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From the outset Mavis has been very much alone. They should have let her friend travel to the hospital with her as she is clearly very confused and a familiar face would have eased some of the anxiety about everything that is going on around her.

There is no priority given to getting Mavis' husband to the hospital and as she is alone and not unconscious/ there should be no reason why this is not a priority.

It is clear that she is confused, so staff should be communicating with Mavis to find out more about her and level of confusion.

Staff should not be speaking over Mavis or discussing her as if she isn't there.

Nothing is being explained to Mavis i.e. everytime they move her to different departments, or explain what they are going to do e.g. x rays and what that means for her.

She appears to be in a lot of pain yet no mention of pain relief.

There are some elements that are reassuring e.g. a couple of member of staff whom appear more caring and warm towards Mavis. Mavis seems to be very receptive to these individuals. It would have been better to have one of these people speaking to Mavis from the outset and gathering as much information as possible.

Georgina-May Goss

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It seems as though Mavis had a very poor quality experience, which sadly seems to be due to to lack of communication and empathy from a lot of the staff who were attending her. Mavis is 58, and only recently diagnosed with dementia, who relies on familiar su

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It seems as though Mavis had a very poor quality experience, which sadly seems to be due to to lack of communication and empathy from a lot of the staff who were attending her. Mavis is 58, and only recently diagnosed with dementia, who relies on familiar su

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surroundings and her husband to function safely. Had paramedics handed this information over to hospital staff, a designated person could have been assigned to getting in touch with Bill promptly, and reassuring Mavis that he was on his way. It seems as though Mavis wasn't able to have a voice, due to her dementia, however with effective care and communication, this could have been avoided. For example, the hospital porter could have talked to her on her journey to x ray, as it seemed the radiographer did well. It seemed sad that Mavis was labelled as non-compliant due to her confusion and lashing out, when all she needed was somebody that understood her needs , and be allowed to accompany her through her journey. Deb Wilson

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surroundings and her husband to function safely. Had paramedics handed this information over to hospital staff, a designated person could have been assigned to getting in touch with Bill promptly, and reassuring Mavis that he was on his way. It seems as though Mavis wasn't able to have a voice, due to her dementia, however with effective care and communication, this could have been avoided. For example, the hospital porter could have talked to her on her journey to x ray, as it seemed the radiographer did well. It seemed sad that Mavis was labelled as non-compliant due to her confusion and lashing out, when all she needed was somebody that understood her needs , and be allowed to accompany her through her journey. Deb Wilson

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From when Mavis was taken in the ambulance and throughout her stay in hospital, Mavis has been on her own on frightened, no one throughout the scenario has reassured Mavis that they have rung her husband that that he knew about her whereabouts or that he was coming to see her. No one has actually taken the time to tell Mavis what is actually happening, no one has told her what they are looking for on the x-ray and that the are querying a broken hip, or even what an x-ray is. The care Mavis is being given is not patient centred in the slightest, no one is explaining what they are doing as they are constantly invading Mavis personal space and no one is even spending the time to talk too her to make her more comfortable, and put Mavis at ease.
The quality of the experience for Mavis was very poor, she appears to be very frightened and no one is treating her as an individual or trying to comfort Mavis at all.
To improve the scenario for Mavis, a member of staff could simple spend some time with Mavis to explain to her what is going on, what they expect is wrong with her hip, how they are going to investigate and what treatment she would require. Also a huge why which is so simple that would improve Mavis' experience is to let her know that Bill knows where she is and is on her way.
Mavis had no voice in this scenario, no one was listening to her or even bothered to ask her if there was anything they could do for her. Mavis could be given a voice by staff explaining what was happening and asking Mavis questions such as did she know what was wrong? If there was anything Mavis needed or anything that could make her feel better. Just for a member of staff to talk to her and not just assume she has no idea what is happening due to the dementia.
Chloe Hallam

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file:///C:/Users/dwgw2_000/Downloads/Dignity-in-dementia-transforming-general-hospital-care-carers-and-patients.pdf  Interesting reading. Deb Wilson

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•       What are the main issues you find from this situation?

The main issues in this situation are linked to Mavis either not being supported during her hospital admission or not being involved in the care provided.

When Mavis arrived at the hospital lots of people leaned over her to speak to others and her. This would have been quite disorientating and intimidating for Mavis.

The same questions were repeated and she was repeatedly examined- which caused her pain.

Mavis is told she has had pain relief but she has either not been told this by the professional who administered this, or has not been given pain relief.

There is little continuation in care, as Mavis builds a rapport with one member of staff she is moved- seemingly without anyone explaining to her about what is going on and where the porter is taking her. The porter also isn’t introduced to her.

When Mavis is told she needs an x-ray the staff member uses medical terminology which Mavis cannot understand- they should have used a simpler explanation so that she could understand.

•       Was this a quality experience for Mavis?

The quality of the experience had some poor aspects. These are mainly due to poor communication, either a lack of communication with Mavis or communication that is not easy for Mavis to understand. At times Mavis seems in need of an advocate and as her husband is not there to do that for her, members of staff needed to fill that role- but at times this didn’t happen.

•       Could anything be done to improve this for Mavis?

Mavis’ neighbour was not allowed to travel with Mavis to the hospital, however if she had been allowed this could have helped Mavis if she’d had a familiar face with her and may have helped her to feel less frightened.

There could have been more continuity of care or more consistent care provided by staff. With continuous good communication with Mavis so that she could understand what’s going on and didn’t feel alone.

•       Did Mavis have a voice here?

Mavis didn’t really have a voice in this situation and at several times she is spoken over by different teams. This could be solved if staff took the time to explain things to her so that she could understand what was happening.

•       If no, what could you do to give Mavis a voice?

Mavis could be more involved in her own care and staff could have communicated with her better. Staff needed to work better at being Mavis’s advocate and helping her voice be heard. She could have been assigned to a member of staff to be her advocate while her husband was not available- which could improve the continuity of care for her.
Nuala Leake

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What are the main issues you find from this situation?The main issues from the scenario show that no attempt was made to effectively communicate with Mavis. The paramedics declined to let the neighbour go with Mavis to the hospital and in turn took her away from everything familiar, with Mavis’ current diagnosis of dementia it could have been particularly distressing for her to be in an unfamiliar surrounding with unfamiliar faces, alone as well as being in pain. Due to Mavis being ‘Uncooperative’ it seems she was overlooked as a patient and no effort was made to ensure she knew what was happening. If the paramedics had let Mavis’ neighbour accompany her to the hospital Mavis may have had a much more pleasant experience as well as being cooperative within the hospital. There was also a lack of respect for her autonomy- her right to self-determination and the opportunity to make informed choices. Mavis’ capacity has not been assessed therefore no actions can undertake within her best interests. Was this a quality experience for Mavis?No, Mavis was scared and confused and had no familiar people around her. She was continually calling out for her husband Bill who makes her feel safe and secure outside of her own home. The hospital staff made no attempt to communicate effectively with Mavis and instead just pushed her to different stations without any consideration to how scared she may be feeling. One member of staff also said Mavis was being aggressive rather than attempting to figure out why she was acting that particular way. Staff were talking over Mavis instead of attempting to engage in conversation with her and only 1 member of staff tried to make her feel comfortable. Could anything be done to improve this for Mavis?Priority should have been given to making Mavis feel safer, her neighbour should have been allowed to accompany Mavis to the hospital and staff should have attempted to see how long her husband would be. Staff didn’t attempt to communicate with Mavis but instead talked over her. Mavis was confused and in pain and was unaware of what was happening to her. Mavis should have been settled with pain relief until her husband had arrived. There were a lot of different people asking Mavis a variety of questions when this could have been just one person in order to make Mavis a little less confused. Mavis does not feel heard, she is unable to understand what is happening and unable to find the words to express her needs. It appears that she is given little opportunity to have one to one conversation in a quiet place where she may feel safer and be able to think more clearly. Did Mavis have a voice?No!What could you do to give Mavis a voice?Allowing Mavis’ neighbour to travel with her as an advocate until her husband arrived. Allowing one member of staff to be assigned to ensure Mavis is aware of what is happening and is not traumatised by the care she receives and to support her to make decisions as able. If he is able to attend within a reasonable time frame wait until Bill arrives to commence investigations and treatment, however Mavis’ pain should be addressed as soon as possible. Collette Murray, Nick Edwards, Caroline Kent

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What are the main issues you find from this situation?The main issues from the scenario show that no attempt was made to effectively communicate with Mavis. The paramedics declined to let the neighbour go with Mavis to the hospital and in turn took her away from everything familiar, with Mavis’ current diagnosis of dementia it could have been particularly distressing for her to be in an unfamiliar surrounding with unfamiliar faces, alone as well as being in pain. Due to Mavis being ‘Uncooperative’ it seems she was overlooked as a patient and no effort was made to ensure she knew what was happening. If the paramedics had let Mavis’ neighbour accompany her to the hospital Mavis may have had a much more pleasant experience as well as being cooperative within the hospital. There was also a lack of respect for her autonomy- her right to self-determination and the opportunity to make informed choices. Mavis’ capacity has not been assessed therefore no actions can undertake within her best interests. Was this a quality experience for Mavis?No, Mavis was scared and confused and had no familiar people around her. She was continually calling out for her husband Bill who makes her feel safe and secure outside of her own home. The hospital staff made no attempt to communicate effectively with Mavis and instead just pushed her to different stations without any consideration to how scared she may be feeling. One member of staff also said Mavis was being aggressive rather than attempting to figure out why she was acting that particular way. Staff were talking over Mavis instead of attempting to engage in conversation with her and only 1 member of staff tried to make her feel comfortable. Could anything be done to improve this for Mavis?Priority should have been given to making Mavis feel safer, her neighbour should have been allowed to accompany Mavis to the hospital and staff should have attempted to see how long her husband would be. Staff didn’t attempt to communicate with Mavis but instead talked over her. Mavis was confused and in pain and was unaware of what was happening to her. Mavis should have been settled with pain relief until her husband had arrived. There were a lot of different people asking Mavis a variety of questions when this could have been just one person in order to make Mavis a little less confused. Mavis does not feel heard, she is unable to understand what is happening and unable to find the words to express her needs. It appears that she is given little opportunity to have one to one conversation in a quiet place where she may feel safer and be able to think more clearly. Did Mavis have a voice?No!What could you do to give Mavis a voice?Allowing Mavis’ neighbour to travel with her as an advocate until her husband arrived. Allowing one member of staff to be assigned to ensure Mavis is aware of what is happening and is not traumatised by the care she receives and to support her to make decisions as able. If he is able to attend within a reasonable time frame wait until Bill arrives to commence investigations and treatment, however Mavis’ pain should be addressed as soon as possible. Collette Murray, Nick Edwards, Caroline Kent

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Scenario oneMain Issues identified- 1.neighbor was not allowed to travel with mavis, this would have contributed to her feeling insecure and unsafe.2.staff did not explain fully what was happening and instead assumed lack of capacity and understanding.3.consent was not gained, as staff assumed she was unable to give consent, they instead spoke over her.4.procedures and Mavis's care were not explained to her it was assumed she understood.5.Mavis was caused considerable pain and struck out at staff unintentionally coming into contact with staff. she was then anxious that she has hit someone. was this a quality experience?no. The needs of Mavis were not considered, nor was holistic care provided by staff to help Mavis feel as comfortable as possible.Could anything be done to improve this?1.communication.2.contact Bill to find out his ETA, with a view to waiting or him to arrive.3.explain to Mavis what is happeningDid Mavis have a voice?no, Mavis was spoken over and assumed to understand what she was being told. After striking out at a member of staff which may have been because she felt she needed to protect herself, she was labeled instantly with 'Dementia'.What could be done to give Mavis a voice?1.explain what is happening.2.check understanding with Mavis3.ask her about what happened or what Bill does to open communication and make her feel more comfortable.4. ask if she would like to wait for Bill5.ask what she would like to do.Hollie Roe 

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Scenario oneMain Issues identified- 1.neighbor was not allowed to travel with mavis, this would have contributed to her feeling insecure and unsafe.2.staff did not explain fully what was happening and instead assumed lack of capacity and understanding.3.consent was not gained, as staff assumed she was unable to give consent, they instead spoke over her.4.procedures and Mavis's care were not explained to her it was assumed she understood.5.Mavis was caused considerable pain and struck out at staff unintentionally coming into contact with staff. she was then anxious that she has hit someone. was this a quality experience?no. The needs of Mavis were not considered, nor was holistic care provided by staff to help Mavis feel as comfortable as possible.Could anything be done to improve this?1.communication.2.contact Bill to find out his ETA, with a view to waiting or him to arrive.3.explain to Mavis what is happeningDid Mavis have a voice?no, Mavis was spoken over and assumed to understand what she was being told. After striking out at a member of staff which may have been because she felt she needed to protect herself, she was labeled instantly with 'Dementia'.What could be done to give Mavis a voice?1.explain what is happening.2.check understanding with Mavis3.ask her about what happened or what Bill does to open communication and make her feel more comfortable.4. ask if she would like to wait for Bill5.ask what she would like to do.Hollie Roe 

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Pre-module questions: Thinking about everyone that has been involved in the process of this patient’s journey.How many people do you think were involved from the scenario you have been given?• The neighbours- 2• Paramedics- 2• Accident and Emergency- Nurse in triage, Nurse in A and E cubicle or stretcher, Healthcare for physical obs, Doctor and/or consultant for differential diagnosis. 4-5• X-ray- Radiographer x2, Porter, “nice lady” (?nurse). 4• Ward area- Nurse handover, healthcare, Doctor and/or consultant. 3• And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5Total: 21 people.What input do you these different professionals have in relation to this patient’s journey?➢ The neighbours:They called the emergency services➢ Paramedics: They carried out the initial assessment➢ Accident and Emergency:Nurse in triage- Take handover from paramedics, hand over to nurse in cubicle or stretcher.Nurse in A and E cubicle or stretcher- Works with healthcare and relies on them to retrieve physical observations and routine tests, does differential diagnosis, administers analgesia, communicate with doctor/ consultant to discuss potential nerve block to potentially relieve pain when transferring beds and with x-ray.➢ X-ray:Radiographers- To position and collect images of the broken bone.Porter- To transfer patient from a to b.“Nice lady” (?nurse)- To comfort and reassure patient, communicate what is going on. ➢ Ward area:Nurse- Take handover using SBAR, maintain documentation, complete care-plan, review medications to see what Mavis has had, look at physical observations, pain chart- has the analgesia been effective, and other routine frameworks such as MUST, Waterlow ect. Refer Mavis to the Dementia specialist (If the hospital had one).Healthcare assistant- To take physical observations, property list and to complete any other requests from nursing staff such as prep for theatre.Doctor and/or consultant- To work with and communicate to nurses of the plan, and potentially liaise with surgeons to discuss risks and plan of action.➢ And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5 How many of those roles do you understand? If there are some you do not, what barriers or challenges does this present?We understand all the roles stated due to our practice placements. However, if we did not know, this would be a barrier because we would may not be able to support the patent adequately.What would help you to understand this further?I don’t understand this question.Activity 1: Scenario questionsWhat are the main issues you find from this situation?➢ Firstly, the neighbours could have potentially stopped the fall all together by taking in the bun for her.➢ Mavis’s lack of support at home, no mention of care package to assist with tasks such as taking the bin in.➢ The communication to the patient was poor: eg. Lack of “Hello my name is...”.➢ The perspective of the scenario has made it look as if the staff were just “doing” things her, moving her leg and transferring her around the hospital with minimal explanation as to where or why she was moving.➢ The perspective of the scenario made Mavis look powerless and as if she wasn’t being listened to. OR were the staff talking and explaining things but scenario missed it out?➢ The communication between the teams were poor: eg. Radiographers were unsure about whether they were able perform x-ray or not. This should have been discussed prior to moving Mavis.➢ Lack of reassurance or confirmation that her husband is on his way, this could have possibly pacified her for the time being.➢ The A and E environment was intimidating and the opposite to Mavis’s normal environment.Was this a quality experience for Mavis?➢ No it was poor, only one person showed compassion.Could anything be done to improve this for Mavis?➢ Communicate to Mavis slowly➢ It appears pain management was absent, from the ambulance to the ward Mavis was in pain. Ambulance service should have offered break-through analgesia initially and then her pain should have been managed throughout her hospital journey.➢ Be gentle when moving her, offered pain relief when transferring.➢ Speak to Mavis to settle her anxiety and confusion.➢ Explain things such as “An X-ray is when we look at your bone in your leg to see where you have endured a break” Or when assessing her leg “I am just checking your leg to see what we can do for you Mavis”.➢ Contacting her husband to confirm he was on his way.➢ When she was being transferred, explain why.Did Mavis have a voice here?➢ NoIf no, what could you do to give Mavis a voice?Initially wait for husband as it is her support network and may be a good advocate and a rich source of information➢ Asked her questions/ asked about Mavis’s preferences➢ Ask and discuss the plan of action➢ Ask if Mavis agrees

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Pre-module questions: Thinking about everyone that has been involved in the process of this patient’s journey.How many people do you think were involved from the scenario you have been given?• The neighbours- 2• Paramedics- 2• Accident and Emergency- Nurse in triage, Nurse in A and E cubicle or stretcher, Healthcare for physical obs, Doctor and/or consultant for differential diagnosis. 4-5• X-ray- Radiographer x2, Porter, “nice lady” (?nurse). 4• Ward area- Nurse handover, healthcare, Doctor and/or consultant. 3• And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5Total: 21 people.What input do you these different professionals have in relation to this patient’s journey?➢ The neighbours:They called the emergency services➢ Paramedics: They carried out the initial assessment➢ Accident and Emergency:Nurse in triage- Take handover from paramedics, hand over to nurse in cubicle or stretcher.Nurse in A and E cubicle or stretcher- Works with healthcare and relies on them to retrieve physical observations and routine tests, does differential diagnosis, administers analgesia, communicate with doctor/ consultant to discuss potential nerve block to potentially relieve pain when transferring beds and with x-ray.➢ X-ray:Radiographers- To position and collect images of the broken bone.Porter- To transfer patient from a to b.“Nice lady” (?nurse)- To comfort and reassure patient, communicate what is going on. ➢ Ward area:Nurse- Take handover using SBAR, maintain documentation, complete care-plan, review medications to see what Mavis has had, look at physical observations, pain chart- has the analgesia been effective, and other routine frameworks such as MUST, Waterlow ect. Refer Mavis to the Dementia specialist (If the hospital had one).Healthcare assistant- To take physical observations, property list and to complete any other requests from nursing staff such as prep for theatre.Doctor and/or consultant- To work with and communicate to nurses of the plan, and potentially liaise with surgeons to discuss risks and plan of action.➢ And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5 How many of those roles do you understand? If there are some you do not, what barriers or challenges does this present?We understand all the roles stated due to our practice placements. However, if we did not know, this would be a barrier because we would may not be able to support the patent adequately.What would help you to understand this further?I don’t understand this question.Activity 1: Scenario questionsWhat are the main issues you find from this situation?➢ Firstly, the neighbours could have potentially stopped the fall all together by taking in the bun for her.➢ Mavis’s lack of support at home, no mention of care package to assist with tasks such as taking the bin in.➢ The communication to the patient was poor: eg. Lack of “Hello my name is...”.➢ The perspective of the scenario has made it look as if the staff were just “doing” things her, moving her leg and transferring her around the hospital with minimal explanation as to where or why she was moving.➢ The perspective of the scenario made Mavis look powerless and as if she wasn’t being listened to. OR were the staff talking and explaining things but scenario missed it out?➢ The communication between the teams were poor: eg. Radiographers were unsure about whether they were able perform x-ray or not. This should have been discussed prior to moving Mavis.➢ Lack of reassurance or confirmation that her husband is on his way, this could have possibly pacified her for the time being.➢ The A and E environment was intimidating and the opposite to Mavis’s normal environment.Was this a quality experience for Mavis?➢ No it was poor, only one person showed compassion.Could anything be done to improve this for Mavis?➢ Communicate to Mavis slowly➢ It appears pain management was absent, from the ambulance to the ward Mavis was in pain. Ambulance service should have offered break-through analgesia initially and then her pain should have been managed throughout her hospital journey.➢ Be gentle when moving her, offered pain relief when transferring.➢ Speak to Mavis to settle her anxiety and confusion.➢ Explain things such as “An X-ray is when we look at your bone in your leg to see where you have endured a break” Or when assessing her leg “I am just checking your leg to see what we can do for you Mavis”.➢ Contacting her husband to confirm he was on his way.➢ When she was being transferred, explain why.Did Mavis have a voice here?➢ NoIf no, what could you do to give Mavis a voice?Initially wait for husband as it is her support network and may be a good advocate and a rich source of information➢ Asked her questions/ asked about Mavis’s preferences➢ Ask and discuss the plan of action➢ Ask if Mavis agrees

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Pre-module questions: Thinking about everyone that has been involved in the process of this patient’s journey.How many people do you think were involved from the scenario you have been given?• The neighbours- 2• Paramedics- 2• Accident and Emergency- Nurse in triage, Nurse in A and E cubicle or stretcher, Healthcare for physical obs, Doctor and/or consultant for differential diagnosis. 4-5• X-ray- Radiographer x2, Porter, “nice lady” (?nurse). 4• Ward area- Nurse handover, healthcare, Doctor and/or consultant. 3• And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5Total: 21 people.What input do you these different professionals have in relation to this patient’s journey?➢ The neighbours:They called the emergency services➢ Paramedics: They carried out the initial assessment➢ Accident and Emergency:Nurse in triage- Take handover from paramedics, hand over to nurse in cubicle or stretcher.Nurse in A and E cubicle or stretcher- Works with healthcare and relies on them to retrieve physical observations and routine tests, does differential diagnosis, administers analgesia, communicate with doctor/ consultant to discuss potential nerve block to potentially relieve pain when transferring beds and with x-ray.➢ X-ray:Radiographers- To position and collect images of the broken bone.Porter- To transfer patient from a to b.“Nice lady” (?nurse)- To comfort and reassure patient, communicate what is going on. ➢ Ward area:Nurse- Take handover using SBAR, maintain documentation, complete care-plan, review medications to see what Mavis has had, look at physical observations, pain chart- has the analgesia been effective, and other routine frameworks such as MUST, Waterlow ect. Refer Mavis to the Dementia specialist (If the hospital had one).Healthcare assistant- To take physical observations, property list and to complete any other requests from nursing staff such as prep for theatre.Doctor and/or consultant- To work with and communicate to nurses of the plan, and potentially liaise with surgeons to discuss risks and plan of action.➢ And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5 How many of those roles do you understand? If there are some you do not, what barriers or challenges does this present?We understand all the roles stated due to our practice placements. However, if we did not know, this would be a barrier because we would may not be able to support the patent adequately.What would help you to understand this further?I don’t understand this question.Activity 1: Scenario questionsWhat are the main issues you find from this situation?➢ Firstly, the neighbours could have potentially stopped the fall all together by taking in the bun for her.➢ Mavis’s lack of support at home, no mention of care package to assist with tasks such as taking the bin in.➢ The communication to the patient was poor: eg. Lack of “Hello my name is...”.➢ The perspective of the scenario has made it look as if the staff were just “doing” things her, moving her leg and transferring her around the hospital with minimal explanation as to where or why she was moving.➢ The perspective of the scenario made Mavis look powerless and as if she wasn’t being listened to. OR were the staff talking and explaining things but scenario missed it out?➢ The communication between the teams were poor: eg. Radiographers were unsure about whether they were able perform x-ray or not. This should have been discussed prior to moving Mavis.➢ Lack of reassurance or confirmation that her husband is on his way, this could have possibly pacified her for the time being.➢ The A and E environment was intimidating and the opposite to Mavis’s normal environment.Was this a quality experience for Mavis?➢ No it was poor, only one person showed compassion.Could anything be done to improve this for Mavis?➢ Communicate to Mavis slowly➢ It appears pain management was absent, from the ambulance to the ward Mavis was in pain. Ambulance service should have offered break-through analgesia initially and then her pain should have been managed throughout her hospital journey.➢ Be gentle when moving her, offered pain relief when transferring.➢ Speak to Mavis to settle her anxiety and confusion.➢ Explain things such as “An X-ray is when we look at your bone in your leg to see where you have endured a break” Or when assessing her leg “I am just checking your leg to see what we can do for you Mavis”.➢ Contacting her husband to confirm he was on his way.➢ When she was being transferred, explain why.Did Mavis have a voice here?➢ NoIf no, what could you do to give Mavis a voice?Initially wait for husband as it is her support network and may be a good advocate and a rich source of information➢ Asked her questions/ asked about Mavis’s preferences➢ Ask and discuss the plan of action➢ Ask if Mavis agrees

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Pre-module questions: Thinking about everyone that has been involved in the process of this patient’s journey.How many people do you think were involved from the scenario you have been given?• The neighbours- 2• Paramedics- 2• Accident and Emergency- Nurse in triage, Nurse in A and E cubicle or stretcher, Healthcare for physical obs, Doctor and/or consultant for differential diagnosis. 4-5• X-ray- Radiographer x2, Porter, “nice lady” (?nurse). 4• Ward area- Nurse handover, healthcare, Doctor and/or consultant. 3• And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5Total: 21 people.What input do you these different professionals have in relation to this patient’s journey?➢ The neighbours:They called the emergency services➢ Paramedics: They carried out the initial assessment➢ Accident and Emergency:Nurse in triage- Take handover from paramedics, hand over to nurse in cubicle or stretcher.Nurse in A and E cubicle or stretcher- Works with healthcare and relies on them to retrieve physical observations and routine tests, does differential diagnosis, administers analgesia, communicate with doctor/ consultant to discuss potential nerve block to potentially relieve pain when transferring beds and with x-ray.➢ X-ray:Radiographers- To position and collect images of the broken bone.Porter- To transfer patient from a to b.“Nice lady” (?nurse)- To comfort and reassure patient, communicate what is going on. ➢ Ward area:Nurse- Take handover using SBAR, maintain documentation, complete care-plan, review medications to see what Mavis has had, look at physical observations, pain chart- has the analgesia been effective, and other routine frameworks such as MUST, Waterlow ect. Refer Mavis to the Dementia specialist (If the hospital had one).Healthcare assistant- To take physical observations, property list and to complete any other requests from nursing staff such as prep for theatre.Doctor and/or consultant- To work with and communicate to nurses of the plan, and potentially liaise with surgeons to discuss risks and plan of action.➢ And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5 How many of those roles do you understand? If there are some you do not, what barriers or challenges does this present?We understand all the roles stated due to our practice placements. However, if we did not know, this would be a barrier because we would may not be able to support the patent adequately.What would help you to understand this further?I don’t understand this question.Activity 1: Scenario questionsWhat are the main issues you find from this situation?➢ Firstly, the neighbours could have potentially stopped the fall all together by taking in the bun for her.➢ Mavis’s lack of support at home, no mention of care package to assist with tasks such as taking the bin in.➢ The communication to the patient was poor: eg. Lack of “Hello my name is...”.➢ The perspective of the scenario has made it look as if the staff were just “doing” things her, moving her leg and transferring her around the hospital with minimal explanation as to where or why she was moving.➢ The perspective of the scenario made Mavis look powerless and as if she wasn’t being listened to. OR were the staff talking and explaining things but scenario missed it out?➢ The communication between the teams were poor: eg. Radiographers were unsure about whether they were able perform x-ray or not. This should have been discussed prior to moving Mavis.➢ Lack of reassurance or confirmation that her husband is on his way, this could have possibly pacified her for the time being.➢ The A and E environment was intimidating and the opposite to Mavis’s normal environment.Was this a quality experience for Mavis?➢ No it was poor, only one person showed compassion.Could anything be done to improve this for Mavis?➢ Communicate to Mavis slowly➢ It appears pain management was absent, from the ambulance to the ward Mavis was in pain. Ambulance service should have offered break-through analgesia initially and then her pain should have been managed throughout her hospital journey.➢ Be gentle when moving her, offered pain relief when transferring.➢ Speak to Mavis to settle her anxiety and confusion.➢ Explain things such as “An X-ray is when we look at your bone in your leg to see where you have endured a break” Or when assessing her leg “I am just checking your leg to see what we can do for you Mavis”.➢ Contacting her husband to confirm he was on his way.➢ When she was being transferred, explain why.Did Mavis have a voice here?➢ NoIf no, what could you do to give Mavis a voice?Initially wait for husband as it is her support network and may be a good advocate and a rich source of information➢ Asked her questions/ asked about Mavis’s preferences➢ Ask and discuss the plan of action➢ Ask if Mavis agrees

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Pre-module questions: Thinking about everyone that has been involved in the process of this patient’s journey.How many people do you think were involved from the scenario you have been given?• The neighbours- 2• Paramedics- 2• Accident and Emergency- Nurse in triage, Nurse in A and E cubicle or stretcher, Healthcare for physical obs, Doctor and/or consultant for differential diagnosis. 4-5• X-ray- Radiographer x2, Porter, “nice lady” (?nurse). 4• Ward area- Nurse handover, healthcare, Doctor and/or consultant. 3• And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5Total: 21 people.What input do you these different professionals have in relation to this patient’s journey?➢ The neighbours:They called the emergency services➢ Paramedics: They carried out the initial assessment➢ Accident and Emergency:Nurse in triage- Take handover from paramedics, hand over to nurse in cubicle or stretcher.Nurse in A and E cubicle or stretcher- Works with healthcare and relies on them to retrieve physical observations and routine tests, does differential diagnosis, administers analgesia, communicate with doctor/ consultant to discuss potential nerve block to potentially relieve pain when transferring beds and with x-ray.➢ X-ray:Radiographers- To position and collect images of the broken bone.Porter- To transfer patient from a to b.“Nice lady” (?nurse)- To comfort and reassure patient, communicate what is going on. ➢ Ward area:Nurse- Take handover using SBAR, maintain documentation, complete care-plan, review medications to see what Mavis has had, look at physical observations, pain chart- has the analgesia been effective, and other routine frameworks such as MUST, Waterlow ect. Refer Mavis to the Dementia specialist (If the hospital had one).Healthcare assistant- To take physical observations, property list and to complete any other requests from nursing staff such as prep for theatre.Doctor and/or consultant- To work with and communicate to nurses of the plan, and potentially liaise with surgeons to discuss risks and plan of action.➢ And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5 How many of those roles do you understand? If there are some you do not, what barriers or challenges does this present?We understand all the roles stated due to our practice placements. However, if we did not know, this would be a barrier because we would may not be able to support the patent adequately.What would help you to understand this further?I don’t understand this question.Activity 1: Scenario questionsWhat are the main issues you find from this situation?➢ Firstly, the neighbours could have potentially stopped the fall all together by taking in the bun for her.➢ Mavis’s lack of support at home, no mention of care package to assist with tasks such as taking the bin in.➢ The communication to the patient was poor: eg. Lack of “Hello my name is...”.➢ The perspective of the scenario has made it look as if the staff were just “doing” things her, moving her leg and transferring her around the hospital with minimal explanation as to where or why she was moving.➢ The perspective of the scenario made Mavis look powerless and as if she wasn’t being listened to. OR were the staff talking and explaining things but scenario missed it out?➢ The communication between the teams were poor: eg. Radiographers were unsure about whether they were able perform x-ray or not. This should have been discussed prior to moving Mavis.➢ Lack of reassurance or confirmation that her husband is on his way, this could have possibly pacified her for the time being.➢ The A and E environment was intimidating and the opposite to Mavis’s normal environment.Was this a quality experience for Mavis?➢ No it was poor, only one person showed compassion.Could anything be done to improve this for Mavis?➢ Communicate to Mavis slowly➢ It appears pain management was absent, from the ambulance to the ward Mavis was in pain. Ambulance service should have offered break-through analgesia initially and then her pain should have been managed throughout her hospital journey.➢ Be gentle when moving her, offered pain relief when transferring.➢ Speak to Mavis to settle her anxiety and confusion.➢ Explain things such as “An X-ray is when we look at your bone in your leg to see where you have endured a break” Or when assessing her leg “I am just checking your leg to see what we can do for you Mavis”.➢ Contacting her husband to confirm he was on his way.➢ When she was being transferred, explain why.Did Mavis have a voice here?➢ NoIf no, what could you do to give Mavis a voice?Initially wait for husband as it is her support network and may be a good advocate and a rich source of information➢ Asked her questions/ asked about Mavis’s preferences➢ Ask and discuss the plan of action➢ Ask if Mavis agrees

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Pre-module questions: Thinking about everyone that has been involved in the process of this patient’s journey.How many people do you think were involved from the scenario you have been given?• The neighbours- 2• Paramedics- 2• Accident and Emergency- Nurse in triage, Nurse in A and E cubicle or stretcher, Healthcare for physical obs, Doctor and/or consultant for differential diagnosis. 4-5• X-ray- Radiographer x2, Porter, “nice lady” (?nurse). 4• Ward area- Nurse handover, healthcare, Doctor and/or consultant. 3• And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5Total: 21 people.What input do you these different professionals have in relation to this patient’s journey?➢ The neighbours:They called the emergency services➢ Paramedics: They carried out the initial assessment➢ Accident and Emergency:Nurse in triage- Take handover from paramedics, hand over to nurse in cubicle or stretcher.Nurse in A and E cubicle or stretcher- Works with healthcare and relies on them to retrieve physical observations and routine tests, does differential diagnosis, administers analgesia, communicate with doctor/ consultant to discuss potential nerve block to potentially relieve pain when transferring beds and with x-ray.➢ X-ray:Radiographers- To position and collect images of the broken bone.Porter- To transfer patient from a to b.“Nice lady” (?nurse)- To comfort and reassure patient, communicate what is going on. ➢ Ward area:Nurse- Take handover using SBAR, maintain documentation, complete care-plan, review medications to see what Mavis has had, look at physical observations, pain chart- has the analgesia been effective, and other routine frameworks such as MUST, Waterlow ect. Refer Mavis to the Dementia specialist (If the hospital had one).Healthcare assistant- To take physical observations, property list and to complete any other requests from nursing staff such as prep for theatre.Doctor and/or consultant- To work with and communicate to nurses of the plan, and potentially liaise with surgeons to discuss risks and plan of action.➢ And potentially: Occupational Health, Physiotherapist, Junior Doctor, Student Nurse, Surgeon. 5 How many of those roles do you understand? If there are some you do not, what barriers or challenges does this present?We understand all the roles stated due to our practice placements. However, if we did not know, this would be a barrier because we would may not be able to support the patent adequately.What would help you to understand this further?I don’t understand this question.Activity 1: Scenario questionsWhat are the main issues you find from this situation?➢ Firstly, the neighbours could have potentially stopped the fall all together by taking in the bun for her.➢ Mavis’s lack of support at home, no mention of care package to assist with tasks such as taking the bin in.➢ The communication to the patient was poor: eg. Lack of “Hello my name is...”.➢ The perspective of the scenario has made it look as if the staff were just “doing” things her, moving her leg and transferring her around the hospital with minimal explanation as to where or why she was moving.➢ The perspective of the scenario made Mavis look powerless and as if she wasn’t being listened to. OR were the staff talking and explaining things but scenario missed it out?➢ The communication between the teams were poor: eg. Radiographers were unsure about whether they were able perform x-ray or not. This should have been discussed prior to moving Mavis.➢ Lack of reassurance or confirmation that her husband is on his way, this could have possibly pacified her for the time being.➢ The A and E environment was intimidating and the opposite to Mavis’s normal environment.Was this a quality experience for Mavis?➢ No it was poor, only one person showed compassion.Could anything be done to improve this for Mavis?➢ Communicate to Mavis slowly➢ It appears pain management was absent, from the ambulance to the ward Mavis was in pain. Ambulance service should have offered break-through analgesia initially and then her pain should have been managed throughout her hospital journey.➢ Be gentle when moving her, offered pain relief when transferring.➢ Speak to Mavis to settle her anxiety and confusion.➢ Explain things such as “An X-ray is when we look at your bone in your leg to see where you have endured a break” Or when assessing her leg “I am just checking your leg to see what we can do for you Mavis”.➢ Contacting her husband to confirm he was on his way.➢ When she was being transferred, explain why.Did Mavis have a voice here?➢ NoIf no, what could you do to give Mavis a voice?Initially wait for husband as it is her support network and may be a good advocate and a rich source of information➢ Asked her questions/ asked about Mavis’s preferences➢ Ask and discuss the plan of action➢ Ask if Mavis agrees

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In the scenario, there were a few positive areas, such as how fast they managed to get in contact with Bill to keep Mavis calm and also when a member of staff did actually sit with Mavis to keep her company and calm.
However there are many areas that required improvement. One being the staffs dementia training. None of the staff seemed to behave appropriate with Mavis due to her dementia. The staff were not respectful of Mavis, did not spend the time to explain to her what they were doing as they just thought she would not understand.
No one took the time to ask Mavis how much pain she was in, even though there is the Abbey pain, especially designed to assess pain for people with dementia. Staff needed to ensure Mavis had a voice. Also the porter did not introduce himself to Mavis and that is a simple way to make patients feel more at ease and make patients feel more comfortable.
Also, no member of staff seems to be informing Mavis about what care she requires and why she is where she is.
Chloe Hallam

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Mavis's journey could be improved  by using a fish bone diagram. By highlighting the problem that Mavis felt confused and alone due to her dementia, then highlighting the causes as to why she felt like that, may highlight how we can change other patient's journey's for the better. For example, by looking at how people affected Mavis's journey, we could argue that communication was although at times e 

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Mavis's journey could be improved  by using a fish bone diagram. By highlighting the problem that Mavis felt confused and alone due to her dementia, then highlighting the causes as to why she felt like that, may highlight how we can change other patient's journey's for the better. For example, by looking at how people affected Mavis's journey, we could argue that communication was although at times e 

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effective, the majority of the communication between staff was poor, resulting in anxiety for Mavis. Communication, could then be addressed, particularly in the situation where patients are diagnosed with dementia. The diagram could also allow environment to be addressed. Could dementia patients have a quieter area? A specialised room with calming colours? Equipment and policy could also be looked at? Could we go through the journey and adjust any equipment we use for dementia patients? Tools to aid, for example fiddle toys? Deb Wilson

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effective, the majority of the communication between staff was poor, resulting in anxiety for Mavis. Communication, could then be addressed, particularly in the situation where patients are diagnosed with dementia. The diagram could also allow environment to be addressed. Could dementia patients have a quieter area? A specialised room with calming colours? Equipment and policy could also be looked at? Could we go through the journey and adjust any equipment we use for dementia patients? Tools to aid, for example fiddle toys? Deb Wilson

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Mavis journey within the hospital could be tracked and reviewed using the spaghetti diagram. This map would provide a visual representation of where Mavis had travelled and pin point which staff were involved within her care, however unless it was done in real time it may not always be accurate. Mavis felt that staff were talking about her and not too her so therefore Mavis’ journey could be altered by the use of effective communication. Due to her dementia, Mavis felt scared and alone and was just being whisked away to different departments without being notified first. No-one took the time out to explain things to her and she did not understand what some of the medical terms meant nor did she know the correct words in order to ask staff.Even though Mavis feels safer now her husband is with her, she still feels the place is noisy and this is making her feel uneasy. If Mavis had have been moved to a side room with her husband she may have felt much more comfortable and settled. 

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Mavis journey within the hospital could be tracked and reviewed using the spaghetti diagram. This map would provide a visual representation of where Mavis had travelled and pin point which staff were involved within her care, however unless it was done in real time it may not always be accurate. Mavis felt that staff were talking about her and not too her so therefore Mavis’ journey could be altered by the use of effective communication. Due to her dementia, Mavis felt scared and alone and was just being whisked away to different departments without being notified first. No-one took the time out to explain things to her and she did not understand what some of the medical terms meant nor did she know the correct words in order to ask staff.Even though Mavis feels safer now her husband is with her, she still feels the place is noisy and this is making her feel uneasy. If Mavis had have been moved to a side room with her husband she may have felt much more comfortable and settled. 

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Nick Edwards
Caroline Kent
Cheryl Gilbert

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Using a Why diagram we can brainstorm to ask why problems happen and get to the root cause of a problem.

Using the identified problem poor communication and a why diagram we can explore root causes of the problem.

Poor communication with Mavis:

Why? Lack of confidence/ perceived value in talking to a patient with dementia

Why? Lack of training among staff about good communication skills with patients with dementia

Why? Lack of resources to send staff on training days

Why? Less priority put on holistic patient care when services are under pressure

Why? Priority is on cutting waiting times and making efficient service rather than providing best care

Better communication with patients

How? More value in communicating with patients who have dementia

How? More training among at least some of staff about good communication skills

How? Fundraising and links with dementia charities to create a helpful training day

How? More priority put on holistic care of all patients and not just care of patient’s physical needs

How? More priority on better care even if at times it doesn’t mean waiting times are cut.

Nuala Leake and Georgina-May Goss

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- Identify the change

The change that has been identified is better communication with patients who have dementia, and by improving this increasing patient participation in their care. And the change implemented to do this would be to create a training day, inclusive of service users’ previous experiences and suggestions for how the service could cater towards these patients needs and address common concerns as well as improving communication skills.

- Managing the change (inclusive of applicable theories)

Managing the change the stakeholder Analysis strategy will be used to assess the influence and power of stakeholders and the level of their interest, this will mean that the needs of the key players are focused on and the needs of highly influential stakeholders are met and that less important groups are shown consideration.

- Leading the team (inclusive of applicable theories)

To lead the team it would be important to identify the innovators and early adopters who will be able to convince the team that to push the project forwards as they will be able to identify driving forces for them within the change.

- What barriers will come up against?

Barriers that can be come up against may be if the adoption gap of a change takes a long time to reach as more staff members are either the late majority or laggards and there are fewer innovators and early adopters.

- How could you prevent or overcome these barriers?

To help prevent and overcome this barrier the team could review both the driving and restraining forces of the change to better understand each other’s point of view so that problems can be overcome.

Nuala Leake

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identify the change- In order to identify the change, communication has been an area highlighted for improvement. Training for staff could be arranged in order to extend communication skills and focus on dementia awareness. Using training specified for dementia communication could also prove invaluable.

Managing the change- Whichever tool used would require constant feedback and evaluation from patients and staff in order to find out whether changes were being welcomed and adhered to. For example it would be important to feed back from patients.

Iead the change- By leading from example and having a positive approach to the change would encourage every body to get on board. Providing constant support in any change related matters arising would allow the change to be adopted successfully.

Barriers- barriers could occur particularly from a staff perspective due to lack of enthusiasm for the proposed change and ingrained cultures.

Avoiding barriers- good communication from the outset would allow barriers to be expressed earlier and having good leadership within the change would encourage to getting the team on board not only to implement that change but also encourage patients to be receptive to the change.

Georgina-May Goss

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In order to implement any changes you have identified in Mavis’ care what skills will you need to?Skills to influence change – Leadership and Followership understanding how teams work and how to support organisational change. Identify the changeCommunicationManaging the change (inclusive of applicable theories)Indentify barriers (force field analysis, Lewin ) Unfreeze (Lewin’s Transistion stages) Provide motivation / emotion / rational to change – involve people in the change (allow bottom up change – staff engagement and ownership of problem)Support TransitionRefreeze – embed as Standard Operating Procedures / agreed ways of workingLeading the team (inclusive of applicable theories)Belbin’s Team Roles – identify who will do whatTeam Stages – Tuckman Styles of Leadership – Lewin Styles of Followership – ChaleffWhat barriers will come up against?Lack of resources:TimeMoneyStaff resistance / resilience / motivation / Change with no clearly identified improvement (or difficult to see immediately) / may not help those changingFearHow could you prevent or overcome these barriers?Share the problem, engagement and empowerment of front-line staff or those affected to implement their own solutions to the problem, or at least ensure that changes (and the need for change) is clearly communicated in an open and transparent manner.

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In order to implement any changes you have identified in Mavis’ care what skills will you need to?Skills to influence change – Leadership and Followership understanding how teams work and how to support organisational change. Identify the changeCommunicationManaging the change (inclusive of applicable theories)Indentify barriers (force field analysis, Lewin ) Unfreeze (Lewin’s Transistion stages) Provide motivation / emotion / rational to change – involve people in the change (allow bottom up change – staff engagement and ownership of problem)Support TransitionRefreeze – embed as Standard Operating Procedures / agreed ways of workingLeading the team (inclusive of applicable theories)Belbin’s Team Roles – identify who will do whatTeam Stages – Tuckman Styles of Leadership – Lewin Styles of Followership – ChaleffWhat barriers will come up against?Lack of resources:TimeMoneyStaff resistance / resilience / motivation / Change with no clearly identified improvement (or difficult to see immediately) / may not help those changingFearHow could you prevent or overcome these barriers?Share the problem, engagement and empowerment of front-line staff or those affected to implement their own solutions to the problem, or at least ensure that changes (and the need for change) is clearly communicated in an open and transparent manner.