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District Nurse, IMPACT

A narrative of change in support at home

'I had never done this before and wondered is this what the patient is expecting. The first thing he said was ‘You’re late, it's 11.50 and I'm going out at 12”.  When I used the ‘What are you hoping for?’ question he said ‘Nothing, you don't need to come’. It's been a year and a half since he was hospitalised for COPD.  He told me about managing his infection, he knows the signs. The patient had learned to self manage and I had not asked the right questions about his confidence or his managing his condition.

'I asked ‘Where do you want to go from here?’ and he said ‘I know what I’m doing, I use my antibiotics and steroids’. I had to resist saying "You've done a good job”.  I started using ‘From what you're saying’….I saw his body language changing, he was less defensive. So we agreed he would be on the passive workload and I would call in three months’ time.

'Another woman said she felt too well and, when I came in, she felt like a patient.  She was okay with just seeing her GP.  These visits could have gone on regardless involving clinical checks. It's definitely changed my practice. I'll use the questions, given the reassurance and know I'm on the right road and doing okay. I now will follow up with more curious questions. I will phone in three months’ time and if all is well, arrange a six-month visit. I’m pleased that I went down a different avenue completely to what I used to do.  I would check everyone the same way.  I shared this with the team and reflected on it at the office.'


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