Ensuring everyone has a voice: a communication tool for non-verbal patients

RCNi Nurse Awards student winners spread the word about their Makaton language resource

RCNi Nurse Awards student winners spread the word about their Makaton language resource

Alice Waddington, Eve Hesketh and Emily Kavanagh with the Makaton healthcare cards
they designed and created as nursing students.

‘My daughter Alice has Down’s syndrome,’ Amanda Glennon told learning disability nursing students at the Positive Choices conference in 2017. ‘She is 11 years old and despite hundreds of hospital and GP appointments she has never had a healthcare professional communicate with her in her own language, Makaton.’

This statement so shocked Edge Hill University students Emily Kavanagh, Eve Hesketh and Alice Waddington that they resolved to do something about it.

We created hundreds of sets

‘We decided to create a communication aid for nursing students to use in practice with a person who used Makaton, and/or postoperative patients or people who are non-verbal,’ explains Ms Hesketh. ‘This was a set of cards designed with the symbol of the word on one side and how to do the Makaton sign on the other for the person using the communication aids reference.’

The students printed, cut out, laminated and cut out again 300 sets of signs and symbols to provide to the new cohort of students about to start at Edge Hill, in Lancashire. They then threaded each set onto a metal ring that can be attached to a healthcare professional’s lanyard.

‘It took us around four weeks, coming into university, sitting at a desk 9am to 5pm and sometimes as late as 8pm to get them ready in time,’ says Ms Kavanagh. ‘This was all while we were writing assignments, attending lectures and out on placement. It was a struggle, but Alice’s story kept us going.’

Ms Hesketh adds: ‘We then went into new cohorts to hand out the communication aids and asked them to use the signs and symbols in practice when their patient needed help communicating their needs – and explained why this was so important.’

‘We would like it if every healthcare professional had a set of cards to support themselves and service users’

Eve Hesketh, joint winner of the 2019 RCNi Andrew Parker Student Nurse Award

Since creating the cards, the team has visited four more cohorts to share the story and explain where to find the tools to print off and how they can aid communication with non-verbal patients.

The Makaton Charity was so impressed with the communication tool and the feedback the students were gathering from their peers on placement that it made them available as a free resource on its website. The cards have been downloaded more than 7,500 times to date.

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The charity’s chief executive Stephen Hall says the cards are a ‘vital aid’. ‘We are thrilled with the work Eve, Alice and Emily have done to develop and promote the Makaton healthcare cards to support those with communication difficulties,’ he says.

‘Makaton transforms the lives of those with communication difficulties by giving them a way to express themselves independently, which is proven to overcome frustration and promote inclusion.’

The creators explained to students
how the resources can aid their patients.

What it took to turn an idea into a useful tool

Alice Waddington, joint winner of the 2019 RCNi Andrew Parker Student Nurse Award, writes:

‘As we were full-time students also working part-time, we found it quite challenging fitting in all the work for our projects while fully committing to our studies.

‘Working closely together and having a great support system through our university helped. By working in a team we were able to share tasks between ourselves and work to our strengths.

‘Our good working relationships with our university lecturers meant they supported us to go into cohorts of student nurses to raise awareness around communication, promote the use of the Makaton healthcare cards and recruit learning disability student champions.

Real-life examples had an impact

‘Another challenge we faced was making students understand why the cards are an important and useful tool. We found that using real-life examples from other students of how they have helped improve care for patients was an effective way of highlighting this. 

‘More than 100 people have now become learning disability student champions. Recruiting them and finding a suitable date for the training event was not always straightforward, as we had to factor in that students were not able to miss lectures, did not want to come when on annual leave, and although they could use this training towards their placement hours, they needed the support from their mentors to attend.

‘Our advice to anyone wanting to change something in practice is to go for it and #BeTheChange. With the support from your peers, university and placement you can make a change, which can make difference. Together we are better.’


Sharing the cards with a wider group

All three students have recently qualified. Ms Hesketh and Ms Kavanagh have roles at Manchester Children’s Hospital and Alder Hey in Liverpool respectively. Ms Waddington has a role in a community learning disability team.

‘This is giving us more opportunities to share our cards with nurses, physiotherapists, speech and language therapists and more,’ says Ms Hesketh. ‘We are covering a large area, giving us a chance to spread the word about our cards even further.

‘We would like it if every healthcare professional had a set to support themselves and patient/service users that need additional support with communication.’

‘The simply designed tool can be used by anyone and the work of the team across social media, university groups and clinical settings demonstrated their desire to enhance the lives of clients and families’

Kath McCourt, 2019 RCNi Nurse Awards judge

Lynda Carey, senior lecturer in strategic and operational leadership at the university’s faculty of health and social care, says the students’ drive and ambition to make a difference is inspiring.

‘They have worked tirelessly, embracing innovative and creative use of social media to spread their work and engage with a wide and diverse population. Furthermore, thanks to their support and promotion of the #Hellomynameis Makaton campaign, this has become embedded in practice in all nursing programmes, with all lecturers and students now proficient and ambassadors of change.

‘By developing the learning disability champions, they have supported adult, child and mental health students to develop their knowledge, challenge their beliefs and develop an inclusive approach to their practice.’ 

Inclusive communication

The 2019 RCNi Nurse Awards judges agreed and this month named the team winners of the Andrew Parker Student Nurse category.

Judge Kath McCourt CBE FRCN says: ‘The team’s use of Makaton throughout the presentation to the judges showed their intense desire to ensure that inclusive communication can be established.

One of the Makaton healthcare cards.

‘The simply designed tool can be used by anyone and the work of the team across social media, university groups and clinical settings demonstrated its desire to enhance the lives of clients and families.’

The team is delighted to have won. ‘The awards have been a fantastic opportunity to spread our message of inclusive communication for all across the NHS,’ says Ms Kavanagh. ‘We are really proud that our role to improve patient care has been recognised by such a prestigious organisation.

A platform for helping more patients

‘It’s a phenomenal achievement to win. We will use this platform to shout loud and proud for patients who use alternative communication systems such as Makaton. Communication counts and everyone deserves a voice. The more people we tell where the resource pack can be found, the more people it could help.’

Healthcare professionals can wear the
cards on a lanyard as a reference tool.

They are justly proud of the difference their project is making for people with learning disabilities. 

Ms Kavanagh says: ‘We have had lots of positive feedback from nursing students, patients, carers and qualified professionals.

‘One student used the signs and symbols in practice on his children’s ward. In one case, ward staff found a child was unhappy when observations were undertaken but when the student used the signs and symbols, the child immediately smiled and from then on would only allow the nursing student to carry out any observations.’

All the winners from the RCNi Nurse Awards 2019

Easy reference tool

Alice’s mum agrees the cards have made a real difference. ‘I was thrilled when I next met Emily, Alice and Eve and saw the cards they had produced.

‘I liked that the cards could be attached on healthcare professional’s lanyards so if they could not remember how to sign the cards were there for reference.

‘I am so grateful to these nurses for supporting and helping Alice and hundreds of children and adults like her who really have to find their voice’

Amanda Glennon, whose child Alice inspired the students to create the Makaton tool

‘It is such a fantastic idea and I was so pleased to hear they had spent weeks making so many sets to share with their peers.

‘I am so grateful to these nurses for supporting and helping Alice, and hundreds and hundreds of children and adults like her who really have to find their voice.

‘I recently went to an appointment with my daughter and Alice handed the cards to her paediatrician, who then added to the notes that they would learn the signs by our next appointment. Alice, finally, will have an appointment with a healthcare professional who can use her language.’

‘And that,’ says Ms Kavanagh, ‘is our absolute highlight.’

Elaine Cole is RCNi special projects editor

Find out more

The Makaton healthcare cards (download for free at The Makaton Charity)

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