Clinical placements

Identifying a common interest allowed me to engage with a young service user

Our shared love of gaming gave me an opportunity to offer person-centred care

Our shared love of gaming gave me an opportunity to offer person-centred care


Picture: Alamy

During the first year of my degree in learning disability nursing, I had a six-week placement in a step-down facility. The residents had come from more secure hospital settings and were supported by staff at the unit to develop the skills they needed to live more independently in the community.

One of the residents I worked with was a young man in his twenties who had a moderate learning disability and autistic spectrum disorder. The resident, who I will call Ben, had had a difficult childhood and had spent time in a mental health secure hospital before coming to the unit. He had displayed episodes of violent and challenging behaviour in the past.

Learning disability linked to obesity risk

Ben’s annual health check identified he was morbidly obese, with a body mass index (BMI) of 45. Research has shown that people with a learning disability are at greater risk of being overweight or obese than the general population, largely due to poor diet, low levels of physical activity and medication regimes.

People with learning disabilities also have significantly higher rates of conditions associated with being overweight, such as diabetes, heart failure and strokes, and are known to more commonly experience mental ill health, bullying and abuse.

‘Identifying common interests can be an effective way of engaging people’

A dietician had created a healthy eating plan for Ben and he was advised to do more exercise, starting with regular walks. But he wasn't keen on sticking to the plan. Ben enjoyed spending most of his time alone in his room playing computer games and watching cartoons, and routine was very important to him.

I wanted to support Ben with his healthy eating plan 

I decided to find a way to help Ben become more engaged with his healthy eating and exercise plan. Adopting a person-centred approach was crucial to this, so I focused on his interests. I soon discovered that Ben was a huge fan of the Uncharted series of computer games, which was something we had in common.

Identifying common interests can be an effective way of engaging people. Sharing my love of computer games with Ben enabled us to have conversations about something we both understood, putting Ben more at ease. He recognised my enthusiasm for and knowledge of the games, and I was able to answer any questions with confidence.

Presenting information in a pictorial format

Ben found it much easier to understand information in picture format, so I used an image of Nathan Drake, the main character from the Uncharted games series, to create a monthly chart to help Ben achieve his weight loss goals.

PlayStation games use a series of trophies to record players’ achievements. Adopting this approach, I offered Ben a trophy at the end of each week, starting with a bronze trophy for week one.


The weight loss chart devised around the Nathan Drake character

 

Use of the gaming chart resulted in healthy weight loss

Ben would earn the trophy if he had chosen healthy food to eat and taken exercise. The trophies could be recorded so he could accumulate an ongoing total, in line with the other games he played.

‘I learned first-hand how innovations in nursing practice can really help improve patient care’

Ben engaged with the chart and had a healthy weight loss of 8lb over the four-week period. As my placement only lasted six weeks, it was important to create a weight loss programme that was sustainable and could be used by other staff members caring for Ben. Before leaving the unit, I made sure other staff knew how to use the programme so they could continue to support Ben.

A therapeutic relationship based on common interests

One of the most important things I learned through this experience is not to pre-judge people. Ben was a large man with a history of violent outbursts that could make him difficult to work with, but I was able to build up a good therapeutic relationship with him based on common interests.

This ensured he was listened to and treated with dignity and respect, and adopting a patient-centred approach to weight loss that Ben could take ownership of empowered him to make important changes to his lifestyle.  

Working with Ben also taught me to have confidence in my ideas – I learned first-hand how innovations in nursing practice can really help improve patient care, a valuable lesson which I will take forward in my nursing practice.


Daniel Branch is a second-year learning disability nursing student at the University of Chester and a finalist in the Andrew Parker Student Nurse Award category at the 2019 RCNi Awards

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