A smooth pathway to surgery – supporting patients with learning disabilities
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A smooth pathway to surgery – supporting patients with learning disabilities

Elaine Cole @prideinnursing

How the can-do attitude of nursing support worker Rea Pugh-Davies ensures vulnerable surgical patients feel reassured during their hospital stay

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.

Nursing Standard. 35, 11, 28-29. doi: 10.7748/ns.35.11.28.s15

Published: 04 November 2020

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

Her 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 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.

‘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 low lighting.’

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Rea Pugh-Davies creates bespoke surgery plans based on the needs of individual patients

Picture credit: Stephen Shepherd

Planning for a stress-free stay

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

‘I use this opportunity to take measurements for hoist equipment and to find out 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 help him get used to the imminent change to his daily routine.

The admission programme Ms Pugh-Davies created for another patient created such a smooth admission and stress-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.’

The man’s care home has adopted her approach and now uses it to support residents who have appointments to see the GP and dentist.

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‘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 a service user’s hospital experience’

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

The RCNi Nurse Awards judges were impressed by the lengths Ms Pugh-Davies goes to make each admission a special 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 multidisciplinary team, which shouldn’t be underestimated or undervalued.’

An invaluable team member

The hospital’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.’

Ms Pugh-Davies says she feels ‘absolutely flabbergasted’ to have won the RCNi award. ‘I love my job and to be recognised for doing something I feel so passionate about is so rewarding,’ she says.

‘Pride in what I have achieved’

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

‘This award 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.’

Application and outcome of a desensitisation hospital action plan

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Picture credit: Stephen Shepherd

While attending a multidisciplinary team meeting about a person with complex learning disabilities, nursing support worker Rea Pugh-Davies recognised that a complete change of their routine on the day of surgery – and a general anaesthetic – was not going to be in the patient’s best interest.

Ms Pugh-Davies saw that a desensitisation plan was needed, so she identified some of the patient’s interests and incorporated them into a process that would help familiarise him with what would happen on the day of his surgery.

She formalised an admission plan with the man’s carers and enabled him to communicate through social stories, where pictures were placed on a board to show the plan of his day. Every day, his carer would put out the pictures to help prepare him.

‘Some days didn’t go to plan, but we didn’t give up’

‘The first day didn’t go as planned and we learned from this,’ 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 distractions such as loud noises or crowds of people gathering.’

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

‘He put his arm out as soon as he saw me and gave me permission to put the cuff on,’ she says.

‘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 he was 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.

The man’s carers later sent her photographs of the patient painting with friends, an activity that was only made possible because of the surgery.

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