Creative Care Planning

This Blog by Geraldine Rodgers tells the story of how creating person centred care plans can make a big difference in terms of healthcare and quality of life.

Mabel, was approaching her 100th birthday and each day leading up to this milestone she experienced chest pains, which resulted in an ambulance being called and an admission to hospital. On assessment there was no cause identified for her symptoms.The result was not cardiac related and anxiety was thought to be the main cause. One day Mabel rang the ambulance nine times, which greatly concerned everyone involved, and I knew that in my role as advanced nurse practitioner I had to put my thinking hat on to create a plan to ease her anxiety.
Let me tell you a little bit about her. Mabel had 11 children, was widowed at the age of 55 and now lived quite independently in special sheltered accommodation. She had lived there was some time, and being the oldest lady on the block gave her great pride. She had 11 children and for her upcoming party there were now 100 descendants scheduled to attend. This multi-generational living family tree gave her much joy and each Christmas she would knit them a scarf or a blanket. On each of my visits she would relate their success stories, pending marriages, births etc. and to her family was everything. Her young outlook on life was inspirational.
Given the nature of my work I like to look at the TV soaps occasionally to know the recent story line and also check the football scores as both can be very helpful in checking short term memory. I had recently watched Emmerdale for inspiration and noted the amazing colourful blankets on the back of the Dingle’s sofa; I thought of a plan!
Sitting now with Mabel and her daughter we worked on creating a more personal care plan to relieve her anxiety. I thought if I could incorporate the things she liked to do we could prevent her anxiety related pain. I knew she loved to knit and crochet and she loved watching Emmerdale, and asked whether I should write to ITV and enquire whether she could kit blankets for the set of Emmerdale. On suggesting this Mabel was so excited and immediately starting thinking of colours and designs, and Mabel’s daughter thought it was a great idea. After my visit, holding my breath and keeping my fingers crossed, I e-mailed ITV stating I knew a lady approaching her 100th birthday and it would make her day if she could have her blankets on the Dingle’s sofa (I did not mention the chest pain or care plan). Three hours later a return e-mail came stating they would be delighted to accept the blankets. I really could not believe it, and Mabel and her daughter were equally excited.
Over the following weeks I got regular updates about the blanket design, colours etc.; Mabel was keen to have an impressive blanket for TV. However, the best news was that her chest pain stopped as she was so focused on the task and telling all her family and friends about her potential new found fame. A week before 100th birthday the blankets were wrapped and sent to the Emmerdale!
Mabel attended her 100th party with all her family and friends and on the morning of her birthday a beautiful telegraph came from the Queen, together with another envelope containing a thank you letter from Emmerdale and a newsletter from the fan club; Mabel was so pleased.
Each night Mabel watched the show looking out for her blankets, and the joy she experienced on seeing them made us all proud of what we achieved.
This story highlights that knowing your patient and personalizing a care plan can achieve some amazing results.
An example where little things can make such a big difference!
Written by Geraldine Rodgers, Nurse Consultant for Frailty & Long Term Conditions


‘Off my feet’: experiences of a health professional turned patient – Part 2

Part 2: Small acts of kindness that really do matter

Frustration with the system…
The clinical care I received was excellent– however the organisation around it was not. The onus is always on the patient– even when letters were incorrect they all included the threatening ‘if you don’t turn up you will be removed from the system’ so I would have to call to clarify; this usually involved automated options, time on hold, and eventually being told that the person I needed was unavailable and could I call back tomorrow? AARRGGHH!!! I understand the ‘system’ having worked in the NHS for 20 years and I can be assertive, and yet I struggled… This made me wonder how ‘average’ patients manage to navigate the system? It also highlighted to me how much extra work (and grumpy patients) the system creates for itself– eg online appointment booking would enable the patient to do much of the work and arrange times that suit them!

On the day of my surgery I had to wait 11 hours, yes 11 hours, on an uncomfortable waiting room chair and of course, not allowed to eat or drink. One nurse had been particularly kind but even she could no longer look me in the eye after about 6 hours. I watched as staff members left their shifts without any acknowledgement that I was still waiting. Although it was not my fault that I was still in the waiting room at ‘closing-time’ I somehow felt that I was a nuisance. Did I get stroppy and upset – of course I did, wouldn’t you?! We need to see things from the patient’s perspective- patients are less likely to become ‘difficult’ if they are informed of what is happening and if they feel that staff have some empathy for their situation.

But there were also moments of kindness. The morning after surgery was my birthday and every member of staff who came to see me wished me happy birthday– it meant a lot to know that someone had taken the time at handover to mention this and that I was more than just the ‘patient in bed 5’. The nurses brought me a birthday cake– a small gesture but something which really cheered me up as well as giving the other patients and staff a treat with morning coffee!

Am I invisible?
After the first few weeks I began to start to venture out and about. Initially to the corner shop, gradually building up to get a bus to the high street for a coffee and then into work a couple of times a week. Navigating public transport with a disability does give you a real insight into human behaviour! There seemed to be four types of people:
1) Those who appeared not to see me- it is amazing how people apparently do not notice someone struggling to balance on half-boots with crutches, particularly when sitting on the priority seats!! I would often have to swallow my pride and ask (even beg!) for a seat.
2) Those who viewed me with contempt– rushing past or tutting because I was taking slightly longer at the till (having to have both hands free for my crutches meant that I had to put my purse in my bag before walking away). Sometimes I would catch a small disparaging look; sometimes with Mark I could see people giving a glance as if to say ‘poor guy, he’s with a disabled girl’.
3) Those who gave misinformed help- speaking down to me as if I suddenly was not capable of anything. For example, the well-meaning shop assistant who tries to help me count my change– my brain was still working even though my feet aren’t!
4) But finally there were those who are kind- and this is where the little things really did matter. An offer of an arm going down some steps, holding a door open, a car stopping to let me cross the road- the offer of a seat without having to ask.

The Little Things…
I am lucky– my disability was temporary. This is not the case for everyone.
So the next time you are out think about the little things you do. Just because someone is not old does not mean that they are not in need of some help or some kindness.
The little things that people have done, or not done, really have mattered to me. Sometimes it is a gesture, sometimes just a small look– but it has often been what has made it a good or bad day for me.
Be that person who does a little thing to make someone feel that they have had a good day.

‘Off my feet’: experiences of a health professional turned patient – Part 1

Part 1: Independence – The Little Things we take for granted

I am an occupational therapist and would like to think of myself as an empathetic practitioner. However, I have also recently been a patient and it has surprised me how many new insights this has given me into how difficult it is to cope with disability.
I had surgery on both my feet recently. As a result I had to use surgical boots and two crutches to walk for almost seven weeks and a crutch or stick for a further three weeks. It has been fascinating to be ‘on the other side’ and really see the world from a patient’s perspective.
I do not intend this blog to be a moaning session – but hope that it makes you reflect on some of the little things. The first part of my blog will describe how I felt as a patient and how not being able to do some of the little things have really mattered. Part 2 will he second part will talk about the actions of others and the impact of some of the little things that people did, or didn’t do, which made such a huge difference.

Nothing prepared me for the feeling of vulnerability I experienced. The little things we all do every day without thinking about it suddenly became big things for me. For example, I now had to plan ahead knowing that it would take me a long time to go upstairs to the toilet, I had lost the freedom to shower when I wanted to and not when my fiancé Mark was able to help me, I was unable to go to the shops to buy something for tea when I didn’t fancy what was in the fridge or to buy milk when I was desperate for a cup of tea and we had run out….
I also felt a real loss of dignity. For the first few weeks I had to use a bath-board to shower. I have given out dozens of bath-boards as an occupational therapist but to actually have to use one…to have to sit naked on a bit of plastic balanced over the bath was embarrassing enough when it was someone I know and love who was helping me. How must it feel to have to be helped by a stranger?
Venturing out and about was a whole other issue – more about that in part 2!

My life is usually too busy! With a busy work and social schedule, I am constantly rushing and thought that having a few weeks of working from home would be blissful! Admittedly not having to tackle the morning commute and being able to work in my pyjamas is lovely …but I quickly learnt that I missed the pressure and social contact of my normal work! Despite friends kindly visiting me and my fiancé rushing home from work in the evenings, for much of the working week I was essentially on my own and after a couple of weeks began to crave company and stimulation.
Time at home and by yourself is not so nice when it is imposed and not through choice. Let’s remember those who are truly lonely; Age UK estimate that a million older people in the UK have not spoken to anyone for a month.


Written by Laura Stuart, @laurajstuart

Why we set up LittleThingsTLC

Why we set up LittleThingsTLC

Geraldine and Laura had both been discussing for some time the willingness of healthcare staff to go that ‘extra mile’ in the delivery of care, and who encapsulate the ‘P’ in personalised care. Admiring those who are creative when preparing care plans, and who make the little things matter; fully reflecting the 6Cs. Individuals who show care and compassion in how they look after patients, and find the courage to expand the boundaries of their role description.

Whilst discussing examples that reflected our vision of such care we were drawn to a storyline from the Royal Albert Edward Infirmary in Wigan, where a dying patient’s wish to see and bid farewell to her beloved horse, Bronwen, who she had looked after from a foal. The amazing picture of this touching moment was tweeted by the Trust’s chief executive and struck a chord with a huge audience. The story has reached more than 46 million people on Facebook and was to be seen on national television, radio and newspapers globally.

The sadness of that picture showing this final goodbye and the highlighting of personalised care ensured positive press for the healthcare sector, and we were keen to explore the journey that had led to this moment by speaking with the Wigan team who had made it a reality. We had the privilege of meeting the Wigan deputy director of nursing, Pauline Law, and the bereavement nurse, Gail Taylor who worked with the staff on the surgical ward to make the patients wish a reality. They recounted how initial thoughts to enact the plan had been married to an apprehension driven by the rhetorical question ‘we can’t do this, can we?’ This opened a window to a new world of enquiry and decision which we believe showed both courage and compassion rolled up to become an unstoppable force.

Gail had initially discussed options and started to examine the practicalities, sharing these thoughts with Pauline who stated she would take responsibility. This was an amazing response, and Pauline readily admitted that as events unfolded and the meeting because a reality she was both entranced by the moment but also nervous as she considered what could go wrong!

As the scene unfolded no one could have envisaged the emotional response from the horse to his human adopted mother and friend. This was further enhanced by the forward thinking of the patient’s daughter who brought a second horse to help put Bronwen at ease and create an atmosphere of calm. The horse approached the patient, kissed her gently, eyes transfixed on his long-time companion. Staff reported that a smile crossed the face of the patient and that she emanated an air of contentment. Everyone was drawn to tears as they watched this bond of love and the sharing of a final goodbye. The bereavement nurse who led this journey captured the moment for the patient’s daughter as these amazing memories were created.

With the continued care and compassion of the ward staff, and her daughter at her side, the patient passed away peacefully only a few hours later.

Whilst the personalised care and compassion of this story has captured the attention of the general public in an unprecedented way we are aware that this is not an isolated instance. Stories with a similar ethos to this occur every day across the healthcare sector but often go unnoticed.

It was this in mind that we wanted to design a platform to share these beacons of good practice and create a mosaic of individual moments of personalised care that will highlight that, despite the many pressures thrown at us, our health and social care professionals remain truly caring with the patient at the heart of all we do.