Clinical placements

What to do when words fail

Communication problems are not uncommon when people with complex needs are admitted to hospital, and one nursing student is creating a toolkit that will include tips from specialists and signposting to additional support

Communication problems are not uncommon when people with complex needs are admitted to hospital, and one nursing student is creating a toolkit that will include tips from specialists and signposting to additional support


Picture: Alamy

In my third year of training I was on clinical placement on a children’s ward where I helped to care for a 12-year-old boy with autism, who I will call James.

James had been admitted following a prolonged period of distress and self-harming, and was due to be discharged that day. He had been calm for most of the shift, but the moment he was told he could leave the ward he started kicking and screaming, lashing out at his mum. Nothing the nurses, play specialists or his sister said could calm him down.

Before starting my nurse training, I worked as a team leader in a care home for adults with severe learning disabilities and behavioural problems, where I learned some strategies that I thought might help James.

‘I got down to his level’

With the permission of the nurses and his mother, I approached James carefully and introduced myself. Keeping some distance between us so as not to frighten him further, I got down to his level and talked to him softly, refocusing his energy towards me and our immediate surroundings.

By finding ways to communicate with James – including looking him in the eye and asking his mum for advice about his preferred method of communication – I was able to calm him down. This improved his hospital experience and the experience for everyone involved, including his family, the nurses and other healthcare professionals.

Communication problems are not uncommon when people with complex needs are admitted to hospital. While I was working in the care home, one resident had to go to the emergency department (ED) for stitches after a fall resulted in a laceration to his head.

Ways to improve the hospital experience

But the ED staff said they didn’t know how to communicate with him and wouldn’t be able to cope with his needs. This was a difficult experience for everyone involved, particularly the resident, and I started thinking about ways to improve the hospital experience for this patient group, and the staff caring for them.

My experiences prior to and during my nurse training prompted me to develop a communication toolkit which could be used by all staff caring for patients with complex communication needs, both adults and children.

Although there are tools to help staff exchange vital information, such as hospital passports, they are not always used in practice. I wanted to create a toolkit with easy-to-follow guidelines and tips for nurses and other healthcare professionals, such as always asking parents or carers for the patient’s preferred communication method and always talking to the patient, not over them. Difficulties with communication should not stop patients from being involved in conversations about their care.

Library of best practice

Hospital wards could help by providing communication aids, such as letter boards or PECS (picture exchange communication system) books with pictographs, which can support staff who don’t often come into contact with patients who have complex communication needs.

The toolkit is still at an early stage, but the plan is to create a booklet that staff can download. It would contain tips from specialists that can be easily implemented in a ward environment and signposting to additional support and online resources, such as easyhealth.org.uk, which provides accessible information on a variety of healthcare topics.

In October 2016 the RCN launched Celebrating Nursing Practice as part of its centenary celebrations. Funded by the RCN Foundation, this will produce a library of innovative best practice from a variety of settings across the UK, with some of the ideas receiving investment to develop them further.

Sharing and learning

I have put my communication toolkit forward for this, and hope to get funding to complete the project. I am also creating an educational framework which will build on the ideas behind it, including one-day training sessions looking at communicating with patients with complex communications needs, with the possibility of implementing a train-the-trainer scheme.

The goal is for healthcare staff to become ‘communication champions’, creating a network of staff from different areas of care who are interested in sharing their experiences and learning from one another.

Caring for patients with complex communication needs can be difficult. Providing healthcare staff with the tools they need to help them will increase their confidence and knowledge base and reduce anxiety for both staff and patients, improving the hospital experience for everyone.


Ewout van Sabben is a third-year children’s nursing student at the University of West London and an RCN student information officer for the London region. He is also an ambassador for The Student Nurse Project @StNurseProject

@Ewout1985

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