Aisha, a 55-year-old asylum seeker from a war-torn country, finds herself in Ireland seeking refuge from conflict and persecution. Arriving with little more than the clothes on her back, she struggles to access basic necessities, let alone adequate healthcare, in her new host country.

Having endured trauma and stress during her journey to safety, Aisha begins experiencing symptoms of heart failure, including shortness of breath and fatigue. However, as an asylum seeker with limited resources and uncertain legal status, she hesitates to seek medical attention, fearing the consequences of her precarious situation.

Despite her reservations, Aisha's symptoms worsen, impacting her ability to carry out daily activities and care for herself. With no access to healthcare coverage and language barriers hindering her communication with healthcare providers, Aisha's heart failure goes untreated, leading to further complications and declining health.

As Aisha navigates the asylum process, she faces numerous challenges, including inadequate housing, financial instability, and isolation from her community.

Caoimhe, a 50-year-old Irish Traveler, faces a daunting battle with asthma amidst the backdrop of her close-knit community. Born into a culture steeped in tradition and familial bonds, Caoimhe's journey with asthma is influenced by the unique challenges and dynamics of Traveler life.

Despite the strong sense of camaraderie within her community, Caoimhe encounters obstacles in accessing adequate healthcare services and asthma management resources. Language barriers, mistrust of mainstream institutions, and limited awareness of respiratory conditions hinder her ability to seek timely medical assistance and education on asthma prevention and treatment.

Growing up in Traveler camps characterized by cramped living conditions and exposure to environmental triggers like dust and mold, Caoimhe experiences frequent asthma exacerbations. Despite her efforts to mitigate triggers, the pervasive presence of environmental allergens complicates her asthma management, leading to persistent symptoms and frequent visits to local clinics for relief.

Initially dismissing her symptoms as minor inconveniences, Caoimhe's respiratory struggles intensify, prompting her to seek medical attention. At the clinic, she receives a diagnosis of asthma

Navigating asthma care within her cultural context presents additional challenges for Caoimhe. Adhering to treatment regimens amidst the demands of Traveler life, while navigating cultural beliefs and norms surrounding healthcare, requires careful consideration and support from healthcare providers who understand her unique circumstances.

Siobhan, a 45-year-old Irish woman, has weathered a lifetime of challenges shaped by experiences of domestic violence and the complexities of Ireland's foster care system. Born into a tumultuous household marked by abuse and instability, Siobhan endured years of trauma before being placed in foster care during her adolescence.

Separated from her biological family, Siobhan's transition into foster care brought a mixture of relief and uncertainty. While escaping the cycle of violence provided a sense of safety, navigating the intricacies of the foster care system as a vulnerable teenager proved daunting, leaving her with unresolved emotional scars and a fractured sense of identity.

Despite the upheaval in her personal life, Siobhan remained determined to forge her own path and create a better future for herself. However, the instability of her living situations and the lack of consistent support systems within the foster care system hindered her academic progress, preventing her from completing her Leaving Certificate

As Siobhan entered adulthood, the weight of her past experiences and the challenges of managing her health became increasingly burdensome. Diagnosed with type 2 diabetes.

Living with diabetes presented its own set of challenges for Siobhan as she navigated the complexities of managing her health while grappling with the trauma of her past. Amidst the upheaval of foster care transitions and the absence of consistent support networks, Siobhan struggled to prioritize her health and adhere to a healthy lifestyle regimen, exacerbating her diabetes-related complications.

Seamus, a 60-year-old farmer living in rural Ireland, grapples with the burdens of poverty, limited education, and social isolation as he confronts a diagnosis of high blood pressure. Born into a family of farmers, Seamus inherited his family's small plot of land but lacked the opportunity for formal education beyond primary school due to financial constraints and the demands of farm work.

Isolated from urban centers and lacking access to educational resources, Seamus's knowledge of health and wellness remained limited. Unaware of the risk factors for hypertension and the importance of lifestyle modifications, he continued to lead a sedentary lifestyle characterized by long hours of physical labor on the farm and a diet high in salt and processed foods.

As Seamus entered his later years, the cumulative effects of stress, poor diet, and lack of physical activity began to take their toll on his health. Experiencing symptoms such as headaches, dizziness, and fatigue, Seamus sought medical attention from the local clinic, where he received a diagnosis of high blood pressure.

Additionally, Seamus's social isolation exacerbates his health challenges. Living alone on his farm without the support of family or neighbors, he lacks the social connections and emotional support networks necessary for maintaining mental and physical well-being. The stress and loneliness of his isolated lifestyle further contribute to his hypertension and overall health decline.

Pt - I'm ok but Im worried about my diabetes

Nurse - Ok so what do you know about your diabetes?

Pt - The GP told me I had type 2 but I feel I dont know what it actually means. I don't know where or how to find any information. I dont know what I can eat.

Nurse - Lets talk through it. Would you be happy if we looked at some information together? We can discuss exactly what it means and you can ask any questions as we go. We will bring you back in 4 weeks to see how you are feeling.

Pt - Im happy to do that.

Nurse - Let me show you a Diabetes passport that we use and ill just run through this leaflet about healthy eating with type 2 diabetes. - ( Lifestyle changes, introducing physical activity, addressing diet, smoking, health and well being, social support network, culture)

Pt - I've had a difficult past and its difficult for to look after my health.

Nurse - Are you attending any counselling at the moment or do you have any support from family friends.

Pt - No, not at the moment.

Nurse- We can look at CIPC which is an opt in service if you are interested. There are also very helpful courses you can do online or face to face

Pt - Yes well I currently don't work so maybe I would have the time.

Nurse - Ok great, can I ask a few things about your lifestyle after taking your BP, Weight, height, waist, general bloods.

Do you smoke, vape? Do you take any alcohol? and how many times a week? how many units? Are you physical activity?

Pt - I don't smoke and I dont drink. Unfortunately I do struggle with my weight. I find looking after my three kids is hard and I have no family support. I dont do any exercise although I am running around doing everything for the kids. I buy a lot of frozen food as I don't like to cook.

Nurse - Firstly lets address your physical activity. Its very important that you look after yourself. When your drop the kids to school, would you maybe go for a walk. You could start at 30 mind three times weekly and maybe increase but we can look at that then in 4 weeks.

Nurse - Do you have access to a computer.

Pt -I dont have a computer at home but I use my phone.

Nurse - Great. If your happy I can show you the Diabetes Ireland website and you can look at it later on your phone?

Pt - Id like that, thank you.

Nurse - I thinks it important we take things slowly. I have referred you for the CIPC councilling as its important that you have support before taking on any changes. I know you have a friend nearby which is great. Maybe have a chat to her about you diagnosis as its important to have support. Can we please look at the physical activity aspect first?

Pt - Yes I would like that as I used to enjoy exercise years ago

S - To walk 30mins 3 times a week while kids are in school. "keep active" given.

M - To set the alarm on phone at 30 mins.

A - This is the only possible time at present -when kids in school. She enjoys walking and she walks to school anyway at 9 am.

R - Relevant for treatment of diabetes and benefit for mental health. Cost effective.

T - Review at 4 weeks.

O - NURSE-HELLO SEAMUS, HOW ARE YOU? HOW CAN I HELP YOU TODAY?

SEAMUS- SURE I DONT KNOW , YOU ARE THE NURSE.

NURSE- CAN YOU TELL ME HOW YOU ARE FEELING

SEAMUS - GRAND.

NURSE - HAVE YOU ANY ISSUES THAT WE NEED TO DISCUSS?

SEAMUS- I HAVE SOME HEADACHES AND DIZZY SPELLS. IM ALSO VERY TIRED. WRECKED.

NURSE- HOW IS YOUR DIET? ]

SEAMUS NOT GREAT, SURE I EAT BITS AND PIECES. I LIVE ALONE.

NURSE - SO YOUR DIET IS NOT GREAT, WHAT ARE THE BITS AND PIECES ? WOULD YOU LIKE SOME SUPPORT WITH THE MEALS?

SEAMUS- YES PLEASE

S. Hello nurse, I havent been doing so well recently.I have been told I have high blood pressure and I am worried as I live alone and not sure what I can do to help myself.

N.Ok Seamus, I can understand that must have been upsetting for you, dont worry I am here to help you and we can go through your concerns.

S. Thanks Nurse that would be great as I am worried about having a stroke or heart attack or something like that.

N.So Seamus would that be your main worry, having a stroke /heart attack and not perhaps know what the signs would be ?

S. Thats right nurse. I havent felt well and I dont know much about these new tablets they have given me.

N. Ok Seamus what we will do then if you like is have a chat about what having high blood pressure means and we will discuss your new medications and perhaps we can go through what you can do in terms of changing a few things like diet and supports that can help keep that blood pressure under control.

S. great thanks nurse.

S.Seamus will learn about the meaning of high BP, will be able to understand his BP meds and make lifestyle changes to reduce modifiable factors.

M. By the next meeting Seamus BP will be within acceptable limits.

A.Small goals to begin with for Seamus, to increase his social connections he will join the mens shed.

R.Social isolation and loneliness has been demonstrated by TILDA to have poorer outcomes for older peoples overall health.

T. Seamus will be reviewed in 3/12 to assess how he is getting on with his meds and new social goals.

S: headaches, dizzyness & fatigue, I've been told ^BP

N: are you aware of what ^BP means? do you know what normal is?

S: No, what is BP?

N: explains BP & target/ideal & risks of untreated BP, ^ CV risk, stroke, heart disease/attack

N: have you took meds as px?

S: yes

N; well done, thats great, taking control of your health

would you be able to buy a BP monitor? cost X amount, be good for you to know your blood pressure

S- aim for BP<140/<90 mmhg, take medication as px,

M- check BP himself if he can get monitor, if not come back in 2 weeks in 2/52 for BP check with BP, or check pharmacy

A- take meds as px, manage lifestyle changes, healthy diet, eat less saly +^fruit & veg, ?smoking, ?alcohol, ?weight management, ? exercise, although we know he labours on farm, social prescribing for isolation, i.e. mens shed, explore Exwell

R- has sx of headache, dizzyness & fatigue & this why he presented to clinic

T- recheck BP in 2 weeks +/- 24 hr BP monitor

Nurse: Good morning Seamus, thank you for coming in today

Seamus: Good morning Nurse.

N: You can call me Laura, is it okay if i call you Seamus?

S: Yes that's grand Laura.

N: So Seamus, you've recently been diagnosed with high blood pressure, can you tell me a bit about how you've been feeling?

S: Ah, I'm not too bad. I was having these awful headaches and I was quite tired. But sure everyone feels like that, especially in my line of work.

N: It sounds like you've been having a tough time Seamus and it's important not to dismiss how you've been feeling. There's nothing wrong with saying "I'm feeling a bit awful right now".

S: Thanks Laura, yeah I am feeling a bit all over the place.

N: So, why don't you tell me what's going on in your head and maybe we can come up with a plan to tackle things together?

S: Okay, well, I live and work on the farm. I have done my whole life and know no different. It's usually not been a problem. But lately, with all this stuff happening with my health, I've been feeling quite down and to be honest, a bit afraid. I don't know anything about tablets or diet or anything the doctor told me about.

N: Okay Seamus, it's obvious you've got a lot going on in your mind. Let's tackle each concern, one at a time. What is your biggest worry?

S: I don't know what I'm meant to be doing with these tablets.

N: Okay, well let's have a look at your tablets. So, you have high blood pressure and the main reason the doctor wants you on these tablets is to control it. It tells us on the outside of the box your dosage and when to take them. Maybe, will we write it down on a bigger sheet of paper and you can stick it up on your fridge so you don't forget to take the tablets?

S: Oh yeah, that's a good idea.

N: Great. There's also a patient information leaflet inside every box of tablets, maybe will we go through the leaflet and pick out the important aspects, like what time to take the medication, whether to take it with food etc and we can write them on a big sheet too?

S: Yes that would make things easier. I can't really read the writing on the leaflets, it's too small.

N: Yes the writing can be quite hard to read. Okay, so that's one concern dealt with, or what do you think Seamus?

S: Yeah I'm very happy with that. It makes things clearer to understand.

N: Perfect, so what's next?

S: The doctor mentioned changing my diet, but Laura I wouldn't have a clue where to start!

N: Sure not to worry Seamus, the diet stuff can be very simple. Stick to low salt, so no adding extra a the table. Low fat options for your dairy and milk will also help with reducing your blood pressure. Also, reducing the processed foods, so limit takeaways or ready-meals.

S: Oh that sounds a little bit difficult but I'm sure I can do that.

N: I'm sure you can! Maybe set yourself a timeline Seamus, try to stick to the dietary guidelines for one week and see how you fair out. Another important aspect is exercise.

S: Sure I'm out doing physical labour all day.

N: While that's true Seamus, the best exercise for lowering blood pressure is a brisk walk for 30 mins per day or cycling or swimming.

S: I'll do the walking, I can take the dog for a walk in the evenings when I finish on the farm.

N: That's great Seamus. How about joining a local walking group? I imagine it can be a bit isolating spending all your time on the farm. Isolation can have a big impact on our health too.

S: Yeah, I do feel lonely at times. Maybe I'll join the local GAA walking group, I know an old friend of mine goes twice a week and he says it's good craic.

L: That's great Seamus, there's also some great social activities, like the local men's shed that are great for meeting people.

S: Yeah I might try that another time Laura. I'll start with the GAA first and see how it goes.

N: No problem. You're really taking a proactive approach to your health and that's not always easy. You should be proud of that.

S: Thanks Laura.

N: So let's recap on our plan Seamus; we're going to write out our information on bigger pages and hang them on the fridge, this will help with taking the tablets everyday. You're going to make the dietary changes we discussed. You're going to try it for the week and see how you go. You're going to join the walking club first and then see about the men's shed. I think that all sounds achievable, what do you think?

S: Yeah I think i can manage all that.

N: Great. I'll give you a phone call in one weeks time to see how your managing and if you need to come in to see me we can arrange an appointment. How does that sound?

S: That sounds great Laura, thank you for helping me.

N: No problem at all Seamus, it's you who is doing the work, I'm just here to help guide you if you need it. We'll chat soon.

Seamus: Well now, everybody in my family had high blood pressure. I don't know much but the tablet has helped my headaches.

Nurse: So the tablet helps your headache and dizziness and what time of the day do you take it?

Seamus: I just take it when I think of it.

Nurse: Ok, would you like to talk about this tablet to learn more about it like side effects and how it works?

Seamus: Yeh ok. no problem nurse

Nurse: Great, so this tablet reduces your blood pressure which helps the headaches and dizziness, but its important to take it every day with your first cup of tea. Can I go through this leaflet with you, its about your tablet.

Seamus: Can I leave that for another day until I've been taking it for a while.

Nurse: Ok no problem Seamus. Will you come back to me in 2 weeks to talk to me about how you're getting on with your tablet, lets say Tues 14th at 10 in the morning?

Seamus: yeh thats fine

Nurse: I hear covid caused allot of the Marts to move online, do you ever get to the mart or do you meet other farmers or friends?

Seamus: It's great to be able to sit by the fire and watch them bid at the mart.

Nurse: So you don't really go out?

Seamus: Sure am I not out all day?

Nurse: Oh of course and I know you are very busy but sometimes meeting up with friends for a chat can be helpful, have you ever heard of mens sheds? Here is a leaflet for you to look at and we can discuss again when you come back on the 14th.

Nurse: Ok Seamus, its been lovely meeting you, just to summarise we have an appointment for 14th and we can discuss how how you're getting on with the medication that you have to take every day and we might talk a bit more abut the mens shed or getting out to meet people a bit more, how does that sound?

Seamus: Oh that's grand nurse, i'll look forward to meeting you again.

Nurse: What brings you here today?

Seamus: I've not been feeling well lately. i'm having headaches, dizziness and I'm feeling very tired. I was in with the doctor and he says that I have high blood presure.

Nurse: Can you tell me what you know about high blood pressure?

Seamus: Not much. Doctor says to take tablets and I'll be grand.

Nurse: Ok, Seamus, how do you feel about that?

Seamus: Alright

Nurse: Would you like me to explain a bit more?

Seamus: Yes please

Nurse: I have a You-Tube video about living with blood pressure, would you like to watch it with me?

Seamus: Yeah.

After the video:

Nurse: How do you feel now about your blood pressure? Did you find it useful? Can you tell me found useful?

Seamus: I understand more now and how important it is to mind myself and I'd like to know more about how I can mind myself.

Nurse: Okay, do you use a lot of salt in your food?

Seamus: I use it on everything

Nurse: Can you see yourself being able to cut back? Its very important to reduce salt intake.

Seamus: I'll definitely give it a go.

Nurse: Seamus, now you understand a little more about minding yourself, will we make a plan. Before we make a plan, can we talk about how you manage your time and life when you not working?

Seamus: Ah, sure, I don't really go out much, not since Covid and I'm too tired when I finish up work.

Nurse: What I'm hearing how you spend a lot of time on your own. Did you know that this can have an effect on your health?

Before Covid, did you go out anywhere to meet people?

S: I used to the Market but I sold the cattle. Now I don't see anyone.

N: Is there anything that you would be interested in locally? Can I give you this information about activities and support in your area, that you may enjoy?

S: That will be great! Thanks very much.

N: That's great, sounds like you are really interested in improving your overall health.

Now, we will make a plan about you can do to help manage your own health and reduce your salt intake,

Specific: to reduce salt intake.

Measurable: Keep a record of the times you use salt for the next four weeks.

Achievable: Seamus feels that he can cut back

Relevant: this will help his blood pressure and overall health

Time: Bring your salt diary in when you come back to see me in a month and we can see how you are getting on.

Brief discussion on social history discussed and outlined supports available.

Regarding Diabetes:

Nurse: What is your understanding of diabetes?

Patient: I know its to do with eating sugar but honestly I don't even know what that means. My BSL vary everyday.

Nurse: How long have you been a diabetic?

Patient: I haven't been feeling well for the past 3 years.

Nurse: How is it affecting you on a day to day basis?

Patient: I am not sure if its related to my diabetes but I am fatigued, experience regular dizzy spells and extreme thirst.

Nurse: Those symptoms can be related to your diabetes.

If I'm hearing you correctly your concerned regarding your level of knowledge on diabetes. Would you like me to go through diabetes in more detail with you?

Patient: Yes that would be very helpful.

Nurse: Diabetes affects the sugar in your blood, if it becomes to low or to high you can become very unwell. Its very important we monitor your BSL daily to get to a level that is stable. Would you like me to inform you of services available to you that will help you understand diabetes in depth.

Patient: Yes that would be great.

Nurse: Prioritization of your health is essential. We are conscious we don't want to overload you so if your are agreeable I would like to refer you to a diabetes specialist in the community. I have some website links and leaflets here I can give you today to read over. Is that something that will work for you?

Patient: yes thank you I will try if you think it will help.

S- attend diabetes nurse and become aware of managing condition through knowledge.

M- linked in with services that support you to manage your diabetes safely.

A- how confident are you that you can achieve this.

R- do you feel you are supported in relation to managing your diabetes?

T- we will agree to meet back in 1 month and review how you are managing and any questions you may have.

S- that would be great

N- I will get you the number and you can make contact

S- No you might ring them for me nurse, I'm no good on the phone

N- so you are happy for me to arrange meals on Wheels for you?

S-yes please nurse

N- Have you heard about the Day Centre? I think it might be good for you to socialise and have some support. you could go once a week and see how you feel about that?

S- I'll give it a try

N- OK , so the plan is, I will contact meals on wheels and the day centre and make a referral to both this week. Are you happy with that?

S yes nurse, that's great.

N- Seamus, is there anything else you are having difficulty with?

S- I don't think so nurse

N- how is your diet? are you taking less salt in your meals?

S- I'm not sure nurse

N- how would you feel about a referral to the dietician, they will be able to give you advice and ideas on how to reduce the salt in your foods?

S- that sounds good

N- Ok I will sent a referral today and she will get in contact with you and arrange an appointment

S-great

N-So Seamus, I am going to refer you to MOW, Day Centre and the dietician today. Will we make an appointment for us to meet in 3 months and see how you are getting on with the services?

S- yes that sounds great

N-If yo need to speak to me before that you can ring the office here

S-that's great, thanks nurse

Seamus- Ah the blood pressure is up I think. I was getting dizzy and headaches and was wrecked tired all the time.

Nurse- Ok Seamus, can you tell me a bit more this? what did the G.P advise you?

Seamus- ah sure, I wasn't half listening to him, I wasn't feeling the best that day. He gave me a leaflet and sure it's up there on the counter, I haven't looked at it since. I don't read very well

Nurse- ok Seamus, by listening to you,, would you like me to go through the information again with you?

Seamus- alright sure, that would be great.

Nurse- perfect, can I just get ask you another few questions before we go through that?

seamus- Yeah fire away

Nurse- have you family support close by?

Seamus- No, I've no one. I never married.

Nurse- alright Seamus, and have you neighbours that you can call on?

Seamus- No, I don't. they've moved on.

Nurse- Ok Seamus, that can be difficult, we may have ways to help you with this. Would you like me to go though that next week with you? We might go through the blood pressure today, and ways that can help to reduce it.

Seamus- great thanks

S- Seamus's blood pressure is 150/90 today. We have agreed that we will aim for the B/P of 140/80.

M- by the next meeting, the B/P will be reduced and documented on a notebook.

A- Seamus has agreed to introduce exercise into his day by walking down to the farm instead of taking the tractor. He also has agreed to cut back on the salt with his meals

R- Seamus has agreed to attend his G/P appointments and he has also agreed to a referral to social worker

T- Seamus has agreed for us to review him next week but he will contact the G.P is he feels unwell

RGN: Hello Seamus , How are you today?

Seamus: I'm not good Nurse, I have headaches, dizziness and I feel a bit tired.

RGN: That must hard to try and work on the farm all day when you are tired and not feeling the best. Would you be happy if I checked your blood pressure and ask you a few questions about what is going on.

Seamus: That's grand Nurse whatever you think.

RGN: Your blood pressure is reading a bit high there, i'll check it on the other arm if you don't mind.

Seamus: What does that mean Nurse

RGN: I just want to see if there is any difference in each arms, but actually its the same in both arms.

Seamus: Oh God is that why I have been feeling a bit dizzy

RGN: Yes Seamus sometimes if your blood pressure is high you can be dizzy and get headaches.

Seamus: What would cause that Nurse

RGN: There are many reasons including family history, diet and lack of exercise

Seamus: My diet wouldn't be great, my parents have passed, I think my dad might have had problems with his heart. I'm on the land all day so I get loads of exercise.

RGN: That's great about the exercise, what would you eat for dinner usually?

Seamus: I live on my own so i don't cook everyday. I'd fry up a bit of steak and rashers and eggs, or i would just get a bit from the deli in town.

RGN: Thats great Seamus that you can cook for yourself, would you eat vegetables and would you use salt on your dinner.

SEAMUS: I love salt and butter on the the spuds for a bit of flavour, I d have a bit of cabbage with the bacon and a few fried onion.

RGN: Too much salt in the diet can cause your blood pressure to go up a bit,if you could reduce the amount of salt you use and eat a few more vegetables that would help the blood pressure. Have a look this book and it will give you ideas on healthy diet. (The food pyramid)

Seamus: Thats great nurse thanks

RGN: Perfect Seamus, I think I will weigh you now, book you for a 24 hr BP monitor and get the DR to see you. We might do some bloods would that be OK with you

Seamus: What ever you think nurse, I d to feel better soon and not as tired

RGN: Dont worry Seamus we'll get you sorted but it might a few weeks for the blood pressure to settle. Have you any other questions Seamus.

Seamus: When I go to the Mart on a Tuesday I have a few pints is that alright? I live on my own and its the only day I get to have a chat

RGN: Yes Seamus of course it is 1 or 2 pints is ok. It is important to socialise and meet your friends. Would you have any interest in playing cards

Goals

Re check bp

medication informATION

sEE YOU IN 2 WEEKS

social groups

dietary management

dietician

S. ive been told my blood pressure is high and i havn't been feeling well

What symptoms have you felt seamus?

S. Well i felt dizzy and had headaches and im tired a lot.

What do you work at seamus?

S. i have a farm which i inherited and run on my own

So would you say its stressful for you at the moment?

S. yes its very stressful but im used to it

Can you tell me about your lifestyle Seamus... your diet/what you eat on a daily basis?

S. i eat my three meals a day- a cooked breakfast, maybe grab a sandwich at lunch and my dinner of meat potatoes and veg

That sounds really good Seamus, do you add salt to your food? and what about alcohol intake?

S. Yes i love salt on the dinner, i have about 10 pints of guinness a week

Apart from the physical side of work Seamus would you get any exercise...do you walk to go the bar?

S. i would but its not far from the house

have you got time today and would you like me discuss you blood pressure with you more seamus?

S. that would be great

High blood pressure can come from family history, stress and diet or lifestyle. It can affect your heart and increase risk of stroke but reducing salt and processed foods can help, reducing stress and being more active can help. Maybe try to reduce your guiness by a couple of pints a week also. i could refer you to the local community centre which have Active Age classes to help increase activity levels and its a great chance to meet people.

S. ok ill give it a go

Nurse: OK Seamus, I understand you've already been to the doctor, and what did they say to you?.

Seamus: He didn't say much; he only took my blood pressure, but he said I had a bit of white coat syndrome, so he let me off and said come back to you to recheck my blood pressure so this is why Im here today. I'm on the farm most today's tending to crops and animals it's hard work, but its what I've known all my life, As for food God I've got a terrible diet well. Will I tell you what I eat well?

Nurse: So, I want to recap, so you're here because the doctor asked you to come in to recheck your blood pressure?. You're not quite sure other than that, only that you haven't been feeling great lately and just not feeling great overall. Is that right?

Seamus: Yes,

Nurse: Ok, so it would be great if you tell me your typical diet?

Seamus: As for food, `I eat what I can afford", mostly salted meats and processed foods. You know I get the old chicken dippers out the fridge they're easy to put in the oven. I get a bit of indigestion now and again. You know it's getting worse the last few weeks.

Nurse: Seamus, you feel your diet hasn't been great? Am I right in saying that? I'm hearing from you today that you're very busy on the farm, so probably not a lot of time to cook?

Seamus: Yes. I'll come in after a heavy day's work, and all I want to do is sit down and eat something quick because I'm too tired to cook a meal, and I don't know how to cook a meal, but I can put things in the oven and fry a few rashers and sausages.

I love my salty meats. The GP said I had something condition like high blood pressure, but he wanted to check it a second time. So can you tell me what is the cause of this high blood pressure, I’ve no idea what high blood pressure is?

Nurse: Sure Seamus so really, blood pressure is a measurement of the pressure exerted by your heart pumping. We need to keep it at a certain level because if it goes too high, it can make us feel unwell. This could explain why your having some of your symptoms recently like your dizziness and tiredness and just not feeling great.

There are many things we can do to help you manage blood pressure, so I did a little recheck when you came in and its still elevated. I know the GP will want to start you on some medication today. But there are also things you can do about diet and exercise if you are. Go through a few things we could apply for me to help you going forward.

Seamus: It sounds like a lot to take in, but I'm willing to try and change. I live independently and have to look after myself because no one else will.

Nurse: That's exactly it. The first step is that you're here today which is brilliant and that you're interested in taking care of your health.

Nurse: Would you mind if I just asked you a few more questions like farming life? Is it very busy?

Seamus: Yes, I spend all the time on the land. I get on my tractor and do a lot of work on it and my quad bike.

Nurse: Would you be fairly far away from neighbours and farmers, or would you meet at various farming functions like markets? etc?

Seamus: No, to be honest, the only time I meet anyone is at mass on Saturday

Nurse: OK, so there's a few things that we can address straight off if you're happy for us to form a plan for you, and then there might be some things we could do down the road as well.

Seamus: OK, that's great. I appreciate that. I can make some changes for the sake of my health.

Nurse: Do you smoke?

Seamus: Don't smoke at all.

Nurse: Would you drink much alcohol?

Seamus: I drink a bit of whiskey now and again because it just passes my time when I'm on my own and I look forward to it on Friday nights watching the late Late show.

Nurse: Sure, and would it be just the glass you'd have?

Seamus: I'd say I start the bottle at the start of the late Late,

Nurse: OK, so we can address a couple of little things. We'll take it slowly. Would it be reasonable to start with them? Because you are working on the farm, would it be reasonable to start the exercise?

Seamus: I could start by no longer taking the quad bike up the hill.

Nurse: OK, Seamus would try to build a plan for you because farming is a physically demanding lifestyle, but we could maybe build some exercises in your farming routine if that sounds doable.

Seamus: Yes absolutely

Nurse: Let's start with something like a few days a week. Are certain days a week that you could walk? For example: walking more than using the quad bike or that sort of thing?.

Seamus: I won’t take the tractor up to look at the sheep?

Nurse: OK, how many times a week would be reasonable for you to walk up?

Seamus: I must do it every day.

Nurse: So, would it be every day? Would it be a fair distance?

Seamus: It would be a couple of miles.

Nurse: OK so look we're not going to start with that. Could you bring the tractor to a certain point and walk from there?

Seamus: Yes, that’s brilliant. I'll try that.

Nurse: Can you do that three times a week? Would that be reasonable?

Seamus: Yes, that sounds reasonable.

Nurse: Good, we already took your weight, and you are slightly overweight.

We could make some improvement with weight and exercise is one of the factors we can look at? So if you can go for a walk halfway to see the sheep you know park the tractor three times a week, it would be nice to keep a little record that. Monday Tuesday Wednesday? And we will check back with you. Would it be reasonable to get you to do that? and come back to us maybe in a month to see how you're getting on.

Seamus: That's perfect. I'll make my appointment now out in reception, and I'll come back to you in about a month.

Nurse: Yes, There's a couple of other things before you go? Id also like to look at diet? I know you're not great at cooking, so it's a bit more difficult for us to address at present, but could you try and reduce the salt in your diet before we meet next time? So the salt in foods is in the convenience foods, the quick meals like the rashers and sausages so that we could try salt. and choose even the quick meals with the lower, so maybe try a boiled egg or something in the morning a few mornings a week instead of the rashers and sausages and try to choose the convenience foods with less salt? Do you think you could also fit that in along with the exercise?

Seamus: Yes, I've got a bag of porridge at home so I'll check the expiry date or I'll go and buy a new one in ALDI again. I'll start from there.

Nurse: OK thank you so much and so we'll see you back in one month. We're just gonna recap again on what we're doing. We know what blood pressure is high, we know you're a little overweight, you know you've been symptomatic with the blood pressure. We know it's really important to take the tablets because high blood pressure over time can affect you and some of your organs without us being aware, so if we can take our blood pressure at the same time every day if we can walk three times a week and if we can try changing your diet to avoid processed fpod such as porridge or the boiled egg in the morning.we agreed to choose the convenience foods with less salt were just a starting measure. Then we'll see you back in one month.

Seamus: OK, Yes, that sounds good. I need to make those changes, and I realise that. Thank you for your time; I'll head to reception now to book my appointment.

S: Walk to check the sheep three times a week, starting from a certain point where the tractor is parked. Choose convenience foods with lower salt content and replace some meals with healthier options like boiled eggs or porridge.

M: Monitor salt intake and walk three times a week

A: Seamus expressed his willingness to make changes in his routine, such as walking more and adjusting his diet; the changes are realistic

R: The goals are directly related to Seamus's health concerns. HBP

T: Seamus has a follow-up in one month

N: So you find your inhalers are working but you are caught in the morning, it sounds really tough for you.

N: What do you know about Asthma?

P not much at all, maybe it’s because I smoke. There is some mold in the house and I’ve scrubbed it with bleach and I’m trying to keep the house warm and have the fire lit as much as I can now, but it’s not making much of a difference. My mother used to be on inhalers and my granny too. Does it run in the family nurse?

N: it sounds like you have thought about it quite a bit and have really tried to manage it yourself. But you are bit but you are still unsure about a lot of details. Do you mind if we talk a little bit about what triggers your asthma?

P: What’s a trigger?

N: A trigger is what sets your asthma off, what makes you feel more out of breath

P: when I exercise or when I’m cold and cleaning out the fire definitely and probably the smoking too.

N: It sounds like you know what is making it worse and I see it upsets you to feel that way. Which of these triggers do you think we can change?

P: I’m not sure I can change any of them.

N: If cleaning out the fire sets off the Asthma, can you think of anything you can do about that?

P: Maybe I can ask my husband to clean it out until I’m better

N: That’s a great idea. How about we set a goal for yourself until we meet again in a month and we see how you get on then? By that time you will also have seen the Resp Hub Nurse for your inhaler technique.

P: Ok, sound reasonable.

N: So in summary, you will stop cleaning out the fire and get your husband to clear it out every 2 days for the next 4 weeks and we will see you for the next visit then and how would you feel if we talked about the other triggers and your smoking then?