aggressive about seeing police in the department when he had gone for triage. I spoke to the patient about his concerns, highlighting that the police were dealing with another issue and were not interested in him. I highlighted his obvious injury that clearly needed treatment and that the hospital had a zero tolerance policy. I asked him to try to calm down because no one was interested in him (police wise) and I really thought it was important that he got his injury looked at. I explained I was a student but even I could tell it was important for a doctor to look at his injury, which was a possible bone deformity.

Laura Grimley, adult nursing student


I used de-esculating technuques when working with a very anxious patient at work who refused to come out of their room, they would not eat, drink, take medication and refused to change out of wet clothes, saying it was their right. Staff had gone in throughout the morning to no luck, I was asked to go in and try as a last result. To my surprise, the person was happy to talk to me. I put no pressure on getting the person to eat or drink I just concentrated on the need to get the patient out of wet clothes. I explained it was his right however I was concerned about them getting sore and cold due to wet clothes, they agreed to get changed. While I went off to get dry clothes for them, I asked if I could get them a drink while I was assisting which they agreed. I took back clothes, food and drink and explained in case they got hungry, after they were changed and had eaten and drunk they were more than happy to come out into the main areas, sometimes focusing on one thing can change a person’s outlook.

Sarah Parkes, learning disability nursing student

 I had to use de-escalating techniques on my first day as a student nurse. I was helping a carer get a patient ready for the day. The patient became very aggressive and started hitting out. I started telling the patient that we were just helping her get ready for the day and there was nothing for her to be scared of. The patient immediately calmed down and stopped hitting out.

Hannah Boyd, adult nursing student 

cwTop tips for record-keeping pg 251 

Always date and sign everything, always have a black ball point pen in your pocket. Write clearly, be succinct, and accurate, do not use abbreviations and do not write irrelevant information.

Siân Hunter, child nursing student

 Document everything you have done and why you have done something; make sure that everything is fact and not your opinion unless you can back up your statement.

Sarah Parkes, learning disability nursing student

At the end of every shift I make sure that I have documented everything that I need to, or have passed on anything to my mentor or the next shift’s staff. I also most importantly shred any notes that I have made on patients throughout the day before leaving the department.

Laura Grimley, adult nursing student

cwTop tips for memorizing terms pg 260

I have learnt these simply through repetition, for me and my style of learning mnemonics aren’t that effective. It is only through using them in practice that I remember them.

Samantha Vanes, newly qualified mental health nurse

A notebook in my pocket or bag, and write it down and keep looking at it. Even as a newly qualified I still have a notebook and will write things down.

Sarah Parkes, learning disability nursing student

I have a multi-method approach. I carry a pocket note book while on placement to make notes of anything I need to look up. I have flash cards for all terminology and abbreviation. I have a small a-z note book for terminology or definitions. I lastly have a book with each body system and add things to this section to add with drug knowledge, anatomy and physiology, assessment and everything else. I also use diagrams, mind-maps and acronyms.

Laura Grimley, adult nursing student

cwSupporting decision making pg 267

While on a drug round with my mentor, I was involved in the decision to not give a warfarin because there was not a recent INR result. I have also been involved in the decision to give a palliative patient pain relief. The discussion took place, as with the patient’s condition, the pain relief could depress the patient’s breathing and result in death sooner. However any palliative patient’s comfort should be put first, and the patient should not be left in pain.

Laura Grimley, adult nursing student

My last placement I needed to hold a caseload, so I talked through things with my mentor but as a whole, I was the one responsible for my decisions. Never be afraid to ask for help or to talk things through with another nurse.

Sarah Parkes, learning disability nursing student

cwIntuition pg 272

Whilst I was a student I had the opportunity to work within a dual diagnosis team that specialize in therapeutic interventions for individuals with mental health problems and substance misuse. During the time I spent with the team I was able to see how their expertise of dual diagnosis contributed to a collaborative approach to care for those with both mental health problems and substance misuse. During my time with the team I would say that although I didn’t feel there was an intuition as such, the expertise that they had within that specialized area enabled them to put in place an intervention that was appropriate to the needs of the individuals they were working with. From this area I learnt a lot about the stages of change a person goes through and how this needs to be considered when tailoring care to be person centred. The team also collaborated closely with other healthcare professionals and care coordinators in particular. I gained a lot from seeing this approach as it solidified for me the importance of working closely with other professionals and the service user in order for the care being provided to be of any benefit to the individual. By working this way all those involved in the care of the individual were able to identify certain early warning signs as to when they were relapsing in their mental health and also if they were misusing substances and if this was having an effect on their mental health, as both the care coordinator and dual diagnosis practitioner were involved the appropriate intervention for the stage of change could be implemented.

Samantha Vanes, newly qualified mental health nurse 

cwHealth promotion pg 282

I helped to promote health behaviour of one patient. He was a regular smoker but because of the amount of medication he was on he couldn’t leave the ward. I went and spoke to him and I told him that smoking isn’t good for your lungs, he told me that he knew he just needed something to stop for. I told him that being in hospital was the ideal opportunity. So for the 6 weeks he was in hospital he didn’t have one cigarette. He said that he felt a lot better and that was him stopped forever. I believe that this behaviour change will have had a huge impact on his life.

Hannah Boyd, adult nursing student

While in a minor injuries unit it was standard to ask patients between 16–24 yrs if they would like a chlamydia screening. After a discussion with a patient it was suggested that they would like to use precautions and have the anonymous test. A quick urine sample was collected and the form completed for the test to be completed. Condoms were given out to the patient along with some further information on a leaflet of what we had discussed earlier. I think that the health promotion was useful in this instance. It gave the patient a secure place to ask questions and gain knowledge as well as providing them with the means to protect themselves and their partners. The patient would have the knowledge within the fortnight if they needed to have treatment for chlamydia and they knew where to obtain condoms.

Laura Grimley, adult nursing student

Encourage a patient with LD to attend a yearly health care check. I offered to attend with them and explained before the importance of health checks and the positive effects it could have one their health.

Sarah Parkes, learning disability nursing student

cwMedia coverage –pg 306

I feel annoyed with the amount of negative coverage I see of the NHS. I see the amazing work which is done every day, without thanks and with challenging demands. Staff bend over backwards, giving up their free time and pay to further themselves and to provide care for patients. I think that there is manipulation by the press at certain times to further add to political sensationalism. I have been witness to when the press has got things incorrectly. I was lucky to attend RCN congress this year when the press stated that we were voting for the public to pay for doctors’ appointments. However all the debate on this issue had been against this topic.

Laura Grimley, adult nursing student

When I see negative coverage of the NHS I am always saddened that our patients have had a difficult time. I also remember that we deal with thousands of people every day and these negative cases are small in number in comparison to the many good outcomes we achieve which are never publicized in the media. The negative coverage reminds us to keep up to date with our training and our knowledge and to remember our patients are people and we must remember their needs and respect their dignity often in very trying times.

Julie Davis, learning disabilities nursing student

When I see negative coverage of the NHS on the news it makes me feel very sad that it has had to reach that point in order for people to feel that they are being listened to. I also feel very sad that they have had such a bad experience of the NHS and I wonder how it went so wrong. However what really upsets me is that from working in the NHS I know that there are so many staff that are extremely caring and compassionate and provide a brilliant service yet this does not get shown in the media. I know the NHS has it faults but I would like it if the media would show some positive experiences and I would like to see the negative experiences to be taken more seriously so people do not feel that the media is their only option.

Samantha Vanes, newly qualified mental health nurse

No one likes to hear or read about when safeguarding goes wrong but at times it’s the system that lets people down, not just the nurses or social workers. Throughout my training I have learnt that nurses, social workers and other professionals try their best for patients and due to the red tape their hands get tied with what they can do until certain steps have been taken which all takes time.

Sarah Parkes, learning disability nursing student

cwPatient education pg 318

While with the respiratory nurse we were able to give a patient with dexterity problems an easier to use inhaler. The patient was shown how to use this with good technique. The patient was also educated on when to take these. This resulted in the patient taking the medication more effectively, being discharged and not having another readmission in the few weeks I was there.

Laura Grimley, adult nursing student

I think educating patients is a really good idea because it will help them improve their life and prevent them from becoming ill again.

Hannah Boyd, adult nursing student

Educating our patients can give them the self-empowerment to manage their health and saves time because they can help themselves stay fit and healthy and therefore spend less time seeing their doctors because they have prevented ill health. This would then reduce the waiting lists and prevent further demand on the services in later years.

Julie Davis, learning disabilities nursing student

Reliable sources –pg 313

I will look for organizations that I know are legitimate so using NICE guidelines or resources from the department of health. Also within mental health there are charities that are well known and will provide well-researched resources such as mind or rethink. I would be more cautious about using information that have come from chat sites or forums or wikipedia on the internet as I would be questioning their evidence base. I would be looking for a reputable publisher or organisation.

Samantha Vanes, newly qualified mental health nurse

When looking at resources I take into account what I have learnt in university and apply the principles of: the credentials of the authors, the quality of the study, e.g.; the sample base, measurable outcomes, etc. In a work environment I use trusted sources on the intranet but I also research a topic during my study time to ensure I can give the best care and advice.

Julie Davis, learning disabilities nursing student

Check for undated evidence and research. Make sure that resources that you give out or refer to are still in use, look at the publication date, type of resource it is and if they have help lines or drop in clinics that are still in operation

Sarah Parkes, learning disability nursing student


Voices from Nurses 

Freedom, dealing with emotions, compassion, communcation, relationships – Francis Thompson, Head of Nursing Education and Standards, West London Mental Health NHS Trust

I am responsible for education, training commissioning and the setting and maintenance of nursing standards across the organization. My field of practice is mental health and I have been a nurse for 11 years.

I became a nurse because I love working with people, and could not see myself working in an office. Nursing was one of the few careers which would allow me to continually learn and develop, while supporting people through difficult times. I also realized that it is a very varied career, with a structured development pathway, which would allow me to work in a variety of different roles while progressing through a career pathway.

I enjoy the variety of the work and the freedom it gives you to live and work anywhere, whilst doing something meaningful.

It can be very emotionally draining however. I work in mental health services, which involves working with people who are very distressed a lot of the time. It can be challenging trying to support someone to manage their distress and maintain hope for the future when they can’t see one.

One positive instance of care which I was involved in was when I was working in an inpatient drug and alcohol detoxification service. This was a nurse-led unit which ran a 28-day detoxification for people who had become addicted to drugs and alcohol, prior to them going into long-term rehabilitation. Most people who used the service had complex, harrowing life histories, often having been the victims of abuse and frequently having known no lifestyle other than using alcohol and drugs. Trying to detox and change their whole lives was a huge challenge and it was often an emotionally charged environment, it was not easy for people to get through the month and we were there to help them to do so.

I remember one service user, a lady who was desperate to change her life. She had been sexually abused as a child and found that heroin, cocaine and alcohol helped her to cope with her emotions from quite an early age.  She had been taking a gradually reducing dose of methadone (a heroin substitute) to enable her to stop using and was approaching the end of her medication.  She was experiencing a huge range of emotions which the heroin had been blocking out and was really craving for drugs. I remember the visible dissonance she was experiencing; on the one hand the strength of her desire to ‘clean up’ and on the other the emotional pain she was going through and the huge challenge of the long-term future: living a new life. 

She was packing her bags in floods of tears, being led by the cravings and desperate to escape the conflict she was feeling and the flood of emotions triggered by coming off heroin. I asked her to give herself some time and to talk through with me what she wanted to do. We discussed the reasons she had come in, her hopes for the future and what she was finding hard; the lady could barely speak she was so upset. I was in a position where I could help her to think about her choices and the impact her choice today might have on the rest of her life. I was helping her to explore her options and realize that this was a choice, to make sure she was leaving with a clear idea of what this might mean and what she might lose and gain by doing so. This went on for the best part of an hour. Over time she managed to swing her thinking towards staying and managed to continue fighting for one more day. This lady went on to complete her detox and went on to rehab. I never found out what happened when she left our service but I do know, whether she managed to stay clean or not, that that conversation was important for her and showed her that she could make active choices in spite of the challenges in doing so. I feel privileged to have been in a place where I had a good enough relationship with her to facilitate this conversation and that my training had given me the right skills to support her to make a reasoned decision. Whatever the outcome was this would have been meaningful for her and I feel this made a difference to her life. 

My advice to a student nurse would be that you are in a role where you can make a real difference to people’s lives. The most important thing for me is that you actively work to maintain your interest in, and compassion for, the people you are working with: staff, patients and carers. The technical aspects of the role can be learned and will make you a proficient nurse, but your attitude and passion will be what makes the difference and will drive you to continue to grow and learn and will help those around you to do the same.

Pay attention to the relationships you have with work colleagues, it is often said that patients are the most important people in health care but as a nurse you need to be able to work effectively with your colleagues in order to deliver the best care. Working relationships are vital to do this well.

Working with families, care assessments, multiprofessional working, documentation – Emma Tate, Health Visitor, Mid Yorkshire Hospitals NHS Trust

As a Health Visitor I care for families with children under the age of five years. I provide advice and support for young families, focusing on health promotion. We perform developmental assessments of children at different stages focusing on early intervention. We work closely with Social Workers to ensure the safety of vulnerable children. I have been a health visitor for three and a half years. When I came into nursing, my father had recently died and after my experiences as a relative I wanted to care for people who were going through similar periods in their lives.

I enjoy coming across a variety of people and learning about their own experiences.

A difficult thing about being a nurse is that it is often hard to let go and allow clients the opportunity to do things for themselves – we almost feel that we have to do it for them. 

As a Health Visitor I screen for post natal depression. A young mother recently disclosed that she was very low in mood, tearful and unable to enjoy motherhood. I now see this mum frequently and support her with her mental health; she has also been referred to a counselling service. It is rewarding to know that I have helped – had I not asked her about her mood then her depression may have gone undiagnosed.

My advice to student nurses would be to maintain high standards of documentation. Always make time to complete accurate records, no matter how busy you may feel.

Remember holistic nursing assessments. Often nurses forget the fundamental nursing models which teach us to view our patients as a whole.

Multiprofessional working, meeting patient needs, patient education, diginity and respect – Jackie, Clinical Nurse, and Lesley, LD Nurse

Learning Disability Nurses support individuals with a Learning Disability to maintain their health and overall wellbeing. We work within a multidisciplinary team with other health and social services professionals. We aim to work collaboratively with the person, their carers and across organizations to identify and meet the person’s needs.

Lesley is a nurse care manager. A key aspect of her role is undertaking a comprehensive assessment which informs the support plan of the individual’s health and social needs.

Jackie is a clinical nurse. A key aspect of her role is to support the individual to maintain optimum mental and physical health.

Lesley has been a Learning Disability nurse for 34 years. Lesley enjoys the diversity of her role.

Jackie has been a Learning Disability nurse for 32 years. She enjoys meeting different people and helping them with ‘what matters to them’.

Jackie and Lesley became nurses through volunteering in a local hospital for people with learning disabilities. 

The hardest thing about being a nurse is being unable to meet some of the individuals’ needs due to limited resources available.

People with Learning Disabilities have greater health needs then the general population but have more difficulty accessing services and are routinely treated differently. The presentation of the health condition can be complex, multi-layered and the ability of the individual to communicate their symptoms can be compounded by their learning disability. 

Grace (pseudo name) is a 49-year-old lady who lives independently with some domiciliary care support. She has a diagnosis of mild learning disabilities and some additional mental health needs which can have a significant effect on her quality of life and her daily wellbeing. At times, Grace has difficulties managing some situations and is unable to self-regulate her anxiety levels and impulse control.

In August 2012, Grace dislocated her knee which resulted in hospital admission. She was diagnosed with an unstable patella which required surgery. Over the following months, various complications occurred which required additional liaison and input with both primary and secondary health care. 

The following interventions, facilitated by Jackie and Lesley, made a significant difference to the quality of Grace’s care by placing her wishes at the heart of quality health care delivery.

  • Promoting effective and efficient collaboration with primary and secondary health care settings. This included liaison with a number of settings, including: four wards across two hospital sites, various outpatient departments, other members of the learning disability team, district nursing, the GP surgery, etc.
  • Provision of information and use of accessible information to promote Grace’s knowledge and understanding of various procedures/treatments to ensure better informed decision making.
  • Provision of frequent emotional and practical support to Grace and her family to ensure her mental health and well being remained stable and anxieties were reduced.
  • Offered guidance and support to the ward staff regarding appropriate interaction styles and ways of working with Grace.
  • Reasonable adjustments were negotiated in both primary and secondary health care settings, these included: times and duration of appointments, flexible visiting times, access to appropriate aids, equipment and transportation.

 Grace has now fully recovered and is enjoying life.

Our advice to a student nurse would be to treat people with dignity and respect, the way you would like yourself or a member of your family to be treated. Always maintain high standards. 

6Cs of communication, working with families, multiprofessional working – Katie Potter, Community Adult Staff Nurse, NHS

I have worked in an Adult Community Hospital for 18 months. I started out as a healthcare assistant and compassion has always been my driving force. I enjoy making a difference and bringing my passion for delivering high standards of person-centred care to my workplace. The hardest thing about being a nurse is not always having enough time in the shift to sit and chat with patients, this is what I miss about being a student nurse! Make the most of your time!

Working as a registered nurse I have provided support and teaching to first year student nurses in bathing patients whilst promoting dignity and care. I felt proud to contribute to their learning whilst demonstrating positive nursing care. Currently I am a 6Cs Champion and using this to influence colleagues in delivery of the six actions of care. 

A recent personal achievement for me was providing nursing care to a palliative patient and support to her family on the ward. I liaised with the multidisciplinary team to ensure quality of life by promoting dignity and comfort for the patient and maintaining communication with the family members. I have learnt looking after the patient’s family is an important part of nursing a palliative patient.

My advice to student nurses would be always strive to be a role model to your colleagues. 


Voices from Patients

cwSpirituality pg 178

Visit for a interviews and videos on spirituality and the role it plays in patient care and wellbeing.

Acute renal failure following bi-femoral bypass grafting for mycotic AAA – JM, born 1944

In 2010 JM, a healthy vigorous man of 66 developed an abdominal infection after an insect bite. Initially undiagnosed, it was found that he had developed a mycotic aneurism on his aorta. The operation at St Georges to insert a bypass stent could not preserve the renal arteries, and he lost the use of his kidneys. In hospital he had two bouts of pneumonia and a fall while delirious. He was discharged to St Helier after 8 weeks.

JM has been cared for in St Helier Haemodialysis Unit, and at home. When JM, a man of 5ft 10 ins, moved to St Helier he weighed 55 Kgs. In addition to struggling with the process of dialysis, which left him with excruciating headaches, he had persistent infections, his heartbeat was irregular, he felt nauseated by food and was permanently dizzy. The Home Dialysis Nursing Team has been responsible for his care, and for multiple nursing interventions. In addition to an impressive professional level of medical knowledge, nursing him back to health has required that they listen carefully to what JM says about his condition. They have accepted the importance of my involvement in his care and given credence to my views. They have taught us about the many complexities and complications of irreversibly losing kidney function. They have patiently trained us on the technical aspects of using a dialysis machine, on reducing infection risk in hospital and at home and on techniques for maintaining the health of his fistula. They provided us with training literature that has been carefully devised by the St Helier Home Dialysis team to be used by home patients. They have given us coping strategies and referrals to sources of advice – for example on diet. This team gives an extraordinary level of commitment to its patients and has been available to us for emergency advice and visits outside regular work shifts. As an involuntary observer in the Dialysis Unit I have seen nurses provide exceptional care with a lightness of spirit and good humour that allows them to treat even their most difficult patients without discrimination. Above all, they have communicated optimism and hope to JM, which has given him the confidence and courage to continue living and to enjoy his family, friends and activities.

Breast cancer  – Anonymous, 53 years old

Hobbies include walking with my dog, going to the theatre and reading novels (when I get the time!). I dislike injustice.

I was visited by the Breast Care Specialist Nurse at home prior to my admission for a mastectomy. I had visited the out patients’ clinic at the hospital a few days beforehand and had been given a diagnosis of breast cancer. The visit was to provide me with information to assist me with decision making regarding my treatment and to help me make plans for after my operation. I needed to decide whether to have a lumpectomy or a mastectomy, a sentinel node biopsy or total lymph node clearance, and reconstructive surgery or not – a lot of decisions when you are still reeling from a diagnosis!

The nurse provided me with information but took things at my pace. She didn’t try to sway me in terms of any treatment options and respected the fact that I needed a little more time to make my decision. She listened to me and also took account of the fact that in addition to the diagnosis I had also recently undergone a bereavement.

The fact that the nurse listened as well as providing information and respected the importance of me making a decision that was right for me made me feel valued. However, her ability to answer my questions based on her knowledge and experience made me feel that I could make an informed decision confident that any queries or concerns I had would be honestly addressed.

Even though the prospect of surgery and the potential for further chemotherapy and radiotherapy was daunting she gave information at a pace I could deal with, made me feel that I could go back to her with any subsequent questions I had and (as she was going to link with me post-surgery) made me feel that I had continuity of support.

Learning disability, eye test, with thanks to Mencap – Lloyd, 54 years old

My name is Lloyd, I’m 54 years old and I have a learning disability. In 2011, I attended the ‘listening event’ in Westminster through my role as a Campaigns Spokesperson for Mencap. 

Following this event, two weeks later, I had an eye test.  For the first time in my life, me and my mum booked an appointment at my local opticians in Bromley, Kent called ‘Points of View’. I chose this one because it was close to my home and within easy walking distance. I had wanted to get my eyes tested before but had not done it because I was frightened by it, but I am not now. 

I thought it was going to be scary, but after I went to the ‘listening event’, I talked about it with someone else and thought there was nothing to be scared of. I think it is a good thing to have your eyes tested. It was good fun. The optician service is run by two brothers who work there. They were both helpful and friendly. I wish I had gone years ago.

A week after the eye test I collected two new pairs of glasses, one set for reading and the other for when I am watching television or going to the cinema. I chose both the frames. I really enjoy wearing them. I am definitely going to get my eyes tested again in two years’ time. If you are thinking about having your eyes tested I would say this to you: Do it. It's not scary but fun.

Paranoid schizophrenia – Anonymous, 50 years old

I have three sons and five granddaughters. I like walking and I hate shopping. I am currently unemployed but am involved in two expert by experience programs; one is with Chase Farm Hospital and the other is at West London University.

I will always remember one nurse at Chase Farm Hospital, who really did care and listen. In comparison to the treatment I received from other nurses and nursing assistants, this nurse really stood out for being human and actually listening to my needs. This nurse made me feel human and understood. Sometimes I felt cared for by other members of staff, but most of the time they were too busy and impatient. When they had to calm me down, other staff were far too heavy handed and this made me feel even more anxious and unwell.

Pin removal from leg, with thanks to Mencap – Nicola, 51 years old

My name is Nicola. I’m 51 years old. I went into hospital to have pins removed from my leg. While I was there the learning disability liaison nurse attached to the hospital was fantastic.

The liaison nurse met me at my pre-operative assessment, showed me around, went through concerns and took me to the recovery room and ward where I would be staying. This helped me understand what was going to happen.

The nurse also spoke with medical staff on the ward and in the recovery area, telling them about my needs and giving them copies of my health passport. This was all to make sure I would get the right support and care to meet my needs.

Unfortunately, while I was in hospital after the operation, I had a fall and banged my head, becoming unconscious. The ward phoned my mum who became very worried and immediately called the learning disability liaison nurse. The nurse was then able to go to my ward to meet staff and to make sure all was OK. The liaison nurse then arranged for my mum to visit out of visiting hours to reassure her that I was OK.

My past experiences within hospitals had been very bad which made me and my family very anxious about the whole thing. Having the learning disability liaison nurse there throughout helped me and my family to get the right information and feel fully involved and in control of the situation.

Autism spectrum disorder – Anonymous and son, 4 years old

I am both a qualified children’s and school nurse and currently working in an intensive care baby unit in South Wales. I have two children, a daughter Lili aged 12, and a son Theo aged 4, who has been diagnosed with autistic spectrum disorder (ASD). I like walking and reading and I am also a fluent Welsh speaker and enjoy conversing with my daughter and family in Welsh.

Once Theo had been referred by my doctor to be assessed for ASD, he was assigned a special needs health visitor who would regularly come to the home to visit before and after diagnosis. The only way I can describe her is that she was a ray of sunshine at a time when I was feeling down and unsure of what steps to take next. She gave advice and helped refer Theo to relevant agencies. For example she started the ball rolling for Theo to get a statement so that everything was in place for him to start school and encouraged me to say if I was unhappy at what was being proposed. She also helped me navigate my way through all the red tape and endless form filling. She actively listened to me and was never judgemental, and had up to date knowledge of services that could help me. I looked forward to her visits and her genuine interest in supporting me to care for a child with special needs. 

She made me feel relieved and also strangely empowered, in the sense I felt I had some control back in my life again.

Nursing is essentially about communication in which you demonstrate a caring and supportive attitude. The specialist health visitor did this with such implicit skill that it was akin to watching a master at their craft. Normally with a skilled carpenter you have something visible to touch – you marvel at viewing what the master has done with a piece of wood. Nurses work with people and they can use their skills to shape their feelings and self-worth. To leave someone feeling valued and empowered is an end product that all nurses should strive to shape and achieve.