Part D

qPart D Podcast

 

Voices from Students and Newly Qualified Practitioners

Injections – Hannah Boyd, adult nursing student

The first time I did an injection was very scary. I had practised in university but doing it on a real person was completely different to an injection pad. My mentor talked me through it and we then went to the patient. After I had done it the patient said that she had hardly felt it. This made me feel happy because I had managed to give them their injection and did not cause them too much pain. The patient also said to me that she didn’t know what she got herself so worried about. This made me feel even better because I was able to put my patient at ease. 

Moving and handling – Karen Millar, adult nursing student

I started my nursing course having no health care experience at all. Some of the first skills that we learnt were personal care, bed bathing and moving and handling. The first time that I was asked to do these skills in practice was extremely daunting. I was anxious that I would hurt the person moving and handling them and fumble with their personal care when they were in a vulnerable position. My mentor that I had at the time was great and talked me through each part of the process, explaining to the patient that I was a student and just learning. 

Medicine management – Rebecca Kidman, mental health nursing student

One of the most positive things I have experienced on placement is being able to see service users on medication rounds. I like getting a chance to talk about their wellbeing and talk to them. 

Last Offices – Rebecca Kidman, adult nursing student

During the first year of my nursing degree my father was diagnosed with terminal cancer. He spent six weeks on a general ward before he was sent home to be cared for by my mother and myself with the help of Macmillan nurses. It was extremely difficult to juggle my work with the emotional strain of caring for my father. At the same time as this I was on placement, working on a surgical ward with 4 step down beds from ITU. One of the patients was a woman who had recently been diagnosed with terminal cancer. Her husband and children were at her bedside day and night. From early on in my placement I worked with the family. Because of my father I knew how difficult the situation can be when you are losing a loved one, as well as how simple gestures of kindness or support can mean a great deal when you feel so alone. Being able to share this information showed them how deeply I understood their feelings and their situation. Later the children told my mentor how valuable my support had been to them. 

cwHand hygiene—pg 327

I always get my patients to wash their hands before they eat their meals, and I also encourage them to follow the hand hygiene steps next to the soup dispensers to ensure their hands are washed correctly.

Hannah Boyd, adult nursing student

I always give patients a bowl of water at the bed side after using the commode and assist those I help to the bathroom, even if this means that I wash their hands one by one for them. I feel that hand hygiene and mouth care for patients is very often forgotten about. However this can make a massive impact on patients’ confidence and social value.

Laura Grimley, adult nursing student

Use the posters above sinks in placement and explain why it is needed, if the patient is unable to wash their hands in the sink take a bowl of water and explain and encourage from their bed. 

Sarah Parkes, learning disability nursing student

Whilst it is our duty to ensure that our practice is up to date, at times you will experience working with mentors who have been trained differently to us and as such may well use gloves in different circumstances to us or will not wear gloves. If this occurs and you are unsure what to do read the local policies to guide your practice or simply ask your mentor why they are/aren’t wearing gloves. At all times ensure that you are working within best practice guidelines.

Alice Rowe, newly qualified mental health nurse

cwSupporting patients in pain –pg 381

I was changing a patient’s dressing and the patient told me that it was hurting them. I asked the patient if they would like some painkillers before I continued doing their dressing. They said that this helped them and I was able to successfully complete their dressing change.

Hannah Boyd, adult nursing student

When my patient was in pain I asked her where it was, got advice from my mentor and saw to it that she received the pain relief she needed. In different patients this could be pain killers, changing position in her chair/bed, I also reassured her and ensured she felt better. When a patient is unable to verbalize they are in pain I look at body language and behaviour to gauge if they need my assistance.

Julie Davis, learning disabilities nursing student

cwOvercoming obstacles –pg 383  

Caring for a patient with a hypoxic brain injury, who made no communication and was completely unresponsive. There was no way of assessing the patient pain, as unlike palliative patients I have cared for, this patient did not move, make noises, or have facial expressions. Therefore in this case it was important to maintain the patient’s analgesic levels via their NG tube.

Laura Grimley, adult nursing student

Working with a person with learning disabilities who could not clearly communicate their needs required us to look at other ways of discovering if they are in pain. We have used body language and facial expressions. If a person has behaviours it is important to be familiar with these and to see when these change or become more pronounced as they can be a result of pain.

Julie Davis, learning disabilities nursing student

cwWorking safely –pg 406

One of the key skills in nursing is to have a very good aseptic technique. This can help prevent infection, in stopping the introduction of bacteria. Aseptic technique can also help protect yourself through proper hand-washing and protective equipment. This therefore will also prevent the spread of infection.

Laura Grimley, adult nursing student

Being able to understand and apply an aseptic technique is important because it helps prevent infection. If I didn’t know then I could be putting my patients at risk of infection.

Hannah Boyd, adult nursing student

cwCollecting a specimen –pg 410

I would discuss with the patient the reasons why we are wanting to collect a specimen and gain consent. I would then discuss with them to see if they are happy to collect saliva in a pot themselves, or take their own nasal swab. If not possible I would explain what I would do and collect the specimen as quickly and confidently as I could. Before collecting I would read up on the procedure and discuss with my mentor, role playing it though with them if necessary.

Laura Grimley, adult nursing student

Fully prepare the patient about what you need to do so they are relaxed and can cooperate. Ensure you have all the equipment needed and you are very familiar with the procedure you are carrying out. If you are unsure about anything ASK. Don’t worry and relax, the patient is usually more anxious then you are.

Julie Davis, learning disabilities nursing student

cwChronic wound care pg 431

I only met this patient once but after spending five minutes I was amazed at how brave he was. He had a massive pressure ulcer that had developed into a hole. The registered nurse carried out the dressing change and I held the patient’s hand. He was so brave and he inspired me to keep going in tough times because if he was able to cope with that on a daily basis then I am able to cope anything.

Hannah Boyd, adult nursing student

I have re-dressed a very bad skin tear with advice of the tissue viability nurse. It needed gentle cleaning with saline. However this wound would need monitoring as there was a possible haematoma under the flap which may have needed lava therapy later on.

Laura Grimley, adult nursing student

cwWound care worries pg 437

Infection Control, patients’ self-concept of their wound, what the wound looks and smells like. What visitors think of the wound and what other patients think about the patients with the wound.

Hannah Boyd, adult nursing student

I was concerned I would not be able to follow the procedure without being clumsy and hurt the patient. However I was given time to observe the procedure and ask questions, I was also supervised and given all the support I needed.

Julie Davis, learning disabilities nursing student

Compression bandages

I have changed compression bandages on a patient with server oedema. Absorbent pads were needed. Setting up the trolley with everything you know you need and some things that you might. At least one assistant is required. The patient if for example diabetic, with sensitive legs, they will need pain relief before changing the badges.

Laura Grimley, adult nursing student

Health promotion

Good health promotion is key for children with diabetes because it will help educate them so they have a healthier diet.

Hannah Boyd, adult nursing student

Health promotion is particularly key as early, good management of their condition will prevent future problems and complications from the condition such as eye sight issues, progression, in some cases, from stage 1 to stage 2, even amputation. Therefore it’s important they are well educated and aware of what they need to do to stay healthy and prevent further complications.

Julie Davis, learning disabilities nursing student

CPR 

I now feel able to deal with a situation calmly and in the knowledge I have been given comprehensive training and support should the need arise for me to use CPR.

Julie Davis, learning disabilities nursing student

I was on placement in a small community hospital when a patient was brought in by their relative after collapsing. There was only me and one trained nurse on shift in the department nearest the car park. The patient had no pulse. Having the knowledge of CPR and the confidence of performing chest compressions in an A&E department previously made me feel able to confident to deal with the situation. When the crash team showed up and an ambulance did arrive, there was more disorder than in an A&E resus environment. The ambulance crew that arrived had technicians, not paramedics, which meant that they would not be able to administer drugs. There was no-one leading the times of the rounds of CPR. Therefore I took up the role of timing the rounds of CPR, stating when to check for a pulse and when to shock. I felt comfortable doing this as I knew how important this was, but when there were highly trained medical staff present, I thought it more important that they take care of the physical care of the patient.

Laura Grimley, adult nursing student

There are several dangers you could encounter while trying to give first aid, you have to be aware of: Having a car being moved in a small space in order that more people and equipment could get to the patient needing CPR. Maintaining a barrier between the member of staff, patient and car. Also thinking of things like the patient’s hands, which can get trodden on easily in an emergency situation. When I was assisting with CPR, there was also concern for the patient’s dignity as it was in a public space. At the time there were members of the public filming, and barriers were needed along with staff to ask them to stop.

Laura Grimley, adult nursing student

Cardiac arrest pg 479

My first experience as a student nurse in a medical setting with a cardiac arrest was in A&E. The patient had been in majors and needed to go to resus. The patient was elderly and frail. I was asked to be ready to do chest compressions. Just as I was about to do this further news of the patient’s history and relatives’ wishes was received. CRP was stopped. I found this experience particularly challenging after the event, as it was the first death I had experienced since my father two months earlier. Luckily I had an understanding mentor, who allowed me to take my break and decompress after the event. I had the events and reasoning behind decisions explained to me. I feel that compartmentalizing and mindfulness is important for dealing with difficult situations. I find CPR on frail and terminally ill patients difficult. If you are successful in reviving the patient, the patient’s prospect isn’t good. My greatest fear is breaking ribs, or equally not performing efficient CPR.

Laura Grimley, adult nursing student

Old medication

I have a chat with my patient and, if they were able, advise them to return the medicines to the chemist or if they were unable to do so themselves I would seek advice to ensure they were properly disposed of.

Julie Davis, learning disabilities nursing student

If I encountered this situation I would discuss with the patient the problems with having medication which is no longer being prescribed, or is out of date. I would try to gain consent to dispose of the medications. I would also discuss and assess if there is any other needs which the patient may have, e.g. difficulty remembering which medications to take.

Laura Grimley, adult nursing student

cwMaking mealtimes positive pg 521

At meal times I make sure that the patients have control of all choices available to them. If they require assistance that they receive this and are asked what food they would like to eat etc. I ask the patients if they normally have hot food or cold food, if they prefer sandwiches at lunch time, dinner, etc.

Laura Grimley, adult nursing student

 I try to make meal times more positive by getting them salt and pepper and sauces if they want them.

Hannah Boyd, adult nursing student

cwSupporting patients with dementia pg 524

It is very important to find out what their likes and dislikes are, and what their triggers for becoming anxious might be. Encouragement throughout the day with fluids and foods is required. Thinking about higher calorie options if their intake is low, such as whole milk.

Laura Grimley, adult nursing student

So that they don’t become starved or dehydrated because it could make their dementia worse.

 Hannah Boyd, adult nursing student

Patients with dementia can have cognitive impairments which lead to confusion and distress. They may not remember they have eaten or need to drink. If they become malnourished and dehydrated they will be prone to further issues such as UTIs. They can become drowsy and suffer further confusion and they may have falls.

Julie Davis, learning disabilities nursing student

What tips or advice do you have around passing and caring for an NG tube? pg 527 

To ensure that the patient has been cleared of any possibility of facial fractures. To have confidence when passing the NG tube. Measure twice before attempting to insert the NG tube, and to check this with a colleague where possible. Once the tip of the tube is in the nose, to angle downwards. It is important to be firm to get the tube over the nasal arch. If the patient is able to assist, getting the patient to take a few sips of water to avoid the NG spooling into the patient’s mouth.

Laura Grimley, adult nursing student

cwUsing bedpans pg 541 

I think that every situation can be different. Really gaining advice and guidance from the HCAs during your first year of training is key. Thinking though the worst possible aspect of each situation before you help a patient and thinking about the assistance or equipment you may need. Knowing your infection control and PPE in depth. This is important to know how to clean a bed pan and assist a patient who is being barrier nursed. The key thing I have learnt with bed pans is, eco sheets help if there is a chance of spillage. Be prepared to change the sheet. Use two bed pans as one is not enough. Considering hosts for those patients who are fragile or have poor skin integrity.

Laura Grimley, adult nursing student

Helping patients for the first time with a bedpan can be nerve racking for both nurse and patient. I have taken my time but worked efficiently, I have worked in cooperation with my patient and my colleagues to ensure the patient is positioned comfortably. Using the toilet or commode I have ensured I followed any risk plans in place. I would encourage my patients to be as independent as possible. I also reassured and guided and supported them. Over time I have become more confident as I ensure I access my patient’s capabilities before we proceed. It is important to always remember their dignity and privacy. However nervous you are they will usually feel much worse.

Julie Davis, learning disabilities nursing student

Organization has to be the key when using bedpans and assisting someone to the toilet. Never rush, as that is when accidents can happen. Make sure you know where everything is and if the patient wants to go to the toilet where they all are and how you would get the patient to the toilet in time.

Sarah Parkes, learning disability nursing student

cwOrganization and hygiene pg 564

It is important to have equipment and an assistant or possible assistant before you start, as you don’t want to leave your patient feeling undignified or cold.

Laura Grimley, adult nursing student

It is important to be organized to ensure the process is smooth and efficient. The patient’s privacy and dignity must be paramount. If we are not well prepared and have to stop to retrieve items it will prolong their discomfort and impact on their privacy. Before beginning it is important to be aware of their needs and level of independence. All toiletries, bowls, towels and clean clothing must be ready in advance and the curtains pulled around the bed.

Julie Davis, learning disabilities nursing student

Infection control is a major issue in healthcare and with patients picking up infections whilst they are in hospital that is prolonging their stay in hospital and impacting further on their health it is clearly a big concern. It is essential that you protect yourself from infection and protect those in your care from picking up any infections as well. Nurses need to use personal protective equipment and these should be prepared for in advance.

Samantha Vanes, newly qualified mental health nurse

Always make sure that before you start you have all the equipment you need. I always look at how I would like to be treated and I know I would not be happy if someone kept stopping and saying I just need to go and get this and that, knowing that the patient could be left feeling vunerable.

Sarah Parkes, learning disability nursing student

I think mindfulness is important for all nurses. Making sure you get 10 mins a day to relax and stop everything is important to prevent burn out.

Laura Grimley, adult nursing student

cwLast offices pg 579

I work in mental health and although I have not had to care for a service user that is dying I have had to work with very emotional situations. It is important for me to get clinical supervision in order to deal with situations that are emotionally draining. Often you do not realize how much a situation or a person’s care has on you until they are no longer in your care and you start to realize just how much of an effect it was having on you. Sharing such a personal journey with someone you can become emotionally attached and I feel that it is important to be able to actively discuss and reflect upon this so as nurses we can continue to provide care without burning out.

Samantha Vanes, newly qualified mental health nurse 

cwCaring for yourself and others pg 587

(I'm an RNLD) When supporting a dying patient it is important to consider their mental well being as well as their physical state. It may be a very daunting prospect for them and they may need to talk through their feelings and concerns. However, it is also very important to take care of your own emotional well being. Supporting someone through such a big issue can take its toll on you as well, and it is essential to seek clinical supervision to ensure you are handling the situation effectively. You must also seek out training on how to cope with these events and how to manage them appropriately.

Michelle Hill, newly qualified RNLD 

 

Voices from Nurses 

Clinical skills, risk assessment, managing your time – Joanna Moyle, Staff Nurse, Learning Disabilities/Abertawe Bro Morgannwgy University Health Board

I work as a Registered Learning Disability nurse within an Acute Assessment and Treatment Unit environment. I work with adults who have a learning disability. Patients are admitted due to a deterioration in their mental health or challenging behaviour, which cannot be managed in the community. The unit is a local, short-term inpatient assessment and treatment service.

I have been a nurse for four years and eight months. Beforehand, I was already working with individuals who have a learning disability as a support worker. I wanted to progress my career and become more professionally involved with people with learning disabilities.

I enjoy working hands on with patients, and developing and implementing interventions that improve their mental state or behaviour. It is rewarding to see an individual get well and how our intervention can improve their quality of life.

Being a nurse can be emotionally demanding however. You have to effectively manage your time; working hands on with patients but also ensuring documentation is completed.

An experience I remember is when I had to support a patient to attend an echocardiogram. The patient has a fear of hospitals, due to previous negative experiences. Good liaison with the cardiology department allowed the learning disability team to attend the department prior to the appointment to carry out a risk assessment. Through liaising with the department reasonable adjustments were made to arrange the appointment at a quieter time when there were less patients attending the department. We booked the larger room to allow space for learning disability staff to support the patient. A separate waiting room was also arranged. The patient was informed of the adaptations being made which reduced their anxieties. The patient was then prepared for the appointment, using pictures of what to expect. The patient successfully received an echocardiogram, which was a positive experience that is a step towards reducing their fear of hospitals.

My advice to a nursing student would be to enjoy it and use your initiative to make the most of your learning disability placements. All branches of nursing are likely to nurse people with learning disabilities at some point during their career.

Becoming a nurse, going on placement, patient journeys, suggest ideas, don’t give up – Ashley Brooks, Staff Nurse, Stroke Care, Essex

I am a staff nurse on a stroke rehabilitation ward. Within the multi-disciplinary team, we provide a service to stroke patients, which enable them to have the best quality of life post-stroke, with any assistance needed, such as equipment and carers.

When I was roughly four and a half, my little sister Sophie was 18 months old and unfortunately fell head first off the top bunk bed in our room. To this day I still remember it so well. My mum was running round frantically because she couldn’t get hold of my dad, and in those days (1997) people didn’t really commonly own mobile phones, so it was even harder to find where he was. During this time, my sister was becoming very sleepy. So I sat her on the sofa in her green knitted Teletubby jumper and put one of her favourite videos on hoping to keep her awake. Suddenly my little sister fell asleep and at the age of four and a half, instead of panicking and crying, I put my little sister into the recovery position. I had learnt two weeks prior to this how to place someone in the recovery position and why on Blue Peter on CBBC channel. When the paramedics arrived she was still unconscious but breathing and they knelt down to me and told me I had saved my little sister’s life! It hit me then, it was literally like a flash of extraordinary power had set a timeline in stone for my life and this was going to make me do everything in my will to be a nurse. So from that day in 1997 to September 2013, I followed a path and I lived my timeline and that had now led me to my dream…Staff Nurse Ashley Brooks!!!

I always thought that I wanted to be an A&E nurse, because to be quite frank, I love all the blood and gore! However after having a placement there, and witnessing the fast pace and the fact you see a patient and they’re out of your hands relatively quickly never to be seen again, really didn’t appeal to me.

My job now is what I love about nursing. Patients are with us for a minimum of six weeks for rehab. This enables you to see a stroke patient from the acute stage, right to when they go home. You see the whole patient journey, get to know the person not just as a patient or a bed number, but on a personal enough level to be able to treat them with as much individualization as possible to benefit their recovery time.

You’d think the hardest thing about nursing was seeing a patient die, but I think that is wrong. Yes, it is heart breaking to witness the sadness and emotion of someone’s passing and that first time you touch a person’s body. For me, I try to envision someone dying in my care as more of an honour. An honour by which, you could be the last voice they hear, the last person to make them smile because you are there 24/7, you are their nurse. Also, you do the last offices and make them look like themselves for their relatives – brush their hair, wash them down, maybe even apply a little bit of makeup if that was their signature look.

A specific instance of nursing care I remember was with a patient who I will call Betty. Betty was an elderly lady. The main reason she was in hospital was because her dementia had worsened and reached end stage and her physical health deteriorated as a result; she was refusing medication, food, hygiene, etc. On a daily basis, at roughly 10am, after breakfast and a read of a magazine, she would get extremely agitated and try and abscond from the ward. This was because she was adamant she needed to get the train to get her shopping. After a week of watching this and thinking what to do, I took it upon myself to physically pretend to be a train! I got the bay of four patients, including her, that she was in and walked them up and down the corridor and let Betty pick up some papers and the contents of my lunch bag, as if she had been shopping. This calmed Betty right down and encouraged her to maintain her hygiene, eat and take her medication as she wasn’t agitated at all. It was recognized as an achievement by my whole ward and university.

My advice to any student nurse would be to be innovative. Never be afraid to suggest ideas. If you think there could be something that would benefit nursing and patient care, even if it is so small, speak up. Mention it to your mentor or someone you have built a friendship with, because you never know where it could lead. I did this and now at six months post qualification, I am in the process of writing a new policy with the help of specialist nurses. Don’t hold back, be an advocate for our patients. Be an advocate for greatness!

Also, don’t give up. To be on a nursing course, you have been recognized as a special person who shows empathy and compassion for others. Not everyone gets that opportunity! Okay, it might not be the best pay for the job and sometimes, especially in your first year, you’re learning the basics and might be elbow deep in faeces! But you are there to save lives. It’s not about the money and everyone has to work their way up! Be yourself and be great!!!

 

Voices from Patients 

Extreme anxiety and depression  – Anonymous, 24 years old

I am an Administration Assistant. I enjoy socializing and crafts.

I was diagnosed with extreme anxiety and depression. I was anxious to the point that I would have an anxiety attack when leaving the house. A nurse at the local doctors’ surgery helped me. She actually listened to me and made me feel calm. I believe she actually cared for me as a person. After speaking to her I felt like a weight had been lifted off my shoulders and I wasn’t going crazy.

I had to have a blood test and my blood pressure taken to rule out other possible illnesses. As an anxious person this is a nightmare for me. The nurse explained what would happen and how I might feel afterwards. She understood that I was anxious and had so much patience with me that I actually relaxed a little. She actively tried to distract me from the needle, but in a professional way. She tried chatting to me and asked me questions so I wouldn’t focus on what she was doing.

Afterwards, I felt dizzy but the nurse reassured me that this was natural. She made me laugh which I did not expect! The whole ordeal would have been a lot worse if my nurse had not been so patient and caring.

Skin blister – Robin, 30 years old 

I spilt a cup of scalding hot tea on my foot and developed a huge blister about the size of a computer mouse across the top of my foot an ankle. I tried to treat it myself for a few days, but it didn’t seem to be getting any better. I went to the doctor’s surgery. The nurse took the time to listen to me. I was nervous my blister was getting infected and I wasn’t treating it correctly. It was so big I couldn’t wear normal shoes. It also really hurt when anything touched it, so I couldn’t really keep it covered. Before visiting the GP I looked on all the medical websites on how to treat a blister and they all had different advice. Some said to lance it. Others said not to. Some said to let it air dry, other said to keep it covered. With so much different medical information on the internet I really wasn’t sure how to treat it. I explained all this and he listened to my concerns and looked at my blister, which thankfully wasn’t infected. He also gave me good affordable advice on treating it, which I really appreciated.

The nurse was understanding and empathetic. He also didn’t act like I was stupid for dumping a cup of boiling water on my foot. He just told me to be careful next time and what to do to care for the wound. I felt like he empathized with me and didn’t think I was being silly or stupid. He joked about how confusing all the advice on the internet was and that I did the right thing by getting it checked.

I was nervous he was going to look at my foot and tell me I had gangrene or something and they were going to have to cut my foot off. I was also worried the nurse would think I was a total hypochondriac and that I was overreacting and there was nothing wrong with me. He explained the procedure to me, told me what he was looking for and why. He also didn’t hurt me when he looked at my blister and told me he understood my concerns. He told me it was always better to check things like this, particularly because of the size of the blister, than waiting till something was seriously wrong. He answered my questions about how best to treat the blister at home. He also gave me a new padded bandage to keep it protected. Afterwards, I felt relieved. No one was going to cut my foot off. A lot of my anxiety was around not knowing how to treat the wound. I felt a lot better with clear instructions on what to do to make sure it healed okay and didn’t get infected. 

Blood pressure – Amy, 28 years old

My blood pressure is regularly measured for my repeat contraceptive prescription at my GP surgery and the first reading is always high. It usually takes three or even four goes to get a reading that anyone is happy with. Most health practitioners put this down to nervousness but recently a nurse at my surgery wasn’t prepared to leave it at this. She insisted that I came back to the surgery over a period of a few weeks to monitor my blood pressure before she would change my medication. Gradually, she changed the way she went about the measurement until we found that taking it at the very end of the session means I am relaxed and the reading is normal.

Although it meant I had to make time to go to the surgery I felt really cared for. The fact she remembered me by name for my second visit and made small talk with me between measurements was really nice and made me feel more at home. I was amazed she had to the time to spend with me and really appreciated the effort she went to.

cwInjections – Joanna and Bobby, 3 years old

Bobby loves to play superheroes and trains. He really likes pink milk and riding his bike. He doesn’t like loud noises, especially hand dryers. His occupation at three years old is being a general menace!

When we went in for his last vaccinations Bobby was two and a half and was very aware of the doctors. He remembered his previous injections and was not very happy about being there. The nurse that saw him at the GP surgery was wonderful with him, making him feel very relaxed by asking him about his superheroes on his t-shirt. He was made to feel very calm and was happily distracted. When the needle went in he did cry, so he was told what a brave boy he was and was given a certificate that promptly went on the wall in his bedroom as soon as he was home. He was made to really feel like he had achieved something special and that he was the important one in the room.

The nurse made me feel much more confident about what was being done to him. It is always difficult when you know what is about to happen to your little one is going to hurt them, however, because he was relaxed, so was I. We both left very happy.

Before all of his injections I have always felt very nervous about how Bobby would react and if I was actually doing the right thing allowing him to have them in the first place. The nurse made me feel confident about the procedure by fully explaining to me what the reasoning behind immunisation was, and made me feel like I was not alone with my concerns. She supported Bobby by talking to him and making him feel part of the process, not rushing us when he fussed. We felt well looked after, making Bobby leave with positive memories – which has helped him have positive associations with trips to the doctor generally.

Nurses are so important in shaping children’s opinions of doctors and the NHS. A positive experience with a nurse can make all the difference as to whether a trip to the doctors/hospital is a positive and friendly trip or painfully difficult one. The work they do is completely invaluable to child health care and is just as important as the treatment itself, as it is their reactions that create the positive atmosphere that a poorly child needs.