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How a nursing support worker is making surgery a positive experience for patients

People with learning disabilities can expect a calmer and safer experience of surgery due to the efforts of nursing support worker Rea Pugh-Davies

People with learning disabilities can expect a calmer and safer experience of surgery due to the efforts of nursing support worker Rea Pugh-Davies

  • Rea Pugh-Davies bespoke planning makes complex hospital admissions a positive experience for people with learning disabilities
  • Her tailored admission and creative desensitisation plans for surgery have been lauded by colleagues
  • Her efforts have been rewarded by winning the Nursing Support Worker category of the 2020 RCNi Nurse Awards
Award-winning nursing support worker Rea Pugh-Davies in one of the theatres with coloured lighting

A nursing support worker is proving that creative planning can make even the most complex hospital admissions a positive experience as she supports people with learning disabilities to have the surgery they need.

People with learning disabilities can expect a calmer and safer experience of surgery due to the efforts of nursing support worker Rea Pugh-Davies

  • Rea Pugh-Davies’ bespoke planning makes complex hospital admissions a positive experience for people with learning disabilities
  • Her tailored admission and creative desensitisation plans for surgery have been lauded by colleagues
  • Her efforts have been rewarded by winning the Nursing Support Worker category of the 2020 RCNi Nurse Awards
Award-winning nursing support worker Rea Pugh-Davies in one of the theatres with coloured lighting

A nursing support worker is proving that creative planning can make even the most complex hospital admissions a positive experience as she supports people with learning disabilities to have the surgery they need.

Rea Pugh-Davies has supported the setting up of a learning disability service at Neath Port Talbot Hospital in south Wales, part of Swansea Bay University Health Board.

Nursing colleagues laud tailored hospital admissions for people with learning disabilities

RCNi Nurse Awards logoHer tailored admission and creative desensitisation plans have been lauded by colleagues and now she has won the RCN-sponsored Nursing Support Worker category of the 2020 RCNi Nurse Awards.

Ms Pugh-Davies attends multidisciplinary team (MDT) meetings for people with a learning disability who are scheduled for surgery before developing bespoke plans to ensure they are able to come to theatre.

‘If possible, I contact the patient to find out as much information about them as I can – or for patients with more complex needs I liaise with parents, carers, social workers or consultants to ensure their theatre journey runs smoothly,’ she says.

Responding to service users’ anxieties, stresses or pain pre- and post-op

‘This could include their likes, dislikes, changes in behaviour, how they respond to stress or pain, triggers for anxiety, special diets for post op and anything that would comfort them during their visit, such as using quiet rooms or low lighting.’

She then creates a plan including social stories and fact sheets, and highlighting items to be brought in, such as posters, playlists and picture books.

How one desensitisation hospital action plan went in practice

Rea Pugh-Davies sets up the hoist used to move patients in the theatre after their anaesthetic. Picture: Stephen Shepherd

At a multidisciplinary team meeting about a person with complex learning disabilities, nursing support worker Rea Pugh-Davies recognised that a complete change of daily routine on the day of surgery under a general anaesthetic was not in the patient’s best interest.

Ms Pugh-Davies saw a desensitisation plan was needed by focusing on the following protocols:

  • She identified that the patient liked stationery so arranged that he would deliver a letter to her at the hospital, followed by breakfast at a café (being nil by mouth was essential for the surgery)
  • She formalised an admission plan with his carers
  • The patient communicated through social stories where five pictures were placed on a board to show the plan of his day
  • Every day his carer would put out the pictures of him delivering the letter to Ms Pugh-Davies, then him eating breakfast at the café to ready him for the day of surgery

‘Some days went better than others, but we didn’t give up’

‘The first day didn’t go as planned – the patient left the letter with the first person he saw,’ says Ms Pugh-Davies.

‘We learned from this and cleared the route to theatre,’ says Ms Pugh-Davies. ‘Some days went better than others, but we didn’t give up.

‘I made posters of his favourite TV programmes and positioned them at eye level for him to follow to the reception area and we minimised any distractions such as loud noises or crowds of people gathering.’

The blood pressure cuff being placed on his arm was then introduced to his social story.

When he went to the anaesthetic room, Ms Pugh-Davies ensured his favourite film or music was playing.

‘Theatre staff were out of sight to avoid distractions and we had sensory lights, no theatre noises or lighting. It was a calming environment’

‘He put his arm out as soon as he saw me and gave me permission to put the cuff on before quickly reminding me he was going for breakfast,’ she says.

As well as giving him a social story booklet illustrating the day of surgery, Ms Pugh-Davies decorated the path to theatre with posters of his favourite television shows.

‘Precision planning ensured a safe and positive experience’

‘We used the theatre with the safest access and set up the big screen TV to show his favourite programme.

‘Theatre staff were out of sight to avoid distractions and we had sensory lights, no theatre noises or lighting. It was a calming environment.’

The procedure took 20 minutes and afterwards the patient’s comfort blanket was placed over him and his special shoes put on while asleep – when he woke up, he looked around and saw Ms Pugh-Davies, checked his feet and went back to sleep.

An hour later, he didn’t want to leave.

‘Precision planning ensured a safe and positive experience,’ says Ms Pugh-Davies.

His carers later sent her photos of him painting with friends, which was only made possible because of the surgery.

The plan also addresses logistics – how, when and where the admission should take place – to suit the person’s needs.

‘Reasonable adjustments and tailored care is essential,’ she says. ‘It ensures dignified patient-centred care that doesn't frighten people for future hospital admissions.’

Friendly face for hospitalised patients with learning disabilities to remember

‘I want to be the friendly face they remember.

‘I use this opportunity to take measurements for hoisting equipment and whether any extra equipment will be needed.

For one patient with extremely complex needs, admission planning took 12 weeks with daily visits to the department to change his daily routine.

Rea Pugh-Davies (right) at a ‘best Interest meeting’ discussion with colleague Catherine Thomas
Picture: Stephen Shepherd

The admission programme Ms Pugh-Davies created for another patient created such a smooth admission and pain-free theatre journey that he did not want to leave and asked to return the next day to say thank you.

‘It brought tears to the team’s eyes,’ says Ms Pugh-Davies. ‘This procedure has made a huge difference to his quality of life.’

His care home has adopted her approach and uses it for GP and dentists’ visits.

Judges impressed by unique person-centred care and support to alleviate patient anxiety

The RCNi Nurse Awards judges were impressed by the lengths Ms Pugh-Davies goes to make each admission a special and unique experience and alleviate patients’ anxiety.

RCN nursing support worker committee chair Lindsay Cardwell says: ‘Rea’s enthusiasm and passion for her role and her patients stood out.

‘Her commitment to support individuals was exceptional, highlighting that person-centred care is vital and the rewards are second to none.

‘She’s an excellent example of the unmistakable value nursing support workers bring to the MDT, which shouldn’t be underestimated or undervalued.’

Rea Pugh-Davies puts up some of the posters and images used to help put patients at their ease in the theatre. Picture: Stephen Shepherd

Above and beyond ‘can-do’ attitude with individualised care plans, manual handling and hoist training

The organisation’s specialty manager for anaesthetic and recovery Joanne Phillips nominated Ms Pugh-Davies for the award.

Ms Phillips says: ‘Rea’s ‘‘can-do” attitude creates individualised plans of care with innovative and inspiring ideas.

‘She has undertaken manual handling and hoist training above and beyond her role to be able to accommodate the needs of these patients.’

‘Winning this award shows that anyone from any grade can display and be recognised for excellence… No matter what your role is, even the smallest changes can make a huge difference to service-users’ hospital experience’

Rea Pugh-Davies, winner of the Nursing Support Worker category of the 2020 RCNi Nurse awards

Ms Pugh-Davies feels ‘absolutely flabbergasted’ to win.

‘I love my job and to be recognised for doing something I feel so passionate about is so rewarding.

‘It can be extremely challenging, but I am proud of what I have achieved over the past four years.

Any nursing grade can be recognised for excellence

‘This will give me the confidence to adapt to the ever-changing needs of patients with a learning disability requiring procedures and surgery.

‘And it shows that anyone from any grade can display and be recognised for excellence.

‘I hope that winning this award inspires others to become learning disability champions and highlights how, no matter what your role is, even the smallest changes can make a huge difference to a person with learning disabilities’ hospital experience.’

Royal College of Nursing logoThe Nursing Support Worker category of the 2020 RCNi Nurse awards is sponsored by the Royal College of Nursing

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