Clinical placements

What a placement on a remote island taught me about truly person-centred care

Working in this environment means really getting to know your patients, says Elizabeth Spence

 Working on an island that’s further from the Scottish mainland than Orkney means really getting to know your patients, says Elizabeth Spence

With just 600 residents, Westray is a small community in which a few health professionals
provide a wide range of services.

My elective placement towards the end of my second year of nurse training was on a remote island off the north of Scotland.

I am the first nursing student to have a placement on Westray, one of the Orkney Islands, which has a population of just under 600. I heard about the island from, a medical colleague at the Lincolnshire-based charity LIVES, a voluntary emergency service where I am a level-three community first responder.

Jutta Meiwald works as Westray’s doctor on a rotational basis and after hearing about her work, I was keen to expand my nursing knowledge and skills, and see first hand what healthcare is like in such a remote place.

Remote access

Getting there is an experience in itself; it involves a flight, a bus journey, then catching a ferry from Orkney, which only goes twice a day in the summer months and once a day in winter.

Twelve hours after starting my journey from Manchester, I arrived on Westray on a Friday evening, ready to start work the next day.

The island’s only surgery was my main workplace throughout my 11-day placement. Healthcare is provided by a doctor and a nurse, with each role covered by two people who rotate in six-week slots. The doctors rotate on and off the island, but the two nurses live there. They are assisted by a receptionist and an ambulance driver who has basic life support training.

The ambulance, which is kept at the surgery, is mostly used for emergencies, transporting patients to the airfield if they need to be taken off the island by helicopter.

Patients have access to primary care services 24 hours a day, but an emergency surgery is held for the whole island on a Saturday morning. The patients we saw had a variety of conditions, including dementia, hypertension, back pain, cuts and bruises and mental health conditions, such as depression.

Learning opportunities

Even though there is only one doctor at the surgery, patients have their conditions diagnosed and treated quickly, as they can see a health professional when they feel unwell rather than having to wait for an appointment.

I had the opportunity to observe the doctor-patient consultations and also saw some patients on my own, taking a history before they were seen by the doctor.

The surgery also holds a phlebotomy clinic twice a week and clinics for long-term conditions, such as diabetes, asthma and cardiovascular disease. These were a great learning opportunity; under supervision from the nurse I was able to carry out assessments, such as foot reviews for patients with diabetes.

Patients needing emergency care may be airlifted to the mainland by helicopter.

On the Saturday, I was returning to the surgery with the doctor after seeing a patient in the community when the pager went off, meaning there was an emergency; a patient we had seen in the surgery that morning had become very unwell and needed to be transported to the mainland by air ambulance.

Before that morning’s surgery, I had helped the doctor and nurse check the equipment they carry in their cars for emergencies. Essentially a makeshift emergency department, this equipment includes observation and cannulation equipment, fluids, chest drains, emergency tracheostomy equipment, dressings, nebulisers, oxygen, emergency drugs and a defibrillator.

‘Bad weather has been known to delay the helicopter significantly, leaving patients in the care of the health professionals on the island until they can be airlifted to hospital’

The closest hospital is Kirkwall, on Orkney's largest island, known as Mainland yet still 10 miles from the Scottish mainland. So this equipment is vital for the nurse and doctor to be able treat the patient as quickly and effectively as possible.

Fortunately the weather was on our side and the helicopter was with us in just under two hours – bad weather has been known to delay the helicopter significantly, leaving patients in the care of the health professionals on the island until they can be airlifted to hospital.

Beyond the usual nursing role

During my time on Westray, I also joined the nurse on her community visits and soon learned that this work extends beyond the usual nursing role.

The nurse also acts as a physiotherapist, occupational therapist and social worker, as these services do not exist on the island. A midwife visits the island once a week if required, but this is not always possible in bad weather.

Working on Westray was an amazing experience that I will never forget; challenging at times but hugely rewarding. I learned so much about the value of teamwork and effective communication, and what it is like to have a nursing role with a great deal of autonomy.

‘I learned how to work effectively in a small team and, most importantly, I really got to know my patients’

Nursing in this environment was unlike anything I have experienced. As well as increasing my clinical knowledge and skills, particularly in history-taking, I learned how to work effectively in a small team and, most importantly, I really got to know my patients.

This gave me a better understanding of their symptoms, allowing for quicker diagnosis and treatment, and also improved my communication skills.

Nurses in today’s NHS are hugely overstretched, and spending quality time with patients can be difficult. But one of the most important lessons I learned on Westray is that to deliver truly person-centred care, we have to get to know our patients.

As a result, I will take every opportunity to build up therapeutic relationships with my patients throughout my training and once I qualify.


Elizabeth Spence is a third-year nursing student at the University of Lincoln



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